Graphic: Flying Doctor team members training in Dubbo
It's not every day doctors arrive at a property on the outskirts of Dubbo to find a tractor overturned, brown snake circling and a severely injured farmer stranded with his mate. But that's exactly what new Royal Flying Doctor Service (RFDS) recruits were confronted with recently.
As part of an intensive three-week training program, emergency medicine registrars took part in a series of medical simulations designed to get them ready to save lives in the Australian Outback.
"Our training is about teaching the doctors to expect the unexpected," said RFDS South Eastern Section Senior Medical Officer and lead trainer Dr Peter Brendt.
"They are all advanced clinicians but they've previously worked in hospitals with big teams where medical testing equipment is available.
"In the Outback we are usually hundreds or thousands of kilometres away from the nearest hospital, without access to different specialists that would be found in a large hospital.
"Our doctors have to do all the tasks which are done by different doctors in hospital."
Managing the scene, working with flight nurses and pilots, dealing with high stress situations and being as adaptable as possible are all key parts of training exercises that take place, Dr Brendt said.
"We practice treating patients using two state-of-the art training simulators that closely resemble real life patients," Dr Brendt explained.
"During three-days of training in Dubbo last week, doctors had to respond to various cases including a pregnant woman who needed to deliver urgently, a man with severe blood loss, patients with airway blockages, someone suffering a brain injury and intoxicated patients and observers."
Dr Brendt said the new registrars will get one-on-one support with senior doctors each time they embark on an emergency retrieval mission.
"The registrars will spend 12 months working out of our Dubbo and Broken Hill bases. We have a partnership with the University of Sydney's School of Rural Health. This allows the registrars to spend a portion of the 12 months working at Dubbo Base Hospital in anaesthetics or the emergency department.
Dr Peter Brendt shares more training insights.
Every six months we have a new intake of emergency medicine and critical care doctors.
Our doctors need to be prepared for everything and ready to go whenever they need to go.
Apollo is our male outdoor trauma simulator. You can intubate him and do surgical airway interventions. He can bleed from different orifices.
In the Outback there is a shortage of birthing delivery services. All our flight nurses are trained midwives and if our doctors go with them, we need to be prepared to do difficult deliveries.
Lucina is our birthing simulator. She can bleed up to five litres and simulates a range of birthing complications. She can give birth 25 times within a couple of hours. This means we can train as many times as we need until we get it right.
It's obviously hard to train on pregnant women but we need to train for rare or complex situations. If you have an obstetric emergency in a hospital setting, the patient can go to theatre and maybe get a caesarean section. We can't do them in the middle of the Outback so having Lucina to practice for scenarios like this is very beneficial.
We have a small team. Our nurses and doctors have to communicate with each other so we can use all the knowledge available. Maybe our flight nurse has knowledge the doctor doesn't have, or maybe the doctor has specialist skills the flight nurse can learn from.
We want to attract registrars because they help us develop and improve our services. They bring new ways of learning and doing things. We can learn from each other.
We often have critical cases and you can see when the training we have done has worked out. Because of this training we're able to save patients.
New registrar Dr Melanie Berry introduces herself and her work
We're taking a critical care service out to the middle of a paddock, side of the road or anywhere it's needed and that's great. It's why I studied medicine.
I started being an intern in 2007 in Gosford. Then I worked at Royal Prince Alfred in Sydney. I started emergency medicine in 2009. Along the way I get married and had two kids. We moved to the central west in January last year.
The people that we're working with are so highly skilled. Every day I'm learning something new and it's very rewarding.