Mission Critical: Race Against Time - Chapter 1

The smell of jet fuel drifted across the tarmac. The whir of a HH-60 powering up cut through the morning calm. From the hangar doors, Erin watched as the helicopter lifted from the runway and turned south, heading out over the English Channel on another mission.

She had spent 3 years working towards this moment, the selection process had washed out over 90% of the candidates that had started. Erin looked at the patch on her arm. The black rectangle had two letters emborided into it.

PJ. 

Two letters that she had given blood sweat and tears to earn. Now she was here however, it felt like day one all over again.

She remembered how she felt when she arrived for selection at a disused airfield in Wales, the rain hammering down as a gruff looking PJ told them that they should get used to being wet, while he was wearing a full set of waterproof kit. That same feeling of anxiousness and fear was inside her now. Behind her, the sound of footsteps brought her back to reality. Erin turned around, looking to see who it was.

In front of her stood a 6-foot giant of a man. His arms filled the sleeves of his uniform; it’s faded black colour contrasting with the brand-new look of Erin’s.

‘And you are?’ the man asked, although it didn’t sound sincere. Erin choked up before she was able to answer.

‘Erin…Erin Walsh…Sir.’ The man frowned.

‘Tell me, Erin, what letters are on my arm?’ he asked, hostility in his voice. Erin looked at the man’s arms. Like Erin, he had a patch on his upper arms.

‘PJ…it says PJ’ Erin stuttered out. She felt like the man was about to eat her alive. His expression did not change.

‘Correct, I am a PJ’ he said calmly. ‘Therefore, I don’t expect you to call me sir.’

Erin had been required to call anyone above her Sir or Ma’am during selection. The man put his hand out to offer a handshake. Erin, still terrified, shook the man’s hand nervously.

‘Liam Hale, detachment commander,’ said the man, his voice still firm.

Erin’s fear it turned out, had been justified. Liam was a legend in the PJs, a 10-year veteran of the service who had once been the senior instructor on the selection course. Liam let go of Erin’s hand and looked out towards the HH-60, now a small dot on the horizon. He turned back to Erin and smiled.

‘You’ll get your chance’ he said, this time a little more kindness in his voice.

Liam turned and walked towards the aircraft that was behind them. Erin trailed behind, following, her mind still in awe at the fact she was now here. Inside the hangar, the HH-60 felt like it was towering over everything, the rotor blades taking up nearly the whole space. Erin slowed slightly as she approached.

She had done a training flight on a HH-60 but had felt out of place on that helicopter, like she was just a passenger. But this time, something felt different, she just couldn’t put her finger on it.

Stepping forward gingerly, Erin looked at the door of the aircraft. Sprayed on were the names of the crew. She saw Liam’s name, a few others, then at the bottom was a name, its bright white colour telling her it had been recently sprayed on. She looked a little closer at the name.

‘Erin Walsh – PJ’.

A smile grew on her face, but the nerves soon took over again. She was a part of this crew, whether she felt it or not.

Behind her, Liam watched silently. He remembered when he saw his name on the side of a helicopter for the first time, the same feeling of pride and fear rolled together. He couldn’t help but smile a little as Erin took it all in.

‘Shall I introduce you to the others then’ Liam said. Erin nodded, still slightly nervous to speak.

Around the other side of the aircraft the rest of the crew were huddled round a yellow scoop on the floor. On top of the scoop, a dummy had a spider’s web of leads, and IV lines running from all over. Erin stopped around 5 feet from the dummy, not sure where to stand.

No one looked up at her, it was like she wasn’t there. At the head, a woman had a bag-valve-mask over the dummy’s nose and mouth, her hand gently squeezing the bag. ‘

That’s Leah Mercer, she’s the other PJ on the team’ Liam explained, staying quiet so he did not disturb the team. Next to Leah, another woman was pulling a syringe from the pouch on her belt.

‘You got the ketamine ready Hannah? Leah asked the woman. Hannah, a small built woman, turned towards Leah, a needle now fitted to the syringe in her hand.

‘Good to go when you are’ she replied.

Liam leaned in again. ‘Hannah Price, Critical Care Nurse from King’s,’ he explained. A man then stepped forward into a space between Leah and Hannah.

‘What am I looking at Leah?’ he asked.

‘Reduced consciousness post head impact, SpO2 is barely above 90 despite the OPA, Systolic is sat around 94’ Leah rattled off, calm and concise. The man nodded once, eyes scanning the monitor. Erin noticed that the man’s chest rig, what they used to carry their basic equipment, looked considerably bigger and heavier than the PJs, the pouches set up in a way the PJs’ rigs weren’t.

‘Okay. Let’s hold a little longer on the bag, can we look at some other airway options please Ethan,’ the man asked, although Erin got the impression that it wasn’t really a question.

Liam had just started to guide Erin forward when a woman standing just to the side of the team glanced over her shoulder. She gave a small, welcoming nod and beckoned Erin closer with a subtle tilt of her head. Like the others, she was wearing a black PJ uniform, but Her’s looked even more faded than Liam’s, the high-vis striping looking like it was as old as Erin. She stepped back from the huddle just enough to speak quietly to Erin without pulling focus from the drill.

‘Come on in a bit nearer if you want sweetheart,’ she said softly, her voice low and steady.

‘Don’t worry, you’re not in the way. We’re just running through the compromised airway drill, make sure everyone is happy with it. Don’t feel you have to be keeping up with everything yet.’ Erin gave a nervous smile as she moved forward. Liam gave a quick smile and let the woman take over, stepping aside as Erin moved next to her.

‘Has Liam pointed everyone out to you yet?’ Erin shook her head. She looked at the name patch on the woman’s chest and felt the same nerves she had felt meeting Liam. The woman was Jess Carter, another PJ legend.

‘That’s Daniel Ashcroft leading today, the one between Leah and Hannah, he’s the doctor on the team. He’s the boss when it comes to the patient. And the PJ running about getting stuff is Ethan Shaw.’

On the far side of the scoop, another older looking PJ stood with his arms loosely folded, watching intently. Jess nodded towards him. ‘That’s Lewis Rudd, he’s also a PJ, same as me. We’re here to run the scenario and make sure everyone is taking away some learning points.’

Daniel pushed on with the scenario, turning slightly toward Ethan. ‘Right then Ethan, OPA isn’t giving us what we need, so we’re going to go for an I-gel. Let’s get a green one set up. Leah, keep ventilating gently and maintain that jaw thrust.’ Daniel turned to Ethan. ‘Ethan, talk me through what you want to do.’

Ethan hesitated, considering his options, then answered.

‘The OPA isn’t giving us good enough chest rise, and the sats are still sitting low. An I-gel should give us a much better seal and secure the airway, help improve ventilation and bring the oxygen levels up before we even think about RSI. We’re contraindicated for RSI at this stage due to low sats,’ Ethan said confidently. Daniel gave a nod of approval.

‘Good lad, crack on when Leah is happy’ he said proudly.

Ethan pulled the green I-gel from its pouch inside the airway bag and set up the airway circuit. Leah continued the ventilations, aware of where Ethan was and what he was doing. They didn’t have to talk to each other; this was a well-oiled machine at work.

With calm, deliberate movements, Ethan opened the dummy’s mouth, slid the I-gel in and pushed it down gently until he felt the familiar resistance at the base of the tongue. He connected the circuit to the BVM, with Leah starting ventilations immediately.

‘Chest rise looks good,’ Ethan confirmed, watching the monitor closely. ‘Got good waveform, 5.3 on the CO2.’

Daniel turned his eyes to the monitor. ‘Sats are starting to climb. Good effort Ethan. Let’s keep it there, see how we get on with the I-gel.’ The team remained calm and in control, the sounds of the patient monitor filling the hangar like a quiet backdrop. No urgency, just silent composure, focussing on treating the fictional patient.

Jess caught Lewis’s eye and a subtle, almost imperceptible nod passed between them, the silent signal that the team had got all they were going to get from this scenario. Lewis unfolded his arms and stepped forward.

‘Okay, let’s call that one there. Overall, it was decent. You kept the patient alive and the sats came up eventually, so good job on that. But we should have dealt with the airway earlier. The OPA wasn’t giving us what we wanted, and no one did anything about for a good while before getting that I-gel in. On a real job that delay could have meant brain damage for the patient. We all got a bit excited about doing the cannulas and getting the drugs in, but we didn’t have someone getting eyes on the monitor. We’ll debrief more in the crew room but overall, not a bad run.’

Jess stepped forward and spoke up next.

‘Okay can we get the kit packed away and back in the training cupboard, once that’s squared away meet us in the crew room. Any burning questions right now?’ she asked, her tone far from the soft tone she had taken with Erin. The crew shook their heads and began packing the kit away.

Jess turned to Erin, her tone warm.

‘You coming to watch the debrief, won’t be too painful today. More of an informal chat than a telling off.’ Erin nodded, the adrenaline still pumping through her veins even though it had only been a training scenario.

As the team started walked across the hangar towards the crew room, Liam fell into step beside Erin.

‘I’m guessing it looks a bit different to how they taught it on the course?’ he said quietly, a hint of amusement in his voice.

Jess held the door to the crew room and beckoned Erin inside.

The crew room was surprisingly modern, part operations hub, part accommodation. One wall was covered by large screens showing weather, current incidents that were being watched by control, and a live map of the Channel. Opposite the screens was a kitchen area, separated off from the rest of the room by a countertop. In the middle was a large table surrounded by chairs, with laptops and plug sockets at each spot. Two sofas faced a wall-mounted TV in the corner of the room.

Erin immediately thought about how much nicer it was than the old portacabins she’d stayed in during selection. A few of the others were already taking their seats at the table, setting up the laptops and discussing quietly with each other. Ethan was in the kitchen with Hannah, getting coffees for the rest of the team.

Erin found a seat next to Leah and sat herself down. Leah turned to Erin and gave her a small, friendly smile.

‘You’re Erin, aren’t you?’ Leah asked.

‘Yeah, I’m the new PJ’ Erin replied.

Leah smiled. ‘The boss will introduce you properly in a minute’ she said, nodding towards Liam, who was now talking to Jess and Lewis. The rest of the team slowly filtered from the kitchen to their seats, all getting their laptops ready to take notes from the debrief.

Liam stepped forward and sat at the head of the table. He didn’t speak straight away, just looked around the table, making sure he had everyone’s attention before starting. The rest noticed and slowly the noise died out.

Then his eyes settled briefly on Erin.

‘Before we start,’ he said, his voice calm, but carrying a sense of authority, ‘we’ve got someone new.’

Every head in the room turned towards her.

Erin felt it instantly.

‘This is Erin Walsh. Fresh out of selection,’ Liam continued. ‘She’ll be working with us from today.’

Liam paused for a moment; his eyes focused on Erin.

‘Stand up.’

Erin hesitated for half a second, then pushed her chair back. She stood up straight but felt her legs going weak, the eyes in the room burnt into her.

Liam watched her for a moment, then gave a small nod.

‘She’s earned her place here, same as the rest of us.’

Erin looked around the room.

There was no judgement, or hostility. Just acceptance.

‘Alright,’ Liam said, shifting his focus back to the group. ‘Let’s get into it.’

Erin sat back down, her heart still racing, but she felt that the atmosphere. She wasn’t standing on the outside anymore. As she pulled her chair forward, Leah patted her on the back and gave her a warm smile.

‘Talk me through it,’ Liam said. ‘What did we do well?’

Ethan cleared his throat and spoke up first. ‘Airway improved once we moved to the I-gel. We started to get good sats, but we were still contraindicated for an RSI.’

Liam nodded once. ‘Agreed. So, what didn’t go so well?’

There was a small pause before anyone spoke.

Leah answered this time. ‘We waited too long to step up from the OPA. We knew it wasn’t giving us what we needed but there seemed to be a long time where we did nothing about it.’

‘Why?’ Liam asked, firm, but not harsh.

Leah glanced briefly at Hannah. ‘We got drawn into everything else. Lines, drugs…we lost our situational awareness.’

Hannah gave a small nod in agreement. ‘I should’ve stepped back and said something sooner. I think we all got too involved.’

Lewis leaned forward slightly. ‘It’s easy to get tunnel vision when we deal with patients like this. But if we haven’t fixed the airway, everything else is pointless.’

Liam let that sit for a second.

‘Exactly. Our priorities don’t change just because we have to get access on a patient.’

Jess spoke next, her tone measured. ‘You all knew what needed to happen. It’s just about doing it sooner. Don’t be afraid to speak up and say something, that way we all hear it and it keeps us grounded.’

There were nods of agreement around the table.

Liam shifted slightly, about to continue with the debrief before being sharply cut off by the sound of a phone ringing.

The whole room turned to where the noise was coming from.

It was the red phone in the corner of the room.