We started off the new term with a series of interesting presentations based around the theme of drowning and water rescue.

Inland Water Rescue in the UK

Thanks to the wonders of the internet, Matt Ward, Head of Clinical Practice at the West Midlands Ambulance Service presented a very informative talk on inland water rescue in the UK, in particular, the work of the Severn Area Rescue Association and its involvement in the rescue operation following the severe floods affecting Tewkesbury, Gloucester in 2007.

Drowning: pathophysiology and management

Tom talked us through the physiology of drowning and its management

An excellent summary from Life in the Fast Lane can be found here

Role of HEMS physician in water rescue

• This is one of the few situations where the physician needs to act independently without paramedic support as the paramedic is outside the helicopter on the end of a winch cable!
• Make sure everything is secured in the aircraft – kit can easily be blown around when the doors are open
• Physician moves to rear left seat but remains on wander lead in preparation for receiving the patient
• Connect BVM to oxygen supply but keep it secured within the dropdown emergency airway bag
• Suction underneath head of the bed
• Supraglottic airway to hand
• Patients are usually fine (but cold) or in full cardiac arrest so prepare for both
• Further resuscitation can be performed once landed on a nearby helipad or oval

Simulation scenarios

It seemed fitting that a day focused on water rescue should have a number of water-based simulation scenarios to put the new registrars through their paces.

The standard of practice was excellent with some great examples of teamwork and the sharing of a mental model.

Dr Rachel managing a paediatric drowning

Case Discussions

The day was brought to a close with a discussion of a number of interesting cases attended by the new registrars since joining Sydney HEMS. There were many learning points from each case including:

• Regional Trauma Centres provide excellent care to a number of major trauma patients however there are times when a regional trauma centre should be bypassed in order for the patient to receive specialist care only available in a major trauma centre.
• The Senior Retrieval Consultant (SRC) is always available to provide advice and to share in this decision making process.
• Although the days are getting warmer, it can still get cold in the bush overnight. It is possible that you may be winched in to a patient but unable to be winched out due to poor weather or darkness. Make sure you’re prepared for the possibility of remaining with a patient overnight and consider taking thermals, a beanie, food and drink.
• There is an excellent operating procedure for managing raised intracranial pressure. Have a low threshold for paralysing patients for the duration of transfer following adequate sedation and analgesia. Paralysis may mask seizure activity but it is effective in preventing coughing or gagging which can aggravate raised ICP.
• Prophylactic phenytoin in intracerebral haemorrhage is controversial. Following intracerebral haemorrhage it may reduce the chance of early seizures but does not alter long-term outcome.
• IV nimodipine is often started at the referring hospital on the advice of the receiving neurosurgeon. Consider stopping IV nimodipine during transport of the patient, particularly if there is a need to rationalise the number of IV infusions.

The next Clinical Governance Day is on 24 September 2014, when we hope to be back in the refurbished training building. More details to follow