Consultant anaesthetist and emergency physician Kevin Fong, who has served with the Kent, Surrey and Sussex Air Ambulance for more than a decade, shared insights into operating under extreme conditions and the lessons such environments offer for leadership and resilience in broader society.
Fong, also a professor at University College London and an innovator in medicine in extreme settings including space, recounted a critical incident on a hospital rooftop where circumstances demanded an emergency thoracotomy—a rare procedure he had never performed himself before. Despite the urgency and unfamiliarity, he executed the life-saving intervention with guidance from paramedics, highlighting the intense pressures faced by air ambulance teams.
The rising global climate of uncertainty echoes the kind of high-stakes environments faced routinely by these emergency medical services, Fong said. Citing the World Uncertainty Index’s record high this year, he argued that navigating ambiguity and rapid change is increasingly vital beyond emergency medicine. His new book, titled *Minute Six*, draws on military experiences where rapid adaptation and teamwork are essential, referencing the adage that no plan survives the first few minutes of battle.
Within the air ambulance teams, leadership is not confined to a single role; instead, Fong described a distributed model where pilots, paramedics, and doctors share decision-making dynamically. Pilots, many of whom are ex-military, assess environmental and technical factors before launching missions without prior knowledge of incident specifics to prioritize safety. Paramedics, highly experienced in hazardous situations, often lead on-scene decisions, with doctors like Fong providing focused clinical input during treatment.
Fong underscored the non-commercial nature of the UK air ambulance service as a key factor contributing to its safety record, contrasting it with higher accident rates seen in other countries. He emphasized strict operational protocols, such as restrictions on radio communication during certain flight phases to avoid distraction.
Debriefing practices form an integral part of the service’s culture. After critical calls, teams conduct immediate “hot debriefs” aimed at balancing honest reflection with constructive feedback, fostering continuous improvement and mutual support. This approach reinforces a collective resilience viewed as a fundamental property of the system rather than an individual attribute.
Beyond operational challenges, Fong spoke about the emotional impact of working in emergency medicine, particularly in pediatric cases. He acknowledged the psychological toll carried by air ambulance personnel and the importance of peer support networks to process difficult experiences.
Fong highlighted that his work consistently reminds him of life’s unpredictability and fragility, as well as human resilience. Observing emergency scenes from a helicopter, he said, provides a unique perspective on the complex realities of crisis and recovery.
Former air ambulance pilot William, the Prince of Wales, has also noted how his experience in emergency medical flight contributed to his understanding of leadership and resilience. Fong sees the air ambulance environment as the epitome of teamwork, where adapting to chaos and uncertainty is not just routine but essential.