Interview: Professor David Lockey

Why did you decide to take on the role of National Director of the Welsh Flying Medics?

For those who may not be aware, the Welsh Flying Medics (also known as EMRTS Cymru) refers to the NHS medical provision on board the Wales Air Ambulance (WAA) Charity helicopters. In this unique partnership, the Welsh Flying Medics supply the medical teams and equipment while the WAA raise the funds required to run the helicopter operation.

I have been involved in many UK air ambulance operations in my career. This Service has been set up from scratch in a short period of time and has learned many lessons from the successes and problems in long-established services. It is a young, highly professional organisation with excellent governance serving a population with a fascinating mixture of trauma and medical emergencies in a mixed rural and urban environment. The National Director role was a rare opportunity to lead a great organisation and one I could not miss.

The National Director role was a rare opportunity to lead a great organisation and one I could not miss.

What are the primary challenges the organisation faces at the moment?

The major current challenge is developing a service configuration that delivers critical care to the highest possible proportion of the population when they need it. This means expansion of the service into night hours, which will be a major undertaking.

How do you see the Service model developing in the future with regards to the Major Trauma Network, and the effect that its introduction will have on delivery of urgent medical services?

The Service is already delivering high-quality trauma care in Wales. Approximately half of the current case mix is trauma. When a trauma network is developed, high-quality pre-hospital care is an essential component of the trauma patient journey. We look forward to working with the ambulance service to develop even better early trauma care and transfer to appropriate receiving hospitals as part of trauma network development.

We are currently engaged with the development of a major trauma network in South Wales and South Powys, while already contributing to the existing trauma network that covers North Wales. Any developments in our service will enhance patient care the whole county.

What innovations has WAA been coming up with to improve the care on offer to patients, and are there any more in the pipeline?

We are one of the first services in the UK to carry blood products on board its helicopters, and we have developed a comprehensive range of blood products to treat haemorrhage and patients on anticoagulation drugs (e.g. Warfarin).

The organisation is looking at innovative ways to improve service delivery. One of these ideas has already been rolled out, in the form of an app, which has been produced for staff and provides the ability to have a huge amount of information about hospitals, staff and major incidents to hand when working on scene. 

The Service is also looking to broaden its research portfolio, and this may lead to opportunities to introduce innovative technologies across the medical and operational spectrum. However, in the shorter term, we have plans to introduce telemedicine capabilities from the aircraft and we are exploring body-worn video cameras to enhance clinical audit and learning. In addition, the Service has strong links with Swansea University and is continuing to link data to allow longitudinal follow up of patients through their world-class SAIL database. This data is used to quality assure and examine the impact that the Service is having.

Our Charity partners have introduced, and are fully funding, the Children’s Wales Air Ambulance. This aircraft, currently being trailed, is dedicated to the inter-hospital transfer of neonates and paediatrics, and when required adult patients. This specialist service has also prompted the introduction of a new role, Helicopter Transfer Practitioner (HTP). 

Continuing professional development of the medics onboard the helicopter is key to their ability to deliver the best pre-hospital care; how does the Service make certain that all its medics are gaining sufficient knowledge and experience?

The Service runs a comprehensive selection, training and continual professional development programme to ensure that our doctors and critical care practitioners (CCPs) are well placed to utilise best practice and new developments in pre-hospital care. All full-time medics have access to a generous package of protected training time and study budget. This not only includes access to standard life support courses, but extended skills such as ultrasound use. In addition, CCPs undertake an MSc in critical care from one of a number of providers and we are currently developing a bespoke course with academic partners. This is overseen by consultant and CCP leads for training and education who regularly review portfolios, as well as named supervisors for each member of staff.  

In addition to developing our own staff, we deliver a large number of CPD events and observer opportunities to partner organisations and individuals every year. This ensures that we meet one of our aims of supporting clinical and skills sustainability.

Previously, you were a consultant and research lead at London’s Air Ambulance, and are a trustee of that charity. How has your role there helped you to prepare for your new job in Wales?

Although the two services are very different, many of the challenges (e.g. 24-hour working, meeting the specific needs of the population and the introduction of new interventions) is common to both. This, and exposure to a huge number of trauma patients over 20 years, has made London a great preparation for this Service. Working as a charity trustee has also given me a valuable perspective into some of the challenges and successes of our key operational partner – the Wales Air Ambulance Charity. The Welsh Flying Medics also has a great deal of potential as a research organisation – and this is an area in which we are keen to deliver.

You also have military experience of pre-hospital care. In what capacity did you serve?

I have served in pre-hospital and in-hospital military roles in several recent conflicts. It has been a privilege to be involved in a system that has evolved so quickly to deliver amazing outcomes to the seriously injured in very difficult operating conditions.

In what ways do you think that civilian air ambulance organisations can learn from the military medical evacuation service?

System design is the key component of improved outcomes. In common with military medical evacuation services, we need to adapt our service to the needs of our population, the geography and the other services that we interact with. Although specific interventions and medical advances are important, the overall performance of a good system is what really delivers results.

There has been international interest in medical innovations used by the Welsh Flying Medics from Northern Ireland, New Zealand and America; what were these medical innovations, and did new practices get introduced in services in other countries as a result of those being undertaken by your teams?

Whilst many of the innovations were relatively new in 2014 when the Service was being developed, these are rapidly becoming standard practice across the sector. One aspect that still stands out, though, is the workforce model that has many advantages to the Welsh NHS, clinicians and, of course, patients. Our consultants already hold permanent contracts within the NHS in Wales and England. In the majority of cases, their sessions with us are done in addition to their standard NHS sessions, so hospitals are not being denuded of consultant cover. This model has acted as a blueprint for other new services who are in the process of setting up.