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A day in the life of a 'flying doctor' The pioneering'flying doctors'service was launched in Wales two years ago. It has allowed NHS consultants to be flown via helicopter across the country to treat patients in life-threatening situations. Here, consultant in anaesthetics Dr Ami Jones describes her typical day.

IDRIVE the 60 miles from my house in Abergavenny to the Wales Air Ambulance Charity's purpose-built base in Llanelli ready for the 8am start.

Alongside the critical care practitioner (CCP), today I have one of the pre-hospital Emergency Medicine (PHEM) trainees with me.

This is a registrar who takes a year out of their hospital speciality training programme to spend time doing shifts on the air ambulance.

Our first job of the day is to go through the daily equipment and drug checks, and load our kit onto the helicopter.

Once the checks are done and we have received our daily weather, aircraft and safety briefing from the pilot, we head to the training room to put ourselves through a simulated case.

Our daily simulation allows us to practice a high-pressure case in a relatively low-pressure environment so we can work on improving our decision-making and communication skills.

We also use simulation to practice rare events such as limb amputations or open heart surgery.

We have a catalogue of about 150 different cases to choose from.

Today the team are practising performing a roadside anaesthetic on a child who has been hit by a car and sustained a brain injury.

Putting a patient off to sleep for a severe head injury would ordinarily only be done at the hospital.

As an advanced medical service, we can bring these skills safely to the scene of the accident.

We can institute brain and lung protection and then take the patient to the hospital with specialist resources, rather than the nearest hospital.

This ensures that they receive specialist treatment quickly and avoids a timely and costly secondary transfer between hospitals.

As we are finishing our simulation debrief, the emergency alarm sounds.

The pilot, PHEM trainee and I grab our helmets and drugs bag and head out to the aircraft while the CCP takes the details of the job.

The pilot starts the helicopter and, after a series of safety checks, we lift off.

We are flying to west Wales to a middle-aged man who has suffered a cardiac arrest.

As we near the scene, we receive a message to say that the Welsh Ambulance Service paramedic crew have managed to restart his heart.

This is great news but there is still much to do. His heart required external massage with CPR for over 20 minutes so he's unlikely to have woken up once his heart restarted.

It's rare for a patient who has required a period of CPR to wake up and breathe properly for themselves.

If their heart is successfully restarted, they often need a breathing tube to be inserted and to be placed onto a ventilator.

The paramedics have done a great job and our ultrasound machine confirms that his heart is beating well, but his level of consciousness is low.

The paramedic crew have performed a heart tracing which confirms that the patient is having a heart attack likely due to blocked arteries in the heart.

We decide to anaesthetise him and place him on our ventilator to support his breathing.

The patient needs to be taken to a specialist heart centre so that he can get the arteries in his heart opened.

The nearest centre is in Swansea, which would take over an hour by road but just a matter of minutes by air.

I make a call to the heart specialists and arrange for the patient to be taken straight to surgery, where the hospital medics will perform a specialist heart procedure.

This gives his heart the best possible chance of a good recovery, and the fact that we have put him on a ventilator gives his brain the best possible chance of recovery. When we land in Swansea the heart specialists are in their surgical gowns and ready to perform the procedure.

After we hand over and complete our paperwork we head back to the helicopter.

Back at the base, we replenish our drugs and check our equipment.

As we have performed an anaesthetic on the patient, there is also a paper process to work through.

At our monthly governance meetings, consultants and CCPs examine and scrutinise each anaesthetic and blood transfusion that the service has delivered.

This ensures that they are being performed to the highest possible standard.

It's mid-afternoon and the emergency alarm goes again.

This time we are heading to a young child who has received nasty leg fractures after being hit by a car.

When we arrive we give her pain relief via a special piece of equipment which allows us to administer a painkiller via the nostril.

This avoids having to insert a needle into their vein when they are already very upset and in pain.

Often this settles the child down well enough that we are then able to get them to accept a needle being inserted into the vein to give other medications required once in hospital.

After easing the discomfort, we transport her to Cardiff where they specialise in paediatric care.

On the way back to base, while still in the air, we receive another call from the charity-funded Air Desk.

We are sent to a middle-aged lady in mid Wales who was complaining of a headache and is now unconscious.

We are able to administer an anaesthetic and insert a breathing tube to take over her breathing with a ventilator.

We also give her some specialist medications to reduce the pressure in the brain and then fly her to the neurosurgical centre in Cardiff.

Unfortunately, a CT scan at the hospital confirms our worst suspicions - she has a bleed in her brain. However, due to our advanced care and the fact that she arrived at the specialist centre in good time, we have given her every possible chance of making a meaningful recovery.

We are a 12-hour service and the shift was scheduled to finish at 8pm. Our last job meant that we arrived back at base around 10pm.

| Originally from Shropshire, Dr Ami Jones is a consultant in anaesthetics, intensive care and pre-hospital medicine within the Aneurin Bevan University Health Board. She is also a Lieutenant Colonel in the Army Reserves with 203 Field Hospital and has undertaken two tours of duty in Afghanistan on MERT (the military prehospital service). Ami has been a part of the Emergency Medical Retrieval and Transfer Service (EMRTS Cymru), or "Flying Doctors" since its inception in 2015, as a consultant on board the aircraft as well as being the South Wales Base Lead. In May, she became the interim national director of the service. The following month she was awarded an MBE in the Queen's Birthday Honours List for services to the military and the Wales Air Ambulance.

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Consultant in anaesthetics Dr Ami Jones is a member of the 'flying doctors' project
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Title Annotation:Features
Publication:Western Mail (Cardiff, Wales)
Geographic Code:4EUUK
Date:Oct 2, 2017
Words:1133
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