21 December 2022

Richard James
[FYI request #21155 email]

Tēnā koe Richard
Official information request HNZ00007457
On 19 November 2022, you emailed the Ministry of Health requesting under the Of icial Information
Act 1982 (the Act) the following information:

“I am writing to request information on the Air Desk function provided for national co-
ordination and tasking of helicopters. I am unclear from publicly available documents if the
Air Desk functions under St. John Ambulance, NASO, or another group so would
appreciate clarity on structures and reporting.

- Current and historical staff numbers of the Air Desk for the last 3 years (number of staff
employed and their function)
- Data relating to historical tasking of helicopters: number of requests for helicopters and
the number which were subsequently sent, broken down by quarter, over the last 3 years to
allow assessment of the Air Desk 'refusal' rate
- The documented criteria for deciding if a helicopter is sent or not
- Reporting structure for the Air Desk within the Ministry of Health/NASO: who do they
report to? What governance structures are in place to ensure their function?
- Details set by the Ministry for the Air Desk Key Performance Indicators (KPIs)
- Details of the process by which retrospective review of decisions made can occur and
who is involved in that process”
On 23 November 2022, your request was transferred to Te Whatu Ora in full for response because
the information to which your request relates was more suited to our functions and responsibilities.
Background
The purpose of the National Air Desk is to provide consistent dispatch decisions for rotary wing
emergency air ambulance services within Aotearoa ensuring the most appropriate air ambulance
service is used to meet specific pre-hospital incident requirements. It decides whether these
incidents meet specific Access, Number, Time and Skil (ANTS) criteria, dispatches a rotary wing
air ambulance if appropriate, and monitors/coordinates the response. In addition, the Air Desk
must provide operational data to the National Ambulance Sector Of ice (NASO) and implement
quality improvement initiatives where appropriate.

The Air Desk is located within the Hato Hone St John (HHSJ) Auckland Emergency
Communication Centre, which is one of three interoperable 111 call centres in New Zealand. It
currently has some business continuity capability in the Christchurch Communications Centre.

Responses to your questions

1.  Current and historical staff numbers of the Air Desk for the last 3 years (number of staff
employed and their function)
The National Ambulance Sector Of ice (NASO) does not receive or hold exact staff numbers
for the Air Desk at any given time, noting that the number may fluctuate due to operational
reasons. The Air Desk has a small leadership team, training and quality functions and
administrative support functions, often shared across multiple business areas.
2.  Data relating to historical tasking of helicopters: number of requests for helicopters and the
number which were subsequently sent, broken down by quarter, over the last 3 years to allow
assessment of the Air Desk 'refusal' rate
  The Air Desk undertakes three main dispatch types. Specifically: Interrogated Dispatch (ID),
Rapid Dispatch (RD) and Scene Request Dispatch (SRD).
•  ID: incidents where the Air Desk uses information obtained from the scene, outside of the
chief complaint, to make a clinically-based decision that the incident meets the NASO-
approved dispatch criteria.
•  RD: incidents of a predetermined primary determinant brought to the attention of the Air
Desk via an automated process that are appropriate for immediate dispatch. Validation of
the appropriateness of dispatch by the Air Desk wil  usually occur after the dispatch of the
helicopter.
•  SRD: incidents where clinician or emergency services personnel at the scene request a
helicopter, and the Air Desk has decided dispatch is appropriate and meets ANTS criteria.
ID comprises the bulk of the dispatch load for the Air Desk. The monthly total varies but
typically averages 75 - 85 per cent of all Air Desk dispatches. RD and SRD split the remainder,
with RD being slightly more than half of the remaining 25 -15 per cent total in a typical month.
It is important to note for ID that Air Desk staff search through ‘pending’ and ‘assigned’
incidents in the computer-aided dispatch system to see whether there are opportunities where
the patient may have an improved clinical outcome from an aeromedical service attending. The
proportion of ID relative to RD and SRD demonstrates the proactive nature of the Air Desk. If,
after additional information is obtained, the Air Desk discovers that an air ambulance helicopter
is not needed, this does not reflect a ‘refusal’ rate.
Below is the distribution of incidents processed for the last two years. The first two charts
represent all incidents reviewed by Air Desk personnel. The number of incidents that resulted
in air ambulance helicopter dispatch are shown in the third and fourth graphs. (Note: before
October 2020, data was provided to NASO in a different format, making data extraction dif icult
and time-consuming.)
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3.  The documented criteria for deciding if a helicopter is sent or not
In 2012, the ambulance services and relevant parties set up a commit ee that developed the
ANTS criteria. The ANTS criteria provide guidance on appropriate air ambulance helicopter
dispatch and is intended to provide an improved clinical outcome for patients.
Only one of the following criteria need to be met:
•  A– Access: If access is difficult and a helicopter is the most appropriate means of
extrication. Examples include extrication from mountains, forests, and other areas with
inadequate road access.
•  N– Number: The number of patients at the scene exceeds the capacity of road resources.
•  T– Time: If the patient has a time-sensitive condition and a helicopter wil  result in a
clinically significant timesaving in the patient arriving in hospital.
•  S– Skil : The patient requires specific skil s, and a helicopter wil  result in a clinically
significant timesaving in appropriately skil ed personnel reaching the patient.
4.  Reporting structure for the Air Desk within the Ministry of Health/NASO: who do they report to?
What governance structures are in place to ensure their function?
The contract now sits with ACC and Te Whatu Ora (not the Ministry of Health). HHSJ has
quarterly meetings with Te Whatu Ora, ACC and NASO, and there are regular meetings
between HHSJ senior management and senior responsible officers within Te Whatu Ora and
ACC.
HHSJ manages the clinical governance of the Air Desk via the Air Desk Clinical Oversight
Group (ADCOG). The ADCOG comprises NASO and service provider clinical representatives,
medical directors, operational staff and aviation representatives. It considers data and issues
concerning systems, dispatch processes and patient outcomes. The ADCOG is supported by
an audit working group, which is also run by HHSJ and includes NASO and air ambulance
helicopter service provider representation.
The Air Desk provides reports to NASO monthly. Additionally, the Air Desk meets with NASO
monthly and quarterly to review performance.
5.  Details set by the Ministry for the Air Desk Key Performance Indicators (KPIs)
KPIs are set jointly by Te Whatu Ora and ACC, not by the Ministry of Health, and are monitored
by NASO on behalf of Te Whatu Ora and ACC.
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Specific KPIs are considered commercial and in-confidence and are not listed below. However,
KPIs relating to the Air Desk are similar in nature to those used for road ambulance. These
cover a range of clinical and operational metrics used to establish performance and demand.
KPI measurements include:
•  timeliness of reporting regarding performance variations and trends, health and safety, as
well as clinical data
•  use of ANTS criteria
•  time taken to dispatch aircraft
•  regular audits and associated reports.
6.  Details of the process by which retrospective review of decisions made can occur and who is
involved in that process
HHSJ has a transparent process for retrospectively reviewing Air Desk decisions. The process
invites representatives of the air ambulance helicopter sector to contribute to the review.
Representatives from NASO also attend the review.
Information on triage and clinical guidelines for HHSJ is available on its website
https:/ www.stjohn.org.nz/globalassets/documents/health-practitioners/clinical-procedures-and-
guidelines---comprehensive-edition.pdf
Emergency Ambulance Service (EAS) providers must adhere to the HQSC Adverse Events
Policy 2017. This policy can be found online at the following link:
https:/ www.hqsc.govt.nz/assets/Our-work/System-safety/Adverse-events/Publications
resources/National_Adverse_Events_Policy_2017_WEB_FINAL.pdf
EAS providers report adverse events to NASO. Further information on Adverse Events can be
found on the NASO website - https:/ www.tewhatuora.govt.nz/our-health-system/who-were-
working-with/naso/naso-publications/.
EAS providers including HHSJ discuss and review the risk management framework and risk
register with Te Whatu Ora, ACC and NASO at least four times a year. In addition, EAS
providers are required to have current, nationally consistent Clinical Procedures and
Guidelines.
If you have any questions, you can contact us at [email address]. If you are not happy with
this response, you have the right to make a complaint to the Ombudsman. Information about how
to do this is available at www.ombudsman.parliament.nz or by phoning 0800 802 602.
As this information may be of interest to other members of the public, Te Whatu Ora may
proactively release a copy of this response on our website. Al  requester data, including your name
and contact details, wil  be removed prior to release.

Nāku iti noa, nā

Adeline Cumings
Group Manager Primary Health Care System Improvement and Innovation
Commissioning

TeWhatuOra.govt.nz
Te Whatu Ora, PO Box 793,
Wel ington 6140, New Zealand
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Document Outline