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Retrieval & Disaster
Retrieval
General
WA Specific

Disaster
General
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, ...
Transfer & Retrieval
• Why Transfer (& when NOT to) and aim
• Modes of Transport with increasing levels
of care
• The Esse...
Choice of Mode
• Distance (Transit and
Transfer)
• Escort requirements
• Geographical
considerations
• Availability &
reso...
Mode of Transport
Preparing
•
•
•
•
•
•
•

Aim to do everything before transport
Aim to do nothing during transport
Prepare for all eventual...
Barometric Considerations
• Oxygen: PaO2 60mmHg at
5000 ft
• Gas expansion: 1/3 at 5000
ft
– ETT cuffs
– Entrapped gas in ...
RFDS WA
Requesting a transfer
1800 625 800
Clinical Coordinator
Operator for basic details
Retrieval doctor for clinical details.
...
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...
The Fleet-Now All PC 12s
ICU in a phone box
•
•
•
•
•
•
•
•

All operations consistent with
Joint Faculty standards.
Intensive Care Medicine
Ventil...
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...
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
– N...
Road v Helicopter
Example of patient awaiting retrieval in Narrogin

To Hospital

Waiting transport
Initial Resus

Transpo...
Disaster
Disaster
• Natural
– 1995: Kobe earthquake, 6398 dead
– 1976: T’angshane Earthquake, 655 000 dead
– 1983: Victorian bushfi...
Major incident
• Defined by the need for extraordinary
resources (location, number, severity, type of
live injuries)
– Nat...
Major Incident: Response based on
MIMMS
• 1) Preparation: Planning/equipment/training
• 2) Response: All hazards approach ...
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,...
MIMMS WA Operational Structure
Hospital based response
• Notification
• Preparation
– Equipment: Incl. disaster kits (green airway, blue
breathing, red c...
SCGH
• Code Brown
– Areawide medical co-ordinator will contact duty
ED consultant
• Can request disaster response team
• A...
Questions ?
Retrieval Medicine and Disaster Management
Retrieval Medicine and Disaster Management
Retrieval Medicine and Disaster Management
Retrieval Medicine and Disaster Management
Retrieval Medicine and Disaster Management
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Retrieval Medicine and Disaster Management

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Retrieval Medicine and Disaster Management

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Retrieval Medicine and Disaster Management

  1. 1. Retrieval & Disaster Retrieval General WA Specific Disaster General At site/hospital response WA Specific
  2. 2. Retrievals & Transfers ‘On retrievals, no one can hear you scream’
  3. 3. 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”
  4. 4. 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
  5. 5. Choice of Mode • Distance (Transit and Transfer) • Escort requirements • Geographical considerations • Availability & resources
  6. 6. Mode of Transport
  7. 7. 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
  8. 8. Barometric Considerations • Oxygen: PaO2 60mmHg at 5000 ft • Gas expansion: 1/3 at 5000 ft – ETT cuffs – Entrapped gas in body • Equipment
  9. 9. RFDS WA
  10. 10. Requesting a transfer 1800 625 800 Clinical Coordinator Operator for basic details Retrieval doctor for clinical details. Tasking, fuel, hours, vermin checks, logistics. Prioritises and determines crew and flight parameters. Advises on management and preparation for flight. Liaises with receiving hospital including bed finding.
  11. 11. RFDS Operations Centre
  12. 12. 5 RFDS Bases In WA
  13. 13. 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
  14. 14. The Fleet-Now All PC 12s
  15. 15. 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
  16. 16. Paediatric ECMO
  17. 17. The ideal sick patient
  18. 18. Some challenges
  19. 19. Poor preparation: Would you be happy to retrieve this ?
  20. 20. A bigger challenge
  21. 21. A solution but a problem prior
  22. 22. Would you have pushed or objected ?
  23. 23. 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)
  24. 24. An unstabilizable patient: What priority, 1, 2 or 3 ?
  25. 25. Do you retrieve this patient?
  26. 26. The reality: Do you retrieve this patient?
  27. 27. A linguistic challenge
  28. 28. The FESA chopper
  29. 29. Range
  30. 30. 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
  31. 31. Road v Helicopter Example of patient awaiting retrieval in Narrogin To Hospital Waiting transport Initial Resus Transport Road Helicopter 0 50 100 150 200
  32. 32. Disaster
  33. 33. 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
  34. 34. 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)
  35. 35. 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
  36. 36. The Silver Zone
  37. 37. The Bronze Zone
  38. 38. Triage & Evacuation Map
  39. 39. The Thunderbird Model For Disaster Is Validated
  40. 40. The Triage Sieve
  41. 41. Triage Revised Trauma Scoring System: Triage Sort
  42. 42. Triage Revised Trauma Score & Priority
  43. 43. 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
  44. 44. MIMMS WA Operational Structure
  45. 45. 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
  46. 46. 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)
  47. 47. Questions ?

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