Module Four Unit Three

Question 1

What are the reasons for secondary retrievals?

Answer 1

1. Treatment critical / step up in care
2. Time / transport critical / speed up in care (e.g. rescue angiography, neurosurg emergencies)

Question 2

What are key considerations during secondary retrievals? (7)

Answer 2

Is this mission really a hospital extrication requiring techniques more consistent with a primary retrieval?
What can we do to affect the pt’s outcomes?
Can these things be done en route?
Is there anything to be gained by staying to meticulously stabilise the pt?
How much needs to be done prior to transport?
Is the team in a position to provide intensive or definitive care?
Who needs to know about this pt?

Question 3

Outline the process of a secondary retrieval. (5)

Answer 3

Tasking pre-departure
In-flight
Onsite
In-flight
Handover

Question 4

Outline the process at the referring hospital. (9)

Answer 4

Introduce yourself and team
Get handover
Briefly review investigations
Rapid head-to-toe assessment
Talk to patient
Consider family
Hospital staff
Reassure but be honest and realistic
Thank team

Question 5

Describe airway considerations in secondary retrieval context.

Answer 5

If in doubt, intubate - esp if difficult airway
Check ETT position, security of tube, suction

Question 6

Describe breathing considerations in secondary retrieval context. (6)

Answer 6

Is NIV/high flow a viable alternative? Trial first - start early
Can this be done prior to your arrival?
If intubated, most pts will be transferred paralysed
Ventilation parameters and POCT
Take care with chest drains
For ventilated pts, thoracotomy is usually best for decompression unless a chest drain is already present

Question 7

Describe circulation considerations in secondary retrieval context. (5)

Answer 7

2 x IVCs minimum, well secured
Art line if appropriate, esp with inotropes/vasopressors
Fluids with pressure bag and blood giving set
Critical drugs and infusions drawn up and ready
Keep IV ports usable

Question 8

Describe the process to move pt from hospital bed to stretcher. (5)

Answer 8

Explain procedure
If pt is conscious, go through “thumbs up” and communication plan for in-flight
Confirm appropriate analgesia before moving pt
Check all lines and tubes are secure
During critical movements hold on to ETT

Question 9

Describe key monitoring considerations in-flight. (5)

Answer 9

All ventilated pts need end tidal CO2
Ensure alarms are visible
Constant clinical assessment: peripheries, RR, colour, comfort, temp
Particular attention during take-off/landing
Access to emergency equipment and pt

Question 10

List some tricks of the trade in secondary retrievals. (12)

Answer 10

Don’t fiddle with stable pt
Rationalise to essential infusions
Use hospital drug supply unless it will exhaust their stocks
Switch to transport ventilator early and recheck blood gases
Consider antiemetics
Have defibrillator pads on for most cardiac pts, or very accessible
If transcutaneously paced, ensure enough battery power
Have low threshold for antiarrhythmics
Use vacate for all trauma and intubated pts
Document neuro exam in all spinal pts before movement
Consider blueys under all obstetric pts and those who are bleeding
Empty ALL bags prior to departure