Graphic: Medical Chest
This year the RFDS welcomed its first pharmacist, Elizabeth Doran, to the organisation as RFDS Medical Chest Service Lead.
With more than 12 years of experience as an emergency medicine pharmacist, Elizabeth is reviewing the RFDS Medical Chest Program through a clinical lens to assess how the organisation can further improve medication services, safety, and quality for those living in rural and remote communities.
“In my prior experience, I created and developed a team of advanced clinical pharmacists to provide an innovative service to the emergency and trauma centre at the Royal Brisbane and Women’s Hospital to lead what was to be an innovative practice,” Elizabeth said.
“This placed a pharmacist clinician at the bedside as a resource in resuscitation and trauma response and to support the patients and other clinicians in the ED, which was a new initiative for Queensland.
“Working in the ED I would always see the RFDS with patient transfers, and I saw a unique opportunity to work with their medical chests.”
The RFDS Medical Chest Program started in 1942 and has been a safety net for Queenslanders who are isolated from a pharmacy or medical service, providing access to life-saving medications and medical supplies.
The concept was developed by a RFDS doctor who realised a lot of time was spent during a consultation identifying what was available in their first aid kits and would be suitable for the condition at hand and decided it would be easier if standardised chests were available.
The chests include antibiotics to treat soft tissue, urinary tract, and chest infections, all the way through to adrenaline, midazolam and morphine to treat accidents, trauma and other significant medical emergencies until the RFDS arrives.
Approximately 1,200 medical chests are located across the state at various locations including cattle stations, communities, mines, marine vessels, police stations, campsites, caravan parks and clinics.
“Medical chest holders speak with a RFDS Doctor via telehealth who will undertake a medical assessment and consultation to advise you which medications to use,” Elizabeth said.
“If they determine you require a medical retrieval, then they will tell you what to use in the interim whilst someone comes to get you. Providing adequate pain relief or an early dose of antibiotics can make a real difference to patient experiences and improve clinical outcomes.
“Patients are also more independent with taking care of their own health needs – particularly people in the bush, so the chest contents should allow for a greater degree of self-care and escalation when needed.”
While the chest and its contents are governed by RFDS Federation and reviewed every two years, Elizabeth is using her strategic clinical skills and pharmaceutical knowledge to vigorously review the contents to look at the usage data and clinical evidence to decipher which first-line treatments could be added to improve patient care.
“A good simple example is providing a medication in a formulation that can be administered as a liquid into the cheek or into the nose as well as an injection,” she said.
"This small change can make it a lot less stressful for someone to administer treatment to a person who is experiencing a seizure."
There is also the opportunity to review medical chest usage data to inform and support RFDS primary health care clinicians by identifying healthcare issues and public health promotion needs in their region.
“The medical chest is so much more than a box in someone’s kitchen – it is a privilege to have access to these medicines and an incredible service offered by the RFDS,” she said.
Elizabeth is also involved in other aspects of medication management across the organisation, including providing expertise around components of the new electronic health record, content to policies and procedures, medication safety and assisting in the review of clinical incidents.
“The scope for a pharmacist in RFDS (Queensland Section) is limitless, with opportunities for improving medication management and pharmaceutical care across the whole spectrum of services we offer for the people of rural and remote Queensland,” she said.