Torrential rain lashes the runway as the Tri-Star aircraft comes to a halt by Birmingham International Airport’s air cargo terminal, followed closely by a C-17 Globemaster, one bleak day in 2007.
The aircraft, part of the RAF's aeromed service, are bringing back 20 injured soldiers (eight from Iraq and 12 from Afghanistan), several of whom are on life-support machines.
Waiting on the tarmac are four NHS West Midlands paramedic ambulances, a large military ambulance, called a jumbulance, a coach for the walking wounded and police escort vehicles.
Co-ordinating the operation from the ground is Sergeant Nigel Tye of the Royal Air Force, head of the aeromed office at the Royal Centre for Defence Medicine (RCDM) in Birmingham.
In his three years of arranging the transfer of patients from their point of arrival in the UK to Birmingham hospitals, Sergeant Tye has seen nothing like this airlift.
He hasn't slept much in the past 24 hours. He was at the RCDM until 3am the night before preparing for the arrival and was back in the office at 7am.
To complicate matters, it's the height of the widespread flooding of 2007. Many roads are closed and emergency services are stretched to the limit.
“That day was a logistical nightmare,” he says, looking back. “And the rain didn’t help. We were walking through puddles to meet the flight.”
Having been given 10 hours’ notice of the incoming flights, it was a race against time to make all the necessary arrangements for the patients’ onward journey.
“My role involved reserving ambulances, registering patients, confirming beds, allocating medical staff to meet casualties at three hospitals, making family welfare arrangements and keeping everyone informed at all times,” says Sergeant Tye.
It was an operation requiring the combined efforts of the military, University Hospitals Birmingham (UHB) and Birmingham City Hospitals, West Midlands ambulance and police services and Birmingham airport authorities.
All available help was needed. “I was calling people to come off leave,” says Sergeant Tye. Even the RCDM commanding officers’ driver had been enlisted to drive some medics back to UHB.
“They were the busiest 24 hours I've had yet,” says Sergeant Tye. “But being ready at short notice and adapting to last-minute changes is part of the job.”
Another critical moment was when thick fog prevented an aeromed flight from landing at Birmingham in January 2009. The flight, carrying 10 casualties from Afghanistan, was unexpectedly diverted to Derby.
A convoy of nine vehicles, including four ambulances and a jumbulance, was ordered to move out of Birmingham International and head to East Midlands Airport. “We still got there on time,” says Sergeant Tye.
Vital airlink
Time is critical for these injured soldiers, many of whom need emergency life-saving treatment when they arrive in the UK.
Aeromed provides a vital link between the field hospitals in the conflict zones, such as Afghanistan, and UHB, the main receiving centre for combat casualties.
About 4,500-5,000 patients pass through the aeromed service annually.
Aeromed's headquarters, the Aeromedical Evacuation Co-ordination Cell (AECC), are at RAF Brize Norton in Oxfordshire.
The medical teams are based at RAF Lyneham in Wiltshire. When the order is received to return a critically ill patient to the UK, an aeromed team can deploy within an hour.
The five-member Critical Care Air Support Team, or CCAST, consists of a consultant anaesthetist, two critical care nurses, a qualified medic and an equipment technician in case any of the medical hardware develops a fault.
The team can be increased with additional nursing and medical staff, depending on the number of patients being moved.
The medical equipment onboard includes oxygen cylinders, ventilators, monitors, infusion pumps, stretchers, vacuum mattresses, intravenous fluids and medication.
The flight from RAF Lyneham to Camp Bastion, the UK armed forces’ centre of operations in Helmand province, southern Afghanistan, takes about 10 hours.
On the flight home, the aeromed team’s task is solely to maintain the stability of their patients’ clinical condition.
“You can’t operate onboard,” says Sergeant Tye. “Their job is to keep patients stable rather than provide clinical treatment.”
Certain types of injury will influence the type of aircraft used or at what altitude it can fly. “If the patient has a head injury, for example, the aircraft might be obliged to fly at lower altitude,” says Sergeant Tye.
The medics provide the AECC with a condition update during the flight while Sergeant Tye and his team plan the collection and transfer of patients to hospital.
It’s an elaborate evacuation chain, which works so efficiently that a casualty can be in a UK hospital less than 24 hours after being wounded.
A 2009 report on the standard of military medicine by the Healthcare Commission called the aeromedical evacuation service an area of “exemplary practice”.
When he gets the call about an aeromed evacuation, Sergeant Tye’s only focus is to make sure everything is in place and ready for when the aircraft ramp comes down on the tarmac.
“My concern is to get the best care for injured troops as quickly and as smoothly as possible,” he says.
“My job finishes once the patient is in his or her hospital bed. We put people in beds so the rest of their care can begin.”
