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When lives are at stake: decision making is critical during rotary wing medevac operations

Babcock Australasia’s Emergency Medical Service Pilot Shaun Willson discusses how operational decision making between the medical team and aircrew during a complex medevac are critical when a patient’s life is at stake.

Experience shows how a simple medevac mission can quickly become far more challenging.

In-the-moment decisions are critical and communication between the aircrew and medical team is vital when someone’s life is at stake.

In my job as a Babcock Australasia Emergency Medical Service Pilot, our team is faced with life-saving work and split-second decisions every day.

I’ll share with you a recent aeromedical trauma experience showing how difficult decisions are made in the moment and above all, how teamwork is essential in tough conditions.

Setting the scene, there were three different coloured uniforms in the aircraft that night; the Babcock aircrew in blue, doctor in red, special ops paramedics in green. But that night we were all one team.

The nature of aeromedical retrieval operations means there is often minimal planning time due to the need to get airborne as soon as possible. Before a call comes in, we constantly build situational awareness of any conditions that can affect our operations.

Arriving on shift at 5:30pm, a weather check revealed strong northerly winds, forecast thunderstorms and high ambient temperatures in the operating area.

Last light was around 8:45pm, so we knew we had a three-hour window of daylight before transitioning into night operations.

At 7:40pm, we received a tasking around 150 kilometres from Adelaide; a single vehicle accident with multiple patients. A weather update determined we could achieve the task and get back to Adelaide ahead of the forecasted thunderstorms.

As we departed Adelaide airport at 7:53pm, I knew that I had two special ops paramedics and one doctor on board the heavily modified Bell 412EP ‘flying ambulance’.

It was time to build rapport and trust between everyone on board. After some quick introductions I asked the age-old question, “What have we got?”

As the medical team sought a sit-rep (situation report), thunderstorms began developing to the west and we hit stronger than forecasted headwinds, meaning increased transit time to the scene.

The sit-rep confirmed multiple patients, one deceased and two trapped with critical injuries. While the aircraft could be configured to carry two patients, aircraft performance considerations, high ambient temperatures and unknown Helicopter Landing Site (HLS) meant we couldn’t commit to a course of action until we had more information.

We devised plans A, B and C — land and take off from the incident site, drop the medical team at the site and reposition, or land at a nearby oval with the medical team to be transported by road to the scene to return with the patients.

Arriving on scene at 8:31pm, ‘time tension’ became a factor; the need to get the medical team on ground as quickly as possible versus maintaining the safety of the aircraft and crew.  Light was fading fast and dust at the scene meant a potential brownout (where dust gets swept up in the rotor downwash and obscures the pilot’s vision).

I assessed conditions before landing and opted for a dummy approach to assess the environmental conditions and HLS surface, apologetically advising the crew.

The crew said to me: “No worries, Shaun, take your time, do what you have to do”. Their response removed any internal pressure that I was feeling about extending the time airborne.

Once on the ground and shutdown at 8:38pm, the medical team faced a chaotic and confronting scene with police, SES, volunteer firefighters, and ambulance crews on scene. A patient had unfortunately passed away shortly after being extricated and another was still trapped.

Whilst we were on scene, the forecast for the Adelaide area was updated and we were likely to encounter thunderstorms during our return leg, with an associated requirement to carry additional fuel for the poor weather.  As time on scene extended to hours, we continued reassessing the weather, planned multiple contingencies, and continually reviewed our options with the medical team.

I recalculated fuel. Fortunately, we had above the minimum required to legally depart for Adelaide, however we now faced the possibility of thunderstorms.

“Never fly an aircraft somewhere that you haven’t already flown to in your mind,” I reminded myself.

I discussed options with the crew; we needed to stabilise the patient and be on our way before storms either grounded us at the scene, forced us to land on the way back or delayed our landing at the Royal Adelaide Hospital.

Finally departing at 10:25pm, we conducted a low-level return using NVIS (night vision imaging system) to remain clear of cloud and in visual contact with the ground.

Continual updates passed between the medical team, aircrew and the Emergency Operations Centre as the situation changed.

Diverting east to avoid storms would ensure the aircraft’s safety but delay the patient’s arrival at the Royal Adelaide Hospital, while diverting to Lyell McEwen Hospital in northeastern Adelaide was also an option.

Fortunately, minimal manoeuvring was required, and we landed at Royal Adelaide Hospital Helipad at 10:56pm and handed over the patient to the medical team waiting on the ground.

We held a ‘hot debrief’ on the helipad to discuss the technical aspects of the job, review our weather decisions and check in with each other after the confronting scene we had faced. I consider this debrief a vital part of the mission process in aeromedical operations.

During a task, aircrew need to make numerous operational decisions to ensure the safety of the aircraft and crew, especially when faced with adverse weather or complex incident scenes.

These decisions need to be communicated appropriately to the medical crew to ensure they are aware of any operational limitations that may affect the mission and ultimately, the provision of care to the patient.

These tasks can be stressful as a patient’s life is often at stake and pre-planning, rapid decision making and open communication between all on board make all the difference when stress is elevated, and emotions are running high.

As aeromedical crews, it is vital that we support each other. The psychological benefits of a supportive team can’t be overestimated.

South Australian State Rescue Helicopter Service (SRHS)

First published on Australian Aviation > Decision making is critical during rotary wing medevac operations

Shaun Willson is an EMS Pilot at Babcock Australia. Shaun served in the Australian Army Aviation Corps for 17 years as a helicopter pilot in various roles and was deployed numerous times to Bougainville and to Banda Aceh following the 2004 Boxing Day Tsunami.

After leaving the Army, Shaun joined Australian Helicopters (now Babcock) as a pilot on the South Australian State Rescue Helicopter Service (SRHS) contract. In 2017 Shaun made a career change and joined the South Australian Metropolitan Fire Service as a full-time firefighter. He continues to fly with Babcock in a part-time capacity as a pilot on the SRHS contract.

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