Founding Trustee Member, UK HEMS
Q: APN: Tell us a little about your medical background and where you now work?
A: I went to University of Wales, College of Medicine where I joined the Army. Having spent 2 years on General Duties (including a United Nations Tour in Bosnia), I started training in anaesthesia and intensive care medicine. I spent my SHO time in Wessex and Registrar time in the South West. I also spent a year at the Royal Adelaide Hospital, South Australia, working with their airborne intensive care unit. I now work in the North East of England. I am still in the military and continue to deploy on operations. When in the UK I work at James Cook University Hospital, Middlesbrough and on the Great North Air Ambulance.
Q: What is the aim and vision of UK HEMS?
A: UK HEMS aims to provide a single clinical governance ‘voice’ for Air Ambulance organisations who carry both doctors and paramedics in the UK. In 2004, the Great north Air Ambulance Service decided to add doctors to its clinical staff (up until then it had carried paramedic only crews). At that time the only other Air Ambulance that carried doctors as a routine was London HEMS, so it seemed natural to band together to share experiences and develop a common governance structure. Now there are about 15 Air Ambulances carrying doctors, utilising many different models (some are entirely charity owned and run, others have grant giving charities and use the local ambulance service for all their services, whilst others own the aircraft but staff it with ambulance service personnel). UK HEMS was set up to provide a uniformed approach to care, whatever the background of the aircraft. It is entirely voluntary – completely up to the Air Ambulance Service to join. It is our vision that, in time, every service in the UK will share the standards, and be badged with UK HEMS as a sign of excellence. It now provides mutual support, with a National Clinical Advisory Group (NCAG) setting standards of care, and a peer review process of assuring clinical governance. The procedures set by the NCAG are taught on a 3 week UK HEMS Helicopter Crew Course (HCC), which starts with airmanship, goes through multi-agency working and finally teaches changing normal practice to that needed to work effectively in a physician paramedic team. As emergency departments are reorganised and there is a centralisation of specialist care, the need for complex stabilisation of patients in the field followed by rapid transport to definitive care is going to get more important. For this reason it is vital that the Air Ambulance Industry in this country provide a unified service that all can rely on.
Q: What is your role within UK HEMS?
A: I am part of the founding board of trustees, and honorary secretary of the clinical advisory group.
Q: What aspects of your job do you find most rewarding?
A: There are two distinct parts of my job. On operations it is truly a privilege to be able to look after wounded soldiers, many of whom have been injured carrying out the most heroic of deeds. Undoubtedly we have made advances in their care over the years, and they now have a standard of care overseas equal to, if not better than in the UK. In the UK my work within the pre-hospital environment, anaesthesia and Intensive Care allows me to treat patients through the whole progression of their disease. This gives an amazing insight, but ultimately there is nothing more satisfying than treating someone in the field, looking after them on the Intensive Care Unit and then providing anaesthesia for them during their rehabilitation.
Q: Please tell us more about the anaesthetic input in your role?
A: Pre Hospital Care by doctors involves many skills, but possibly one of the most complex and demanding parts is providing anaesthesia on the field. This also remains a controversial aspect of the job, with much conflicting evidence as to effect. However few of us would put a semi conscious patient into a CT scanner without securing their airway, so surely it’s sensible to do this before putting them in an aircraft, if it can be done safely? On top of this, anaesthetists are becoming more involved in ‘total trauma care’, this starts in the field. It takes, on average, 40 minutes to get a patient from an incident to a hospital, so the ‘Golden Hour’ is a pre hospital event. Resuscitation has to start at the scene.
Q: Does the organisation support anaesthetists in doing their job?
A: As I said, anaesthesia in the field is very different to in a hospital – you only have the kit you carry on your back and the immediate team around you if there is an emergency. UK HEMS provides valuable support through training (both through the HCC and a 2 day course at the Great North Air Ambulance), it also quality assures the Air Ambulance systems that are part of it. Afterall, it is only working a quality system that success can be assured.
Q: What do you think are the most important changes to anaesthesia over the last decade?
A: Whilst there have been huge technological advances over the decade, many of which have made anaesthesia safer and more accessible, I think the single biggest advance has been the realisation that human factors are a real issue in patient care. This has been taken from aviation where it was noted that perfectly air worthy aircraft were crashing, many due to miscommunication. From this Crew Resource Management (or learning how to effectively interact/respond in an emergency as a team member or leader) was born. This is now an essential element of any aircrew training, and it would appear that less aeroplanes are crashing. However, there is almost certainly an over emphasis on CRM as bought over from aviation, this is a worthwhile analogy but only goes so far – the anaesthetist is involved in a far bigger team, with many more specialties working directly alongside them. Therefore we need to develop the concept further and look more closely at a medical model of human factors. On top of this, it is important to note that untoward incidents are happening less in commercial aviation, in general (hobby) aviation there seem to be just as many incidents. The essential difference here is that there is an increasing amount of automation in commercial airliners, this again is a lesson we need to learn. We need to ensure that any new equipment that comes on the market has been through an ergonomic process, in times of emergency it is vital that everything is intuitive and to hand.
Q: How can people become more involved with UK HEMS?
A: Anyone involved with Air Ambulances should look at our website