Delivering intensive care in the air

Published: 10 Oct 2017

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Initially working shifts as a young doctor at a helicopter rescue service in Munich, Dr Thomas Buchsein, now medical director for FAI Group, has been able to combine his two passions: medicine and aviation

As a doctor, what prompted you to get involved in air ambulance work?

It was a gradual convergence between my interest in aviation and specialisation in emergency/intensive care medicine. They share the need for precision, responsibility, swift decision-making and dedication. Back in the mid 1980s, as a young doctor then, I worked at a hospital, where the Munich Rescue Helicopter service was based, and started doing shifts with them. Years later I joined a fixed wing air ambulance programme, attended special training in Aviation Medicine and after many years of experience in rotary and fixed-wing missions began lecturing on aeromedical topics, which got me in contact with FAI who eventually appointed me medical director.

What are your main duties on a day-to-day basis?

I supervise the medical aspects of running an air ambulance service, which includes setting medical standards and guidelines, hiring and training doctors, and quality management. Exciting parts of my daily responsibilities include reviewing medical records for forthcoming missions, often to quite remote places, and advising our clients in special medical situations – on the need for sea level cabin pressure, for example, or oxygen demands. In special cases I brief the medical crews pre-flight and I’m a contact for crews during missions (all FAI aircraft have a satellite phone).

Who are your clients and what kind of medical care do you offer?

Most are assistance companies who action the contractual obligations of the insurers, particularly under travel insurance, which means arranging the medical repatriation and emergency evacuation of patients in trouble abroad. Our other clients are government bodies, corporate groups and sometimes private individuals who are travelling for treatment.
As for the kind of medical care: we basically cover all fields of medicine, but are proud of our expertise in transporting complex intensive care patients worldwide, including from remote places and hostile areas such as Afghanistan and Iraq.

What constitutes a typical mission?

Once an incoming request for patient transport has been checked and approved for medical feasibility by me or my deputy, FAI Flight-OPS gets the green light to proceed with the aviation part of mission-planning. A medical crew, which typically consists of one doctor qualified in emergency and intensive care plus one flight nurse or paramedics, is assigned and briefed, and the aircraft is loaded with the appropriate medical equipment.

Apart from younger patients with all kinds of trauma, an increasingly ageing population is now travelling more frequently. Many missions involve patients in their 80s or even 90s suffering an internal medical condition, such as a stroke or heart attack. When this occurs for example, on a cruise, the patient is typically disembarked at the next port of call. Cruise ships cocoon passengers so they are often very scared when they are suddenly left behind in a foreign hospital. This makes reassuring them a unique challenge for our crews and the assistance company.

What has been your most difficult mission?

There have been many difficult missions over all the years, but one I particularly remember involved evacuating a German NGO worker during her final weeks of pregnancy from Tajikistan, which has no qualified neonatal care. I consulted a neonatologist as part of the pre-flight risk-versus-benefit assessment and the decision was taken to transport her to Leipzig. The baby was delivered prematurely mid-flight weighing just 1.2kg. The flight doctor called me via satphone to help locate the nearest place with a neonatal unit to divert the flight to, which we identified as Samara in Russia. FAI operations team alerted our Samara handling agent who was able to arrange a well-equipped ambulance with a neonatologist in surprisingly short time to meet the diverted flight at the airport. The baby was well taken care of and survived.

What do you like best about your job?

I really enjoy working closely with the assistance companies, and contributing our experience to the decision making process. Clients value us as a partner and these trusted relationships are key to FAI’s success.

Why do you think FAI is so successful in its air ambulance work?

Staying focussed, thinking out of the box and having all the components needed for a successful air ambulance mission under one roof. FAI is the largest fixed wing air ambulance operator – it has an 11-strong fleet of dedicated ambulance jets with excellent pilots, in-house maintenance, a 24/7 flight-operations and dispatch centre and 24/7 customer centre. It uses state of the art medical equipment, highly qualified medical staff and offers in-house medical training courses. Then there’s FAI’s breadth of experience – in 2016 we completed 892 missions, averaging two inter-continental flights per day.

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