RickInOz

Continuing on from the previous posting, it might now be helpful to run through an average job so you can get an idea of what we actually do on these retrieval jobs, or “missions” as they are called in the trade.

It all starts with a referral. If our presence is required at an accident scene, we will simply get a call from SAAS to say the helicopter is on it’s way and we are off. More typically the call will come from a distal hospital. We then have to decide on whether the patient needs to be transported and how to do it logistically. We make a lot of phone calls in a very short time frame. We have to organise a receiving centre (we don’t always bring patients back to the RAH, some go to one of the other hospitals in the metro area), receiving medical team, and transport – this means a call to SAAS for an ambulance, Australian Helicopters for a chopper and RFDS for a plane. Next we get our retrieval packs together. We always take a ventilator, monitor, bags full of resuscitation equipment and drugs, phones and a 2-way radio. The idea is that we have to be able to replicate an ICU anywhere without requiring mains power, overhead lighting or landline communications.

Then we go to meet our transport. The ambulances wait outside the casualty department so it is a simple trip downstairs to get to our ride. If going by helicopter we have to get a lift up to the helideck. They can scramble to the RAH within 15 minutes of initial call so we have to time carefully so they aren’t waiting unnecessarily for us. We tend to load “hot” – in other words, they keep the rotors spinning as we put our gear on the helicopter and get in ourselves. It is quite sobering to consider there are very sharp metal blades flying above your head as you get in. We have to wear flying helmets with built-in headsets for communications and to spare our ears as the chopper is very noisy. For plane retrievals we take a taxi down to the RFDS base at the airport and load our gear into the plane prior to departure. The service they provide is very efficient and we can usually be in the air within 30 minutes of that initial referral.

When we arrive at the scene or referring hospital we have to make a quick assessment and make the patient fit for transporting. There are a number of considerations that are unique to aeromedicine. The most important one is to aim to do as little as possible in transit. The inside of the ambulance, helicopter and plane is very cramped and we are usually belted in, which limits freedom of movement. Access to the patient is very restricted so we always err on the side of caution. If anything this may mean we would do procedures and take precautions unnecessary in a tertiary hospital, but trying to intubate a patient in midair is extremely difficult, so better to do it before we leave.

On the return leg we usually radio through to the RAH, or other receiving hospital, to let them know we are on the way. Another team will meet us either at the casualty if we are coming by road, or from the airport, or will be waiting on the helideck. We hand the patient over and our job is done. In reality it is a lot more complicated than this but hopefully this rather long-winded spiel will go some way to providing an insight into the work. When I do shifts in the future I’ll try to remember to write about some more detailed aspects.

Photos to illustrate the text can be found on the 2008 Retrieval Missions Gallery.