Retrieval Medicine and Disaster Management

1. Retrieval & Disaster
Retrieval
General
WA Specific
Disaster
General
At site/hospital response
WA Specific

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

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

6. Mode of Transport

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

9. RFDS WA

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. RFDS Operations Centre

12. 5 RFDS Bases In WA

14. 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

15. The Fleet-Now All PC 12s

17. 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

18. Paediatric ECMO

19. The ideal sick patient

20. Some
challenges

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

22. A bigger challenge

23. A solution but a problem prior

24. Would you have pushed or
objected ?

25. 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. A linguistic challenge

31. The FESA chopper

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

37. Disaster

38. 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

39. 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)

40. 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

41. The Silver Zone

42. The Bronze Zone

43. Triage & Evacuation Map

44. The Thunderbird Model For
Disaster Is Validated

45. The Triage Sieve

46. Triage Revised Trauma Scoring
System: Triage Sort

47. Triage Revised Trauma Score &
Priority

48. 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

49. MIMMS WA Operational Structure

50. 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

51. 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)

52. Questions ?