Episode 6 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 crewmen.

We see lots of sharks 200 or 300 metres out.

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

They say they got the bends from coming up too quick.

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 is that tummy pain now? Now, like hundreds of medics every year,

he's swapping rainy Britain for a life in the sun.

We are living right by the ocean. It's a beautiful spot.

Work is 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 have a listen to your heart?

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

Today a baby's life could depend on a low-level flight through the mountains.

The pilot is pretty happy to fly a little bit lower for us. That's good.

We're not sure in these conditions.

A flying doctor faces a dangerous descent into the bush.

Lots of foliage, lots of trees and not very easy access.

And a motorist is trapped after a head-on collision.

The left foot is kind of wedged between the clutch and the front of the car.

Australia is a nation built by the British

and visitors from the UK often have a familiar feeling when they arrive.

This is Newcastle, a city built on coal with suburbs called Gosford and Wickham.

Only this is New South Wales, not Northumberland.

It's home to former Royal Navy Officer, Mike De Winton,

who is planning a rescue mission to a place called Tamworth

that's certainly not in Staffordshire.

So we will always look at a job

and decide whether we as a crew can do it

and whether the aircraft can safely do the actual mission

and then we'll discuss and have a brief with the crews before we do it.

They've been joined by a specialist neonatal team

that's about to head to one of its youngest ever patients.

It's a premature baby, 34 weeker,

who is currently in Tamworth neonatal unit.

This is quite normal for us to go out and do this, out to Tamworth.

I have been up there by road before but that took about five hours

so time is pretty crucial here. 'Medical Westpac One.'

Dr Larissa Korostenski is bringing her skills to this job from Britain.

I actually started doing paediatrics when I was in the UK.

Started off in North Wales in Bangor as an intern

and then my ending in London was in Great Ormond Street, which was a wonderful experience.

The team is heading for a very different hospital,

one where local doctors are caring for a newborn baby with a collapsed lung.

We'll have to decide whether we put a chest drain in,

to drain the little bit of air that is there.

They have to consider, up in the air, whether the pneumothorax can re-accumulate,

so that's the main decision we'll need to make now.

BABY CRIES

Because he was born at 36 weeks,

his lungs at the moment are not making all the things

they need to make to be able to expand the right way so he's having trouble breathing.

So now this baby has to go to a bigger centre,

where some more positive pressure can push the air into his lungs.

So this is the latest one, there. It's pretty much the same, isn't it?

BABY SNEEZES BOTH: Bless you.

We're not specifically trained, I suppose, as retrieval doctors.

We are trained as neonatal doctors and this comes as part of the job.

We're still working really hard, when we get upset, up to 90 breaths per minute,

but still maintained saturations in air.

But we are flying, I suppose, is the thing I have.

I can always have a butterfly needle ready if I need to, in-flight, and ask them to fly low.

Although Laiylan is now 10 hours old,

his mum Cynthia hasn't yet even been able to hold her son

because he has been needing specialist care.

When they phoned us, he was in 30% oxygen

and now he is down to air, so he is improving.

And we would expect him to carry on improving.

The thing that I've been trying to work out is sometimes when you get up in the higher pressures,

higher altitudes, it can cause pneumothorax, even in healthy people.

And because he's got that lung disease,

he's at increased risk and because he has had a bit of air leak as well.

So I've been thinking whether to put a chest drain in

but he's doing so well on the CPAP in air, so I think we'll be fine.

Dr Larissa knows that if Laiylan's breathing worsens,

she may need to operate in mid-air,

using a needle to allow air out of his chest.

And altitude could affect him.

I don't know if it is a possibility we can fly lower? I don't know.

Yeah, no. That's no problem. Good.

It's not a problem. Daytime, the weather is fine.

So we'll just go over the hills on the way back.

The weather is fine so we will see it all.

I'll put my party hat on.

'Medical Westpac One.'

But low-flying brings added risks, especially when there are big obstacles in the way.

Between here and Tamworth, there are 5,500 foot mountains

and there are a couple of tracks back from there

where we can actually keep the height down to around 2,000 feet,

if we pick a few of the valleys to fly down.

These are areas that we fly regularly at height

so we know what's in there and where the wires and masts are,

so when we come back, we will, if the doctor's asked us to keep low,

we'll fly down those valleys, which will minimise any risk to us

and also minimise any altitude to the child.

It was very good. No issues.

We had a little bit of oxygen and travelled really well.

Mum will come down tomorrow.

We've got expressed breast milk so as soon as he settles down

and his respiratory rate comes down, we'll be able to start feeding him.

Anything else? No, that's it. Thank you so much, guys.

Have a good day. Thank you, you too. See you next time.

Laiylan.

I got told that because he was born at 36 weeks, he had immature lungs.

And he may have had a bit of fluid on his lungs.

They just basically said that because he was a bit early,

he didn't have that stuff to help him and it's a bit harder for him to blow up his lungs.

He had a little bit of an air leak

and one of my biggest decisions was, being in a helicopter,

increased altitude can make more air leak

and that air leaking can compress the lung and cause further respiratory compromise.

So that was the decision I needed to make,

whether I needed to put a chest drain in to drain that air before we got into the helicopter,

but because his clinical condition had improved and the pilots could fly low,

I decided we would be OK without a chest drain.

He's doing really good.

He is breathing on his own and he is not needing help

but they said that hopefully, this afternoon,

if he's really good, I can get is to hold him and stuff.

So for Dr Larissa, it's been another successful outcome.

Using the skills down under which she learned back home.

Getting up and standing in the freezing cold for the train from East Sheen into London,

it's nothing compared to having the beach 10 minutes away.

So it's a much more relaxed lifestyle, I would say.

Then again, there are times when I think about my bus trip across the bridge, you know,

going to Great Ormond Street, that was also beautiful in its own way.

I think certainly, because I have two children, it's a much better place to live here.

But not all of Australia is child-friendly.

This is Crocodile Dundee country, the Northern Territory,

where the wildlife is as harsh as the climate.

It's also home to another iconic Australian institution,

the Outback flying doctor.

Emergency medicine tends to be a little more autonomous

and you can push the envelope just a little bit further over here,

so you have ownership of your patients for a little bit longer,

rather than just passing them on to other colleagues.

Dr John Roe is from Liverpool.

Today he's flying 250 miles from Darwin

to the small town of Wadeye, home to an Aboriginal community.

They've got many health issues,

a lot of social disadvantages compared to other Australians, unfortunately.

It's very common for these guys to have diabetes,

which I think is a bit of a silent epidemic up here.

Nurse Shona Laird runs the cottage hospital.

She's been treating a young woman with sepsis,

a lethal condition caused by her diabetes.

She came up to the clinic yesterday and had some sutures removed from her ear.

Dr John knows the average member of Australia's indigenous communities dies at just 47.

The causes are complex.

Drug and alcohol can be a problem in some communities

and the way of life is perhaps changed

from what things were traditionally,

throw in European involvement and a lot of the strong community ties

that would have existed have been eroded over time.

So it makes it a pretty complicated picture,

it's not just the medicine that's different here but there's a whole swathe of social issues

to be mindful of in the background as well.

Wadeye was founded by missionaries nearly 100 years ago

but many of the population is suspicious about modern medicine.

There are many communities that live close to the traditional way of life

so they are still into hunting and fishing

and doing a lot of things their ancestors would have done

when the Europeans first got over to Australia

and that is another barrier, really, to healthcare.

Those guys don't want to leave where their ancestors are

and come to Darwin for treatment

and they can often perceive that as white man medicine

and there are many stigmas attached to that as well.

We've kind of semi stabilised patient for retrieval back to Darwin

so the flight team have taken over her care

and she's on her way to Darwin,

hopefully she's going to get better very quickly.

So John and the team are now flying back

across the Northern Territory to Darwin,

this area's major city and the only place their patient can get the life-saving treatment she needs.

My previous experience in Australia is really metropolitan,

out in Melbourne, and that really didn't give me any clue as to what I would face up here

and it was a massive eye-opener coming and seeing the communities

and some of the problems these guys have to face.

At Darwin, their patient is taking the final stretch of her journey by road.

She is kept in the hospital for further treatment.

For John, it's a job that's typical of his workload Down Under

and with the landscape and lifestyle, he has no plans to head back to the UK.

I can just see a great future for my little baby, going to school

and hopefully learning to surf and play footy and be outdoors.

Even though he's two weeks old, he starts rugby training next week

and will he play for Australia or will he play for England?

There are issues to be ironed out with my wife

as we move along the track a little bit.

One thing that keeps the flying doctors down under,

is the unpredictability of their jobs.

MOBILE RINGS

624. Yes, mate.

Two people are trapped after a head-on car crash

and Scottish doctor, David Anderson, is on the case.

OK, we'll go back to the aircraft.

A routine hospital transfer flight has changed to an urgent rescue.

We've got a quick Latin Long John to Tomerong,

but we'll get something more definite in a minute. OK.

The crush has happened in a remote stress of the Princes Highway,

which is a 1,200-mile road running down the coast, south of Sydney.

HELICOPTER RADIO: We'll be overhead Tomerong in about five minutes.

I have a long background working in pre-hospital care.

I used to be a paramedic and that's what brought me

to work with HEMS service here.

It's a good mixture of my background as a doctor and my background as a paramedic.

Too much bush between there and the road for the guys to go.

The nearest landing site is a paddock next to the road.

INDISTINCT TALKING ON THE RADIO

Pilot, Ian Broome, known as 'Broomy', is relying on the skills

of the paramedic and the crewmen to guide him in through the trees.

We're in a bit of a hole, it's looking OK.

Looking inside and underneath.

71-year-old, Gloria Ardwin,

is trapped after losing control of her car and crashing head-on into another vehicle.

She's complaining of pain to the right side of the ribs and right side of the leg.

There's a laceration as well. The feet aren't compressed at all. OK.

She's got deep skin tears on this side and that side.

Cannulated five of morphine and oxygen.

I was driving north back home, back to Sydney and I noticed a car

veering on the wrong side of the road, just missed me

and I looked in my rear vision mirror and it collected the car behind me.

After the impact, did a few barrel rolls.

All I saw after that was a plume of dirt and it came to rest right there.

Gloria was driving home after visiting her son in Sydney, when the accident happened.

Do you know where you are at the moment?

I'm going home. You're going home? I'm nearly home.

Nearly home...do you remember what happened today?

The first thing I knew I was spun around.

What day is it today?

I've no idea.

Just going to look at your legs, then talk to these guys about how we can get you out, OK?

The left foot is wedged in between the clutch and the front of the car.

It looks like it'll come out but if we get snagged on it, we might just have to reassess.

But I think it'll be all right.

Dr David and the team managed to manoeuvre Gloria

out of the car without using any cutting equipment.

GLORIA: Argh.

OK, pivot her round. Bring it over. Sorry guys.

Can you straighten your left leg? No.

Gloria has broken her knee and her leg.

But because she hit the other car so hard,

it's likely she also has more serious, internal injuries.

So, we're just going to get the patient out of the car and do some more assessments.

It's very difficult to assess her in her car, so we'll do it in the back of the ambulance.

The couple who were in the other car have escaped with cuts and bruises.

OK, on the count of three we'll lift and we'll go in stages so we'll probably do three stages, OK?

Ready? One, two, three, lift.

About 40 minutes St George Hospital which is the trauma centre

that covers the southern part of Sydney.

Gloria's pretty stable now,

we're happy with her pulse and blood pressure.

She's still a bit cool peripherally but we don't want to give her too much fluid

because there's evidence now that people who're bleeding and giving them

fluid that isn't blood isn't so good for them.

She's got good blood pressure, we're happy with that.

Managing her pain with a bit of morphine and we'll stay in touch with her during the flight.

Good afternoon it's the air ambulance helicopter, how are you? Good, thank you.

We're coming over the south coast where we've retrieved

a 72-year-old lady from a car accident. Are you ready to take the medical details?

This 40 minute journey in the helicopter would have taken at least three hours by road.

And in Gloria's case, the time saved could prove critical.

Trauma in the elderly is an increasing problem.

People have less reserve to cope with things.

They're often on blood-thinning medicines which makes any bleeding worse,

and often on blood pressure medicines which affects their ability to cope with blood loss.

She has an increased heart rate, it's going fast all the time anyway.

She's probably on medicines to slow it down slightly so the fact

she's going fast already does imply there is a degree of shock.

But she's maintaining her blood pressure at the moment, so we're happy with that.

But we're checking it every three minutes to make sure.

Also, she is opening her eyes and looking around and she's breathing normally.

If any of that changed that would get us alarmed.

Gloria can't remember much about the accident.

She thinks she may have fallen asleep at the wheel.

We've taken Gloria into the resuscitation room at the hospital here.

She's actually deteriorated a little bit since we got her into resuss.

It's reassuring we've brought her to the trauma centre.

Her blood pressure is decreasing and her heart rate has gone up a bit,

and she's had a blood transfusion, but I think we got her here just in time,

and it's good she came in the helicopter rather than an ambulance to another hospital.

Given the speed she was travelling at when she had the other car head on,

Gloria was lucky to escape with just a broken knee and leg.

She spent several weeks recovering in hospital,

but was still able to celebrate her 50th wedding anniversary with her husband, Harold.

In places like Sydney, many of Australia's hospitals are state-of-the-art.

British-born Dr, Toby Fogg works in one.

We've got everything we need, pretty much.

And that evolves as we see new technology coming out.

We will evaluate it,

think about it and maybe incorporate it in what we do carry.

Now that technology is bringing big-city medicine to remote health centres via the internet.

69-year-old cancer patient, John Laurent,

is up about to be examined by a doctor 50 miles away.

We've got a new web cam and this patient has leukaemia.

His blood pressure dropped really, really quickly, so it's important

we get urgent medical treatment to get him to a bigger referral hospital than us.

We're a very small rural hospital and we have few resources.

And our GPs have been to see him but they need extra support,

so the web cam has provided us with that.

At the other end of the camera is a consultant in Newcastle's John Hunter Hospital.

And he's decided to send his emergency retrieval team to go and fetch John.

Newcastle city helicopter, Westpac.

Crew is airborne now, from the John Hunter Hospital for Dungog Hospital...

Dr Simon McLaughlin will be responsible for John during the transfer,

but first they need to get there and make sure he's stable enough to fly.

I'm just after some lignocaine and a syringe and needles and stuff, where would I find that?

At Dungog Medical Centre, the local GP has been treating John,

but he knows there's only so much his team can do.

John is actually a long-term patient of mine,

so today he's come in with low blood pressure

so we treated him with antibiotics and fluids

and medication to increase his blood pressure.

Just leave your hand there, we'll let that do its job, OK?

Simon needs to be sure John is stable enough to fly.

Carly, Simon here out at Dungog, is Martin around?

But now he is able to share that decision.

He looks unwell and septic.

Not only can he describe John's conditioned to the consultant at John Hunter Hospital...

He's only got a HB of 54.

..that senior medic is also able to watch every development.

Probably a central line and then bring him back, what's your thoughts?

While I'm putting that line in we'll run another blood gas

and then we'll reassess from there.

It's not as good as being there, but the technology is good.

So whether it's looking at an ECG or a heart tracing,

or looking at a patient, you can get a sense of what's going on.

You can tip the monitor to the screen to get constant readouts of their vital signs.

We need to get you to a bigger hospital really quickly,

because we need to get you some blood products, OK?

If you've got any pain, or anything, just give me

a thumbs down and point to what the problem is, OK?

John's wife Pamela knows that deciding to take John as he is, is risky.

If he deteriorates, there's little they can do in flight.

But his need for a blood transfusion is too great to delay any more.

RADIO CHATTER

In Australian terms, this is a short flight, just 15 minutes.

But during it, John's condition gets worse.

His treatment continues here at John Hunter Hospital.

But, despite all the team's efforts, his health slowly deteriorates as his leukaemia takes hold.

And a week later, he dies.

But, his family knows John's final hours were made more comfortable

by the doctors who treated is illness and the technology

that allowed them to manage his care from many miles away.

Sydney has been voted one of the world's top ten best places to live, many times.

But at the weekend, the four million people who call this place home like to do the same

as city dwellers the world over, and that escape to the country.

It means working weekends for flying doctor, Pete Sherren from London is rarely restful.

On top of all of those things,

the medical and clinical things we're doing,

we're also having to function as a bit of

a search and rescue aircraft as well.

RADIO: Thank you, Rescue 23 has departed now...

It looks like a mountain bike rider has come off his bike on a trail in the National Park.

We're not really sure of his condition, but there's some pretty

experienced guys on the ground who will let us know what's happening.

Somewhere in the forest below, 58-year-old, Mark Stillwell, lies badly injured.

Ground paramedics are trekking through the trees to find him.

They're walking in, is that correct?

Yeah, they should be in further than us right now...unless it's a different track.

If they are walking in, the patient is not going to be coming out that way, either?

It's not going to be easy to get the patient out.

The crew of rescue 23 can only circle the area in the hope

of catching a glimpse of the casualty through the tree canopy.

Rescue 23, we've now located the patient.

Went over the handlebars. Loss of consciousness for up to five minutes. Facial abrasions.

Amnesia to the event when referred to questioning.

It sounds like the patient may have the symptoms of a brain injury.

Rescue 23 has a winch, but lowering Dr Pete into trees will be difficult and dangerous.

We're going to set up and winch our medical team in and go from there.

But, when Dr Pete gets to his patient, he finds his injuries

aren't serious enough to justify the risk of winching him out.

Instead he's driven out of the woods in a 4x4.

Mark Stillwell's condition is now stable.

Just four and half kilometres down a bush track,

he was mountain biking this morning, which he does every week, apparently.

Just came off over the handlebars when he hit a rock, but there's a lot of cyclists, a lot of horse riders

and people out on nice days like this, so recreation activities are common

and unfortunately often happen in remote areas with lots of foliage, lots of trees

and not very easy access down dirt tracks. We'll be in North Shore, probably about

five minutes, if that.

Land on their new helipad.

Mark's family has heard of the accident. It's his daughter's wedding tomorrow

and it's looking like he may not be there.

You look a mess. Oh, honey. Oh.

I'll ruin the wedding photos.

Oh, hey, there's an idea.

RADIO CHATTER

Mark is being flown direct to specialist at Sydney's most modern hospital,

the Royal North Shore.

OK, this is Mark, he's 58-years-old.

And, just around 8:30 this morning he was mountain biking around Terry Hills.

Came off his bike, an unknown speed, hit a rock,

no presyncable or syncable episode at the time, was not feeling otherwise unwell.

Came off the rock, hit his head on the right side of his body...

Mark needs a full body scan to determine the extent of his injuries.

It's down to the doctors at the Royal North Shore Hospital to get

him patched up and back on his feet to walk his daughter down the aisle.

OK, I'll leave you with the doctors and nurses here, all right.

Thanks very much. No problem.

Luckily, Mark's not quite as badly damaged as his bike

and the following morning, he's home.

It was mainly abrasions and cuts that I sustained by falling off.

I also hit my head. I had a helmet on, which I normally ride with.

I think the rock must have hit my right side here

because the facial injuries seem to be more on the right side

and it's not me unconscious and put a few dents in my helmet, and four cracked ribs.

But it takes more than a few injuries to keep this dad from his daughter's big day.

Less than 24 hours after he last flew into the centre of Sydney Mark is back,

smiling through the pain to walk Kate, down a very spectacular aisle.

I don't think I was supposed to find out, for starters,

so I rang up wanting to speak to my brother

and one of my cousins casually said, "He's at emergency with your dad".

OK, step back...explain!

I give you my love for eternity.

It was nice seeing him walk in through the door, even though he's a bit scraped and banged up,

but he's walking, he's fine.

And having given away a daughter, Mark's determined to be

back on his bike before the end of the honeymoon.

Subtitles by Red Bee Media