Night Flying Project A Report by Adian Bell, CEO 30 November 2012
The Kent, Surrey & Sussex Air Ambulance is about to replace its oldest helicopter with a more modern MD902 Explorer helicopter which is capable of conducting night operations, with the intention of commencing a two year trial on the most effective way of delivering night Helicopter Emergency Medical Service (HEMS) in the region. The helicopter will be fully capable of ad hoc landings by night as well as the more conventional pre-surveyed and helipad operations.
Having audited patient demand by night, the charity is confident there is a need for the service but that, unlike the day service, the need can be met by one helicopter and one medical team and possibly a second team in due course. Marden is well-placed to host this service but we cannot yet operate by night from there due to the current limitations of the site; although we do hope to develop that capability over the next two years.
We have therefore moved the Dunsfold helicopter to Redhill, which is as well placed geographically as Marden for the operation. From there the helicopter is capable of reaching anywhere in the Kent, Surrey & Sussex region within 30 minutes, and of completing a mission on a single tank of fuel, which is essential given the paucity of refuelling options by night.
There are a number of differences in the way we are planning to conduct night operations from how we presently deliver HEMS by day. The helicopter will continue to be tasked centrally, through the HEMS desk at the SECAmb control room, and patients will still be triaged to one of the three major trauma centres that support the region, or to one of the trauma units or other appropriate destinations as dictated by patient needs.
However, this process by night will initially be very different because none of the three major trauma centres yet has a 24-hour helipad capability – indeed, none yet has a helipad! St George’s Hospital is planning to commission a helipad by late 2013, and the Royal Sussex County Hospital at Brighton in mid 2014, but neither has yet sought planning permission for night operations. King’s College Hospital is planning to have a 24-hour helipad some time in 2014, but does not yet have full funding or planning consent. Various trauma units such as the Eastbourne District General Hospital in East Sussex and Frimley Park in Surrey have 24-hour helipads, but we do not routinely take major trauma patients to such facilities, nor should we.
Because of this the emphasis will be on getting the medical team to the patient as swiftly as possible. This will allow for time-critical interventions to be carried out as soon as possible and ensure that the subsequent onward transportation of the patient to the most appropriate hospital by land ambulance will be as safe as possible. Whilst this method of operation is the starting point and not the perceived end point of the night HEMS trial, it is not envisaged that the overall service will be significantly different from that by day, or in any way detrimental to patient care and outcomes.
The particular focus for the charity is to have at least one regional major trauma centre that is capable of receiving the helicopter 24 hours a day and it remains optimistic that this will be achieved within the next two years or so.
By day each aircraft has a single pilot and medical crew, of which one acts as the technical aircrewman and sits in the cockpit beside the pilot. Because of the way the service will be delivered by night, this configuration is not appropriate, and therefore there will be two pilots by night, as the technical aircrewman (either the doctor or paramedic) will not normally be available for return flights.
Equally, and to start with, the threshold for launching the aircraft at night will be lower than by day and will include a period of manned alert in the aircraft as a situation develops to allow more rapid deployment should the incident so demand. The charity is therefore prepared for a higher percentage of stand-downs by night.
To mitigate the risk that the night operation becomes a single-shot operation, given the eventual dislocation of the medical team from the helicopter, we are looking for the helicopter to rendezvous with the team, post patient handover, at the closest and most convenient locations to the receiving hospital and thus have the service back online soonest.
During the course of the first year of night operations further work will be undertaken in order to assess whether a second team is required, and the Trust enters this two-year trial period planning to deploy a second team by night in early 2014, but will test that assumption during 2013.
There remains a lot of work to be done in terms of practices, procedure and equipment but this is under way. For instance, it makes eminent sense that while only the pilots will need night vision equipment in the aircraft, the medical crew should be similarly equipped in order that their situational awareness in the air and initially on the ground is as high as possible.
At the moment there is no night capable relief aircraft should the Redhill helicopter be unavailable by night, but it is envisaged that MAS, the aircraft operator and lessor, will have such an aircraft by the middle of 2013. To further enhance the aircraft availability by night, the Trust is already planning to replace the Marden helicopter with a night capable aircraft within the next two years, so that, should the Redhill aircraft be unavailable at short notice, there is sufficient resilience to keep the service online. This also underscores the importance of the development of the Marden site to enable night flying, so that, should the helicopter at Redhill be grounded by the weather or other constraints, then in time the charity will have the option of running a night service from Marden as well.
This is a massively complex and challenging new service and the charity will be taking its time to carefully develop the way it deals with night operations. The focus remains on the patient, and doing the best for patient outcomes, and the charity will do nothing to undermine or endanger those beneficial outcomes that it currently delivers.
The charity firmly believes that this system will give significant benefit for the patient who needs the services the charity provides, and the emphasis will remain on timely and appropriate interventions to save life and improve the quality of survival.
Rye’s Own January 2013
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