What’s the job like?
The combination of pathology and geography presents a unique challenge and our retrieval doctors need to be able to manage a broad range of critical illness in a remote environment. The one service covers all age groups and presentations.
Telephone advice is available from the retrieval consultants, who work closely with intensive care, paediatric and obstetric specialists as required.
In 6 months, you are likely to undertake around 100 cases, including:
- Lots of severe sepsis, including patients requiring critical interventions such as intubation.
- Up to 20% paediatric patients, predominantly with respiratory, GI tract and soft tissue infections.
- Trauma — such as motor vehicle accidents on remote highways.
- Missed dialysis with pulmonary oedema / hyperkalaemia.
- Cardiac disease — such as acute coronary syndromes, rheumatic heart disease and valvular disease.
- Obstetric emergencies such premature labour.
- Psychiatric and behavioural emergenices requiring sedation for safe transport.
We are also responsible for the inter-hospital transfer of patients to tertiary services. This means a minimum transport time of 5 hours to tertiary hospitals with definitive care options such as angiography, neurosurgery or cardiothoracics.
In addition to the day-to-day job, retrieval doctors are rostered to provide medical support for some major sporting events in the region, including the Finke Desert Race and Run Larapinta.
Retrieval Doctor Requirements
- You must be at minimum senior registrar in the last two years of a training programme (ACEM, CICM, ANZCA, ACCRM, RACGP).
- Desirable critical care experience of at least:
- 6 months in an Emergency Department,
- 6 months in an Intensive Care Unit, and
- 3 months in Anaesthetics
- The ability to be the clinical lead, working with a flight nurse or paramedic, providing critical care to patients in remote settings.
- Excellent communication and teamwork skills.
- The ability to work safely and sensitively in complex cross cultural environments.
What’s a typical day?
We operate a flexible rota covering four shifts, progressing through days, evenings then nights.
After being activated for a task, the retrieval doctor may be asked to liaise with the remote clinic staff to reassess the patient’s current state. The doctor then meets the flight nurse and pilot at the hangar to collect any additional kit before flying out to the remote airstrip. The vast majority of clinics are within 1 hours flight time, with a few up to 2 hours away. There’s normally a short journey by 4WD to the clinic at the other end, although some journeys may be as long as 40 minutes from the airport to clinic. Once in the clinic, you then assess and treat the patient as required to stabilise them for safe transfer on the return leg to hospital.
The retrieval doctor will also undertake road retrievals with St John Ambulance paramedics, particularly in situations where the patient is less than 150km away (or 2 hours driving time), where there is no suitable airstrip, or the situation requires an urgent response and no other assets are available.
The second day shift doctor is available for inter-hospital transfers. The flight times alone are 3 – 4 hours one-way, so a single return trip takes an entire shift.
Retrieval registrars will be rostered to support shifts in the consultation centre in order to gain an appreciation for the logistics required to do the job. Any given day can have multiple patients simultaneously across a large area and the retrieval doctors must prioritise patients whilst factoring in aspects such as transfer times, day-only airstrips, weather, demands on individual crews, pilot hours and how to make the best use of the resources and assets available. Although challenging, this can be one of the most satisfying elements of the job.
If not tasked to fly, there are opportunities for up-skilling (for example, with anaesthetics lists) and ambulance observer shifts. Retrieval doctors also contribute to the growth of the service, undertaking relevant quality improvement activities such as audits.