Clinical intervention in retrieval medicine

Abstract

ObjectiveTo describe the clinical interventions undertaken by retrieval physicians during interhospital transfer between different hospital types and discuss the implications for staff training. MethodCase sheets from all interhospital transfers undertaken by the Sydney Aeromedical Retrieval Service for the 1995 calendar year were analysed retrospectively. Clinical interventions were categorised into airway management, invasive procedures, fluid resuscitation and drug therapy. Each category was then reviewed according to the functional level of the referring hospital. ResultsA total of 577 interhospital transfers occurred during this period. Two hundred and fifty eight (44.7%) patients transported required at least one clinical intervention. A total of 421 interventions were made. Of the 421 interventions performed 43% were classified as drug therapy, 34.4% as invasive procedures, 13.3% as fluid resuscitation and 9.3% as airway management. The overall intervention rate for those patients transported from tertiary hospitals was 0.31, for other metropolitan hospitals 0.78, for rural base hospitals 0.70 and for other rural hospitals 1.06. ConclusionThose physicians with advanced training in critical care medicine are most suited to the requirements of retrieval medicine. Patients from smaller hospitals have a greater likelihood of requiring intervention by the retrieval physician.