Improving prehospital care in rural Australia

- time to borrow from overseas models?

Tim LeeuwenburgKangaroo Island SA

@KangarooBeach

what doesa GP

know about critical care?

“Quality care, out there”

#FOAMed

2012 Survey of Rural Docs

KIdocs.org

TENET #1

critical illness has no respect for

geography

tyranny of distance

TENET #2

trauma outcomesworse

rural vs metro

Fatovich et al (2011) A comparison of metropolitan vs rural major trauma in Western Australia

Resuscitation 82 : 886-890

“...pre-trauma centre interventions may significantly decrease mortality.

These processes represent local solutionsto a complex organisational problem”

4x

TENET #3

Prehospital care

is no place forenthusiastic

amateurs

quality care

TENET #4

Prehospital care should be

TimelyAppropriate

StandardisedAuditedPrehospital tracheal intubation in severe facial

trauma:a short window of opportunity

Bredmose P P, Rock S, & Lockey D JEmerg Med J 2012;29:767e768

53%of RURAL GP-Anaesthetists

called to attendpre-hospital incidentin the previous year

collisions

rollovers

extrications

farms

emergency airway

TENET #3

Prehospital care

is no place forenthusiastic

amateurs

who is calling

rural docs?

experts in pre-hospital care

yawning gap in the country

TENET #4

Prehospital care should be

TimelyAppropriate

StandardisedAudited

Roadkill ?

53% of rural docsinvolved pre-hospital in previous year

agreed call out criteriarelevant training & equipmentusing same protocols as retrieval

7%12%37%

Overseas ModelsBritish

Associationfor Immediate

CareBASICS, UK

Primary ResponseIn Medical

EmergenciesPRIME, NZ

RERN in South Australia

airway & resuscitation skills

training with medSTAR

appropriate equipment

agreed call out criteria

use of SOPs

regular case audit

fee-for-service under SA Health

no more cowboys

moreusefulthan

this ?

Integrated Trauma System

53%

Rural Doctors are mostly private entities

HENCE NOT INCLUDED IN STATE PLANS

one size does not fit allLocal GPs not called to Kerang crash,

Rural Doctor’s Association tells inquest

11 dead 23 injured

Do we need BASICSin Australia?

Can we agree?Critical illness does not respect geography

Prehospital is no place for enthusiastic amateurs

Rural doctors may have relevant skills

Early entry to trauma system = better outcomes

Right Person, Right Place, Right Time

Stop calling us?

KIdocs.org / ruraldoctors.net

@KangarooBeach