What attracted you to the role of Medical Director with LAA?
In 2008, I came to London for a six-month secondment with LAA, which at the time was one of the very few places in the UK where as a doctor you could work full-time in pre-hospital care, and be properly trained. I look back on those six months as being one of the most positive experiences of my professional life. Not only did I make some amazing friends, but I was also trained, supported and pushed to achieve my very best. I have continued to be involved with the service in various ways since then and remain one of the duty consultants on the service.
LAA has the privilege of serving an amazing city and we attend a case mix containing very seriously injured patients, who we attend very early after injury. I think this gives us the opportunity to make the greatest possible impact in terms of saving lives. Being able to help shape the clinical strategy of the organisation and work with such a talented and committed team to deliver it was an opportunity I would not consider passing up.
How does your in-hospital experience as a consultant in intensive care medicine at King’s College Hospital set you up for working in pre-hospital medicine on the streets of London?
All of the consultants at LAA also have roles in hospital-based medicine, across a range of specialties. This is important because part of what we bring to scene is an understanding of the subsequent in-hospital care a patient will receive and hence what would be appropriate at scene.
In the announcement of you taking on the new role with LAA, you mentioned ‘exciting new procedures coming down the track that have the potential to be transformative for our patients’. Can you tell us any more about these new procedures?
LAA performed the first pre-hospital REBOA procedure and we have been using this technique for patients with life-threatening bleeding from pelvic fractures. We will soon be conducting a study of using this technique for bleeding from abdominal organs. We are also collaborating on a study of the feasibility of pre-hospital ECMO for patients in cardiac arrest.
LAA pilots have to negotiate one of the most crowded urban landscapes in the world to deliver doctors to the scene of an emergency; what does it take to be part of the flight crew for LAA?
We are a two-pilot operation, so doctors and paramedics fly as medical passengers. All our team get training from the pilots and fire crew to ensure we work well in that role. We place a lot of emphasis on involving the whole team in debriefs of each mission, which includes analysis of the enplaning and deplaning phases.
What CRM training do flight and medical crew undergo together?
We welcome new doctors and paramedics to the service frequently – on average a new doctor and paramedic every month. We cover human factors both in relation to aviation issues, but also in relation to how we perform during complex high-tempo clinical interventions – we have learnt a huge amount over the years from our pilots and we are also evolving our own very specific training approach to human factors in medicine.
The mental wellbeing of first responders is something that AirMed&Rescue has reported on many times, and is of great importance to our readers. What does LAA do to ensure its medical crew is given the opportunity to have a mental wellbeing health check at regular intervals, given the traumatic nature of the injuries they attend?
We have a range of processes to address this issue, because everyone is different and will have different needs. Despite the very high-profile nature of the events we attend, we find that for most healthcare professionals, what they need is supportive debriefing from someone within the service and hence really understands the scenario.
We hold rapid case review meetings every day to cover the last 24 hours, and more in-depth meetings twice a week. We’re a strong team and everyone looks out for each other. We also have access to formal psychological support and to a confidential employee support line.
What piece of kit can you make use of in a hospital setting that you most wish you could take onboard the helicopter?
At the moment, we do use ultrasound for procedures such as vascular access, but we plan to get more advanced machines that will allow us to do echocardiography (heart scans) and other ultrasound scan to help us refine our treatment of patients who are very unstable after trauma.