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Updated 02 June 2014

Speed of life

Experts believe a quick response to a critical injury is crucial to the patient’s survival – and sometimes such an emergency rescue means having to fly across Africa.

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Experts believe a quick response to a critical injury is crucial to the patient’s survival – and sometimes such an emergency rescue means having to fly across Africa.
By DR ANSKE VAN AS for YOU Pulse magazine

It's just after midnight. "Please go to the airport immediately," the emergency centre operator says. It’s an all too familiar telephone call requesting an urgent response.

"What’s the patient’s condition?" I ask automatically.

"Critical following a car accident a few hours ago. Multiple broken bones and organ damage. A 40-year-old French nurse in East Africa. She has lost a lot of blood and is on a ventilator to help her breathe..."

I pull on my flight uniform. On the way to the airport the emergency centre operator provides more information about the patient’s condition including her blood pressure, the number of units of blood she has received and the emergency treatment so far.

I’m put through to the paramedic who’ll be accompanying me on the emergency flight and we discuss in detail the treatment we’ll have to administer and the kind of supplies and equipment we’ll take on board. The weight of the supplies is important because it affects the weight of the aircraft and therefore the amount of fuel we’ll need.

Despite the late hour, there’s a buzz of team activity at the airport. The ground crew is organising clearances, fuelling the plane and smoothing our way through customs. We check the weather en route, file the flight plan and make arrangements for the patient to be admitted to a trauma hospital in South Africa.

We’ll be using a propeller-driven air ambulance – the landing strip is too short for a fast-landing jet aircraft.

The strip also has no landing lights, only weak oil lamps that a pilot flying a fast-moving jet would have difficulty spotting.

Touch and go
When we land, the patient’s husband is waiting for us, having donated blood to his wife in the meantime. We quickly load the hi-tech medical equipment into a waiting ambulance and rush to the hospital through the humid East African night.

The patient is critical and bleeding profusely. The hospital’s Russian surgeon saves her life by removing her badly bleeding right kidney – and this in a hospital that doesn’t even have X-ray facilities. In addition to multiple broken bones, the patient has a torn liver, spleen and pancreas, and both her lungs have collapsed.

The paramedic and I work together as one: airway, breathing, circulation, units of blood and resuscitation fluids. We intubate the lungs, splint the breaks and immobilise her body. We handle the patient as if she has a broken neck or back, because without X-rays we can’t be certain. All the emergency treatment is carefully documented; if it’s not documented it wasn’t done.

We stabilise the patient to stop her condition deteriorating and prepare her for the air-pressure variations during the flight back to South Africa, then we transfer her to the aircraft. During the flight we monitor every heartbeat and every breath. Intravenous medication is administered continuously. The interior of the aircraft has become an intensive care unit.

A team of seven specialist doctors and nurses are waiting for us when we arrive at the trauma hospital in Johannesburg. A counsellor takes the patient’s husband aside while I brief the hospital team.

Good news
Sometimes patients are too ill to fly and there’s nothing you can do to save their life. In this case, however, I receive a heart-warming call two months after the incident.

The former patient would like me to meet her and her husband for coffee. For a moment in the coffee shop we sit in awed silence at the extraordinary second chance this woman has received.

After five years as an air ambulance doctor I have exchanged that adrenaline-driven occupation for a more predictable one with more regular hours. My colleagues warned me that adapting to treating patients who are not critically ill could be quite a challenge.

I’ve learnt, however, that for a suburban mother with a feverish child it’s just as important to see her child improve – quickly – as it is for any mother elsewhere in the world.

I salute every one of my former air ambulance colleagues and all medical and non-medical emergency staff wherever they work. They have tough, stressful jobs but they’re passionate about what they do.

(This is an edited version of a story that originally appeared in YOU Pulse / Huisgenoot-POLS magazine, Winter 2008. Buy the latest copy, on newsstands now, for more fascinating stories from the world of health and wellness.)

 
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