Just another day on the job

Part of my job here at Townsville hospital is to coordinate the transport of patients from rural parts of north Queensland to more urban centers where they are able to receive the care they need. Unlike my EMS experience in Boston where I helped to coordinate ambulance traffic around the city, in north Queensland about 95% of the transport is in the air. Today was a wild day.

North Queensland is big. About 400,000 square miles big. As a reference, Texas is a mere 260,000 square miles. The major cities include Cairns in the north, Townsville (my home away from home) in the middle and Mackay in the south. Just so you have an idea of the distance, its 830 miles from Townsville to Brisbane and 1275 miles from Townsville to Sydney. That is halfway across the US. Townsville is the only center in the entire area with any true tertiary services. The only things we need to ship (To Brisbane in the South) are burns and some complicated Neurosurg or Peds. Almost everyone else in north Queensland ships to us.

90% of the population lives on the coast and the remaining 10% live in small towns or cattle/sheep station scattered all over the outback. A small but unfortunately sick population of aboriginals lives throughout the area all the way up to southern Papua New Guinea. Apparently there is an agreement that Australia provides care for the residents of the Torres Strait islands which stretch from northern Australia up to “PNG” as its called.

This was my day….

7:00

Mt Isa

This is a small inland regional hospital 450 miles away that contacted us with multiple requests for transport. These patients had come in over the last 24-48 hours and now needed additional care.

1)A 65 year old indigenous woman with diabetes and acute on chronic renal failure. She had initially refused transport but was worsening

2)A NOF or fracture of the neck of the femur in a 58 year old alcoholic

3)A 45 year old woman with bilateral pneumonia and possible swine flu.

4) A 26 year old guy with bilateral empyema that was not improving.

5) A 56 year old man with a resolving STEMI after lysis.

When we arrived all had accepting docs but only the NOF had a bed in Townsville…so we started working on finding a bed for the others. Now to get to Mt. Isa it is a 2.5 hour flight each way and we can only take two people at a time, so we had to chose who was going to get a seat. We had a chat with the docs and compared the patients clinical scenarios (I was harping on vitals as I often do). After some discussion it was decided to take the STEMI and the ARF. The others would simply have to wait.

At this point we called up the flight crew including a flight doc to give them the details. They got set and took off about 25 minutes later. It would be about 2 hours until they arrive in Mt. Isa and 5 until they were back in Townsville.

8:15

Outside of Collinsville

From a town of about 300 people we get a scene call from a trauma. A 25 year old was pinned between a 4x4 and a fence. He was altered and complaining of chest and abdominal pain. The doc from Mackay had sent the ground ambulance, but it wouldn’t arrive for 45 minutes. We decided to send the helicopter for a primary retrieval simple because the mechanism sounded so bad.

8:30

Bamaga

This a small settlement on the tip of northern Australia. A 73 year old woman from one of the islands who presented with abdominal pain is getting worse. She showed up 3 days prior but refused transport. She now had a fever of 40, a rigid abdomen and a WBC of 32K. We got on the phone with the flight team in Cairns who quickly set off with a flight doc for retrieval. Its 3 hours by plane each way to Bamaga.

9:30

Mt Isa

The doc has informed us that a 26 year old woman G2P1 has arrived with BP of 180/110 and 4+ protein in her urine. She just moved to the front of the line. So we had to decide which of the two we were planning on picking up would have to stay. After consultation with the ED doc, renal failure would have to stay put for a little while longer.

10:30

Mareeba

A small town in the mountains northwest of Cairns. A 50 year old man on ace inhibitors presented with severe angioedema of the tongue and the GP (general practitioner) has never intubated a patient before. The report is that the patient’s tongue is filling his mouth and he is breathing at 25 times/min. Cairns is a 10 minute flight away, but their helo (helicopter) was off line for maintenance. After calming the GP down, we called the flight doc who happened to be an anesthesiologist and told him to go by ground….quickly. It is 1 hour each way by road.

11:30

Townsville

We ate lunch

12:15

Innisfail

A coastal city 1 hour south of Cairns. A 45 year old COAD or our COPD patient arrived with a GCS of 14 and pH of 7.1 and a Co2 of 111. After 2 hours on bipap his GCS is 7 and his respiratory rate is 7. Not good. He has not been intubated. The vent is broken. A spare vent is on the way. We start looking for ICU beds. Cairns says no. Townsville and Mackay are already over capacity. So we make the call to Brisbane.

12:25

Magically an ICU bed becomes available in Townsville AND the patient is intubated and on the spare vent. The only problem now is the doc from Cairns is in Mareeba with the angio edema, the doc from Townsville is somewhere over central Queensland on her way to Mt. Isa and the backup doc is not allowed to fly until 6:00PM due to fatigue regulations set by the state. We start working on finding a backup doc for the backup doc.

1:30

Bamaga

A 26 G3P2 with a history of rheumatic fever and mitral valve disease at 36 weeks presents to a clinic in active labor. The plan was for her to electively go to Cairns at 36 weeks to be monitored, but the baby didn’t want to wait. Unfortunately the only helo in the area is not available due to a search and rescue operation. The only other doc with any OB experience is on the main hospital on Thursday Island off the coast. Due to the active seas, the only way to reach it is via helo and I’ve already told you where that was. So after explaining this all to the GP, we basically came up with the plan to support her via phone as much as possible until 6 when the helo would be available and we could bring the other doc to help out.

2:30

At this point additional requests are pouring in but with ALL of our resources either unavailable or in the air, we are stuck. Most of the folks on the other end of the line seem to appreciate the difficulty of the situation. There are only so many aircraft and only so many docs. We make plans for the next priority when either the docs or the aircraft get back to base. I realized at this point, that sometimes the care one receives is more a matter of luck than anything else. If you get hurt or sick out in the bush and there is no mode of transport available you just have to wait. Rich, poor, aboriginal or white, you just wait.