Cattle crushes and raging bulls: Inside the NSW air ambulance service

Pepsi the bull is lean, mean and striding with menace towards the helicopter that has just landed on his patch.

Air ambulance pilot Tim Frankel, a veteran of the British and Australian armed forces, has stared down insurgents in Pakistan and flown emergency aid around earthquake-stricken Nepal, but even he is unsettled by the territorial beast he has just aroused.

Pepsi trots up to the helicopter before his owner ushers him away, allowing the medical crew – doctor Sarah Berger and paramedic David Kidd – to get to work. It has been fewer than 20 minutes since they were jolted into action by an emergency call about a woman who had suffered a blow to her head from a cattle crush (a device used to hold livestock while they are given veterinary care) on a farm west of Sydney. Their task today is simple: stabilise the patient and take her to Westmead Hospital.

Other days are more complicated. Among the 2500 rescues and retrievals they perform each year are some of the state’s sickest patients, collected from the most difficult environments (Frankel has wrangled helicopters to rest on the edge of cliffs and over raging seas). In the darkest days of the COVID-19 pandemic, they were called upon to airlift heart and lung specialists to treat patients in smaller hospitals who could no longer breathe and, the Sunday before our visit, four helicopters were deployed to a bus crash in the Hunter Valley which killed 10 people and injured 25 more.

“The more traumatic jobs are really seared into your memory,” said Frankel. “I can remember them clear as day, those jobs that I did almost 10 years ago, as if I did them yesterday.”

Bankstown Aerodrome, 7am. A light fog sits over the tarmac as today’s crew arrives for the change of shift. The NSW Ambulance rescue helicopter base is easy to miss, nestled between long stretches of runway and truck-width service roads, but its unassuming exterior belies the importance of what takes place within. In the hangar, there are three helicopters in service at any one time and, in the dedicated training centre, there is a multimillion-dollar helicopter simulator and a training pool that was used to shoot scenes for the Ryan Gosling film that closed the Sydney Harbour Bridge earlier this year. In the main headquarters, there is a billiard table in the lounge room, a basketball hoop in the courtyard, and a dark TV room with soft couches that comfortably swallow sleepy paramedics on overnight shifts.

These home comforts are essential. NSW Ambulance helicopters are on call 24 hours a day, 365 days a year, and staff do two night and two-day shifts a week, lasting 12 hours each. It is high pressure, and highly competitive. Nobody ends up here by accident. There are roughly 5800 paramedics in NSW, but the air ambulance takes only 60. For many, it is their career goal to work here, and very few leave before retirement. David Kidd celebrated 25 years as a paramedic the day before the Herald’s visit. Lindsay Court – who came through the same station – has been here 30 years. Neither intend to leave.

Cameron Edgar is their boss, responsible for making sure helicopters are staffed and ready at any given moment. He arrived in the ambulance service as a 20-year-old who had barely left the northern beaches and, from the moment he spotted a paramedic wandering around state headquarters in a flight suit, he knew he didn’t want to do anything else.

“I thought … whatever that is, I want to do that,” he says. “For someone who’s grown up and lived on the northern beaches his whole life, I’ve had the opportunity to end up in some pretty remote areas of NSW … we’re very lucky.”

The doctors make up the other half of the medical equation. Their boss is Sarah Coombes, an emergency doctor who did her aeromedical training with the air ambulance at Royal London Hospital and has, in her words, grown up with the system.

Executive director of aeromedical operations Dr Sarah Coombes and director of helicopter operations Cameron Edgar at the Bankstown base. Credit: Kate Geraghty

“It’s definitely a benefit of the job [having been a clinician],” she says.“When you’re advocating, whether it’s within the service, to other [health districts] or up to the ministry, it’s helpful to have an intimate knowledge of what they need.”

Having an emergency doctor onboard, Edgar says, allows the air ambulance to bring the first 45 minutes of emergency department care to the patient, “whether they’re in the bottom of a canyon, the side of the road or in a remote rural hospital”.

In one case, an air ambulance rescued someone who had fallen ill while kayaking from Sydney to New Zealand – 170 nautical miles out to sea.

“From the moment that paramedic reaches that person, they’re getting some sort of medical assessment, and then the moment they reach the helicopter, they’ve got a mobile intensive care unit right there,” he says. “You bring those two things together, and it’s amazing.”

At 8am, the team gathers for the morning briefing. They go through the day’s weather and swell conditions (temperatures between 4 and 20 degrees and swell of 30 to 60 centimetres), which hospitals will take them (most helipads are open, but Grafton will need two hours’ notice), and what retrievals jobs they have on the calendar today (Dubbo, twice).

Once the briefing is ticked off, the medical teams go through their equipment checks. In the hangar, the air crews are checking their fuel and doing a first run of the engines. Every second is precious; Toll, which won the $1.1 billion tender to run the service until 2032, is contractually obliged to have its helicopters on the tarmac and running within 10 minutes of accepting a call.

So far this morning the “bat phone” (their nickname for the black telephone where all calls come through) has stayed quiet, allowing the team to mark off other jobs on their lists; equipment checks, helicopter maintenance and training exercises to maintain their highly specialised skills.

At 10am, the team reconvenes for what they call “coffee and cases”, which gives the doctors and paramedics on shift a chance to debrief the week’s events with their colleagues. For some who attended the bus crash in the Hunter Valley just days before, this is their first chance to talk through the events of that night.

Helicopter and medical crews go through recent emergency cases during the daily “coffee and cases” discussion.Credit: Kate Geraghty

Says Coombes: “They know that they’re talking to somebody who will have gone through something similar, and they’ll understand it. Once you’re part of the aeromedical family, you’re always part of the aeromedical family.”

The cumulative trauma of smaller events can also take a toll.

Edgar says: “A bus accident may trigger one person, or going and seeing an elderly gentleman who’s died and his wife has opened the front door and said, ‘My husband won’t wake up’ could trigger someone else. We’ve got a system that doesn’t just assume that it’s the big visual incidents that affect people – we know that’s not the case.”

Shortly before 1pm, the first call for the day comes in – a woman has received a blow to the head in a cattle crush. Although the patient is conscious and talking, the paramedics are worried a blow to the side of the head could lead to swelling in the brain.

Today, Frankel has the helicopter ready for take off within eight minutes and the flight takes 17, passing over mountainous bushland and rolling farmland.

Once they have placated Pepsi the bull and stabilised the patient, she is loaded into the helicopter and airlifted to Westmead.

The whole job would take a road ambulance out of action for half the day, but Frankel and his crew are back at base in under three hours.

At 4.30pm, not long after they have returned, Dr Berger and paramedic David Kidd are called to action again – this time into a road ambulance to transfer a patient from Fairfield to Liverpool Hospital.

“Flying and all that has a wow factor, and you see some great sights … but you also get that satisfaction of treating those really sick patients,” says Kidd. “Put together, it’s a great job.”

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