Thanks to Nirosha and John for another great Clinical governance day!
Highlights of M&M (thanks to Dr Sarah Coombs and Dr Chioma Ginigeme)
- Multiple cases were discussed that saw us tasked to distant locations in the far west of the state following catastrophic intracranial events. The decisions surrounding who to transport, when to transport, whether for investigation, treatment or even end of life care were all explored with an understanding of the minimal resources available to patients and staff living remotely.
- Cases were discussed which highlighted the frustrating logistical ’sinkholes’ that potentially arise in particular locations in NSW, where distance to airfield/fuel/interstate borders conspire to lengthen our retrieval times regardless of whether we task helicopter, fixed-wing or road assets.
- We discussed the challenges of multiple moving teams trying to converge in a single place with a single patient. A typical case was of a patient moving in a road ambulance, trying to meet our helo crew who were actually in another road ambulance at the time, and co-ordinate with the helo itself whose flight-crew were constrained by weather in where they could land. The concept of always trying to have said assets moving towards the final point of care was agreed to be a good guiding principle in these situations.
Ollie and Bob did fantastic work intervening in a deteriorating patient many hours from a neurosurgical centre. The carpenter on the right of the picture is Dr Harrison armed with a Hudson Brace and a grim sense of determination in the face of an otherwise unsalvageable patient.
(Wilson et al give a fantastic ‘How to…’ summary for emergency burr holes in Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2012, 20:24 doi:10.1186/1757-7241-20-24 – http://www.sjtrem.com/content/20/1/24)
Felicity and Richard were confronted with a chaotic sea of medical opinions surrounding a deteriorating, unstable patient . With a potpourri of ischaemia, hyperkalemia and pharmacology leading to a decompensated bradycardia our team had to balance their interventions against the ongoing PR blood loss and the persistent (but unintentional of course) attempts by our actors to derail their efforts.
Highlights from ‘other health systems’ presentations
SCAT Paramedic Bob Lisle gave us a great insight into the challenges of working as a medic in the highlands of Papua New Guinea with amazing footage of some aircraft being pushed to their limits and more snakes than you can shake a stick at (NB - never deal with a possibly venomous snake by shaking a stick at it).
Irish registrar Dr John Glasheen gave a great talk charting the rise and rise of the “Enhanced Aeromedical Service” of Ireland and the challenges of rationalising the tasking of operations when there are 7 regional ambulance control centres and an as yet variable level of awareness amongst all the pre-hospital players involved as to what the helicopter can and should be doing. The overall impression was of a service going from strength to strength even amidst the substantial financial pressures of recent years.