Medics from around the world have expressed serious concerns after it emerged that Northern Ireland's first air ambulance may not have a doctor on board when the service launches.
Flying doctors from leading Helicopter Emergency Medical Services (HEMS) have warned the Health Minister that the new service risks falling short of the vision of the late Dr John Hinds.
The 35-year-old Tandragee man worked as a consultant anaesthetist at Craigavon Area Hospital and was a leading activist for a regional air ambulance.
After his death in a motorcycle crash while providing volunteer medical cover at the Skerries 100 race in Dublin, his partner Dr Janet Acheson continued his campaigning work.
Dr Hinds was nicknamed the 'flying doctor' of Irish motorcycle racing for the lifesaving emergency support he provided during high speed races such as the North West 200.
But now, in an open letter to Michelle O'Neill ahead of the launch of the long-awaited service next March, medics have warned that the absence of a doctor on the flight could ultimately be unsafe.
"We fear the service will not be capable of providing the best life-saving care possible to the people of Northern Ireland from the outset if a doctor is not on board the helicopter," it read.
"Placing a combative, agitated, head injured or bleeding patient in a helicopter without a general anaesthetic is unsafe, both to the patient and the crew.
"The 'Golden Hour' is then lost, as these patients will have to be transported on sometimes lengthy journeys by road to the trauma centre.
"Sedating head injured patients without a general anaesthetic is a 'solution' from the 1970s and has been shown to cause harm.
"This is what would happen without a doctor on board."
The letter, signed by 26 experts from as far away as Australia, the US, Canada, Hungary, Norway and Slovenia, said that there are excellent paramedics in Northern Ireland who can be trained to work at the highest level in a doctor/paramedic team. "Trauma is the biggest killer and cause of morbidity in those under 40," the specialists added.
"The people of Northern Ireland deserve excellent trauma care.
"Northern Ireland is currently developing a robust trauma system and network.
"A physician-staffed, high performance HEMS will underpin this trauma system," the letter added.
Referring to the proven "economic cost-benefit argument of staffing a helicopter with a doctor" the authors urged Ms O'Neill not to launch "a sub-standard model in haste that has the potential to harm patients".
"There have been numerous international offers of help and assistance with training, education and sharing of operating procedures and clinical governance to ensure this occurs; these offers still stand," they added.
"Dr John Hinds was an advocate of excellence in trauma care. He believed the people of Northern Ireland deserved a world-class HEMS.
"His advocacy has focused the global trauma community's attention on N. Ireland. We sincerely hope you make the right decision."
The service will have two helicopters and is to be based at the old Maze prison site near Lisburn, where an existing building will be converted into hangar space and an operations room.
The Minister has previously indicated there would be an "initial staffing model" and that "ultimately there will be a doctor and paramedic on board the aircraft" - sparking fears over the nature of the service.
A spokeswoman for Mrs O'Neill's department said: "The planning process is not yet complete".
"The Minister will make her final decisions on the HEMS model based on the professional advice which the chief medical officer Dr Michael McBride is assembling following consultation with all key stakeholders, both on HEMS and the Trauma Network.
"While the Minister welcomes views from all interested parties, she will announce her decision after she has had the opportunity to consider the chief medical officer's report."