Improving prehospital care in rural Australia - time to borrow from overseas models? Tim Leeuwenburg Kangaroo Island
what does a GP know about critical care?
“Quality care, out there” #FOAMed
2012 Survey of Rural Docs KIdocs.org
TENET #1 critical illness has no respect for geography
tyranny of distance
TENET #2 trauma outcomes worse rural vs metro Fatovich et al (2011) A comparison of metropolitan vs rural major trauma in Western Australia Resuscitation 82 : “...pre-trauma centre interventions may significantly decrease mortality. These processes represent local solutions to a complex organisational problem” 4x
TENET #3 Prehospital care is no place for enthusiastic amateurs
quality care
TENET #4 Prehospital care should be Timely Appropriate Standardised Audited Prehospital tracheal intubation in severe facial trauma: a short window of opportunity Bredmose P P, Rock S, & Lockey D J Emerg Med J 2012;29:767e768
53% of RURAL GP-Anaesthetists called to attend pre-hospital incident in the previous year
collisions
rollovers
extrications
farms
emergency airway
TENET #3 Prehospital care is no place for enthusiastic amateurs
who is calling rural docs?
experts in pre-hospital care
yawning gap in the country
TENET #4 Prehospital care should be Timely Appropriate Standardised Audited Roadkill ?
53% of rural docs involved pre-hospital in previous year agreed call out criteria relevant training & equipment using same protocols as retrieval 7% 12% 37%
Overseas Models British Association for Immediate Care BASICS, UK Primary Response In Medical Emergencies PRIME, 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
more useful than this ?
Integrated Trauma System 53%
Rural Doctors are mostly private entities HENCE NOT INCLUDED IN STATE PLANS
one size does not fit all Local GPs not called to Kerang crash, Rural Doctor’s Association tells inquest 11 dead 23 injured
Do we need BASICS in 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?
KIdocs.orgKIdocs.org / ruraldoctors.net