‘FLYING doctors’ is a term that is usually associated with remote outback areas of Australia, but now the west coast of Scotland is cultivating its own breed of airborne medics.
Over the last few decades medical consultants have become more specialised in what they do and their skills have become more concentrated in city hospitals.
This has led to the problem of getting critically-ill patients quickly from remote and rural areas to hospitals which are better equipped to treat them.
While the Scottish Ambulance Service has long operated helicopter and fixed wing planes to transfer patients, it has become clear over the years that sometimes immediate treatment is needed before a patient can even be moved to a city hospital.
For three years a number of emergency medicine consultants volunteered their time to operate a small ‘cost neutral’ emergency helicopter retrieval scheme in Argyll and Clyde to show the powers-that-be how it could work.
This set the scene for a Scottish executive fully-funded, independently-assessed pilot scheme being set up for 18 months on the west coast, from Stranraer to Stornoway, including three rural general hospitals, 13 community hospitals and numerous isolated practices.
Based on the outcome of this pilot, the service could go national.
Dr Alistair Newton, one of the team of 15 consultants, including those trained in emergency medicine, intensive care and anaesthetics, explained: ‘The idea is to take a critical care team – equipment and doctors with the expertise, to the places that don’t necessarily have it.
‘Or in rural general hospitals, like Oban and the Western Isles, where they have more facilities, we are providing transport for patients to take them back to city hospitals.’
Already in the first three months of service, since June this year, more than 60 seriously ill and injured patients have been retrieved from rural health care units, with the team providing advice on the assessment, treatment and safe transfer of another 41 patients.
Two thirds of those retrieved were medical emergencies and one third had life-threatening injuries.
Ten patients have been retrieved from Oban, Tiree and Lochgilphead since June.
On one occasion, the team was called to Islay where a woman was unconscious with meningitis.
Treat
Over the phone, the consultant gave the GP on the island advice on how to initially treat the patient before the consultant was flown to Islay by a royal navy search and rescue helicopter.
In the island hospital, the consultant was able to anaesthetise the patient and insert catheters into an artery on her wrist and into her heart to help improve her blood pressure before she was flown, with a ventilator, to an intensive care bed in Glasgow.
The woman made a full recovery and was able to be discharged from hospital within a week.
The retrieval service is not there to replace existing local services but to work with them to make the health service more effective when dealing with life-threatening emergencies.
The team will fly to a community hospital or rural health centre where a patient will be under the care of practitioner or a paramedic. The patient will be assessed and given treatment, if necessary, to stabilise them in order to transfer them to the nearest appropriate intensive care unit.
Dr Newton said the same applied with critically-ill patients, when it comes to getting treatment as quickly as possible, as it did with trauma patients, often referred to as ‘the golden hour’.
‘It is all about getting the team with the skills and equipment to the patients as quickly as possible,’ he said.
‘We have got everything we need ready to go; we are set up to deal with 999 calls from the ambulance or retrieval – we just grab the bags and go.’
One member of the team is on call at all times based at the Scottish Ambulance Service’s helipad on the Clyde but there is a team of consultants and registrars that can also be called upon for their skills if needed and they usually travel with the paramedic teams in the helicopter, the fixed-wing aircraft or royal navy Sea King helicopter.
The average time to have a full team in the air is 49 minutes, with the average time between receiving the call and delivering the patient to an urban hospital down to four hours.
‘Some of the feed-back we have had from rural practitioners that we have gone out to has been fantastic,’ said Dr Newton.
‘Generally it has been well-supported at all levels across the health boards and the Scottish executive’s health department.
Dr Newton, who has moved up from London to take up a post with EMRS, added: ‘A lot of the other consultants were involved in the Argyll and Clyde limited pilot, so they are delighted that it has been extended to a formal 18-month pilot.’
Dr Newton worked in London’s Helicopter Emergency Medical Service (HEMS) full time for six months and as an honorary consultant for three years, but first worked in a small retrieval team when in Sydney, Australia, the home of the original flying doctors.
