This was it.
As Andrew McLaren, MD, FRCPC, braced for impact, the CH-147F Chinook ditched rapidly to the water’s surface. The 17-tonne beast hit the surface, teetering for a moment before overturning; it just couldn’t sustain the weight of the twin engines overhead.
The shock of the cold water was breathtaking, but he’d been in this situation before. With seconds to spare, he got himself oriented and set to the task of escaping the (now) upside-down helicopter.
…only Dr. McLaren had never left the ground.
High-intensity training in preparation for deployment
Dr. McLaren (or “Doc McLaren,” as he is commonly known in the field) was taking part in Underwater Escape Training, part of an intensive roster of survival systems and safety training in the lead up to his deployment as part of a helicopter rescue team to Mali in the summer of 2018.
An internist-intensivist in Nanaimo, B.C., who describes himself as “a bit of a hybrid,” Dr. McLaren’s considerable experience in trauma care and rescue made him a perfect Roto 0 (first rotation) medical lead for Operation PRESENCE — Canada’s one-year mission to support the United Nations peacekeeping mission in Mali through 24/7 capability to medically evacuate UN troops by air.
Note: Dr. McLaren holds the title of “Major McLaren” with the Canadian Armed Forces, but chose to be referred to as “Dr. McLaren” in this article.
From the mountains to the air to the battlefield
Dr. McLaren grew up in the suburbs of Vancouver. Drawn to the mountains from an early age, he got involved in mountain rescue work. Initially, he thought about becoming a paramedic. It was a neighbour of his (who was himself a senior paramedic in B.C.) who changed his career trajectory.
“I’ve always had an interest in pre-hospital care in an austere environment. He said, ‘look, you should just go to medical school and get doing what you want to do earlier than hanging out in the paramedic world.’ He pushed me into medicine, and I’ve tried to maintain my interest in all things rescue and pre-hospital throughout my medical training. I’ve managed to do that.”
After completing an ICU fellowship in London, Ont., he moved to London, England. There, he took a job with HEMS (Helicopter Emergency Medical Service), operated by London’s Air Ambulance.
The HEMS response rapidly places a trauma doctor and paramedic at the point of injury and ultimately transports patients to one of dozens of receiving hospitals within the M25 highway circling London. Due to London’s population and hospital density, early and advanced decision-making are possible (and big factors in the success of this civilian model of pre-hospital care).
Unsurprisingly, the Canadian Forces had interest in taking this concept to the battlefield.
The UK’s Medical Emergency Response Team (MERT) that deployed to Afghanistan operates using a similar model to London HEMS. It became the basis of CMERT (the Canadian MERT) — the project that would ultimately land Dr. McLaren in Mali.
Physician-led resuscitation team
CMERT started several years ago as a project to push advanced care and decision-making “far forward” in a non-permissive environment. As the capability was developed, Operation PRESENCE was announced; this became the CMERT’s first deployment.
Through CMERT, Canada is supporting the United Nations Multidimensional Integrated Stabilization Mission in Mali (MINUSMA). When called upon, a team of medical professionals fly to the point of injury, evacuate the patient(s) and provide resuscitation care while in flight. By improving the response time to deliver damage control resuscitation (DCR), they effectively extend the safety envelope and enable troops on the ground to travel farther out into the field to do peace support.
“CMERT not only aims to put a physician early in the patient’s timeline, but also gets high-quality blood product to the point of injury and a resus room to the patient,” explained Dr. McLaren. “All of those elements are quite unique.”
Quick facts on CMERT
- Helicopter: CH-147F Chinook and two CH-146 Griffons (travelling as a group)
- Four-person team: Critical care physician, critical care nurse and two medical technicians
- Deployment: Gao, Mali (July 2018 to July 2019)
- Unique characteristics:
- Early, advanced decision-making by a trauma physician
- Blood product is brought to the point of injury within the “golden hour”
- The resuscitation room is brought to the patient: “load and go and play”
Making it in Mali
Dr. McLaren was deployed to Mali in July 2018. He led CMERT Team 2 through to the end of the year and returned in January of 2019 to teach the incoming team (Roto 1), deployed to cover the second half of the mission.
“The first month [after arrival in Mali], the humidity was incredibly high — more than 80% — and that made it very uncomfortable for living, let alone training and working,” said Dr. McLaren, who was familiar with desert- and savanna-type heat from previous work in Kandahar, Haiti and Sierra Leone. “We were drinking upwards of 15 litres of water a day.”
His team rotated one-day-on, one-day-off aeromedevac call for six to seven months.
While on-call, they were expected to launch within 15 minutes. The first few hours of those mornings would be spent getting into that state of readiness (e.g. getting orders, understanding the state of affairs outside camp, readying the aircraft and getting the gear on board).
To provide effective care on a moving helicopter, he and his team would be tethered to the floor. They had to move carefully, so as to not get tangled. They also relied on a mix of body language and intercoms for effective communication. To combat the wind, equipment was fixed to special bags. Garbage and waste were stored in roll-down bags attached to their tactical vests.
The need for precision meant they spent their off-call days running drills and doing more training, often running full simulated scenarios. On occasion, they would switch it up for classroom discussions on different medical components, aviation topics and tactical training with the infantry unit.
“The whole job is about improving the safety profile and staying within a risk envelope that’s acceptable (whether it’s a mission or whether it’s training). I really like thinking about that balance and operating on the ‘sharp end of a rope,’ so to speak. I think that’s the challenge and the fun part for me.”
Take a tour of Dr. McLaren’s working environment on the CH-147F Chinook
Watch Dr. McLaren’s video on the Department of National Defence website (5.46 mins).