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!