The RFDS in WA
Conducting a flight
What happens after our aircraft has been tasked?
Once the aircraft has departed, the pilot will provide an ETA which, with modern navigation systems, is usually accurate to within 1-2 minutes. The state-wide Coordination Centre will liaise with the referring hospital nursing staff and local ambulance services, to try to ensure the patient is at the airstrip at the correct time.
Collect at airstrip
The majority of patients are collected at the airstrip. This is the most efficient arrangement. It enables our limited aircraft resources and staff to deal with the greatest numbers of patients within their duty period. It allows us to collect a patient whilst another is already on the aircraft. If we have to come in to a hospital, we cannot leave a patient behind on the aircraft unattended in the heat or cold.
Coming in to a hospital
For critically ill and complex patients, our retrieval team may elect to travel in to the hospital to enable the patient to be resuscitated, stabilised and "packaged" for transport in better surroundings than at the airstrip. This usually adds at least an hour and a half to the transfer. For some serious but time critical patients, (for example, a bleeding abdominal aortic aneurysm which cannot be "stabilised"), we may still elect for an airstrip handover from the referring doctor to save time.
Where patients are complex and have multiple interventions (intubated, ventilated, multiple lines, tubes and infusions) or need further preparation, this will be undertaken in the referring hospital.
An essential principle of retrieval medicine is sound patient preparation before transfer to prevent in flight problems. However there is always a balance between spending too long stabilising the patient and
the need to evacuate them as promptly as possible to a place of definitive care.
A similar situation exists for primary response where we must balance up the merits of travelling to an accident site to extricate and prepare the patient, compared with collecting them at the nearest airstrip from
volunteers and ambulance crews and undertaking interventions in our aircraft.
Once the aircraft has shut down our staff will undertake a formal handover with escorting staff. This will include normal standard questions about the patient's current condition, relevant to their diagnosis, such as pain, recent analgesia, contractions and the like.
Our nurse or doctor will examine the patient briefly in the ambulance and take a baseline set of vital signs at handover. They will check the status of any infusions running and swap over to our own vital signs monitoring equipment and infusion pump if necessary.
The patient will be taken out of the ambulance to a sheltered area, or near to the aircraft, and then transferred to the aircraft stretcher (road ambulance stretchers are not compatible with our aircraft loading and restraint systems). They will then be loaded into the aircraft, and connected to our monitors. A small bag of personal belongings can be taken but there is no room for large items of luggage.
After our clinical staff are satisfied the patient is secured, monitored and all is well, and that they have all the documentation to accompany the patient, doors will be closed, the patient given a safety briefing and the pilot will commence the engine start up procedures and radio calls.
After Departure with the Aircraft
The aircraft will taxi and then take-off. We appreciate if the ambulance and escort can remain until after we have safely departed. Occasionally problems arise and it is helpful to still have someone at the airstrip should we have to abort our departure. For example, if the patient deteriorates, or there is an aircraft technical problem, we may need to return for assistance. It is otherwise difficult to contact someone to come back to the airstrip to help us.
En route with the Patient
Once the aircraft departs, our state-wide Coordination Centre is notified and given a firm ETA for the next patient's location or final destination. Depending on the distance involved this may range from less than an hour to many hours.
We coordinate and book road ambulances to meet the aircraft at their arrival destination and to transfer the patients to their destination hospitals.
In Perth, stable low complexity patients will be handed over to professional paramedics for the final road transfer to a destination hospital. However patients on drug infusions, receiving blood, in active labour or in a more serious or unstable condition will be escorted to their destination. All critically ill patients have retrieval doctors accompany them through to the destination hospital, to continue their care and ensure an appropriate handover.
Arrangements are made to refuel the aircraft, recharge medical oxygen and replace medical consumables prior to the next task. Details of aircraft hours, fuel usage, pilot hours and serviceability status are confirmed prior to tasking another flight.