Heathrow is one of only a handful of airports worldwide with paramedics on bicycles standing by to deal with medical emergencies. Katharine Cooke meets the two-wheeled team.
You may have seen a blue flash as they slip past you in the departures hall: neon-yellow figures on customised mountain bikes, navigating the crowds that throng one of the world’s busiest airports. They are Heathrow’s bicycle paramedics, operating a fast-response service across all four – and soon five – terminals of the UK capital’s biggest hub.
The number of paramedics taking to two wheels is growing. Used by both police and emergency services, cycle response units are appearing in crowded town centres, sports arenas, tourist areas, and at public events all over the world – anywhere that takes a conventional ambulance longer to reach.
There can be few more congested, inaccessible places than Heathrow. Almost 70 million people pass through each year and it is the workplace of a further 68,000. That someone, somewhere will need urgent medical attention every day is not just a possibility, but a certainty.
Heathrow’s cycle response unit had just completed its third year when I meet duty station officer Alan Payne who heads the unit, and Gerard Robinson, service co-ordinator. We meet at their “office” – Caffè Italia in Terminal 1, where emergency staff are entitled to discounted hot drinks. The team has a small office and garage just off-airport, but between calls they catch a breather here. Both paramedics have the cheerful stoicism of experienced emergency professionals, and their faces light up when they talk about the service.
Alan suggested cycle responders at Heathrow after seeing a similar service at Vancouver airport several years ago. “I was standing at the check-in desk when the guy in front of me collapses and has a cardiac arrest,” he says. “So I got out my face shield [which stops body fluids or infection passing person to person] and started doing CPR. I’m hearing these sirens really loudly and I thought, ‘They must be coming on a golf cart’ – the next thing is this bike comes up, and I came back thinking, ‘Wow, that’s what we need at Heathrow’.”
Heathrow has a dedicated ambulance and, like many major airports, a health centre, but Alan says: “The trouble with them is that people see them as an easy way to get healthcare – you don’t have to be a passenger to use one of these centres. Heathrow is busy enough without attracting other people.”
A transfer to central London delayed Alan from putting his idea into action until October 2004, when a trial was launched in Terminal 4 with three paramedics on a rota using one bike. Its impact was clear almost immediately. “It was a six-week trial that never stopped,” jokes Alan. “We cut down dramatically the number of ambulances that went to Terminal 4 and within two weeks of starting the trial BAA said, ‘This is a go’.”
The team now has eight riders with three always on duty, one at Terminal 4 and two at the central area of Terminals 1-3. They work 11-hour shifts between 5am and 10pm to cover the airport seven days a week, dealing with more than 3,600 calls a year.
It is simple and effective: by sending a nimble, two-wheeled paramedic to emergency calls, patients can be assessed quickly and the Heathrow ambulance (a dedicated vehicle based just off-airport) stood down if it is not needed. This frees the ambulance to attend only serious cases where hospitalisation is needed.
Gerard says: “Between 65 and 70 per cent of ambulance requests don’t actually require an ambulance. So if you can send a medic on a bike to assess, treat or refer back to a chemist, to a GP, to one of our walk-in centres in the area or to the occupational health unit, why go to hospital?”
The unit deals with anything from seizures to asthma attacks, and cardiac arrests to women giving birth. The team has delivered plenty of babies – there have been two cases of abandoned babies found in bins at Heathrow in the last two years.
There are also problems unique to air travellers, who are weary after long flights, enduring exhausting delays or waiting patiently to connect. “One of the things we deal with a lot more than other bike units is ear, nose and throat problems from the altitude,” says Gerard. “Our guys carry additional equipment that no other ambulance carries. We carry an otoscope which can examine the inside of the ear, and the guys have been trained to do so.”
Upset stomachs are common, and if it’s an incoming passenger the standard line that greets the paramedics is “It’s something I ate on the plane”. But airline food companies get a raw deal. Alan says: “In the last 15 years there have been three cases of actual food poisoning caused by airline food. We have people every day who have vomiting, but almost every time it’s from something they ate before the flight.”
Up to 40 per cent of calls come from people with pre-existing conditions for whom long flights or delays have disrupted their body clocks or access to medication. Gerard says: “Say Heathrow is fogged in – nothing’s coming in, nothing’s going out. Passengers are still turning up, checking in, and they may be diabetic or epileptic and they’ve got the drugs they need for that day but the rest is packed in their suitcase. Once their suitcases have gone through, they might be delayed by four, five, six, ten hours. So they could have a diabetic trauma or epileptic seizure because they haven’t got their medication.”
Then there’s “sheer exhaustion”, says Gerard. Many overworked business travellers develop symptoms of extreme stress and tiredness once they reach the airport. “You’ve got your business traveller who’s got to clinch a deal and has to get this flight to be in Tokyo the next morning. He’s thinking ‘Have I done this, have I done that?’ [Heathrow] is not an easy place to get to and get around, so just by the taxi dropping him off at the wrong place it can add up to breaking point: chest pains, hyperventilating and so on.”
Not everyone the paramedics see is happy to take their advice. Alan explains: “The London Ambulance Service will never declare anybody fit to fly. However we will declare you unfit to fly.” He recounts a case a few weeks earlier onboard a departing aircraft when a VIP aide refused to leave his employer’s side despite suffering chest pains. After his advice was ignored Alan appealed to the captain who, with some assistance from the police, physically removed the passenger from the aircraft.
This attitude is surprisingly common, says Gerard. “If there’s a £100 million deal that needs them to turn up and close the deal then they’re going to risk their life for promotion because if they clinch that deal they might be made general manager of UK or Europe. The blinkers come on – they say ‘I’ll be alright in ten minutes’ time’.”
The paramedics tell me Heathrow has a higher number of cardiac arrests than any other single location in the UK. Bizarrely, it is also statistically one of the best places to have one. In general, the successful resuscitation rate for cardiac arrests that happen outside of hospital is 15.8 per cent – measured by the number of people discharged alive from hospital after having treatment for their heart stopping. For Heathrow this figure is 21 per cent.
According to the American Heart Association, every second’s delay in treating a person in cardiac arrest pushes down their chance of recovery by 10 per cent. This makes response time of the emergency services crucial. Alan’s team gets a head start whenever a call comes through. In a medical emergency, Heathrow staff dial the airport’s “Star” control centre, which connects them to the London Ambulance Service’s emergency operations centre (EOC) at Waterloo. EOC then alerts the biker by mobile phone.
But the Star centre listens in to the call and warns the biker using Heathrow’s radio system, so that by the time the biker’s mobile phone rings, they are often already with the patient. If a passer-by has raised the alarm by calling 999 the biker will first hear of the case from EOC. Short-circuiting the system works: the riders reach 95.8 per cent of category A calls (the most serious) within eight minutes, compared with a national target of 75 per cent.
Just how fast they respond is apparent when the rider on duty, Guy Lavender, joins us for coffee. A calm, smiling paramedic wearing black cycle gear, with 24 years in the London Ambulance Service, he has long enough to say that he has been on four calls so far this shift, all for people feeling faint, exhausted or generally unwell, before his mobile phone trills in its holster. He talks quietly for a moment in impenetrable jargon: “FCC for a DIB.” A passenger in the flight connection centre is having difficulty breathing. Guy excuses himself; 60 seconds later his voice is picked up on Alan’s radio reporting his arrival with the patient.
Alan and Gerard tell me that seven weeks ago in Terminal 1, Guy resuscitated a passenger in cardiac arrest – he reached them in two minutes and administered a shock to the heart, and an ambulance that had just finished dealing with a call nearby was able to whisk the patient to hospital. People on the receiving end of these paramedics’ care often return to thank their rescuers in what the paramedics call “patient reunions” – there have been three in the last few months.
Alan will recruit only the best for this job. Riders are seconded for a year from ambulance stations across London and must pass a vigorous fitness test. Being nimble on a bike is a must, and riders undergo a four-day training course run by the International Police Mountain Bike Association (IPMBA). It also takes some skill to cycle through crowds. The bikes have sirens but the riders rarely use them. When people hear a siren they make unpredictable movements which might bring them into the path of the bike – far better to ride silently and move with the flow, says Alan. “For the number of calls we get we’d be causing chaos. We cycle with the crowd, not against them.”
Riders must be confident enough to make solo decisions. They are also ambassadors for the ambulance service, says Alan.
“Cycle response units patrol the buildings so they’re more like policemen. They’ve got to be approachable. If my guys don’t get their picture taken twice a day there’s a problem.”
The riders know better than anyone the peaks and ebbs of human traffic at Heathrow, and can position themselves at the busiest spots at the right times to pre-empt calls. Alan says: “Long-hauls are busy first thing in the morning coming into the UK – certainly at Terminals 3 and 4 that’s the busiest period – and then the peak will be in the evening for the long-hauls departing.”
Terminal 1 peaks in the morning and evening with business people leaving and returning on short-haul flights, while Terminal 2 is “a leaking tap” with a small but steady trickle of passengers.
Terminal 5 will prove more demanding. “We’ve looked at the passenger demand that has been supplied by British Airways and that peak and trough won’t happen any more – it will peak at 6am and stay there until nearly 9pm,” says Alan. “The reason is the amalgamation of the long-haul and short-haul services into one building. So it’s giving us a constant demand through the day.”
The service will need to expand not only to cover Terminal 5 but to cope with an overall increase in calls: there is no holding back growth of all kinds at Heathrow. Gerard says: “There’s a cliché about Heathrow that it’s the only building site with its own airport, because there is so much construction work going on all the time.”
It’s also almost the only airport where, if you’re unlucky enough to need urgent medical attention, you’ll be joined within a couple of minutes by a smiling, unflappable bicycle paramedic.
