Retrieval & DisasterRetrieval

General

WA Specific

DisasterGeneral

At site/hospital response

WA Specific

Retrievals & Transfers

‘On retrievals, no one can hear

you scream’

The Worlds Most Boring Slide: To get it out of the way

• C Cylinder: 440L• D Cylinder: 1600L• E Cylinder 3800L

Vox pop, hear what they are saying on the street

“man, that was so boring”

Transfer & Retrieval

• Why Transfer (& when NOT to) and aim

• Modes of Transport with increasing levels of care

• The Essentials of Patient Preparation: Aim to do nothing en route with some exceptions

• Problems

Choice of Mode

• Distance (Transit and Transfer)

• Escort requirements

• Geographical considerations

• Availability &

resources

Mode of Transport

Preparing• Aim to do everything before transport

• Aim to do nothing during transport

• Prepare for all eventualities

• Early advice and communication by site• Early liaison with transport providers• Destination unit

• Empty / Check everything (tubes, lines, relatives, bladders)

• All documentation, investigations

Barometric Considerations

• Oxygen: PaO2 60mmHg at 5000 ft

• Gas expansion: 1/3 at 5000 ft– ETT cuffs– Entrapped gas in body

• Equipment

RFDS WA

Requesting a transfer

1800 625 800

Operator for basic details

Retrieval doctor for clinical details.

Prioritises and determines crew and flight parameters.

Advises on management and preparation for flight.

Liaises with receiving hospital including bed finding.

Tasking, fuel, hours, vermin checks, logistics.

Clinical Coordinator

RFDS Operations Centre

5 RFDS Bases In WA

RFDS National Priorities (WA figures for 2009/2010)

• Priority 1 (n=557)– Life / limb threatening– “ One for One!” time of call to doors closed <60 mins

• Priority 2 (n=2987)– Urgent– Depart for patient within 4 hrs

• Priority 3 (n=2223)– “Routine” – within 48 hrs– Timeframe can be specified

The Fleet-Now All PC 12s

ICU in a phone box• All operations consistent with

Joint Faculty standards. Intensive Care Medicine

• Ventilators, Monitors with invasive pressures, ETCO2

• Blood Gases, electrolytes• Ultrasound• Transcutaneous pacing/12 lead

ECG• Infusion pumps.• O neg packed cells.• Time critical drugs, eg

antivenoms, digibind

Paediatric ECMO

The ideal sick patient

Some challenges

Poor preparation: Would you be happy to retrieve this ?

A bigger challenge

A solution but a problem prior

Would you have pushed or objected ?

If you would have pushed!

• RFDS has ACEM and Anaesthetic accredited terms

• One term has come up at short notice for next year

• Email hakan.yaman@rfdswa.com.au if interested

• (if you objected, join the radiology training program)

An unstabilizable patient: What priority, 1, 2 or 3 ?

Do you retrieve this patient?

The reality: Do you retrieve this patient?

A linguistic challenge

The FESA chopper

Range

Broad Tasking Criteria

• Skill critical– Skills of RFDS MO/CCP

• Time critical– Time to tertiary hospital

• Access– No road, Rottnest, no airstrip, rescue requirement

• Resources– No fixed wing aircraft or other resources available

• Likely to improve patient outcome

Road v Helicopter

0 50 100 150 200

Helicopter

Road

To Hospital

Initial Resus

Waiting transport

Transport

Example of patient awaiting retrieval in Narrogin

Disaster

Disaster• Natural

– 1995: Kobe earthquake, 6398 dead– 1976: T’angshane Earthquake, 655 000 dead– 1983: Victorian bushfires, 76 dead, 1100 injured– 1997: Thredbo avalanche, 22 dead, 1 injured

• Non natural– 2000: Explosion Netherlands, 17 dead, 947 injured– 1985: Bradford, 50 dead, 200 injured– 1996: Port Arthur, 36 dead, 22 injured– 2001: New York, 7700 dead, unknown injured

Major incident

• Defined by the need for extraordinary resources (location, number, severity, type of live injuries)– Natural vs. manmade– Simple vs. compound (infrastructure intact vs.

damaged)– Compensated vs. uncompensated (whether

additional resource mobilization sufficient)

Major Incident: Response based on MIMMS

• 1) Preparation: Planning/equipment/training• 2) Response: All hazards approach ‘CSCATTT’

• Command & Control• Safety: Self, scene, survivors• Communications: METHANE• Assessment• Triage/Treatment/Transport

• 3) Recovery

The Silver Zone

The Bronze Zone

Triage & Evacuation Map

The Thunderbird Model For Disaster Is Validated

The Triage Sieve

Triage Revised Trauma Scoring System: Triage Sort

Triage Revised Trauma Score & Priority

Radiation: All hazards approach

• CXR 0.02mSV, lumbar spine 1mSv, CT abdo 10mSV

• RAD-quantity energy imparted to tissues, 100 RAD=1 Gray=1J/kg

• REM: Radiation equivalent dose=QF*RAD=Sv• Significant exposure 0.25Sv, LD 50 with

optimum treatment 5Sv

MIMMS WA Operational Structure

Hospital based response

• Notification• Preparation– Equipment: Incl. disaster kits (green airway, blue

breathing, red circulation bags)– Expand resources– Area

• Receival: Greatest good for the greatest no?• Recovery

SCGH• Code Brown– Areawide medical co-ordinator will contact duty

ED consultant• Can request disaster response team• Activation of disaster plan

– Duty ED consultant activates-contacts hospital health co-ordinator who in turn activates the emergency response team and emergency control group (exec group)

– Also Code CBR (prepare PPE, decontaminate)

Questions ?