Flying doctors: a bird's eye view
For air ambulance medical crews, critical injuries and life-or-death decisions are all in a day's work. Jeremy Laurance takes to the skies with them
Tuesday 28 June 2011
I was holding a cup of coffee in one hand and a chocolate biscuit in the other when the phone rang. The sound it emitted – a high-pitched, piercing klaxon – sent an involuntary shiver down my spine.
The two-storey Portakabin that serves as HQ for the Warwickshire and Northamptonshire Air Ambulance sits on the edge of Coventry airfield. It was 11.57am and I was sitting on the black sofa, togged up in my orange flying suit. Mac McDaniels, a grizzled ex-marine pilot, was halfway down the stairs by the time I got to my feet. As I set off after him, Keith Rutherford, paramedic, answered the call. There had been a road accident – category A, the most serious – with one female casualty.
We headed for the helicopter 40 yards away. Mac started the engines as I climbed aboard, followed closely by Keith and Pam Hardy, consultant A&E specialist and today's on-duty flying doctor. We took off before noon, nose down, skimming low north west across the airfield.
We gained height, but not much. Most missions are flown at between 500ft and 1000ft. A red kite dodged underneath us as a patchwork of green fields unfolded below.
We banked hard and I found myself staring into someone's conservatory. Then we were winging away into the sun. I was beginning to have fun.
Not for long. Below us there was a car on its side and a person under a striped red duvet lying on the carriageway – the M1 southbound. The traffic was still flowing in the outside lane, so Mac put down in a field and we clambered up a bank by a culvert and over a fence to the road. It was 12.10pm. The casualty, a woman aged 35, was lying on her back with her knees up. A land ambulance crew was already tending to her – they had removed her shoes and placed heart monitors on her feet and hands. Her bright-pink painted toenails looked incongruous in the carnage. Every window in her car was smashed and the roof pulverised. CDs were scattered for a hundred yards. She was wearing blue jeans, a blue gauze top and there was a small patch of blood on the road. She was trying to speak.
She had been flung out of her car as it rolled across three lanes of the motorway. Miraculously no one else had been hit. A white-haired man leaning against a crash barrier had been driving the van behind. "I heard a bang and saw her car spin. She came out like a rag doll. I don't know how she is still talking," he said. A young woman next to him leaned across. "I was on my way to university and I thought I had better see if I could help. I am a student nurse. It's my duvet."
Pam and Keith and the land crew quickly established that the woman had apparently escaped critical injury. There would be no requirement on this occasion for anaesthetic, rapid sequence intubation, or thoracotomy – opening of the chest to directly massage the heart in cases of cardiac arrest – all part of their day's work.
Their main concern was that her head or spine might be damaged or she may have suffered internal injury through the force of the impact, tearing blood vessels or rupturing organs.
"Patients talk and die – we've all seen them," Pam said.
The crews manoeuvred the woman onto a stretcher, wedged her head with stabilisers and strapped her down. She began to speak: "I remember now. I was in the middle lane and a big car came in this lane and I had to pull over – and my car lost control."
Police closed the motorway so Mac could bring the helicopter up and put it down on the asphalt.
"You have to stop the traffic in both directions, otherwise you get rubberneckers smacking into the back of the car in front," he said. Keith called Walsgrave hospital to brief them. He gave them an ETA of 15 minutes, but it will actually take us six. A land ambulance would have to go down to the next junction, turn around, come back up the north carriageway and head to Leicester hospital – the nearest – where there is no neurosurgical unit; a longer journey to a less appropriate destination. It is not only the time to hospital that counts. Even more important is the time to "definitive care". That is where the helicopter scores.
With the casualty on board we took off and skimmed down the motorway. Below us people were out of their cars looking up. At 12.46pm we touched down at Walsgrave. "My hand hurts – am I badly hurt? the woman asked. "No, not too bad," said Keith, kindly. In another minute she was in A&E and Keith was briefing the intake team.
"Swerved... ejected... apparently not knocked out... facial abrasions... pain in both arms... no gross deformity."
"Unbelted, presumably?" asked the receiving doctor. But it was a rhetorical question. No one answered.
We headed back to base. From the moment we climbed into the helicopter the team was back on call.
"So many accidents you go to – they have been so lucky," said Keith. "To be ejected from a car is a massive incident – what we call a red flag." "Yeah and others, they have a little bump and they have got a really serious injury," said Pam. "Modern, expensive cars are a problem," said Mac. "They are so well-built that fire crews have a real problem cutting people out."
For speed of response with a specialist medical team, a helicopter ambulance cannot be rivalled. But it is expensive – an average £1,400-a-trip compared with £200 for a land ambulance.
Only one is state run, that serving the Scottish Highlands and Islands. Some 23 others covering the rest of Britain are all run by charities.
The Warwickshire and Northamptonshire service, which operates in tandem with the neighbouring Derbyshire, Leicestershire and Rutland service receives no Government grant or lottery funding and raised £5.25m in 2010, more than enough to pay its running costs of £4.42m.
After a shaky period in 2004, when it made a £400,000 loss, it is now secure, fiercely independent and proud of its success, based on "thinking like a business", according to medical director Dushy Kumar.
He says: "We don't want state funding. To ask for it in a time of austerity would be foolhardy. There is no way the country can afford to fund air ambulances."
But then he adds: "To the people we serve we are priceless."
It is hard to disagree.
* The Warwickshire and Northamptonshire Air Ambulance covers most of the UK's main motorways such as the M1, M6 and the M40.
* It costs around £1,400 per mission, reaching an annual cost of more than £1.7 million and the service receives no funding from the Government.
* The service covers more than 2,200 square miles and a population of 1.2 million people.
* In 2010, the WNAA attended 1,500 incidents, averaging around four call-outs a day. In 2011 so far, they have attended 1,200 incidents already.
* The average response time is around six minutes.
* The service consists of 15 doctors, 15 paramedics and 6 pilots
* WNAA are able to bypass the nearest hospital and provide a fast transfer to the best hospital or trauma centre to treat the patient's specific injuries.
* The additional skills of the crew can bring the hospital emergency department and surgical intervention to the accident scene, often meaning the difference between life and death.
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