Episode 5 Helicopter Heroes

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,

they are likely to be British.

And so is the pilot, paramedic and crewman.

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

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

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, then?

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 is 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, sharks bring terror to Australia's beaches.

He just kept biting as he went down.

The heatwave leaves one tiny Aussie in need of rescue.

This baby's already been given quite a lot of fluids,

so you'd normally expect a response.

And a building worker is hit in the face by his pneumatic drill.

It's a decent implement that's hit him

with a fair bit of pneumatic force behind it.

The coastal waters off Australia are home to some of

the most dangerous creatures on earth,

perhaps most famously, the shark.

The best way to spot them is from the air,

so every summer, the Life Saver Rescue Helicopter in Sydney

goes out on shock patrol,

ready to clear the beaches at a moment's notice.

During the summer months,

we tend to go out every day and just patrol up and down the beach,

and if we see a shark

and we think that it might endanger the public, we can say,

you've got a three metre hammerhead

only 60 metres at the back of your break.

We're hovering possibly 50 feet above them

and pointing at the water.

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

Brit Tony Wood is a former Royal Marine

and he's done this job for ten years, but you won't catch him being

winched into the sea, especially when there are sharks around.

Personally, I wouldn't go in the water,

but my rescue crewmen do, and they're aware of what they're going into.

They're brave kids.

I came here 16 years ago with the impression that every time you

jumped in the water there would be a shark ready to eat you.

We have had shark attacks.

I have been to two in the time I have been on the company,

and we have actually responded to five in the time I have been here.

But today, Mike's helicopter team is responding to another, and it sounds serious.

'This is an Nova 96.9.

'There'll be no swimming on Mid North Coast beaches for 24 hours

'after a shark attack south of Port Macquarie.'

220 miles up the coast north of Sydney,

the rescue helicopter team's been scrambled.

A man's been attacked by a shark.

If we don't see a shark along here somewhere...

...I promise things.

29-year-old Luke Allan was surfing in an isolated bay

near Port Macquarie when he was attacked.

He was sitting on it out the back waiting for a set to come in

and when it hit him and knocked him off and took a couple of shots at him,

he managed to get the tip of his board and knock it down on the shark's head.

Straightaway I ran up and got my uncle to call the ambulance.

The shark has taken a big chunk out of Luke's thigh

and his hand is badly mauled. He may lose two fingers.

The paramedics we fly with are well trained to deal with

that at-the-scene care

and the whole idea behind it is that we get them as quickly

as we can to the place where they can get higher levels of care.

The nearest trauma centre is in Newcastle,

100 miles north of Sydney.

It's a journey that would take three hours by road.

In the next few hours, Luke will find out

if surgeons can save his mutilated fingers.

'Now, from the WSFM newsroom, Sydney's most comprehensive FM news.

'Two beaches in Sydney's north have been closed

'because of a shark which has taken a chunk out of a lifeguard's surfboard.'

Just two days later

and a popular surfing beach just north of Sydney is closed.

There's been another close encounter with a shark.

This time, the victim isn't taken to hospital.

In fact, he doesn't even realise he's been attacked

until he's back on dry land.

As I went to go up the wave, I just felt a big hit on the board,

and it knocked me forward and then it kind of dragged.

Eventually, I've come up.

That's when I noticed the bottom of my board had

this big half of the jaw mark, so it would have gone

the whole way round if it had got its jaw on.

My feet would have been on the other side,

and one would have been here. The other was there.

So the jaw came around.

The shark expert said when I was surfing, it would

have come from behind and he reckons the whole nose of the shark

would have been between my legs.

I've been back in heaps of times.

The next day I went in for a lunch-break surf at work.

I'll definitely have a look around now, a little cautious,

but I still love it and I've done it my whole life

and it's not going to stop me. We're in their territory.

Dee Why Beach has been reopened and the shark attack doesn't appear

to have put many beachgoers off, although the lifeguards say

some foreign tourists have probably watched too many shark movies.

A lot of English backpackers down here.

They've definitely got their questions.

Sharks are usually at the top of the list. "Where did you get that from?"

And straightaway they refer back to Jaws.

Jaws is a story that's getting told back at home.

Everyone's getting freaked out by it.

I don't know whether girls worry about it more than boys.

I surf a little bit and I always worry about sharks,

but a lot of the surfing culture over here, they go in anyway.

Doesn't put you off coming down here.

It's Australia, you know there are sharks are around.

If you keep in the back of your mind, you'll be fine.

And for any nervous swimmers,

the Life Saver Helicopter shark patrols are reassuring.

They're great to have up above you, keeping an eye on you.

The only scary moment is when they stop and hover above you, and that

generally means they've seen something, so that's a good indicator to get out.

Shark attacks on humans off the Australian coast are rare,

and the chances of being killed by one are very slight.

In 2012, 14 people were injured by sharks in Australia,

and two people were killed.

Luke Allan is one of the lucky ones.

Ten weeks ago, he was attacked

while he was serving in a remote bay 220 miles north of Sydney.

I didn't notice him until he was attached to my leg,

so the initial force felt like

someone was pressing a hit on me in a rugby game.

Not a sharp pain or anything, just pressure,

and he pushed me to the side and latched onto here and thrashed,

which sort of opened this first wound up and he just kept biting

as he went down, so he had one sustained bite, which was up here,

and then a second pretty much surgical incision puncture wound,

and the third one was a full thickness bite.

Luke was attacked by a bull shark, which scientists recently discovered

has the strongest bite of any shark species, including the great white.

So Luke has had a lucky escape.

He took this one off clean, and actually skimmed this one down

so it was on the back of my hand, and before I went into surgery,

they said, "You'll lose both of them at the knuckle."

They did such an excellent job and actually completely rebuilt

my index finger, which by all rights I should have lost both of them.

It's reaffirmed my affection for them.

There's no malice in what they do.

It's not a rational hatred to have,

and it's certainly not a rational fear to have, so no hard feelings.

No harm.

The Australian summer of 2013 has rewritten the history books,

with temperatures in Sydney topping 40 degrees Celsius.

But the old and young can't just cool off on the beach.

And today, British doctor Shalika Shetty has been sent to pick up

a casualty of the heatwave.

But she's not going by air.

We cover New South Wales, so it's a massive area,

about three times the size of England.

So we do need the helicopter for some retrievals which are very far out.

This unit is quite a short distance,

so it's doable by an ambulance, it's about half an hour.

Dr Shalika has just left the UK

and is in the third week of her secondment down under.

She's been there for four days,

and she's been progressively deteriorating,

so I think it's unlikely that she's going to suddenly get better.

She's on an urgent call to pick up a six-week-old baby girl with

severe dehydration, a condition not uncommon in this part of the world.

In Australia, we tend to be a hot climate. We can have hot days.

Last month, there were days in the 40s here in Sydney.

Anyone's at risk of dehydration, and in particular a six-week-old baby

who's got diarrhoea anyway and dehydrated, then the chances

of them becoming more dehydrated in that sort of environment increase.

This baby's already been given quite a lot of fluids,

so you'd normally expect a response, but in this case,

that hasn't happened, so it's not your usual patient,

so there could be something else going on.

The baby's parents brought her here

to Mount Druitt Hospital in Sydney's suburbs.

Now it's down to Dr Shalika

and Nurse Mel to transfer her back to central Sydney for treatment.

We're just going to go and find our patient and assess them

and speak to the parents,

and then make a plan of management before leaving.

You're very reliant on each other, so it's really important that

you're aware of your differing skill sets and abilities

and it tends to work very well.

Come on! Put some muscle in there, Mel!

SHE LAUGHS

Oh, my gosh, she's... What have you done?

It's not...

BABY CRIES

We're watching for any signs of deterioration,

so we're watching constantly her heart rate and her respiratory rate,

and we're just checking the blood pressure and profusion is good,

and her heart is circulating the blood properly.

The reason that we're moving her is we've just repeated

a couple of blood tests, and what they're showing is that she

has a quite significant metabolic acidosis,

despite being given a lot of fluid therapy, and it's not clear as to

why this is, so were querying an underlying condition that's causing

this, and it's not clear what, and that will need further investigation.

The concern happened overnight.

She seems to have become more dehydrated,

and the thing is that she didn't have a fluid balance being monitored.

She became very dry overnight,

and in the morning she was quite lethargic, dehydrated,

sunken fontanelle, sunken eyes.

We've just handed her over to the team here

and what we're going to do is have a bit more of a metabolic workup,

so the metabolic team here are going to come and review her and hopefully

have a plan as to what's going on and to investigate it further.

It's interesting,

because it's quite different from a lot of the other jobs.

In this job, every single mission we go on is different, I think

that's one of the great things. There's a lot of variety.

But the fact that we don't actually know what's going on

is quite interesting, and hopefully we'll find out very soon.

But the mystery continues, and even after a string of tests,

the experts are still struggling to diagnose exactly what's wrong.

I've got a couple of ideas about what could be.

Infection and allergy would probably be top of the list.

We may need to do more invasive tests, like endoscopy

and small bowel biopsy to give us that diagnosis.

But Dr Storman is still really impressed by the work Dr Shalika

and the rest of the British medics are doing here in Sydney.

They come well trained. They're usually happy to work hard.

They're here to have a good time. Work hard, play hard.

Yeah, we do have a lot of British doctors who come here.

A lot of them come and settle here for various reasons,

-steal our women...

-HE LAUGHS

It's a very multicultural society

here in Australia, particularly in Sydney.

Eventually, doctors discover

that the baby has a problem with her liver.

She has to return to hospital for regular treatment.

At the ambulance service helicopter base in Sydney,

they've had a call about a 19-year-old who's been

thrown off his horse and is now unconscious.

RADIO: Looks like there is plenty of good landing space at the site.

The doctor onboard is trauma specialist, Shane Trevithick.

For the last ten years, Dr Shane, has been recruiting British doctors

to work on rescue helicopters in New South Wales.

In Australia, amongst intensive care, anaesthesia and emergency medicine every year,

there aren't quite enough trainees who have a passion for working on pre-hospital rescue and helicopters.

So, we simply have to look further afield to get

the 20 to 30 doctors a year we need to fill the rosters.

We use people from England, Ireland, mainly because they have pretty much the same training our doctors do.

And they can fit into our system fairly easily.

RADIO: We're at the scene, 281 Maroubra Road.

Located at the back of the residence at this stage.

Er...we're more than likely going to have to walk in from here due to limited access.

We have such enormous distances,

we can't have a high-quality hospital every hour, even every two hours.

Sometimes you've got to travel more than four or five hours to get to a hospital.

In that case, we do a lot of aeromedical retrieval for those patients.

And that's where there's a huge difference.

RADIO: We're doing a recci as we speak.

It takes just 25 minutes to get to the accident.

By road it would have taken an hour and a half.

In cases of head injuries like this, time is critical.

-G'day.

-G'day, Doc. How are you goin'?

The patient over here?

My son has had a fall from a horse.

And he's unconscious, or he is in and out of consciousness.

We're going to intubate in the helicopter, yeah.

The 19-year-old patient, Aaron Erwin,

was riding out on land owned by his family in Wingello,

a tiny village halfway between Sydney and Canberra.

Yeah, yeah, we're gonna get him straight out now.

Aaron was with his father when he came off his horse.

His mother, who is a nurse, rang for the ambulance.

Nice and easy.

-All right, everybody ready?

-One, two, three...

The bridge is a mobile intensive care unit,

used in all the rescue helicopters in New South Wales.

AARON GROANS

OK.

GROANING

OK, all done.

It's a lightweight tray which sits over the stretcher

and holds the monitoring equipment, a ventilator and the oxygen and infusion pumps.

Dr Shane is about to perform one of the most risky procedures

that can be done outside a hospital environment.

He's going to give Aaron a powerful anaesthetic,

and then Huey, the paramedic will push a tube down his windpipe

so he can take over Aaron's breathing.

Because of his degree of agitation, he'll need a CT when he gets to hospital,

and the safest way to do that is to intubate him.

Yeah, the best way to do that is for me to intubate him here.

Or ask Huey and I will intubate him,

so, I'm pre-oxygenating him at the moment.

Even the simplest thing is made more difficult by doing it

out in the open or in the helicopter.

We like to take control of our environment, rather than letting the environment take control of us.

The sun is this way. So, you are going to have to...

Go from this way.

-Patient position optimised, confirmed.

-Yeah.

OK, sufficient O2, we've got the aircraft and we've got about two sources.

-Pre-oxygenation done?

-Complete.

-Suction tested?

-Yeah.

Even though Aaron needs to get to hospital as soon as possible,

it's essential that everything is properly checked before Dr Shane anaesthetises him.

A simple mistake now could lead to very serious problems

when they start this risky medical procedure.

Australia's economy is in relatively good shape compared with

the country the British doctors are arriving from.

Unemployment is low, and growth was 9% over the last three years.

House prices in some places have doubled in a decade,

which means the construction business is booming.

If you have a serious accident in Australia, it's far more

likely the ambulance that comes to you will be bringing a doctor.

Consultant, Sarah Coombes, left Yorkshire to become a flying doctor in New South Wales.

But today, she's left the helicopter behind.

We respond to a whole range of things,

so we've got the pre-hospital trauma and that is a lot of car accidents,

as you would expect, the same as back home in the UK.

We'll also go to cliff falls, some falls from heights.

The work here is something I cannot do at home now.

Emergency medicine back home has changed a lot since I've left.

And you don't get to do lots of the hands on critical care you get to do out here in Australia.

She's heading to this building site where ground worker,

Larry McMillan, has had a serious accident with a pneumatic hammer.

I'm just gonna send someone to have a look for the instrument

that's actually caused the injury to this gentleman.

It's a jackhammer by the sounds of it.

He was changing the bit and I don't know how he's managed to do it.

I saw a bit of commotion and come across and seen someone hurt and tried to help them.

His orbit looks OK, his eye looks intact.

He's complaining of a 7/10 pain and all his obs are quite stable.

The gentleman was sort of walking back and forth, holding his face.

As I came out, he fell to the ground.

So, I grabbed a few towels because I could see blood on his hands.

I tried to help.

I'll just have a look and make sure the eye movements are good and sensation is good,

and see if he's got anything other than a simple zygoma.

We're also just about to put a cervical collar on too.

Larry, I'm Sarah, I'm one of the helicopter doctors. How are you?

Not so good.

OK, any pain down here? No pain at all? OK.

You feel me touching here? Here? Beautiful, OK.

I want you to gently turn your head to look over your left for me...

Lift your head up and put your chin on your chest.

No pain in your neck when you do that?

OK, so his cervical spine is cleared.

It looks like he was changing the actual bits out of the pneumatic jackhammer,

so he's gone to put the second piece in over here.

There's actually still compressed air in the jackhammer so when

he's loaded it, it's actually sprung back out and hit him in the face.

So it's quite a decent implement that's hit him with a fair bit of pneumatic force.

Just open your mouth for me, darling.

I'm going to slide my fingers in your mouth, and just to feel round that upper jaw.

Tender in there, yeah? I'm just going to grab your teeth and give a wiggle.

The initial report on this was that he had a reduced level of consciousness,

so a risk of a brain injury.

And bringing a doctor to the scene you can potentially secure somebody's airway,

manage their ventilation to give them the best chance of surviving a brain injury.

And then we would take them to a neurosurgical centre so we would probably take them into Sydney.

But it's clear that it's not needed this time, Larry's been extremely fortunate.

He's not looking too bad, he's been very lucky.

He's had a fully charged pneumatic jackhammer hit him in the face.

Wasn't knocked out by it, but he's got a nasty laceration over his cheekbone.

Probably got a broken cheekbone, maybe broken his upper jaw here.

But it all looks in place, all his nerves are working properly.

So, a bit of pain relief and he can go to the local hospital and they should be able to manage it.

So Larry, heads here to Wollongong hospital,

but once inside, they discover just how serious is accident was.

They found the cheekbone was broken and the eye-socket,

and damage to the side of the nose.

The jackhammer went through there, put a hole through my cheekbone.

Fractured the bottom of my eye-socket

and to fix it they put two plates in.

I don't think we're having fish tonight.

This is a father and son team, who also work together.

Kane was working as Larry's apprentice at the time

and was the first one who came rushing to help.

He was kneeling over to change over the jackhammer

and basically it went off and hit him in the face.

He got up and had his hands on his face, so I couldn't really see exactly what happened.

I didn't really feel it at first, but I thought it hit me

in the top of the lip and I thought I'd lost my teeth.

I thought it got him in the eye, so I was expecting to see

the jackhammer piece coming out of his head...

..but luckily not.

Then all of the sudden blood started pouring out of here

and I thought, "No, it's got me."

Any pain down here? No pain at all, OK.

I remember her being there and she basically went over me and checked my wound.

All I remember is her saying, no,

he doesn't have to go by helicopter, he can go by road.

She was really nice. I felt at ease, I felt comfortable.

Considering the pain I was in.

Fortunately it caught him just under his cheekbone which stopped the impact.

If it had been slightly higher it would have gone straight through his eye.

If it had been slightly lower down it would have gone up through his mouth and through into his brain.

So he was exceptionally lucky.

I'm grateful for the outcome for the accident I had.

I wish I never had the accident, but I did.

And, the outcome is pretty good.

I really could've lost my eye and there would be no more fishing.

It would be hard fishing with one eye.

I wouldn't be able to ride my motorcycle.

But I'm pretty happy with how it came out.

You have to be grateful for that.

Back in a paddock near the town of Wingello,

Dr Shane Trevithick is anaesthetising teenage horseman,

Aaron Erwin, badly injured in a riding accident.

Good view?

With a haemorrhage into the brain, it can cause a lot of swelling.

And with the skull, that's a closed box, effectively,

with all that swelling, there's no way the pressure to

go except to force the brain out of the skull, which is fatal.

Right, let's get going.

Given the proximity to the nearest hospital,

this gentleman is quite a distance.

The most appropriate transport option for this patient, he's being loaded in

the helicopter now and they are going to be ready to take off very shortly.

Dr Shane fears Aaron may also have a collapsed lung, but thanks

to the chopper's ultrasound machine, he can rule that out immediately.

No, he's got no pneumothorax.

Aaron's condition is now critical.

Dr Shane and paramedic, Huey, are in full control of his breathing.

Have you got that other bag of fluid, mate?

< It's already up.

Most people who love horses forget they are unbelievably

dangerous to the human being.

They seem to be just the right height that when you fall off them, you're either

critically injured or you bounce off the ground, have a bruise and get on with life.

There's no in between with a horse.

It takes just 20 minutes to get to Aaron into Sydney.

Happy when you are, mate.

His life hangs in the balance,

but Dr Shane can now hand over to a team of surgeons.

The horse has fallen over sideways, he was thrown off the horse.

He was wearing a helmet.

And, he did, once or twice make some moaning sounds...

The following days are an anxious time for Aaron's family,

as they wait for news from the hospital.

Despite still being a teenager, he's a very experienced horseman

and the accident is a terrible shock.

It's probably every parent's worst nightmare, I think.

It's really hard to watch someone you obviously love

and care about so much, be in that kind of situation.

Aaron is kept in an induced coma for two days as fluid

is drained from his skull, easing the pressure on his brain.

Then doctors wake him up.

On extubation, he did really well, but he had trouble walking

and some short-term memory issues.

So, he was sent to the brain injury rehab unit,

at Liverpool hospital for a few weeks.

And now, we have two just work on his balance and his processing

of information that goes in, it's a little slow,

which is pretty typical of that sort of brain injury.

But, really, a month later, he's doing extremely well.

And that's because he got early intervention.

Aaron is one of Australia's youngest professional riders.

He recently gave up his job to concentrate on rehabilitating problem horses.

I didn't want to be a mechanic for the rest of my life,

and I didn't want to do something I didn't enjoy.

This is what I enjoy, so I thought, why not.

Aaron has been riding since he was five, and this isn't going to stop him.

I would love to compete in the Olympics when I'm older.

It's a long, hard journey to get there.

Accidents happen, yes.

You know, it's not going to stop me.

Subtitles by Red Bee Media