Clinical Coordination

Coordinating medical staff work full-time in the air medical retrieval role, have a well-developed understanding of the geography of the state and the resources of referring and receiving centres.  During the day we may have up to ten retrieval doctors spread over our five operating bases all handling concurrent medical advice calls or assessing flight requests.  In addition, there is an experienced retrieval doctor in our Operations Centre in Perth, providing oversight to our Statewide operations and dealing with conflicting priorities which often arise.

Our communications system enables referring doctors to usually speak to the doctor who will be undertaking the retrieval flight, with only a single telephone call.

• This minimizes the number of phone calls and need for referring doctors to relay the same patient information multiple times.
• It provides an opportunity for the retrieval doctor to obtain clinical information first hand, and to discuss with the referring doctor, essential patient resuscitation and preparation.
• It enables us to assign the case a priority.
• As we are ultimately responsible for the transport of patients referred to us, it ensures that our decisions regarding priority, crew mix, flight profile, special drugs and equipment, are made with the most accurate information at hand.
• It enables discussion with the referring doctor of alternatives to transport, and alternative transport methods, particularly if there are likely to be any delays.
• It ensures the absolute minimal delays in tasking urgent flights as the assessing medical officer is familiar with service capabilities and time-frames and is in direct communication with the coordination centre.

In most cases, referring doctors contact the receiving institution directly to arrange admission, although in urgent cases, we can arrange admission of patients to the receiving hospital. Callers are referred to relevant tertiary hospital departments for ongoing specialist advice where necessary.  This is particularly the case with toxicology, cardiac, neonatal or intensive care transfers.

There is frequently a requirement to evaluate the relative merits of a mixture of concurrent requests involving obstetric, paediatric, medical and surgical cases. All clinical staff are expected to have experience in obstetrics, paediatrics, anaesthetics and emergency medicine. They are required to complete EMST and APLS as well as the organization's induction program and clinical competency assessment.

Unlike the arrangements in some other States, all aspects of the retrieval process are handled through a single agency with the call centre, retrieval staff and aircraft operator all integrated under the same roof with the same performance objectives.  Unlike some States, we measure our response times from when the call is first received, to when the aircraft departs - not just when the pilot is tasked.  This means that all elements of the retrieval process from a customer perspective (call handling, clinical assessment, authorization, crew tasking, flight preparation) are taken into account when measuring our performance.  Clinicians assessing retrieval requests are held equally accountable as the aviation staff for their timely performance.  We have none of the delays which can be associated with hospital-based services (switchboard delays, indecision by junior staff, consultation with other staff, juggling of rosters and other committments, transport of staff to the airport).

Evacuations are coordinated on a statewide basis with any team from any base able to be tasked if necessary to achieve the most appropriate response. Likewise, airborne aircraft can be diverted when required.

Of the 30,000 medical calls handled each year, approximately 6,000 result in air transfers. The clinical and logistical coordination of multiple aircraft, medical teams and flight requests at any one time, over one-third of the Australian continent is complex and involves managing an average of 115 cases every week. Of these, approximately 75% have destinations in Perth.

Once a retrieval flight is underway, our Operations Centre staff liaise with:

• the referring hospital (confirming ETA's and whether the team is coming in or handing over at the airport)
• the road ambulance service (organizing and coordinating road vehicle to meet at the referring and receiving end)
• airports (confirming strip condition, lighting and re-fuelling as required)
• the aircraft medical team (if there are any changes to the patient condition whilst en route, special requirements or diversions in flight)
• the aircraft pilot (on any operational issues, weather, duty times, aircraft serviceability matters)
• other hospitals (where more than one patient may be collected on the flight)
• receiving hospitals (queries about ETA's, change of ICU bed status)

We currently deal with approximately 500 incoming and outgoing calls from the Operations Centre each day.

 

Last Updated: 11/06/2008