The other day health minister Ben Bradshaw read out to concerned MPs a list of all the places on the body where young people get pierced these days.

"Ouch," he said as he finished. You and I don't want to enter this strange world of self-mutilation. We might pick up an infection in this under-regulated trade, which is why MPs were questioning Mr Bradshaw.

Suffice to say that navel piercing is most popular among women, nipples among men. Ouch again. In my observation, kids grow out of it, if they survive: people do die of such practices, which cost the NHS money. My theme today (specialist trauma response teams) is more elevated, though it does feature Mr Bradshaw.

Like Mark Oaten (Lib Dem, Winchester), the MP who raised this issue, I had not previously grasped an important point: that assorted organisations which provide emergency medical services doctors at major accident scenes are charities.

I don't mean the paramedics, ambulance crews and other "first responders" at an M1 pile-up. I mean the doctors, consultants even, who drive in or sometimes drop from the sky by helicopter. They work for bodies such as the British Association for Immediate Care (BASICS) outside their usual day job, which is usually in the NHS. Perhaps you knew that? Wow!

Specialist trauma response does not exist within the NHS as such. This is why Britain has a worse record than much of Europe in saving the lives of severely injured trauma patients who reach hospital alive: 40 per cent worse even than the let-markets-solve-all US.

Bob Spink, the Tory MP who recently defected to UKIP, joined the debate (his son is a consultant neurosurgeon), as did ex-health minister, Sir George Young, Oaten's Hampshire neighbour, and one of this column's oldest inhabitants.

Spink explained one crucial problem. It is vital that head injuries are tackled within four hours, but that goal is not met in 80 per cent of cases, the MP said.

Why? Because as soon as a patient is "safe" in hospital, inter-hospital transfer to a suitable specialist unit often takes too long.

Easing obstructed airways is the other key priority. This leads to a central issue. The 2007 report Trauma: Who Cares? by staff at the National Confidential Enquiry into Patient Outcome and Death highlighted the failings of pre-hospital management at the site where the patient is sent, and immediate in-hospital care.

It's a classic postcode lottery, in which Sunderland's death rate in trauma (2.9 per cent) is twice as good as the national average. Hampshire MPs like Sir George piled in with stats. The county's BASICS team has 19 volunteer medics and a consultant nurse, covering one million people, a much better ratio than London's 15 volunteers for 8 million people.

They usually travel to accident sites in their own cars, complete with blue flashing light, and managed to attend 750 of last year's 1,200 calls. Their expertise also redirects the ambulance's destination to somewhere more appropriate in up to half the cases.

All good stuff and Hemel's Mike Penning pointed out how the army has led the way in showing how highly trained soldier paramedics (he used to be one) can save lives in Afghanistan or Iraq.

Lurking here are several problems you may have spotted. Penning, a Tory health spokesman, wants a "central government diktat" to impose standards - not his party's policy in NHS matters, Bradshaw pointed out.

And will the concerned MPs support the government's policy to create specialist regional trauma centres, sometimes at the expense of local accident and emergency, he wondered?

Southampton General Hospital has one, but no helicopter pad, so urgent cases land a seven-minute drive away. Argh! Yet the local trust has a£17m surplus and could build one, the minister argued.

Since 2002, Whitehall guidelines have encouraged local NHS managers to pay for medical staff on air ambulances, not the crews. Apparently their record on targeting cases is still too patchy. Lord Darzi's review will include trauma services. And is it true, as MPs claim, that BASICS volunteers are sometimes prevented from leaving A&E to attend an accident? Ministers are still awaiting proof.