JOINT BASE SAN ANTONIO-FORT SAM HOUSTON, Texas —
An Army physician at Joint Base San Antonio-Fort Sam Houston broadened his knowledge of trauma medicine and enhanced his skills in treating trauma patients in the field during a six-month stint as a member of a world renowned air ambulance service in London.
Maj. Ryan Newberry, U.S. Army Medical Corps emergency and pre-hospital physician assigned to the U.S. Army Institute of Surgical Research at JBSA-Fort Sam Houston, served as a flight physician for London’s Air Ambulance from February to August 2018.
The air ambulance service is based out of The Royal London Hospital, the leading trauma center in the United Kingdom, and responds to calls of people with trauma related injuries within the Greater London area.
Newberry said being a member of London’s Air Ambulance was a life-changing experience for him because he got to learn from what is considered to be one of the top helicopter emergency medical services in the world.
“They are considered one of the top tier programs in the world for innovations – their system, how they do things,” Newberry said. “Anybody who’s into flight in the civilian world knows of London’s Air Ambulance.”
Newberry became familiar with London’s Air Ambulance as an observer in 2015. As part of his residency training at Brooke Army Medical Center, he got to observe the air ambulance service for one month. It was by participating in this observership that Newberry considered applying for a position in London’s Air Ambulance.
When he returned to the U.S., Newberry was encouraged to apply for the air ambulance service by Col. Chetan Kharod, EMS and Disaster Medicine Fellowship Program director at BAMC at the time.
“I was coming back to BAMC and was selected to continue training on a pre-hospital medicine fellowship,” Newberry said. “Col. Kharod was aware of it and he recommended it. He said to go ahead and apply. It’s a very competitive international pool of candidates. I applied and was selected to be one of their physicians in 2018.”
Newberry was accepted into London’s Air Ambulance Service through the Engineer and Scientist Exchange Program, or ESEP, a Department of Defense program to promote international cooperation in military research, development and acquisition through the exchange of defense scientists and engineers, according to an Air Force website. It provides on-site working assignments for US military and civilian engineers and scientists in allied governments' organizations and military establishments and the reciprocal assignment of foreign engineers and scientists in U.S. defense establishments.
Through ESEP, he was a medical exchange officer assigned to the British Army 16th Medical Regiment while serving in London’s Air Ambulance.
Other requirements Newberry had to meet to become a member of the air ambulance service was completing the two-week U.K. Helicopter Emergency Medical Service course and a one-month training period under the supervision of one of the flight physicians with London’s Air Ambulance. In addition, he had to become a licensed physician in the British National Health Service and was able to get his license through a program with the U.S. Air Force.
By joining the air ambulance service, Newberry became the first American physician, military or civilian, to be selected for London’s Air Ambulance, which has been in operation for 30 years.
Newberry worked 12-hour shifts when he was on duty with London’s Air Ambulance. As a flight physician, he was part of a four-person crew that included a flight medic and two pilots.
The air ambulance service covers a Greater London area that includes 10 million people and operates 24/7 using a helicopter during the day and rapid response automobiles at night and during adverse weather conditions. In 2018, 1,650 patients with trauma related injuries were treated by London’s Air Ambulance.
“You respond to anything that they believe is serious or life-threatening that result from accidents, traffic, collisions, falls from height, industrial accidents, assaults, terroristic attacks, burns, stabbings, shootings and people getting hit by a train,” Newberry said.
During his six months with the air ambulance service, Newberry said he participated in 180 patient missions, for an average of 30 trauma patients of month he treated and helped transport to the hospital.
Being a flight trauma physician in London, Newberry was able to start and perform advanced trauma care in the field that is normally reserved for inside a hospital. He performed roadside anesthesia and other medical interventions on patients to keep them alive before and during the time they were airlifted to the hospital.
Newberry said being a flight physician with London’s Air Ambulance allowed him to sharpen his skills, learn new procedures and grow as both professionally and personally.
"There were skills that I had previously that significantly improved – such as managing very difficult airways and providing advanced resuscitation of trauma patients outside of the hospital," Newberry said. "I had a lot of cases of critically injured trauma patients that required multiple interventions and resuscitation in order to give the patient time for us to get them to a trauma surgeon. My confidence in being able to provide critical care while working out of a backpack in a complex environment with limited resources grew exponentially. "
Newberry said he learned not only how to treat a trauma patient in the field but how to manage a complex scene involving multiple patients and, if any, bystanders, including family members who were present.
"I went over there as a very well-trained, highly qualified military emergency physician," Newberry said. "But during my six months there, I saw such a high volume of trauma in an environment I had never really experienced, my bandwidth completely expanded.
"My first month there I was very focused on just the very sick patient and completing the key interventions that needed to be done. Where by the time I left, I felt comfortable being on the scene of multiple critically injured patients and not only medically managing them, but also taking care of any family members or friends that may also be present. It was an emotional experience that not only made me a better physician, but also a better person and leader."
As part of their training and quality improvement, London’s Air Ambulance requires their flight physicians to follow any patient the service cared for throughout their entire hospital stay. Newberry said he was evaluated over the course of his assignment on the accuracy of identifying injuries in the field as compared to the actual injuries that were later identified after the patient was admitted to the hospital.
“This proved to be a critical aspect of the training, as over time, your ability to anticipate injuries based on their mechanism rather than an X-ray or CT scan drastically improved,” Newberry said. “Ultimately, this strengthens all aspects of the care your team provides, from triaging multiple patients at a large incident to providing critical interventions quicker for patients.”
About once a month, Newberry and the rest of the hospital staff would meet with a medical examiner who reviewed the cases of the patients who were flown in by the air ambulance and had died. The medical examiner reviewed the details of the injuries and the findings of a coroner and whether any of the interventions conducted by flight physicians were effective or not in treating the trauma patient.
“It is part of their clinical governance system to make sure they are maintaining the highest level of quality care,” Newberry said.
Newberry said the skills and knowledge he gained while in London will help him if he should be deployed to a combat environment.
“The work of the London flight physician occurs as a member of a small team providing critical trauma resuscitation in a complex and resource limited environment,” he said. “By providing critical care at the scene that is normally not possible outside of the hospital, they are increasing the likelihood of getting the critically injured to a trauma surgeon. This is similar to the role emergency physicians play on the austere and forward medical teams throughout the different branches.”
He also is proud of the fact he was the first American to be a member of London’s Air Ambulance. While he was serving in the air ambulance service, Newberry said he wanted to make a good impression on his British counterparts by representing himself, his country, the Army and the U.S. Army Medical Corps, which he is a member of, to the best of his ability.
“I was learning how to practice British medicine as an American while representing America in a way,” Newberry said. “There was a lot of things that were just on my mind about being a good ambassador, a good doctor and a good team member. I was fully immersed in their culture for six months.”