Please meet Dr. Alistair Maddock, Consultant Anaesthesist at the Queen Elizabeth University Hospital and Retrieval Physician in the Emergency Medical Retrieval Service in Glasgow.
He is interviewed by Hans Morten Lossius, the General Secretary of the Norwegian Air Ambulance Foundation (NAAF) in the beginning of June 2020.
– We have finished the first wave of Covid, and things have definitely de-escalated again. Everyone is anxiously waiting to see if it is going to be a second wave of Covid in the intensive care units (ICU’s) as we move in to winter, Maddock says.
He personally hasn’t had a huge amount of experience in managing Covid-patients.
Prepared for 100 ICU Covid-patients
– I was seconded to go and work full time in the Emergency Medical Retrieval Service (EMRS) in Glasgow, for the first two months of the Covid outbreak.
Over all he thinks that the health service has coped ok with has been thrown at it. They have increased the capacity, and the number of beds.
– Thankfully they were not all needed.
Maddock tells that they managed to increase ICU beds because elective surgery basically has been cancelled for a number of weeks.
– Lots of my colleagues from the Anaestethic Department was seconded to staff an increased number of intensive care beds.
Normally his hospital has 20 ICU beds. They planned to go up to a hundred – if needed.
– In the end at most I think we had about 35 ventilated Covid-patients.
They may have had equipment for hundred beds, but Maddock is not sure they would have managed to staff them all.
– It probably wouldn’t have been traditional intensive care, but that was the plan on what we could achieve.
Operational preparations for Covid
Health in the United Kingdom is a devolved matter, so the government in Scotland, Wales, Northern Ireland and England all set their health policy independently, Maddock describes.
The situation in a public health point of view is defined in the constituent nations of the UK, meaning that some of the lock down and changes in Scotland are different compared to the ones in England.
– The remote and rural Scotland that EMRS mostly covers for secondary retrievals has been speared of Covid compared to the mainland.
The islands, the remote and rural Scotland almost locked themselves down quite early in the outbreak, and the ferry and the plane-companies have been very good at stopping non-locals getting on and off the islands, unless they had essential business.
– They basically locked in and locked out, so we actually have been very lucky that we haven’t had to move very many Covid-patients, because it hasn’t made out to the islands yet.
Therefor Maddock spent eight weeks full time at the EMRS heavily involved in the operational side of trying to put in place Covid-respons. The tactical and strategical stuff has been left to other colleagues.
– I spent a lot of time doing simulation, looking at new pieces of equipment, and trying to work out how to fit things into our usual way of doing business.
Medical PPE versus avation PPE
Like many other services, one of the main conflicts that Maddock describes, has been the conflict between the requirement to wear clinical personal protective equipment (PPE), and also to wear aviation PPE, when you are undertaking a rotor wing flight.
– Trying to find appropriate compromises from what you can wear on a normal helicopter mission and to protect you from patients who may have Covid. It has been difficult, but we got there in the end!
Maddock tells that they roughly ended up doing about 20 isolated transports, 14 of them by road.
– We have been lucky that the outbreak mostly has been at the mainland, with a noticeable exception of Shetland.
There they had a family and a group of people who came back from a skiing holiday in Italy.
– There was a cluster there. We were hopeful that the Norwegian Air Ambulance would move them, because Shetland is closer to Stavanger than to Aberdeen, but we couldn’t convince them unfortunately, Maddock grins.
He tells that EMRS now feel prepared and are in place when it comes to doing isolated transfers of suspected or confirmed Covid-patients as required.
– But we actually haven’t ended up doing very many of them.
He describes it as filling a hole into their business as usual, but the number of missions and activity has fallen a lot during the pandemic.
–There are less primary trauma missions, because people aren’t working or doing leisure stuff.
There are also fewer referrals and secondary missions.
– It might be people not presenting to healthcare facilities with problems they normally would.
Lossius asks about the set-up in the helicopters. Maddock tells that they are used to operating transports on variety of platforms.
– EMRS has always been designed as a transport platform independent of organization. Once we get the patient packaged up, as long as we have oxygen supply we can move people by any means of transport really.
They have used various aircrafts over the years, and according to Maddock, slightly odd stuff, using life boards and things to move the patient as required. Normally in their core business they got two ambulance helicopters which reach 145, they have King Air and fixed wing ambulances as well.
Collaborating with search & rescue, and military aviation
– At the moment we have not found a way that our aviation providers are happy with moving confirmed or suspected Covid-patients in either of those civilian air ambulances, so air transfers have either been with military aircraft – both fixed wing and rotor wing – and with search and rescue helicopters (SAR).
They are very used to working with SAR. Especially in the winter the weather in Scotland is not always congestive to civilian air ambulance flight. Then SAR helps, and they are already used to collaborating with them.
– They have worked very hard to get a system in place where the crew have been tested for FFP-masks and so on, so we can carry ventilated Covid-patients in a SAR aircraft with everyone wearing appropriate PPE.
They have managed to get disposable flame-retardant cover alls and life jackets, and headsets that can be cleaned after a transport. – That’s our rotary option at the moment, and we are working on the civilian stuff in the background, but I am not sure how far we get with that. We have a workable solution, either with SAR or with military assistance with these transfers when they need to be done.
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