Innovation

New life-saving technology bridging links in Chain ofSurvival

The Innovation Report showcases ground-breaking prehospital care being delivered by the QAS. This report introduces the new state-of-the-art Corpuls Mechanical Chest Compression Device (MCCD) which can improve survivability for an important group of cardiac arrest patients. Statewide Reperfusion Coordinator Brett Rogers reports.

Right

The mechanical chest compression device can improve survivability for an important group of cardiac arrest patients.

Photos: Jo Hales and Matt Stirling Over the past 20 years, the valued efforts of QAS paramedics in treating patients for out of hospital cardiac arrest (OHCA) have been compiled to form a detailed and comprehensive collection. The gathered information provides important insights into patient outcomes and survival trends, showcasing the quality of prehospital care provided by QAS clinicians. OHCA survival rates reported by the QAS already compare very favourably with other national and international ambulance services. 1,2 The management provided to cardiac arrest patients has evolved considerably over the past two decades, resulting in increased survival rates. However, there is still scope for improvement and we are committed to continuously evaluating the management provided to identify opportunities to further improve the care and outcomes for our patients.

All links in the “Chain of Survival” – early access, early CPR, early defibrillation, early advanced life support, and early post resuscitation care – remain fundamental to survival. Central to our current practice is the delivery of high-performance CPR, early defibrillation, high quality compressions, minimisation of interruptions and the reduction of hands-off chest time. QAS paramedics have focussed on high performance CPR through “CPR Masterclass” workshops, and it is vital that these concepts remain a cornerstone of our care.

However, there are circumstances that present significant challenges to the delivery of quality manual chest compressions. So, with

increased availability of portable mechanical chest compression devices, the QAS has identified an opportunity to enhance the care we provide for a subset of potentially salvageable OHCA patients who present early with an identified reversible cause of cardiac arrest. MCCDs can provide uninterrupted high-quality chest compressions in situations where it is unlikely that chest compressions could otherwise be provided manually (e.g. during patient relocation or during transport to specialist definitive care). The use of MCCDs in combination with access to Percutaneous Coronary Intervention (PCI) and emergency Extracorporeal Membrane Oxygenation (ECMO) will, for certain patients, increase salvageability within an integrated, high performance health care system such as in Queensland.

The QAS is preparing initial installation of 21 state-of-the-art Corpuls MCCDs, purpose built for the prehospital environment and selected following a rigorous evaluation process. The devices will firstly be rolled out in South East Queensland on selected Critical Care Paramedic (CCP) units that are in the catchment

areas of the tertiary hospitals able to provide this extended care. Subsequently, an additional 19 devices will be deployed to support areas with access to primary PCI but not ECMO. Consideration for a wider deployment will depend upon the performance of the MCCDs and an evaluation of our outcomes. Currently, the literature does not support the widespread use of MCCDs. Within the QAS, they will only be used to provide a bridge for sophisticated in hospital care, where that is available.

A pilot training program has been developed in collaboration with Device Technologies Australia. From July 2020, CCP operators will undertake a one-day face-to-face workshop to gain authorisation to use the devices in the field. Importantly, relevant on-line educational material will also be made available to ensure all QAS personnel are familiar with the device. Additionally, the introduction of innovative adjuncts such as MCCDs must be viewed as prompt for all staff to refresh and revisit all components of care delivered during resuscitation.

The referral of patients on a MCCD to specialist definitive care offers a potential survival benefit, with positive neurological outcomes, for appropriately selected patients when combined with a comprehensive definitive care plan. 3 The introduction of innovative interventions such as MCCDs is yet another example of how our health care system can work collaboratively to give patients the best likelihood of survival. These devices will facilitate continuity of care from the scene, throughout transport and in to hospital; supporting ongoing improvements to the management and survival from OHCA in Queensland.

References

1.

2.

3. Queensland Ambulance Service. Out of hospital cardiac arrest in Queensland 2018 annual report. Queensland Ambulance Service. Survival trends out of hospital cardiac arrest in Queensland 2000-2016. Bartos J, et al. Surviving refractory out-of-hospital ventricular fibrillation cardiac arrest: Critical care and extracorporeal membrane oxygenation management. Resuscitation. 2018; 132: 47-55.

Clockwise from top left

The MCCDs will initially be carried by Critical Care

Paramedics.

MCCDs can provide uninterrupted high-quality chest compressions from the scene and during transport into specialist definitive care.

Statewide Reperfusion

Coordinator Brett

Rogers and Kate

Scriven with the new MCCD.

The Corpuls CPR will initially be rolled out where major public hospitals are evolving their emergency department care for patients suffering cardiac arrest.

Photos: Jo Hales and Matt Stirling

Mine explosion’s coordinated response

A workplace explosion at an underground mine at Moranbah in the Mackay LASN on 6 May left five men with significant injuries. Jo Hales reports on the comprehensive multi-agency response to help save the lives of the patients, four of whom had critical injuries.

Moranbah OIC Jodie Nicholas said when ACPs Luke Allen and Kristen Scougall responded to the incident in separate ambulances, they were initially unaware of how many patients were involved.

“The call was for an explosion with a query regarding the number of patients,” Jodie said.

“When they arrived on scene, Luke and Kristen were informed four patients with burns were being brought up from underground by the mine site’s rescue team. At the surface the mine site nurse and paramedic were waiting at the mine’s medical centre, which is where Luke and Kristen were directed to.

“While they were waiting for the patients to arrive, Luke, who had a single-stretcher ambulance and Kristen, who, had a two-stretcher ambulance, positioned the vehicles so that they would be ready for a quick turn-around. The officers set up a triage area. The stretchers were removed from the vehicles along with fluids, burns kits and other patient care supplies ready for the arrival of the patients.”

Jodie said when Luke and Kristen first saw the patients, they were confronted with the severity of the incident.

“Three of the patients were critically injured with significant burns to their faces and airways, upper body, arms and upper legs. The fourth man, who was walking and had less severe burns and no airway involvement, was taken for irrigation in a shower cubicle while the others were treated and rapidly loaded into the ambulances.

“It was important to get the critically injured miners to Moranbah Hospital for ventilation while they were waiting to be airlifted to Brisbane Airport to be transported to the Royal Brisbane and Women’s Hospital for specialist treatment.”

Jodie said Luke had commenced the transport triaging process when he was informed there was a fifth patient believed to be suffering from the most critical injuries still being brought to the surface. Luke re-triaged when the fifth patient arrived to ensure the most critical patients were transported in the correct priority order.

“Kristen loaded the two most critically injured patients, as well as the patient who was walking, and she and the mine site nurse hopped into the back of the ambulance which was driven to hospital by a mine site emergency driver.”

Luke loaded the third most critically injured patient into his vehicle.

“The mine site’s paramedic was also required to transport a patient in their ambulance in convoy with Luke and to pull over immediately if there was any deterioration in the patient’s condition on the way to hospital,’’ Jodie said.

On arrival at the hospital, Jodie said four of the patients required immediate intubation and ventilation, but the small country town’s medical facility only had one ventilator.

“Nursing staff and QAS officers subsequently had to hand ventilate three of the patients,’’ she said.

At the hospital, the medical staff and QAS officers were assisted by ACP Ethan March, who travelled from Clermont and ACP Ryan Storey, who was the Acting OIC of Moranbah at the time. Ryan had been on days off at the time of the incident.

Jodie, who was in Mackay when the incident happened, made her way to Moranbah Hospital to provide peer support to her team. She arrived at the hospital as the last three patients were about to be transported to the airport.

Retrieval Services Queensland (RSQ) coordinated the aeromedical response for the incident with the assistance of QAS, CQ Rescue Helicopter, LifeFlight (LF) and the Royal Flying Doctor Service (RFDS).

RSQ Medical Director Dr Brett Hoggard said the CQ Rescue Helicopter with Critical Care Flight Paramedic Ian Buck Barrett and a LifeFlight Medical Officer was the first of six aeromedical teams to arrive.

“The flight crew provided support for the staff and QAS officers at Moranbah Hospital and in particular, the preparation and triage for allocation of patients to the fixed wing retrieval teams as they arrived,’’ Dr Hoggard said.

“The remaining aeromedical response comprised two RFDS fixed wings, each with a RFDS Flight Nurse and a LifeFlight Medical Officer on board, as well as three LifeFlight Aeromedical jets (LFAjets), each with a Flight Nurse and a Medical Officer.

“Clinical challenges for the management of the burns patients during transfer were principally related to temperature and fluid management.”

Dr Hoggard said the mine explosion response demonstrated the benefit of an integrated and collaborative system.

“The QAS and all members of the Moranbah Hospital team plus the community should be congratulated for the way they responded to this incident. It was quite remarkable,” he said.

“The early notification from QAS was absolutely critical to the response. Ongoing communication between QAS and RSQ continued to be maintained throughout. Mackay Hospital and Health Service was also proactive in the response and communication of their response.”

Jodie also praised the efforts of everybody who was involved in the response effort.

“Everyone did an amazing job, especially considering the limited resources. We even had our local QPS officers assisting. It was a great community and multi-agency response,’’ she said.

“I am really proud of our paramedics who did an absolutely amazing job of getting the patients from the scene to the hospital and then to the airport for the aeromedical transport.

“They provided a professional response and maintained great communication at all times with Comms, the hospital and RSQ.”

Above

ACPs Kristen Scougall and Luke Allen were thanked for their efforts in responding to the mine site incident by the Minister for Natural Resources,

Mines and Energy,

DrAnthony Lynham.

Background

QAS paramedics in

Brisbane assisted in the response, transporting the injured miners to the

RBWH following the arrival of the aeromedical jets.

Photo: Josh Woning/ Courier Mail. The mine response photos on the cover page and the contents page of Insight magazine are also courtesy of Josh/ Woning/Courier Mail.

Jodie said a clinical debriefing was held the day after the mine explosion. Priority One’s Mackay LASN regional counsellorSerah Steemson also drove to Moranbah a few weeks later to check on the welfare of the staff.

Following the incident, the Minister for Natural Resources, Mines and Energy, Dr Anthony Lynham and Mackay LASN Chief Superintendent James Cunington visited Moranbah to praise the QAS paramedics for their efforts. The Governer of Queensland, His Excellency the Honourable Paul de Jersey also rang Jodie to thank the paramedics for their role in the incident.

Outline of the RSQ response:

The following aeromedical response was activated following the initial call

Immediate response, anticipated Brisbane (Burns) disposition

CQ Rescue Helicopter with a LifeFlight Medical Officer and QAS Critical Care Flight Paramedic. (First to arrive and tasked to provide on-site support. However, they subsequently transferred a patient to Mackay who was not involved in the mine incident).

Two RFDS fixed wings – each had a RFDS Flight

Nurse and a LifeFlight Medical Officer on board

Three LifeFlight jets – each had a LifeFlight Nurse and

Medical Officer

RBWH Specialist Burns Consultant and ICU

Consultant were notified of the event for awareness and determination of ICU bed capacity

Mackay Hospital Emergency Operations Centre and

ICU liaison regarding potential reception of patients

Townsville University Hospital ICU bed capacity sought Confirmation that the RBWH Burns unit and ICU can take all patients

Telehealth established immediately with Moranbah Hospital

RSQ Mass Casualty Incident response stood up

Dedicated Nurse Coordinator and Medical Coordinator allocated to coordinate response Ongoing communication with Moranbah Hospital maintained via telehealth/dedicated Video Conference (VC)

All patients reviewed and ongoing advice via VC with RSQ, treating team at Moranbah Hospital, RBWH ICU and Burns specialist concurrently Patients triaged for transport priority Handover and Situation Reports from retrieval teams with VC.