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Retrieval

State Major Trauma Gudielines (Word 95KB)

Victorian rural emergency retrieval

To save lives and prevent serious disability the entire length in time and mechanism of transfer have to be taken in to consideration when making this decision. The ‘golden hour’ applies to both medical and surgical conditions and too often can be wasted in a rush to get the patient to a major centre. The entire range and complexity of emergency medical care requires a full medical education and is beyond the scope of trained paramedic and MICA ambulance officers by themselves. MICAs also are in short supply in rural areas.

Weather very often prevents the use of air transport through cloud, wind and ice, leaving rural doctors to provide intensive care for prolonged periods. The attached picture is of a helicopter that crashed while attempting a retrieval. The lives of pilots and airborne medical staff and patients must not be put at risk. Ensuring that appropriate medical care is provided before transfer means a commitment on the part of the State to maintain the rural medical workforce, and to ensure that rural Hospitals take appropriate steps to guarantee round the clock availability of well-trained and experienced rural doctors.

All this appears to be imperfectly understood by Authorities and ambulance services. Whilst long serving doctors, with advanced emergency and airway skills, especially when in regular anaesthetic practice , are still utilised by local ambulance officers, this was seriously brought into question at the June 2007 Kerang rail disaster, where virtually complete bypass of local services occurred despite the availability of anaesthetists, surgeons and blood transfusion. It is expected that the Coroner will eventually deliver an opinion but this still has not occurred in March 2012. Meanwhile, previous State Trauma Guidelines directing use of local services have been withdrawn, and rural GPs, no matter how involved in routine emergency care, have been excluded in an emergency capacity from the State Health Emergency Response Plan. In some locations however, continuing involvement can be expected, especially in Alpine areas.

The 2008 decision to amalgamate Victorian rural with metropolitan ambulance services, made against the advice of several inquiries, made it more difficult to implement services responsive to rural realities, especially with respect to collaboration with local hospital and medical services.