How to treat renal stone disease
When Dr Gill Jenkins isn't at her practice she is flying around the world to rescue expats
If it's Tuesday it's Bristol general practice, but the rest of the week I'm travelling the world in my role as a flight medical officer for a repatriation and air ambulance service.
Working for Wings Aeromedical Service, one of the biggest of around 20 UK assistance/repatriation companies, means short-notice travel (usually arranged the evening before) to such exotic destinations as Belfast, Benidorm and occasionally Barbados or Brisbane. Most sorties are by plane, rarely helicopter and, as Wings also runs the UK's largest private road ambulance service, sometimes by road, ferry or Eurostar.
The sickest patients get an air ambulance usually a small turbo-prop or business jet chartered for the job and equipped by the repat company, although increasingly the dedicated aircraft of the European Air Ambulance companies with their cheaper fuel dominate the business. For the less sick, stretcher or business-class travel on scheduled airlines provides the bulk of their transport, though sometimes logistics demand other options such as a short charter flight which may be better than a three-leg trip with lengthy transfer stops.
The majority of our patients are the holidaying public so the commonest destinations include the Med and USA, although a trend to more adventurous travel has led to some interesting, and often logistically difficult, destinations. Bringing an immobile patient, who had a stroke and then an MI halfway up a Himalayan rock out of Katmandu, laid on her 10 bags of climbing gear in the back of a transit van, isn't ideal but was as good as it was going to get.
A variety of business contracts result in even more unusual jobs, whether it's a lorry driver stranded with a pilo-nidal abcess in Azerbajan, a stressed businessman with an MI and acute anxiety about his dilemma in Shanghai, or returning a Russian sailor stuck in a British hospital after falling into the cargo hold of his, long departed, ship.
I found Wings by local word of mouth but most repatriation companies need bank doctors. The British Medical Emergency Services Forum website will link you to several (bmesf.org.uk). Qualifications such as ACLS, several years' medical experience and, depending on the job, specialist training, are mandatory.
Courses such as the 'Clinical Considerations in Aeromedical Transportation' course (www.ccat-training.org.uk/mef.htm) and Wings's own medical transportation course (www.wings-medical-group.co.uk/training.html) are useful starting points for more specific training.
For me, the work led to sitting my pilot's licence, although that's not strictly necessary. You must be resourceful and self-reliant with an ability to think on your feet and cope alone the air ambulance team is well sorted but otherwise there's no one with you to help make decisions.
At best you may find a British Airways stewardess to hold the patient's hand while you sort them out, at worst you're on your own with a nervous and sick patient and, quite frequently, their more nervous and sometimes sicker spouse or relative, while you organise the wheelchair transfer, flights and oxygen which should have been sorted by the strangely absent local agent.
The decision is yours much as it may cost the company time and money, if you don't think the patient is fit to travel you have to say so. This can result in the logistical set-up being blown, the patient returning to hospital, and the flights, stretcher and oxygen being rebooked. Space may not be available for several days so you have to be prepared to be stranded with them (try telling your GP partners you're stuck in Hawaii!) or, one of the hardest things to tell that desperate-to-return patient, you go home without them.
Other skills that help are foreign languages, extreme patience, an ability to get on with people you may be travelling with your patient for 48 hours and a passion for airline food!
The financial rewards aren't great. The pay for long days doesn't compare with general practice. The travel is tiring, cramped and dirty, and you often only see the inside of an airport, hospital and hotel room but the adventure, the change from routine and the look on the patient's face when you arrive are invaluable.
Gill Jenkins is a flight medical officer for Wings Aeromedical