Mario Carretta, Unit Chief Pilot, explains how we have maintained flight operations during COVID-19.

Dorset and Somerset Air Ambulance and our air operator, Specialist Aviation Services (SAS), were determined to keep our aircraft flying throughout the COVID-19 pandemic. A huge amount of work and collaboration has enabled this to be achieved, of which we are extremely proud. 

Initial guidance from Public Health England (PHE), taken up by the Civil Aviation Authority (CAA), recommended that air ambulances should not convey either known or suspected COVID-19 patients to hospital by air. This was primarily because there was no barrier in place between the cockpit and cabin, together with the perceived difficulty of flying patients to hospital while having to wear personal protective equipment (PPE).

We thought that at some point ALL patients would need to be suspected as having COVID-19, so we began looking at how we could get to a position where PHE and the CAA would be satisfied for air ambulances to convey them. 

Obviously, social distancing in the cockpit was not possible, so the first stage was to see what effect the wearing of masks had on aircraft operations. To do this, we needed to trial several face masks that were available to us via the South Western Ambulance Service NHS Foundation Trust (SWASfT).

Before we got inside the cockpit, we needed to ensure that the masks would be effective while wearing a flying helmet and so we went through a fit-testing process. This is where a hood is placed over the person wearing the mask (in test conditions) and a bitter solution is sprayed into the hood to check if the seal of the mask is good enough.

When in the cockpit, we checked that the masks were comfortable and allowed easy communication. Also, that they were compatible with the helmet visors and for when the crew needed to wear night vision goggles. All but one of the trialled masks were suitable for use.

While it was good to know that the masks were safe to use, what we really needed was an effective barrier between the cockpit and the cabin. We already had a barrier of sorts; a curtain that was designed to prevent light getting from the cabin into the cockpit during night operations. Although delivered with the aircraft, this had never been used as we found out early on that having the light on in the rear cabin (while the crew were tending to a patient), did not interfere with the pilot’s night vision goggles. 

The curtain was installed and it was given what has now become a daily check; a ‘sniff test’. This involves an air freshener being discharged in the cabin with all the doors closed. Then we test to see if the air freshener can be detected in the cockpit.

At first, the curtain failed the test due to gaps around the cabin floor and ceiling. A special fire-proof tape was then procured to seal the gaps. This worked, but the tape did not stick to the curtain material for very long and so it was decided that we should install an additional plastic sheet barrier on the cabin side of the curtain. The combination of the curtain, plastic sheet and sealing tape proved to be an effective barrier and the daily ‘sniff test’ proves its continuing integrity.

We now had an effective physical barrier between the cockpit and the cabin, but the air conditioning system linked the two areas together. We therefore needed to check if there was any chance of air flowing from the cockpit through to the cabin in this way.

Unfortunately, it turned out that there was no way of guaranteeing that air wouldn’t flow forwards without some changes being made to the aircraft. Therefore, SAS worked very closely with the aircraft manufacturer, Leonardo Helicopters, to come up with a viable solution. This was a combination of minor changes to the air conditioning system and the introduction of certain procedures, which ensure that the system is in the correct configuration before a patient is loaded onto the aircraft. 

The decision was also made to try and keep the cockpit and its crew ‘clean’. This meant that they were not able to get involved at the scene or in the handling of a patient. It was accepted that the cabin and the clinicians wearing PPE would not be ‘clean’, given the fact that they may have been in contact with suspected or confirmed COVID-19 patients. Therefore, new procedures were produced to ensure the continuing safe and effective operation of the crew under these limitations.

With complete separation between the cockpit and cabin (which allows the helicopter to operate in a similar manner to a land-based ambulance with a fixed bulkhead) and clear operating procedures to deal with the COVID-19 threat, Dorset and Somerset Air Ambulance and SAS approached PHE asking them to reconsider their guidance on conveying COVID-19 patients in air ambulances.

After new guidance was issued on 14th May, Dorset and Somerset Air Ambulance became the first air ambulance in the UK to be able to treat and convey suspected or confirmed COVID-19 patients to hospital.

It has been very satisfying to maintain an air ambulance service and deliver critical care from the air throughout the pandemic. Keeping the same level of capability, while keeping the crew safe, has been a challenge, but a worthwhile one. We could not have achieved this without a collaborative effort and the dedication and commitment of our remarkable team.

NEXT: New approach to caring