Paramedicine at Ten Thousand Feet

Flying Retrieval in the Pacific

· Lived Experience

“You want to have a closer look?” the pilot calls out as he banks the aircraft right. If the Pacific Islands had a crown Jewel, Vanuatu would have to be in the running. A series of 83 palm tree-clad, white beach fringed shorelines skirted by crystal blue water teeming with coral reef all year round. It’s a country that has worshiped Prince Philip and invented Bungee jumping. However perhaps the best thing in Vanuatu is the people. Largely Melanesian, the people are Ni-Vanuatu (meaning 'of Vanuatu').

The aircraft I am in is a BN2A-26 and is the ideal aircraft for inter-island flights in Vanuatu. With a max payload capacity of 700 kilograms and a range of just over 700 kilometers, it can land on any of the outer islands. However, I have been dispatched to retrieve three patients, a septic child who presented to a remote health post yesterday, an unconscious elderly female maintaining her own airway (unknown aetiology), and a middle-age man, walking, non/relieved rapid atrial fibrillation. Some would say this makes the aircraft less than ideal, it has two seats and a mattress on the floor, but here in the Pacific, people and ingenuity are key. If not this aircraft right now, then it’s a boat ride, and a very long bumpy boat ride.

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The aircraft levels out for landing and as we touch down the pilots break hard enough my kits tumble forwards. Whoops. Just as the aircraft screeches to a halt on the remote airfield my phone beeps. I have a message from Scott the clinical manager back in Port Vila asking for confirmation that we have landed. Whilst many people travel for leisure, like my colleague Scott, I often travel for humanity. We are both similar and yet we are not, but we share a common connection in relieving suffering and supporting communities through ambulance delivery in some of the most remote corners of the globe. His journey started in the United States as a Marine, and mine in Australia as a soldier, we met as paramedics in Queensland Ambulance Service some years ago, yet here our paths have crossed as paramedics in Vanuatu. Scott has been the clinical manager of ProMedical for the better part of this year. ProMedical is the local ambulance service that provide professional ambulance service to the two largest cities in Vanuatu. He and his wife manage a small team of NiVan student paramedics and today Scott has sent local officer Celine to support me on this logistically challenging retrieval. 

Although the aircraft is ideally suited to flying in Vanuatu, it is not an air ambulance. I am still not even sure where our patients will be positioned for the return flight but at least the pilots have removed seats and placed the mattress on the floor to assist us. I have a standard oxygen kit, lifepak12 and a response kit. As the engines shut down, I step out of the aircraft and walk across the tropical tarmac. I am met by Jerome who is the local ProMedical station officer. The unconscious patient is septic with gangrenous pressure sores, the unrelieved AF is now relieved but still warranting investigation, and the septic child is responsive but obviously unwell. The child was carried by her mother, so she is placed on the back seat next to me, the unconscious patient is positioned on the mattress in front of our feet, and the now relieved AF is well enough that he sits up front with the pilot with Celine. It is a cramped and tight working space, but Celine is supporting the mother and child which leaves me to monitor the unconscious patient on the floor.

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As a professional health care provider, this situation may challenge your view of professional responsibility, but this is currently the best we can do with the resources available. Either these people fly, or they don’t and suffer for it. It is the lesser of the solutions where people would find themselves experience hours and sometimes days at sea seeking medical help. Whilst paramedics inherently learn to adapt to their surroundings, which is specifically what is required flying these types of retrievals, they are sometimes institutionalised from their experiences at home. Although rudimentary, this retrieval is no different from the historical techniques once utilised in Australia. 

The return flight was largely uneventful with a headwind forced our flight time to just over an hour. The three patients were safely transferred to the awaiting ambulance teams in Port Vila.

Whilst paramedicine is a developing profession in Australia, it is in its infancy in many other parts of the world that benefit from professional engagement. If you are a paramedic seeking adventures in caring, you can contact  who support multiple ambulance development programs in the Pacific Island nations.

Helen Keller once said 'Life is either a daring adventure or nothing at all.' 

Words By: Steve Sunny Whitfield