Readers of the blog will know that I spent the second half of 2015 with MedSTAR, South Australia’s retrieval service and part of SA Ambulance Service (SAAS).
As a rural doctor I am usually a user of this service. It’s taken a few years after being invited to coordinate time off to arrange time out of practice on KI and visit MedSTAR, but it eventually worked out.
I have become interested in the use of FOAMed to help deliver “quality care, out there” and my gut feeling has been that there are many lessons from prehospital care that are relevant to rural practice – the rural environment is limited in both resources and personnel…and there is no immediate backup in a crisis. With the advent of FOAMed there really is no excuse for the isolated rural clinician to be the ‘weak link’ in critical care, at least in terms of knowledge. However, whilst critical illness does not respect geography, rural clinicians are limited by the occasional nature of such work, limited equipment, lack of standardisation and audit as well as deskilling.
So it was useful for me to use time at MedSTAR in order to see the heterogeneity in practice “out there” in rural SA, as well as to learn from paramedic colleagues as the experts in prehospital care. It was also an opportunity to see how well the skill set of the enthusiastic rural doctor can translate into the prehospital environment…
It wouldn’t be appropriate for me to dissect my experience of MedSTAR in full here. It was a useful experience, although it was not what I had expected based on previous experience since the inception of MedSTAR in 2007.
Relevant lessons for rural practice included :
- the value of regular case audit to drive improvement
- the need for standardisation of equipment and use of SOPs for key procedures
- potential for immersive scenario training to improve team work
- need for benchmarking with others, whether intra- or interstate
I hope that we can implement some of these lessons into rural hospitals run by Country Health SA. Bottomline, I hope to use the lessons learned to help encourage rural clinicians to embrace the difficulties faced by dealing with critical care infrequently, and seek to drive quality improvements. Whilst the retrieval service offers an excellent standard of care, I believe that opportunities exist for rural clinicians to value-add in the time awaiting the cavalry, rather than just call for help…
All About that Base
MedSTAR covers both adult and paediatric populations in SA and interstate. Transport platforms include land ambulance, rotary wing, RFDS and Lear jet (the latter for interstate missions). Work involved primary missions (mostly from the roadside), modified primaries (usually from a small rural facility) and secondary transfers from larger rural and metro hospitals. The base is located at the Adelaide Airport with training hangar, sleeping quarters, admin offices and general areas. A purpose built new base will soon be co-located adjacent to both RFDS and helicopter hangars on the airfield, which is exciting.
With two adult and one paediatric team on 24/7, there was plenty of time to train and also plenty of downtime between missions. As part of the ‘farewell’ for the 2015 cohort we prepared this video (with the self-taught iMovie guru, Dr Kat Shelley editing the raw footage).
Sadly the full unexpurgated version of the video (including hilarious bloopers) hasn’t been approved for general distribution. The above is the sanitised version….enjoy!
Thanks to all at MedSTAR (particularly the SOT/Rescue Paramedics) who added to my learning and made this a valuable experience.