An Cosantóir

21 Air Ambulance work was not new for No.3 Operations Wing, the first helicopter Air Ambulance mission took place in 1964 in the venerable Alouette III and we have continued to conduct Air Ambulance missions from our base in Baldonnel as well as our SAR bases over the years in various aircraft. The major differences between an Air Ambulance and a Helicopter Emergen - cy Medical Service (HEMS) mission are time, staff and risk. A traditional Air Ambulance mission profile is to take a stable patient from one level of medical care to another. They are traditionally escorted by hospi - tal staff who are not well known to us, and given the nature of the mission, do not need to be. Because the patient is stable there is usually ample time to plan the mission and we know from where we are picking the patient up (a hospital with a controlled helipad) and where we are bringing them (another hospital with a controlled helipad). Unlike our traditional Air Ambulance work, with EAS we were to be launched by the NAS at immediate notice to move to the scene of an emergency anywhere in the country, with our own NAS Advanced Paramedic (AP) crew, without knowing where we will end up. The AP can only make the call as to what is the best hospital in the country to bring the patient after assessing them, so on any given call the crew dispatch, with no firm idea of where the mis - sion will terminate. This time criticality, coupled with the external staff and dynamic mission profile lead to risks that needed to be managed. So, when asked to establish an EAS, our initial reaction was guarded optimism. We were optimistic that we could do the job but were a little guarded regarding our partner in the venture, the National Ambulance Ser - vice. We had not worked much with them in the past, other than quick chats with their staff as they brought a patient into Baldonnel for an Air Ambulance. EAS would require a different level of collaboration if EAS was to succeed, as not only would the task be coming from NAS dispatchers to assist NAS personnel on the ground, but the mission commander in the aircraft, the person calling the clinical shots in a dynamic environ - ment would be an NAS Advanced Paramedic (AP). Air Corps 112 about to land during an EAS mission An EAS mission involves many elements as can be clearly seen in this shot. THE EMERGENCY AEROMEDICAL SERVICE: IRELAND'S FIRST HEMS In 2012, it had been suggested that the flight crew of pilot and Air Corps EMT, stick strictly to crewing the aircraft and the NAS AP should stick to medical aspects like in an air ambulance mission. Similar to an Air Ambulance mission, this would ensure clean boundaries between the aviation role and the med - ical role. However, from our early days in GASU we learned that integration and cooperation helped create a shared mental model which is fundamental to a high-performing team. We opted to fully integrate the AP into our team and our aviation culture. They would be assigned to us on a more prolonged basis, giving us a chance to know them and vice versa. A trait that military and clinical people share is a love of jargon and acronyms, and we tend to revert to type when in a stressful situation. Knowing some of each other's lingo helped break down silos and eased communica - tion, aiding team decision making. We were able to put the APs through a course of training on aviation plan- ning, just culture, aeronautical risk management, Crew Resource Management (CRM), meteorology and other non-clinical matters. In return, we got an education on the difference between a STEMI and a CVA, the merits of penthrox, morphine and ketamine and what a PCI is. Air Corps personnel also gained exposure to the type of call they would see in the helicopter by partaking in 'ride-alongs' in NAS Ambulances and in busy hospital Emergency Departments. We didn't want our pilots realising they fainted at the sight of blood at 2,000ft! Cultural differences between the Air Corps and NAS were evident in these formative days. The APs looked quizzically at our rank structure and military meth - odologies, equally we took some time to get used to the NAS culture, not least that unions and overtime existed! This integrated approach helped ensure there was no clash of cultures between the military aviators and the civilian clinicians. Another issue that would be encountered would be the psychological toll that HEMS calls can take on our crews. We would be going to road traffic collisions, house fires, industrial and agricultural accidents, paediatric trauma and more. These add up to a lot of

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