ANZCA Bulletin June 2012 - final.pdf - Australian and New Zealand ...

Cathay Pacific use Medlink, which isa 24-hour service based at the TraumaCentre of Banner Hospital, Phoenix inArizona, US. The doctors on board areto follow the instruction of the groundmedical support and to communicatepatient information to them. Thedecision for diversion ultimately restswith the captain of the aircraft in liaisonthe leader of the medical response team.A decision for flight diversion was madein both scenarios.mber 2011“ In-flight medical emergenciesare relatively common occurringat approximately one per 10,000– 40,000 passengers.”procedures together with memoryitems in an emergency. We discussedhow we can adapt these principlesto anaesthesia.We received many encouragingcomments on the way back in thecoach. I heard a number of times thatthis was the highlight of the CSM forsome participants. This workshop wasthe result of collaboration with CathayPacific and they generously providedtheir simulation facilities, aviationmedical specialists, flight instructorsand flight attendant trainers. They alsolearned a great deal from the encounter.Dr Tim Brake, FANZCAAbove from left: Dr Phillipa Hore and DrUnited Christian Hospital, Hong KongMichelle Mulligan in the cockpit; the flightsimulator controls; the Flight Training CenterDr Tim Brake was the “Is there a doctor at Cathay Pacific, Hong Kong; anaesthetistson board?” workshop co-ordinator at taking part in the in-flight medical emergencythe 2011 Hong Kong Combined Scientific simulation workshop.Meeting.ANZCA Bulletin September 2011 41A funny thing happened onthe way back from the HongKong Combined ScientificMeeting (CSM).On one flight, an asthmaticinadvertently took somepeanut snacks and developedanaphylactic shock. Hissister was frantic and calledfor the flight attendant. Theflight attendant responded,informed the cockpit and“ In-flight medical emergenciestheir ground medical supportare relatively common occurringwhile putting out a call onat approximately one per 10,000the intercom: “Is there a– 40,000 passengers.”doctor on board?”Fortunately there were six anaesthetistsIt is likely that doctors who travel Table 1. Example of aviationOne of the main issues raised inDuring debriefing, the leader of the Referencesreturning from the CSM, and theregularly will receive a call for helppatient responded to treatment that wasemergency medical kitthe debriefing is who had authority medical response team disagreed with 1. Cocks R., Liew M. Commercial aviationduring their careers. In-flight medicalin the emergency. According to the the decision for diversion but was notavailable in the emergency medical kit.in-flight emergencies and the physician.involved in the decision. One of theEmergency Medicine Australasia (2007)Soon after, on another flight a young emergencies are relatively common Kit Specification – European JointCathay Pacific protocols, the cabinobservers was involved in another19, 1–8man had a grand mal convulsion,occurring at approximately one per Aviation Authoritiescrew retains control and will run theground support medical service and 2. Gardelof B. Inflight medical emergencies.10,000 -40,000 passengers, with oneanother group of anaesthetists(JAA) Regulation: JAR-OPS 1.755emergency within their abilities. CabinAmerican and European viewpointsdeath per 3-5 million passengers andcrew personnel are trained in first aid, noted that there may be communicationissues during an emergency.on the duties of health care personnel.responded to the call “Is there a doctor– Emergency Medical Kitcardiopulmonary resuscitation and theuse of the AED. They will be guidedThe cockpit simulations showed howLakartidningen 2002; 99 (37): 3596–9.on board?” Meanwhile, in the cockpitmedically related diversion of aircraft Contents:in 7-13 per cent of cases 1 . There will be a3. DeJohn C, Veronneau S, Wolbrink A,things were not much better with takeoffaborted due to windshear and themedical support.before and after takeoff and landing, of in-flight medical care aboard selectedby the medical advice of their ground the aviation industry uses checklistsmedical person on board in 83 per cent - SphygmomanometerLarcher J, Smith D, Garrett JS. Evaluationof flights 2 . The most common diagnose - Syringes and needles“fire engine one” alarm occurringCathay Pacific use Medlink, which is and the use of standard operatingUS air carriers. Cabin Crew Safety 2000;are vasovagal syncope (22.4 per cent),four times.- Oropharyngeal airways (two sizes)a 24-hour service based at the Trauma procedures together with memory35 (2): 1–19.cardiac (19.5 per cent) and neurologicalThese scenarios took place at- TourniquetCentre of Banner Hospital, Phoenix in items in an emergency. We discussed(11.8%) 3 .the Flight Training Center at CathayResuscitating a patient in the- Disposable glovesArizona, US. The doctors on board are how we can adapt these principlesPacific in Hong Kong as an offsiteto follow the instruction of the ground to anaesthesia.workshop of the CSM. We ran in-flight confined space of an economy seat- Needle disposal boxmedical support and to communicate We received many encouragingmedical emergency simulations for 24may be difficult. The seats will not lie - Urinary catheterpatient information to them. Thecomments on the way back in theflat and there will be other passengersdecision for diversion ultimately rests coach. I heard a number of times thatparticipants to familiarise them with- A list of contents in at least twothe emergency medical equipment crowded around who may need thewith the captain of the aircraft in liaison this was the highlight of the CSM forlanguages (English and one other)available on board, to appreciate theflight attendant. In this scenario thewith the flight control. This surprised a some participants. This workshop wasmannequin was moved from theDrugs: Adrenocortical steroid,number of the anaesthetists on board the result of collaboration with Cathayunfamiliar and confined environmenteconomy seat to the galley area. We antiemetic, antihistamine,who assumed they had autonomy in Pacific and they generously providedand to understand the airline protocolshad been briefed on the contents of antispasmodic, atropine, bronchialin medical emergencies.decision-making for patients under their simulation facilities, aviationthe emergency medical kit by Cathay dilator (inhalation and injectabletheir care. However, the cabin crew medical specialists, flight instructorsWe used a mockup of the BoeingPacific’s aviation chief medical officer forms), coronary vasodilator, digoxin,withheld the medical responders from and flight attendant trainers. They also777 cabin, a Sim-man 3G high fidelitybut it was still difficult in the emergency diuretic, adrenaline (epinephrine)administering medications until it was learned a great deal from the encounter.mannequin, actors and a team of flightto find the correct drugs and equipment. 1:1000, major analgesic, medicationapproved by Medlink.attendant trainers to set up the scenarioAn oxygen cylinder was used and for hypoglycaemia, sedative/Communication with MedlinkDr Tim Brake, FANZCAfor in-flight medical emergencies.the automated external defibrillator anticonvulsant, uterine contractant.is by satellite phone, which may beinterrupted. We noted during bothUnited Christian Hospital, Hong Kong Above from left: Dr Phillipa Hore and DrCockpit simulation was done with a flatMichelle Mulligan in the cockpit; the flight(AED) was available but not used. Thesimulator controls; the Flight Training Centerscreen simulator with flight instructorscontents of emergency medical kitsscenarios that the participant whoNote that there is no requirement for anDr Tim Brake was the “Is there a doctor at Cathay Pacific, Hong Kong; anaesthetistsfrom Cathay Pacific.may vary between airlines but is being IV kit, although some carriers includingcommunicated with Medlink was notthe leader of the medical response team.on board?” workshop co-ordinator at taking part in the in-flight medical emergencystandardised in the aviation industry. Qantas will have IV fluid. There isA decision for flight diversion was madethe 2011 Hong Kong Combined Scientific simulation workshop.Meeting.Table 1 gives an example.no intubation equipment althoughin both scenarios.a laryngeal mask may be included.40 ANZCA Bulletin September 2011ANZCA Bulletin September 2011 41AwardstotorOne of the main issues raised inthe debriefing is who had authorityin the emergency. According to theCathay Pacific protocols, the cabincrew retains control and will run theemergency within their abilities. Cabincrew personnel are trained in first aid,cardiopulmonary resuscitation and theuse of the AED. They will be guidedby the medical advice of their groundmedical support.with the flight control. This surprised anumber of the anaesthetists on boardwho assumed they had autonomy indecision-making for patients undertheir care. However, the cabin crewwithheld the medical responders fromadministering medications until it wasapproved by Medlink.Communication with Medlinkis by satellite phone, which may beinterrupted. We noted during bothscenarios that the participant whocommunicated with Medlink was notDuring debriefing, the leader of themedical response team disagreed withthe decision for diversion but was notinvolved in the decision. One of theobservers was involved in anotherground support medical service andnoted that there may be communicationissues during an emergency.The cockpit simulations showed howthe aviation industry uses checklistsbefore and after takeoff and landing,and the use of standard operatingReferences1. Cocks R., Liew M. Commercial aviationin-flight emergencies and the physician.Emergency Medicine Australasia (2007)19, 1–82. Gardelof B. Inflight medical emergencies.American and European viewpointson the duties of health care personnel.Lakartidningen 2002; 99 (37): 3596–9.3. DeJohn C, Veronneau S, Wolbrink A,Larcher J, Smith D, Garrett JS. Evaluationof in-flight medical care aboard selectedUS air carriers. Cabin Crew Safety 2000;35 (2): 1–19.on board?on in-flighttraining at theprompts me to relayened only a monthat happens in theflight from Fiji,thalmic surgicalere was a calls system of theoctor. The fourd been working withed at me and firmlymade myself knownwas ushered to thee a man was lyingry narrow corridoro rear toilets.n from his wifeman in his mid-50sidities including, liver cancer and ad been on holidaywell for the past fewinal pain, nauseabeen unable to keepn.ifficult but he wasHe looked pale,ulse and his systolicpation, (there was nom.Hg. I concludedas a result ofry to dehydration.dical kit wasgh somewhat oldlitre of Hartmann’sset.Letters to the editorI managed to cannulate a vein, althoughthere was no tape available and we hadto secure it with Band-Aids. His conditionimproved somewhat with the fluid andwhen the captain called to ask if he neededto divert the plane I informed him thatthis would not be necessary. However, Irequested that an ambulance be ready atthe arrival of the plane and that a stretcherbe waiting as soon as we disembarked as Iconsidered that he needed urgent hospitalcare. I was assured that this wouldbe done.On arrival in Sydney all the passengers Re: NZ anaesthetic technicians canwere let off before us but when I got to now register as health professionalsthe door I found that there was neither (September 2011)stretcher nor any thought of one. Finally I was delighted to read the article byan airport employee arrived with aSusan Ewart, describing the “11-yearwheelchair and all we could do wasprocess” that has resulted in anaestheticbundle the patient into this. No one in technicians in New Zealand nowsight was aware of a medical emergency, Editor’s being note able to register under the Healthnor seemed to care much. We wheeled In the December Practitioners Competence edition of Assurance the ANZCAthe patient to passport control where Act. I congratulate all those involved inBulletin, weachieving a quote this in important a letter professional submitted bydid get some priority in the queue butthen had to wait for bags to be collected Associate goal Professor for our operating Michael room colleagues. Davis onbefore he was finally wheeled out to New Zealand Throughout my anaesthetic technicians career, I wasthe concourse where I expected thevalued highly the support of the manyinadvertently fine men and left women out. This who have is the worked letter,ambulance to be waiting. No one knewanything about it and the patient, his republished alongside in me full in this with capacity. the missing,wife and myself were dumped rather slightly abridged, However, the quote process included.of developingunceremoniously in the cold and draughty the professional role of anaestheticarrivals hall. I inquired about the medical technicians to where it is today is, in fact,NZ anaesthetic much longer than technicianscentre at the airport but it was midday on athe 11 years since theSaturday and it was closed. I was delighted NZ Anaesthetics to read Technicians the article Society by SusanFinally, in desperation, I phoned 000 Ewart, expressed describing “their the wish “11-year to be covered process” by thatand spoke to the NSW ambulance who this legislation”. The first anaesthetichas said resulted in anaesthetic technicians inno call or arrangement had been made. technicians training course in NewNew Zealand was now developed being by able myself to in registerNonetheless they sent an ambulance andthree quarters of an hour later the patient 1978, 33 years ago, soon after I arrivedwas finally on his way to hospital.in Christchurch as a full-time specialistAviation is often held up to wefor the then North Canterbury Hospitalanaesthetists as model of practice but Board. In order to complete the earlyin this instance a serious breakdown Is there history a doctor of technician training in NZ, it isof communication between the air and on board? worth quoting from a 1990 Departmentthe ground led to sub-optimal care ofthis patient.Dr Terry ClarkeDirector, Department of Anaestheticsand Pain ManagementNepean Hospital, Penrith, NSWunder the Health Practitioners CompetenceAssurance Act. I congratulate all thoseinvolved in achieving this importantprofessional goal for our operating roomcolleagues. Throughout my anaestheticcareer, I valued highly the support of themany fine men and women who haveworked alongside me in this capacity.However, the process of developingthe professional role of anaesthetictechnicians to where it is today is, in fact,much longer than the 11 years since theNZ Anaesthetics Technicians Societyexpressed “their wish to be covered bythis legislation”. I developed the firstanaesthetic technicians training course inNew Zealand in 1978, 33 years ago, soonafter I arrived in Christchurch as a full-timespecialist for the then North CanterburyHospital Board. In order to complete theearly history of technician training in NZ,it is worth quoting from a 1990 Departmentof Anaesthesia internal publication thatcovered the history of anaesthesia inChristchurch from 1974 to 1990. 1“In the late 1970s...a nationaltraining committee was formed under theauspices of the Department of Health, on“Oh, you can’t; they’re the men whobring the stairs to the plane,” was the reply.In-cabin phone communicationwhich Doug Chisholm [Medical Director,Anaesthesia Services, CAHB] was invitedto sit. Anticipating the establishmentof proper training programmes, a pilotcourse was commenced...in Christchurchmodelled on the anaesthetic and basicsciences components of the UK OperatingDepartment Assistants training programme.This Christchurch course became the basisfor the development of the NZ programme.[Dr] Jim Clayton from Dunedin was the firstexaminer.”As far as I know, at least two of thoseoriginal five graduates were still workingas anaesthetic technicians in Christchurchuntil recently.Associate Professor (retired)Michael Davis, MB, BChir, MA (Cantab.),FRCA(Eng.), FANZCA, MD(Otago),DipDHM, CertDHM(ANZCA)Reference:1. Davis FM, editor. Department of Anaesthesia1974–1990. The changing face of anaesthesiain the public health system. Christchurch:Canterbury Area Health Board; 1990.to Launceston and thence to on-airfieldLaunceston Airport Fire Response.After what seemed like 24 hours, the fireof Anaesthesia internal publication thatcovered history of anaesthesia into the front of the plane achieved two truck arrived and Deo Gratias, along withChristchurch from 1974 to 1990.Anaesthetic technicians in New Zealand1important objectives: the pilot requested the senior medical emergencies instructorAs far as I know, at least two of thosestairs urgently and the senior cabin crew for Tasmania, and oxygen.original five graduates were still workingas anaesthetic technicians in Christchurch announced my imminent urgent egress.[When he offered to take over holdinguntil very recently.I now know how a sheep dog feels as it the face mask I said something like, “Sure,runs along the backs of a flock of sheep all I’ve been practising for about 35 years if youFor Associate Professor sake (retired) Michael of accuracy, trying to flee the barking dog! I wish could just to help with expandthe other bits.” He wasDavis, MB, BChir, MA (Cantab.),FRCA(Eng.), FANZCA, MD(Otago),I was off the plane as soon as the stairs so calm, “Okay”, and proceeded with theRe: “Is DipDHM, there a CertDHM(ANZCA)doctor on board?”hit the fuselage, to find the gent had been other bits.](ANZCA Christchurch Bulletin, September 2011), and the rolled into an unconscious-patient position. Meanwhile, the patient was respondingon subsequent what letter from Dr Dr Clarke (ANZCA MichaelTo my seriousDavisconsternation, hehasandwrittenI could hear Ambulance TasmaniaReferenceBulletin, 1. Davis December FM, editor. 2011) Department prompts of Anaesthesia me to exhibited no response, deepest cyanosis wailing up the highway. Never was I so gladrelate an 1974–1990. account The of changing my own. face of anaesthesia and no palpable pulses. My silent private to greet ETT, and skilled paramedics.in the public health system. Christchurch:aboutI was seated atearlythe window in theanaestheticendCanterbury Area Health Board; 1990.response could be summed up technicianin one word. A young plastics surgeon kept shakingrow on board an A330-220, which hadWith an earnest request for formal help my hand with congratulatory exuberancejust nosed into park on the tarmac into the man in the yellow jacket with the and a local ED RMO was delegated to briefLaunceston.secret service device in his ear, I proceeded them.training Looking out the window, in I notice New three with Zealand expired air mouth-to-mouth (ANZCA and aThe next day Bulletin,the intensive caremen in yellow and, as I watch, one of them thump that should have woken something. unit [as a retrievalist/hanger on in ICU]gracefully slides from walking to prone-onconcreteposition.assuming that they would arrive with “K…. I’ve kissed you once and I’m not doing“Get the fire-ies” was my catch cry, I expressed to the gentleman patient,March Oddly, my first thought 2012). was, “Must be Efforts to instituteit again …formalflashing lights and oxygen, at least.Give up the fags!”difficult for that person working aroundAs I learned at an informal debriefing, Lesson: Smash the closest fire alarmaircraft with epilepsy …”the man with the secret service device in for oxygen-to-go at airport!trainingAs I watched, he did notbeganmove from the his in ear could communicate 1960s with only the and beganassumed prone-on-concrete position as his pilot of the aircraft to which his device was Dr George Waters FFARCStwo comrades rallied. The more I watched attached. [I thought that he could talk to Acting Director, Anaestheticsthe less he moved.the world].and Intensive Careat Christchurch I indicated to the cabin crew that I Hospital Nevertheless that instigated a chain andMountGreenIsa, Queenslandwished to offer assistance.of communication from him to aircraftcockpit to Melbourne, to Hobart finallyLane Hospital, Auckland, April 1977.Submitting lettersWe encourage the submission of letters to the editor of ANZCA Bulletin. They should be sent to communication@anzca.edu.au.Letters should be no more than 300 words and may be edited for clarity and length.The first examination for the Certificate10 ANZCA Bulletin March 2012 ANZCA CELEBRATING 20 YEARS 1992-2012of Proficiency was held in March 1979.Six candidates presented, four fromChristchurch and two from Auckland.All passed. Training extended to othercentres after that.Dr Basil Hutchinson, FANZCA, Auckland(Former chair, Anaesthetic Technicians’Board, NZ)Submitting lettersWe encourage the submission of lettersto the editor of ANZCA Bulletin. Theyshould be sent to communications@anzca.edu.au. Letters should be nomore than 300 words and may beedited for clarity and length.Dudley Buxton Medalof the Royal Collegeof AnaesthetistsProfessor Teik Oh has been awardedthe Dudley Buxton Medal of the RoyalCollege of Anaesthetists in recognitionof his estimable services to the specialty.The medal was established in 1967 toprovide an annual award of a prize formeritorious work in anaesthesia or in ascience contributing to the progress ofanaesthesia.Australia Day HonoursDr Andrew Kenneth Bacon has beenawarded the Ambulance Service Medal(ASM), Victorian Ambulance Service, inthe 2012 Australia Day Honours List.Australian Queen’sBirthday HonoursAssociate Professor Malcolm Wrighthas been appointed a Member of theOrder of Australia in the General Division,for service to intensive care medicine, asa clinician, teacher and administrator,and through advanced medical trainingprograms in developing countries.Dr David Henry McConnel has beenawarded the Medal of the Order ofAustralia in the General Division, forservice to medicine, particularly as ananaesthetist, through a range of executiveand professional roles.Dr Drew James Wenck has been awardedthe Medal of the Order of Australia in theGeneral Division, for service to intensivecare medicine through advisory roles,and to the community.New Zealand Queen’sBirthday HonoursSir Roderick Deane has been made aKnight Companion of the New ZealandOrder of Merit (KNZM) for his contributionto business and policymaking, and forsupporting the arts and disability sectorfor more than 30 years. Sir Roderick is onthe board of ANZCA’s Anaesthesia andPain Medicine Foundation.Dr James Judson, FANZCA, FCICM,received an MNZM (Member of the NewZealand Order of Merit) for services tointensive care medicine. Dr Judsonworks as an intensive care specialistat Auckland City Hospital’s IntensiveCare Unit.Would you like a2013 ANZCA Diary?If you did not receive an ANZCAdiary last year and would like a2013 ANZCA Diary, please emailcommunications@anzca.edu.auwith your name and ANZCAID number.PLEASE NOTE: If you received a2012 ANZCA Diary last year, you willautomatically receive a 2013 diary.9