Heroes in the Hover

Coming Together
The helicopter was from one of the independent emergency medical service (EMS) providers such as Careflight, Westpac Life Saver and Childflight. Today, the structure is more centralised and while these saviours still survive in some form, most EMS helicopters fall under the management of the NSW Ambulance Service.

The headquarters of the state’s Helicopter Retrieval Services is based at Bankstown Airport and managed by Superintendent Garry Sinclair. Before my visit to the Bankstown base, the previous time I had seen Garry was 25 years ago when we attended an emergency together.

At the time he was about to become one of the first special casualty access team paramedics, called upon to attend the most critical rescue operations and often winched in by helicopter. As such, Garry has been involved with EMS helicopter operations for a substantial period and has seen the service transform tremendously.

Today, 14 helicopters cover the state’s coast, roads and skies. The ambulance service doesn’t own any helicopters but contracts specialised pilots and machines from companies such as international provider CHC Helicopters. In CHC’s case it’s a 10-year contract to provide helicopters and crew around the clock, 365 days a year. For anyone with experience in the aviation field this is no small feat,given the need for maintenance and modifications ongoing and unforeseen.

In the greater Sydney region of Wollongong, Bankstown and Orange alone, the missions tally is 1,500 a year. At any one time there are four operational helicopters with one spare to cover maintenance requirements and together these machines account for about 2,600 hours of flying, with 300 of these hours allocated for training.

The missions flown are as varied as the situations people find themselves in. There are search- and-rescue sorties, cliff and canyon access, ‘000’ responses and numerous specialist medical missions. Of the latter, an especially interesting retrieval involves heart-lung bypass patients.

During the 2009 flu pandemic, lives were lost as the patients’ lungs reached the point where they could no longer support themselves. The disease was non-discriminatory in its victims and lives young and old were liable to be struck down unless they could receive appropriate treatment before their oxygen levels reached terminally low levels.

Such treatment was only to be found in the heart-lung bypass machines in capital cities until engineering ingenuity and the EMS helicopters were able to take a portable heart-lung device to the patient. As a direct consequence numerous lives were saved — although such marvellous efforts often fail to make the headlines.

Taking care

Fundamentally, intensive patient care involves the management of our citizens when they’re at their most vulnerable. They are frequently unconscious and dependent upon others for basic tasks such as breathing. Consequently, unlike the average discerning airline passenger, they have no choice in who transports them and how this is achieved. With this backdrop, the philosophy of organisations such as the NSW Ambulance Service is to offer the very best of care and equipment on offer to all of its patients.

The reach of the road ambulance can extend only so far in a timely manner — beyond this the service takes to the air. The helicopter generally gives way to fixed-wing transport for longer sectors but still retains the unique ability to access remote and unprepared locations. The helicopter also allows direct transfer of the patient from the scene to the hospital with intensive care en route, reducing the number of times a patient needs to be moved.

The Sydney region has three AgustaWestland AW139 helicopters and a Eurocopter EC145. The AW139 is bigger, cruises at 140k with a 300nm range and can lift off vertically at its maximum weight of 6,400kg. CHC is the biggest operator of the AW139 so not only knows the helicopter intimately but has significant access to Agusta in maintenance support. The EC145 manages about two miles a minute, has a range of 270 nautical miles and while smaller has equally impressive internal equipment.

Both types have a specialised fitout for almost every emergency scenario and each seems specifically designed for the operation using the lightest, strongest materials, as equipment and personnel makes weight critical in the helicopter’s operation. So when the AW139 sets to the skies out of Bankstown it’s not unusual to see a 3,500 feet per minute climb announced on the vertical speed indicator.

The cabin is decked out in a standardised configuration so a paramedic can operate in any of the AW139s with absolute familiarity. Similarly, the aircraft can switch bases if needed. From equipment locations to the critical winch located outside the helicopters main door, there is a specific design. This standardisation in equipment, protocols and procedures is one of the benefits taking root as a result of centralised NSW Ambulance Service management.

In the cockpit, the scene is equally impressive: full Honeywell Primus Epic EFIS instrument panel and flight management computers, power-line detectors, TCAS and weather radar. These fully IFR helicopters also are compatible with the use of night vision goggles.
The pilots who fly in these challenging roles all hold the AW139 in very high regard — and they’ re all highly qualified, rated on both Augusta types and at the top of their field.

To maintain a 100 per cent service delivery, maintenance is ongoing with no spare minute being wasted to keep the aircraft in peak condition. CHC also recognises the significance of these machines. When major maintenance checks fall due they assign about 20 staff to strip the aircraft back to bare components and achieve in three to four weeks what would take a smaller team three months.

From the ground up it is an impressive operation, well organised and well equipped. But as we all know, even with the best hardware the critical factor is often the human element.On this, the state’s Helicopter Retrieval Services is especially well prepared.

Critical Care Crew
The flight crew on any given helicopter consists of the pilot, a paramedic crewman and a specialist trained doctor. The pilots are employed by CHC, the paramedics by the NSW Ambulance service and the doctors are experienced individuals trained in retrieval. Although from different professional backgrounds the key players operate cohesively with each respecting the vital role the others play in achieving a successful outcome. But such high-quality teamwork and expertise doesn’t happen magically.

To start with, all crew members are highly qualified in their own fields before joining. The doctors are highly skilled consultant specialists, called upon to perform significant surgical procedures in the cabin of the helicopter that many doctors would be unqualified to undertake in the confines of a hospital.

Also in the cabin there are special casualty access team paramedics who have seen all manner of rescues and retrievals — Chris Wilkinson was in attendance when Stuart Diver was trapped beneath the rubble at Thredbo in 1997. Lachlan Slatyer is typical of the pilots, with a military background that spans operations in East Timor to military check and training and even a secondment from the Army to the NSW Police Service during the 2000 Olympic Games.

Much of the crews’ success can be credited not only to their experience but also to their ongoing training and review. For the 120 winch missions each year to rescue a rock fisherman or airlift a critically ill accident victim there are 500 training missions. There are water drills, night operations, regular tailored helicopter underwater escape training for all crews and ongoing practice on their clinical skills and protocols.

Barely a week passes for each crew member when there isn’t some training exercise or examination and as Garry Sinclair highlights: “We aim to leak sweat, not blood.” On top of the training there is a daily review of the cases from the preceding day and full case reviews, including patient progress, every two weeks.

These reviews result in a significant database of statistics and knowledge in emergency care. Overseas, rescue services often are split into areas of specialty such as search-and-rescue, coastguard or mountain rescue. In Australia, our emergency crews are multi-skilled, attending all manner of rescues, and have to be trained accordingly.

In conjunction with the data that has been accumulated, the first-hand experience of the crews is a valuable commodity. So much so that organisations around the world are keen to source information from the operation, readily offered by the NSW Ambulance Service in a truly collegiate manner.

Heroes in the Hover
When I first walked into the Helicopter Retrieval Services base at Bankstown Airport, it was initially like an old school reunion as I met familiar faces from my own days in the NSW Ambulance Service. However, it was not long before the renewed friendships gave way to an overwhelming sense of focus on the part of the pilots, doctors and crewmen whom I encountered.

From paramedic to superintendent there is a wealth of operational experience and mutual understanding of the role. Yet there’s something more — a real sense of making a difference and achieving a successful outcome despite what the elements can throw at a crew.

These individuals operate at an elite level yet don’t receive the accolades and rewards they deserve when compared with the likes of high profile sportsmen. But these crew members also are extremely fit, highly skilled and trained to the highest level and often risk their own lives to help others on dark, wet nights when w’re curled up in our beds.

And when we sit comfortably in front of our TVs watching the news, they’re the anonymous, helmeted forms in the background, hanging from a winch or holding station in a helicopter perilously close to a rock ledge.

Like all of us, I sincerely hope I never find myself in need of their help. But should I find myself again on a country roadside in the midst of an emergency, I will listen intently once again for the thumping of the rotor blades that signal the arrival of these heroes in the hover.