Continuing the posts arising from the ASA conference (not the anaesthetics one, the Aeromed one), we share thoughts from just a few attendees with th esessions that proved to be a highlight.
The Northern Territory is known for many things. Even some things that aren’t related to crocodiles. Just recently it also hosted the annual conference for the Aeromedical Society of Australia. It’s a good choice as host location because retrieval around the Top End tests clever professionals in very particular ways.
There’s also a good proportion of the year where the northern climes of Australia are weighed down with the collected sweat of tropical sauna season. So any visit outside those times is well worth it.
As CareFlight provides retrieval services around Darwin, there were plenty of the crew who got along. We asked three to nominate a couple of the bits that most tickled their interest.
Dr Toby Fogg, CareFlight Medical Director
Amongst lots of great talks, the talks from Dr Russell McDonald, who hails from Canada and works with ORNGE, were particularly fascinating.
One of these, with the title “The Glue That Binds – Patient Transport in Regionalised, Rural and Remote Healthcare” looked at the pros and cons of regional services vs centralized services with more retrieval. There was a lot that felt familiar about the description of a big country with vast spaces between people.
Russell made the point that regionalisation reduces duplication of expensive infrastructure and increases case load in those centres, thus improving outcomes. Having big centres means patients who are very ill will need to be transferred. He quoted a figure for errors on these transfers – 1 in 6. (Those are Russian roulette numbers.)
1 in 6 is a very high number (though he didn’t define exactly what the errors were, which would have been a bit of extra detail I would have liked). These errors are more common and potentially more likely to result in big problems where the transport involves inotropes, intubated patients, haemodynamic instability or longer transport times. I guess that only covers pretty much every retrieval in the remote top end.
The potential downside of regionalization is seen in the smaller communities. Building up big centres can easily lead to loss of local services. This makes a safe and timely transport service critical. For such a service to work, it really needs to be fully integrated into the system.
One of the other highlights was a talk from Dr Andrew Pearce. Andrew is the Clinical Director of Education and Training at MEDSTAR (operating in South Australia). His topic du jour was “Advances in Prehospital and Retrieval Medicine” and he took it as a chance to sample broadly from the smorgasbord that offered.
He opened up with a bit of chat about the role of social media in education. In particular he spoke a little on the need to apply a bit of critical reasoning in the social media space like any other area we learn medicine. There’s some good information out there but it’s not universally excellent (disclaimer: except for everything on this site – everything here is top notch). A key question he left behind: are our trainees accessing the right information and following up by going back to the source?
Andrew also touched on prehospital REBOA in the MEDSTAR context. As many reading this (yes, via social media) would know this is already in use by London HEMS. For remote spots in Australia though it’s less clear if there is much of a role. In pig models the ischaemic time in pig models is a maximum of 50—60 minutes. In humans it seems to be 20-30 minutes. For many operating in the Australian space, there is no prospect of completing the journey to hospital within this time frame. All of that before you even get to the issues of adequate case load and how to train.
Jodie Martin, Clinical Educator, CareFlight NT Operations
If there was one thing I took away from this conference it was the continuing focus on human factors and CRM. Everyone seems to have taken the message that we can’t forget the human bit in medicine and make it integral to what they do.
When it came to the talks my highlight was Dr Andrew Pearce talking about advances in prehospital medicine. He talked about fancy stuff but emphasised that if you don’t do the basics well and compliment that with great team work all the shiny stuff is worthless. The basics. Do them and do them well. (I am a big fan of basics.)
I also found the talk from Andrew Duma, Senior Base Pilot with Air Ambulance NSW thought provoking. He broached a topic about clinical currencies of medical crews. That was fairly game of a pilot I thought. He pointed out that aviators have a range of currencies to update and proficiency tests to reaffirm that those core elements of the job are up to scratch. Should there be an agreed approach to make this stuff universal for clinical staff across all jurisdictions as well? (More educators to deliver on that would also come in handy of course.)
Jodie Mills, Senior Flight Nurse/Midwife (Research and Quality), CareFlight NT Operations
I also really enjoyed the “doing the basics better” approach from Dr Andrew Pearce. It’s the cornerstone of good practice in my book.
The other standout presentation for me was from SAAS MedStar Kids on the topic of thermoregulation of outborn neonates. Obviously I’m partly interested because it can be directly related to our practice in Darwin.
The incidence of neonatal complications due to hypothermia is most likely underreported. Temperature is a good KPI for neonatal retrieval, as was covered by Naomi Spotswood.
SAAS MedStar Kids conducted an audit and were able to implement measures to decrease the incidence of outborn neonates arriving at their destination hypothermic. By instituting core temperature measurement (which they did via rectal temperature monitoring) and charging cots at 350C they were able to ensure 100% of outborn neonates were delivered to the receiving centres normothermic. 100% success is what we all want from our targets.
So there you go. Did you see a theme? No, not the Pearce-related theme, though that was sort of a theme too. When it comes to delivering the best health across the vast tracts of space we deal with in Australia, it is vital to do the basic stuff right, every time. The tech that does so much more than bing goes nowhere without good basics.
And of course the team. All delivered by a good team. Relevant to med. Probably relevant to dealing with crocodiles at a guess.
The image here was on the flickr Creative Commons area and is an amazing image (which is here in an unaltered format) by Alexander Cahlenstein.