improving prehospital care in rural australia - time to borrow from overseas models?
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Improving prehospital care in rural Australia - time to borrow from overseas models?. Tim Leeuwenburg Kangaroo Island SA @KangarooBeach. what does a GP know about critical care?. #FOAMed. “Quality care, out there ”. KIdocs.org. 2012 Survey of Rural Docs. - PowerPoint PPT PresentationTRANSCRIPT
Improving prehospital care in rural Australia
- time to borrow from overseas models?
Tim LeeuwenburgKangaroo Island SA
@KangarooBeach
what doesa GP
know about critical care?
“Quality care, out there”
#FOAMed
TENET #1
critical illness has no respect for
geography
tyranny of distance
TENET #2
trauma outcomesworse
rural vs metro
Fatovich et al (2011) A comparison of metropolitan vs rural major trauma in Western Australia
Resuscitation 82 : 886-890
“...pre-trauma centre interventions may significantly decrease mortality.
These processes represent local solutionsto a complex organisational problem”
4x
TENET #3
Prehospital care
is no place forenthusiastic
amateurs
quality care
TENET #4
Prehospital care should be
TimelyAppropriate
StandardisedAuditedPrehospital tracheal intubation in severe facial
trauma:a short window of opportunity
Bredmose P P, Rock S, & Lockey D JEmerg Med J 2012;29:767e768
53%of RURAL GP-Anaesthetists
called to attendpre-hospital incidentin the previous year
collisions
rollovers
extrications
farms
emergency airway
TENET #3
Prehospital care
is no place forenthusiastic
amateurs
who is calling
rural docs?
experts in pre-hospital care
yawning gap in the country
TENET #4
Prehospital care should be
TimelyAppropriate
StandardisedAudited
Roadkill ?
53% of rural docsinvolved pre-hospital in previous year
agreed call out criteriarelevant training & equipmentusing same protocols as retrieval
7%12%37%
Overseas ModelsBritish
Associationfor Immediate
CareBASICS, UK
Primary ResponseIn Medical
EmergenciesPRIME, NZ
RERN in South Australia
airway & resuscitation skills
training with medSTAR
appropriate equipment
agreed call out criteria
use of SOPs
regular case audit
fee-for-service under SA Health
no more cowboys
moreusefulthan
this ?
Integrated Trauma System
53%
Rural Doctors are mostly private entities
HENCE NOT INCLUDED IN STATE PLANS
one size does not fit allLocal GPs not called to Kerang crash,
Rural Doctor’s Association tells inquest
11 dead 23 injured
Do we need BASICSin Australia?
Can we agree?Critical illness does not respect geography
Prehospital is no place for enthusiastic amateurs
Rural doctors may have relevant skills
Early entry to trauma system = better outcomes
Right Person, Right Place, Right Time
Stop calling us?