Jo Irons / Consultant in Cardiothoracic Anaesthesia / Papworth Hospital, Cambridgeshire
In a hospital environment it is easy to take for granted the support network of senior medical colleagues and other professional staff, the abundance of sophisticated monitoring equipment and drugs, and the unlimited access to electricity and running water. But when Jo Irons was given the opportunity to work for Careflight in Australia, she left all this behind to face a new challenge.
Induction
Before I left for Australia, I had no prior training in retrieval and pre-hospital rescue. Whilst I had on a few previous occasions jumped in the back of an ambulance to accompany a critically ill patient across town for tertiary treatment, this would be very different. However, my lack of experience was certainly no barrier to joining Careflight. With the relevant background skills in emergency medicine, anaesthetics and intensive care medicine – the job will teach you the rest.
There was a comprehensive 5-week induction program during which you were properly orientated, trained and prepared prior to any patient contact, whilst having great fun and receiving full pay for it. Not something I’ve ever experienced in the NHS: it seemed like a dream! This included a 3-day Pre-Hospital Trauma Course where I learned about scene safety, extrication, disaster management, complex airway management, roadside splinting and surgical procedures. Helicopter Underwater Emergency Training taught me escape procedures, water survival methods and ocean safety. There was on-the-ground and in-flight aviation training, including 2 days of learning how to winch. Weekly teaching days combined tutorials and M&M meetings with scenario simulation involving cliff edge and canyoning training. We travelled to the Blue Mountains, roping and abseiling into the canyons with our medical equipment and stretchers and stabilized and transported simulated patients to safety. I felt prepared and excited about the new challenges I was about to face.
The missions
Sydney is located between the water and the mountains, and these contrasting environments provided me with the experience of much more than an urban helicopter rescue service. We were called out to drownings, cliff falls, injured canyoners, cavers and bushwalkers as well as motor vehicle accidents, assaults and industrial accidents. My 71 missions during my 6-months work comprised 59 in NSW and 12 international from Bali, Fiji, Solomon Islands, Vanuatu, Kiribati and New Caledonia. 28 call outs were primary rescue and 43 secondary retrieval. The helicopter team included a pilot, a crewman (responsible for navigation, winching and cabin safety), a Special Casualty Access Team paramedic and a doctor.
Strong communication and teamwork skills were vital in this job, both within your own team, and also with the receiving hospital, fire service, police and voluntary rescue services. I also had the opportunity to develop my own resourcefulness through independent and remote practice, often in highly stressful situations. Support and advice was always available over the phone or radio, but as the medic on the ground, you learn to deal with the task in hand in the most efficient and effective manner.
There was great emphasis on safety. Briefings at the beginning of each shift identified and discussed any potential dangers or issues, such as fatigue management, illness or injury, personnel and equipment weights, weather, tides and fuel. There were strict flight safety checks, winch checks and medical operation procedures had to be followed.
Debriefings routinely followed every mission to discuss both problems and successes of the job. This was of particular value when there had been a deterioration or death of a patient. In my previous experience, briefing and debriefing in the hospital is something that is often reserved for critical incidents. There is, however, always something we can learn from every clinical case, no matter how routine. The introduction of the ‘surgical pause’ in the last few years is starting to address these issues but there is still more we can learn from the aviation and emergency services’ briefings and safety checks.
The work
While the work was challenging and at times very exciting, the reality of retrieval medicine involves long and antisocial hours. Shifts were a minimum of 12 hours, and there were many night and weekend duties. It wasn’t uncommon to be delayed if a 6-hour job came in 30 minutes before the end of your shift. There could be long periods of time spent at the base waiting for a job to be called in or on a “dead leg” of a retrieval job. Many of the jobs are routine inter-hospital transfers of critical care patients around Sydney by road ambulance, rather than exciting helicopter missions.
I learned so much from my time with Careflight, both in terms of clinical and non-clinical skills. The opportunity to practice independently in remote and often hostile environments with limited resources, equipment and medical back up has definitely enhanced my ability to deal with highly stressful and emergent clinical situations.
It also provided a great opportunity to travel and explore New South Wales and more distant parts of Australia whilst on a working contract. The appeal of being on-call from Bondi beach was a big plus!
In all, working at Careflight was one of the best experiences of my life. Who could resist flying over the beaches with the helicopter doors wide open and looking out of your “office” window over the Sydney Opera House and Harbour Bridge?
The details
Careflight is a charity providing rescue and retrieval services in Australia, carrying out over 3000 missions per year. They provide a high standard of rapid response critical care to the ill and injured using helicopters, fixed wing aircraft and road ambulances. It has its own rapid response helicopter based in Sydney, and Careflight provides 50% of the doctors to the New South Wales (NSW) Ambulance Service, has international air ambulance bases in Cairns, Darwin and Perth and has recently been engaged to provide all medical retrieval and rescue in the Northern Territories. Jo worked with them from July 2010 – January 2011.
Website / www.careflight.org
Intakes / 4 times a year – January, April, July, October
Terms / 6 month (minimum), 9 month, 12 month, longer
Accreditation / 6 months college accreditation for registrar training in anaesthesia, emergency medicine or ICU
Requirements / Primary Examination in Anaesthesia, Emergency Medicine or Intensive Care Medicine; Completion of EMST, ATLS or equivalent; Physical Fitness; Ability to work at heights and in water.
