When the Saints go flying in

(Airwaves Magazine Issue 4 December 2007)

No matter how they reach you, the paramedics on board a rescue helicopter or a road ambulance are just what the doctor ordered.

In its usual emotionless, matter-of-fact way, the dictionary defines the term paramedic as “a person, such as a member of an ambulance crew, that supplements the work of the medical profession”. Technically that may be correct, but you can’t help wondering if the person who came up with that definition has ever spent time in the back of a road ambulance or in a rescue helicopter trying to keep a critically ill patient alive long enough to reach hospital. If they had, there’s a chance you’d find a few more superlatives and a lot more emotion in that description.

The paramedics on the Westpac Rescue Helicopter flying out of Christchurch are, like the majority of other helicopter rescue teams around the country, highly trained medical professionals provided through an operational partnership with the St John organisation. In many cases, the same land-based paramedic that arrives at an accident scene by road ambulance one week, could arrive by rescue helicopter the next.  But even though the Westpac Rescue Helicopter itself is often referred to as a “fully equipped ambulance in the sky”, most air rescue paramedics would agree that’s where any similarities between the two styles of operation end.

All St John Ambulance officers are trained under a nationally accredited training programme over a five year intern period. After achieving the National Certificate in Ambulance (Patient Care & Transport), they progress through intravenous and cardiac qualifications to become St John Paramedics. Ambulance officers can then progress to complete a three year diploma at either Auckland University, Victoria University in Wellington or Monash University in Melbourne, to attain a Health Science Degree in Paramedic Studies. On gaining this, officers become Advanced Paramedics.

In Christchurch, air rescue services are operated by Garden City Helicopters from their base near Christchurch Airport. Here, a team of three St John paramedics and six advanced paramedics are rostered between shifts to provide services 24 hours a day, seven days a week.  Rosters are organised to allow the base to be manned by paramedics from 7.30am - 5.30pm each day and for teams to be on-call from their homes between 5.30pm and 7.30am. Rosters are also organised to ensure at least one advanced paramedic is available at all times.

Of the nine current crew, four are also trained and qualified winch operators and again, the work schedules are organised to ensure that whenever possible, one winch person is available for duty.  The air rescue paramedics also rotate their duty rosters with land-based ambulance shifts allowing them to continue a full range of paramedic duties and training across both areas of the service.

The integration between the two services becomes evident when you consider the St John road ambulance parked outside the Westpac Rescue helicopter hangar. The St John Emergency Call Centre in Christchurch is the ‘central command’  for the despatch and coordination of all emergency medical responses around the region - whether land or air based. Should an emergency call be received where the paramedics stationed at the air rescue hangar are considered the ‘closest available ground unit’, that team will be dispatched by road ambulance from the air base as normal.

While technically, the services provided by St John paramedics could be loosely considered the same regardless of which vehicle the teams arrive in, most paramedics would agree that the differences between the two disciplines are vast. Paramedics who have chosen to work on rescue helicopters undergo continuous training and testing programmes, designed to hone their skills towards a unique and physically challenging environment. These programmes include personal fitness, learning bushcraft and alpine survival skills, sea survival and surf rescue techniques, map reading and navigation skills, aircraft technical and mechanical avionics, night vision and HUET (Helicopter Underwater Escape Training).

As well as these, there are individual programmes associated with winch operations including basic, confined, alpine and boat winching. Each area of training and testing underlines the fundamental differences in the operation of aviation rescue to land-based ambulance services. Whereas a conventional road ambulance is maintained in a standard state of readiness, a rescue helicopter and its crew must ‘customise’ its response to suit individual emergencies. Helicopter pilots and ground crew must evaluate flight parameters that include fuel load and capacity and particularly extra weight restrictions after bringing patients on board.

With this in mind, air rescue paramedics must decide as the call comes in, what equipment will be essential to carry and what can be left behind. If they are attending a motor vehicle accident for example, there won’t be much call for the alpine survival pack. Paramedic crews rely on as much accurate information as possible about the accident or emergency. Without it, it’s impossible to decide the correct equipment to carry and prepare in advance.

It’s understandable however, that the general public report accidents and emergencies with a great deal of emotion, anxiety and stress which can lead to crews arriving at a completely different incident scene than the one they expected. The unique characteristics of a rescue helicopter offer a rescue paramedic team two crucial advantages over a road ambulance - speed and access.

With direct-line flight, speed and manoeuvrability advantage, rescue helicopters can most often reach rural or remote accident or emergency victims faster and get them to advanced medical facilities quicker than a road ambulance.  Unless an accident scene is on or beside a road, a conventional ambulance crew cannot get direct access to the victim in remote areas, whereas a rescue helicopter can deliver a paramedic crew virtually to the spot. To that end, a rescue helicopter itself is simply a transportation mechanism - albeit one that offers tremendous advantages to both the rescue crew and the patient.

However an airborne scenario presents a completely different set of stresses and thought processes for the paramedic involved, who must generally consider a far wider picture of each individual rescue.  The paramedic must at all times be aware that a three tonne helicopter with constantly moving rotor blades in an often unfamiliar environment, is not exactly the safest place to be.

From the start of each operation to the debriefing afterwards, constant attention must be paid to the intricacies of each rescue : the overall surroundings, weather and environmental conditions, aircraft operation, the paramedics own safety, crew safety, safety of the patient, equipment requirements and security and safety of the accident scene. Incidents often draw a crowd and the arrival of a rescue helicopter invariably attracts attention from the public who must also be controlled for their own safety. Added to all this is the fundamental reason the paramedic is there in the first place - to attend to a patient, often critically injured, chronically sick or suffering trauma, and ensure a safe, efficient and effective transfer to an advanced medical care facility.

Here again is another example of the inherent differences between patient transfer in a rescue helicopter and a road ambulance, with the noise of the aircraft impacting on patient stress. While pilot and crew are linked by communication systems, the patient is most often not, and the attending paramedics must be constantly attentive to changes in the patients condition. One-on-one verbal communication between a paramedic and patient while in flight is generally not an option. Regardless of the type of operation undertaken, the one word that continually presents itself when looking at the work of air rescue paramedics, is teamwork.

Without the close, professional teamwork between paramedics, rescue pilots and ground crews, each mission could simply not operate.

Without the integrated operational teamwork and partnership between Garden City Helicopters and St John, the service could not function.