By Ben Porter
Our March education day was focused around the theme of burns, which was stimulated by the recent Australian bushfires. A BBQ lunch was had for all attendees and raised over $120 towards the RFS bushfire victims.
Surgical Airway Clinic
The morning started with one of our regular practical skill “pop-up clinics”; this month the skill was surgical airway. We discussed some of the potential causes of the rare “can’t intubate, can’t ventilate” (CICV) scenario including difficult airway, upper airway obstruction and massive facial trauma and discussed the importance of regular practical and mental rehearsal of the procedure given it is a low frequency, high importance intervention. Everyone had multiple opportunities to practice on one of our neck models which simulate the tactile nature of the procedure using fake blood to obscure any visible landmarks and making the procedure closer to the reality of the experience of the real-life cases handled by Sydney HEMS.
Bushfire Response by AUSMAT
Our first talk of the day was given by Clayton Abel, Team Leader of NSW Fire and Rescue’s Natural Disaster and Humanitarian Response Team and Kavita Varshney, Emergency Medicine Specialist and AUSMAT team member. Both Kavita and Clayton were part of the team asked by the Federal Government to respond to the bushfire crisis at Batemans Bay to support local medical resources. Clayton highlighted the importance of self-sufficiency and logistical organisation to avoid adding pressure to already stretched local resources. Kavita reinforced the huge impact and importance of getting to know your deployment colleagues in order to work effectively as a team and deliver maximum efficiency. Clayton and Kavita used the example of a large storm wreaking havoc through the tents and equipment as a great example how preparation and team training can reduce the hazards of complacency and high risk, low frequency events.
White Island Volcano Patients
The second talk of the day was given by Karsoon Lim, Anaesthetic Specialist and Peter Maitz, Burns and Plastics Specialist and Department Head, both at Concord Hospital. The focus of this talk was on the findings and management of the repatriated victims of the recent White Island Volcano eruption in New Zealand. We spent time discussing the mechanism of the burns and the atypical findings in this cohort of patients including very fine grit and dust ingrained in the eschar. The associated chemical injury from the noxious substances released from the volcanic rock grit proved to be highly toxic and rapid surgical excision of the eschar resulted in almost immediate reductions in vasopressor requirements. The Concord team also advised us that one of the other issues identified in this patient cohort was persistent hypocalcaemia and hypomagnesaemia secondary to hydrofluoric acid exposure. Fluoride binds cations such as calcium and magnesium rendering them unavailable for physiologic processes and thus leading to profound and life-threatening metabolic disturbances. The team reinforced the multidisciplinary nature of caring for burns patients and made particular note of the entourage of staff from a huge variety of allied healthcare professions that are involved in these patients care. These include, but were no means limited to; dieticians, physiotherapists, psychologists and speech and language therapists.
The Major Incident Response
The third lecture was given by Cameron Edgar, Director of Helicopter Operations who spoke about the role of the Incident Management Team in reference to the recent bush fire crisis. Cameron talked about the difference between command and control during a major incident and the importance of closed loop communication as well as allocation and clarification of roles. Cameron was able to give a summary overview of the incident management team structure and its divisions and the importance of the SMEAC (Situation, Mission, Execution, Administration and Command) document in communicating a incident response plan.
NSW Bushfire Patients
The final talk of the day was given by Justine O’Hara, Specialist Plastic and Burns Surgeon from Concord Hospital. She described the clinical course of the 48 bush fire victims who were treated on the Burns Unit. These were a diverse range of patients with burn surface areas of between 1.5% to 59% and an age range of 17 to 84 years. Justine focused on the benefits of novel skin replacement technologies that allow early eschar removal but delayed skin grafting. This delay in grafting allows the patient’s initial inflammatory response to subside and results in better graft success due to improve physiological stability, reduced vasopressor requirement and replete nutritional state. Early and prompt retrieval with appropriate acute management to the correct centre allows for rapid eschar removal (thus limiting toxin release), replacement of the skin with these new synthetic agents and a multidisciplinary team approach which together improve patient’s outcome.