Meet the Flying Doctor

An air ambulance flight medic recounts their first repatriation mission

Dr Noamaan Wilson-Baig is an anaesthetist in an NHS hospital in North West England and Academic Fellow In Anaesthesia. In August 2019, he joined Capital Air Ambulance in the role of Critical Care Flight Medic, undertaking missions around the world to bring sick and injured people home to the UK. He describes his first impressions of providing medical care ‘in the air’ – and how being an air ambulance flight medic differs from his day-to-day role inside an NHS hospital, where his feet remain firmly on the ground.

“During my NHS career, I’ve undertaken many ground ambulance transfers in the UK – but I had little idea just how different every aspect of the role would be, once the transfer was taking place tens of thousands of feet in the air.

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“Over the years, I have picked up ‘tricks of the trade’ – building on my training to improve my skills as an anaesthetist within the NHS. My aim in taking on this new role was to consolidate these skills, develop new competencies, and all whilst, mastering the role of a flight medic. From day one, the learning began in earnest.

“My flight, after training and induction, was as part of a team on a six-hour round trip flight to bring home a young man who had developed serious chest and lung infection with pneumothorax. This had required surgery and would mean IV antibiotics in a UK hospital for a further six weeks.

“On this first mission with the team, I got a clear sense of just how skilled, flexible and capable flight medics need to be.

“Unlike a ground transfer, where ambulances typically carry a relatively limited amount of equipment because the journeys are not generally very long and you can (in an emergency), stop the ambulance and get out to collect something you need, or seek treatment at a local hospital, we had to carry a full intensive care unit quota of equipment, plus bedding and mattress for the patient, food, drinks, ventilators - and back-up equipment too. Once you’re in the air, there’s no going back if you’ve forgotten something!

“Climbing on board the aircraft that day, the first thing that struck me was the lack of space. The aircraft is equipped with everything we could possibly need, but there’s no spare room - particularly once a patient and their stretcher is on board. This means planning is incredibly important – as is working efficiently both as a team and as individuals.

“Unlike a hospital, flight medics don’t just care for the patient’s medical needs – we also cater for non-clinical requirements, e.g. serve the patient (and relatives) their meals and drinks. During the flight, we were in regular contact with the pilots - who kept us informed about the weather, landing times etc. This allowed us to take necessary steps to ensure the patient and relative had a safe journey. If we had any issues about the patient that may require urgent management, we could communicate that to the pilots so that an appropriate plan could be formulated. I saw at first hand the importance of crew resource management.”

“After the transfer was complete, we were responsible for unloading the equipment and making sure it (and the aircraft) were ready for the next mission – including all the cleaning. The aircraft must always be ready to go. I was introduced to the role of emptying the pressurised system within the Oxygen pipeline, prior to the next flight. This is for safety reasons and minimizes the risk of fires on board. An absolutely essential role, but not something I have to think about in my day-to-day job!

“I also saw how flight medics need to be able to build good working relationships with a variety of people, from various professions, and in all sorts of places – very quickly. In the NHS, I mainly deal with doctors, nurses, healthcare assistants, paramedics, pharmacists and management where required...on that first mission alone I dealt with all of these staff, plus airport employees, border patrol guards, ops people and security, some of whom either didn’t speak any English.

“I’ve never much considered international politics as relevant to my role as an anaesthetist – but on that very first day, the border patrol at the destination city insisted on doing ‘enhanced checks’ on our passports as the “UK had left the EU” – which, in August 2019, it had not at that point! Not something I usually think about on NHS transfers, to be honest – but another new and important experience in a long and tiring day.

“We reached our hotel, near our final destination of Luton Airport, late that night and totally shattered. Happy that the patient was now safety transferred to a UK hospital near home and being well cared for – and confident that the air ambulance was fully stocked, clean and ready to go for the next person that would need it.”