FIRST PERSON
human factor L
The
Captain Andy Rooney, a pilot with the Helicopter Emergency Medical Services, describes a “day in the life” – and champions the value of team resource management (TRM) skills in medicine
IKE most people associated with the emergency services I can never really anticipate what the day ahead has in store. All I can do is turn up in the morning and try to prepare myself as best as I can and hope that when I leave work in the evening the preparations have been up to the challenges I have faced during the shiſt.
And so it is one dull spring morning on our HEMS (Helicopter Emergency Medical Services) helicopter. Kit check complete, aircraſt serviceable, crew qualifications in date and the weather checked. Oh yes the weather, not a great day with worse on the way. Well it is spring, aſter all.
It’s mid-morning when the phone rings. We are tasked to a car-vs-van RTA (road traffic accident), some 40 miles to the northwest, with no other details. As soon as we liſt we encounter the deteriorating weather conditions forecast earlier. Te issue is the lowering cloud base. We are heading towards a mountainous area and so the direct route is not an option. We soon encounter worse than expected weather and find ourselves struggling to find a route through the valleys. It looks unlikely we will be able to make it to the incident but our deliberations are interrupted by a radio call from ambulance control. Fully expecting to receive a stand-down the news is not good. Apparently there are two fatalities, a woman and a child and CPR is on-going on another child. Te nearest road crew is still 15 minutes away.
Absolute limits
Te nature of the casualty should never be a factor in how we operate the aircraſt. However, it is hard not to feel pressured by the fact a young child clearly desperately needs medical intervention. We fly on the absolute limits of our rules while constantly updating what our escape plan would be. We finally clear the worst of the weather, in no small part due to the brilliant map reading and navigation skills of
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the paramedic in the front of the aircraſt, and it looks like we will now make it to the incident. We discuss several plans of action for when we arrive. On arrival however, the first problem is finding a place to land. Te incident is on a road running through a forest and landing on the road is the only option. However, traffic is blocking the road on both sides of the incident. Only by communicating through the police helicopter that had just arrived are we able to get the police on the ground to move the traffic and create a large enough space for us to land. As soon as the aircraſt is on the ground both paramedics deplane and I remain rotors running. Tey soon return with a small child on a stretcher. On entering the aircraſt and connecting to the intercom system the first thing I hear is “she’s not breathing” and the second is “we’re not strapping in, GO”. Te few minutes I had spent on the ground had been enough to tell me I did not have enough fuel to return the way I had come. Te only option is to climb up into cloud and route to an airport near the hospital and carry out an instrument approach. Fuel is still going to be tight but the air traffic controllers clear all other traffic out of the way and give us priority. Having talked to ambulance control we are met by a medical team as we land at base. Te decision is taken to carry out an RSI (rapid sequence intubation) in our hangar before onward transport to the nearby children’s hospital. At this point the prognosis does not look good. We carry out a hot debrief involving pilots, paramedics and police from both helicopters and doctors from the medical team. In the end we agree that given all of the circumstances on the day this child has just been given the very best of chances.
Managing the team
In fact a few days later we find out the child is making a remarkable recovery. What went right for us?
SUMMONS
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