Retrieval Medicine

1. Retrievals & Transfers
‘On retrievals,
no one can hear
you scream’

2. A multiple choice question
• C Cylinder: 440L
• D Cylinder: 1600L
• E Cylinder 3800L

3. Barometric Considerations
• Oxygen: PaO2 60mmHg at
5000 ft
• Gas expansion: 1/3 at 5000
ft
– ETT cuffs
– Entrapped gas in body
• Equipment

4. Preparing
• General principle is to increase the level of care
• Pre flight preparation decisions are based around
dealing with the consequences
• Communication with the transferring and
receiving hospital is essential
• Documentation is vital

5. Mode of Transport

6. Choice of Mode
• Distance (Transit and
Transfer)
• Escort requirements
• Geographical
considerations
• Availability &
resources

7. Private Car & Commercial Aircraft
• Non urgent problems
• Usually no escort
requirements

8. Road Ambulance
• < 200km from Regional Centre or
Tertiary Centre
• Volunteer / paramedic skill set
• Local depletion of critical resource
• Can stop

9. Cervical Spine Immobilization Pre
RFDS Arrival

10. RFDS WA

11. 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

12. RFDS Operations Centre

13. 5 RFDS Bases In WA

15. 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

16. The Fleet-Now All PC 12s

18. 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

19. The ideal sick patient

20. Paediatric ECMO

21. Some
challenges

22. Poor preparation: Would you be
happy to retrieve this ?

23. A bigger challenge

24. A solution but a problem prior

25. Would you have pushed or
objected ?

26. 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)

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

28. Do you retrieve this patient?

29. The reality: Do you retrieve this
patient?

30. The FESA chopper

31. Bell 412
• Twin turbine medium lift helicopter
• 1800 shp PT6T-3D Twin Pac engine
• Crusing speed 130 knots (240 kph)
• Single pilot IFR
• Empty weight 3079 kg
• Max take off weight 5398 kg
• Useful payload 2200kg
• 350 nm (630 km) range
• Usually tasked within a 200km radius

32. Range

33. 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

34. Road v Helicopter
0 50 100 150 200
Helicopter
Road
To Hospital
Initial Resus
Waiting transport
Transport
Example of patient awaiting retrieval in Narrogin

37. )

38. Airway 1

40. Case presentation:
Multi-casualty incident at SX

41. 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)

42. Initial call
19:33
Rescue 65
tasking

43. RFDS
informed
19:49
Rescue 65
stood
down

44. 3 October 2012 15:50hrs:
• RIO: Broome- JT
• OWD: Albany- JT
• OWI: JT- Margaret River
• YWO: KG- Mount Magnet
• OWG: Carnarvon- JT
• OWQ: Marble Bar- PD
• OWA: At JT
• OWR: At KG
• NWO: At PD
• ZWO: At DBY

45. Call 19:49 Auth 19:52
Bunbury:
Task 20:00 SX 21:37 JT 04:01
Jandakot:
Task 20:18 SX 22:22 JT 01:31
Meekatharra:
Task 21:00 SX 00:11 JT 03:16
Kalgoorlie:
Task 00:35 SX 01:50 JT 03:21
(Bunbury patient)
Task18:28 BN20:00
Re-task22:00 PMH 02:58

47. Jandakot to SX:
740km round trip
• Bell 412: 10” + 3’50” = 4 hours (+ refuel)
• PC-12: 45’+ 1’50”+ 40” = 3 hour 15 min
• 800XP: 1’30” + 55” + 1’ = 3 hour 25 min

48. 4mo: Not walking – Is breathing – RR70 -
1yo: Not walking – Is breathing – RR40 – CRT <2
2yo: Not walking – Is breathing – RR60
3yo: Not walking – Is breathing – RR30 – CRT <2
4yo: Is walking
25yo: Not walking – Is breathing – RR50
32yo: Not walking – Is breathing – RR40
35yo: Is walking
62yo: Is walking
63yo: Not walking – Is breathing – RR20 – P140
• P1
• P2
• P1
• P2
• P3
• P1
• P1
• P3
• P3
• P1
Sieve & Sort
• P1
• P2
• P2
• P2
• P3
• P2
• P2
• P3
• P3
• P1

49. RFDS coordination issues:
• Multiple aircraft at SX airfield
• Infant on lap against CASA
• OSD into coordination centre until 9pm- 3am
• Hospitals kept ringing - annoying
• Adequate resources
• Tele Health doctor interaction

50. Discharge summaries:
4mo: Complex skull fracture with secondary seizures
1yo: Skull fracture with extradural, diffuse axonal injury, #tib/fib
2yo: Renal laceration
3yo: # clavicle, scalp contusion
4yo: Scalp laceration, cervical whiplash, abrasions
25yo: Multiple rib fractures, pneumothorax, # humerus, # metatarsals,
# metacarpals, # TP L2
32yo: # 5th
rib, pneumothorax, multiple lacerations
35yo: # 1st
metatarsal, multiple lacerations
62yo: Abrasions only
63yo: Abdominal wall hernia, multiple rib fractures, pneumothorax,
lung & splenic contusions, liver & renal lacerations, TP #’s of 5
scattered vertebrae, PIPJ dislocation

51. Questions ?