Lia’s Wings is a UK-based air ambulance charity that specializes in the long-distance domestic and international transport of pediatric and neonatal patients. However, unlike other charities in the sector, Lia’s Wings doesn’t operate its own fleet of aircraft. Instead, ‘the provision of the aviation and clinical aspects of the service are shared across a number of organizations, with core charity staff providing support and coordination’, explained Dr Lee Collier, Medical Advisor for the organization.
“This lean operational model is further reflected in the day-to-day running of the charity. There are no charity premises– rather, staff work from home and meet together once a week in conference facilities donated by a key partner. We are proud that 79 per cent of donations go directly to providing our flight service,” Collier declared.
Rather than operating under a broker arrangement, in which quotes from multiple operators are sought out for each mission, Lia’s Wings operates through collaborative partnerships with flight operators and NHS teams – with ‘preferred provider status’ being reviewed on an annual basis.
Collaboration ‘includes involvement in clinical training days and monthly governance meetings where all partners … discuss and debrief recent missions’, explained Collier, who added that these ‘close relationships enable the charity to ensure a great experience for the families, over and above a medically safe transfer’.
Lia’s Wings’ current preferred provider is the Bristol-based Capital Air Ambulance – which hosts the charity’s flight incubator and consumables. The two organizations also share some personnel – in addition to being a Medical Advisor for Lia's Wings, Dr Collier also serves as a Flight Doctor and Neonatal Clinical Lead for Capital.
Capital operates two Beechcraft King Air 200 aircraft in permanent air ambulance configuration, ‘and has standing arrangements to access a fleet of Learjet 35, 45 and 55 planes for longer range when needed’, explained Collier.
A focus on fixed-wing
Lia’s Wings and its operators are unusual by UK air ambulance standards due to their focus on providing fixed-wing air ambulance services – most aeromedical charities focus on providing regional helicopter emergency medical services (HEMS), rather than long-distance transfers. This preference, argued Collier, was due in part to the medical specialties often required by young patients.
“I think flight services, and especially fixed-wing services, are more commonly needed for children because specialist services tend to be focused around certain hospitals such as Great Ormond Street in London, Alder Hey in Liverpool, and so on,” he explained. Consequently: “This is less about rapid response, and more about the distance needed to access a unique service on a planned date.”
This is less about rapid response, and more about the distance needed to access a unique service on a planned date
Higher specialization, higher stress
A key difference between the transfer of standard adult patients and the pediatric operations that Lia’s Wings and its operator partners conduct is the increased levels of specialization required from staff to perform a pediatric transfer, as well as the higher emotional stress. “There can be challenges in putting teams together when staff also have a busy NHS career. The care of a sick child can also be very emotional, and teams may need debrief and extra time to process between missions,” Collier explained.
He noted that one challenge in meeting the needs of neonatal patients is the ‘huge variation’ in specific equipment required, adding that it is a common sentiment that ‘neonatal teams carry 100kg of equipment for 2kg of patient’. This variation is, in part, driven by differences in patient height, weight and other physiology, even among children of the same age.
For example, when dealing with neonates, Lia’s Wings’ preferred operator Capital Air Ambulance will typically carry a wide range of single use consumables, ‘including two different sizes of pulse oximetry probes; five different sizes of blood pressure cuffs; seven sizes of continuous positive airway pressure (CPAP) nasal prongs; and eight sizes of hat to secure the CPAP’. This demand is alleviated partly by the charity’s partnership with the UK National Health Service (NHS), which offers the charity access to its medical supply chain.
Another key challenge when dealing with young patients is thermoregulation – Collier explained that there is ‘very strong evidence linking hypothermia with poor long-term outcomes for premature babies’, making a ‘well maintained and modern heated flight incubator essential’, alongside the continuous monitoring of patient temperatures.
Close monitoring of vital signs and experienced clinical assessment is always important when dealing with patients – but Collier concluded that this is especially so with neonatal patients, who ‘can’t express that they are in pain’.
Taking care of the parents
Once the details of the operation are arranged, Lia’s Wings typically hands over clinical governance to the flight operator – with the charity then focusing on maintaining links with the parents, to offer support before and after the flight.
Collier explained that while involving the patient’s next of kin, or another companion, is always important when conducting any medical transfer, ‘for children, this is even more vital’.
For many families, movement across the country or repatriation back to the UK from abroad, is both a very welcome but also very stressful experience
“The charity sees the commissioning of a flight as the start of a partnership with the patient’s parents and family to provide ongoing support,” explained Collier. “For many families, movement across the country or repatriation back to the UK from abroad, is both a very welcome but also very stressful experience. By the day of a transfer, we have built a good rapport with the parents, and when they find themselves in an unfamiliar hospital with a brand new team of health professions, that charity team are a welcome source of continuity and comfort.”
“Typically, we will have two telephone calls with the parents – one from a member of the charity’s core, non-medical staff, and one from a Flight Nurse or Doctor,” he said. “We can also arrange for parents to speak with a volunteer whose child has previously benefitted from our service, [which is] one of the advantages of the charity’s model.”
Commercial flight medical escorts are challenging
The charity can also provide commercial medical escort flights using the same model. However, Collier stated that ‘within Western Europe such flights are rarely worthwhile’.
“Most airlines will not discuss a patient in principle,” he explained. “Rather, tickets must be purchased and a medical information form (MEDIF) form submitted. This causes delay and frustration, as we try to find an airline that will accept the patient and coordinate this alongside bed availability, which is often limited. However, he added that for longer distance journeys, ‘particularly to the US, commercial flights have proven to be a safe and cost effective means of repatriation’.
Collier added that a ‘key challenge’ for neonatal patients is the lack of understanding of their needs among airline operators. “For example, one leading commercial airline will not allow premature babies to fly until they are six months past due date, regardless of medical escort,” he explained.
Bringing baby home
One complication for neonatal patients who were born outside of the country is the need for emergency travel documents
Collier explained that one complication for neonatal patients who were born outside of the country is the ‘need for emergency travel documents’. “When a baby is born prematurely while abroad – usually because the mother is on holiday or travelling for business – emergency travel documents must be applied for while the patient is outside of their home country,” he explained. “Most administrations demand a great deal of evidence of the parents’ citizenship, and documents that may not be readily accessible.”
One example, says Collier, is the possibility that officials may request photo identification of the baby – despite the fact that ‘an unobstructed photograph of the baby’s face may also be impossible if they are on respiratory support’ – and be unwilling to accept this difficulty. Lia’s Wings offers support to families facing such struggles, and has helped by writing letters to government officials in support of them.
Additionally, Collier explained that the charity encounters ‘several families each year who have travelled abroad with no insurance – or insurance that doesn’t adequately cover neonatal care and repatriation’.
“For those who do have insurance cover, there is often reluctance from medical assistance teams to approve a repatriation flight,” he continued. “This is entirely understandable when there is a perception of risk to the patient.” However, Collier argued that this direct risk needs to be weighed up against the wider risk to the patient and family, ‘in terms of poor mental health, loss of income, bonding between parents and baby, the need for siblings to return to school or parents to return to work, etc’.
“All of these can have long-term consequences for the social and emotional development of the child when they are discharged home,” he concluded. “For premature babies, hospital care in some cases can extend to many months, and it is such a shame when a window of opportunity for a safe and stable transfer home is missed.”
A range of unique equipment
Lia’s Wings owns a range of medical equipment designed for use in pediatric missions, including a flight incubator system fitted to a LifePort cargo sled, ‘configured with an incubator, monitor, ventilator, suction and four syringe drivers’.
“The incubator is the most obvious specific equipment for neonatal patients, but other special equipment includes a humidity system for the ventilator gases and an air/oxygen blender to give blended gas for resuscitation rather than pure oxygen,” said Collier, who added that the ventilator is set up for ‘high-flow humidified oxygen, nasal CPAP and bilevel positive airway pressure (biPAP).
We carry backup devices for all essential kit including a basic pneumatic-driven ventilator, alternative pulse oximetry and chemical heat pads in case of incubator failure
“We carry backup devices for all essential kit including a basic pneumatic-driven ventilator, alternative pulse oximetry and chemical heat pads in case of incubator failure, [while] more mature babies can be carried in a BabyPod, but otherwise require the same range of equipment,” he continued, while older children may be carried on a stretcher with an age- and weight-appropriate restraints system.
Most excitingly, the charity received delivery of a new Paraid Transporter Infinate Aero custom folding trolley, capable of transporting, loading and unloading the charity’s flight incubator system into aircraft and ground ambulances.
The organization is currently looking to acquire a new ‘high-definition simulation manikin’ to support training. “We are also looking at developing a lower-dependency ‘incubator lite’ system with a BabyPod and heated mattress that can be used in tandem with the incubator,” said Collier.
Past and future
Since first registering as a charity in 2010, Lia’s Wings has developed from primarily being a ‘source of funding for flights, towards a more collaborative model … building strong relationships with flight operators and NHS teams over many years’, said Collier.
“The demand for flights has steadily increased,” he said, “which has led the charity from primarily being funded through grassroots donations – still greatly appreciated – towards building links with longer-term commercial supporters and grant-making bodies.”
Consequently, the charity has also increasingly been seen as a ‘source of expertise within the UK and further afield,’ Collier added. This, he added, was an increasing focus, with the organization taking a ‘greater role in advocacy for pediatric and neonatal patients requiring international repatriation’, and working to ‘raise awareness with expectant mothers around having suitable insurance when travelling abroad’.
“We would like to see the emergency travel documentation process in the UK streamlined with training for staff to understand the particular needs when a baby is born abroad … and we would like to see more suitable travel insurance products to meet this need,” said Collier.
In support of these changes, the charity changed its name earlier this year, from Lucy Air Ambulance for Children (Lucy AAC) to ‘Lia’s Wings’ – to honor Emilia ‘Lia’ Schoennagel, a young girl who died unexpectedly aged five in September 2022. The ‘Lucy’ of the charity’s current name is not a person – rather it stands for ‘Life-changing, Urgent Care for the Young’. The change also recognizes the support that Lia’s parents, Patrick and Melissa, have given the charity in the months since, enabling it to raise significant funds.