Elective Placement With The Air Ambulance: Reflective Account and Top Tips

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What my elective entailed

I undertook a four-week Pre-Hospital Emergency Medicine (PHEM) elective with the Midlands Air Ambulance Charity. This entailed two day shifts on the helicopter and one night shift on the critical care car each week. Through this role, as an observer, I was able to experience various pre-hospital emergencies; the most common scenarios I attended were cardiac arrests, but I also attended trauma patients at the scene of road traffic accidents, fractures in a wilderness medicine setting, anaphylaxis, and many others.

What I learnt
  • I went into this elective thinking the majority of my learning would stem from trauma scenarios. I did see some patients who had minor trauma, and one patient who had a traumatic cardiac arrest resulting from an RTC, but other than that, this was not a common event I encountered. What I learnt during this placement was varied, and some of it unexpected; I have summarised some of my key takeaways below.
  • Scope of practice – a HEMS team can practice aspects of hospital medicine at the scene of an incident, but they are still only able to carry a small and carefully selected range of drugs and equipment. I learnt that pre-hospital medicine is a very changeable field, and teams are constantly looking at evidence from cases they’ve attended to review if the scenario would benefit from additional skills or drugs. I was able to see what they were able to do compared to other paramedic crews, such as airway management with endotracheal tubes and administering drugs like ketamine.
  • Assessing patients – as a student, I am used to using the A-E method to assess patients. This is still the basis of assessment in a prehospital setting, but it felt much faster and very different to what I was used to, as there was a lot less capability for investigations throughout the process. This seemed to result in more diagnostic uncertainty, which meant management was primarily directed by clinical judgement. Patients were also often critically unwell, so acting quickly was the priority. I noticed the huge amount of clinical experience in the team – diagnoses seemed almost instinctual. There were however some investigations used that you would not typically see in a ward A-E, such as thoracic ultrasound to rule out traumatic injuries.
  • Experience in difficult scenarios – not every patient we attended needed critical care interventions. The team had an extraordinary amount of experience from hospital-based to pre-hospital medicine, and attended critically unwell patients on a near daily basis, so were able to make judgement calls that ambulance crews would not always be able to. There were multiple patients where the only intervention from the team was stopping resuscitation. I was pleasantly surprised that PHEM was less about performing exciting invasive procedures, as it can often be represented to be, and more about holistic care of the patient, and trying to act in their best interests when there is little information. There was an emphasis on involving and managing the expectations of families, with conversations about them being present with their loved ones occurring early in the resuscitation attempt.
Challenges 

Although I thoroughly enjoyed my time with the air ambulance, there were some unexpected realities of undertaking this placement that I would want others who were considering this to know. Firstly, as a medical student, I had not been involved in many arrests on my placements. I had only ever seen one or two previously on the wards, and then saw three in one night on my first critical care night shift, which was quite a jump for me. This could potentially be quite traumatic if you weren’t prepared to encounter this, but that being said, it was also actually a benefit of this placement for me. It has made me much more comfortable with being involved in arrest scenarios and deaths of patients, has given me practice with performing chest compressions, and improved my knowledge of the arrest algorithm.

Pre-hospital medicine is not always glamorous! At times I was sitting on the back of an ambulance cleaning sick off of a patient, standing in the pouring rain at the side of the motorway, or wading through thistles and grass that came above my waist (also not good for my hay fever!). The helicopter took some getting used to, and I felt extremely travel-sick on the first journey. As my elective was in the summer, it got incredibly hot being in the helicopter when it was over thirty degrees, which was fairly unpleasant, and getting dehydrated was a real concern while out on back-to-back callouts. Landings were always at the most convenient location for access to the scene, meaning I had to climb over hedgerows and fences, which occasionally resulted in getting scratched by brambles and almost sliced open on barbed wire.

It also is not always a very busy placement to undertake. At some jobs, we would be stood down at the scene, or before even arriving. On the first day of my elective, I had one callout for the whole twelve-hour shift, and even then we only stayed on scene for about twenty minutes. Although I did have more callouts on other shifts, there was a lot of waiting around, so I would recommend bringing your laptop and a book or two.

Applying for a UK-based PHEM elective

I managed to secure my placement simply by applying online. Several air ambulance services in the UK offer elective placements for medical students. Here are the ones I have found from doing simple online searches: Magpas Air Ambulance, Midlands Air Ambulance (where I did mine!), East Anglian Air Ambulance, Essex and Herts Air Ambulance, and London Air Ambulance. There are other air ambulances, such as the Air Ambulance Service WNDLR that do seem to take elective students, though only through the faculty of prehospital care, so if you are a member of FPHC then I would recommend contacting them. Although I applied to MAAC in around January, a few air ambulance services have deadlines of September and October for applications, so bear that in mind if you are searching for opportunities later in the year, and, if possible, start looking into options around a year before your elective. If the air ambulance is not an option for you but you still want to undertake a PHEM elective, remember it is not the only option! Try to contact the ambulance service and see if they will take you on for observer shifts. Other options include wilderness medicine opportunities, such as via the mountain rescue service. Apply for as many opportunities as possible to increase your chances, and if struggling to secure a placement, there are also some great ward-based opportunities. I did part of my elective on ICU, which I found very valuable for exploring critical care medicine and longer-term care of the patient.

I thoroughly enjoyed my elective placement with the Midlands Air Ambulance; I saw a wide variety of presentations, some of which will stay with me for the rest of my life, gained a deeper understanding of pre-hospital medicine, and lived out my dream of flying with HEMS in the helicopter.

Author: Sarah Fleetwood-Walker – Final Year Medical Student

Reviewer: Dr Joshua Grubb – MTB Pre-Hospital Medicine Lead

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