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Assessment & Advice - RFDS and Queensland Emergency Medical System (QEMs)

RFDS and Queensland Emergency Medical System (QEMs)

Queensland Royal Flying Doctor Service (RFDS) provides services from its network of strategically located Bases in Brisbane, Bundaberg, Cairns, Charleville, Longreach, Mt Isa, Rockhampton and Townsville. All RFDS Bases in Queensland, except Longreach provide an aeromedical retrieval/transport service. The RFDS Longreach base provides mental health service to people living in central western Queensland.

Queensland RFDS is part of the Queensland Emergency Medical System (QEMS) with Queensland Health (QH), Queensland Ambulance Service (QAS) and Queensland Emergency Services (QES). This integrated system includes road transport, rotary and fixed wing aircraft and reduces the impact of time and distance on the treatment of sick and injured patients living, working or travelling in Queensland.

Fixed-wing RFDS aircraft based in Cairns, Charleville and Mt Isa are coordinated by RFDS Medical Officers. Fixed-wing RFDS aircraft based in Brisbane, Bundaberg, Rockhampton and Townsville are coordinated by the Queensland Emergency Medical System Coordination Centre (QCC).

RFDS Mission Statement
To provide and support primary health care in rural and remote areas
and to be the pre-eminent
provider of aeromedical services throughout Queensland

SERVICES PROVIDED BY RFDS

1. Provision of routine and emergency medical advice and clinical support to Registered Nurses and Indigenous Health Workers

Routine and emergency medical advice can be obtained 24 hours a day from your nearest RFDS Base with RFDS Medical Officers (Cairns, Charleville, Mt Isa and Rockhampton) by telephoning one of the contact numbers
Rural and Isolated Practice Endorsed Registered Nurses and Authorised Indigenous Health Workers should consult with the appropriate local Medical Officer or nearest RFDS Medical Officer as stipulated by Health Management Protocols (HMP) and Clinical Care Guidelines (CCG’s) detailed in the Primary Clinical Care Manual (PCCM). Other Registered Nurses are encouraged to use the PCCM as a guide to their practice and consult as required and in accordance with Health (Drugs and Poisons) Regulation 1996
All requests for medical advice should be accompanied by clear presentation of an appropriate history and examination, including basic observations as detailed in the PCCM. It is preferable to have the patient present in case further information is required by the Medical Officer
In rural and remote areas of north and western Queensland the RFDS also provides primary care services through a network of clinic locations. Clinic locations range from Queensland Health facilities with no resident doctor, to small isolated properties and mines

2. Provision of advice regarding patient retrieval and transport

Health professionals unsure of the patient transport requirements may seek the advice of an RFDS Medical Officer (Cairns, Charleville, Mt Isa) or Clinical Coordinator (Brisbane, Townsville). In most cases there are several options for management and several potential methods of transport which can be explored. All RFDS Medical Officers and Clinical Coordinators are experienced in providing this kind of practical support
It is preferable to make contact early, even if transport requirement is not confirmed, as this allows more efficient use of resources

3. Coordination of patient retrieval and transport using RFDS aircraft (and other available resources)

RFDS Medical Officers and Clinical Coordinators are able to task RFDS fixed wing aircraft or make use of other available resources as appropriate. All patient transports are prioritised according to clinical need and availability of local resources. Less urgent cases may be delayed to facilitate the transfer of urgent cases from other locations
WHAT YOU NEED TO TELL THE RFDS MEDICAL OFFICER OR CLINICAL COORDINATOR

Appropriate clinical information:
            Patient name, date of birth, gender, specific location
            History (including past history, medications, allergies, infectious conditions)
            Examination and investigation findings
            Management commenced, including drugs administered and infusions in progress
Change in clinical condition:
            Please inform the RFDS Medical Officer or Clinical Coordinator of any change to the
            clinical condition of the patient (worsening or improving) in order that flight priority can be
            appropriately reassessed. Note: a Medical Officer does not accompany all RFDS flights.
            If a patient’s condition worsens it may be necessary for a Medical Officer to accompany
            the flight when it was not originally planned to do so
Admission details
            If the referring health professional is a Registered Nurse, the RFDS Medical Officer will
            organise admission to an appropriate facility. Otherwise, the following information is also
            required:
                   reason for inter-hospital transfer
                   receiving hospital and unit (bed availability must be confirmed prior to transfer)
                   name of accepting doctor

WHAT THE RFDS MEDICAL OFFICER OR CLINICAL COORDINATOR WILL
TELL YOU

The RFDS Medical Officer or Clinical Coordinator will discuss the patient and confirm any requirements. Please ask if there is anything you are unsure about
A planned time frame will be given but accurate ETA will not be confirmed until the aircraft is in flight. Retrievals and patient transports are prioritised and timing is subject to amendment
You will be informed of significant change to planned activity such as another more urgent case taking priority

HOW TO PREPARE A PATIENT FOR TRANSPORT

1. General Considerations
         All patients must be adequately prepared and stabilised prior to transport. In many cases this can
         be done prior to arrival of the RFDS team
         Please discuss with the RFDS Medical Officer or Clinical Coordinator as required
         Complete the RFDS Aeromedical Retrieval Checklist xxii. This is to be completed for all
         patients requiring transport with the RFDS. Forms can also be obtained from the RFDS.

Consideration	Rationale	Requirement
Documentation	Documentation is required by the flight crew and by the receiving facility in order to provide appropriate ongoing care.	All patients must be accompanied by appropriate documentation including referral letter, copy of medical and nursing records, pathology results, ECGs and X-rays.
Analgesia	Any transfer involves movement of the patient, which may exacerbate pain.	The patient should receive adequate analgesia prior to transfer.Consult MO.
Antiemetic	Vomiting will potentially exacerbate certain clinical conditions by raising intracranial and intraocular pressure and placing the airway at risk. Motion sickness is common in the aeromedical environment.	Parenteral administration of an antiemetic is essential for patients with head or spinal injury, penetrating eye injury and bowel obstruction. It should be considered if there is a past history of motion sickness. Promethazine or prochlorperazine is preferred, given 30 minutes prior to transfer. Consult MO.
Parenteral Drug Infusion	The RFDS carries a comprehensive but limited range of drugs. Uncommon drugs may not be carried. Infusions are administered using infusion pumps or syringe pumps. Time is saved if the infusion is prepared prior to RFDS arrival.	Please prepare infusions prior to transfer using RFDS compatible equipment if possible.
Nasogastric Catheter	Nasogastric/orogastric catheters allow drainage of stomach contents and therefore reduce the risk of vomiting and aspiration.	All ventilated patients and those with spinal injury or bowel obstruction should have an NGT/OGT inserted and secured prior to transfer.
Urinary Catheter	There are no toilet facilities on RFDS aircraft. The use of bedpans is avoided due to limitations of space and difficulties with waste disposal.	In addition to standard indications for urinary catheter insertion, a urinary catheter is required for all incontinent or potentially incontinent patients. All patients should have their bladders empty prior to transfer.
Venous Cannula	Venous access may be difficult to achieve during transfer due to space limitations and turbulence.	All patients in whom venous access is likely to be required should have a IV cannulae inserted and secured prior to transfer. All patients in whom venous access is essential should have at least 2 IV cannulae inserted and secured prior to transfer.
Infectious Conditions	Confined space in the aircraft limits the ability to isolate patients with infectious conditions from other patients being transported on the same flight.	Advise RFDS Medical Officer/Clinical Coordinator of infectious conditions when requesting aerial transfer
Patient Escort	Seating availability is often limited, particularly if more than 1 patient is carried. In addition, there are strict weight restrictions for take off and landing which are influenced by amount of fuel and other passengers on board.	An escort will be carried if possible, at the discretion of the pilot.
Baggage	Space and weight restrictions limit the capacity to carry baggage. Baggage is carried in the same area as medical equipment, which must remain easily accessible at all times.	Maximum baggage allowance is 1 small bag with a weight of 8 kg. Medical aids and additional baggage will be carried at the pilot’s discretion.
Handover Location	Where clinically appropriate, airport handover of the patient greatly reduces turnaround time and therefore increases aircraft availability for other tasks.	Patients who have been appropriately stabilised and prepared may be handed over to the RFDS crew at the airport. Critical and unstable patients will be retrieved from the health facility. Handover location will be discussed during the coordination process.

2. Specific Clinical Conditions

Many patients require preparation specific to transport and the aeromedical environment. The following table illustrates some clinical conditions of particular importance.
Please discuss with the RFDS Medical Officer or Clinical Coordinator as required.

Consideration	Rationale	Requirement
Spinal Injury	All patients with proven or suspected spinal injuries are transported on a vacuum mattress. Insertion of a nasogastric catheter and administration of an antiemetic will reduce the risk of vomiting and airway compromise. Insertion of a urinary catheter is necessary to monitor urine output and maintain immobilisation.	All patients with proven or suspected spinal injury should have a nasogastric/ orogastric catheter and urinary catheter inserted. All should receive a parenteral antiemetic at least 30 minutes prior to RFDS arrival. The RFDS will supply a vacuum mattress.
Bowel Obstruction	Trapped gas will expand in volume at altitude and cause pain. A nasogastric catheter may allow escape of trapped gas and reduce vomiting.	All patients with proven or suspected bowel obstruction should have a nasogastric catheter inserted and receive a parenteral antiemetic and adequate analgesia prior to transfer.
Pneumothorax	Trapped gas in the pleural cavity will expand at altitude and may result in respiratory compromise. Underwater seal drains are avoided due to the risk of retrograde flow during transfer.	All patients with proven pneumothorax should have an intercostal catheter inserted and connected to a Heimlich valve or Portex ambulatory chest drainage system. Suspected pneumothorax must be excluded by X-ray.
Penetrating Eye Injury	Trapped gas in the globe will expand at altitude and potentially worsen the injury. Vomiting may also worsen the injury by raising intraocular pressure.	All patients with proven or suspected penetrating eye injury must receive a parenteral antiemetic. They will be transported at reduced cabin altitude.
Mental Illness	Mental health emergency patients are a potential threat to aviation safety. Appropriate physical +/- chemical restraint is used to reduce this threat.	Mental health emergency patients are transported in daylight hours with no other patients on board the aircraft. They require physical restraint and reliable intravenous access +/- appropriate sedation. A Medical Officer or additional escort trained in restraint is also required. All cases must be discussed in full with the RFDS Medical Officer or Clinical Coordinator.
Women in Labour	An aircraft is not an appropriate place for delivery. Transport may occur if labour is suppressed, otherwise it may be more appropriate to deliver locally and transport mother and baby as required.	All cases must be discussed in full with the RFDS Medical Officer or Clinical Coordinator.
Anaemia	Anaemia reduces the oxygen carrying capacity of the blood. This is exacerbated at altitude due to the reduced partial pressure of oxygen.	Patients with haemoglobin concentration of less than 70 g/dl should ideally be transfused prior to transfer. All cases must be discussed in full with the RFDS Medical Officer or Clinical Coordinator.

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Last Updated: 23 May 2008
Last Reviewed: 23 May 2008

Primary Clinical Care Manual 2007

Assessment & Advice - RFDS and Queensland Emergency Medical System (QEMs)

RFDS and Queensland Emergency Medical System (QEMs)