Naomi Dodds / Academic Critical Care FY1 / Aberdeen
Last year, Naomi Dodds headed to Tromsø in northern Norway for her final year elective. In an enviable couple of months, she experienced a mix of anaesthetics and pre-hospital care in a truly unique environment. Read on for how you can do it too, and why being a ‘HEMS Rescue Man’ might just be the most kickass gig in the Arctic.
Healthcare in Arctic Norway
Tromsø is a remote city located 350 kilometres north of the Arctic Circle in Northern Norway, famous for its midnight sun and magical northern lights. The University Hospital of Northern Norway in Tromsø is the regional hospital for 475,000 inhabitants from a vast land area of 110 square kilometers across Finnmark, Nordland and Troms. Additionally, the hospital provides care to the thousands of visitors travelling to Northern Norway for work and pleasure.
Comparable to the NHS, the national Norwegian health care system is run by the government with funding from the national budget, meaning that health care is free of charge for all citizens. However, the hospitals are not open access via the Emergency Department. To receive specialist care patients must be referred by their GP or if they are critically unwell they are brought into hospital via the one of the pre-hospital emergency medical services.
My elective was organised through the Anaesthetics Department, with my time split between managing airways in theatre and learning about the pre-hospital emergency care system.
In Norway the specialty of ‘Anaesthesiology’ or Anaesthetics currently encompasses Intensive Care Medicine, Emergency Medicine and Pre-hospital Care as there is currently no formal pathways for these specialties, although rumours suggest that there may be in the near future.
Similarly to America and other parts of Scandinavia, anaesthetic nurses in Norway are extremely skilled and take on much of the role of the UK anaesthetist. The ‘Lege’ or doctor oversees a number of different operating theatres and is required during difficult or complicated intubation. This means there was ample opportunity for medical students to gain hands-on airway experience under close supervision in a variety of settings.
Language was never an issue, despite always initially apologising for their poor English, the Scandinavians actually spoke it perfectly and were keen to practice by conversing with me.
Pre-hospital care is an integral part of the national health care system in Norway due to the remote landscape. To put things into perspective, Northern Norway encompasses an area of similar size to the whole of England with only one major hospital, therefore access to specialist care can be geographically challenging.
To meet the challenge, the pre-hospital emergency care service in Northern Norway consists of ground ambulances, fixed-wing ambulances, Helicopter Emergency Medical Service (HEMS), and the Royal Norwegian Air Force 330 Squadron Civilian Search and Rescue (SAR) service. These services are available 24 hours a day and are coordinated through the regional 113 Emergency Medical Dispatch Centre in Tromsø. I was lucky enough to join each of these in turn to gain a greater insight into the service they provide.
The ground ambulances form the backbone of the pre-hospital emergency care service. These were staffed predominantly by paramedics, with a local GP often present at the scene. Interestingly, final year medical students are also permitted to work as part of the crew, which provides them with some fantastic pre-hospital emergency care experience and pocket money!
The fixed-wing air ambulances are predominantly used for retrieval and inter-hospital transport, and travel as far as Longyearbyen, the world’s northernmost city on the Norwegian archipelago of Svalbard. They collect patients from smaller rural hospitals and bring them to Tromsø for more specialist treatment. They are staffed with two pilots and a specialist anaesthetic or critical care nurse, and an anaesthetist if the patient is critically unwell or requires airway support.
HEMS and SAR
Tromsø is one of the twelve national Norwegian HEMS Air Ambulance bases, providing a 24 hour service 365 days a year. It is tasked to life threatening incidents such as cardiac arrest, stroke and trauma. The HEMS crew consists of a highly trained pilot, an anaesthetist and a HEMS Rescue Man. The Rescue Man is typically a paramedic or nurse with significant pre-hospital experience capable of radio communication, winching, navigating and even flying the plane!
The aircraft was spacious, allowing the team to actively treat two patients during flight. The equipment on board the aircraft was innovative with mechanical compression devices, diagnostic ultrasound and even the capacity for extracorporeal membrane oxygenation. The crew work roughly one in four weeks and work 24 hours a day during those seven days on call, with compulsory breaks in flying to allow the pilot to rest. The HEMS pilots are the most experienced in Norway and the highlight of my time with them was certainly the incredible scenic flights over the fjords, glaciers and mesmerising Norwegian mountains.
The Royal Norwegian Air Force 330 Squadron provides a civilian service in the form of white and orange Sea King SAR helicopters located at five bases across Norway, including Banak in Finnmark, Northern Norway. They can reach anywhere in Norway within 90 minutes flying time from one of these bases, and each aircraft has the capacity to rescue up to nineteen casualties. The Sea King flies with a crew of six; two pilots, one navigator, one engineer/winch operator, one rescue man/swimmer, and one rescue trained civilian anaesthetist.
As with HEMS, the rescue man is a paramedic or nurse with phenomenal sea and mountain rescue expertise who is winched down to the scene. It is probably one of coolest jobs in the world! Also similarly to HEMS, the crew work long shifts of 24 hours for seven days. They live at base during this week, which means that the base is exceptional with a gym, badminton court, café/restaurant and even a Sea King BBQ!
My most memorable scramble was to a remote area inaccessible by road on the Northern coast of Finnmark. Unable to safely land near the injured patient due to the sea fog the pilot brought us down on an isolated beach. The doctor and rescue man managed to find a local Sami reindeer farmer and convinced him to give them a lift over the mountains in a trailer on the back of his quad bike. The rest of us sat in the sunshine picking blueberries and swimming in the Arctic Ocean until the sea mist cleared and we could fly in to pick up the crew and take the injured patient who had sustained a fractured humerus during a fall safely to hospital.
Pre-hospital care in Norway isn’t all glamorous though. We spent rather a large amount of time hanging out at base lounging in jumpsuits, drinking coffee and watching really awful Norwegian films!
Born on skis, the Norwegians have an innate passion for adventure. Therefore, recruiting companions was no issue and with 24 hours of daylight the fun never stopped! There can only be a few places in the world where it is common to receive texts at 10pm inviting you on a remote mountaineering venture.
Norway is an adventurer’s paradise with endless fjords to paddle, isolated rock to climb and beautiful mountains to explore. Norway also has a unique network of mountain huts belonging to the Norwegian Trekking Association providing a base for multiday expeditions into the wilderness. My favourite Norwegian adventure was a weekend alpine mountaineering in the Lyngen Alps, climbing the famous dome-shaped glaciated peak of Jiehkkevárri 1834m.
Doing it youself
Logistics / Choosing where to go on elective is one of the biggest decisions faced as a medical student. Do I want to learn about medicine, develop my clinical skills or just go on an incredible adventure? For me, Norway ticked all the boxes. Norway is renowned for it’s expensive living, though with some additional planning and preparation this was easily overcome. Norwegian Air charge a small fee for additional baggage and customs allow a generous amount of goods to be imported, therefore I took the vast majority of my food with me and went fishing for fresh mackerel to boost supplies.
Positives / I met some fantastic people and gained more remote pre-hospital experience than I could have ever hoped for. I have certainly been inspired to learn Norwegian so I can travel back and work in this picturesque remote arctic landscape in the future.
Negatives / There is no formal elective programme and therefore no guarantee this experience can be repeated. It was challenging to confirm any pre-hospital opportunities until I arrived in Tromsø and I was extremely lucky that they valued my previous pre-hospital experience and invited me to join them.
Destination / Tromsø, Northern Norway
Time of Year / June and July but possible anytime of year.
Weather / Similar climate to the Scottish Highlands – sunshine, cloud and rain during the summer and arctic conditions during the winter.
Budget / Administration fees £0, Flights £300, Accommodation £100 per week, Food £50 per week.
Vaccinations / Usual British vaccinations
Essential Item / Hiking boots, a fishing rod and cheap imported alcohol to make Norwegian friends!
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