Helicopter 061: saving lives in mid-air

It's 8am and the skies are getting lighter at the Brica air base in Cártama where the 061 medical emergency helicopter has its permanent home. From dusk until dawn tense hours lie ahead, waiting for that phone call from the coordination centre to set the team in motion.

The helicopter stands on the tarmac. Juan Pedro García, duty mechanic for the day, makes final tweaks to the aircraft. Meanwhile, in prefab cabins used for medical supplies, meetings and staff downtime, the crew, formed by a doctor, nurse, pilot and HEMS specialist (helicopter emergency medical service), prepare for another unpredictable day. Some days they have nothing to do; on others they might be called out as many as three times to anywhere in Malaga province or the southwestern quadrant of Granada.

Doctor and nurse scrupulously check all supplies are in place. There is no margin for error. They check the CPR machine, the ventilator and all monitoring devices used to assess the general condition of a patient.

"A swift transfer is essential but it also helps that time is saved by providing primary care in-flight before reaching the hospital. It is very important that patients are alive when they get there, but even more that they survive to go home," says Dr Jairo Muñoz.

While he examined the incubator for the transfer of urgent cases of newborns, his colleague and nurse, Ernesto Muñoz, checks the blood supplies.

A year ago, the 061 medical emergency helicopter for Malaga became the first and only aircraft in Andalucía equipped to perform blood transfusions mid-flight. Furthermore, after undergoing strict traceability protocols, this base now operates as a blood bank, with a dedicated blood bank refrigerator and all that that entails. The bank stores only O-negative red blood cell concentrates (being the only blood group that can be given to all blood types).

On every call-out they always fly with two bags of blood. "We don't take more because we have calculated that we would not need them in the time allotted to reach our target hospital. We are talking about 30 minutes max from take-off with the patient onboard until they enter a hospital emergency room following a trauma, stroke or sepsis code.

"With every code call a procedure is followed, and the A&E duty doctor is informed of the in-flight care provided to the patient and the condition they will arrive in. This level of care buys us time to improve patient survival," says Ernesto.

Most transfusions are performed on patients who are bleeding heavily due to severe trauma, typically from road accidents, stabbings, gunshot wounds or serious falls. In the first year of providing this service, eight patients received transfusions onboard.

"Having this service, with blood available to be transfused mid-air has put Malaga among the elite," says Fernando Ayuso, managing director for the 061 Andalucía medical emergencies centre, who said that the service would be gradually implemented in the other air ambulances across the region.

Besides the Malaga base (crewed in rotation by four doctors and three nurses), the medical emergencies centre has another four bases covering the rest of Andalucía: Isla de la Cartuja (Seville); Jerez Hospital (Cadiz); Cordoba Airport and Baza Hospital (Granada). Of the five helicopters, four of them are the high-speed A109/SP (with a smaller interior), and the fifth is an Agusta AW139, which has the largest cabin volume in its range, based in Granada.

The smaller dimensions of the helicopter in Malaga are a handicap when transporting all the necessary supplies and equipment for blood transfusions, as this needs a seat all to itself.

"During the flight, we have to attend to the patient on our knees; there is no room to treat them in any other way," says the nurse

Another issue is the lack of certified helipads in Andalucía (airports excepted) preventing the helicopters from operating in the dark. "It's a question of summoning both the will and the money, because both aircraft and pilots are capable of night flights," says Ernesto.

Andalucía launched its air ambulance service in 1995 with the aim of delivering faster primary care, ensuring they could reach patients anywhere in the region and improving the transfer time of critical patients to specialist, regional hospitals and beyond, such as to the national hospital for spinal injuries in Toledo.

Calls come in from the control hub, where call-handlers assess whether it is necessary to activate the air ambulance.

"We always attend seriously ill patients, but especially when they are far from a hospital," explains Ernesto.

This means that often the pilot has to look for unconventional places to land, such as football fields or roads.

"In many towns in Malaga, the town halls have created suitable landing spaces. They are not standardised helipads, but it helps us to be able to attend an emergency," he added. Whatever the situation, helipad or no, they still go. "We'll go, we'll find somewhere to land."

The pilot of today's crew knows that only too well, having already demonstrated her flying skills when a life is at stake.

However there are lines that she will not cross: "The mission is to keep the aircraft and those inside it safe," stressed Nuria Anguera, who has 30 years of flying experience.

First thing in the morning she reviews the weather conditions with her colleague Enric Dalit (HEMS crew member) and briefs the team on the best landing places for the conditions.

Both maintain their composure while the medics do their work.

"There are times when their faces show the gravity of a call-out, because the CPR has taken too long," explains the pilot. "And then it's as if a miracle has happened. The satisfaction, when we find out days later that the patient has been discharged, is priceless."

Nevertheless she stressed that deciding to take a helicopter up cannot be done on the "toss of a coin", and that if she ever risked too much, "I would never do it again."

It nearly happened at the top of La Concha responding to a major fall. "I couldn't find a place to land and after circling a few times I decided to set down just one front and one side wheel so the medics could jump down safely enough. They risked more than me, but we are a team," she says.

Besides a minimum surface area to land safely (at least 30 metres of flat ground), the 061 helicopter requires favourable weather conditions.

"Visibility is essential so, with fog, driving rain or 40-knot gusts of wind, we cannot execute a safe landing," says the pilot.

Although the only certified helipads in Malaga are at the airport and Guadalhorce hospital, they usually land in the designated area in the car park at Hospital Clínico and, occasionally, at the provincial police station in Malaga.

"Exceptionally, we landed last summer in the middle of the Guadalmedina river bed. We were transporting a child who had been pulled from a swimming pool in Coín. His condition was critical and he had to be taken to the Materno children's hospital. With no time to waste and those helipads too far away, the security forces helped organise the landing and keep the general public safe. Unfortunately, the child died the next day," she adds.

The emergency call on the day of our visit comes at 5pm. A 60-year-old Norwegian man is trapped under a tractor after it rolled onto him as he was working on a farm in Casarabonela. The crew anticipates a critically ill patient with crush injuries and internal bleeding requiring a possible blood transfusion. The medics prepare their gear and the helicopter takes off in ten minutes max.

Upon arrival, they verify that, despite the dramatic appearance of the accident, he only has a closed fracture of the left femur. He is transferred to the Hospital Clínico with healthy blood pressure and heart rate.

Again, back to base. The day ends with no more surprises and a shared feeling of "job well done".