Ambulances in the Sky
Hugh Gilmour asks if we can meet up in the afternoon. Blame the flight gods, he says. It turns out he’ll just be getting to sleep around the time we’d originally scheduled our interview. Totally understandable.
When we get together that afternoon at his hangar headquarters, surrounded by meticulously kept cardio kits, portable ventilators and pre-sorted supply packs, Gilmour doesn’t actually look too sleepy. (Though he did accidentally call me Hamish in an email right after he woke up. Again, totally understandable.) Despite the disruption to his sleep routine, he isn’t irritable, patiently explaining why he wanted to push things back. The previous night, a young man in Kugluktuk got a fish hook stuck in his eye: one hook in upper eyelid, one in the lower eyelid and a third hook that penetrated the sclera—the white part of the eye. Just as Gilmour was settling into bed in Yellowknife, his iPhone 6 buzzed. So he threw on his blue AMS jumpsuit, drove to the Air Tindi hangar out at the airport, grabbed his gear, hopped into a Northern ambulance—in this instance, a Beechcraft King Air 200—and responded to the scene, on the coast of the Arctic Ocean, 600 kilometres due north, 90 minutes away. After flying through the night, they brought the patient into Stanton Territorial Hospital in Yellowknife for treatment at 5:30 a.m. But Gilmour didn’t get home until 7 a.m., after filling out a patient report, restocking equipment and getting it ready for a cross-shift. “I always find if I’ve been sitting in a plane for hours, no matter how tired I am—I could be just bagged—I can’t go straight to sleep,” he says. “I need to just not be moving for a few hours.” Gilmour nodded off around 9 a.m
That’s just a regular day for the flight paramedics with ACCESS, a partnership between Advanced Medical Solutions and Air Tindi, which responds to nearly 1,700 air ambulance transfers—“we’re not supposed to call them medevacs anymore,” says Gilmour—throughout the NWT and Nunavut’s Kitikmeot region each year. That’s roughly 1,000 calls out of their Yellowknife base, about 300 from the Inuvik base and more than 300 from the Cambridge Bay base annually.
Why so many calls? The North’s well-documented shortage of roads, coupled with the long distances between small communities, which lack all but the basic health amenities, and larger towns with better equipped health care centres, mean that air ambulances take on the bulk of urgent and unique medical transfers. They transport trauma patients, women experiencing complications with their pregnancies or going into labour prematurely, or even just patients with contagious viruses who probably shouldn’t travel on scheduled flights, bringing them to regional health centres, the territorial hospital in Yellowknife or down to Edmonton—depending on the patient’s needs. In the NWT, Gilmour says only the hospitals in Yellowknife, Inuvik, Hay River and Fort Smith will regularly deliver babies; if there are any complications at all, the expectant mothers are sent to Yellowknife or Edmonton.
Gilmour’s been a paradmedic for 14 years now; he’s spent more than seven with AMS. He is seven days into his 28-day rotation. Yes, he works 28 days in a row. And he’s on-call 24 hours a day. But if a call comes in, he’s only allowed to work 14 consecutive hours, before taking a mandatory 10-hour break. If another call comes in, one of the other eight critical care paramedics on rotation will take it. “Fourteen hours is a long day, but I can grind that out knowing that there’s a 10-hour rest period at the end,” he says. “That’s going to make sure that our staff are a lot less fatigued, which is really what’s the most important thing.” You still have to eat, get groceries, go to the gym. And sleep. If you think this schedule sounds inhumane, Gilmour does get 28 days off once his rotation ends. This gives each of the 20-odd flight paramedic crew members—all of whom reside outside the NWT—time to go home and be with family. Gilmour lives in Grande Prairie, Alberta; one of his co-workers lives in the Caribbean.
He takes me on a tour of the Air Tindi hangar that now doubles as the AMS base, showing off the first of three brand new 2014 King Air 200s that had just arrived, purchased after AMS and Air Tindi won an eight-year contract to provide medevac service in the NWT. The plan is to have two of these aircraft parked inside the hangar, so patients coming or going in the depths of winter will be transferred into the plane in relative comfort, avoiding -40 C temperatures that not only affect an anxious, ailing human being, but also cause IV lines to freeze up and even ventilator tubing to shatter.
The new King Airs have space for two stretchers, with new comforts like swivel (and reclining) seats for the critical care paramedics. Gilmour’s a self-professed aviation nerd, and he brings me into the flight deck to show me the screens that, when lit up, will give the pilot and first officer a simulated picture of the terrain below them. He can’t wait to get up in the new bird.
Though the geographic and logistical conditions necessitating air ambulances haven’t changed much over the years, the conditions for patients on the flights sure have. Gone are the days of improvisation: where daring bush pilots took off and asked questions later; where you got the patient on the next flight out of town no matter what—even if it meant carting them down the aisle, past stunned passengers on a scheduled flight, to the back of the plane and putting up a curtain, with passengers on pins and needles the whole trip hoping the patient survives.
“He doesn’t know anything, so there’s no influence for emotion—like, ‘It’s a kid, I’ve got to get in there.’ That’s not allowed to happen.”
Lois Chetelat was a registered nurse in Aklavik in the early 1960s, and she went on her fair share of medevac flights. Just four months ago, she bumped into an air ambulance paramedic in her hometown of Ottawa and was fascinated to learn about the advances in the industry: how planes are custom-fitted with medical equipment and personnel are specially trained for the unique demands of the job. It wasn’t like that in her day. On one trip back from Sachs Harbour, she remembers, “we had to hang intravenous bottles up just inside a normal airplane”—jury-rigged with a coat hanger, no less.
And when something happened in Aklavik back then, community centre staff would have to coordinate everything on the fly. She recalls once in 1962, a young girl succumbed to burn injuries: Chetelat and her nursing partner didn’t want to see that happen again. Soon after, another child came in with similar burns. “We were concerned because we were again without correct supplies and medication treatments,” she says, reading me a letter she’d written home at the time. “After radio contact with the doctors, we made the decision that I would escort the patient to Inuvik General Hospital. Our problem was to find a bush pilot who would fly at night. We approached a former RCMP pilot who had set up a business in Aklavik. He agreed to transport the patient and me.” To create a runway in the darkness, “the pilot filled a number of cans with kerosene and placed them in a long rectangular shape on the frozen [Peel] River. Once the cans were lit, we boarded the plane and, guided by the flickering fires, we ascended quickly into the starry night. I sat in the front seat beside the pilot, holding and comforting the suffering child in my arms.” The child pulled through.
Today, harrowing tales such as these aren’t likely. For one, when a call comes in from a community health centre, it goes directly to an operator in Yellowknife, who coordinates a plan with the caregiver making the call and the doctor at the receiving unit. If a medevac is required, a call goes to Air Tindi, “because the first step that has to happen to ensure an air ambulance transfer can occur is if it’s safe to do,” says Gilmour. This means getting weather information to ensure the plane can land in the patient and the receiving community—and also that there’s an alternate airport if weather conditions deteriorate enroute. (Fall and spring tend to be most volatile seasons, says Gilmour, with ice fogs plaguing communities near large bodies of water before freeze-up.) As a precaution, the captain isn’t given any unnecessary information about the trip, in order to keep him or her from potentially taking risks. “He doesn’t know anything, so there’s no influence for emotion—like, ‘It’s a kid, I’ve got to get in there.’ That’s not allowed to happen,” says Gilmour. Once the flight is approved, critical care paramedics have 30 minutes to get to the base to prepare for the flight. They’re expected to be ‘wheels-up’ 45 minutes after the flight is approved.
“Distances are so vast, many communities have no road access whatsoever, we’re the only option to get these patients the care that they need.”
AMS and Air Tindi had seven years of medevac experience together prior to the contract renewal in April. But for the new contract, the two companies decided to partner up, rather than having one subcontract to the other. “What that means is that we have our budget and we run our operations the way we need to ensure top quality and Air Tindi does the same. So Air Tindi cannot influence our decision-making and vice versa,” says Sean Ivens, CEO of AMS, which just celebrated its 20th anniversary. “If it was a subcontract relationship, the prime contractor can manipulate the subcontractor based on price and on operations. We felt that it was important not to be able to influence each other’s decision-making in that regard.”
Since getting into the medevac game, AMS has found some interesting ways to keep staff trained up. Rather than waiting for openings in southern certification courses—which only happens a couple times a year—AMS got some of its own employees certified as educators. This allows them to train their own staff, and other Northern medical professionals, whenever required. It has also spurred the creation of a new business unit with AMS that offers medical training and education.
And Northern air ambulance paramedics get a ton of training, including specialized certifications to treat infants and newborns, tailored to the types of calls they receive. (That’s another contrast to Chetelat’s day: registered nurses weren’t even able to put in IVs on their own; only doctors could.) Gilmour, also a part-time educator with AMS, says this is a big draw. “In a lot of places, you’ll have speciality teams for neonatals and you’ll have speciality teams for pediatrics and then the normal flight team will take all the adults,” he says. “But we’re a little bit unique: we take them all. So we have to be really strong generalists, good at all patient populations.”
In fact, the company has invested in a whole family of hi-tech mannequins—essentially life-sized dolls that cry, vomit and even have their tongues swell in reaction to various simulations. “You just start pushing buttons and this machine does whatever your body does. It’s unbelievable,” says Ivens. “You can simulate a patient having a stroke. You can simulate a heart attack; 20 different types of heart attacks, in fact. You can have allergic reactions, you can have all kinds of other medical complications going on within this patient and they’re scenario driven, which is pretty cool.” This lets teams practice real-time scenarios in a classroom on a virtual man, pregnant mother, baby or newborn doll. Ivens and trainer Nick Nowe demonstrate the versatility of the adult male doll, Andy, in the classroom at the AMS facility out in an industrial area of Yellowknife. Hearing his Homer Simpson-style shrieks and seeing him stare out blankly is a little unsettling as different simulations are punched in—but better an unfeeling robot than a living person on the ground.
Still, all the advances in technology and procedures haven’t taken the adventure out of the job. “Here in the Northwest Territories, we actually fly a lot of patients by air ambulance that, in other jurisdictions in Canada, wouldn’t be flown because they’d have other means of getting to health care,” says Gilmour. “Distances are so vast, many communities have no road access whatsoever, we’re the only option to get these patients the care that they need.” And after landing in a community, or a mining camp or out in the bush, critical care paramedics still have to deal with wild and unpredictable situations, in extreme weather conditions—in clunky gear. “It’s almost like you’re an astronaut, because you’re wearing the big Canada Goose jacket and the down pants and the big mitts and the toque and the headlamp and you’re moving around like the Michelin Man and then you’ve got to get the patients into the plane,” he says. “And then you’ve got to get your spacesuit stuff off so that you can actually move around in the back of the airplane because you’re so encumbered, otherwise you can’t function.”
Gilmour’s most memorable calls? Maybe it was the time he had to transport a patient by sled, dragged behind a snow machine, out at Bathurst Inlet. Or when he responded to a plane crash—by plane. They once had to land on the Dempster Highway to respond to a motor vehicle accident. Every day presents the potential for something new.
“I’ve been to every single named community in the Northwest Territories and in the Kitikmeot region of Nunavut and most of the large mining and exploration camps. And then a myriad of small bush camps, cabins,” he says. “I get a chance to go to places that a lot of Canadians don’t even know exist, let alone are able to pronounce. And we do that on a regular basis and that’s cool. Not only do we do cool medicine up here, but the culture is interesting, the people are amazing, the scenery is breathtaking and it’s challenging.”
Yet the number one focus is always on the patient—someone who might also not be the most comfortable flier. “There’s a lot of coaching that goes on. There’s a lot of reassurance,” says Gilmour. “That’s just being a good human being to somebody who’s having a really bad day.”
We say goodbye and I drive back downtown, to sit behind a desk for the rest of the day. Gilmour goes back to work too, which, as it turns out, ends up taking him to Fort Liard, Hay River and Fort Smith that day. And that’s only day seven of 28.