London HEMS Documentaries

[MrBrown]

Mate of mine sent me these; from a British TV show about HEMS London

They use a doctor and a Paramedic (Intensive Care/ALS) who wear really awesome orange jumpsuits and can do open chest thoracotamies (with a knife rather than a needle or Turkel). I was quite suprised to see some of the drugs they carry such as ketamine, suxamethonium and vecuronium are doctor only drugs in the UK whereas our Intensive Care Paramedics (ALS) carry them here.

The achient old LAS Bedford's look like something you might see milk delivered in rather than used for an ambo, they dont even have IV hooks on the roof you can see one of the HEMS doctors holding a bag of fluid up!

I love the line of "oh love we're helping you, honest!" I'll have to remember that one, might come in handy!

Blues and Twos (includes the 1993 Bishopgate IRA bombing)
Part One
http://www.youtube.com/watch?v=PgtFXXcUS9g&feature=related

Part Two
http://www.youtube.com/watch?v=KaiDmdZ6BxE&feature=related

Part Three
http://www.youtube.com/watch?v=jFgpHC6moag&feature=channel

Flying Doctors
Part One
http://www.youtube.com/watch?v=UP9ODcwr7ck

Part Two
http://www.youtube.com/watch?v=phFennxhQiU&feature=related

Part Three
http://www.youtube.com/watch?v=mAa-onAd7wg&feature=related

Part Four
http://www.youtube.com/watch?v=e9z33ebAN68&feature=related

Part Five
http://www.youtube.com/watch?v=Pvwd4OeIoMw&feature=channel

Part Six
http://www.youtube.com/watch?v=NcVmAw0ySmg&feature=related


Condition Critical
Part One
http://www.youtube.com/watch?v=lRSSaSVOqGs

Part Two
http://www.youtube.com/watch?v=XuSSfaV3AsU

Part Three
http://www.youtube.com/watch?v=MOuQCfMuVtI


Medic One
Part One
http://www.youtube.com/watch?v=G0EENc_zNR0&feature=related

Part Two
http://www.youtube.com/watch?v=VFl6e6wikYs&feature=related

Part Three
http://www.youtube.com/watch?v=5Gq-Etpyc7Q&feature=related

Part Four
http://www.youtube.com/watch?v=JyMv4kkExBo&feature=related

Part Five
http://www.youtube.com/watch?v=zLK0yeRLlSs&feature=related


The London
Episode One
http://www.youtube.com/watch?v=VpJnY3mwLO0

Episode Two
http://www.youtube.com/watch?v=43Y40rEtVe4


One Under
http://www.youtube.com/watch?v=7jmc4AyELrc

 

[Melclin]

Awesome, cheers mate.


I love docos on EMS in other places. I like seeing how its done all over the world.

EDIT- HAha, but this is ganna piss people off. HEMS to nearby accidents, talk of golden hour, running on scene, dangerous landings.

 

[LondonMedic]

EDIT- HAha, but this is ganna piss people off. HEMS to nearby accidents, talk of golden hour, running on scene, dangerous landings.

HEMS doesn't fly to nearby incidents, they use cars for them. Remember that London is huge, flying time is usually five to twelve minutes.

Dangerous landings? Maybe. One incident (a chipped main rotor blade) in 21 years and around 30,000 operational sorties suggests otherwise.

Golden hour, high drama, god complexes and ego massages a plenty though.

 

[MrBrown]

I am quite suprised to see some of the jobs that the helicopter went to; for example the cardiac arrest and that kid who hyperflexed his neck playing rugger.

Not the sort of jobs HEMS would go to here, mind you this was in what, about 1993, so I'd take a guess that Paramedics (ALS) within LAS would have been fairly new at that stage. Maybe a bit of "erm I dno, call the helicopteritis".

What are the indications for the helicopter? I know they mentiones stabbing or shooting or severe traumatic injury but I wonder if the responses add value to the skillset and knowledge of your average LAS crew. For example the lady who got hit by the bus and was conscious and not traumatically [brain] injured. People who need RSI or things like that I can understand, or am I missing something really big like LAS Paramedics are not able to intubate?

Either way I find it really interesting and those orange jumpsuits are just so friggin awesome I want it I want it I want it!

 

[LondonMedic]

I am quite suprised to see some of the jobs that the helicopter went to; for example the cardiac arrest and that kid who hyperflexed his neck playing rugger.

Not the sort of jobs HEMS would go to here, mind you this was in what, about 1993, so I'd take a guess that Paramedics (ALS) within LAS would have been fairly new at that stage. Maybe a bit of "erm I dno, call the helicopteritis".

What are the indications for the helicopter? I know they mentiones stabbing or shooting or severe traumatic injury but I wonder if the responses add value to the skillset and knowledge of your average LAS crew. For example the lady who got hit by the bus and was conscious and not traumatically [brain] injured. People who need RSI or things like that I can understand, or am I missing something really big like LAS Paramedics are not able to intubate?

Either way I find it really interesting and those orange jumpsuits are just so friggin awesome I want it I want it I want it!

HEMS are dispatched automatically for;
• RTC person ejected
• RTC with associated fatality
• RTC with person under vehicle
• ‘One under’ (Person under a train)
• Fall from Height (2 storeys or 20 feet)
• Amputation above ankle or wrist
• Fire / Police / Ambulance request (dispatch within 3 minutes of request).
In the early days there apparently wasn't much call for HEMS from the ground crews - there was some bad feeling, LAS resisted HEMS taking 'their' patients.

British paramedics cannot intubate anyone who isn't dead, they are also are limited in giving sedatives and analgesia. But remember, most ambulance crews will see less proper trauma in five years than HEMS will see in a week. HEMS also have far greater experience, more interventions and more equipment.

As for the flight suit; http://www.spservices.co.uk/product_info.php?products_id=3549

 

[MrBrown]

So it seems HEMS in London at least (perhaps the rest of the UK?) is more about continuim of care vs modality of treatment so to speak.

In New Zealand a helicopter offers no higher care then a ground ambulance that has an Intensive Care Paramedic onboard. The main reason they are used is for distance and time to hospital vs ground ambulance and for some search and rescue functions.

Our Intensive Care Paramedics (ALS) are allowed to use advanced combination analgesia eg midaz and morphine or ketamine and some can do RSI.

I am a little suprised at the JRCALC guidelines for Ambulance analgesia and sedation and thought the UK would have been a bit more towards our side of things.

Hmm and seven hundred quid for a jumpsuit sure does save all that time in med school, house officer and registrar training but I don't know .... thats kind of cheating isint it?

Oh and I had to LOL at G-HEMS ... almost like ZK-AMBO

 

[LondonMedic]

So it seems HEMS in London at least (perhaps the rest of the UK?) is more about continuim of care vs modality of treatment so to speak.

Yes and no.

Up until recently, HEMS was unique in deploying a doctor as part of the crew routinely. More and more UK air ambulances are following this model, making it less about clock stopping ambulance response or rapid transport to secondary care but about getting the skills to the punter. We, generally, have less of a problem with distance to hospital (although now we're moving towards a proper trauma centre model, this will change).

 

[MrBrown]

With properly educated and trained Paramedics I am not sure there is need for a doctor in the prehospital arena to be honest.

HEMS seems to have done a fantastic job of it and make great use of their knowledge and skill but I am unsure if that is simply because it goes a level aboue what a ground crew can do, eg RSI.

The more and more I learn about what goes on in the hospital by shadowing my friend who is an anaesthetics reg and talking to the nurses if you take the doctor out of the hospital and don't bring his fancy diagnostic machines and labs is that not like bringing the horse but leaving the cart at home?

I could be wrong ...

 

[LondonMedic]

With properly educated and trained Paramedics I am not sure there is need for a doctor in the prehospital arena to be honest.

HEMS seems to have done a fantastic job of it and make great use of their knowledge and skill but I am unsure if that is simply because it goes a level aboue what a ground crew can do, eg RSI.

The issue with paramedic training is that, apart from being expensive, it's hard to maintain skills. It's estimated that less than 5% of 999 calls in London need a paramedic - most paramedics don't use their existing skills enough to keep them current.

A HEMS doctor and paramedic working shifts will see something like four to six major traumas and RSI two to three of them a week. A paramedic might not see that much in six months.

The more and more I learn about what goes on in the hospital by shadowing my friend who is an anaesthetics reg and talking to the nurses if you take the doctor out of the hospital and don't bring his fancy diagnostic machines and labs is that not like bringing the horse but leaving the cart at home?

I could be wrong ...

I think you're wrong - to an extent. The doctors I've worked with at HEMS have no problems making clinical diagnoses and treating as such.

I suspect that doctors generally would be pretty useless outside of hospital but I think that with a little bit of preparation, familiarisation and support from ambulance crews most do alright.

 

[Giddi]

I work in a (emergency) Physician based System, it doesn´t work!

The result ist, that the "Paramedics" get little to no training and are not allowed to do anything, eg. They are only allowed to do a venopuncture, when there is no physician available. They are nothing more than Taxi drivers and The physicians lose their skill very quick to, bacause when they work as Emergency Physician, they no longer work in the Hospital.

sorry for my bad english and my little rant, but i hope London will not go down the same path.

 

[Melclin]

HEMS doesn't fly to nearby incidents, they use cars for them. Remember that London is huge, flying time is usually five to twelve minutes.

Dangerous landings? Maybe. One incident (a chipped main rotor blade) in 21 years and around 30,000 operational sorties suggests otherwise.

Golden hour, high drama, god complexes and ego massages a plenty though.

I was just commenting on the video. In the first five minutes, they flew to a RTA 2 minutes from a hospital. Most of the landings I've seen thus far have been extremely dangerous by our HEMS standards. But them our HEMS is not for built up areas. That first doctor sprinted to the scene and showed us exactly why you shouldn't. She was flustered, out of breath, found it difficult to communicate, and seemed overwhelmed.

Keeping in mind that some of these videos are 15 years old.

Brown, I saw the FF standing around getting in the way and thought of you. HAHA.

The issue with paramedic training is that, apart from being expensive, it's hard to maintain skills. It's estimated that less than 5% of 999 calls in London need a paramedic - most paramedics don't use their existing skills enough to keep them current.

A HEMS doctor and paramedic working shifts will see something like four to six major traumas and RSI two to three of them a week. A paramedic might not see that much in six months.


I think you're wrong - to an extent. The doctors I've worked with at HEMS have no problems making clinical diagnoses and treating as such.

I suspect that doctors generally would be pretty useless outside of hospital but I think that with a little bit of preparation, familiarisation and support from ambulance crews most do alright.

Do you not have a two teared system? The whole point of our two teared system is to keep our 2nd tear skilled in things like RSI.

I agree that doctors are not ready to simply waltz into the prehospital environment, but I also agree that it would only take a short while for them to become accustomed to the difference.

Yes and no.

Up until recently, HEMS was unique in deploying a doctor as part of the crew routinely. More and more UK air ambulances are following this model, making it less about clock stopping ambulance response or rapid transport to secondary care but about getting the skills to the punter. We, generally, have less of a problem with distance to hospital (although now we're moving towards a proper trauma centre model, this will change).

I think doctor based HEMS is fine, but I see no reason why paramedics who are particularly good at what they do can't do the same. Mostly because I don't think prehospital interventions REQUIRE a doctor. I just think its a better allocation of resources to keep an expensive doctor in the trauma uni and have the cheaper but just as effective paramedics in the sky. The continuum of care argument is interesting though. Perhaps trauma nurses would be more appropriate.

(Keep in mind that I'm coming from a system where the MICA flight paramedic has significantly more education and experience than the average paramedic, who still, I believe has on average more education than the average British medics).

I must say though I'm becoming increasingly frustrated with the education we are getting putting us in a clinical no mans land. I'm thinking we need to generalize more with nursing.

 

[MrBrown]

That RTA with the elderly lady as something else, the HEMS Doctor (Dr Heath) had a great sense of humour, she can fly in in her orange suit and work on me anyday

I think LAS and most of the UK is moving towards a one tiered, all ALS system where its Paramedic and "assistant" who is basically a glorified driver.

We have one clinical training day every eight weeks in an attempt to keep up skills but I agree ambos are not using thier high level skills enough. That is why like Australia we are increasing our base level scope of practice of keep ALS free for the most complex medical emergencies.

 

[Melclin]

"How could I get stabbed?"

"Well you are a big lad. You're not hard to miss, lets be fair"


I can't stop laughing.

 

[MrBrown]

The British do have a good sense of humor ..... sometimes