A year of development & night flying

Hi guys, definitely time for an update from myself. I will talk about the last year of development, send a welcome to the new Paramedics joining the team, and look at the next exciting project…..Night Flying.

Review of past 12 months
This feels like a poignant time to recap on a year of development. The first year of our Msc in Pre-hospital Critical Care Retrieval and Transfer is all but done, pending some final dotted I s and crossed T s. Needless to say this experience has sent the team on a dramatic clinical learning curve that will benefit our operation and the patients we serve. We have stuck up good working relationships with the Doctors, which are working alongside, and mentoring us Paramedics through our development into Critical Care Paramedics. This has been great for my personal development as a clinician, and has improved the whole service, by closer interaction with the Doctors that receive our patients at Hospital. Knowing the Doctor at the end of the phone during pre-alert, and at the hospital during hand over, increases our understanding of each other’s roles and goals, and makes the passage of information easier and the patients journey smoother.

No longer the new boy!
The next development is that I am no longer part of the last intake! Four excellent Paramedics have joined our team; Alex Sanders-Page, Lee Hilton, Nick Ratcliff and Mark Hodkinson, are all starting the process that I went through 20 months ago, that inspired this Blog (wow that went quick!). Good luck guys and welcome to the team. This is one of the best jobs you can do as a Paramedic so grab the challenges with both hands. I’m looking forward to working with each of you.

And so onto the future
Night flying is just around the corner for Devon Air Ambulance. Lots of work has been done to bring us to this point. Communities have been engaged to provide lit landing sites to make our operation safe and secure. Aircraft have been upgraded to fly and land at night. The team have trained together after dark to get used to the adjustments that night flying brings. All of this, and much more, has been done to allow us to reach patients we previously couldn’t. After the year just passed, we will be reaching these patients with increased clinical ability and options for treatment. The future at Devon Air ambulance is looking bright, even when it’s dark outside!

9 Essential Checklist Tasks For A HEMS Paramedic To Review During Missions

It’s coming up to six months as a HEMS Paramedic with the Devon Air Ambulance!
Time moves quickly and the learning curve has been steep. I have attended a variety of incidents; all challenging in different ways and thought I would share my personal checklist that I go through before, and at key points during missions.

This is my personal list of tasks that I have developed from my experiences over the last six months. I generally go through this en route to an incident when sat in the rear of the aircraft with no other immediate tasks to perform. It is intended to lessen the mental pressure or ‘cognitive load’ that comes when getting ready to arrive at a serious incident, and avoid tasks being overlooked or missed.

In the aviation world such an error would be called a ‘human factors incident’. Aviation is well known for its use of checklists to reduce human errors and the medical world has incorporated similar practices in areas such as surgery and some ED practices. For me this list is just to help me turn up at an incident and make things run smoothly without any errors – the goal is to ace every job! We can’t always achieve this but you have to start with that intention, and this list is part of that intention.

So let me take you through the scribbles…

1. TIMES: Start by writing down the time the incident took place, time we took off, the time the helicopter arrived etc, sounds simple but can be easily overlooked when trying to get updates on the patient condition and getting kit ready to leave the aircraft. These times can be important when building a picture of events later and when answering questions posed by the doctors at hospital as it may inform their decision making. These times can be gained from control but are better if they are in your hand when someone wants an answer.

2. TETRA: This is the type of radio in the aircraft we use to communicate with control. It allows us to send our status i.e. ‘arrived at scene’ without having to speak to them, this both saves time and lets them know where we are.

3. OS: Stands for ‘Ordinance Survey’. Get the map for the area of the incident and mark the target in pencil, pass it forward to the paramedic in the front of the aircraft. They are working the electronic navigation aids but need this as a back-up and quick reference. The landing site can then start to be planned (a location such as a forest means we need to look at the nearest practical site, and there are lots of other issues to consider with landing sites)
 
4. WETFAG: This is something we do when attending incidents with children. WETFAG stands for Weight, Electrics (in the form of the number of joules required to deliver a defibrillating shock to a child in cardiac arrest), Tube (size of tube used to secure the airway), Fluid (a weight adjusted IV dose), Adrenaline/Amiodarone (drugs we give in cardiac arrest), Glucose (again an IV dose).

All of the previous are adjusted to the age and suspected weight of a child and given the emotional pressure that can come with paediatric incidents it is clearly helpful to have these values prepared and visible in advance. When I do this I remind myself to check the age given is accurate when I arrive on scene.
 
5. DEST: The Destination gives us an idea what is wrong with the patient and which hospital is going to be most appropriate for them. The joys of a helicopter mean we can take patients to specialist centres that give the patient the best chance of recovery. Sometimes the weather has other ideas so we need to know our options and plan around them, it is always better to do this early.

6. BRIEF TEAM: I may know what I intend to do with the patient but the others can’t read minds!

We work closely with the ground emergency ambulances and generally attend incidents together. Covering the whole of Devon and beyond means we work with a lot of great different crews. If the patient is going to travel in the aircraft then it is up to the HEMS crew to take responsibility for their care during the flight. That means getting them packed suitably for the aircraft with any essential interventions performed ideally before take-off (noise and space makes certain things more challenging in flight). Making sure that happens requires effective team-work, a team can only function once they know the tasks they need to perform so I endeavour to state what needs to be done and organise who is going to do it. Getting peoples first names helps this process run smoothly. I am regularly impressed by the way ambulance staff that have never worked together suddenly become an effective team and get numerous tasks done in rapid fashion. Sometimes the care on scene has been so thorough that there is little more that needs to be done.

7. KIT CL(Check List): This is the last check we carry out as the patient is placed in the aircraft and ensures that the medical equipment/drugs we may need during flight are placed close to hand. A printed sheet in the back of the aircraft needs to be looked at and read so we know the essentials are there. It only takes seconds.

8. ATMIST: Another check list within a list! Our method of pre-alerting the hospital we are taking the patient to with the relevant information (Age, Time of incident, Mechanism of injury, Injuries found, Signs & Symptoms, Treatment given). I like to do this whilst the rest of the assembled team is loading the patient in the aircraft, away from the incident if possible in my own ‘sterile’ environment, so this can be passed clearly, quickly and without interruption (not forgetting to let them know the patient is coming by aircraft! Please meet us at the Helipad!)
 
9. HEMS: Last but not least, our dedicated HEMS controller needs contacting. There are a number of Air Ambulances that operate in our ambulance service, sometimes we want to go to the same hospital at the same time, so we need to know that our intended helipad is clear or if we need to start forming plan B.

So there are lots of things to consider and the checklist acts a visual reminder so as not to miss anything when the pressure is on!

That’s rather a long blog for a short list but I hope it was of interest!

Catch you next time!

Dave

 

Crew Resource Management (CRM)

In this post I look at CRM and how it helps teams to function more effectively, both in the world of aviation and pre-hospital care. You can’t discuss CRM without looking at ‘Human Factors’ and so we will get to grips with this term also. CRM has become a familiar term to both Aviation and medicine. As such, my role as a Paramedic and HEMS Technical Crewmember (the aviation qualification I had to undertake when joining-see earlier post) both require knowledge of CRM.

Crew Resource Management is a term that arose in the aviation world in the late 1970s, early 1980s and described a process that requires open interpersonal communication between teams to avoid human errors. CRM encourages a flat hierarchical structure, where any team member can raise concerns over a potential threat or mistake that could lead to a safety issue.

What does that mean to the Aircrew of Devon Air Ambulance?

It means that our Pilots, who are extremely competent aviators, have command of the aircraft but can still be challenged by the Paramedic crew if a safety issue is missed or overlooked. It means that the whole crew are responsible for identifying hazards during flight and verbalising them, so that everyone is aware. This is especially important during the most demanding part of our flights, landing in ad-hoc sites to reach our patients (a subject for a later post I think). All the crew are encouraged to highlight hazards as we approach an ad-hoc site, even if we think they are obvious to the pilot. This is always responded to with a ‘thank you acknowledge’ from the pilot and is seen as good team working, and never as a challenge to their ability or authority.

Morning Briefing

The open communication between our crew begins each morning during our brief, where all aspects that may affect the day’s missions are discussed (weather, aircraft maintenance, and aerial hazards). CRM has its own section of the brief where each crew member has their chance to raise any concerns from previous missions, discuss suggestions for improved team functioning, and be open about each other’s physical, mental and emotional state. The mnemonic HALT is useful for this (Hungry, Angry, Late, Tired).  Anything a crew member is experiencing around those issues needs to be addressed to allow the team to function effectively. Highlighting them at the start of the day allows this to happen. Given that over 70% of aviation crashes are attributed to ‘Human Factors’ (or the things that cause human error) you can see that CRM is an essential part of aviation. At Devon Air Ambulance CRM is engrained in our culture and something we are required to formerly requalify in yearly (see Pilot Rob Mackie’s blog for more info).

Open Communication

All of this translates well into pre-hospital care. The emphasis on safety is still present, using open communication to prevent errors or poor practice. Medical CRM has also been described as a ‘pit stop’ approach where teams function effectively in performing acts such as resuscitation which require several co-ordinated tasks to happen simultaneously. Open communication is critical in these incidents as the team may consist of a variety of clinicians such as Ambulance Crew, Air Ambulance Crew, and Doctors, all of which may be meeting for the first time. First names are generally used to set the atmosphere for good CRM. Through CRM clinicians can be allocated tasks specific to their role and strengths, as part of a verbalised plan that the whole team are tuned in to. No assumptions are made around who is responsible for what, and any concerns can be raised and addressed by any team member. This leads to a safe, effective team performance.  Enacting this with clinicians that I have just met, and performing slick successful patient care is one of the most rewarding parts of my role. Here’s to the next successful interaction!

The Clinical team team up with Plymouth University

It’s been a while since my last post, but for a good reason. All the clinical team at the Devon Air Ambulance, me included, have had their heads in the text books and laptops, as we embark on an exciting period of clinical development. Each Aircrew Paramedic is being provided the opportunity by Devon Air Ambulance of beginning a period of academic study with Plymouth University that will allow us to become Specialist Paramedics in Critical Care. So what does that mean for the people of Devon and beyond, who need our help?

It means when we turn up to the most critically ill or injured people we will be educated and equipped to deliver even more effective care. We will eventually be able to select from a wider range of drug treatments and skills, to diagnose and address a greater range of those life-threatening conditions that we encounter on the Air Ambulance. So how do we get there?

Years ago I read an excellent paper on clinical education which contained a phrase that has stuck with me to this day “If you practice a skill, without the deep underpinning knowledge of that skill, then you are dangerous; if you have deep underpinning clinical knowledge, but are unable to physically perform the necessary skills, then you are incompetent. Therefore one should be able to perform the required physical skills, with deep underpinning knowledge, and with the correct attitude to be considered a competent professional.” (Hand, 2005)(note the academic referencing! Something else the team is getting used to!)

So, as our range of abilities and responsibilities increases, so must our underpinning theoretical knowledge. Back to school we go then! Lots of work has been going on behind the scenes between DAAT and Plymouth University, to design a bespoke Master’s Degree programme, that will perfectly deliver the knowledge and skills we need for this next phase of development. What has been great during the early stages of this enterprise is the knowledge sharing within our group. Our first assignment required us to choose a clinical topic and critically appraise the research that exists on it. At the end of this exercise each person had some great information to pass on to the group, increasing all our learning through the hive mind!

As stated in Hand’s excellent phrase, theoretical knowledge is not enough on its own, which leads me to the next exciting development that will greatly enhance our paramedic’s ability. DAAT will be recruiting a team of senior Doctors with extensive pre-hospital experience who will be on hand on board the air ambulance to mentor and supervise our clinical practice in the areas we are developing. Needless to say this alone will be a fantastic learning opportunity that the team will make great use of.

This post is just the beginning of a long journey. That journey should end with a service that can deliver the most advanced state of the art care to the people that need it most, all with the speed and range that an Air Ambulance offers. (If only the ambulance service had a phrase to capture that, something like right care, right place, right time?)

Hopefully post again soon, provided my homework is finished!

9 Essential Checklist Tasks For A HEMS Paramedic To Review During Missions

It’s coming up to six months as a HEMS Paramedic with the Devon Air Ambulance! Time moves quickly and the learning curve has been steep. I have attended a variety of incidents; all challenging in different ways and thought I would share my personal checklist that I go through before, and at key points during missions.

This is my personal list of tasks that I have developed from my experiences over the last six months. I generally go through this en route to an incident when sat in the rear of the aircraft with no other immediate tasks to perform. It is intended to lessen the mental pressure or ‘cognitive load’ that comes when getting ready to arrive at a serious incident, and avoid tasks being overlooked or missed.

In the aviation world such an error would be called a ‘human factors incident’. Aviation is well known for its use of checklists to reduce human errors and the medical world has incorporated similar practices in areas such as surgery and some ED practices. For me this list is just to help me turn up at an incident and make things run smoothly without any errors – the goal is to ace every job! We can’t always achieve this but you have to start with that intention, and this list is part of that intention.

So let me take you through the scribbles…

TIMES: Start by writing down the time the incident took place, time we took off, the time the helicopter arrived etc, sounds simple but can be easily overlooked when trying to get updates on the patient condition and getting kit ready to leave the aircraft. These times can be important when building a picture of events later and when answering questions posed by the doctors at hospital as it may inform their decision making. These times can be gained from control but are better if they are in your hand when someone wants an answer.

TETRA: This is the type of radio in the aircraft we use to communicate with control. It allows us to send our status i.e. ‘arrived at scene’ without having to speak to them, this both saves time and lets them know where we are.

OS: Stands for ‘Ordinance Survey’. Get the map for the area of the incident and mark the target in pencil, pass it forward to the paramedic in the front of the aircraft. They are working the electronic navigation aids but need this as a back-up and quick reference. The landing site can then start to be planned (a location such as a forest means we need to look at the nearest practical site, and there are lots of other issues to consider with landing sites)

WETFAG: This is something we do when attending incidents with children. WETFAG stands for Weight, Electrics (in the form of the number of joules required to deliver a de-fibrillating shock to a child in cardiac arrest), Tube (size of tube used to secure the airway), Fluid (a weight adjusted IV dose), Adrenaline/Amiodarone (drugs we give in cardiac arrest), Glucose (again an IV dose).

All of the previous are adjusted to the age and suspected weight of a child and given the emotional pressure that can come with paediatric incidents it is clearly helpful to have these values prepared and visible in advance. When I do this I remind myself to check the age given is accurate when I arrive on scene.

DEST: The Destination gives us an idea what is wrong with the patient and which hospital is going to be most appropriate for them. The joys of a helicopter mean we can take patients to specialist centres that give the patient the best chance of recovery. Sometimes the weather has other ideas so we need to know our options and plan around them, it is always better to do this early.

BRIEF TEAM: I may know what I intend to do with the patient but the others can’t read minds!

We work closely with the ground emergency ambulances and generally attend incidents together. Covering the whole of Devon and beyond means we work with a lot of great different crews. If the patient is going to travel in the aircraft then it is up to the HEMS crew to take responsibility for their care during the flight. That means getting them packed suitably for the aircraft with any essential interventions performed ideally before take-off (noise and space makes certain things more challenging in flight). Making sure that happens requires effective team-work, a team can only function once they know the tasks they need to perform so I endeavour to state what needs to be done and organise who is going to do it. Getting peoples first names helps this process run smoothly. I am regularly impressed by the way ambulance staff that have never worked together suddenly become an effective team and get numerous tasks done in rapid fashion. Sometimes the care on scene has been so thorough that there is little more that needs to be done.

KIT CL(Check List): This is the last check we carry out as the patient is placed in the aircraft and ensures that the medical equipment/drugs we may need during flight are placed close to hand. A printed sheet in the back of the aircraft needs to be looked at and read so we know the essentials are there. It only takes seconds.

ATMIST: Another check list within a list! Our method of pre-alerting the hospital we are taking the patient to with the relevant information (Age, Time of incident, Mechanism of injury, Injuries found, Signs & Symptoms, Treatment given). I like to do this whilst the rest of the assembled team is loading the patient in the aircraft, away from the incident if possible in my own ‘sterile’ environment, so this can be passed clearly, quickly and without interruption (not forgetting to let them know the patient is coming by aircraft! Please meet us at the Helipad!)

HEMS: Last but not least, our dedicated HEMS controller needs contacting. There are a number of Air Ambulances that operate in our ambulance service, sometimes we want to go to the same hospital at the same time, so we need to know that our intended helipad is clear or if we need to start forming plan B.

So there are lots of things to consider and the checklist acts a visual reminder so as not to miss anything when the pressure is on!

That’s rather a long blog for a short list but I hope it was of interest!

Catch you next time!

Why the basics of being a paramedic are crucial to your success

Hi all, apologies for the delayed update but I have been enjoying some much needed time off!

To bring you up-to-speed on the latest, I recently attended the Devon Air Ambulance monthly governance meeting, where we regularly review challenging incidents from the month and disseminate any learning points amongst the group. I also attended an excellent PEN (Pre-hospital Education Network) study evening facilitated by our HEMS lead Darren Goodwin and ED consultant Doctor Tim Nutbeam. This included a presentation from David Wise, another ED consultant with an absolute wealth of pre-hospital experience gained with the London Air Ambulance (as a developing HEMS Paramedic this is a guy whose ear you really want to bend!) These learning events, coupled with some time off have given me the chance to reflect on my HEMS career so far.

One of the main attractions about the Paramedic role with the Devon Air Ambulance was, for me, the chance to develop extended skills and drug interventions that I was not able to use in my previous Paramedic roles, coupled with some interesting ‘Gucci’ courses that would allow me to have a greater influence on patient outcomes. These things all have their place and are of significant value but the running theme I have noticed throughout most debriefs, study events and discussions is that it is important to do the basic things to a high standard. It is a phrase you hear a lot ‘do the basics well’. So what does this mean? Surely most of us with experience mastered the basics a long time ago?

Someone once explained to me that developing sound knowledge and practice is like building a pyramid. The higher or more advanced your practice goes, the wider and more drilled the foundation of your basic practice needs to be. Neglect the foundation and the structure will fall! Sounds a bit Obi wan, so what does this mean in Paramedic terms, what are the basics?

A large part of David Wise’s presentation on pelvic trauma was on preserving the lifesaving clot in the bleeding pelvis through careful movement of the patient (highlighted by a manikin with an accelerometer attached to the pelvis). Apply your pelvic splint with finesse and care to avoid your patient bleeding to death. Good patient movement and handling are key basic ambulance skills.

This of course should not cause an unnecessary delay on scene. It is basic skills that stop undue delay when performing necessary interventions, advanced or otherwise, at the scene of an emergency. Skills such as time management and communication to your assembled team are crucial. Each member is assigned a specific task along with a desired end point, then their name verbalised to the rest of the team to aid communication and coherence. A team leader is also assigned to keep everyone on track. When these basic things are done well, patient care is optimal.

That care becomes more proficient when you handle your kit regularly – you should make time to fiddle and play with it so that you really get to know your equipment, then drill your procedures using that kit. This will allow you to iron out snags and find the most efficient way to use it.

Interesting courses, enhanced skills and drug interventions, conferences and networking all have importance and bring benefit to our patient care, but that benefit has to be build on the foundation of good basic practices. That is the most important thing I have learned so far. My intention is to keep that basic foundation wide and strong to stop my pyramid crashing back to earth (bad analogy for aircrew!).

Experiencing all that Dartmoor has to offer

January and February has now passed with more missions flown and experiences to learn from. There has been some challenging but beautiful weather, Dartmoor really does look gorgeous, especially from the sky, when the high ground is dusted in white.

Dartmoor has been the setting for a number of the incidents I have attended recently. It’s a location that many people enjoy for it’s scenery and remoteness. When injuries and illness occur there, access to the patient can obviously be challenging, that’s when a helicopter can be extremely useful. But it is not just about the transport, it is about the team! Our HEMS guys in Devon can bring added skills and drugs that aren’t in the standard Paramedic toolbox. On one of these incidents on Dartmoor I was able to assist and observe a patient receive Ketamine analgesia for the first time.

Dr J Kuehne was on board to oversee the administration of this excellent drug  (our team of Paramedics have to complete five administrations under the supervision of a doctor before they can use this drug autonomously). Ketamine puts the patient in a dissociative (faraway) state which reduces the experience and the memory of severe pain.  The patient had a rather bad fracture which was re-aligned and he was able to be transported in a comfortable state. Once we had arrived in the Emergency Department he had no recollection of us moving his leg and placing it in a splint.

All in all not a life-threatening injury but a satisfying job as the patient need to be accessed rapidly (the temperature was below freezing where he was walking and fell) and had excellent management of his pain when we arrived. Viva helicopters and extended skills!

The first few shifts as a helicopter paramedic

The First Live Shifts

I could call this period starting again.  Thankfully I have an invaluable preceptorship period, which means I operate as an extra crew member to the pilot and two experienced HEMS paramedics, allowing them to show me the ropes. I am an experienced paramedic but am more than happy to be guided through these early stages. There is so much new information to process: aircraft safety; navigation; communication systems; different medical equipment; choice of hospital destination; pre-flight packaging and planning around the patient’s condition and so much more!

My first shift was thankfully quiet which gave me chance to pull the medical bags apart and start to remember where each piece of equipment lives, something that is incredibly important when you need to do something quickly.

During my second shift I did my first mission! In fact we flew two missions that day: one trauma patient who we flew to the Major  Trauma Centre bypassing the closer hospital (joys of a helicopter) and another patient that we airlifted to an Emergency Department under pressure of disappearing light (as yet DAAT or Devon Air Ambulance don’t fly in the hours of darkness but watch this space…).

Both incidents were good opportunities for me to see how missions run from start to finish. I know it will take time for me to really get slick at everything, a bit like moving house and walking around with the lights off, it takes a while before you stop patting the wall and put your hand straight to the light switch.

The third shift was quiet due to poor weather and no-one needing an Air Ambulance. I spent the day discussing, debriefing and drilling; a good way to find that light switch quicker!

Clinical development

One of the things that attracted me to the HEMS Paramedic role was the chance to accelerate my clinical development. There are a few ways that this happens and each way compliments and enhances the others.  So here they are;

1: We have helicopters that allow us to reach the most serious trauma and medical cases that happen in Devon and sometimes beyond. We generally reach them in a short period of time and are frequently exposed to these types of cases.“There is no replacement for experience” is a term I have heard before, I agree with this term so long as it is accompanied by the following.

2: We review the incidents that we attend and our performance in them. This happens internally at our own Clinical Governance evenings and externally at events such as Trauma review meetings held at the Major Trauma Centre hospital (Derriford). These are generally ‘no holds barred’ events where all aspects of care are looked at, and the question is posed, could this have been done better? No incident runs perfectly from start to finish and it is only through brutal honesty and reflection that we all improve.

3: We practice, again and again. Simulation is the word currently used in the Emergency Medicine for this. This entails creating a training scenario such as a certain type of cardiac arrest or traumatic injury and running through it as though it were real from start to finish. The approach to this is sometimes born from things identified in the previous two sections, with ideas for improvement. This allows us to trial run our ideas and become slick in the application of our techniques. This affects the quality of our performance at live incidents and so the cycle of development continues!

Those three areas I see as core to a clinician’s development in any setting. In addition to what I have described so far, Aircrew Paramedics with DAAT have the opportunity to attend various courses that enhance their ability to do their job. We are trained to perform advanced pre-hospital skills such as, surgical airway and Finger thoracostomy (Surgical procedure to treat life threatening chest injuries), and we are developing the ability to give enhanced pain relief in the form of ketamine and midazolam (two very effective drugs).

Another great method of clinical development that occurs within DAAT is through the senior clinicians that you meet. Joerg Kuehne is a consultant anaesthetist who regularly gives up his time to fly with DAAT. I was lucky enough to spend an operational shift with him recently.

What do you do when you spend a day with a consultant anaesthetist? You practice airway management! It really is a privilege to be able to speak to a subject matter expert and let them refine your technique, Joerg certainly did that with myself that day.

What happened on the following shift? Real airways to manage! Refined skills put into action! Review of performance……..the cycle of clinical development continues!

The HEMS Course

What is a HEMS Course?

Completing this course has given me the skills and knowledge to (eventually) become a contributing crew member of the aircraft and not just a medical passenger.

We covered topics such as:

How chunks of metal fly, sometimes referred to as the principles of flight, and what can go wrong.

Meteorology, which I found really interesting, not least because I can now annoy my wife by naming the cloud formations of the day, and again what can go wrong.

(For meteorology see also language studies: 211450Z 14011KT 8000 –RA FEW009 BK014 12/10 Q1012 This is not my youngest getting hold of the keyboard it is a weather report that needs interpreting each day as it tells us where we can and can’t fly safely!)

The aircraft: where everything is; what catches fire and how to deal with this; how to communicate using the radios; how to communicate without the use of radios; how to unhinge the doors when you need to and how not to unhinge the doors when you don’t want to. Of course I hope I never have to do either!

Navigation: again really interesting, this covered how to plot a course using latitude/longitude as well as OS grid references.  Just as essential was learning to know where you are going, where you are at any point on the way and when you have arrived. This is incredibly easy to write, not so easy to perform!

The HEMS course culminated in an exam, which everyone passed, and a navigation exercise, which everyone returned from! There was lots of learning, lots of experienced instructors and all of this contributed to a fantastic course.  A big thanks to Dave from the Bond Aviation Group for guiding us all through it successfully.

Make sure you check out my next blog on ‘The First Few Shifts as a Helicopter Paramedic’