Episode 1 Helicopter Heroes

RADIO: '..CareFlight... Fall from a tree.'

It's one of the most beautiful but dangerous places on earth...

My name's Helen. I'm one of the doctors. Any pain in there?

Any teeth loose or anything like that?

..and when Australians call out the flying doctor...

Coming round.

..they're likely to be British,

and so is the pilot, paramedic and crew men.

We'll see lots of sharks, 200, 300 metres out.

I think they get the idea when we go like that.

'Lifesaver 24...'

'They said they got the bends from coming up too quickly.'

From shark attacks on surfing beaches

to exploding barbecues in the Sydney suburbs,

these are the Brits who can make the difference between life and death

down under.

James Milligan is an NHS consultant

working at Leeds General Infirmary.

How's that tummy pain now?

Now, like hundreds of medics

-every year, he's swapping rainy Britain...

-It's wet.

-It is wet.

..for a life in the sun.

We're living right by the ocean, it's a beautiful spot,

work's nice and relaxed, the atmosphere's great -

life probably couldn't be much better.

But it's a place where the nearest hospital can be 200 miles away

and the wildlife can kill you.

Are you ready? Can I listen to your heart?

Welcome to one of the world's most extreme health services.

Today the flying medics come to the aid of a surfer who's been

smashed against the rocks...

Treachery Beach, woman dumped in the surf - head injuries.

..a famous Aboriginal singer with kidney failure needs

air-lifting to hospital...

He looks, certainly, on that ECG, all over the place.

..and an adventurous teenager is injured falling from a tree.

Someone's waving at us down here.

Oh yes, there it is. They're all waving down there.

It's the hottest summer for decades on the Australian coast.

In Sydney they've just recorded the hottest day since records began.

Not surprisingly, people are flocking to the water to cool down.

It's 48 degrees Celsius, or 118 degrees Fahrenheit,

and former Royal Navy officer Mike de Winton is sweating it out

in his flying kit.

Mike is the chief pilot of the rescue helicopter

based at Newcastle, 100 miles North of Sydney.

Treachery Beach, woman dumped in the surf - head injuries.

Basically, we're on call here 24/7,

so unfortunately as chief pilot, my job is to wait for the phone to ring

to come out and sort another problem out.

CREW TALK OVER RADIO

It looks nice and clear, which is good.

Yeah, it's 48 degrees on the pad in the aircraft.

So the air-con's not going to work very well.

Today Westpac 2 has been scrambled to a remote beach north of

Newcastle. Surfing accidents are common on this coast,

especially among foreign holidaymakers.

All we've got on this is a girl with a neck injury,

maybe a head injury, from being dumped on a rock by the wave.

It won't be a very big wave.

That is why Leggy reckons it's either an English tourist or a Swedish...

Local paramedics have reached the patient.

They're going to drive her to a nearby bowling club where

the helicopter can land more easily.

Just as soon as we land, can you guys hop out?

Cos there's normally a lot of people there, just to access safety.

Yep, copy.

VOICES MUFFLED OVER RADIO

It's going to be a steep descent down because we're going to

drop down into that area.

Extreme heat makes handling a helicopter difficult.

It reduces the power of the engines and creates turbulence,

especially close to the ground.

Yeah, that's it. That's a bit more. That's a bit better.

-MUFFLED VOICE ON RADIO

-..on the left-hand side.

-Yep.

The aircraft's working close to its limits here, and also you can tell by

the weather here, it's very, very windy and quite gusty, which makes it

difficult, especially around the high trees,

so it's a bit of a challenge, but you get used to it.

We're going to assess the patient, who I believe is a 24-year-old

female with spinal injuries from being dumped in the surf.

So, medically, if she has neurological deficits related to

a spinal injury, then we can fly to a more spinal-specific hospital

in Sydney if we need to - Royal North Shore Hospital -

for advanced specialist treatment.

Holidaymaker Dominique Doyle was surfing with her family

when she was hurled onto rocks by a freak wave.

She has a nasty head injury, but its the pain in her neck,

shoulder and back that's most concerning the paramedics.

Can you grab both my hands for me and give them a squeeze?

Fantastic. All right, good. Can you feel both your hands OK?

All right. I understand you'd be nervous. That's fine.

That's normal, OK?

'We work as a team. That's the reason we succeed -

'because we are a team when we fly.

'That linked in with the paramedics doing their job

'and then the hospital doing their job. That makes the whole thing

'part of that...you know, final result.'

In the helicopter it's really noisy and it's a little bit hot,

so the way we're going to communicating is I'm going to be

sitting right next to you and I'm going to give you a tap

every now and then, and give me a thumbs-up if everything's all right.

It's in Australia's enormous open spaces that air ambulances

come into their own.

For us to drive from here all the way down to Newcastle is quite

a treacherous drive.

It's bumpy, hilly, and the roads aren't very good at all,

so for her it's not going to be a good outcome

if we have to go all that way,

thinking that she might have some major injuries.

That's why we initiate the helicopter.

MUFFLED VOICE OVER RADIO

Dominique's being flown direct

to the John Hunter regional trauma centre in Newcastle,

100 miles North of Sydney.

She's still complaining of pain in her head, neck and shoulder.

They're what we call possible distracting injuries,

that might be masking something more serious with her central

cervical spine, which is an important area not to damage,

so we're taking all the precautions,

but she is certainly within good parameters with her blood

pressure and heart rate, and we'll just continue to monitor her.

She is lucky, because this kind of injury can cause paraplegia

and worse spinal injuries.

For British pilot Mike, that's another hour's flying added

to the 10,000 already in his log book.

The distances between major centres in Australia, together with

year-round better weather, mean pilots down under spend more

time in the air than most of their counterparts in the UK.

I'd say that this is closest to the military-style flying,

without being shot at.

We're a small cog in a big wheel and the results say it themselves -

we get the patients to hospital on time, and treated well.

And today's patient, Dominique, got all the tests and scans

she needed at John Hunter Hospital.

She's now back working as a lawyer,

although she says she doesn't plan on surfing again for a while.

For some, the true scale of Austraila's vast expanse

only really becomes apparent when they try to cross it by land.

If you drove it non-stop, it would take you two days

to get from Sydney in the south-east to Darwin in the north.

In the bushlands of the Northern Territory which surround Darwin,

the huge distances and sparse population

mean the majority of the emergency medical transport is done by air.

The countryside, particularly when you see it from the plane,

is absolutely outstanding, and when I was first arrived I was really,

really surprised at how green it actually was.

Dr Sarah McNeilly is an anaesthetist

and intensive care trainee from London.

She's working in Australia for a year before returning to the UK.

Medicine out here is relatively similar within a hospital,

and then, obviously, you can fairly easily get a retrieval job out here,

which are often much harder to get at home.

Today Dr Sarah and the team have taken a call about a diabetic man

with kidney failure, who's suffering complications.

CareFlight 22. Request taxi. Two nine.

The majority of our patients are the indigenous population,

and they have quite unique health issues.

A lot of the diseases that you do see - for example, diabetes,

kidney failure, heart disease - seem to happen here also

but in much younger patients.

It turns out the patient she's going to see is a famous musician.

Mandawuy Yunupingu is the lead singer of the indigenous band

Yothu Yindi.

SINGS IN NATIVE LANGUAGE

Just days ago, Mandawuy received

a lifetime achievement award at the ARIAs,

which is the Australian version of the BRIT Awards.

Mandawuy lives in an Aboriginal community on the Gove Peninsula.

It's 400 miles away from Darwin, and during the wet season,

which lasts from November to April, the only way to get there is by air.

Lovely. Good man.

At Gove District Hospital, Mandawuy Yunupingu

and his wife have been waiting for the CareFlight team.

Can I have a wee look at you? Is that all right? Can I examine you?

Is that OK? Let me just pop this across for a second.

So how long have you been feeling crook?

This morning.

Just since this morning? You were OK yesterday?

And I believe I'm treating a celebrity - is that right?

And you felt OK when you were having dialysis, or not so good then?

-I felt all right.

-You felt all right then.

We've had a little look at the condition of our patient over here,

and feel that it's stable enough to move him as he is.

It's a very small world up here

You just never know who you might come across, but yeah,

it's one of the delights of working up here.

It's very interesting.

-They're quite different, aren't they?

-They are.

And he looks, certainly on that ECG, all over the place.

This gentleman has an infection

and we're not entirely sure where at the moment.

His heart rate's going quite fast and it's quite irregular,

which often makes monitoring his blood pressure with the cuff -

particularly moving in the plane and the ambulance -

quite difficult, so we're going to put a drip in the artery in his

wrist, which will monitor his blood pressure continuously,

and that just gives me better control and better idea

of what's happening as we're moving him back to Darwin.

And can you bend your hand back for me? That's fabulous.

Perfect position.

Oh, just try and keep really still for me.

Is it all right if I just help you try and stay still there?

That's it. This is going to sting a bit. Well done.

-Sorry, I know this is...

-That's totally numb after this - all right?

Diabetes and kidney failure are common problems

in Aboriginal communities.

We can just monitor this very carefully, in this one,

and also give certain drugs in case he needs it.

OK.

..down,

while wife keeps you in check.

Which one?

Second one.

Second one.

THEY LAUGH

I think the doctors here have discussed his microbiology,

antibiotics, with the guys in Darwin,

because he's a little bit complicated,

and he's had all the antibiotics that have been suggested

and he's got two lines in and we were going to bring him back

like that.

-Thank you very much for your help, guys.

-Bye-bye.

Mandawuy and his wife, Yalmay, have just come back

from the ARIA Music Awards in Sydney,

where he gave a speech about the devastating effects of his illness.

My husband's band, Yothu Yindi,

they got inducted to the Hall of Fame.

It was really a proud moment for the band and their family.

'He's in a fluid restriction.

'He loves his tea. He likes drinking tea.

I can't make him stop drinking tea.

He's got to...

He's got to do it himself.

The indigenous population is one of the oldest cultures in the world,

so, obviously, they have this enormous background and heritage

that I didn't know the huge amount about before coming out here

and working with patients like that, and it's actually

really interesting.

Mandawuy's kidney failure means he has to have five hours of dialysis

three times a week or he'll die.

His condition also leaves him

vulnerable to infections that other people might just shake off.

His recent trip to the ARIA Awards may have been too much for him.

He's not looking too bad, actually.

He, obviously, has got a bit of infection somewhere,

so he'll need some tests and investigations to see

if we can find out where that infection is.

His heart rate has settled down with some treatment, and I think

overall he's looking a little bit better and feeling a bit better.

Mandawuy will have to stay in hospital

while those tests are completed, but whatever they reveal,

he says he wants to get back home as soon as he can.

In Sydney, the CareFlight team is called

when someone is unconscious or has a suspected head injury.

The helicopter has to be airborne in less than two minutes.

Air crew officer John Legge, known as Leggy,

is the last on board. He's got the map co-ordinates for the pilot.

95, 6, 7.

Leggy is a former RAF crew man from Liverpool.

He did six tours of Afghanistan,

airlifting wounded soldiers out of the battlefield.

You do get the same kind of feeling. You still have that same sense

of urgency. Somebody needs your help

and so you want to get there as quickly as you can.

In that respect, it is very similar.

You are still in a helicopter at the end of the day, so you still

have the same considerations whether you're in Afghanistan or whether

you'd be in Sydney, but obviously you don't have the same threat levels.

Today, Leggy and the medical team have been called out

to a park in Sydney where a child has fallen out of a tree.

CareFlight. There's a 12-year-old male fallen.

-OVER RADIO:

-Affirmative, CareFlight.

Further information, fall from a tree, head injury.

Fallen six metres.

LEGGY'S VOICE MUFFLED OVER RADIO

There's no park coming up, so we'll just head there.

It's Leggy's job to navigate for the pilot and help him

find a good place to land.

It's just inside the zone, mate.

Just on the other side of this headland here.

'There's a few things that I have to think about -

'the distance it is and the bearing. If we're going to go into the city

'then I'll need to tell air-traffic control before we go.'

OK, it's this park, at 12 o'clock.

-Someone's waving at us down here.

-Oh, yeah, there it is.

They're all waving down there.

Unlike on most British air ambulances, the doctor

and the paramedic physically hang out of the aircraft,

looking for the patient.

'We train up our paramedics to be able to do conning,

'which is a type of voice marshalling,

'so we'll keep the doors open at the back, and it just helps us

'with going into tight spaces.'

You do have a power pole. It's just on the right-hand side.

As long as there's no cross wires...

30 below to the ground. Free to go down 20.

Five, four, three, two, one.

VOICE MUFFLED OVER RADIO

Just six minutes after getting the call, the CareFlight Team is on

the ground in one of Sydney's oldest parks, in the suburb of Cabarita.

-Hi there.

-G'day.

-We might just get a bit of space back if we can.

Just Mum... Mum or Dad here?

He fell from a fair way up in the tree. Fell on his bottom.

He's actually feeling quite a bit of a pain.

Well, he said he can't feel his bottom right now.

-Hi, Danial. Can you talk to me?

-He banged his head on the tree too.

-We're just going to have a look at you and see how you are, OK?

-OK.

My son, you know, he likes climbing and he just was climbing the tree.

I think he was on the second branch, and he just fell

and hit the back of his head and fell on the floor,

and, yeah, everybody got panicked and they called an ambulance

and everything. Hopefully, he's OK.

-And where are you hurting at the moment, mate?

-My bottom.

-Just your bottom? Did you hit your head at all, buddy?

-I'm not sure.

You're not sure.

-OK, and the main pain is just around your bottom region, is it?

-Yeah.

OK, we're just going to have a look at your back and your bottom

and we're just going to press on you. I just want you to tell me

-if it's sore as the doctor pushes on you just gently, OK?

-OK.

Ben Southers has been a paramedic for 12 years

and Dr Andrew Weatherall is a paediatric specialist,

so 13-year-old Danial could not be in better hands.

So, Danial, you've probably done a whole lot of breathing

-before in your life, yeah?

-Yeah.

I just need you to do that again. There's no special tricks.

I'm going to listen to your chest while you do it. You go right ahead.

It's almost like you practice that most days of your life.

Fantastic.

Can you tell me exactly which branch he was on?

He was right up the top and then he was just making his way down.

-I think it might have been that one.

-So maybe that one.

So maybe two to four metres.

-Yeah.

-He sort of came down that way, hitting his back

and then maybe the back of his head.

So, Danial, what we're going to do is roll you to the side.

Ben's going to count to number three to prove he can,

and then we'll all roll you.

You do lots of nothing.

Just put arms across your chest like this for me.

And while we're doing this, I'm going to have a little feel

along your back, and I just need you to tell me if it's sore when I feel.

-OK?

-OK.

-That's all you've got to do. You just speak to me. Easy?

-Yes.

-We're going to roll on three. One, two, three.

-OK.

So I'm going to have a little look along the back.

Can't see anything that looks nasty, so that's good.

-Get one of the coppers, then, to help us, do you reckon?

-Yeah.

Can we've some police officers to give us a hand? Thanks.

At the moment he looks completely stable.

He's had a reasonable fall, and the witnesses who were there

on the scene actually saw him hit the back of his head

on the way down on the branch of a tree,

but he remembers the whole thing, hasn't passed out at any stage and

at the moment is just complaining a bit of pain in his back,

so as a precaution we're going to take into the kids' hospital,

but I suspect it'll just be a boring afternoon for him

of getting checked out.

The journey from Cabarita Park to the children's hospital

takes at least 30 minutes by land ambulance.

The CareFlight chopper will cover the same distance in five.

Good afternoon, Mandy. We're departing the scene, trans 41,

paediatric fall, to West Main kids. ETA five minutes.

At the children's hospital, Danial is scanned and X-rayed.

Luckily for him, his bump on the head hasn't caused

any lasting damage.

Just hours later, he's back at home with his parents

and his sister, Sophia.

I couldn't even remember how it happened, how I fell.

I just remember seeing a woman and Mum crying,

and then I saw you crying, and then...

I felt shocked,

and scared, and the pain was a lot in my bottom. It hurt.

Yeah, I was on the ground and everybody was surrounding me.

My mum was crying and everybody was crying.

Then my friend's dad called the ambulance. He said...

I think he said that he's unconscious and he's on the ground.

He just had fallen out of the tree.

I had a few British doctors, and they were talking in British accents,

and they were really nice to me,

and no one's treated me that special before, cos they treated me so well.

I got to experience my first helicopter ride.

It was nice but I couldn't really see the view.

It was so far. They got us in the helicopter,

and then two minutes later I was on the ground.

I was amazed at how fast the trip was.

The pain in my tailbone, it still hurts quite a lot,

and I can't really sit down on hard objects,

or if I get tackled or something to do with that,

I might have to go to hospital again, but besides I feel better now.

At the Ambulance Service's main helicopter base in Sydney,

the medical team is on a mission which is very rarely

carried out by air in the UK.

They're bringing in a patient with an acute viral infection,

who's being kept alive by a machine which is doing

the work of his heart and lungs.

This patient has come in in respiratory failure.

Don't know exactly why but they're presuming it's some

kind of infection - possibly viral, possibly bacteria - so they're

treating him with antibiotics as well.

Dr Helen Oliver is an anaesthetist from London. She's working

in Australia for a year to get more experience of pre-hospital care.

He's on ECMO, which stands for extracorporeal membrane oxygenation,

so basically his lungs are not working,

so what they're doing is they're oxygenating his blood outside

of the body, using this circuit which you can see here.

That blood we want to sort of be coming out, pointing towards...

There's a very large cannula that's going into one of the major veins

in his neck. You can see the two tubes coming out.

One is carrying blood away from the body -

it's going through the machine, being oxygenated,

and the other tubes are carrying the oxygenated blood

back into his system, so it's basically bypassing his lungs.

It's doing the job of the lungs for him.

This stripped-down ECMO machine was developed

by the New South Wales Ambulance Service

during the SARS outbreak of 2009.

I've certainly never seen anything like this before.

Back home, routinely, all ECMO transfers are done by road.

In very special circumstances, they can be done by air,

but the military would take care of the aero-medical side of things,

so the medical retrieval service wouldn't get involved,

but it's quite standard here to do these sort of transfers by air,

just given the massive distances that we're dealing with

here in Australia.

Again, it's something new for me to see.

Moving an ECMO patient requires a large medical team.

The patient's going to St Vincent's, which is one of the ECMO centres

in Sydney, so we've got the ECMO team from St Vincent's,

who are basically in charge of establishing the system

and then maintaining it during the transfer.

The paramedics that are going to be driving the MPV vehicle

that you see, and then our retrieval team - our doctor and paramedic -

are with him as well.

Putting patients on the ECMO machine as soon as possible

has been shown to keep more people alive,

but like all medical procedures, it doesn't always work.

The patient in this case died in hospital.

In the Northern Territory, on the tip of the Gove Peninsula

400 miles from Darwin, lies the community of Yirrkala.

This is ancient Aboriginal land and is owned by indigenous families.

Yirrkala is home to Mandawuy Yunupingu,

the famous singer-songwriter.

He has chronic renal failure as a result of diabetes,

which is not uncommon amongst Aboriginal people.

He has to have dialysis at his community clinic three times a week

to stay alive.

I'm just going to check your blood pressure, Mandawuy.

Ten days ago, Mandawuy got an infection

and had to be flown to Darwin.

The doctors and nurses at the...

..main hospital in town

thought I would be better going to Darwin,

and they flew me on the CareFlight.

The doctor who flew with Mandawuy was Sarah McNeilly from London.

And then can you bend your hand back for me? That's fabulous.

She was an OK doctor, for a British one.

HE LAUGHS

She was quite friendly,

and I liked her.

'Pretty much all the patients up here are really nice patients to treat.'

They're generally really, you know, friendly, receptive, open.

Occasionally you get a grumpy patient but it do at home as well, you know.

When you're not feeling very well,

nobody particularly wants to be charming.

School's finished?

Mandawuy's infection clears up

and within days he's back into his routine at home in Yirrkala,

under the watchful eye of his dialysis nurse, Rowena,

who's also British.

I've been in Australia over 30 years.

My dream, when I went into nursing,

I wanted to be in the Royal Flying Doctor Service.

I thought it was very glamorous.

But when I came to Australia I got stuck into the city life,

so I think now I'm realising my dream of actually getting out

to the real Australia, into the bush.

When you come out to the communities, you see the people

where they should be. They're in their home.

And it's been a revelation for me, coming up to the Northern Territory.

There are obvious dangers in this part of the world, but one of the

biggest health risks for Aboriginal people is chronic renal failure

resulting from diabetes.

Indigenous people are three or four times more likely

to develop diabetes than the rest of the Australian population,

and then their kidneys are ten times more likely to stop working.

Renal failure's a problem

in most indigenous communities.

I think it's important for people like me

to spread the message.

Part of that message is that Aboriginal people with renal failure

need dialysis machines and nurses in their communities

so they don't have to move away to get treatment.

Mandawuy has been our first patient. We are still very new.

It's only been going three, four months.

And so he's my sort of guinea pig, and so we're learning together.

Family is everything to the Aboriginal people.

They're with their children and their grandchildren

and the family is kept together, and it's just so important to them.

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