Robert Mitchell, Emergency Physician, chats to Patrick Gillespie and John O’Neill about pre-hospital and retrieval medicine from the junior doctor’s perspective and how to cope with rural rotations and emergency situations.
Summary Writer: Jane McDonnell
Script Writer: Rob Mitchell
Editor: Rob Mitchell
Interviewee: Patrick Gillespie, John O’Neill
Dr Pat Gillespie is an Emergency Medicine registrar. He completed his medical degree at the University of Queensland and has worked across a number of disciplines including Emergency, Intensive care, Anaesthetics, Paediatrics, and Pre-Hospital Medicine in Cairns and South East Queensland. He is currently working as a retrievals registrar for Lifeflight Queensland and is studying to complete his Emergency Medicine Fellowship in 2019. He is passionate about pre-hospital care and medical education. He loves spending his working days flying over the beautiful landscape of Far North Queensland and his spare time exploring its beaches, reefs and rainforests.
Dr John O’Neill is an Emergency Physician and the Clinical Lead for Lifeflight Retrieval Medicine in Cairns.
After completing Emergency Medicine training in the United Kingdom and Australia he decided the grass really was greener and moved to Cairns five years ago.
After many years in pre-hospital and retrieval medicine he has developed a keen interest in the challenges of providing critical care in remote environments. This started somewhere in the desert of Western Australia and continued in the United Kingdom and New Zealand working for a number of Helicopter Emergency Medical Services (HEMS), before returning to the reef and the rain forest in Far North Queensland with the Royal Flying Doctors Service and Lifeflight.
John is part of a group developing the regional trauma service at Cairns Hospital and has published work on trauma and resuscitation.
When he’s not crying over the fate of the England rugby team John is an optimistic triathlete.
With Dr Patrick Gillespie, Advanced Trainee in Emergency Medicine at Cairns Hospital & Lifeflight Retrieval Medicine and Dr John O’Neill, Emergency and Retrieval Consultant at Cairns Hospital & Lifeflight Retrieval Medicine, Queensland, Australia
It is common for junior doctors to feel apprehensive about embarking upon a rural rotation. Apart from having to work in a new environment, rural rotations often require more independent decision-making, often without the resources available at large teaching hospitals. In Queensland, junior doctors may be rotated to small rural hospitals, where they may be first on call for Emergency Department presentations, so it is not uncommon for junior doctors to have to refer a patient from retrieval. In Queensland, high acuity transfers are coordinated by Retrieval Services Queensland. There are equivalent organisations in other states. The principles discussed in this podcast apply to all settings, not just Queensland.
Case 1 – A 50 year old patient has presented to your rural hospital at 10am with a 2 hour history of central, crushing chest pain. You are the sole doctor on site but there is a senior medical officer on call. One of the two nurses has performed an ECG which demonstrates an anterior STEMI. The referral hospital is a 2 hour drive away or a 30 minute flight by helicopter.
Case 2 – A 25 year old male has fallen off his motorbike at high speed at 2pm. He is brought in to the rural hospital where you are working. His vitals are: GCS 12, SaO2 100% on high-flow O2, HR 100 and SBP 100. He has a head injury and, clinically, it looks as though he has a left-sided pneumothorax. On the basis of extensive bruising over the left upper quadrant of his abdomen, you’re worried about a splenic injury. There are no apparent limb injuries. The retrieval team is only 5 minutes away because they were notified by the ambulance service.
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