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BPs Decks > 15 MRC CARDS LOGISTIC (51) > Flashcards

15 MRC CARDS LOGISTIC (51) Flashcards

1
Q

SAAS GRN TALK GROUPS (update)

A
  • 12 = Medstar Ops, for clinical communications
  • 15 = REGION, for retrieval & SOT tasking
  • 02 = METRO North, including Gawler
  • 03 = METRO South
  • 81 = REGION NORTH, including the Barossa
  • 71 = REGION SOUTH, including the Adelaide Hills & Riverland
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2
Q

WHY CANT I GET CFS TALKGROUPS ON SAAS RADIOS?

A
  • Only TGs 17-32 are ‘MULTI-AGENCY’ TG which can be accessed on any GRN radio
  • Otherwise, TGs are unique to each agency, and can only be accessed on their radios
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3
Q

RESCUE HELO OPS CHANNELS?

A
  • SAAS GRN 51 HELI TRK = Rescue Helicopter Ops - Trunked
  • SAAS GRN 52 HELI SPX = Rescue Helicopter Ops - Simplex
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4
Q

AUTOMATIC DESPATCH OF MEDSTAR TEAMS TO PRIMARIES

A
  • most MEDSTAR primary activations will be classified as ‘NOTIFY’ by the MEDICAL PRIORITY DESPATCH SYSTEM (MPDS) and referred to the MRC for consideration
  • some high acuity events (eg unresponsive trauma) will be classified as ‘ACTIVATE’ and teams initially tasked by SAAS without MRC approval, although this can subsequently be over-ridden by the MRC
  • either may be STOOD DOWN by SAAS resources arriving on scene, stating the reason for stand-down, but without detailed obs etc
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5
Q

WHICH TEAMS DO PAEDIATRIC PRIMARIES?

A

MEDSTAR ADULT teams do Paediatric scene primaries

Exceptions:

  • MEDICAL PRIMARIES (eg asthma)
  • the pt is expected to reach a health care facility before team arrival
  • MSK team is added to an adult team responding to a trauma primary including paediatric patients
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6
Q

TEAM CHANGES FOR WEIGHT RESTRICTED PRIMARIES

A

the normal MEDSTAR PRIMARY RESPONSE is 2-3x MEDSTAR pers + 1x SOT

where weight reduction is required, the general schema is:

  • first delete any MEDSTAR 3rd person
  • then delete SOT kit
  • then delete SOT

EXCEPTIONS:

  • when the mission is primarily RESCUE: SOT only goes
  • when RESCUE & MEDICAL are both required: SOT goes, +/- MEDSTAR Dr
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7
Q

WHO TO CONTACT REGARDING INTERAGENCY DISPUTES OVER HELICOPTER USAGE

A
  • As a general rule, MEDICAL MISSIONS take priority over CFS or SAPOL unless there is an immediate LIFE THREAT (eg a sinking boat)
  • where disputes arise, the HELICOPTER OPERATIONS MANAGER (previously Evan Everest) adjudicates
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8
Q

WHAT ARE THE RULES FOR PATIENT DESTINATION?

A
  • patients will generally return to a hospitals where they have relevant histories, and the LMO will often have already been in contact
  • otherwise, beds are sought geographically according to the ‘N-S’ line (RAH N, FMC S)
  • where the designated geographic hospital is full, the MRC will seek a bed from other Metro Public ICUs
  • if all decline, the designated geographic hospital MUST accept the patient under the ‘ICUs all full’ procedure, or find another accepting unit themselves
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9
Q

NRC APPROVED METRO ICU INTERHOSPITAL TRANSFERS

A

In order to reduce MRC workload, particularly out of hours, NRCs are authorised to task MEDSTAR teams to move patients between Metropolitan ICUs without notifying the MRC, PROVIDED

  • both the requesting and accepting DUTY INTENSIVISTs agree
  • there are no resource liabilities incurred: last team available, OT etc
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10
Q

INTERSTATE RETRIEVAL REQUESTS

A
  • Interstate patients are generally retrieved to interstate hospitals by interstate retrieval teams, and should initially be referred to them, but may at times come to Adelaide where there are strong geographic (Broken Hill), clinical, logistic or family reasons.
  • In such cases, it is still the primary responsibility of the interstate hospital to arrange acceptance by the receiving hospital, and the interstate retrieval service to conduct the move
  • Medstar may at times accept such missions, in which case the Jet is the first choice aircraft, to preserve local RFDS assetts
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11
Q

LAW REGARDING RESTRAINT OF PSYCH PATIENTS

A
  • MEDSTAR clinicians (Drs, Nurses & paramedics) are authorised under the MENTAL HEALTH ACT to use physical or chemical means to restrain, transport or treat PSYCH* patients who are a risk to themselves, others or property
  • No specific paperwork is required, although the reasons should be recorded in the medical notes, and all cases reported via SLS**.
  • CRITICAL INCIDENTS must also be reported to the Director within 24h: ie where restraint:
    • results in staff or pt injury/deterioration (eg intubation)
    • continues >12h
  • Reportable restraint does not include:
    • voluntary acceptance of sedation by a psych patient
    • Intubation etc of an obtunded OD
    • sedation of combative patients with ORGANIC brain syndromes

  • * including pts with drug induced psychosis, but not those with organic behavioural disturbance, eg due to intoxication or head injury: which can be treated under the 2 Dr provisions of the CONSENT ACT, with the MRC acting as 2nd Dr.*
  • **give details to Cath Parsch to do*
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12
Q

OBSTETRIC RETRIEVALS

A
  • 24/7 Consultant Obstetric advice is available via 13 78 27, and the majority of country obstetric problems can be managed locally or RFDS transferred with this advice, so where obstetric retrieval is requested, first ensure the duty obstetrician is aware
  • where retrieval is warranted, options include using a MEDSTAR ADULT TEAM for the mother, +/- a NEONATAL TEAM (with MANSELL) if remote delivery is a significant possibility
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13
Q

RESOURCES FOR DEALING WITH POISONINGS

A
  • For POISONINGS, the NATIONAL POISONS INFORMATION CENTRE can be reached on 13 11 26.
  • For EVENOMATIONS, the SA State Duty Toxinologist (eg JULIAN WHITE) is available via the WCH switch.
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14
Q

CLINICAL MANAGEMENT AND RETRIEVAL OF ORGANOPHOSPHATE POISONINGS

A
  • ORGANOPHOSPHATE poisoning can occur through ingestion, inhalation or skin contact.
  • It results in inhibition of the enzyme ACETYLCHOLINESTERASE, producing overactivity at the
    • NICOTINIC receptors of the NMJ: producing paralysis
    • MUSCARINIC receptors of the PNS, with bradycardia, bronchospasm, salivation, V&D & convulsions
  • MEDICAL MANAGEMENT =
    • DON CONTACT PPE*: Gloves/Gown, (+Eyepro/mask if spitting and spluttering)
    • secure ABCs THEN strip and scrub
    • ATROPINE 1.2mg IV prn for PNS symptoms**
    • BENZOs for seizures

NOTE: unlike primary scenes, secondary organophosphate transfers are not HAZMAT incidents and patients can be safely handled with Contact PPE, and cabin ventilation to reduce irritation from solvent offgassing.

  • * Aircrew and others not touching the pt dont need PPE*
  • ** works only on the Muscarinic (PNS) symptoms, not paralysis*
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15
Q

WHAT IS ICCnet?

A
  • ICCnet (originally called ICARnet) = a 24/7 cardiology advice service provided by RAH and FMC and contactable on 13 78 27
  • throught it, many country arrhythmias & ischaemias (including lysis) can be managed by the LMO +/- RFDS transfer, so ensure the duty cardiologist is involved with any Cardiac retrieval requests
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16
Q

TIMING OF STEMI RETRIEVALS

A
  • the goal in STEMI is PCI within 60m of presentation and 120m of pain, but this is largely unachievable for country patients, so thrombolysis within 30m is often substituted.
  • MEDSTAR experience is that 75% of lysis patients will reperfuse successfully by 60m, and that most of the failures will be stable and safe for RFDS transfer, thus, current policy is to wait 60m after lysis before assessing suitability for RFDS v Retrieval
  • earlier transfer complicates logistics as it necessitates Retrieval, so any such requests should be discussed at a 3 way call between LMO, Cardiologist & MRC.
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17
Q

24/7 INTERVENTIONAL CARDIOLOGY SERVICES 6/2018 correct master

A
  • RAH, QEH, FMC & LMHS all have 24/7 cath labs*, but only RAH and FMC have Cardiac surgical backup
  • Patients on Balloon Pumps should be at RAH or FMC
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18
Q

STROKE PATIENT RETRIEVAL LOGISTICS

A
  • the goal in stroke is lysis of appropriate lesions within 4.5h of onset (and/or clot retrieval at RAH within 24h)
  • thus, if the ABCs are intact and SAAS can deliver the pt to a CODE STROKE hospital within 4h of symptom onset by a <60m road transfer: expedite transfer direct from the scene, otherwise take to nearest ED
  • where local hospital requests, and ABCs at risk, launch retrieval to expedite transfer to code stroke hospital
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19
Q

SA STROKE HOSPITALS (2018)

A
  • the RAH is now the premier SA STROKE HOSPITAL and offers the only 24/7 metro stroke thrombolysis service
  • FMC & Lyell Mac are the other major stroke hospitals, but only offer a 7 day 0800-2000h stroke thrombolysis service
  • 24/7 Regional, stroke thrombolysis services are also offered by Whyalla, Berri and Mt Gambier.
  • all are co-ordinated by a central POC on 1300 365 211
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20
Q

WHAT IS THE ROSIER TOOL?

A
  • the ROSIER (Recognition Of Stroke In the ER) tool is used to separate acute stroke patients from the 4 common ‘STROKE MIMICS’
    • Sugar
    • Seizures
    • Syncope and
    • Sepsis
  • Check BSL, then:
    • award one add one point for each of Face, Arm or Leg weakness, Speech difficulty and Visual disturbance, and
    • subtract one point for each of Seizures & Syncope
  • Giving a total score of -2 to +5, with >0 likely indicating stroke
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21
Q

WHEN TO RETRIEVE v RFDS SAH PATIENTS

A
  • SAH patients are at risk of sudden deterioration due to rebleeding, seizures or acute hydrocephalus, so are only suitable for non retrieval transfer if they have:
    • no neurological deficit
    • small bleed only on CT
22
Q

RETRIEVAL PRACTITIONER SCOPE

A
  • RPs are experienced Retrieval paramedics or RNs who are authorised to independently manage STABLE patients with significant clinical needs, although they should not electively manage intubated pts solo
  • INDEPENDENT SKILLS include:
    • A: LMA insertion, managing existing ETT incl relaxants
    • B: NIV, IPPV, needle thoracostomy
    • C: siting IV, IO & art lines, managing drug infusions, managing existing pacing wires & IABPs
    • FAST
  • SKILLS WITH CONSULT include:
    • procedural sedation & elective ICC, cardioversion, dislocation reductions
    • blood transfusion & Sengstaken Tube placement
  • EMERGENCY ONLY SKILLS include :
    • cold intubation, surgical crike & finger thoracostomy
23
Q

7 THINGS TO KNOW ABOUT BARIATRIC RETRIEVALS (2018)

A
  1. the F2650 has an SWL of 182kg, but this equates to a 162kg patient maximum in retrieval, after allowing 20kg for bedding, bridge and equipment
  2. the STRYKER has an SWL of 318 kg, although SAAS has adopted 250, and the 412s are rated only for a 200kg patient on the Stryker - above that the Megalift is used.
  3. the MEGA-LIFT stretcher has an SWL of 350kg, and will go in any SAAS ambulance or large helo, but the floor load limit in the 412s are rated only to a max pt wt of 260kg. Note it is a trundle stretcher with no legs and is a difficult manual load, so is usually done with stretcher preloaded and pt hovered in and out over a patslide.
  4. the SAAS BARIATRIC STRETCHER, has a max pt wt of 500kg, but this will only fit in the Bariatric truck & not in any aircraft
  5. The LIFEPORT AEROSLED has a max pt wt of 150kg, but loading considerations reduce this to 130kg in the LEAR and 100kg in R53
  6. the RFDS patient wt limit is 162kg on the FERNO, and a max width of 70cm (including arms) also applies
  7. SAAS country Bariatric services exist at Coober Pedy, Ceduna, Streaky Bay, Pt Lincoln, Pt Augusta, Pt Pirie, Berri, Kingscote and Mt Gambier, these have a HOVERJACK/MAT and MEGA-LIFT stretcher, but no special vehicle.
24
Q

RFDS PC12 AVAILABILITY (2015)

A
  • 0700-2230: 3 Aircraft: 2 at WBAP, & 1 at Pt Augusta
  • Overnight: 2 Aircraft: 1 at WBAP and 1 at Pt Augusta
25
Q

WHO GIVES CLINICAL ADVICE/ORDERS TO THE RFDS?

A
  • The RFDS have their own clinical governance process and such requests, unless emergencies, should be referred to the RFDS duty Dr
26
Q

LEARJET MEDICAL CAPABILITY

A
  • The Learjet carries a single LIFEPORT AEROSLED on a self contained medical base with
    • one E size O2 (4000L*)
    • 920w of domestic 240v power (there is no ‘aircraft’ 28 or 400V outlet)
    • ?? suction
  • Patients are generally transferred onto the Aerosled at the door, and slid in up a ramp.
  • remember to bring the MEDSTAR Learjet bridge in the blue case.

* 2x backup 1600L D cylinders are also carried separately

27
Q

PC12 and LEAR CRUISE SPEEDS AND MAX SEALEVEL CABIN ALTITUDES

A
  • PC12:
    • 270kts (500kmh)
    • 12,500ft
  • Lear:
    • 470kts (870kmh)
    • 25,000 ft
28
Q

RFDS FLIGHT PRIORITIES & TAKEOFF TARGETS

A
  • P1 = Retrieval = 45m normally, 60m after midnight
  • P2 = Urgent IHT = same
  • P3 = 3h
  • P4 = 6h
  • P5 = 12h
  • P6 = 24h
29
Q

LOCATION OF COUNTRY HOSPITAL CT SCANNERS?

A
  • Pt Lincoln
  • Whyalla
  • Pt Augusta
  • Pt Pirie
  • Berri
  • Mt Gambier
  • ? Wallaroo
30
Q

PRIVATE HOSPITAL RETRIEVALS & TRANSFERS

A
  • as MEDSTAR is the only agency capable of moving high acuity patients, it does accept requests for elective movements of patients to or between private ICUs
  • there is, however, no mechanism for taking patients acutely to private ICUs, even if privately insured
31
Q

THE NEUROSURGICAL RETRIEVAL BOX

A
  • there isnt one, Neurosurgeons must bring their own instruments if joining a retrieval
32
Q

ANTIBIOTICS CARRIED BY MEDSTAR?

A
  1. CEPHAZOLIN 2g
  2. MEROPENEM 2g
  3. VANCOMYCIN 2g
  4. ACICLOVIR 1g

(not CEFTRIAXONE or AZITHROMYCIN : these are borrowed locally)

33
Q

WHAT PAEDIATRIC ETTs and LMAs DO MEDSTAR ADULT TEAMS CARRY?

A

MEDSTAR ADULT teams carry:

  • 3.0 uncuffed
  • 3.5 and above cuffed ETT
  • Size 1 LMA
34
Q

BALLOON PUMP TRANSFER LOGISTICS

A
  • the MEDSTAR Balloon pump lives in the Mansell room at the MEDSTAR base
  • it can be transported outbound in the rear of any MEDSTAR light fleet
  • the patient carry leg can be in any SAAS Road ambulance
  • the Jet is the only aircraft currently capable of conducting IABP transfers
  • the Medstar IABP should not be left at the receiving hospital
35
Q

DEFINITIONS OF PRE, CONT & POST IN THE DATABASE

A
  • PRE = they started it, we stopped it
  • CONT = they started it, we continued it
  • POST = we started it
36
Q

RFDS AUDITS

A
  • RFDS audits are held every Thursday at 0830 (except CGD) and should be attended by the 54
37
Q

CARRIAGE OF PATHOLOGY SPECIMENS ON RFDS AIRCRAFT

A
  • these are classed as ‘Infectious substances’ : liaise with the RFDS flight nurse re appropriate carriage
38
Q

MEANING OF RAISED CRP ?

A
  • Raised C-REACTIVE PROTEIN is a non specific marker for inflammation & infection, and now preferred to ESR for its faster response and greater specificity.
  • NR = < 12mg/L
39
Q

TIME TAKEN TO MEDICALLY CONFIGURE R53?

A
  • approx 40m
40
Q

HOW TO CARRY MORE THAN ONE HELO PT (11/18)

A
  • The std setup in all the 412s is one Stryker carried East-West but 2 patients can be carried by shortening the Stryker and rotating to NS, and carrying the 2nd pt NS in a basket stretcher*, with both lashed to the floor.
  • * the 412s always carry a basket stretcher also*
41
Q

AGE CUTOFF FOR PAEDIATRIC TRAUMA & PSYCH PATIENTS TO THE ACH?

A
  • paediatric trauma patients go to adult hospitals once they attain the age of 16 years
  • psych cases still go to the ACH until reaching 18y
42
Q

DESTINATION HOSPITAL FOR (ADULT) SPINAL INJURY PTS

A
  • Stable patients with clear neurological loss after spinal injury should go to RAH
  • unstable pts, or those with unproven injuries, should go to the nearest trauma centre
43
Q

DESTINATION FOR IHT TRAUMA PTS GOING TO RAH

A
  • All patients <48 from injury are assessed in ED, even if from another hospital
44
Q

WHATS NEW IN PSYCH RETRIEVAL?

A
  1. Low acuity Inpatient psych units are now operating in Whyalla, Berri & Mt Gambier, so Medstar NRCs may at times manage IHTs of country patients to these units. Such patients should not require retrieval
  2. a new, numerical, psych patient assessment tool is being used by the NRCs, where:
    1. 5-10 = LOW risk: RFDS RN only
    2. 15-25 = MEDIUM risk: add SAAS mental health escort
    3. >25 = HIGH risk: consider retrieval
  3. where patients under Involuntary Treatment Orders (ITOs) improve before transfer (eg drug induced psychosis) RRMHS may lift those orders & cancel the transfer
45
Q

DEFINITION OF NEONATEs and PAEDs?

A
  • unfortunately this is somewhat inconsistent - TERM babies (defined as born at >37+0 wks) are neonates until birth + 28 days
  • PRETERM babies are neonates until 40weeks + 28 days
  • they then remain paediatric patients until they attain 16y
46
Q

MSK TEAM COMPOSITIONS

A
  • there are 3x nurse anchored MSK teams, MS 80, 107 & 208 with the 80 RN then oncall from 2000-0800h as MS46
  • There are 2x 10.5 h MOs, MS81 & 181, and a 24h oncall MO, MS94, which are variously added to the RNs above to constitute the team
47
Q

DATE FOR MONTHLY MRC MEETINGS?

A
  • first Thurs of each month, usually at Eastwood
48
Q

PEDIMATE WT RANGE

A
  • 4.5 - 18kg
49
Q

WHO ARE THE MRC PHONE A FRIENDS?

A
  • Richard Harris, Andrew Pearce & Stefan Mazur are all paid an on call allowance to provide senior input
50
Q

WHO TO CALL FOR ECMO TRANSFERS

A
  • Call Andrew Pearce, always
51
Q

ECMO TRANSFER LOGISTICS

A

Medstar’s main roles are

  • Logistic: requires a Ferno ambulance, generally the RFDS one
  • Ventilation
  • Monitoring and Infusions: bring the ECMO pack with extra pumps & pressure cable
  • An ECMO team from RAH or FMC will accompany and manage the technical aspects..

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