Words by Steve Whitfield
Over a month ago I was on shift as a paramedic pondering my next career step when an email caught my attention. It was an opportunity for flight paramedics in Fiji, and naturally, as an ALS paramedic, I filed it for a later read. Flight positions are normally highly sought after by intensive care skillsets with flight experience and having minimal experience in-flight work in the last 5 years I never considered myself eligible. However, later that night I was scrolling through my emails and saw it again and after a quick read, I was rather intrigued.
Fiji is a Pacific island nation made up of 333 islands and lots of ocean situated approximately 1,100 nautical miles (2,000 km) northeast of New Zealand's North Island. Like many Pacific islands, the ambulance services are confined to the main regional hubs and capital cities meaning that the people in the rural and more remote islands have very limited access to quality pre-hospital health care. When an accident occurs or someone is sick they don’t have the luxury of awaiting the comforting sound of a siren that precedes the rapid arrival of a professional health service, on the contrary, they must use their own initiative in assisting each other and sometimes transporting people by any means necessary to the local health posts and community centers where medical staff are located.
The more I read the more I became fascinated by the proposal. It went on to discuss how Fiji had recently launched its first dedicated air ambulance equipped with an emergency flight crew with medically trained professionals. They were seeking the assistance of Australian and New Zealand-based paramedics in filling the flight roster with qualified staff. There was not a program in place at the time however I responded with a strategic proposal that would benefit the air ambulance as much as it could benefit paramedics back home.
I soon found myself flying high over the Pacific Ocean heading to meet the stakeholders of the program and discuss the proposal further. Upon landing at Suva international airport I was met by the directors of the program and we were soon in the hangar discussing the strategy further. The conversation was cut short with an emergency medivac called in from an outer island and within 45 minutes the air ambulance was airborne with myself being supported by Fijis first flight nurse Mere. Mere had been working as an emergency nurse for over 20 years with a master’s degree and a sense of humour anyone can appreciate. The aircraft, an AW109 can comfortably sit three people plus a stretcher in the back of the aircraft and a pilot up the front. With a twin-engine redundancy and a maximum cruising speed of 285 km/h (177 mph), it had has approaching the green palm tree-fringed white beaches of an outer Fijian island in no time. Due to scattered lower-lying cloud hugging the green peaks of the island we circled the turquoise water a number of times before identifying a safe approach to the landing zone (LZ). The LZ on the island inadvertently doubled as the local footy field and people quickly cleared the area where we were met by some staff from the medical post in a utility vehicle.
The patient had suffered a deep laceration to his leg during a storm the day before and it had taken him some time to present at the health post. He was dehydrated, fatigued and already febrile, but it was comforting for me to witness the level of care provided to him by the medical staff at the health post and I was equally impressed at how seamlessly the patient was loaded into the vehicle for the transfer to the aircraft. I received final instructions from the local doctor and thumbs up from Mere indicating that our collective team had stabilised and packaged the patient ready for lift-off to the main island, Vitu Levu.
Landing at the Suva waterfront attracted a small crowd of onlookers as we transferred the patient into an ambulance for a short road journey to the hospital and then packed up the kits and reset the aircraft. The next morning were airborne again heading south this time to retrieve a paediatric patient with an infection. Our crew was supported by a locally registered Fijian doctor with neonatal retrieval experience and the team worked seamlessly together to support both the patient and the patient’s mother (who had never been in a helicopter).
The following day we were forced grounded due to a category 3 cyclone bearing down on the island nation and we took the time to develop the initial strategy. Simply, the strategy was structured around how paramedics on short-term rotations could support the vital work being done as part of an ongoing professional development program. With flight roles in Australia and the UK being so competitive, the strategy focused on suitable paramedics with an interest in aeromedical retrieval filling the role to support the service whilst gaining valuable experience themselves in flight operations.
Having been personally involved in supporting the Vanuatu ambulance service with volunteer paramedics through Planet Medic since 2015 we used a similar framework to accelerate the process and establish the responsibilities and boundaries for the Fijian program.
The cyclone belted the islands and then moved on almost in sync with the stakeholders agreeing on the program and we were airborne the very next day on a new retrieval. Flying 800 feet above the islands gave the three crew an obvious clue to the gravity of this most recent storm, roofs were missing, housing was damaged and the lush green canopy of yesterday had been striped on the wind side of the peaks. In a true testament to the Fijian resilience, the property was being collected and returned, people were already out repairing neighboring properties and kids were already out playing footy on the local fields. We conducted another 3 medical retrieval that had been delayed due to the cyclone before we were rotated on days off for a couple of days. As the weeks passed and the jobs continued almost daily my clinical skills in the flight role developed and improved. I had been working with Fijian flight doctors, flight nurses, and local EMTs in the delivery of prehospital care with a difference, we had sometimes flown for over an hour with nothing but the blue Pacific Ocean below us, we were forced to overnight in some remote locations occasionally and met some of the most resilient and generous people I have ever been exposed too. The program offered me a real opportunity to gain valuable insight into the flight paramedic role and coupled with a growing and developing prehospital industry in a pacific island.
Now having returned to Australia I am eagerly anticipating my return to paradise once more. The generosity of the Fijian people and their resilience is a testament to the people. I miss the roadside fruit markets, the dedication of the medical professionals I had the privilege to work with, watching the local footy games in torrential rain, and my morning greeting (Bula Vinaka bro) from my trusty flight nurse Mere, but I am very thankful for the opportunity from the people to share this.
Vinaka vaka levu
Author – Steve Whitfield Flight Paramedic, Fiji 2018.
Adapted from the original article: Helicopters, cyclones and coconuts. Found in Australian Paramedic. Used with permission.