Join internal medicine and rheumatology specialist Siobhan Deshauer, MD, as she shadows a flight paramedic team.
(Following is a transcript. Note that errors are possible.)
Deshauer: Hey, guys. I’m Siobhan, an internal medicine and rheumatology specialist. Today, I’m joining flight paramedics as they rescue and transport critically ill patients in helicopters.
Engineers: Aircraft-wise, November is the aircraft online, except it’s not online right now. It should be up and ready in about an hour or so.
Deshauer: This morning the helicopter has been grounded for maintenance. The engineers are torquing the rotor hub, which means they are tightening the bolts to secure the blades. I’m not going to lie, loose bolts sound terrifying. So I’m not surprised when the paramedics tell me that they avoid disrupting or distracting the engineers while they are working.
While we are waiting, Mike and Evan prepare their medical equipment. Stocking up on life-saving medications as well as tightly regulated medications for pain and sedation.
Mike: A bunch of fentanyl, smaller ampules, bigger ampules of fentanyl as well, and midaz [midazolam, Versed].
Deshauer: All their equipment is organized into small, portable bags so they can easily bring them to the scene of an accident. Here is their equipment for intubation, which allows them to insert a breathing tube. Recently they have started carrying blood, so they can transfuse trauma patients right at the scene of an accident.
We just got a call so we’re heading out. Guys, I have never been on a helicopter before. I’m both excited and very nervous. Oh my gosh. Notice how it looks like the blades of the helicopter are moving super slowly. It’s because the blades are actually moving so quickly that my camera’s shutter speed can’t keep up. Cool, eh? All right. Here we go.
[PILOT OVER RADIO]
Deshauer: I thought I was going to feel pretty nervous, but I honestly feel quite comfortable, especially knowing all the redundancies in place. Unlike many helicopters, we have got two pilots in case something happens to one of them. And this one has two fully functioning engines. Even if one completely fails, we’ll still be okay. Plus, look at these views of Toronto. It’s absolutely unreal.
While we’re in the air, I had a chance to chat with Mike and Evan about what it’s like to be a flight paramedic. I’m learning there are two main parts to the job. All right, so you must be seeing a really wide variety of patients on each of these shifts.
Evan: Yeah. We’re sent to take care of a lot of the most critically ill and injured patients in the province. Because of that sort of almost selection bias, we get to see in our huge catchment area a high volume of those sort of weird and wonderful things that if you were in any one center you might not see very often in your career. It’s sort of like the most exciting 30 minutes of every specialty, every day.
Deshauer: The second part is keeping the patient alive and comfortable.
Mike: My primary job is transport. It’s to get them to where they need to be.
Evan: I think one of the challenges we have is just the limited resources we have. Compared to a big trauma team at a level 1 trauma center, we might arrive to a scene call for a multi-system trauma patient who might be unresponsive with all kinds of injuries. They might need to have chest needles done and their pelvis wrap. They might need fractures reduced. They might need rapid sequence induction of anesthesia and placing them on a ventilator, and running sedation analgesia for them. They might also be hypotensive and require blood products and tranexamic acid, calcium — like running a massive transfusion essentially, and it’s just me and Mike.
Deshauer: While we’re flying, we learn that we’re heading to the scene of a trauma. It sounds like a motor vehicle accident involving a motorcycle, and at this point we are still waiting to hear more about the patient’s condition.
Mike: Lindsay, 799 just to let you know we’re about 6 minutes back to your scene call. We are having some com issues here. Any update on the patient?
Dispatch: 799, stand by. I’ll see if I can get the crew.
Evan: There we go. When we get out, what we’ll typically do is we’ll probably just take the bags to start. Then just stay with us, keep your helmet on, stay close, and then we’ll go have a look. They usually will be in the back of a truck by the time we get there, so we’ll hop in the back of a truck.
Mike: All right, 10-4. Copy, we are cancelled.
Evan: Well, that will happen. This happens all the time. We get cancelled. Sometimes they get there and it’s not as bad as they think. We get cancelled and now they are getting us to go to another scene call. We’re going to check the coordinates to see where it is. We’ll get the pilot to…
Dispatch: The coordinates are North 44 27 58.
Mike: Good to DT in a sec here. That call is still 99 November.
Dispatch: 99 November, go ahead.
Mike: Yeah, the pilot has accepted. We’ll be there in about 15.
Dispatch: Roger that. I’ll send you the details there.
Deshauer: Now we’re being sent to urgently transfer a patient from a small center to a large hospital. The patient presented with tearing chest pain, and the emergency team found that one arm had a blood pressure 100 points higher than the other arm. Putting the whole picture together, this is very concerning for an aortic dissection. The aorta is the largest, most important blood vessel in the body, which connects directly to the heart.
In a dissection, the inner part of the blood vessel wall tears, and the force of the blood being pumped out of the heart causes it to continue tearing. This can block off arteries like the one supplying blood to the arm and that can lead to a big blood pressure difference between both arms of the patient. If this is what’s happening, the patient needs emergency treatment. Unfortunately, he is currently at a small center with no CT scan to confirm the diagnosis. In this case, minutes matter and transferring him by helicopter rather than driving by ambulance could mean the difference between life and death.
The patient arrives at the meeting location shortly after we land. Mike and Evan get a quick report from the nurse, rapidly secure the patient, and within minutes we’re back in the air. They are monitoring him very closely, connecting him to a cardiac monitor, controlling his blood pressure and managing his chest pain with a medication called fentanyl.
Canada is a huge country, and a major challenge we face is providing equitable care for people living in rural and remote communities. Organizations like Ornge are helping to close that gap by transporting patients to major cities where they can access services. Yet we still have a long way to go before we can truly call it equal health care for all.
Once we arrive at the larger hospital, he is immediately transferred to the cardiac care unit to get further testing and treatment.
Mike: He said no pain since then, but a 100- point difference between left and right arm when it comes to blood pressure.
Deshauer: Our job is done here, and now it’s time for lunch. Since it’s Canada, of course the only restaurants available in the hospital are Tim Hortons. Hanging out with the pilots and paramedics is a lot of fun because, as you can imagine, they have seen some wild things and have unbelievable stories.
All right, we just took off. We’re only a couple of minutes in the air. And we were heading to a car accident, but it actually got cancelled. I’m learning that a fair number of these traumas do get cancelled along the way, about a third of them, for various different reasons.
Mike: Yeah. Seasonal.
Deshauer: Yeah, seasonal reasons. Fair enough.
I think the thing that has surprised me the most is the wide scope of practice of these flight paramedics. I mean, they are doing everything: intubation, managing traumas, pregnancy complications, everything from kids to adults. Really, any emergency that could happen they see and they are transporting and dealing with. I have learned that they keep up these skills by using really high-fidelity simulations, which is so exciting. Anyway, this is so cool and I’m speechless. I’m so impressed.
The team has just been called to the scene of a trauma. Now, unfortunately it’s about 45 minutes flight away. And because it’s really hot outside literally the weight of me and my backpack is too much. They have to conserve as much fuel as possible, so I can’t go for this one. But we can wave them goodbye, because it has been such an incredible experience.
That’s it for today. A huge thank you to Ornge and, of course, to Mike and Evan for taking me along with them. I feel like I have sort of checked something off my bucket list that I didn’t even know was there. I have learned so much and gained so much respect for the medicine that they do as flight paramedics. It’s really remarkable.
I hope you enjoyed this video. If you did, be sure to subscribe and that way I’ll see you in the next video. Bye for now.
Siobhan Deshauer, MD, is an internal medicine resident in Toronto. Before medicine, she was a violinist, which is why her YouTube channel is called Violin MD.