Taking critical care treatment to the scene

In our early years, we focussed on maximising the helicopter’s speed to benefit patients by rapidly delivering experienced paramedics to the patient and quickly transporting them to the hospital, where most of the life-saving treatment was delivered. Nigel Hare looks at how Devon Air Ambulance’s approach has changed in recent years in order to provide more positive outcomes.

Delivering a patient to a hospital that can provide definitive care is just as important today as it was over 30 years ago when our service started, however, equally as important today is bringing advanced life-saving treatment and interventions to the scene, that traditionally are only given in hospitals.

Over the years, our operation has developed. Our doctors and paramedics are now employed by us, which alongside being registered with the Care Quality Commission to deliver our service independently, provides the foundations needed to focus their training and education specifically to meet the needs of our patients.

About half the patients we help have sustained traumatic injuries, while the other half suffer the effects of a lifethreatening medical condition. This means our doctors and paramedics must be multi-specialists; able to deliver high-quality care to an elderly patient suffering a cardiac arrest one moment, whilst providing treatment to a child involved in a road traffic collision the next.

We continuously reflect on our patients’ circumstances, the care we provided to them, and the experience and outcomes they share with us. This enables our team to operate safely and effectively as a team, or while working independently at an incident where they may need to separate to treat multiple patients or when responding alone in one of our Critical Care Cars.

In this edition of Helipad, I thought I would share some of the life-saving treatments and interventions we can now provide, whilst at the scene with the patient.

Medicines we carry

We carry a greater range of medicines which means that not only are we able to help relieve a patient’s suffering where standard medicines have not had the desired effect, but we can undertake the treatment needed to stabilise them quicker, reducing the impact of their injuries and the time it takes to get them to hospital.

Where patients are in such severe pain that treating them is excruciating, or where their medical condition makes it challenging to deliver the care the patient needs, we can administer medication to sedate the patient.

We also carry medicines to help treat other critical conditions such as reducing the internal pressure within a patient’s head if they have sustained a traumatic brain injury, improving the ability for a child to breath when suffering a life-threatening asthma attack, or stabilising a patient during pregnancy when suffering from eclampsia or pre-eclampsia; both life-threatening conditions for mother and baby.

All the above, our clinicians can administer even when they are treating a patient alone. The same is true for some of the surgical procedures we perform such as creating a temporary opening in a patient’s throat through to their windpipe (trachea) to allow them to breath if their airway is compromised, and creating a small hole in the patient’s chest if they are suffering from a collapsed lung (tension pneumothorax), to help reinflate it again.

However, there are some interventions for which the complexity means we deliver them only as a team of one doctor and at least one paramedic:

A Surgical Hysterotomy (not to be confused with a Hysterectomy) is a procedure similar to a caesarean section, but delivered in an emergency situation to deliver a baby when the mother has a sustained cardiac arrest and not responding to resuscitation attempts. It provides the best opportunity for a successful outcome for both the mother and the baby.

A Thoracotomy is often described in the media, for good reason, as ‘open heart surgery’. It is an emergency procedure we undertake when someone’s heart has stopped pumping blood associated with a traumatic injury to the chest, and we suspect that the heart or one of the major blood vessels connected to it has been damaged. By accessing the heart through the chest wall, any small wounds/holes can be sutured or clipped together to help restore circulation. If needed, it is also possible to manually compress the heart to circulate blood to the brain and other vital organs.

Pre-Hospital Emergency Anaesthesia (PHEA), is a complex and time-critical procedure to deliver the emergency induction of general anaesthesia in the pre-hospital environment. On average, we undertake this procedure at least once a week when a patient is critically ill and, amongst other things, requires our team to secure their airway. Although similar in principle to anaesthesia delivered in a hospital, because it is undertaken in an emergency situation, the patient hasn’t been ‘nil by mouth’ in advance and the well-equipped, lit and heated hospital room is instead a bedroom, someone’s front garden or even the roadside or pavement in the pouring rain.

The safe and effective delivery of these advanced treatments by the Devon Air Ambulance team requires a significant commitment to ongoing education, training and regular patient treatment simulation. Your continued support provides not only our Air Ambulance helicopters, Critical Care Cars, doctors and paramedics, but also the means for us to provide the ongoing education and training needed to ensure that when someone has time-critical needs, we are ready to help give them the best chance of a successful outcome.

Training

Nigel Hare Operations Director & CQC Registered Manager

Air Ambulance in 1997 as an Aircrew Paramedic

Thank you!