Episode 10 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...

Keep coming round.

..they're likely to be British.

And so is the pilot, paramedic and crewman.

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

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

-RADIO:

-'Over 20 forward...'

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

From shark attacks on surfing beaches

to exploding barbecues in the Sydney suburbs...

Went round you?

..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 have a listen to your heart?

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

Today, there's a tricky rescue after a woman plunges down a cliff.

You look down and there's 200 feet below you.

It does make you think about the wire and how strong it is.

A baby needs a life-saving flight to hospital in Sydney.

Yes, you're fine. You're just fine.

And, in the mountains, a man is badly injured falling out of a tree.

You can always walk to the hospital if you prefer.

Yeah, I was going to get my daughter to drive me there.

Australia is a young country in more ways than one.

It has a more youthful population than the UK and a higher birth rate.

But the size of this vast continent means premature

and sick babies can be born hundreds of miles from specialist care.

At the headquarters

of the Newborn and Paediatric Emergency Transport Service,

or NETS for short, an urgent call has just come in.

RADIO: 'Basically, a six-week-old baby

with congenital myotonic dystrophy.

'Got several other issues as well.

'The reason they're calling for her transfer to

the Children's Hospital Westmead is, she's had two significant

episodes of desaturation down to the seventies over the weekend.

The reason that we're picking the baby up is because

if the baby deteriorates any further,

it's currently in a unit where they can't really stabilise

or give an added level of support,

so we're transferring to a more tertiary centre where they can,

and also where they can investigate the baby further.

Dr Shalika Shetty's the new girl around here...

Hi, I'm Sharli, nice to meet you.

..fresh from her air crew training.

This baby has basically been fairly stable

over the last 48 hours. Already clear with antibiotics.

Apart from those two desaturations, hasn't been significantly unwell.

Desaturation means there's been a decrease in the oxygen

circulating in the baby's bloodstream.

It's just a fortnight since Dr Shalika

swapped a quiet children's ward in London

for the back of a noisy Bell Helicopter, a modern version

of the choppers that flew American troops in the Vietnam War.

Ahead of Dr Shalika and British flight nurse Emma Cooke

is a 150 mile flight to the rural hospital.

This is a baby who seems to be having problems.

Had a couple of vomits before these drops in saturation,

so what's on the back of everyone's mind is, has the baby

kind of inhaled the vomit,

aspirated its vomit into its lungs?

That's definitely a possibility.

Over. Begin your approach. Ground visual.

Local hospital staff have done all they can for the team's patient.

Now she needs specialist care.

BABY CRIES

Sorry, sweetheart.

Baby Kayleigh has muscular dystrophy,

a genetic disorder.

She'll be flown to Sydney in an incubator that will feed

oxygen-enriched air into her tiny lungs.

Transporting babies is a complicated process that cannot be rushed.

It normally takes at least an hour, really, for a stable patient, even.

It's just the process of switching over the fluids and switching

over the monitoring and getting your handover and assessing the patient.

And so even all of that can still take an hour

for a fairly basic patient.

Inhaling vomit is dangerous for newborns.

It can lead to lethal complications and, in the noisy environment

of a helicopter, they can be difficult to diagnose.

Yeah, you're fine. You're just fine.

BABY CRIES

Dr Shalika won't relax until her patient's safely in Sydney.

Oxygen by mouth, she should be stable for the transfer.

Because you're going up in the air,

there's certain things that can change.

A patient might need more oxygen, so you just keep a close eye on

observations and we've put in a lot of external monitoring gear as well.

Obviously, you monitor the clinical status as well, as you go along.

So that would be the main thing in a baby like this.

The team's tiny patient is leaving her parents behind.

They have Kayleigh's brothers and sister to care for.

The next hour will be critical for their daughter.

With a price tag of £60 million each, Sydney's air ambulances

are equipped to rescue anyone anywhere, day or night.

And that means crews have to be trained to use the winch cable

that can pluck survivors out of the sea or lower

a paramedic into mountain ravines.

It's a dangerous job.

Dangling on the wire is not quite part of the medical school syllabus,

so it's a little bit different

and it's something that's quite specialised to this service

and a few other Australian services as well.

It means we can take our skills to patients that

ordinarily wouldn't be easily accessed.

It means we can resuscitate them, get them back to the helicopter

and get them to hospital as quickly as possible.

In the city of Newcastle, the capital of Australia's

Hunter Valley wine growing region, a 000 call has come in.

It's the local version of 999.

We've got a report, there's a 60-year-old woman

that's fallen down a ten metre cliff somewhere up between Tinonee

and Wingham, up sort of northwest to Taree.

They don't know any injuries. They can just see her there.

Don't know how long she's been there for.

The team knows that, to reach the woman,

it will probably have to use the chopper's winch.

It could be a tricky rescue.

People are able to yell out to her,

but not able to hear what she's saying,

so, presuming she's seriously injured, ten metres is a fair way,

we're going to actually take some gear with us

just in case we need to abseil down to this patient.

Basically, we're just covering for all contingencies,

which is a bit hard, sometimes, when we're so far away,

but it's what we need to do.

The Westpac rescue helicopter, which is partly funded by the state,

covers this part of New South Wales.

-RADIO:

-No further info at this stage.

'It will probably require a winch out.'

-Copy that.

-Copy.

'She has what appears to be a right hip or pelvic fracture,

'head injury, GCS of 13.

'Blood pressure is at 100 systolic.

'Pulse of 87. Saturation of 84%.'

Air control, Westpac Two, copy your report, thank you.

The rescue helicopter is heading 100 miles up the coast

to the hills around the town of Taree.

At this stage, we've been informed the vehicles are able

to get to the top of the cliff where the patient is.

We have been informed that one rescue worker has

got down to the patient.

We've had some information on the patient's condition.

At this stage, it doesn't sound too good.

Sounds like she may have some chest injuries

on top of a fractured leg, or something.

It's going to be a difficult rescue.

The patient is lying at the bottom of a cliff in a deep ravine.

Trees make winching even harder than usual.

If you just nose out over the cliff,

we can get a better look at the area.

The crew is preparing to lower the winchman,

to help local paramedics already treating the woman.

Five, four, three, two, one. And hold.

-Bring the guys down to the door. Your reference?

-OK.

First two's coming out the door.

Take out the slack.

-OK, he's out onto the skids. Good hoist.

-Good hoist.

Give thumbs up on the way down.

Height's good, air position's good.

Just maintain your height. Got high ground.

-Got a rope?

-You can use this one if you want.

-Yeah, is that all right?

-Yeah. I'll attach it.

In rural New South Wales, the emergency services

rely heavily on volunteers to cope with incidents like this.

The local voluntary rescue association has turned out

to help the helicopter team.

Its members are unpaid, but well trained.

The VRA, who are what we call vertically trained,

in other words they can rope down cliff faces,

they've taken a Stokes litter down there

to help extricate the patient.

Flying paramedics like Dave Reid are highly qualified

and abseiling is one of his skills.

All right, see you later.

-See you, good luck.

-See you soon.

Dave's going to abseil down, set up the stretcher, so we come in

and we actually are only going to do one winch total.

It looks very thin, the wire.

It's about the size of your little finger

and when you look down and there's 200 feet and not a lot below you,

it does make you think a little bit about the wire and how strong it is.

You're aware that the guy controlling the winch has

a cutting device which is probably about an inch

away from his finger at any time.

So, if do things do go wrong, you may get jettisoned.

Obviously these guys are professionals, they don't do that,

but it's something to think about.

In Britain, only the military or the Coast Guard

can perform rescues like this.

In Australia, this operation is being carried out by medical staff

and partly funded by charity.

The patient's now on her way to hospital.

She has serious pelvic injuries.

Looks like she's been there for quite some time,

so she's quite lucky.

Looks like her injuries could have been a lot worse, but we can't tell.

From here she needs to go for a full assessment.

The woman is detained in hospital in the coastal city

of Newcastle for several weeks before being released.

It's the end of another working day

and Sydney's commuters are on their way home to the suburbs.

But there's one group of workers just starting their jobs.

The British flying doctors must work nights too

and clocking on here requires more than just a white coat.

The first part of our gear is our Nomex flight suit...

Registrar Richard Smith trained in Swansea,

but has spent the last six months working in Australia.

Put that on over the top. Obviously, that's to protect us

in the event of any fire on the aircraft.

The next thing we have to put on is our harness,

so that if we need to be winched on the aircraft, we can be.

And we always put it on.

We need to make sure all these straps are all done up.

The next layer to go on is our Switlik,

which is essentially our life jacket.

So it's a flat type aviation jacket that will then inflate.

And, last but not least, we put on our helmet.

And the last thing is a set of Nomex flight gloves. So let's go and fly.

As the sun starts to set over Sydney, Dr Richard

and the crew of the rescue helicopter are heading out.

MUFFLED RADIO

They're off to a remote island, south of the city.

22, estimating about 2015.

All they know is that a woman has fallen from a moving car

and she's got a serious head injury.

Just the other side of the river.

Oh, yeah. Just on the other side of the river there.

We're right in the middle of wires.

We've got wires about two miles to the east and west,

so that should be all right.

But there might be little wires,

so we'll keep a real good eye out for them.

There's nowhere to land on the island, so Richard is

taken by ambulance on a short cable ferry to get to his patient.

But, despite having a serious head injury,

the woman is refusing to be treated, or go to hospital.

Dr Richard phones a senior consultant for advice.

I want to have a chat to you about a patient.

It's a middle-aged lady who has somehow come out of the vehicle.

It appears she might have opened the door and jumped out herself.

About 25 kilometres an hour.

She has got a significant sort of boggy swelling

to the back of her head.

And basically, she won't let us near her.

Not in a combative head injury way, but more in a drunk way.

She just wants to go home.

I'm a bit stuck, really.

The paramedics here say they're quite happy for her to be

forcibly taken to hospital under Section 20 of the Mental Health Act.

At the moment, the only way we're going to get near her is

literally hold her down and try and get some intravenous access.

The thing is, we need to give you just...

..something to stop you from vomiting, OK?

In the end, persuasion works and Dr Richard doesn't have to use

the powers of the Mental Health Act

to force this woman to go to hospital.

Well done. You might feel a little bit sleepy with that injection,

but it will stop you feeling sick.

-RADIO: 'G22.'

-Thank you, we're now departing with one patient,

to Westmead Hospital.

We've just given a bit of pain relief. Her obs are all OK.

But, other than the boggy mess at the back of her head,

and being intoxicated,

GCS now is approximately 14.

It's certainly an unusual case.

Dr Richard still doesn't exactly know how

she fell from the car or why, but his priority is that she doesn't get

any worse over the next 30 minutes before she arrives in hospital.

You've got the crane, it's off to the left. You see that?

Yeah, I've got it.

We don't want to catch her on anything.

'That was quite a challenging case,

'not necessarily for the medical reasons,'

but more for the issues around

treating patients when they don't want to be treated.

Obviously, the law in Australia is different to in the UK.

We could have compelled her to be treated against her will.

But given that she had hit the back of her head,

we can't rule out that she could have a head injury as well.

So now she's delivered

to the emergency department here at Westmead,

and I suspect they're going to get her a CT scan of her head

and we shall see what transpires when we follow the case up tomorrow.

The scans showed that the woman does have a small

haemorrhage near her brain.

But after spending a couple of nights in hospital, she's sent home.

Every day brings a new intake of patients

for Sydney's big emergency hospitals,

often from hundreds of miles away.

Straight ahead, clear of the crane.

We go around.

2,000 feet above the suburbs of Sydney,

a very special patient is on final approach to the children's hospital.

MUFFLED RADIO

On the ground, Westmead.

Six-week-old Kayleigh has serious complications, made worse

by muscular dystrophy, an inherited disease she's had since birth.

For flying Dr Shalika, this is a moment of relief.

Now her patient is in the care of some of Australia's

top paediatric specialists.

In the dimly-lit baby unit, Shalika must tell them

Kayleigh's troubled medical history.

Required resuscitation at birth due to poor respiratory effort.

Had 30 seconds of cardiac compressions and,

after that, had a return of circulation and heart sounds.

She has a systolic heart murmur, but echo here was normal.

Examination-wise, she has fixed flexion deformities,

lower limbs, and also a fixed extension deformity

of both her feet, as well.

Kayleigh is very ill. But the NETS team now must leave her.

One day, Shalika hopes she'll be well enough to be flown home.

Now she's in a centre that can investigate the issues that she's

been having and, hopefully, once that's all done,

and she remains stable for a period of time, she'll be transferred

back to her home hospital where she is closer to her parents, as well.

So, yes, our bit is done for now.

Baby Kayleigh is 150 miles from her home, her mum and her dad.

The vast distances between cities in Australia present

the parents of sick children with some terrible dilemmas.

But, as well as the helicopter, the Aussies have a clever solution.

Meet Gwen Hillier, the ward granny.

Good morning. How are you?

Are you fast asleep?

Gwen moved to Sydney from Bath 30 years ago.

Now she's a volunteer,

caring for babies whose parents can't be with them.

Every day, she visits Kayleigh to play with her.

Got your little boots on.

Keep your feet warm.

'I enjoy it very much.

'I just come in and I talk to them. I sing to them.

'They don't mind me singing to them.'

MOBILE PLAYS MUSIC: "Winnie the Pooh Theme Song" by Robert B. Sherman

-How has she been, all right?

-Yeah.

Behaved herself last night?

'It's important, because Mum feels happy because I'm here.

'Because she comes from a country town,

'they can't be here all the time, especially

'if they've got other children, and so we stand in for the mother.'

You push it, don't you?

'You read to your child'

and sing to your child and they love it.

Even young babies,

their face lights up when you're interact....

It's cos you're interacting with them, that's really what it is.

# Rock-a-bye baby

# On the tree top... #

Having cared for hundreds of babies during ten years as a ward gran,

Gwen it used to being compared with another well-known English nanny.

'I don't see myself as Mary Poppins.'

Everybody says I sound like Pam Ayres.

She'd be upset, wouldn't she?

Are you looking at me?

Kayleigh's now on the mend and will be soon flown back home,

once again in the care of a NETS doctor.

40 miles west of Sydney stand the spectacular Blue Mountains,

what was once an impenetrable wall separating Australia's

fertile West Coast from its barren interior.

They cover 10,000 square kilometres

and 150 rare plants are only found here.

But today a rather more common species is taking

the ambulance service helicopter out into the mountains.

MUFFLED RADIO

A man has fallen from a tree in his back garden.

The doctor on board today is Toby Fogg. He's British

and works at the Royal North Shore Hospital in Sydney.

I still feel British.

I do miss England, family and friends that are there.

I'm lucky enough to be able to go back

about once a year, sometimes more.

But there are some quintessentially British things that we all miss.

For me, I suppose, it's the pint of bitter

in a country pub on a Sunday afternoon.

Dr Toby and the team are heading for a tiny town called Buxton,

50 miles southwest of Sydney.

There's a park in the middle of town which hopefully

we can find as a landing point.

Their patient, Terry Rossi, has fallen several metres

while clearing his back garden and the land ambulance is

bringing him to meet the helicopter in a local playing field.

52-year-old male fallen from a fence,

approximately three to four metres.

Landed heavily on his left leg, which he ended up breaking.

He's got a tib-fib compound fracture.

Because of the distance to hospital,

we get the helicopter guys in to take him up.

Toby's the doctor here.

Pop your arms down for us. Is everyone ready?

One, two, three.

And back down. One, two, three.

So we're about an hour's drive from Sydney,

down at the southwest in a small country town.

Terry's been up a tree.

I don't know exactly what he was doing up a tree,

but about four metres.

'He fell down, on his way down he caught his leg on this

'steel fence, hit the ground.

'It looks like he's only got an injury to his lower leg.'

Stretcher out.

Three sets of wheels, just let it roll in.

And peel away.

'He's got a nasty fracture

'and he's going to have to go to hospital',

get that operated on. There may be other injuries.

He may have hurt his pelvis or his neck,

so he's got precautionary neck collar

and a binder to hold his pelvis nice and snug,

but we think it's really only his leg that's the problem.

You can always walk to the hospital if you prefer?

I was going to get my daughter to drive me there, only the pain

and the swelling went up...

'We use helicopters a lot, especially in this rural area,'

where it's over an hour to get to a major trauma hospital,

which is what he needs.

Deep breath.

And out.

In. Out.

Dr Toby is using an ultrasound scanner to check that there

isn't any blood in the cavity around Terry's lungs,

a potentially fatal condition.

It's rare to see this equipment on UK air ambulances, but the ability

to carry out life-saving checks in the air is vital in Australia.

'The far-flung reaches that we go to, right in the country,

'New South Wales, amazingly small towns, very limited resources.

'It may be just a local GP who runs a clinic who is doing his best

'to look after some incredibly unwell patients.

'They need a lot of help.

'No matter how well-trained they are, they just need more resources.

'And that's what we are.

'We'll fly an intensive care system to the patient.'

Patient maintains a GCS of 15.

He's haemodynamically stable.

Blood pressure 130 over 80.

Sats 100%.

We'll be at your department in 20 minutes.

'There probably was only one ambulance service in that

'local area, and if they were then taking this chap all the way

'to Liverpool, who else is looking after the local population?'

Liverpool is one of five major trauma centres serving

the 7.2 million people who live in New South Wales.

All five hospitals are in the Greater Sydney area,

where 60% of the state's population live.

So we're going to slide you across onto this bed in a moment.

We'll slide him over.

'They'll take other X-rays to make sure

'he hasn't fractured his pelvis from falling from such a height,'

because that's probably the most dangerous consequence for him

if he had uncontrolled

'haemorrhaging in his pelvis.

'So they will take X-rays, make sure that's still stable,

'and then they will proceed to move him up to theatres probably'

sometime this afternoon to have his leg operated on and

'he'll probably come out with a whole lot of

'screws and plates, I'd imagine.'

Thanks to big city medical technology,

the team's patient is soon sent back home to the Blue Mountains.

I'm not sure which one I was standing on that broke

when I fell, but I think it was that top one, there. This one.

I wasn't that high up either, you know?

That's only three or four metres.

The tree isn't even Terry's,

it belongs to his neighbour,

but birds were sitting on the branches, making a mess in his yard.

I just decided to get up there the best way I could,

thinking I was 21, you know and He-Man.

Get up there and cut some of the branches down,

but one of the ones I was standing on broke

and I came straight down and I landed on my feet,

which broke the tibia and fibula,

that sort of come out of the side,

out of the side of the leg there.

I've never seen nothing like it.

Terry says he'll leave tree surgery to the professionals in the future.

It will be many months before he can properly walk again,

never mind climb trees.

Subtitles by Red Bee Media Ltd