Lessons Learned from TC George, Part II

This is the  TC George evacuation, from the perspective of Dr Sebastian Rubinzstein-Dunlop, who was at the time my “Reg” at Karratha.  Seb has put together his recollections and learnings from the day.  Dr Seb has now returned to the NW after doing a few years of training in critical care and is a Broome Doc.

So, take it away Seb:

Going a few yrs back (2007), I was the PGY3 who joined you on the chopper going out to the mine site which was devastated by TC George.  I was super keen and super short on experience when it came to management of the critically ill patient let alone retrieval medicine.  On the day the cyclone hit I was a spare set of hands as my remote clinic had been cancelled.  In the genial nature of hospital management, it was decided that I was therefore to be the sole Dr going out to the devastated mine camp irrespective of my lack of experience…  Thankfully as my senior colleague, you saw the slight deficiencies of this plan and suggested that you should also attend the scene which was agreed to.
As you remember, it was a scene of utter devastation when we came in to land; it was as though the dongas (living quarters) had been thrown around like match boxes.  Whilst you and the nursing team triaged the scene, my main role became to transport patients into Port Hedland.
I took a lot away from the experience; a few that have stuck in my mind are summarised below.
1. B.I.G intraosseous instruments can fail.  We were struggling with IV access on a severely head injured patient and had to resort to I.O access.  Upon activating the BIG (as per the formal instructions) it jammed and then activated when I tried to unjam it whereupon it shot the metal needle across the room!!  In the end, I sterilised the needle somewhat with chlorhexidine and then used a hammer belonging to one of the workers to insert (hammer) it into the patient’s proximal tibia.  It worked but it certainly isn’t a technique I have considered using again!  In regards to I.O access, I have since used the I.O drill with good success and have steered clear of the B.I.G device.  I would be interested in other people’s comments.

2. Never put a syringe filled with an important drug in your pocket
I have never repeated this “newby” mistake again.  On one of the chopper flights with an intubated, ventilated head injured patient, my last dose of muscle relaxant was conveniently drawn up in a syringe in my pocket.  The patient was behaving beautifully on the oxylog until Port Hedland landing strip came into view whereupon he began to fight the ventilator.  When I reached for the Vecuronium I found a rather empty syringe and a very wet pocket..  So, my patient who had been stable during the entire flight was handed over in a less stable state which never looks good (“I swear, he was great until a few minutes ago…”).

3. Pre pack your IV cannulae packs
On the ground we struggled through the Parry packs to find the gear to put in IVC’s rapidly in multiple patients.  Since then I have prepacked small snaplock bags with; alco wipe, IVC x2 (16 + 18 G), bung, tape, 10ml NS, 10ml syringe).  We found the normal opsite dressings inadequate for securing cannulae in wet or diaphoretic patients and preferred large amounts of tape.

4.  We are ready to go!!
We were waiting on the ground in Karratha for what seemed like an eternity to get a formal go ahead from FESA to board the chopper and head out to the mine site.  Much of this time was not only due to the obvious need to ensure that the site was safe to approach but also negotiations about who was to go on the flight (medical, police, FESA volunteers) and how much equipment the chopper could take.  Without wanting to be too critical of what is obviously a very difficult situation to manage and coordinate, I still feel that it would have been very beneficial to do things differently.  My thought is that, once the scene was declared safe, a small contigent should have been sent out to rapidly assess the situation and what needed to be prioritised.  I think that this team should have been comprised of a senior police officer, a FESA representative, a Dr and a nurse.  This would have saved alot of critical time in the end.  I would be really interested to hear from those of you with more field experience in regards to this issue.

Please, feel free to comment on your experiences in similar situations.  Big thanks to Dr Seb R_D, always a lot of fun to work with and I learn a lot from his experience now!

Casey