The water winch rescue is unique among our mission taskings, in that it requires a non-standard approach to personal and cabin setup. The paramedics will go out in a wetsuit and additional gear (which takes time), and the doctor will need to have more of a role in preparing the aircraft to make the mission less stressful and more efficient. This is not the time to just put your harness on, strap in, and wait.

Although there may be 10-15 minutes to these scenes from Bankstown, crews at Wollongong can be overhead within a couple of minutes, so team-based preparation is essential.

The five jobs of the physician (after getting yourself ready) are:

• Clip the dropdown emergency airway (DEA) pack to the cargo netting and connect the BVM to oxygen (zip the pack back up!)
• Get all four wanderleads down from the ceiling
• Take the extra headset out (lives next to the Zoll monitor) and place on head of paramedic’s seat (in Bankstown, the para may bring one from the ready room)
• Take strop and foam ball from pie warmer and place on bed
• Sit in the back left seat and get belted in

Consider placing an appropriately sized iGel from the DEA in your pocket, and unfurling the suction to place it under the bed.

Once the patient is in the aircraft, the doctor job is basic airway management, whether via BVM alone or iGel. No advanced airway will be done in flight. No defibrillation can be done in the aircraft on a soaking wet patient – see Defibrillation HOP

Limited space and limited communications should be anticipated.

Caveat: this is general guidance to give you an idea of what may be expected of you in the AW139. As with any mission, each paramedic and aircrewman is different, so it is imperative that you have frequent and open communication with your team about how best to accomplish the job.

For the newer docs, ask a friendly-faced paramedic to go over all of this with you on one of your next shifts (especially if you are H1 or at Wollongong).