Flying to the rescue The RAF’s Aeromedical Evacuation Squadron treats patients in the back of an aircraft en route for the UK. Alistair Kleebauer reports
Part of the RAF’s Tactical Medical Wing (left to right): Cpl Andrew McAdams, Wg Cdr Jonothan Ball, Flt Lt Chris Wells, FS Wanda Hughes, Flt Lt Ainsley Kennett, Flt Lt Sally Homer, Sgt Holly Chambers, Sqn Ldr Peter Lax, Sgt Chris Andrews, Sgt David Bett, and Cpl Gareth Ash
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Your patient’s arm has been crushed and has about 50 staples holding it together. But the arm is starting to swell and he is now in a lot of pain. So what would you do next? All healthcare professionals are used to making clinical judgements in stressful situations, but how easy would it be to decide on a course of action in a noisy, military transport plane flying at high altitude? This is the kind of decision that Flight Lieutenant Emma Kirk, a nurse, and her colleagues in the Royal Air Force’s (RAF) Aeromedical Evacuation Squadron has to make on a regular basis when bringing back sick and injured military personnel from across the globe to receive care in the UK. Flt Lt Kirk says the solution for the soldier with the crushed arm – who she accompanied back from Canada – was simple. ‘Swelling can increase when you go up at altitude. So we had to pop a couple of staples out for him and give him some comfort. It is those kinds of things that you would not necessarily think about on the ground.’
including nurse William Pooley (see box, page 22); and provide mental health care to service personnel in crisis. An aeromedical evacuation can see a nurse caring for up to ten patients (although that figure is uncommon) on a long and tiring flight, while dealing with everything from oxygen desaturation to bleeding and pain relief. Only confident nurses, secure in their nursing skills, can deliver this kind of care, says squadron officer commanding Jonathan Vollam. ‘If you’re working in a hospital or a medical centre, there’s always someone to turn to for advice,’ says Squadron Leader Vollam. ‘But the nurses are quite autonomous when they’re working in the back of an aircraft. They have to make a lot of decisions as a nurse because they can’t get on the
‘WE DEAL WITH SITUATIONS YOU WOULD NOT NECESSARILY THINK ABOUT ON THE GROUND’ – Flt Lt Emma Kirk
War zones
SUMMARY
BARNEY NEWMAN
From its base at RAF Brize Norton in Oxfordshire, the air force’s Tactical Medical Wing (TMW) sends nurses and other healthcare professionals to help evacuate critically injured soldiers from war zones; safely bring back people infected with diseases such as Ebola, The RAF’s Tactical Medical Wing (TMW), based at Brize Norton in Oxfordshire, sends nurses and other healthcare professionals around the world to pick up sick and injured British military personnel and civilians and return them to the UK. William Pooley, the nurse who became infected with Ebola while working in Sierra Leone, was a TMW patient in August 2014. Nurses need to be highly skilled and confident to make clinical decisions in the back of an aircraft.
phone to someone – they have to make clinical decisions off their own back.’ Sqn Ldr Vollam’s office is at the Brize Norton base, a quick drive from the airfields where large C-17 Globemaster and C-130 Hercules military aircraft set off on missions. Requests to help sick or injured army, navy and RAF personnel come into an aeromedical evacuation control centre. Aeromedical Evacuation Squadron, which has around 38 nurses and medics, can also be called on to help government officials and British citizens. Staff at the centre, including two nurses, assess patients’ level of need; the aim is to get any patient requiring life-saving or limb-saving treatment to the UK in a day.
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RESPONDING TO AN EBOLA EMERGENCY Flight lieutenants Emma Vincent and Belinda Mollan had been preparing for the Ebola crisis for a couple of months when they got the call to go to Sierra Leone to pick up William Pooley. The British nurse had become infected with the Ebola virus while providing healthcare in response to the epidemic in the region. The infection control nurses – two of four at the Tactical Medical Wing (TMW) – were part of a team of 15 who accompanied Mr Pooley back to the UK. Flt Lt Vincent says: ‘It was a good experience; for both of us it was our first mission to pick up a highly infectious patient. He was generally pretty well. He was hydrating himself and eating. We were doing basic observations to make sure he was okay.’ Mr Pooley spent the flight to the UK in an air transportable isolator unit – in effect a ‘plastic bubble’ mounted on a stretcher that keeps the patient separate from the healthcare team so they are not at risk of infection. The nurses can reach into the unit through gloves that are built into it, and the air pressure system means that if there is a breach in the plastic, there is enough time for the team to fix it. The isolator units are based at Brize Norton and are jointly owned by the Department of Health and the RAF, so they can be used to bring home any British citizen with a highly infectious disease, such as Ebola, Lassa fever or Crimean-Congo haemorrhagic fever. It is likely more Britons will have to be repatriated as a result of the Ebola crisis, and the two TMW nurses are now on call at short notice to respond to further emergencies. ‘It is a national concern and we have got to make sure we have aeromed cover,’ says Flt Lt Vincent. ‘We know the epidemic will not last forever.’
Infection control nurses Flt Lts Emma Vincent and Belinda Mollan tend to a ‘casualty’ in an air transportable isolation unit
Sqn Ldr Vollam says: ‘Although excellent care is provided in the field by Defence Medical Services, the level of medical care they need usually cannot be provided where they are so we need to get them back urgently. Once they are returned to the UK the ongoing care is always provided by the NHS.’ The team will also act if someone is facing a prolonged recovery period and needs to be close to their family. A nurse and
a medic, or commonly a nurse on their own, will fly out to the injured or sick person and return with them on a military aircraft or, where appropriate, on a commercial flight. A critical care air support team, made up of two nurses (one of whom is the team leader), up to two doctors, a medic and a technician, will respond to the most urgent situations. On a cold winter’s day, under grey skies, one team is being taken through its paces in a
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Far left and left, a team from the RAF’s Aeromedical Evacuation Squadron runs through possible real-life scenarios with an interactive manikin, from boarding an aircraft to treating the patient onboard
to combat the noise of the aircraft by using headsets and microphones and they would most likely share the space with all kinds of military equipment. A fire engine or helicopter can be transported along with the patients and aeromedical team. Flt Lt Kirk says: ‘We have to work the patients around the equipment.’
Mental health nurses
training exercise at the airfields, carrying an interactive manikin patient on a stretcher from an ambulance onto a C-17 waiting on the runway. The plane won’t be taking off, but apart from that, every care is taken to create the conditions of a real emergency. The manikin is controlled remotely by instructors. It has a breathing mechanism and can ‘speak’ to the team by an instructor talking through a microphone. A monitor provides live readings
of oxygen saturation and blood pressure, among other measurements, which the instructors can change, giving the team ‘real-life’ emergencies to respond to. The team huddles around the manikin, often referred to as ‘Colin the Casualty’, and works through a scenario in which he has to be re-intubated mid-flight. During the exercise their speech echoes around the cavernous space inside the plane, but on an operation they have
Back at the base, Sergeant Michael Bailey explains how the squadron also helps service personnel experiencing mental health problems. One of the squadron’s four mental health nurses can fly out to the patient and travel back with them to the UK, where they will receive treatment in a hospital or in the community. Sgt Bailey says: ‘We make sure that a patient doesn’t come back and just get lost in the ether. It is making sure the appropriate plan is in place.’ Although each TMW nursing role has its own challenges, its staff will often call on their basic nursing skills. They show their caring side to young, frightened soldiers who have a gunshot wound or blast injury, for example, by talking to them without ‘mothering’ them, says Flt Lt Kirk. Sometimes it is necessary to reassure them that they need to return to the UK. She says: ‘A lot of the guys can be a bit embarrassed that they have to come back with aeromed. They might not be engaged with your assessments and you have to get them to warm to you. You have to say “you’re poorly enough to come back”’ NS
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Part of the RAF’s Tactical Medical Wing (left to right): Cpl Andrew McAdams, Wg Cdr Jonothan Ball, Flt Lt Chris Wells, FS Wanda Hughes, Flt Lt Ainsley Kennett, Flt Lt Sally Homer, Sgt Holly Chambers, Sqn Ldr Peter Lax, Sgt Chris Andrews, Sgt David Bett, and Cpl Gareth Ash
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Your patient’s arm has been crushed and has about 50 staples holding it together. But the arm is starting to swell and he is now in a lot of pain. So what would you do next? All healthcare professionals are used to making clinical judgements in stressful situations, but how easy would it be to decide on a course of action in a noisy, military transport plane flying at high altitude? This is the kind of decision that Flight Lieutenant Emma Kirk, a nurse, and her colleagues in the Royal Air Force’s (RAF) Aeromedical Evacuation Squadron has to make on a regular basis when bringing back sick and injured military personnel from across the globe to receive care in the UK. Flt Lt Kirk says the solution for the soldier with the crushed arm – who she accompanied back from Canada – was simple. ‘Swelling can increase when you go up at altitude. So we had to pop a couple of staples out for him and give him some comfort. It is those kinds of things that you would not necessarily think about on the ground.’
including nurse William Pooley (see box, page 22); and provide mental health care to service personnel in crisis. An aeromedical evacuation can see a nurse caring for up to ten patients (although that figure is uncommon) on a long and tiring flight, while dealing with everything from oxygen desaturation to bleeding and pain relief. Only confident nurses, secure in their nursing skills, can deliver this kind of care, says squadron officer commanding Jonathan Vollam. ‘If you’re working in a hospital or a medical centre, there’s always someone to turn to for advice,’ says Squadron Leader Vollam. ‘But the nurses are quite autonomous when they’re working in the back of an aircraft. They have to make a lot of decisions as a nurse because they can’t get on the
‘WE DEAL WITH SITUATIONS YOU WOULD NOT NECESSARILY THINK ABOUT ON THE GROUND’ – Flt Lt Emma Kirk
War zones
SUMMARY
BARNEY NEWMAN
From its base at RAF Brize Norton in Oxfordshire, the air force’s Tactical Medical Wing (TMW) sends nurses and other healthcare professionals to help evacuate critically injured soldiers from war zones; safely bring back people infected with diseases such as Ebola, The RAF’s Tactical Medical Wing (TMW), based at Brize Norton in Oxfordshire, sends nurses and other healthcare professionals around the world to pick up sick and injured British military personnel and civilians and return them to the UK. William Pooley, the nurse who became infected with Ebola while working in Sierra Leone, was a TMW patient in August 2014. Nurses need to be highly skilled and confident to make clinical decisions in the back of an aircraft.
phone to someone – they have to make clinical decisions off their own back.’ Sqn Ldr Vollam’s office is at the Brize Norton base, a quick drive from the airfields where large C-17 Globemaster and C-130 Hercules military aircraft set off on missions. Requests to help sick or injured army, navy and RAF personnel come into an aeromedical evacuation control centre. Aeromedical Evacuation Squadron, which has around 38 nurses and medics, can also be called on to help government officials and British citizens. Staff at the centre, including two nurses, assess patients’ level of need; the aim is to get any patient requiring life-saving or limb-saving treatment to the UK in a day.
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RESPONDING TO AN EBOLA EMERGENCY Flight lieutenants Emma Vincent and Belinda Mollan had been preparing for the Ebola crisis for a couple of months when they got the call to go to Sierra Leone to pick up William Pooley. The British nurse had become infected with the Ebola virus while providing healthcare in response to the epidemic in the region. The infection control nurses – two of four at the Tactical Medical Wing (TMW) – were part of a team of 15 who accompanied Mr Pooley back to the UK. Flt Lt Vincent says: ‘It was a good experience; for both of us it was our first mission to pick up a highly infectious patient. He was generally pretty well. He was hydrating himself and eating. We were doing basic observations to make sure he was okay.’ Mr Pooley spent the flight to the UK in an air transportable isolator unit – in effect a ‘plastic bubble’ mounted on a stretcher that keeps the patient separate from the healthcare team so they are not at risk of infection. The nurses can reach into the unit through gloves that are built into it, and the air pressure system means that if there is a breach in the plastic, there is enough time for the team to fix it. The isolator units are based at Brize Norton and are jointly owned by the Department of Health and the RAF, so they can be used to bring home any British citizen with a highly infectious disease, such as Ebola, Lassa fever or Crimean-Congo haemorrhagic fever. It is likely more Britons will have to be repatriated as a result of the Ebola crisis, and the two TMW nurses are now on call at short notice to respond to further emergencies. ‘It is a national concern and we have got to make sure we have aeromed cover,’ says Flt Lt Vincent. ‘We know the epidemic will not last forever.’
Infection control nurses Flt Lts Emma Vincent and Belinda Mollan tend to a ‘casualty’ in an air transportable isolation unit
Sqn Ldr Vollam says: ‘Although excellent care is provided in the field by Defence Medical Services, the level of medical care they need usually cannot be provided where they are so we need to get them back urgently. Once they are returned to the UK the ongoing care is always provided by the NHS.’ The team will also act if someone is facing a prolonged recovery period and needs to be close to their family. A nurse and
a medic, or commonly a nurse on their own, will fly out to the injured or sick person and return with them on a military aircraft or, where appropriate, on a commercial flight. A critical care air support team, made up of two nurses (one of whom is the team leader), up to two doctors, a medic and a technician, will respond to the most urgent situations. On a cold winter’s day, under grey skies, one team is being taken through its paces in a
22 january 28 ::from vol 29 no 22 ::by2015 STANDARD Downloaded RCNi.com ${individualUser.displayName} on Nov 25, 2015. For personal use only. NoNURSING other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
Far left and left, a team from the RAF’s Aeromedical Evacuation Squadron runs through possible real-life scenarios with an interactive manikin, from boarding an aircraft to treating the patient onboard
to combat the noise of the aircraft by using headsets and microphones and they would most likely share the space with all kinds of military equipment. A fire engine or helicopter can be transported along with the patients and aeromedical team. Flt Lt Kirk says: ‘We have to work the patients around the equipment.’
Mental health nurses
training exercise at the airfields, carrying an interactive manikin patient on a stretcher from an ambulance onto a C-17 waiting on the runway. The plane won’t be taking off, but apart from that, every care is taken to create the conditions of a real emergency. The manikin is controlled remotely by instructors. It has a breathing mechanism and can ‘speak’ to the team by an instructor talking through a microphone. A monitor provides live readings
of oxygen saturation and blood pressure, among other measurements, which the instructors can change, giving the team ‘real-life’ emergencies to respond to. The team huddles around the manikin, often referred to as ‘Colin the Casualty’, and works through a scenario in which he has to be re-intubated mid-flight. During the exercise their speech echoes around the cavernous space inside the plane, but on an operation they have
Back at the base, Sergeant Michael Bailey explains how the squadron also helps service personnel experiencing mental health problems. One of the squadron’s four mental health nurses can fly out to the patient and travel back with them to the UK, where they will receive treatment in a hospital or in the community. Sgt Bailey says: ‘We make sure that a patient doesn’t come back and just get lost in the ether. It is making sure the appropriate plan is in place.’ Although each TMW nursing role has its own challenges, its staff will often call on their basic nursing skills. They show their caring side to young, frightened soldiers who have a gunshot wound or blast injury, for example, by talking to them without ‘mothering’ them, says Flt Lt Kirk. Sometimes it is necessary to reassure them that they need to return to the UK. She says: ‘A lot of the guys can be a bit embarrassed that they have to come back with aeromed. They might not be engaged with your assessments and you have to get them to warm to you. You have to say “you’re poorly enough to come back”’ NS
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