Let’s talk fleet – what aircraft does Midlands Air Ambulance Charity operate, are they leased or owned, and where are they based?

Ian Jones, Air Operations Manager (IJ): Midlands Air Ambulance Charity (MAAC) owns two helicopters – an Airbus H-145 and Eurocopter EC135 T2E – which are located at Strensham, Worcestershire and RAF Cosford in Shropshire, respectively. The third aircraft, based at Tatenhill, Staffordshire, is leased from our aviation partner, Babcock Mission Critical Services, which also employs our pilots and maintains our aircraft.
If we are not able to fly for any specific reason, such as poor weather, we have BMW X5 rapid response vehicles located at each airbase. This ensures aircrew can respond to critically ill and injured patients whilst the helicopters are offline.

In recent years, we have extended our pre-hospital emergency service by introducing critical care cars. With current overland operations covering the urban areas in Birmingham and the Black Country and the region of Worcestershire, we are looking to expand this network based on the resulting impact. The critical care cars are manned by a critical care paramedic (CCP) or trainee CCP and predominantly attend patients suffering from life-threatening medical issues such as cardiac arrests, heart attacks or respiratory problems.

How have you managed MRO challenges during Covid lockdowns?

IJ: Despite being in several national lockdowns, we have continued to be supported by Babcock in the maintenance and repair of our aircraft. We worked in partnership with West Midlands Ambulance Service NHS Foundation Trust (WMAS) and Babcock to ensure that our pilots and engineers received early Covid vaccines and lateral flow test kits.
Just like the critical care cars, the helicopters require extensive servicing to be undertaken in addition to incidental issues. This process is known as a ‘periodical’.

The periodical process takes roughly three weeks and should be carried out once every three years or 1,000 flying hours, whichever comes first. During the first lockdown, one of our EC135s was taken offline to receive its periodical and whilst it was out of action, as per our contract, Babcock supplied us with a replacement aircraft to ensure there was no reduction of service across the Midlands.

When Covid hit and the UK went into its first lockdown, what did the charity do in terms of staffing, infection control protocols and operational changes?

IJ: Throughout the pandemic, MAAC proudly remained focused on our core purpose; utilising our advanced clinical skills to provide rapid pre-hospital emergency response across the six counties we cover. While we were not directly tasked to a great number of Covid-19 patients, the aircrew still faced the daily challenge of potentially treating patients displaying symptoms.

We worked with our health partner, WMAS, and redeployed aircrew to assist teams on land ambulances and support in the 999-call center due to an anticipated increase in demand. WMAS provided MAAC clinical crews with two levels of personal protective equipment (PPE) including masks, aprons, gloves, known as level two PPE, and powered hoods with Tyvek suits as level three PPE. Babcock also provided their pilots with both levels of PPE.

Hanna Sebright, Chief Executive (HS): To ensure the safety of our crew and patients, all charity staff and third-party visits to our three clinical airbases were prohibited. Across the wider charity team, to protect our staff and volunteers, most of whom are vulnerable or elderly adults, and in line with Government guidance, the decision was made to temporarily close the charity’s HQ and shops during the key lockdown periods. We also established a welfare program to support our most vulnerable volunteers.

What level of qualification are doctors and paramedics required to have to work for MAAC?

IJ: To reach CCP status within MAAC, paramedics must first be eligible to apply for selection, having at least three years’ post-registration experience. To pass selection, candidates must pass a written exam, demonstrate physical fitness, and then complete practical stations which simulate various functions of the CCP role. The next step is a PGCert in Critical Care, which is Masters degree-level study at a regional medical school with clinical placements. This education is in addition to a standard Paramedic higher education qualification (BSc, FdSc or Dip). Once the academic component is complete, candidates begin in-house development around the enhanced care specific to MAAC with CCP mentors and doctors.

There are three levels of CCP within MAAC, with level one being initial sign-off and level three being full autonomy of the extended scope of practice as agreed by our clinical lead.

Dr Mark Nash, Clinical Lead (MN): Our pre-hospital emergency medical (PHEM) flight doctors are consultant or senior registrar level from anaesthetics, emergency medicine or critical care backgrounds. All go through a comprehensive training programme before operating within the team. In addition, we support the national Pre-hospital Medicine CCT programme which is formally training doctors for future careers in pre-hospital medicine.

What investments have been made recently in clinical training and equipment for your medical crew?

IJ: As a forward-thinking pre-hospital emergency service, MAAC has a keen interest in continuous improvement and actively provides regular education and training opportunities to our 70-strong clinical team.

We strive to continually improve our training experience by utilising external courses, such as surgical skill days at regional medical school anatomy suites, higher education professional development and NHS-recognized courses. These are in addition to in-house training and simulation. With support from a County Air Ambulance Trust grant, we have acquired several realistic ‘new-age’ manikins cast from real humans of all ages. These incredibly lifelike manikins, supported by modern technology, add a richness to simulation that deepens the learning experience.

Our long-term goal is a purpose-built simulation suite, within our all-new combined airbase and charity facility. Four of our established CCPs have been enrolled onto an independent prescribing course at University of Worcester. Our expectation is that following qualification completion, CCPs will be able to use all of the drugs available to them rather than being bound by patient group directives for medicines beyond the scope of a standard paramedic.

What clinical research is MAAC taking part in at the moment? Have you got any findings coming out soon?

MN: MAAC is currently taking part in a pioneering air ambulance transfer service conveying suspected stroke patients at Hereford County Hospital to the comprehensive stroke unit at Queen Elizabeth Hospital, Birmingham. Hereford County Hospital is the furthest hospital from a comprehensive stroke unit, in the region. The 56-mile journey, which could take land ambulances over an hour, is reduced to just 20 minutes by air with advanced critical care crew escorting, meaning they can swiftly respond to changes in a patient’s condition if this occurs mid-flight.

IJ: From 2016, MAAC was part of a major pre-hospital clinical study, RePHILL (Resuscitation with Pre-HospItaL bLood products), which used air ambulance teams to investigate the benefit of giving patients blood products immediately after a major traumatic injury in the pre-hospital environment. The recruitment phase ended in early 2021 as the trial had recruited the target 400 patients, making it one of the biggest pre-hospital blood trials to date. We eagerly await the results and how it might inform our use of pre-hospital blood products.

Investing in your team’s mental wellbeing is essential when they are responding to trauma calls; what support structure is in place to ensure they can cope with the calls they are attending?

IJ: The clinical team have developed a system of welfare, checking in with crew attending significant or emotional missions. MAAC recognises the importance of the team’s mental health and has implemented the Trauma Risk Management (TRiM) peer support program by March on Stress. This program trains volunteers from within the team to undertake welfare conversations with their peers and assesses the need for further support. TRiM practitioners can signpost to mental health services and plan follow-up conversations to provide longer term support, where required.

Charities have been hit hard throughout the pandemic, with fundraising opportunities few and far between; what has the effect on your finances been over the past year?

HS: In line with Government guidance, all face-to-face community fundraising events were cancelled. This meant that we saw a significant decrease in community- and event-related income. However, we’ve been fortunate as local people and businesses in the counties we serve have continued to show us their unwavering support throughout the pandemic.

This does not mean that things have been easy, if not for the hard work and commitment of all staff and crew at the charity, it may well have been a different story.

How has your background in the aviation and healthcare sectors aided you in the role of CEO of MAAC?

HS: Having previously worked in aviation for British Airways and having spent a lot of my prior career in the healthcare sector, I have taken the knowledge and experience gained and used it to support MAAC through what is probably the most difficult time the organisation has seen its in 30-year history.

We do not receive any Government funding for our daily lifesaving missions, yet we have provided a proactive response to the pandemic and continued to demonstrate vision and leadership through what continues to be a difficult and unprecedented time. We have also shown we are a forward-thinking organisation by making plans to future-proof our clinical operations.

Is the future bright for MAAC? What do you hope will happen, or where do you see the charity going, in the next five years?

HS: We are passionate about continuous improvement and have therefore started work on the construction of a new airbase headquarters facility in the Cosford area of Shropshire, which will enable our crew and non-clinical charity team to work smarter, as well as providing more operational cover across the Midlands.

To equip the crews with the advanced training required, the charity is investing in a simulation training suite to form part of the new facility. This will enable clinicians to practise skills in a controlled environment, while re-enacting cases in real time. This suite will include projected scenes onto walls, temperature control, audio-visual features and patient manikins to perform procedures in a pressurised environment.

The new facility will allow us to extend our daily operating times and respond faster to missions. An increased capacity will mean clinicians can develop their talent, creating a space for research and development in the helicopter emergency medicine and pre-hospital sector, in addition to improving patient care.