Episode 4 Helicopter Heroes

EMERGENCY DISPATCH RADIO

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 here? Any teeth loose or anything like that?

And when Australians call out the Flying Doctor...

-PILOT:

-Keep coming round.

..they're likely to be British.

And so is the pilot, paramedic and crewmen.

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

They get the idea when we go like that.

-RADIO:

-'They're saying they got the bends coming up...'

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, like hundreds of medics every year,

he's swapping rainy Britain 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.

You ready? Can I listen to your heart?

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

Today - a car crashes on a rural road -

two teenagers are critically injured.

Any pain in your chest here, Tye?

The Flying Doctor comes to the aid of a diabetic bush ranger.

How long have you been feeling crook for?

Where is the pain in your leg?

And a runaway horse leaves its owner in the dust.

Tell me if this is sore anywhere.

Open your mouth and breathe.

If you travel down the coast from Sydney towards Melbourne,

it isn't long before you find yourself in rural Australia.

'22 miles away? Sounds about right.'

And it's here where the Ambulance Service rescue helicopters

come into their own.

-PILOT COMMS:

-'Just south of a small town called Buxton.'

Dr Helen Oliver from London has been working in Australia for a year.

I'm an anaesthetic registrar.

And I'm based at the Royal London Hospital in the East End of London.

I'm in the sixth year of my training.

The job here's is quite interesting

in terms of the helicopter work, the retrieval work,

as well as accident attendance.

So there's a lot of transferring patients between hospitals.

Something you don't do in the UK.

Tonight Dr Helen's on her way to a serious car crash

70 miles southwest of Sydney.

Statistics indicate you're twice as likely to die on Australian roads

than you are in the UK.

'Sydney control, Rescue 2-6. ETA overhead is one minute.'

'Large field, just to south there's a farmhouse and tall gum trees

'- five or six gum trees.'

We run a 24-hour service, so we do do quite a lot of night missions.

So night-landings are not that uncommon.

They're obviously much more challenging than landing somewhere in the daytime.

The helicopter team is met by a paramedic

who's done an initial assessment of the two casualties.

Hey, Phil.

-How are you, mate?

-What have you got?

The patient he wants Dr Helen to look at is 19-year old Tye Bradney.

-Hello, how are you?!

-Hi! How are you doing?

-Very well.

He was still pinned in the vehicle with his left leg up behind him.

-I'm going to give his GCS as about 12 at the moment.

-Yep.

TYE?

-He's actually... A shake. You've got to give him a shake, now.

-OK.

He's got a laceration here that you're going to be fascinated by.

Right on his tracheae.

OK, cool.

-Again, he'll probably be wanting a tube into him.

-OK.

Everything else appears OK.

Tye and his friend have both suffered serious injuries,

after their car came off the road and crashed into a telegraph pole.

Tye, is this sore if I push?

Tye? My name's Helen. I'm one of the doctors.

-INITIAL SPEECH INDISTINCT

-I'm freezing.

Yeah, yeah, we'll get you covered up.

Can I just have a quick look? Open your mouth for me, hon?

-All right, awesome. Any pain in there? Any teeth loose?

-No.

-Do you remember what happened?

-Yeah.

-I'm freezing, that's what I remember!

-Yep?

Any pain in your chest here, Tye?

-A little bit, not much.

-A little bit.

-My right one.

-The right one.

-Yep. I need a blanket!

-Blanket's on you, sweetie.

-Tye, slow down, mate. Slow down.

TYE GROANS

He was really uncomfortable. He had a fair bit of pain.

And he was starting to become a bit confused and agitated.

Which does make us worry that there might be a head injury there.

There might be some swelling developing in the brain

that is causing this confusion.

So, really for safety -

obviously, we don't want to have to physically restrain him -

just giving him a little bit of sedation, which eases the pain...

Yeah, calms him down, and makes him more comfortable.

Legs down, Tye.

-Roll over.

-No, no, you got to lie on your back, mate.

-Roll over.

Tye? Tye? Just lie on your back, mate. You'll be right.

I'm freezing!

Yeah, we're going to get another blanket and warm you up. I promise.

So that's 30 ketamine and two of medaz.

He'll be asleep in a minute.

Keep still, keep still, keep still...

Just looking to see if there is any sign of a pneumothorax.

And what we're looking for is sliding...

these sort of pearls on a string sign.

A pneumothorax is a punctured of collapsed lung

and is potentially fatal.

It happens when air builds up in the spaces around the lungs

and stops it expanding properly.

That looks like there is no pneumothorax on either side.

While Dr Helen and the medical team take care of Tye, a recovery crew

attempts to unwrap what's left of his car

from around the telegraph pole.

It's amazing that anyone has come out of this wreck alive.

-Just relax, Tye.

-All right, Tye, that's a boy.

You're doing really, really well. I know you're absolutely frozen.

We are just going to get you nice and warm now, OK?

Dr Helen has taken care of Tye's breathing

by doing what's called an RSI.

While she sedates him using powerful drugs,

paramedic Monty puts a tube down the patient's windpipe.

And then, yes, if you could just try and keep it in line,

that would be great.

This is a procedure normally carried out in hospital

and it takes a great deal of skill to do it in the middle of a field

by the light of a head torch.

Well, basically, Tye had symptoms of a head injury

and was quite confused and was starting to get quite combative

so obviously he wouldn't be safe for a transfer in the helicopter.

So, given that and the possibility he has got pelvic injuries,

possibly a femoral injury as well, we decided to put him off to sleep

and secure his airway.

He also has quite a deep laceration just to the side of his trachea

so, again, just to be safe,

we thought we would just drift him off to sleep and just get control.

During the transfer,

we are continuously monitoring his pulse and his blood pressure,

his oxygen levels, his carbon dioxide levels, just making sure

they're all optimal and stable and then I'm sort of continuously

giving him small amounts of pain relief and small amounts of sedation.

Basically ensuring he stays fast asleep

and comfortable throughout the whole transfer.

There are five major trauma centres in the Sydney area and we took him

to Liverpool, which is one of the five.

And that is in the southwestern suburb of Sydney area.

OK, so this is Tye Bradney. He is 19 years old.

He was ejected through the windscreen, partially.

Left leg was pulled right out behind him

so possible injury to the left pelvis and hip. A deep one to the head.

He has also got quite a deep laceration just lateral

to his trachea but looks like there is no involvement of any deep

structures or any tracheal involvement.

40 but he is getting 15.

At Liverpool Hospital, Dr Helen hands over to fellow

British doctor Rick Wheatley.

It turns out they went to university together in Newcastle upon Tyne.

When the patient arrives, my responsibility mainly is airway

and breathing and I am also here to make sure that he can be

safely transferred from here to the CT scanner and back.

At the moment he is ventilating nicely.

Still on the transport of ventilator.

And there's another Brit doctor on the trauma team.

Amy Talbot is from Hull and has been working in Australia for 18 months.

When traumas come in,

we can do quick bedside ultrasound scans to look for any

fluid in the tummy, any air in the lungs or any fluid round the heart.

This is a big trauma hospital so we get to see a lot of different things

here, which I wouldn't have seen and didn't see working back in the UK.

They are used to us now. Yeah.

Half the staff here are Brits so there's a lot of different

accents so they always get confused with where I'm from.

At the moment that's great.

Once you have got your line in and we've got bloods on the way,

let's go for a roll.

The trauma team have done their primary and their secondary survey.

Basically assessed head to toe,

ABCs and so on and treated anything they have found.

He has had a trauma series of x-rays

and they are just about to take him now to CT scan to do basically

a top to toe scan just to have a look and see what's going on.

They are also going to check out the wound in the neck just to make

sure there is nothing going on that we couldn't see.

But he has been very stable, actually, all throughout

so hopefully it will be a good outcome.

OK, so we'll have the scan and...

The CT scanner is used to get a very detailed 3D image of Tye's body.

This will confirm if he has broken his pelvis

or if the wound on his neck has punctured his windpipe.

The only way we will make him unstable really now is by trying to

do something a bit too quickly and pulling something out.

He has remained stable throughout the transfer so far

and we need to find out what images

we've got in the CT scanner so we see what injuries he has got

and therefore what health monitoring or surgery he might need from there.

Tye will remain sedated for the next few hours.

1,300 Australians die on the roads every year so he's been lucky.

When he wakes up he will learn what happened to his friend who

was in the car with him when he crashed.

Each day, the pilots who fly Careflight's doctors and nurses

around the Northern Territory land their planes on remote airstrips.

They are taking vital medical care to the most sparsely populated

areas of Australia.

You could fit five Great Britains inside the Northern Territory

yet only 220,000 people live here.

That's the same as the population of Southampton.

Dr Sarah McNeilly is a trainee anaesthetist from London.

She's is spending six months

working for Careflight in the Northern Territory.

At home I work in a big hospital that has pretty much

all the medical facilities that we need and I have consultant support

within 15, 20 minutes if I need it or I am directly supervised.

Which is pretty much the direct opposite to here.

Today, Dr Sarah and nurse Janine Hawkes are flying to

an aboriginal community 130 miles to the southwest of Darwin.

A very small community to pick up a gentleman who is generally unwell.

He has multiple health problems

and seems to have deteriorated today in his condition.

So we are going out there to retrieve him

into the Royal Darwin Hospital.

It's quite a distance for them to travel by road and it is

probably the safest and quickest for us to go and retrieve him.

-Thank you very much.

-Clear door.

It is typical. It is fortunate we have got a sealed strip sometimes

when we go to some, you know, very rough strips, dirt strips,

which in the wet season can get quite muddy

but, as you can see, it's very isolated.

I don't think even we have mobile reception.

The patient is a bush ranger

and has been brought to the air strip from the local health clinic.

He's got quite severe ulcers on his heels.

He's got complications from diabetes.

-Whereabouts is the pain in your leg?

-From here down.

When does the pain in your chest come on?

Is it when you are sitting in bed doing nothing, or...?

Yeah, when I'm getting all the other pains now.

-Uh-huh. But you have been taking your insulin still?

-Yeah.

James lives here.

He also works here as a ranger but he came to us

this morning for some help because of pain.

How long have you been feeling crook for?

Aboriginal people are three or four times more likely to

develop diabetes than the rest of the population.

I do all of the investigations, call the doctor in Darwin and then

the doctor and I make a decision what's the best

treatment for James and then it was decided that he needed to be

transferred to Darwin and that's when Careflight come on board

and then we make a plan and a time for them to pick him up.

He just might need a little bit of assistance coming up the stairs,

as steady as he feels.

-I'm just going to turn the oxygen on.

-Sure.

Good man.

James May has already had a toe amputated due to his diabetes.

The pain in his foot has got progressively worse over

the last three weeks and he has ulcers on his heel.

Diabetes is pretty common amongst the indigenous population.

People eventually will develop complications from diabetes.

People end up with kidney failure and problems with their hearts

and problems with their feet and their nerves and their eyes.

All these things are pretty common up here.

-Yeah, you take it easy. One step at a time.

-Good leg first.

It would take at least four and a half hours by road and, this time

of year, with the rain, the roads are very muddy and bumpy and very

difficult to get through

so we could encounter problems on the way anyway

so it's really only a 40 minute flight from Darwin to here

so we really couldn't do our work without them.

How much is in the bag?

We've probably got 400 left.

Can we give all of that, like, stat?

The temperature is over 40 degrees in the aircraft

and it's extremely humid

but heat is not the only thing that Dr Sarah has had to get used to.

Lots of the patients laugh at me

when I have a bit of a freak out about the local wildlife sometimes.

Because I am not used to large flying things and cockroaches and things.

-AEROPLANE INSTRUMENTS:

-'50, 40, 30, 20, 10.'

The patient did actually deteriorate their condition along the way.

The patient is transported into the Royal Darwin Hospital now

with Sarah and the paramedics and will be handed over to

the emergency department so they are in good hands.

James, how are you going? How is that foot? How's that pain in the foot?

-A little.

-Still there. Is it any better at all?

-A little bit.

A little bit. OK.

-Right foot?

-Yes.

-He has got diabetic ulcers, has he?

-Yes.

-On both feet?

Yes, but right is worse than left

and I think he is probably septic from his right foot ulcer.

Good afternoon. I'm Sarah, I'm one of your Careflight registrars.

So, this is James. He is 58. He has been crook for about three weeks.

He had a course of antibiotics that finished a couple of weeks ago

from a clinic where he is usually seen for his right foot ulcer.

He has got ulcers on his left... Both heels.

And he has had toes amputated in the past.

The right is much worse than the left.

The last three days, it has been much worse.

He was brought in the clinic today by his wife cos

he is just debilitated by this foot.

James, take care of yourself, OK? These guys will...

-Why, where are you going?

-I'm off now.

-All right.

But you have got the whole of ED here to look after you, OK?

-And they'll take very good care of you.

-Thanks for everything.

Not at all. It was our pleasure.

James's right foot was so badly infected that two days after

Dr Sarah left him at Darwin Hospital, surgeons had to operate.

He was in an induced coma for several days.

But two months on, he's recovering

and working hard to get his diabetes under control.

This is pretty good. Take a look. Pumpkin and green peas.

I think I've had diabetes for the last, oh, four or five years.

And it is sort of got on top of me, you know? Just being busy working

and not looking after what I was eating, you know?

I lost about seven kilos since I've been here and the food is great.

But there is a massive change that James is having to cope with.

His leg had to be amputated below the knee.

No good reacting to it cos it's not going to help me

bring my leg back and all that.

Just face facts and just get on with life, I suppose.

You could say I was dealt a raw card

but it's all down to looking after yourself

and how you are living and things like that

but I was brought up rough as guts and did the things Aussie

kids done, running around in mud, larking and all that sort of stuff.

I love my job.

I love the outdoors and fishing and camping but this having

one leg missing is not going to stop me doing that sort of thing.

James is slowly learning to stand without his right leg

but it will be a long haul.

I think I've been a good patient. I've got a gold star over there

-for being a good boy.

-HE LAUGHS

So, yeah, doing my rehab

and all that and just hopefully maybe in a month or two or

a couple of weeks, I hope to get out of here

and go home to my actual stump's fitting of my prosthetic leg.

James hopes that once he can walk on a prosthetic leg

he'll be able to go back to work as a manager in the ranger service.

Ever since the first settlers arrived,

the horse has been part of life down under

and, every weekend, thousands still climb into the saddle.

But more than 300 Australians are killed or seriously injured

each year in riding accidents.

RADIO CHATTER

And today the Ambulance Service Rescue Helicopter is heading west,

out of Sydney into horse-country.

On board is A&E consultant Toby Fogg, who trained in the UK

but moved to Australia ten years ago.

When I came out here and heard about Careflight

and the helicopter service here in New South Wales, I knew

I wanted to go and work for them for six months as a registrar

and soon after I started there,

I realised I wanted to do this long-term as a consultant as well.

This is truly the best job in the world, in my eyes.

The New South Wales air ambulances are built for speed

and their twin jet engines can easily spook horses.

This is not an ideal landing site

and Dr Toby has limited information about his patient.

There may be a head injury, they may be unconscious,

their breathing may be inadequate.

They may have a neck injury, they may have, you know, chest injuries,

belly injuries. So I am thinking,

"Well, what am I going to have to do for each of those things?"

I know I have got the kit but what are going to be my priorities

and, you know, what is the environment going to be like

in which we are landing?

Now clear of the trees behind.

Seasoned horsewoman Kerryn Valeontis was cantering down a dirt track

when her horse threw her, fell and rolled onto her.

And you didn't lose consciousness? And you remember everything?

-Have you got much of a headache just now?

-No, it's fine, thank you.

-OK.

Kerryn's daughter and husband have been with her

since soon after the fall.

Local paramedics have put her on a spinal board in case

she has damaged her back.

Just open your mouth and breathe.

She landed on her face.

She may have some facial injuries but she didn't lose consciousness.

A little bit of tenderness on the right side of her chest.

I was concerned because of the pain she has got in her neck

and her upper back, whether she has a spinal injury.

So there is a reluctance to drive these people on extensive road trips.

Rescue 23 is equipped with the latest ultrasound machine, which

allows Dr Toby to look for injuries before Kerryn gets to hospital.

-RADIO:

-Copy that. We'll see you then.

-RADIO:

-ETA 10 minutes.

-That's right.

-No trouble. Thank you.

It's only a 10 minute flight to one of the city's major trauma

centres, a journey that would take four times as long by road.

Over the next few hours, doctors at Westmead will find out

if Kerryn's fall has caused lasting damage.

I felt my neck snap and I thought,

"Oh, what have I done? What have you done?"

A bit of fear actually because, you know,

you don't want to break your neck.

I was just in lots of pain and wondering,

"Should I move? Should I not move? What should I do? Oh, God."

Kerryn's had a lucky escape.

In Australia, horses are involved in more deaths

than sharks, snakes, spiders and crocodiles put together.

I was just very impressed with how many people came to the aid

and all the teams and the backup and everything.

It was just very impressive.

It didn't cross my mind whether I had medical insurance for that

and all that sort of thing. That has come later.

Luckily, Kerryn had enough insurance

to cover the medical bill for her accident.

-They say when you fall off you should get straight back on.

-Yes.

Yes, they do. I just don't bounce any more like I used to.

Kerryn is no rush to get back in the saddle

but she says horses will always be a big part of her life.

Australia's coastal waters teem with fish

and the famous Sydney Fish Market

is one of the best places to buy seafood in the country.

There's everything here, from common flowerpot,

a cod to you and me, to inkers, the Aussie nickname for squid.

But filling the fish stalls is a dangerous job.

One study found Aussie fishermen were 18 times more likely

to die at work than those with jobs on shore.

Today, another fisherman is missing

and at their Newcastle base 100 miles north of Sydney,

the crew of the Westpac Rescue Helicopter has been scrambled.

There is always the hope that you're going to find someone alive.

Realistically, if he was meant to be back at midnight,

he has been in the water for a long time, eight hours.

'You are fearing the worst

'but there is always that element of hope that we might be lucky.'

Paramedic Dave Cheswick moved to Australia after nine years

working with the London Ambulance Service.

Off the coast of the UK, the fisherman would stand little

chance of survival but, with sea temperatures nudging 24 Celsius

today, there's a real chance he'll be found alive.

'If we do get him and he is alive then just how we are going to get him

'onto the helicopter, making sure in my mind that we have got all the

'equipment ready to actually help him out if he needs medical attention.'

The man's disappeared while netting for prawns.

Dave and his crewmates know

the tide is likely to have taken him out to sea.

CHATTER OVER INTERCOM

Eventually, they spot an object in the water.

It is the missing fisherman but it's too late.

Paramedic Dave's medical skills will not be needed today.

Volunteers from the local surf rescue team will recover the body.

Westpac 2 returns to base in the worst possible circumstances.

We did find it a patient which, I guess, in some ways

gives closure to the family. Very tragic.

As I say, we would loved to have been...the patient been alive.

But it might be some comfort that we have actually found

the patient for the family.

70 miles southwest of Sydney,

the teenager pulled out of a wrecked car on an isolated rural road

has had life-saving treatment from British doctor Helen Oliver.

All right, awesome. Any pain in there?

-Any teeth loose or anything like that?

-No.

Tye Bradney was flown to the trauma centre at Liverpool Hospital.

36 hours later, Tye is recovering on the intensive care ward.

There was only four things, wasn't there? Or five?

I've got endless amounts of stitches all over my body,

through my feet, knees. I got holes in my knees.

Bruises all up my back and gammy kidneys and all that.

My face, as you can see.

They said if it has 2cm higher or lower it would have

cut my jugular and I would have bled to death.

Tye was in the car with his best friend and flat mate.

As I said, my mate is the worst one, do you know what I mean?

He is still in a coma. He's got a punctured lung and some broken ribs.

Everyone ready. Ready, steady, roll.

Ready, steady, down. Lovely.

He is very, very lucky. Just having seen now, sort of,

the pictures from the scene of the crash, which I didn't see

initially, I had just been told, yeah, he is incredibly lucky.

It's amazing, actually, that he has come away

with as little injury as he has.

And it wasn't just Tye who was lucky.

His friend came out of his coma and his only injury is a broken arm.

Both of them are now recovering at home with their families.

Subtitles by Red Bee Media Ltd