Dr Gareth Davies, Air Ambulance
From the moment an emergency call is made, doctors and paramedics are in a race against the clock. Every second counts, meaning medical pioneers are continuously trying to pushing the boundaries of what’s possible, from open chest surgery on the roadside to using a balloon to stop internal bleeding. Graihagh Jackson went to see some of these pioneering treatments in action with Dr Gareth Davies, Medical Director at London’s Air Ambulance...
Gareth - In London area, there are literally several thousand 999 calls every day. In amongst those thousands of 999 calls, there's probably 5, maybe 6 that require the specific interventions and skills of the Air Ambulance team. One of our big tasks is sieving all of those calls to find the needle in a haystack where the patients are so critically injured. They are literally in the dying process.
Graihagh - Is that what distinguishes you from a normal ambulance to – I noticed you’ve got advanced trauma team on your vehicle. Is that what distinguishes you too?
Gareth - I think that we have additional skills, additional equipment that we bring to the patient’s side. So, we effectively try and bring what's inside a hospital right out into the pre-hospital arena where we can start those treatments as early as possible.
Graihagh - I suppose, once you receive that dispatch, the clock is ticking to get to them as fast as possible.
Gareth - For trauma patients, time is of the essence. Seconds and minutes really count. So part of the car checks, is taking all our equipment out of the boot and checking it, make sure it’s all absolutely there. There’s no point in turning up, waiting for one piece of kit which we don’t have.
Graihagh - There's a lot of it.
Gareth - There is a lot of it.
Male - Yeah, it’s a bit of a tardis actually.
Gareth - I left Gareth and Richard, our paramedic and driver for this evening to it whilst they checked over what seemed like hundreds of bits of kits. They really did have everything except the kitchen sink. And they wouldn’t have needed it anyway because they had sterilisation wipes.
Within an hour, the first 999 dispatch came through. A message popped up on Gareth’s tablet, alerting him to the possible injuries that the patient may have.
Interestingly though, Gareth didn’t tell Richard the nature of the dispatch. This is to avoid any possible biases that paramedics may or may not have. For instance, Richard might be inclined to drive faster if he knew a child’s life was at stake.
(Gareth directing Richard)
25 minutes later, we arrived at the scene. To protect the confidentiality of the patient, I turned my recorder off and under the same line of thought, I equally can't really describe what I saw. Not that I saw an awful lot because I rather embarrassingly fainted and found myself in an ambulance on the way to a hospital which rather scuppered my plans for this report. But fortunately, I managed to dial-up Gareth later, after I had recovered.
Gareth - Will she just appear in my ear?
Female - Yes, it's ISDN.
Graihagh - I'm here.
Gareth - Hello.
Graihagh - Hello Gareth. How are you?
Gareth - I'm alright. More to the point are you okay? Have you recovered from your trauma?
Graihagh - Yes, thank you. I was rather embarrassed about that.
Gareth - No, you shouldn’t be.
Graihagh - So thank you so much for taking such good care of me.
Gareth - Well, I'm glad you're okay.
Graihagh - Back at the scene, I was amazed at not only how calm and collected everyone was but also, how everyone’s attitude was extremely soothing. There was a general sense of, “Everything is going to be okay. Don’t worry.” Despite the fact that doctors like Gareth are sent to scenes just like these because the patient is already dying.
Gareth - Our patients are entering the dying process and they may do that through several ways. It may be as simple as they don’t have an airway. Without oxygen, all of the cells in the body will eventually die. Sometimes patients may have problems with their circulation that might be the heart or there may be damage to blood vessels where the blood is simply leaking out. There is a part of the dying process that we haven't touched upon and that is when patients are injured, they release chemicals and those chemicals affect how cells utilise oxygen. They affect how the blood clots. So, there is this sort of hidden part of the disease which no one can physically see but we know is going on. So, we can do it at a macroscopic level with operations and what have you, but what's going on at a chemical level, we’re beginning to understand and we’re beginning to treat in some ways, but there's still a long way to go.
Graihagh - I'm conscious about keeping this patient anonymous but what can you tell us about the situation?
Gareth - In patients that have fallen from a height, they may be unconscious. They may damage their limbs, they may damage their pelvis. Inside the pelvis, there is a myriad of blood vessels and the minute those blood vessels get damaged they can ooze into the spaces within the pelvis with what is basically uncontrollable haemorrhage because you can't press it like you can press a cut on the skin. They can bleed to death from that. But we can initiate procedures such as REBOA which a new innovation where we can put a balloon in the top of the leg, float it up into the aorta – the main artery and close off that blood vessel temporarily to try and control some of this haemorrhage.
Graihagh - I assume this is something that a paramedic wouldn’t be able to do. This is something you, as a doctor can do.
Gareth - Yeah. Some of the procedures are literally operations that would normally take place in the emergency department or in a theatre, so it’s pretty high end stuff.
Graihagh - I was going to say, it sounds pretty ground-breaking because what you're describing is surgery on the street.
Gareth - Yes. There are circumstances for example, a patient that may have been stabbed and they have injuries to the heart, we can literally open the chest and then try and re-animate the heart by doing internal cardiac massage.
Graihagh - Once you have stabilised your patient, what happens next?
Gareth - As soon as we have established that position, we will always make our way to a hospital. We put in what's called a code red call which identifies to the hospital that they are quite literally bleeding to death.