RickInOz

So far I have covered how we get to our patients by helicopter or plane. Now, a little about what we do at the scene before leaving on the return leg.

The range of preparation made for us varies enormously. When arriving at a primary, we may be the first healthcare providers but usually some treatment has already been given. We often rely on rural GPs to conduct the first stages of resuscitation and their training includes skills on airway and cardiovascular management. Occasionally, as happened on my job today, we collect patients from another Intensive Care unit in which case most of the work has already been done and all we have to do is package for transport.

Monitoring:

Taking a pulse or blood pressure is nigh-on impossible in the air, so we have to be certain that we can monitor the patient fully while on the move. We record a real-time electrocardiograph, invasive blood pressure, oxygen saturations and end-tidal carbon dioxide levels (if ventilated). These allow us to maintain homeostasis throughout the retrieval. Our monitors are specifically designed for transport being robust and capable of running on battery power for many hours.

Procedures:

The patient may have only had very limited resuscitation so we often have to perform additional procedures to make them fit to travel. This will include invasive monitoring lines, drainage tubes and airway support. The idea as with much of retrieval medicine is to do the bare minimum to make them safe and reach our destination intact. Therefore complex operations and diagnostic procedures are postponed until we arrive at the receiving hospital. Also unlike the myth perpetuated by medical dramas like House, most of us doctors are not capable of performing every technique known to medicine.

Ventilation:

As with monitoring, we have to be confident of controlling the patient’s breathing. If they are unable to breathe for themselves due to unconsciousness or respiratory disease we must take control. It is laborious having to initiate each breath, so a mechanical ventilator is required. Fortunately that has been catered for and we take a transport ventilator with us on all missions. It also can run for many hours on battery power and uses little oxygen by comparison to the complex machines found in the Intensive Care.

Drugs:

There is a limit to what drugs we can both carry and administer on missions. While we take medicines for a fair number of contingencies, we can not anticipate everything. Often we borrow drugs from the referring hospital, but occasionally have to improvise. While in transit we aim to give as little as possible mainly due to restricted access and the risk of injury while unrestrained in a moving vehicle. We can give two drug infusions and, as such, tend to only give essentials like inotropic drugs and sedation.

Packaging:

Once we have the patient on all of our equipment we must make them safe for transport. This means placing them on a stretcher compatible with ambulances, planes and helicopters. For trauma patients we also place them on a Vacuum Mattress. This is a special body length pad filled with polystyrene beads. When a vacuum is created within it, the mattress becomes firm and inflexible. Thus we can mould it to their body and it will hold them snugly, preventing movement which might worsen injury. The other consideration is heat loss. The helicopter often gets cold during flights so we cover the patient with blankets to keep them warm.

Getting ready to go:

By now we are ready for the off. A few phone calls get made to ensure that the receiving hospital is expecting us and to get some advice from the Aeromedical Consultant. Then we load up and leave. The next instalment will cover what happens on the return leg and delivery of the patient. Stay tuned!