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Retrieval & Disaster
At site/hospital response
Retrievals & Transfers
no one can hear
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”
Transfer & Retrieval
• Why Transfer (& when NOT to) and aim
• Modes of Transport with increasing levels
• The Essentials of Patient Preparation: Aim
to do nothing en route with some
Choice of Mode
• Distance (Transit and
• Escort requirements
• Availability &
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
Empty / Check everything (tubes, lines, relatives,
• All documentation, investigations
• Oxygen: PaO2 60mmHg at
• Gas expansion: 1/3 at 5000
– ETT cuffs
– Entrapped gas in body
Requesting a transfer
1800 625 800
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.
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)
– Depart for patient within 4 hrs
• Priority 3 (n=2223)
– within 48 hrs
– Timeframe can be specified
ICU in a phone box
All operations consistent with
Joint Faculty standards.
Intensive Care Medicine
Ventilators, Monitors with
invasive pressures, ETCO2
Blood Gases, electrolytes
Transcutaneous pacing/12 lead
O neg packed cells.
Time critical drugs, eg
If you would have pushed!
• RFDS has ACEM and Anaesthetic accredited
• One term has come up at short notice for next
• Email email@example.com if
• (if you objected, join the radiology training
An unstabilizable patient: What
priority, 1, 2 or 3 ?
Broad Tasking Criteria
• Skill critical
– Skills of RFDS MO/CCP
• Time critical
– Time to tertiary hospital
– No road, Rottnest, no airstrip, rescue requirement
– No fixed wing aircraft or other resources available
• Likely to improve patient outcome
Road v Helicopter
Example of patient awaiting retrieval in Narrogin
• Defined by the need for extraordinary
resources (location, number, severity, type of
– Natural vs. manmade
– Simple vs. compound (infrastructure intact vs.
– Compensated vs. uncompensated (whether
additional resource mobilization sufficient)
Major Incident: Response based on
• 1) Preparation: Planning/equipment/training
• 2) Response: All hazards approach ‘CSCATTT’
Command & Control
Safety: Self, scene, survivors
• 3) Recovery
Hospital based response
– Equipment: Incl. disaster kits (green airway, blue
breathing, red circulation bags)
– Expand resources
• Receival: Greatest good for the greatest no?
• Code Brown
– Areawide medical co-ordinator will contact duty
• 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)