From calling 999 to our paramedics arriving...

Here our critical care paramedic Paul Rock (Rocky) talks through how the aircrew at Wiltshire Air Ambulance operate from the moment a 999 call is made.

When Wiltshire Air Ambulance is needed

We are called if a patient needs our clinical skills in critical care and/or the additional drugs and specialist medical equipment we carry. 

When a patient is critically ill or injured, time is of the essence. The speed of our aircraft can transport us to the scene quickly to treat a patient and also to airlift the patient to hospital to receive further treatment.

Critical care paramedic Paul Rock

Also, Wiltshire is a large rural county with places that are inaccessible by land ambulances, so our aircraft is pivotal in providing a speedy response.

If the aircraft is unable to fly due to weather restrictions or the incident would be quicker to mobilise to by road we will travel in our Rapid Response Vehicles (cars), which have the same medical equipment that is onboard the aircraft.

Being ‘tasked’ to an incident

Wiltshire Air Ambulance is dispatched to emergencies by the HEMS (Helicopter Emergency Medical Service) desk in Exeter, which is run by the South Western Ambulance Service NHS Foundation Trust (SWASfT). The HEMS desk is funded by the five air ambulance charities in the South West of England including Wiltshire Air Ambulance.

The dispatchers on the HEMS desk monitor all 999 calls to the ambulance service in the South West and identify incidents where an air ambulance, including Wiltshire, is needed. The dispatchers listen into calls, phone back callers and get updates from ambulance crews on scene.

We can also be requested to attend an incident by the crew of a land ambulance or a Rapid Response Vehicle who are on scene treating a patient. They may need the additional skills and drugs that we have or are a long way from a Major Trauma Centre where the patient needs to go and our aircraft would enable the patient to get there quicker.

In addition we can self-task to an incident. Our paramedics see all the 999 incidents being logged on SWASfTs computer system and can also identify emergencies where we might be needed. The duty crew will liaise with the HEMS desk to agree that we will attend an incident.

Getting to the scene

We get the details of the incident, where it is and the grid reference for the mapping system. 

The pilot will go out to the aircraft on the helipad to start it up while the paramedics will plot the distance, duration and note any obstructions of the aviation map before going to the aircraft with a paper map and an iPad.

Before we lift off we will have an idea of where we will be landing but often we make the decision when we are overhead and can see the terrain.

When we fly at night our pre-flight planning is more in depth. The area of land required for landings is double the size of that for day flying so we want to identify a landing site before we lift off.  Once we have decided the flight path and landing site, we attach Night Vision Goggles (NVGs) to our flying helmets.

Preparing to lift off

Every Wiltshire Air Ambulance paramedic is qualified as a Technical Crew Member (TCM). They complete a HEMS Technical Crew Member course which covers how the aircraft functions, aircraft safety, emergency procedures, marshalling the aircraft, meteorology, geography and suitable landing sites.

When we get in the aircraft we do pre-take off flight checks, including ensuring all the kit is secured and strapped. One paramedic stays outside and checks all the doors and cowlings are secure before getting in.

The paramedic who sits in the front left seat in the cockpit next to the pilot assists with navigation and radio communication with the HEMS desk.

The paramedic who sits in the back of the aircraft is the clinical lead and will manage the treatment of the patient and the scene.

Lift off and en-route to the incident

After lifting off from our helipad and reaching 200 feet (500 feet at night) the paramedic in the back of the aircraft will notify the HEMS desk that we are airborne. We then discuss with the pilot where we are going, the route and anything that might conflict with the flight, for example, the obstructions that were discussed at the briefing that we had at the beginning of our shift.

En-route we will discuss what the incident is, what our plan for treating the patient is and what medical equipment we will take initially. The HEMS desk update us with any new information about the incident or the patient’s condition.

With the pilot we will discuss possible landing sites, using our mapping systems.

Landing

Two minutes prior to landing we will inform the HEMS desk that we are approaching the incident scene overhead.

We orbit the scene and look for any obstructions such as high trees, power lines, animals, people or sloping ground and when we have decided on where to land we will do a pre-landing checklist.

Most of the places we land are ad-hoc which means they haven’t been surveyed by us in advance. We have landed in farmer’s fields, school playing fields, car parks, on motorways, at golf clubs, on football pitches and many other places.

On scene

Every incident is different. The majority of incidents we attend are cardiac emergencies (22% in 2018) and RTCs (20% in 2018).

We are trained in critical care skills which means we can give advanced drugs for analgesia or sedation or carry out surgical procedures on patients who have suffered traumatic injury. We also carry blood products so we can give pre-hospital blood transfusions to critically ill or injured patients.

When deciding which hospital we convey a patient to we take into consideration which is the most appropriate hospital for their needs (which is not always the nearest hospital) and we discuss with our pilot the distance to the hospitals that we are considering.  Once we’ve decided we’ll contact the HEMS desk and the hospital to update them on the patient’s condition and our estimated time of arrival.

We convey to local trauma centres such as the Great Western in Swindon, the Royal United in Bath and Salisbury District hospitals, and to Major Trauma Centres (MTCs) which have teams of specialist clinicians. The main MTCs we convey patients to are Southmead in Bristol, Southampton General and the John Radcliffe at Oxford.