Critical Care Paramedic Lee Hilton describes the EC-145 familiarisation training and first patient care episode.

In November 2020, we were lucky enough to introduce a new H145 aircraft to our emergency response fleet, replacing the older trusty EC-135 helicopter. The aircraft is a completely different type, which means there was a substantial amount of familiarisation training to undertake ahead of our first mission.  

As one of the Critical Care Paramedics, my role is to provide clinical care to our patients. In addition, I am also a Helicopter Emergency Medical Service (HEMS) Technical Crew Member (HTCM) which requires me to support the pilot with certain aviation and navigation tasks. Given the changes in the avionics and clinical configuration of the aircraft, there has been much to learn.  

Changes in clinical processes 

The new H-145 is a much larger aircraft, allowing more room to move around the interior when carrying three clinicians, a pilot and the patient. With ever-increasing medical kit being made available, this increase in size has been very welcome and indeed, necessary. We can now wall-mount all essential medical equipment, such as the ventilator, patient monitor, defibrillator and suction unit while in flight.  

Upon landing at an incident and when removing the stretcher from the rear of the aircraft, the required essential medical equipment can be securely mounted to the side of the stretcher. This allows us to take the stretcher and equipment all the way to the patient’s side. We are even able to wheel the whole stretcher into the Emergency Department before transferring the patient to a hospital bed.

The stretcher is an incredible piece of kit that can be removed by a single clinician, even with a patient loaded on it. It has wheels which drop down and secure into place with the simple click of a couple of buttons. Additional medical equipment, such as medications and surgical kit is now easily accessible from a shelf than can be lowered into place and secured.  

The interior lighting in the rear of the aircraft means that when we’re flying at night, we have sufficient brightness to ensure our care is as optimal as if we were treating that patient in the day. Our bespoke new kit bags have been made to fit securely and neatly inside the rear of the aircraft and we are able to access anything within these bags if required on route to hospital. Well considered updates such as this have had a significant impact on the way we are now able to operate and maximises the best possible patient experience.  

Changes in aviation processes 

Perhaps the biggest change with the new aircraft to the untrained eye is the avionics and displays. The new H-145 has moved to full digital avionics, with intuitive displays that allow the pilot and HTCM to be provided with much more information when airborne.  

Though flying into cloud is avoided wherever possible, it is sometimes the case that the British weather decides to change unexpectedly! This may mean that we revert to flying in Instrument Meteorological Conditions (IMC,) which the pilots are well trained for and the H145 is very capable of doing. If this happens, the updated avionics ensure that the aircraft, patient and all crew members are kept safe by providing the pilot with significant amounts of information to ensure a continued safe flight until conditions improve.  

The navigation global positioning system provides the latest flight planning guidance to allow the pilot to navigate precisely to the grid reference of the incident we are attending. Any high ground can be clearly seen on the displays and safely avoided. There are many more subtle, yet innovative changes and developments that have been introduced to the new H-145 aircraft that is best explained by one of our highly skilled and experienced pilots. 

My first patient care episode  

My first opportunity to convey a patient was during a late shift after dark. We navigated to one of our community landing sites using night vision goggles and landed safely at the lit football pitch. This is an important to mention the amount of downwash created by the new aircraft is significantly greater than the EC-135, so please be aware of this if you’re watching us take off or land!

We made our way to our patient who was being treated in the back of a land ambulance. They had an injury that required treatment in a Major Trauma Centre, meaning it was necessary to fly the patient to Derriford hospital in Plymouth.  

After providing sedation and putting the fracture into traction, we moved the patient back to the aircraft where our pilot had removed the wheeled stretcher. We were then able to transfer the patient quickly from the ambulance stretcher to ours and load them safely into the aircraft. After a short time, we were airborne and travelling to Plymouth. The amount of light available to us to treat the patient was impressive. It ensured we were able to operate comparably to how we would during the day, and it is important to keep processes as similar as possible to ensure safety.  

We landed in Derriford and were able to unload the stretcher from the rear of the aircraft with ease, complete with the attached medical equipment, and wheeled our patient directly into the Emergency Department. They were well enough to tell us they had a very comfortable flight, which is an important indicator of their satisfaction with the care we were able to offer them during their ordeal. 

It's thanks to supporters like you that Critical Care Paramedics like Lee are able to deliver the best possible care to patients when every second counts. As a charity that is 100% independent of Government funding and continues to exist solely thanks to local communities, we continue to welcome your support.

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