MedSTAR Complexity of retrieval coordination: using all your resources. What s next? Natalie Hincksman
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1 MedSTAR Complexity of retrieval coordination: using all your resources. What s next? Natalie Hincksman Clinical Practice Consultant Retrieval Nurse (Coordination) MedSTAR EOC
2 Outline > Coordination Perceptions vs reality > Day in question date removed for patient anonymity > Resources available for the day > Weather issues / Handover > Requests for retrieval surge (brief overview) > What was achieved > Personal Conclusion > Discussion
3 Perceptions of coordination are different to reality Perception > Coordination: Call centre job Has no understanding of what is actually happening on the road Doesn t communicate Doesn t listen to teams Makes silly mistakes Could be done better by road crews Is a retirement waiting ground
4 Perceptions of coordination are different to reality Truth MedSTAR = South Australian retrieval service - SA Ambulance, SA Health Service (government funded) MedSTAR Nurse Retrieval Coordinators (NRCs) Coordination unique - Neonates/Paeds/Adults. Coordination is done by retrieval/ex-retrieval staff with good understanding of retrieval logistics Complex role multitasking essential Fast paced easy to loose track No visual cues speciality of its own Consequences obvious and easy to critique Often only place with a 360 view of state s resources, situation, capacities but all dependant on accuracy of information Coordination is critical in disaster & times of high need
5 Day chosen personal experience > MedSTAR Kids service was stretched beyond normal capacity MedSTAR Kids average 3.7 missions / 24hrs > MedSTAR (all services) missions: Average missions / 24hrs = 7.36 > Crossed barriers of adult/kids services > Resource planning > Weather issues - impact > Central coordination abilities
6 Known resources for the day Transport 2 x RFDS Pilatus PC12 fixed wing aircraft. subject to weather checks. Team for the 12.5 hours One Nurse Retrieval Coordinator (NRC) until 1000 beyond that two for the rest of the shift 1 x Jet City Lear Jet (available from 1100) 2 General adult teams from (total) 1 Consultant led team General adult teams from (total) 3 x Australian Helicopters Rotary 2 full Paediatric/Neonatal teams Wings (AB412, BK117 & EC130). subject to weather checks 1 x MedSTAR Ambulance One back transfer Paediatric/Neonatal retrieval nurse x MedSTAR Rapid Response Vehicles 1 MedSTAR Retrieval Consultant on call 1 Paediatric Intensivist on call from base 1 Neonatologist on call
7 Handover from previous shift - outstanding retrievals/transfers > Severe weather warnings throughout north & east of the state. Date removed for pts anonymity
8 Handover from previous shift of outstanding retrievals/transfers > Patient 1 - Mildura, Interstate VIC Distance 399kms (road 5hrs, FW 55mins) Current day yr M. Pericardial and pleural effusions hypotensive & tachycardic (Pr2) Hourly weather checks for FW / local retrieval service also unable to fly due to weather
9 Handover from previous shift - outstanding retrievals/transfers > Patient 2 - Alice Springs, interstate NT Distance 1330kms (road 16.5hrs, FW not available, Learjet 1.5hrs, RW out of the question) Previous day hr M, term, 2.9kg, Stroke i/c encephalopathy, I+V (P2) Decision for night team to go but 0033 returned to Adelaide (unable to land at refuelling point due to flash storm) > Patient 3 - Adelaide to Alice Springs, Interstate NT Previous day Neonatal Back Transfer (elective transfer) Failed transfer previous night
10 Handover from previous shift - outstanding retrievals/transfers > Patient 4 Adelaide to Melbourne (interstate VIC) distance 734kms (road 8.5hrs, FW 59mins, RW out of the question) Previous day day M, 38+3, weight 2.7kg. Complex congenital heart disease, IV prostaglandin - for cardiac surgery interstate, planned retrieval (P4)
11 Shift start prioritisation: > Net calls (via GRN) ensure teams available and green: 0700 MS71 & MS77 (kids) 0800 MS81 & MS35 (kids RN) 1000 MS104 & MS96 (kids) 1400 MS143 > Learjet for Alice Springs Quote preparation > Back Transfer confirmation Alice Springs hospital confirmation of bed for baby Plan: MS35 to perform road leg from WCH to learjet > Observer on also confirmed as going on learjet MedSTAR training program for Dr, RN s & Para s
12 Adults Out Kids Out MS71 VIC MS77 MS81 MS35 MS104 MS96 MS143 Extra Dr Patient 1 - Mildura > RFDS advised weather checks ok for 0730 departure > MS71 activated for 0730 ETD > MS71 Doors closed RFDS > st bed request in Adelaide will call back with answer > Call back reluctant to accept patient. > During MRC phone handover (remote for the day) patient accepted at on call MRC s hospital.
13 Adults Out Kids Out MS71 VIC MS77 MS81 MS35 Adel MS104 MS96 NT MS143 Extra Dr Patients 2 & 3 - Alice Springs Learjet confirm take off from Adelaide after 1100hrs. > outbound baby + observer > return family (if travelling) + observer MedSTAR quote accepted MS35 Arrive Aircraft with back transfer baby for Alice Springs, WCH based doctor (MS96 Consultant staying on base) Learjet doors closed for Alice Springs.
14 Adults Out Kids Out MS71 VIC MS77 VIC MS81 MS35 Adel MS104 MS96 NT MS143 Extra Dr Patient 4 - Adelaide to Melbourne RFDS confirmed Adelaide to Melbourne: weather ok from 0930 but advised mum unable to fly (pilot decision) family and local staff upset MS77 kids activated MS77 kids Depart WCH MS77 kids Doors closed MS77 kids Advised team had aircraft issue and had to re-land in Adelaide MS77 kids Landed Melbourne
15 Adults Out Kids Out MS71 VIC MS77 VIC MS81 MS35 Adel MS104 MS96 NT MS143 Extra Dr Patient 5-2 nd Mildura request > Distance 335kms (VIC) retrieval team inbound to hospital for patient yr M STEMI (post arrest) for cardiac cath-lab (Pr2). No SA RFDS planes possibly same aircraft as patient 1. Pt too unstable to be separate retrieval Adult Retrieval Victoria agreed to retrieve this patient to Adelaide. 10 x calls then case closed.
16 Adults Out Kids Out MS71 VIC MS77 VIC MS81 MS35 Wallaroo MS104 MS96 NT MS143 Extra Dr Patient 6 - Wallaroo > Distance 157 kms (2 hours drive Heli 45mins RFDS 25mins) day M, term, 3kg, NVD. High temperatures since birth (Pr4), logistical transfer issue All RFDS FW in use Plan: RN lead retrieval using MS35 Kids BT nurse as follow on after learjet BT pt rendez-vous tasked as MS45 RN MS45 RN arrived Rotary Wing hanger never doors closed as was diverted to Pr2 retrieval. Case cancelled Ambulance accommodated
17 Adults Out Kids Out MS71 VIC MS77 VIC MS81 MS35/45 Pt Lincoln MS104 MS96 NT MS143 Patient 7 Port Lincoln > Across the Spencer Gulf Distance 250kms (road 647kms 7 hours drive RW1hr 12mins FW 40min) 1058 Newborn, term, 3.8kg, NVD, B&M ventilation for first few of minutes, meconium aspiration, respiratory distress, looks pale & unwell (Pr2) 1102 Spare Kids Consultant & MS45 Kids RN (diverted from Wallaroo) tasked RW MS45 kids collect Mansell unit from BME prior to take-off Tasked FW return (sourced from Port Augusta RFDS) Out: Return:
18 Adults Out Kids Out MS71 MS77 VIC MS81 MS35/45 Pt Lincoln MS104 Adel MS96 NT MS143 Patient 8 Adelaide Hospital > Distance 13.6kms (20mins drive) yr F, 25kg, pedestrian vs bus compound femur, # base of skull, facial droop, GCS 14, tachycardic, air around carotid canal for angio at WCH. (no MS kids teams available) Adult team suggested to Paediatric Consultant conferenced with MedSTAR Retrieval Consultant Agreed to send adult team - MS104 Medical Retrieval Consultant + RN/Para MS104 activated MS104 arrived pt
19 Adults Out Kids Out MS71 MS77 VIC MS81 MS35/45 Pt Lincoln MS104 Adel MS96 NT MS143 MS46 Adel Patient 9 Adelaide Hospital > Distance 12.9kms (20mins drive) hr F, term, biliruben 350 (no MS kids teams on base) MS kids RN (MedSTAR Education Facilitator) on non-clinical day activated Pr2 road MS46 kids RN arrived pt Neonatologist waiting pt to do an exchange MS46 kids RN mobile with pt Pr2 who was driving (ambulance driver not booked)?
20 Adults Out Kids Out MS71 MS77 VIC MS81 MS35/45 Pt Lincoln MS104 Adel MS96 NT MS143 Pt Lincoln MS46 Adel Patient 10 Port Lincoln > Across the Spencer Gulf Distance 250kms (driving 647kms 7hrs, RW 1hr 12mins, FW 40min) yr M sudden onset chest thrombolysed at 1433, ongoing ST elevation & pain urgent cath lab planned for RFDS RN only Medical student call-back, VF arrest 1xDC shock with ROSC, ST not improved MS143 activated and boarded RFDS FW planned for this pt
21 Adults Out Kids Out MS71 MS77 VIC MS81 Adel MS35/45 Pt Lincoln MS104 Adel MS96 NT MS143 Pt Lincoln MS46 Adel Patient 11 Adelaide Hospital > 40mins drive (off peak time no other transport modes considered) yr M STEMI post stent. Stent site bleeding +++, HR130, BP 70/, requires urgent vascular surgery in another hospital (Pr2) MS81 activated Pr MS81 arrived pt MS81 mobile with pt Pr MS81 arrived destination with pt
22 Adults Out Kids Out MS71 Yorketown MS77 VIC MS81 Adel MS35/45 Pt Lincoln MS104 MS96 NT MS143 Pt Lincoln MS46 Adel Patient 12 - Yorketown > Distance 234 km, (drive 3hrs, RW 25mins, FW 20mins) yr M seizure + aspiration, GCS9, hypoxic, about to intubate (Pr2) MS71 activated RW advised via Ambulance Coordinators that pt under CPR MS71 arrived, CPR ceased just prior to team arrival.
23 Movement log
24 12 hour day breakdown > 11 Consults retrieved 5 Neonatal retrievals 1 x Metro 2 x Country 2 x Interstate 4 Adult retrievals 1 x Metro 2 x Country 1 x Interstate 1 Paediatric retrieval 1 x Metro > 1 Neonatal back transfer 1 x Interstate > 6 x consults not retrieved Metro (1 paed, 1 adult) Country (3 Adult) Interstate (1 Adult)
25 Meanwhile back at home - EOC > Phone calls & GRN = 41 (1 x NRC) 27 1 call every 4.39 mins 1 every 6.66 mins = 150(2 x NRCs) call every 3.75 mins 1 every 2.5 mins Total for 12.5 hours per hour per hour 1 call every 3.76mins 1 every 2.93 mins (Normal: 1 phone contact every 8.4 mins) Total coordination contacts (phone + GRN) for 12.5 hours 436 overall contacts contacts per hour 1 recorded voice contact every 1.65 mins (maximum 2 x NRC s) (excluding EOC floor conversations contacts between ambulance coordinators and MedSTAR NRC s)
26 Conclusion > All urgent retrievals were achieved with 3 delays: 2 delayed due to weather and 1 due to team availability. 1 non-urgent RW transfer was abandoned Intensive Care Paramedic transfer was achieved prior to team availability > Combined service allowed for optimal transport platform usage/coordination > Combined service coordination allowed for a surge in one speciality to be accommodated by another speciality > Understanding of cross pollination of scenario training allowed for suggestion of senior general team for paediatric trauma retrieval > Operational staff on portfolio time supported the service NRC blissfully unaware of some of them assisting until end of shift (learning point know who s around even when not operational)
27 Any Questions? > Please be kind! > Thank you to: > The organisers of the ASA & FNA conference > MedSTAR colleagues, teams & management for the opportunity to attend and discuss this topic.
28
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