A HEMS experience from a resident perspective (and a few pictures from my last flight)

This post is being written while on a plane back to Toronto…I’m just settling into some serious jetlag so I figured no better time than put down a few thoughts on my experience in Auckland. For the past 6 months I’ve worked in NZ with the Auckland Rescue Helicopter Trust as the HEMS education fellow and flight physician. Coming from Canada where putting physicians on-board helicopters to work in a pre-hospital environment is about as foreign as …. I came to Auckland with little knowledge about what to expect.

Posing for the photo op. Realized a modeling career isn't in my future.

Posing for the photo op. Realized a modeling career isn’t in my future.

To say the least, the entire experience was amazing and unforgettable! And much of this must be attributed to amazing group who work at ARHT. My supervisor and HEMS medical director, Chris Denny, got me organized and met with me weekly. We set out a plan, established learning outcomes and gradually implemented an advanced simulation plan at ARHT. Amazingly the ARHT facilitated this with the purchase of several brand new simulation manikins which only enhanced the learning possibilities. I worked alongside several talented physicians (Sam Bendall and Scott Orman) who mentored me in advanced simulation techniques, e-learning, integration of social media and blogging into education.

My time at ARHT was divided between educational endeavours and work as the HEMS duty doctor. Both allowed me to work and learn with the entire ARHT team who taught me more than they can imagine! While I can’t possibly thank everyone in this format, I developed great relationships with Barry Watkin (chief paramedic) and Herby Barnes (head crewman) who both worked to help me implement some of our educational objectives!

A view of Auckland at sunset

A view of Auckland at sunset

As the HEMS education fellow, I ran weekly simulations (often based on jobs we had recently done or questions that had come up), case-based learning sessions and finally task training sessions. We described our learning online both through the aucklandhems.com blog and via Twitter. We flew across the Tasman to practice our pre-hospital ultrasound skills at SMACC2013 (an impressive 2nd place…despite our less than optimal subject matter we had to teach)! (link). We implemented new standard operating procedures based on (and tested in) simulation. There was collaboration with teaching and simulation with the Auckland City ED as I worked there part-time as well.

On the west coast outside Auckland

On the west coast outside Auckland

Finally, I had the opportunity to practice pre-hospital & retrieval medicine. This opportunity to learn from some amazing doctors, paramedics, crewmen and pilots in a setting that previously was entirely unfamiliar, was awesome! I gained an entirely new appreciation for ergonomics as practicing medicine in the back of a helicopter is entirely different than even the craziest of emergency departments! I had opportunities to do winch rescues (both practice and operational), jumping from helicopters, rock swims with surf rescue, run resuscitations in remote areas and the list goes on.

What stood out however, was the theme of safety. In medicine, safety is sadly a relatively new topic…but for many of our pilots and crewmen, safety has been a part of their work since they started. In fact, those in aviation who don’t embrace safety…tend not to have very long work careers (for obvious & unfortunate reasons). Working in a helicopter is among the highest risk occupations around so it’s not surprising the ARHT team take safety so seriously. I spoke with the crewmen and pilots as much as a could to better appreciate their perspective…so that perhaps in medicine I can borrow and learn from their obsession. I suspect (as others have as well) that medicine lags in safety management because bad outcomes don’t harm clinicians directly…in a helicopter however, lack of concern for safety does affect everyone onboard. Thus the entire team has a vested interest in promoting and ensuring safe procedures. We run safety briefings, we have an online safety management system in place and just like the rest of aviation we incorporated checklists for both routine & high-risk procedures. As HEMS doctors, we tried to emulate the pilots/crewmen so we also use a checklist for our high-risk procedures like rapid sequence intubation…this is just starting to catch on in the ED but in my opinion there’s much room for improvement! I once asked one of our pilots about checklists and why they use them… I told him that in medicine, people fear checklists because they think it will take away their ability to think…he laughed and replied:

“we have checklists not so that we stop thinking…but so we can start thinking during a crisis and not worry about forgetting small details”.

And that brings me to the end of my last blog post at ARHT. A huge thanks to the entire team at HEMS & ARHT for inviting me to Auckland, helping me learn and trying new things! I will continue blogging but likely with a shift towards simulation and education. I’ll still be collaborating with the HEMS team at ARHT and hopefully posting some stuff on aucklandhems.com. So that’s it for now…back to my inflight movie, Argo.

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Flying shotgun on the way home from Hamilton, NZ

I don’t usually get to fly shotgun in the helicopter because of our seating configurations in the helicopter. Usually the crewman, paramedic and I are in the back on the way to the patient. While the cameraman sits upfront. (yes, we have a cameraman on board since our rescue service is the subject of a reality TV show that is filmed & broadcast in NZ) …I wouldn’t say its quite the same as Jersey shore, but an interesting depiction of what we do. And when we transport the patient, both the paramedic and I will remain in the back as well. Obviously focused on the patient, so rarely do we get to enjoy the view.

But once we bring the patient to hospital then sometimes if I’m lucky I can get an upgrade to the front seat with the pilot…free of charge.

Here’s a few pics of our recent flight from Hamilton to Auckland.

Just a few miles from where they filmed Lord of the Rings. This is actually "Middle Earth"!

Just a few miles from where they filmed Lord of the Rings. This is actually “Middle Earth”! If you look closely, you can see two Hobbits having a pint. 

Control panel in a BK117. Very good thing I'm not in charge in flying this thing!

Control panel in a BK117. Very good thing I’m not in charge in flying this thing!

The Auckland coastline

The Auckland coastline

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I was looking down with envy at one of Auckland's golf courses...

I was looking down with envy at one of Auckland’s golf courses…

If you look closely you can see a few guys walking with their golf bags. They just landed in their private chopper at the helipad...my dream would be to fly by helicopter to an amazing golf course. These guys did NOT look angry!

If you look closely you can see a few guys walking with their golf bags. They just landed in their private chopper at the helipad…my dream would be to fly by helicopter to an amazing golf course. These guys did NOT look like they had a tough day at the office!

Another day at the office…

We just got back from a beautiful day working at ARHT. Not a super busy day but we did get out flying for a few jobs. We enjoyed amazing weather, great crew and got the patients safely to the hospital. Weather was about 20 degrees, sunny without much wind. We had a stunning trip out to Great Barrier Island…I’ve just posted a few pics from the day.

View during the flight home with Waiheke Island in the background.

Great Barrier Island

Doing my best Topgun look…maybe I should have a more serious face

Me and Leon (crewman). Probably the best guy to have on your team. Keeps us all under control and has tons of experience! Plus fairly certain he can bench 300lbs…not bad to have on your side