RRESS Guidelines Frequently Asked Questions

Rural and remote facilities throughout Queensland can differ in terms of size, staffing, target population, location, available support services, patient transfer options and times, and distance to the nearest higher clinically capable facility. The RRESSG are developed to suit all facilities within this range

If a HHS determines the RRESSG do not suit their rural and remote facility requirements then, with approval from the local Quality, Safety and Risk unit and the Executive Director of Medical services, the HHS can develop emergency services resourcing documents appropriate to their rural and remote facilities. In these instances the HHS are responsible for all Statewide governance expectations including  document control, review and renewal

Large metropolitan hospital emergency departments are well resourced to deal with large numbers of acute presentations 24 hours a day. In less populated rural and remote communities, resourcing of small health facilities reflects the limited number of acute presentations

Subsequently, the vast variety of specific resuscitation, airway support, IV access or monitoring trolleys found in large emergency departments are not suitable for rural and remote facilities limited by serviceable population, space, workforce or isolation

To support the broadest and most efficient emergency capability of rural and remote facilities, Statewide emergency and retrieval specialists determined that the following systems be implemented as a minimum:

• A resuscitation trolley with enough basic resources to support advanced cardiopulmonary resuscitation
• Adjunct emergency procedural kits to compliment the resuscitation trolley with systems targeted resources e.g. complex circulation emergencies or imminent birth and obstetric emergencies
• An emergency response pack to take when responding to an acute incident outside of the facility

First and second line medicines are stored in the bottom drawer because in the event of an emergency it is easier to relocate the medicines than to relocate equipment held in the top drawers. To aid quick relocation, medicines can be stored in an appropriately sized container.

Yes. Facility managers must ensure the storage of resuscitation trolley medicines, kept in an emergency room complies with the Health (Drugs and Poisons) Regulation 1996 which requires:

• All Schedule 8 (S8) Controlled medicines be stored in a S8 safe and
• All Schedule 4 (S4) Restricted medicines are secure from public access i.e. locked away, that signage indicates restricted public access to the emergency area and all staff actively monitor the approved restriction

Resuscitation trolley compartments containing S4 medicines can be secured with a single use locking tag system which will alert clinicians to any tampering of contents. The choice of tag system:

• Is at the discretion of the governing HHS
• Should be easily identifiable with a serial number
• Should be easily removed in the event of an emergency and
• Should be checked daily, with serial numbers recorded next to the clinician signature

Yes. Local alteration, but not removal, of resuscitation trolley, emergency procedural kit or emergency response pack contents is acceptable after consultation with and approval by the local  Director of Medical Services and Quality, Safety and Risk unit.
In instances of content alteration the HHS are responsible for all Statewide governance expectations including document control, review and renewal.

Items can be obtained from local stores departments, pharmacy or pathology, using normal ordering processes.
To support rural and remote facilities, a regularly updated S4HANA ordering spreadsheet is available for use.

In two ways, by checking and auditing.
Checking of contents daily against contents checklists. To support rural and remote facilities, regularly updated contents checklists are available for use. See the relevant RRESSG for further checking requirements
Audits for checking compliance are conducted every 6 months at a local level and regularly by the local Quality, Safety and Risk Unit at discretionary periods. See the relevant RRESSG for further auditing requirements

No. If a HHS determines the RRESSG do not suit their rural and remote facility requirements then, with approval from the local Quality, Safety and Risk unit and the Executive Director of Medical services, the HHS can develop emergency services resourcing documents appropriate to their rural and remote facilities. In these instances the HHS are responsible for all Statewide governance expectations including document control, review and renewal

The review of these documents are undertaken every 2-3 years by an expert Reference Group with broad experience in rural and remote environments, retrieval medicine and supporting rural networks, by an open, Statewide EOI process. Members usually include representation from:

• Aeromedical Retrieval and Disaster Management Branch, (RSQ/TEMSU)
• Australasian College for Emergency Medicine (ACEM)
• Australian College of Rural and Remote Medicine (ACRRM)
• Broad HHS clinical staff
• Queensland Ambulance Service (QAS)
• Royal Flying Doctor Service, Queensland Section (RFDS)
• Emergency Care Institute New South Wales (ECI - NSW)
• Directors of Pharmacy Services Advisory Committee Queensland Health

Every 2-3 years. Urgent changes can be made if a risk assessment, or a coroners or ombudsman determination identifies a quality or safety issue

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