Graham Lloyd-Brandrick explains what makes the Isle of Man’s air-ambulance service that bit different
Graham Lloyd-Brandrick is one of a number of nursing, paramedical and medical staff who fly VIPs from the Isle of Man to the North West. “I fly VIPs - very ill patients - from Noble’s Hospital, where I am the lead advanced practitioner, to hospitals in the north-west of England,” he says.
“We fly them in a twin-engine, unpressurised, fixed-wing aircraft as part of our 24/7, 365-day-a-year air ambulance service. Unlike most air ambulances we do not provide a primary rescue service; our service is an extension of each department in the hospital to give our patients access to specialised and tertiary services we cannot provide on the island.”
The air-ambulance office is staffed by coordinators, sisters Shirley Clare and Jeanne Erikson, who work 9am-5pm Monday to Friday and provide an on-call service at other times. Coordinators are all band 7, hold the Royal College of Nursing Inflight Nursing certificate and are supported by a team of dedicated nurses, paramedics and doctors. From 2011 to 2012, the service carried 378 patients in 310 air-ambulance flights, of which 21 were Category-A emergencies.
Each patient is clinically assessed by the nurse coordinator to decide how urgent the transfer is and which mode of transport is suitable - scheduled flight, air ambulance or boat.
“We achieve a bed-to-bed time of two hours 15 minutes, which is critical for patients with spinal injuries to prevent pressure ulcers occurring,” says Mr Lloyd-Brandrick.
“The difference about care in the air is that you have to plan everything in detail, securing every vascular line, catheter, tube and monitoring cable so they don’t get caught and fall out, calculating the patient’s oxygen requirements, equipment and drugs for the journey, which we draw up in a sterile procedure before the flight to avoid needlestick injury and to maintain sterility. Controlled drugs must be accompanied by an import and export licence.”
The service follows British Airways guidelines on the transfer by air of the sick and injured - notably a minimum haemoglobin level of 7.5 g/l to fly and combat the effects of Boyle’s law (the higher the altitude the thinner the air). In addition, as the aircraft is not pressurised, oxygen saturation has to be monitored closely.
“We have the ability to duplicate an intensive therapy unit bed space in the air,” Lloyd-Brandrick explains.
Logistics can also put the team under pressure. “One day we had to do five flights and move seven patients from different locations in the UK, which meant working with three different airports. We started at 7am and had to be back on the island before our airport closed at 8.45pm.
“It was a huge operation arranging nurse escorts, hospital beds, ambulances and relatives, as well as making sure hospitals had patients ready for discharge to meet our slot times. We made it.”
Staff at Noble’s train for any eventuality. “Three years ago we established the first degree-level course for the transfer of patients by land, air and sea. We have a variety of transport as some patients cannot return by air after certain procedures, for example those with gas in a non-expandable body cavity.
“The hospital also runs a three-day intensive course to prepare staff to manage transfers, including how to evacuate in an emergency and ditching training, which we do in a local swimming pool.”
Sometimes conditions are life-threatening for all on board. “I once got a phone call at 10pm about a patient with a severe head injury who needed immediate surgery,” Mr Lloyd-Brandrick says. “We left just after midnight; mid-flight we were told our destination airport was closed due to bad weather so we had to divert. The next day we hit hail, rain and sleet, so had to abort landing. When we eventually landed, I kissed the aircraft to thank her for being such a sturdy old workhorse.
“No two days are ever the same, that’s the beauty.”