A Day in the Life of critical care retrieval consultant Dr Simon Hendel

Adult Retrieval Victoria (ARV) is part of Ambulance Victoria and provides clinical coordination, retrieval and critical care services. ARV specialises in transferring patients who require a higher level of care, from one clinical setting to another or providing critical care advice prior to the transfer. Retrieval supports the health system by providing a safety net for people in remote and regional Australia where smaller hospitals may not have access to higher levels of care. Dr Simon Hendel is a retrieval consultant and critical care coordinator with ARV and a consultant anaesthetist.

Shift 08:00–20:00

08:00 — I arrive at base and meet up with one of the new registrars, Dr Luke Smith, an experienced emergency medicine trainee who is with ARV to receive retrieval and pre-hospital medicine training. We run through equipment and kit checks.

09:00 — We grab a quick coffee and head into the morning briefing with the critical care co-ordinator and the rest of the ARV team rostered for the day including patient transport officers, critical care registered nurse, retrieval administration support officer, management and administration staff.

09:10 — We run through some airway management drills and advanced life support training. This morning we focus on cardiac conditions and sepsis.

10:00 — Paperwork and quality assurance processes are an important part of the job. I look over job sheets and review clinical practices while Luke makes follow-up phone calls to check on patients and receive feedback on our service to improve our standard of care.

11:30 — A referral comes through to the ARV co-ordinator to retrieve an elderly man who has developed kidney failure from a severe infection. The patient needs to be intubated and requires advanced medications to treat severe hypotension and transfer to an ICU. Luke is qualified and prepared to take this as a solo assignment. Before he leaves, Luke and I review the case. He grabs a kit and joins ARV’s critical care nurse in the dedicated ambulance and begins the job.

12:00 — Luke calls in from the referral hospital to discuss a few clinical details with the co-ordinator prior to heading to the receiving ICU. I grab some lunch and answer some emails.

13:00 — By now the co-ordination centre is getting busy. I provide support to the co-ordinator by taking some of the calls to reduce the workload.  One of the other new registrars, Dr Frank Parker, arrives for his afternoon shift.

15:00 — I grab another coffee before the morning registrar returns from his solo transfer.

15:30 — Luke and I debrief then clean, check and refurbish the gear, making sure it’s ready for the next job. Luke completes his paperwork and heads home for the day.

16:30 — The co-ordinator receives a referral from a rural Victorian emergency department about a teenager who has been punched several times in the head while trying to break up a fight. Initially he was OK but then his headache worsened and he became confused. A CT scan shows a large extradural haematoma. He needs to be transferred for neurosurgery to drain the blood or he’ll die.

The ARV co-ordinator reviews the patient’s scans and teleconferences with neurosurgeons at the trauma centre. He determines the crew mix and the required clinical expertise and directs a medical retrieval team to proceed to the site via helicopter.

This case is time critical so ARV’s patient transport officer drives the retrieval team with lights and sirens in ARV’s dedicated single response vehicle to the airfield. This is Frank’s first week and so this mission is a chance to ride-along on an air retrieval.

17:00 — 30 minutes from when we received the referral we have launched in the new HEMS 5 helicopter with a MICA (mobile intensive care ambulance) flight paramedic, on our way to the rural hospital. The flight will take one hour. During the flight we run through our plan on arrival.

18:00 — We arrive at the airfield where an ambulance is waiting for us. Within 15 minutes we are at the hospital providing critical care at the bedside combining the skill set of the MICA flight paramedic and myself, the retrieval physician. We learn that during our flight, the patient’s conscious state deteriorated and he will now need to be intubated for safe transfer.

18:45 – Within 40 minutes the patient is intubated, prepared for transport and transferred to the helicopter for the hour long flight back to the city. In mid-flight we try to minimise interventions and procedures only to those absolutely necessary, so prior to departure the team double checks everything and ensures the patient is safe to be transferred.

19:45 — The helicopter is able to land on the roof of the neurosurgical centre and the patient is transferred directly to the operating theatre for life-saving surgery. We hand over to the anaesthetic and surgical teams.

20:30 — ARV transport officer drives Frank and myself back to the ARV base while the flight MICA paramedic flies back to the airfield. We don’t get back to base until 21:00 — an hour after our shift is supposed to end — tired and hungry — but sometimes that’s just the way it goes.