australian retrieval newsusers.on.net/~maverick/docs/1208_newsletter.pdf · tific meeting, entitled...

AUSTRALIAN RETRIEVAL NEWS

AUSTRALIAN

RETRIEVAL NEWS

December 2008 Edition Photo: The Good Old Days of the RFDS

MERRY CHRISTMAS

All retrieval articles, pictures & educational cases are welcome. Submit electronically to ARNA.


Editorial by Debbie Fancett,

Chairperson

Welcome to the summer edition of ARNA NEWS.

Last month we had our first Annual General Meeting and first election since becoming an Incorporated

Association. Committee positions were filled except one. Congratulations and welcome to our new

Executive Committee member for South Australia Ben Stanton. Ben has a wealth of retrieval and ICU

experience that we hope to tap during his time with us. Big thank you to Fiona Ellicott for continuing to

represent NSW members and I am very pleased that Megan Ward has remained in her Secretarial role.

Next year the other half of our Executive committee positions will be up for election. Each committee

position is held for two years, with half the committee group being up for reelection every alternate year.

This is to ensure experience and knowledge within the committee group is maintained.

The ISAS Conference for 2008 was held in Adelaide and well attended by ARNA members (20). This gave

us southerners an opportunity to meet some of our eastern & western members. It was an superb venue to

exchange professional ideas and wine. Four members received financial support from ARNA to attend the

conference. Treasurer Jo Murphy has budgeted some funds to support members to attend similar events

next year. If you would like to recommend conferences to be supported in 2009 please contact Jo.

It has been a long wait for South Australian retrieval nurses to becoming part of the Statewide Retrieval

Service. By the time you are reading this I hope that at the very least the level 5 and level 4 nursing

positions have been advertised. For our eastern members the level 5 and level 4 are equivalent to a

Director of Nursing and Assistant Director of Nursing respectively. Once these positions have been

assigned we can finally get down to employing level 2, Clinical Nurses for the service. As soon as we have

any information we will forward it on.

Have you looked at the ARNA website lately? Michael Schwarz our Web designer has done a remarkable

job in creating this site. If you have any photos or ideas for the website please forward them to Michael.

Take a minute to look at the site www.retrieval.org.au there are some very interesting links that will keep

you amused through any long night duty.

2009 is creeping up very fast. It is going to be an exciting and year for ARNA. The committee is working a

a number of projects to improve our service to members. Including Retrieval Education sessions to be

broadcast on line and recorded for viewing on our website and revising membership forms to include our

email address [email protected]

Thank you to everyone who has contributed to this edition of ARNA News. Special thanks to our editor

Blair Hicks for another superb magazine.

Wishing you all safe journeys at work and at play.

Debbie Fancett ARNA Chairperson


VictoriaVictoriaVictoriaVictoria

Fay Presbury

NETS nursing Director

New South WalesNew South WalesNew South WalesNew South Wales

Jacquie Hyslop

Gosford Hospital

Fiona Ellicott

Tamworth Base Hospital

Ian Gill

John Hunter Hospital, Newcastle

South AustraliaSouth AustraliaSouth AustraliaSouth Australia

Sue Coretti

Women’s & Childrens Hospital

Nat Cook

Flinders Medical Centre

Ben Stanton

Flinders Medical Centre

ChairpersonChairpersonChairpersonChairperson

Debbie Fancett

Mediflight

TreasurerTreasurerTreasurerTreasurer

Jo Murphy

Mediflight

SecretarySecretarySecretarySecretary

Megan Ward

Mediflight

ARNA EditorARNA EditorARNA EditorARNA Editor

Blair Hicks

Mediflight

Website designerWebsite designerWebsite designerWebsite designer

Michael Schwarz

Mediflight

03/11/2008 Treasurers Report Active Membership 69 Associate Membership 2 Incomings $3501 Out goings $802.14 Balance $2698.96

New Executive Committee Member Welcome to Ben Stanton as a new executive

committee member

State-wide (SA) Retrieval Service Nursing Applications for the level 4 & 5 positions

were due by 12th December good luck to all those

that have applied. Changing times to had here in

South Australia

ARNA Newsletter I welcome any feed back from the newsletter. Please

feel free to contact me with anything of interest to our

members. I would especially like to hear from our

interstate members.

I have added an assignment from a student of

The University of Adelaide Retrieval Nursing

Course. If you have anything of interest please con-

tact me and we will get it published

[email protected]


Australian Retrieval Nurse Association PO Box 192 Rundle Mall Adelaide SA 5000 OR email: [email protected]

The current website is finished. Thanks to Michael for all

his work

ARNA MEETINGS

2009

February 9th

May 18th

August 10th

November 9th

Victorian member Gillian Darvill

The 2008 International Society of Aeromedical Services and Flight Nurses Australia 20th Scien-

tific Meeting, entitled “Learning from the Past – Looking to the Future” was held at the Ade-laide Convention Centre, from 2

nd – 4

th October 2008. It encompassed historical perspectives,

where we are now, and what the future holds for the air medical industry. There was an excellent scientific programme involving national and international medical, nurs-ing, paramedical and aviation industry speakers. Keynote Speakers included:

Mr Chris Manacci, Nurse Practitioner from the Cleveland Clinic Foundation in Ohio, USA, who gave an inspiring lecture on the “Role of Nursing in Pre-Hospital Care: Past Present Future”

Mr Peter Randall, Deputy General Manager – Aviation from RFDS Queensland, who gave a fascinating lecture on “Fatigue Risk Management” Dr Terry Martin, Director CCAT Aeromedical Training from Win-chester, UK, who gave an international perspective to “Team Building and CRM Issues” Concurrent Sessions included topics such as: Aviation and Engineering Paediatric and Neonatal Retrieval Challenges Clinical Challenges in Patient Transport (Psychiatry, Bariatric, IABP) Rescue Missions


Registration included a Welcome Reception at the Australian Helicopters and Pilatus Hangars at Adelaide Airport, with aircraft displays, fine wine and live music. The Conference Dinner was themed ‘MASH BASH’ – with delegates dressing as their favourite MASH character, and enjoying the military surroundings of the Torrens Parade Ground. With a fantastic band and the helicopter from the ‘Miss Saigon’ set, the atmosphere set the tone for a memorable evening. Thanks to the Conference Committee and Event Planners, we had 176 delegates, 6 major Sponsors and 16 exhibitors – a great team effort for a great conference! Special Thanks to Weinmann, Pilatus, Hawker Pacific, Hospira, Australian Helicopters and Aeronautical Engineers Australia for their sponsorship. We now look forward to Hobart, Tasmania, October 1-2, 2009! Kevin Holliday ISAS/FNA 20

th Scientific Meeting

Mr Chris Manacci Dr Terry Martin


ARNA members Duncan Bamford and Michael Schwarz work with

The Royal Adelaide Hospital

Mediflight Retrieval Service formed part of the team which re-

sponded to the recent riots at the Port Augusta Prison.

Photographs by Michael Schwarz

Text by Duncan Bamford

Port Augusta is a regional town in South Australia, located at the

head of the Spencer Gulf, 300 kilometres north of Adelaide. It is re-

ferred to as the cross road of Australia, where both rail and road in-

tersect between Sydney and Perth and Adelaide and Darwin. The

town has a population of 14,000 people and is serviced by the Port

Augusta Regional Hospital, an 82 bed acute care facility.

9th October 2008 - 1800 hours

The Royal Adelaide Hospital (RAH) Mediflight Retrieval Service

received a call from The South Australian Ambulance Service (SAAS) Communications Centre stating a

riot at the Port Augusta Prison had commenced at 1600 hours. The initial report was that there were up to

40 dangerous prisoners who had broken out of their cells and were in the prison grounds, with possibly 12

prisoners on the roof of the building. A further 105 prisoners were locked down in their cells.

Initial resources at the scene included 12 fire appliances, multiple S.A. Police (SAPOL), 4 SAAS crews

and the State Emergency Service (SES). SAPOL and SAAS requested the presence of a retrieval team

with an additional Field Medical Commander.

9th October 2008 - 1900 hours

A retrieval team consisting of 2 doctors and 1 nurse were dispatched from the RAH and fly to Port Au-

gusta with the Royal Flying Doctor Service (RFDS). A basic retrieval kit was taken along with a defibril-

lator, a burns kit and three personal packs. The team arrive on scene at 2030 hours.

9th October 2008 - 2000 hours update

SAPOL had blocked off the main highway outside the prison.

SAAS and the SES set up a casualty clearing station adjacent the highway. A small marquee provided

protection for personnel and equipment.

Plans were made to replace the retrieval team the following morning.


The team identified potential sources of injury which

may occur to both responding services and to prison-

ers. These included:

• Injury due to items thrown off the roof. The pris-

oners had access to a building site within the prison

grounds

• Multiple trauma secondary to falls from the roof.

It was decided that if a prisoner fell from the roof a

team would not enter the prison until all prisoners

had surrendered

• Multiple burns should the prisoner set fire to the

prison

• The use of tear gas requiring decontamination of

all affected. It was decided that there would be two decontamination areas, one for responders and one for

prisoners. The prisoners would be decontaminated, clothing removed and handcuffs applied before they

were brought to the casualty clearing station

Other issues identified:

• 40 prisoners receiving Methadone

• 1 prisoner who is an insulin dependant diabetic

• 1 prisoner in protective isolation with a psychiat-

ric background

• Power to the prison was turned off

Water supply was left on as the estimated tempera-

ture for the following day was 30 degrees

10th October 2008 – 0600 hours

The team had an uneventful night and managed to

get a few hours sleep.

A replacement team assembled at the RAH at 0600

and again flew up to Port Augusta with the RFDS.

The teams met at the RFDS base for a handover before the first team returned to Adelaide and the second

team moved out to the prison. The plan was for the second team to remain at the prison until early

evening and arrangements would be made for a third team to fly to Port Augusta.



The second team arrived at the scene at 0830. They had time to review all the equipment before attending

a briefing session in the Command Centre, the Administration Building of the prison.

Briefings continued every 2 hours through out the day. Options discussed with SAPOL ranged from con-

tinue to negotiate and wait for a peaceful settlement through to the use of tear gas and storm the prison.

During the waiting period the retrieval team reviewed strategies for dealing with mass casualties with

SAAS. It was anticipated that casualties would present in small numbers rather that on mass. This would

give the ambulance crews time to ferry the casualties to the Port Augusta Hospital, approximately two

kilometres away.


Eleven prisoners surrendered.

SAAS begin to make arrangements for teams to remain at the scene until 1800 hours on 11th October.

Additional SAPOL resources arrived from Adelaide including an armoured vehicle and police horses.


A further six prisoners surrender.

Further resources arrived from Adelaide including the Salvation Army mobile kitchen and the SAAS mo-

bile command vehicle.


The remaining prisoners surrender.

SAPOL undertook a sweep of the prison to locate and assess all prisoners.


The prison is secured and the retrieval team was stood down.


The retrieval team was requested to transport a patient with end stage renal failure and sepsis from the

Port Augusta Hospital to The Queen Elizabeth Hospital in Adelaide.

The team finally return to the RAH at 2100 hours.


In November I was fortunate enough to be involved in a two day Crew Resource Management (CRM)

training course through Australian Helicopters and RHO Aviation training services. As a retrieval nurse I

found it to be useful in gaining an enhanced insight into the roles of team members involved in a rotor or

fixed wing retrieval mission. This understanding has lead to a heightened awareness into my own role and

performance and how my actions impact on other members of the team.

There were other retrieval nurses and doctors attending as well as SA Ambulance Service Special

Operation Team members, helicopter pilots and STAR force police officers, all of which are integral to a

variety of emergency response situations.

They key elements of CRM involves an ability to review and learn from the mistakes of others, knowing

that unsafe situations usually happen for a number of reasons and also learning to utilise the strengths and

recognising the limitations of others to optimise positive outcomes.

Discussions pertaining to the responsibilities of aircrew and mission crew refreshed participants in as-

pects of aircraft safety in high stress situations, such as moving in and around helicopters, crash drills and

crash positions, controlled ditching and HUET drills. As part of gaining an understanding of different

roles, participants learnt about how human behaviour is influenced by attitudes, motivations and cognitive

processes and how these may help or hinder in physically and psychologically demanding environments.

There was A LOT of footage of nasty helicopter crashes that focussed on human error and how communi-

cation, assertiveness, situational awareness and decision making is crucial in risk management. This train-

ing course certainly puts into perspective how dangerous our job as retrieval nurses really is but also how

vital our input as crew members is during a mission. Spending two days with the different emergency re-

sponse teams fostered a great team culture and we were all keen to share dialogue about the different as-

pects of our jobs.

Although I suffered a little from testosterone overload (being the only girl there!), I was glad I was in-

volved in the training course. It was a worthwhile experience and I have a new found appreciation for the

skills of not only myself but others working around me.

Megan Ward, RGN, B. Nsg, Grad Dip ICU, Grad Cert Retrieval Nursing, ACSC.

Adding on from this, as we know this is a very important subject for all of us who fly and even travel by

road.

An interesting assignment from a Natalie Hincksman is added to the newsletter, Natalie completed the

assignment as a requirement for the University of Adelaide, Graduate Certificate Nursing Science

(Retrieval Nursing). If you would like to read the full assignment please contact the editor

[email protected]


Introduction

This paper shall discuss the implications and importance of Crew Resource Management (CRM) and relate it to

the role of the retrieval nurse caring for patients who have sustained a traumatic injury. CRM is a topic that was

devised by and is spoken about at length in the aviation industry.1,2,3 CRM is at times mentioned to be applicable

in the medical industry, but its use in nursing wasn’t clear to the author and hence it was chosen as a topic to be

related to the role of the retrieval nurse. This paper is therefore going to look at what CRM actually is, whether it

is applicable to the Trauma Nursing scenario and how it may be applied to the medical/nursing industry in the

trauma-retrieval setting.

Crew Resource Management

Crew Resource Management is often used interchangeably with Cockpit Resource Management and Error

Management (different generations) but, all originating from a 1979 workshop “Resource Management on the

Flight deck” which was held by the National Aeronautics and Space Administration (NASA) to look at causes of

air transport accidents.1,4 This workshop identified that human error, although not necessarily the causative

factor, was a key factor in the majority of air crashes and that a breakdown in communication with regards to

decision making and leadership was integral to the final outcome of the crash.1,3

There has been a confusing change in the way CRM has been delivered in its training over the years starting with

leadership skills and psychological approaches. Emphasis was placed on acceptance of junior level input and

assertiveness of junior level staff. There weren’t however, clear guidelines on how to go about challenging

decisions and it wasn’t popular with the hierarchy as a result.1,3 There was then a movement to cockpit group

dynamics training and team approach.

Training gradually changed in the 1990’s from cockpit to cockpit-cabin training, allowing captains to take on a

leadership role rather than the autocratic role of the past.1 This training was then formalised and full mission

simulation evaluation became standardised by most major airlines as recommended by the Federal Aviation

Administration.1,3

Lastly to try to appeal to the non-believers of CRM there was a rationalisation, providing justification to why

CRM was so critical, it started to be defined by the industry as avoiding errors (Error management) through

rehearsal, standard operating procedures (SOPs) and using checklists.1,3 Errors are seen as “human” and an

inevitable fact of life but how these errors are recovered is where the CRM/Error Management comes into play.

This newest form of CRM allows for the ability to adapt, utilises experience and rehearsal to recover the error.5 It

is unrealistic to expect to eliminate all errors.5 CRM advocates the use of all resources to achieve the end goal,

this doesn’t necessarily mean leading others, but means using everything (situational awareness, SOPs,

colleagues, manuals, laypeople, checklists, telephone, radio and training) including experience to trap errors be-

fore they become damaging.1,3,4,5

Research through confidential reporting, mission simulations and cockpit recordings has identified various levels

of error management which support this form of CRM:1,3,4


Overview

This course provides advanced specialist training for nurses to participate in the retrieval of critically

ill adult patients. Retrievals may be undertaken by road, rotary or fixed wing aircraft. Students

within this program will already be qualified in critical care, and practicing in a high acuity critical

care environment.

The Graduate Certificate in Nursing Science (Retrieval Nursing) provides graduates with a rigorous

grounding in principles and practices of retrieval nursing. This is to necessitate the transport of

critically ill patients from a diverse setting such as rural and remote hospitals, motor vehicle crash

site through to international repatriations.

Students will also graduate with a sound knowledge and understanding in the mechanisms of

trauma.

Program Duration

Study in this program is usually undertaken over one year of part-time study.

Entry Requirements

This program is restricted to candidates with an approved qualification in critical care (Graduate

Diploma/Graduate Cert in ICU or ED) and recent experience in critical care nursing. Minimum one

year post specialist qualification and employment or ability to be employed in a retrieval service.

Students must also satisfactorily complete an appropriate medical examination on occupational

health and safety grounds for specialisation in Retrieval Nursing.

Teaching Methods

This course is only available to students within hospitals with intensive care and trauma care

capacities who are employed as part of the retrieval service. This program is available in flexible

delivery mode. Classroom learning is supported with a significant number of practical tutorials such

as aircraft safety orientation and attendance at vehicular incidents.

Contact Details

Please contact the Discipline of Nursing for information on program fees or to obtain an application

form.

Stephanie Glazbrook, Administrative Officer

Telephone: +61 8 83033595

Email: [email protected]

COURSES OF INTEREST: Current Concepts in NEONATAL and PAEDIATRIC Transport 31st Annual Conference February 11-13 2009 Salt Lake City, Utah, USA www.primarychildrens.com/transport Waypoint Airmed and Rescue 2009 Conference and Exhibition May 21—22 2009 Oxford, United Kingdom www.airmedandrescue.com

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