Northern Ireland Air Ambulance anniversary: Just what the doctor ordered
Tomorrow marks one year since Northern Ireland's air ambulance took to the skies following campaigns led by the late consultant anaesthetist and road racing doctor John Hinds. Ivan Little meets the team of medics, pilots, engineers and fundraisers and hears how their carefully organised operations in bringing emergency hospital care to the remotest regions have delivered 380 call-outs so far.
Think Maze/Long Kesh and you think hunger strikes, a mass escape, internment, H-Blocks, riots and the murder of Billy Wright.
But the notorious jail on the outskirts of Lisburn which was long synonymous with hate is now the headquarters of hope.
For the former prison is the base for Northern Ireland's air ambulance - where people have been plotting for the past year on how to save lives rather than how to take them.
It's a transformation that would have been unimaginable in the darkest days of the Troubles.
And on a flying visit to the base ahead of the first anniversary of the air ambulance's first mission, it's hard to stop the eye, and the mind, wandering from the meticulously-maintained EC135 twin-engine helicopter to the reminders of days gone by at the Maze.
The hangar for the helicopter is the old security building where cars and lorries were once routinely searched on their way into the jail.
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And in the distance a watchtower still looms large over the area where hundreds of paramilitaries were locked up and where hunger strikers starved themselves to death.
But amid the remnants of the past at the Maze, the talk now is all about life and preserving it and ensuring that scores of injured people have a future they mightn't have had, as medics, paramedics, pilots and engineers all work side by side co-ordinating a near-military style operation to run the air ambulance.
Officials can't put a figure on the number of lives they've saved but they can say that from July last year to June this year the air ambulance completed 380 missions, flying for 233 hours and using a staggering 62,630 litres of fuel.
Half of the calls were for road accidents and bizarrely the busiest day for call-outs has been a Saturday and the busiest time, 3pm.
An even more compelling statistic is the fact that it takes £2m a year to keep the Helicopter Emergency Medical Service (HEMS) in the air.
And that's where the charity Air Ambulance Northern Ireland (AANI) comes in, raising funds for the aviation and non-medical costs of the service, which is operated in partnership with the Northern Ireland Ambulance Service (NIAS) and the health trusts here.
The blizzard of initials may be confusing but what's easy to understand is that the doctor-led air ambulance has been providing a vitally-needed emergency lifeline to people at serious risk after significant injury or trauma. The air ambulance operates 12 hours a day for seven days a week and can reach anywhere in Northern Ireland in roughly 25 minutes.
But it's what happens next, after landing, that can be the difference between life and death.
The mistaken belief among many people is that it's the speed of getting the patient back to hospital which is the most important factor, but in reality the air ambulance is bringing emergency hospital care direct to the casualty where medical interventions can save lives.
Dr Darren Monaghan, the HEMS clinical lead whose main job is in the Ulster Hospital, Dundonald, says: "We are definitely making a difference. There are people sitting down with their families today because of this service initiating their care within the health service.
"We have a significant rural population in Northern Ireland and a road system which is quite rural. So the real benefit is that we are often bringing a trauma team to very remote places and delivering resuscitation there. We are doing interventions that would normally have to wait until a patient is brought to hospital and we are enhancing their chances of recovery.
"The example that we often use is of a farmer who has perhaps received a brain injury in an agricultural accident. We will do interventions that maximise his chances of getting back to work rather than being disabled for the rest of his life."
At the Maze/Long Kesh, the nerve centre for the air ambulance crews is a control room which is fully equipped with maps, computers and a link to a HEMS paramedic working from what's called the air desk at ambulance control in Knockbracken, on the outskirts of Belfast.
Paramedic Glenn O'Rorke, who is the operational lead of the service at the former jail, says: "The paramedic at Knockbracken monitors the 600 or so emergency calls which come in every day and he assesses if the air ambulance should be dispatched."
Back at the Maze, weather forecasts, which are closely scrutinised, dictate if it's feasible for the helicopter to respond, with the last word going to one of the two full-time pilots.
The chief pilot is Dave O'Toole, a Dubliner who has more than 20 years' experience flying with the Irish Air Corps and with the Garda. He says: "Sometimes I have to make the call that it's too dangerous to fly because of the weather. And that's hard."
He says that no two calls are the same for the air ambulance, adding: "Every day is a school day when you are always learning. My primary responsibility is to fly the medical team safely from A to B and find a place to land but I will also help with handling bags or carrying a stretcher if it's possible.
"Some of the responses are difficult for the crews to deal with. For me, I get particularly upset if there are children involved and there are members of the family nearby."
The medical team consists of around 20 people - six full-time paramedics seconded from the ambulance service and a rota of around 14 consultant doctors who are seconded from the health service and who all have their own day jobs in different hospitals.
The helicopters - there's a standby one in Fermanagh - are rented from British-based firm Babcock Mission Critical Services Onshore, the largest operator of air ambulances in the UK, which also supplies the pilots and mechanics.
The main trauma centre in Northern Ireland is the Royal Victoria Hospital, but one drawback for the air ambulance has been the lack of a helipad there, meaning that the helicopter has to land at Musgrave Park hospital from where patients are transferred by road, regularly adding crucial minutes to the journey to the RVH through busy traffic.
But Dr Monaghan says: "We are being told that the helipad on the roof of the Royal will be operational this summer and that will immensely benefit patients."
Before the start of AANI operations in July 2017, Northern Ireland was the only part of the UK without an emergency helicopter service.
One of the main campaigners for an air ambulance was Dr John Hinds, who was one of the "flying doctors" of Irish motorbike racing. He had been lobbying Stormont to create a HEMS before he died in 2015 in a crash while providing voluntary medical cover at the Skerries 100 race in Dublin, the same event where William Dunlop was killed earlier this month.
Dr Monaghan says the air ambulance might never have taken off without Dr Hinds' tragic passing.
He adds:"While people were working away in the background I think it was John's untimely death that spurred on the public desire to have an air ambulance, which is now his legacy."
Obviously the helicopter isn't flying every minute of every day, but the air ambulance teams don't twiddle their thumbs when they're on the ground. On a daily basis, they go through rigorous checks on their kit and their medications and they train for every eventuality.
During my visit to the helicopter hangar, Dr Alan Laverty - a consultant at the RVH - and paramedic Phil Hay were practising their anaesthetic and paralytic procedures on a mannequin.
Phil says: "I've been a paramedic for more than 20 years on the road in south Down and Belfast. But having a doctor on call-outs has brought the level of care to a much higher level. It's been a huge change. There's been a lot of learning for me, for example, with using the critical care equipment, the paralytic drugs and the ventilators."
Dr Laverty has only recently returned from Australia where he was part of a HEMS unit, an experience which also gave him an insight into the work of emergency responders.
He says: "Being in a pre-hospital situation gives you a lot of appreciation for the responders and the difficulties they face in getting patients to an emergency department. When the patients come into us in hospital they're usually lying there in front of us, but that's not the way they were found at the scene."
Engineer Marty Regan spends his time carrying out maintenance work and checks on the AANI primary helicopter, which was previously used by the Scottish air ambulance, and on the back-up aircraft which saw service in Cornwall.
He says: "Even the smallest defects with them can put great restrictions on what you can do. Helicopters are complicated machines and there's a lot going on in them."
Fundraising for the air ambulance is only part of the task facing AANI. Raising awareness that it is a charity that needs public support has also been a challenge because many people think the air ambulance is part of the province's health structure.
Kerry Anderson, the head of a six-strong fundraising team, says: "For our start-up grant our trustees were able to get £3.5m from the Exchequer from a fund financed by the fines that had been imposed on the banks, but the money we need to raise by ourselves equates to £5,500 every single day.
"However, the community have really got behind us - though in some places we still need to get our message out more. A lot of our support has come from sporting organisations like motorbike, cycling and equestrian clubs who see the element of risk in what they're doing and realise they might need to call on our services.
"We are also trying to reach out to the corporate sector. In our first year we raised £1m but we have a four-year plan to get to where we need to be in terms of sustainably - raising £2m every year."
An air ambulance club has been set up to allow individuals to donate to the cause, with a weekly fee of £2 a week. At the minute 200 people have signed up to a direct debit scheme and they've been invited to a special 'birthday' function at Maze/Long Kesh tomorrow, the first anniversary of the first mission.
Find out more at www.airambulanceni.org