RickInOz

After a protracted delay since the previous instalment, here is the final posting in this series about what our job entails. This time I will cover the delivery stage of a retrieval which forms the transfer of care to a receiving centre and the end of our involvement.

On the way, we have already done our best to keep the patient stable, and even in some cases actually continue to work on improving their clinical status. While 15 minutes out we tend to “patch through” to the receiving hospital to notify them of our imminent arrival. Where we go depends very much on what platform we are using. Fixed-wing retrievals obviously require an airport landing, which means a short ambulance ride to the destination. With rotary-wing jobs we tend to use either the Royal Adelaide or Flinders Medical Centre since they have helipads allowing us to expedite transfer of the patient.

We tend to unload “cold”, i.e.: with the rotors stopped, for safety reasons. It is often quite an ordeal to lift the stretcher, loaded with patient and equipment, out of the helicopter and onto a trolley. Fortunately we are met by a Helipad Landing Officer and orderly, who facilitate moving the patient to the destination ward. Unintubated and trauma patients tend to go to Accident & Emergency, whereas already intubated medical and surgical patients go straight to ICU.

The most important duty we have at this stage is a detailed handover. This is to enable the receiving team to seamlessly continue care and even escalate as necessary. In retrieval circles we talk about the “clinical vacuum”. This refers to a loss of momentum in the care of a patient while the new team work out what is going on and then get to work. The ideal handover will make this as short as possible and even non-existent if done properly.

In the new service we have to be quick as the helicopter waits on the roof for us. The pilots tend to give us a 20 minute deadline, after which they have to return to the base. In reality they would probably wait longer but we have not tested their patience yet.

And so our job is done. The task completed with the patient moved to definitive care. This occasionally leaves us with a sense of loss as we now have no more involvement in the case. Being removed from the Royal Adelaide and based at the airport means it is difficult to find out the fate of the patient. However from time to time we do get feedback from the destination hospital and find out that all the effort did make a difference.