A HEMS consultant with North West Air Ambulance Service and leading figure in the UK aeromedical sector, Dr Forrington joins Capital - the aeromedical brand of Rigby Group’s aviation division and Britain’s No 1 provider of fixed wing air ambulance services, during a period of sustained growth.

CAA founder and Director Lisa Humphries said:

“Since we announced our growth strategy less than four years ago, expansion has been rapid and sustained, with increased demand from both international and domestic clients for dedicated air ambulance capacity driving a corresponding expansion of our fleet, ground support and medical staff.

As an experienced senior flight physician with a great deal of experience in the field of aviation medicine, Dr Forrington brings a wealth of expertise to the company and precisely the skill set we need to maintain the high clinical and service standards that have brought CAA this far. I have every confidence that both he and his new team will continue to build on the excellent foundations laid by our retiring CMO, Dr Terry Martin.”

With CAA recently completing the acquisition of a third Learjet 45 shortly after the expansion of its King Air fleet to five aircraft, and the operator’s Critical Care ground ambulance fleet increased from two to four vehicles to enable greater service cover within the UK, its new CMO joins at an important juncture for the company.

Dr Forrington added:

“This is an exciting time to be appointed as Chief Medical Officer for Capital, and certainly with all the medical and operational personnel I have grown to know in my engagements with CAA over several years. It’s a service where big ambitions are matched by high standards, and I’m delighted to be part of it.”

“In addition to appointing a Senior Medical Team of consultants to strengthen our expertise across specialist areas including critical care, neonatal and patient welfare, we also plan to work closely with NHS organisations to boost our compliance with their latest procedures and practices, and to look for any efficiencies that can be driven to continually improve patient care and outcomes.”

Capital’s new CMO has previously served as a senior flight physician for both CAA and AMREF, is a HEMS Consultant with the North West Ambulance Service, and was co-designer of the standard-setting NAPSTaR course ( Neonatal, Adult and Paediatric Safe Transfer and Retrieval). Gaining his first degree in Information Technology, he has a track record of combining this discipline in his work as a medical practitioner in areas such as training and resources.

CAA provides medical assistance and medical repatriation flights 24 hours a day, 7 days a week, 365 days a year from its UK bases at Birmingham and Exeter Airports.

The Quality Care Commission report, based on a detailed inspection covering all aspects of CAA’s global air ambulance operation, praised the company for its “outstanding practice” in several key areas:

• “The CAA team went above and beyond to support patients and their families when planning missions. Staff worked 24 hours a day, and where necessary across different time zones to safely plan missions for patients. Family members of the patient were provided with direct telephone contact details in more complex cases. This provided the patients family with much required reassurance and keep them informed of the mission plans.”
• “We (the CQC) saw very detailed risk assessments of patients who had a number of complex needs. A number of staff had input into these and they were shared with all staff who would be involved in their care and transfer. These included all actions needed to be taken to eliminate or reduce the risk. Due to patients being transferred by aircraft staff had to make sure they had assessed all risks as any issues whilst being airborne would be very difficult to address.”
• “The medical director had written and contributed to the small amount of literature available to provide support and guidance in the aeromedical industry.”
• “Many systems and processes within the service were bespoke to meet the needs of the service and the patients using it.”

Responding to the report, CAA founder and Director Lisa Humphries said:

“We are delighted that not only was the CQC inspection team satisfied with all aspects of our operations, but that we were praised for demonstrating the very best practices throughout.

“We have invested heavily in equipment and staff training with the express intention of offering the best possible aeromedical services to customers in the UK and beyond, and to see that work formally recognised is a significant step forward for CAA and the many dedicated team members who have worked so hard to make it what it is.

“Capital’s worldwide reach in high quality air ambulance service provision is based on this commitment to excellence, and we will not be resting on our laurels. The progress we have made to improve services will be sustained, and we will continue to invest not only in maintaining the gold standard service to which we aspire, but also in driving growth across our brand by retaining, growing and developing opportunities with our current customer base and through the development of new revenue opportunities.”

None of these scenarios is rare, and all of them have happened within the past year. How does an air ambulance company like Capital deal with these problems? How do we medevac somebody back from the foothills of the Himalaya mountains or from the remotest rain forest in South America? Naturally, every patient is an individual, each with unique needs and each with a set of risks, complications and health problems that need solutions – and fast!

Medevac (medical evacuation) is the popular name for what we call aeromedical transport. Some people think that we take off in to the rising sun at the drop of a hat and, like an airborne cavalry, our flying angels scoop down, snatch up the wounded and the ill, wafting them quickly away to the nearest hospital, or maybe even bringing them all the way home. Nice story, but it's a lot more complicated than that.

Every medevac we undertake first requires the very best and most detailed medical report that we can acquire from the team that is currently managing the patient overseas. We don't want to discover about instability that makes a long-range medevac impossible, only after we send an aircraft and crew all the way to that remote location in the most inaccessible place imaginable. Sometimes we're lucky and we acquire excellent reports written in perfect English and filled to the brim with useful information. But that doesn't happen very often. Most times, we have to piece together a story from a doctor 'on call' who doesn't really know the patient or who doesn't speak English or any other language we easily have at hand. Sometimes we get information from a nurse, traveling companions, family member, and even, of course from the patient him or herself. But information is key! Comprehensive medical details allow us to analyse and manage clinical and logistic risks, and the process itself helps us formulate the most appropriate transfer plan for each individual patient and encourages us to contemplate the 'what ifs' and the 'if we'.

Contingency planning is essential. It demands detail. It helps us choose the right medical team with the right skills, right experience and right equipment. It helps us clarify the right mode and vehicle of transport, the right route, the right destination and the right cabin conditions en route. All this 'right'… what could possibly go wrong?

A good medevac team (flight doctor, nurse and/or paramedic) always anticipates the unexpected. We carry enough equipment, medications and related paraphernalia to stock a small intensive care unit. And we practice, train, simulate, test and practice again, always keeping skills and knowledge as sharp as the scalpel. These skills are backed-up and supported by logistics experts - planners, the people who put the mechanics of the journey together, who make the flight work in a safe, timely legal and responsible way.

…And this is all happening before the rescue flight even leaves base. I'll follow this story in the next blog and build up a picture of what it takes to medevac a very ill or injured patient who is hundreds or thousands of miles from home.

After a night out at a wonderful romantic restaurant, she wakes in the early hours with ‘stomach ache’ aka abdominal pain of unknown origin in a primigravida (lady in her very first pregnancy) in the early third trimester of her otherwise normal pregnancy.

The realisation takes a while to dawn before they decide this may be a premature labour. A flurry of activity, some blue lights and sirens, and soon the diagnosis is confirmed. Obstetric nurses, midwives, an obstetrician and an anaesthetist all come to try and stop this baby arriving too early for its own birthday. But this baby boy is determined and drops in to the world almost 13 weeks earlier than expected.

Unfortunately the new baby is not yet quite prepared for independent living! He isn’t too keen on the harsh dry environment of the neonatal incubator that very quickly become his new home, and prefers to be in mum’s own incubator!

On top of that, mum and dad are not too pleased that junior has arrived at a time when he is so small and so immature that almost every one of his functions of living are not yet developed enough to exist outside of this bubble. This is what being premature is all about.

A second flurry of activity starts after dad learns that flying baby home on their Easyjet special is simply not possible. Baby needs time to mature, time for the lungs to work efficiently, time for growth and weight gain, time to reduce the risks of infection, intracranial bleeding, and of inability to control his own temperature, to name but a few.

Did we take out insurance? Does it include cover for premature labour? Exactly what costs will be covered? How and when can we go home?

It’s not that much of an unusual scenario.

Capital Air Ambulance has been very successfully transporting adult patients for 6 years between all parts of the world, but often back to the UK. In the past two years, our contract with the Channel Islands has brought ever increasing requests to move premature babies and other neonates with urgent need for specialist paediatric or neonatal services. This demand grew as our equipment, personnel and capabilities developed in parallel to deliver the best possible neonatal transfer service for the islands of Jersey and Guernsey.

At the same time, the fund-raising children’s charity LUCY Air Ambulance sought our help to be their provider of aviation and aeromedical services for the transport of children around the UK. Ultimately the coincidence of timings of these major events encouraged us to build a highly flexible and robust neonatal transport service with state of the art equipment and highly trained specialist personnel.

We are now pleased to update our followers, but specially our clients and partners, that Capital has met its aims, and now proudly operates a fully equipped neonatal transport and retrieval service, using neonatal nurses and consultants from around the south of England, trained by us to act as flight medical crew. In doing so we were extremely fortunate to have attracted a very experienced clinical lead for the service. Dr Faith Emery recently joined my medical team at Capital and comes with a strong history of neonatal transport expertise, much of which was on international flights.

Our neonatal service still gathers plenty of experience with its cross-channel work for the islands of Jersey and Guernsey but, under Faith’s expert management and hands-on control, we have already undertaken two international neonatal transfers in the past few weeks This increased capability, coupled with a dedicated quarterly training program to recruit even more neonatal nurses and doctors has been strengthened by Capital’s fleet of three aircraft types of which each have a specific advantage depending on whether the transfers are island-hopping, within national boundaries, or from Europe or further afield.

With leadership from Dr Faith Emery, support from all of Capital’s resources and our state of the art equipment, Capital looks forward to a long lasting relationship with the LUCY charity and to transferring premature and neonatal babies for our many clients and partners who have, up to now, loyally used our services only for adult patient transfers.

As to the rather surprised new parents whose story we began with… baby Julian slept through almost the entire journey to the UK and was finally discharged from hospital to go home for the first time with mum and dad a few days ago. His hospital stay was peppered with a few ups and downs, and, like all premature babies, he will need close follow-up in the months ahead, but his future looks great and his parents are so happy with their bonny early delivery.

Growth and development started quite soon and continued over the past 2 decades until the present day. Our main base was at Filton, near Bristol and, shortly after commencing operations, we added two PA31 aircraft to the AOC. Secondary bases soon opened in Chester and Teesside, but the Head Office is now in Exeter with recent outstations in East Midlands airport and Biggin Hill, as well as chartered air ambulance aircraft still based in Jersey and the Isle of Man.

Although much of the work was still executive passengers and freight, a gradual change from air taxi to complex air ambulance operations became ever more demanding. To meet the extra needs, Capital purchased its first Beech King Airs in and around 2005. We later realised that the future of the company was in operating these turboprops throughout Europe as dedicated air ambulance aircraft and serious thought was put into creating a bespoke and high quality service complete with its own bank of medical and nursing staff as well as enough top of the range medical equipment to fit out 3 air ambulance aircraft.

By December 2011, Lisa and Malcolm had recruited Dr Terry Martin, an internationally acclaimed expert in aeromedical services. He was employed on a part-time basis to build a complete service from the embryonic starting point of the existing fleet of air charter aircraft. Terry was soon joined by Flight Nurse Manager Gail Barkes, and two Flight Nurse Co-ordinators, Nicki Paver and Dominic Rose. The next 6 months was spent procuring and testing equipment and a multitude of other tasks necessary for establishing the type of quality service which was the dream of those involved.

Capital Air Ambulance was unofficially launched on 1st June 2012 and was an immediate success. The high workload took everyone by surprise but only to the extent that the entire team worked even harder to put all procedures and processes in place to run an ethical, safe and efficient service based on the cumulative expertise of Terry in the medical field, and both Lisa and Malcolm in the aviation sector.

By 2015, an 80% share of Capital Air Charter Ltd was bought by Rigby Group PLC who own and manage six airports , including Exeter. We are now part of a group that also includes our sister company, British International helicopters and whose core business is built around an international IT company and includes a chain of five star hotels and a management support company. Being part of Rigby Group has helped Capital to invest in new offices, move to a jet aircraft fleet, and supplement our medical capability by the purchase of state of the art equipment, and increasing the number of our core medical staff.

Sir Peter Rigby, Founder and Chairman of Rigby Group, said: “Capital Air Ambulance has grown rapidly since joining the Group just two years ago, and is now poised to begin competing on a level platform with some of our largest European competitors.

“We have invested in both new aircraft and highly trained crews, and have opened a second UK base at Coventry Airport to extend our services across a much wider geographic area. We are now extremely well positioned to make a significant impact upon the European aeromedical sector over the coming months and years.”

Capital provides rapid response medical assistance services and repatriation flights 24 hours a day, 365 days a year, employing a highly experienced, multilingual team to deliver medical support and translation services on scheduled commercial and charter flights or via road transport. With a 25 year track record in repatriating British citizens when they have been injured or fallen ill in a foreign country, it is the only Eurami (European Aeromedical Institute)accredited UK medical assistance company to operate its own fleet of air ambulances.

The company also provides bed-to-bed transfers for the full spectrum of patients with acute and chronic medical conditions, using its dedicated fleet and commercial airliners. Capital’s services include specialist adult, neonatal and paediatric equipment and the company flies with critical care capability on board should the patient require these services from the outset, or in the event that their medical condition deteriorates during the journey.

Since 2014 Capital has been part of the Rigby Group Plc aviation division, a trusted flying partner to the Military and an experienced international Search & Rescue service provider. In the intervening period it has invested in a custom fitted Lear jet to enable long haul repatriations and has expanded to support a full and part time staff of over 70 trained professionals. The aircraft fleet consists of ten fixed wing aircraft and two aeromedical helicopters.

Paul Southall, who heads up Rigby’s Aviation division, commented: “In just two years since Capital joined Rigby Group, the company has exceeded all expectations, growing from strength to strength in an extremely competitive and challenging market.

“Today, with months of investment and operational enhancements firmly in place, we see a huge window of opportunity for a British owned aeromedical operator to seriously challenge its established European competitors and intend to make significant strides in this area over the coming months.”