Tag Archives: Patient Transfer

Initial destination hospital of paediatric prehospital patients in rural Victoria

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Paramedics are required to make a variety of decisions regarding their patient, not only on the patient’s condition and course of treatment but also on the destination medical facility for further care.

The objective of this study by Kate Kloot was to describe the initial destination hospital of paediatric patients transported by Ambulance Victoria paramedics within the South Western area of Victoria to determine the proportion of patients that bypassed their closest hospital.

It found that almost 20% of paediatric patients were not transported to the closest hospital,  paramedics focused on patient condition and the distance to a larger hospital when choosing destination, and uncertainty regarding 24 hour availability of resources at smaller hospitals contributed to longer transports.

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Kloot K, Salzman S, Kilpatrick S, Baker T, Brumby SA. Initial destination hospital of paediatric prehospital patients in rural Victoria. Emerg Med Australas. 2016;28(2):205-10.

Providing a lifeline for rural doctors

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Rural doctors often have specific training for rural emergency medicine. What they lack for difficult cases is immediate access to onsite specialist advice. Unfortunately, telemedicine programs are often designed to meet the needs of specialists rather than rural doctors and their patients.

This editorial by the Director of CREM, Tim Baker, outlines the view of advice lines and telemedicine programs from the perspective of the rural doctor making the call, and makes a plea for a more coordinated approach.

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Baker T. Providing a lifeline for rural doctors. Medical Journal of Australia -1 Nov 23 2015, Oct 5;203(7):277.

Deakin researcher and paramedic hopes to improve paediatric policies

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September 2010

Warrnambool paramedic and PhD student with Deakin University’s Centre for Rural Emergency Medicine Kate Cleverley hopes a study she is conducting will lead to improved procedures for transferring paediatric patients to hospitals.

Ms Cleverley said the study could lead to new guidelines that could be used across rural Victoria for the best procedures for taking paediatric patients to the most appropriate facility.

A paramedic with 10 years experience, Ms Cleverley said there were no current guidelines to direct paramedics.

“The intention of the study is to look at paramedic decision-making and to develop protocols and guidelines to make sure paediatric patients who need to go to a higher level of facility are transported there as rapidly as possible,” she said.

“It is not only about the timely nature of the transportation but determining the most appropriate facility to take patients to depending on the level of care required.”

Ms Cleverley said that anecdotally there had been some reports over time of cases where young patients had not been taken to the most appropriate facility.

“It isn’t a common problem but I think having guidelines for paramedics to follow would make the situation less likely to arise.”

She is conducting her research across the Barwon South West region and will include paramedic focus groups, interviews and information from the ambulance service databases. However, she said the planned guidelines could apply to any rural region.

Ms Cleverley completed her Master’s thesis in paediatric weight calculations used by paramedics and was keen to continue her studies in a similar field. She started her PhD studies this year and expects it will take several years to complete. “I am studying part-time at Deakin University in Warrnambool and working at the same time. It’s still in the early stages.”

Ms Cleverley has worked from Warrnambool for the past 18 months and for the six years prior to that was based at Hamilton.

Deakin’s Centre for Rural Emergency Medicine (CREM) is a joint initiative between the Department of Human Services, Portland District Health, South West Healthcare (Warrnambool), Alcoa of Australia and the Deakin Medical School.

Deakin research into regional head trauma

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March 2010

A research project has started in south-west Victoria to find out why people who suffer major trauma head injuries recover better in city areas than in country regions.

Deakin University Warrnambool Campus PhD student Ben Fisk said there was a common belief that people injured in metropolitan areas fared better than those with comparable injuries in country areas.

“Anecdotally there seems to be different outcomes between city and country regions so our first task is to identify and analyse the existing data to see if that is the case,” Mr Fisk said.

The research will consider the total range of trauma head injuries from car crashes and home falls to farm and industrial accidents.

Mr Fisk said his research would investigate and report on possible factors which could influence the apparent imbalance.

“The most obvious would seem to be the time delay in getting injured people to treatment but there hasn’t been a study into the whole situation which will make the findings important for future planning.”

“The goal for this year is to create a picture of what is happening in Western Victoria and compare it to Melbourne.”

Mr Fisk comes from a paramedic background and has worked with the Victorian Ambulance Service in Geelong and Warrnambool for the past nine years. He hopes to use his research to learn more about pre-hospital management systems and how rural and regional people access and utilise ambulance services.

The impact of an emergency rescue helicopter in south-west Victoria will be considered in the three-year study. “There are not enough statistics yet in the south-west area to judge what impact it is having,” Mr Fisk said.

The research will also look at the processes when head trauma patients are taken to small country hospitals.

The research has been funded by the Windermere Foundation which provides special grants for the development, introduction and/or evaluation of new practices, models and interventions to improve health in country Victoria

Deakin University’s Warrnambool Campus Pro Vice-Chancellor (Rural and Regional) Professor Sue Kilpatrick and the Director of the Centre Rural Emergency Medicine Tim Baker are joint supervisors of the research.

Portland Hospital responds to a major challenge

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April 2009

Portland District Health’s revamped emergency department has recorded a successful response to a major bus accident on Thursday night.

The hospital accepted all patients from the crash, including those with serious chest and spinal injuries.

Associate Professor Tim Baker, from the Centre for Rural Emergency Medicine (CREM), said the emergency department had successfully coped with the situation.

“On the night of the bus crash the system worked the way it was planned,” Associate Professor Baker said.

He said the department had undergone a transformation over the past 12 months, with recruitment of experienced doctors, installation of new equipment and emergency nurses gaining experience in Melbourne trauma centres.

“The terrible and unfortunate events of the Portland bus crash gave the hospital its first chance to fully demonstrate these changes,” Associate Professor Baker said.

“It succeeded because of the work done over the past few months. Months of preparation have gone into last night running smoothly,” he added.

Associate Professor Baker said the successful response showed the benefits of having rural doctors and a responsive emergency department at Portland.

The hospital has remodelled its emergency department as part of its commitment to improving services to the Portland region.

Two hospital doctors, two specialist emergency physicians, a general practitioner and many nurses trained specifically in trauma care were involved in the response on Thursday night.

Patients were stabilized and given pain relief. The most seriously injured patients had their injuries investigated by CT scan and were transferred to The Alfred and South West Healthcare in Warrnambool, where appropriate surgical units were expecting them. Stable patients were treated locally and admitted to Portland District Health or discharged.

At 2pm Friday … patients remain in PDH with minor injuries. Their conditions are stable. Nine passengers and the driver were taken to the hospital after the bus crash which claimed three lives at 6.40pm on Thursday

CREM is funded by Alcoa, Deakin University, Portland Hospital and Warrnambool hospital has also contributed. Funding from CREM provides a specialist emergency physician, Associate Professor Baker, to assist in the continuing improvement of emergency medicine in Portland.

He said two specialist emergency physicians work in the emergency department each week. “They have focused on staff training, working with local general practitioners, improving protocols, stocking of appropriate equipment and streamlining interaction with pathology and radiological services. In particular, they have worked on improving the way patients are transported from Portland hospital to city hospitals.”

Associate Professor Baker said recent media reports had highlighted the difficulties in getting country patients to the city for surgery.

“CREM has a voice on regional committees overseeing emergency transport of patients, and staff have been trained in the best way to have the system work for their patients.”