Doctors from heaven

Ashley McKimm finds out all about flying doctors

Some would say that his job resembles that of God. He arrives from the heavens to save the critically ill victims of road accidents, shootings, and bomb blasts. To injured people he is their guardian between life and death. Yet when Dr Stephen Oakey from London's Helicopter Emergency Medical Service (HEMS) arrived at the scene of the Paddington train crash last October, not even God would have been prepared for what awaited him.

 
The HEMS team is based at the Royal London Hospital in east London (STEPHEN OAKEY/HEMS)

First at the scene of disasters

Based at the Royal London Hospital in Whitechapel, Dr Oakey is one of the capital's "flying doctors," who attend to some of the worst and most critical human casualties in Europe's largest city. On the day of the rail crash, the service's helicopter was out of service and Dr Oakey arrived at the incident by road. Once on scene he was immediately involved in the ominous task of searching for survivors. "I did a sweep of the carriages for bodies after the initial wave of casualties got out. I looked into the second carriage that was on fire and there was nothing," he explained solemnly. "The seats were melted; the luggage racks were melted. It was just full of black soot." Dr Oakey spent much of the rest of that day with paramedics struggling to free one young girl. She was the last person to be pulled alive from the wreckage after being trapped for a total of four hours 26 minutes.

Even for experienced trauma doctors, dealing with a disaster on this scale can be extremely difficult.

"It can be shocking at first, but you learn to cope with it," Dr Oakey said. "Seeing people mangled in a hospital recovery room is very different from seeing them mangled underneath a bus or train. You can't think that this bloke lying in his suit at my feet looks like my dad." At the end of an understandably distressing day the helicopter emergency service team ate at McDonalds and reflected on the day's events at the pub. "It's by far the best way to cope with it," believes Dr Oakey. "Just talking to everyone else involved is very important because they all share the same feelings and thoughts."

A near decade of service

The Helicopter Emergency Medical Service began to fly from the roof of the Royal London Hospital on 31 August 1990. Since then it has completed over 10 000 missions. The helicopter carries two pilots, a qualified doctor, a paramedic, and up to two patients. The advantage of the service is that it takes the hospital and a trained doctor to the wounded. It can arrive anywhere within the M25 in less than 12 minutes. On average this means that a patient receives specialist care 25 minutes more quickly than by road ambulance--a difference that the service believes can make the between life and death. A study of the service by Sheffield University, however, found that greater survival was "restricted to patients with very severe injuries," with an estimated one additional survivor from major trauma each month. Overall it found that no evidence that the service improves the chance of survival.¹

Dr Oakey has made over 100 landings with the team. "In extreme circumstances we can land on anything down to a site that is 20 ft in diameter," said Dr Oakey. "Most of the time we land in much bigger spaces, it's surprising how green London is from the air." In most cases the helicopter is able to land within a few hundred metres of the casualty, although sometimes it is a little further away. "I've arrived on a bicycle once when we landed about half a mile from an incident. A member of the public offered to take two of the guys and all that was left for me was a policeman's bicycle."

When the Helicopter Medical Emergency Service team attend traffic accidents in central London they are often met by a large crowd of onlookers staring up at the bright red helicopter descending from the sky. Dr Oakey explained how attending to a casualty in public can be quite daunting at first. "You look up, and there are 400 people just staring. Initially that's really weird, but then you just get on with the job and forget they're there."

One of the most common type of incidents that Dr Oakey attends involves casualties trapped under tube trains. Known to doctors working in the Helicopter Medical Emergency Service as "one unders," they happen almost on a daily basis and bring unique problems for the team. "One unders are extremely difficult," explains Dr Oakey. "They usually end up under the second or third carriage. You've got the difficulty of getting the patient out alive from underneath the train without turning the power back on if possible. Often it's a case of, if they stay under there any longer they are just going to die, so you've just got to get them out."

A varied job

Dr Oakey, aged 30 years, qualified as a doctor seven years ago from St Bartholomew's medical school in London. He trained as an anaesthetist before applying for a six month placement with the helicopter emergency service; joining the team had been one of his dreams since catching sight of the helicopter as a medical student. Now that this dream is a reality he believes it is one of the best learning experiences for trauma doctors.

"One of the nice things about the job is that it is so varied that you don't know what you're going to do." He explained how he recently attended to a man in London who had been shot in the chest twice. "Despite being very unwell on scene he survived. He had two patches sewn onto his heart and walked out a week later," he said. "Those sort of jobs make it all worth while."

Ashley McKimm, second year medical student, St Bartholomew's and the Royal London School of Medicine and Dentistry, London


studentBMJ 2000;08:45-88 March ISSN 0966-6494

1. Nicholl JP, Brazier JE, Snooks HA. Effects of London helicopter emergency service on survival after trauma. BMJ 1995;311:217-22.