Monday, March 23, 2009

The Flying Irish

A sailor in a round-the-world race is in severe distress with a broken femur, but he is 800 miles off the Australian coast in one of the most dangerous expanses of the Indian Ocean and a storm front is closing in.
What do you do?
The response of the Australian Navy and medical officials was to send in the best person for an emergency medical rescue of this nature – Irish man Dr David McIlroy of the Royal Flying Doctor Service (RFDS).
The French yachtsman Yann Elies, who had been taking part in the perilous single-handed Vendee Globe race, called for help on his satellite phone after he fractured the femur in his left leg and several ribs when his 60ft boat Generali was swamped by a huge wave on Thursday 18 December.
Hours later an international rescue mission was launched, led by one doctor, Antrim-born Dr McIlroy, who was deployed by the RFDS to accompany Naval officers on the HMAS Arunta. The Anzac class frigate left early on Friday morning on a two-day journey to reach the stricken sailor.
Elies was without pain relief for 48 hours until David McIlroy and a Naval medic boarded his yacht on Saturday 21 December in what he described as “probably the most exciting but also most physically demanding” medical evacuation of his career to date.
Hours after the successful rescue effort, RFDS Medical Director Dr Stephen Langford told Scope Magazine that David “had a very physically challenging rescue in 4 to 5 metre swell”.
“In those sorts of conditions, really cramped, the boat banging around and he was trying to put in an anaesthetic block, to block the nerves in the yachtsman's leg to take away some of the pain, and then put some IV fluids in and some other pain relief,” Dr Langford said.
David then had to splint the Yann’s leg, shift him onto a rescue stretcher, and manage the difficult task of transferring that stretcher across from the yacht to the inflatable boat with lines on each end. The HMAS Arunta docked in Fremantle south of Perth on Monday 22 December and David accompanied Yann on his transfer to the Royal Perth Hospital.
This astonishing mission of mercy grabbed headlines around the world and David was praised for his skill and professionalism in stabilising and safely transferring the injured sailor in dangerous sea condition. Certainly, he can add this latest rescue to a growing catalogue of adventures in his work as a flying doctor.
Currently the only Irish doctor employed by the RFDS, David loves his job. It’s evident in his enthusiastic recounting of challenges and daily trivia on the job as a doctor for the first, largest and most comprehensive aeromedical organisation in the world.
“It has got to be the best job you can do in medicine. I love it,” David declares in his unmistakable Northern Irish accent. “This job would probably appeal to people who enjoy emergency work, it’s just that you do it on your own, but like emergency medicine it also has a high burnout rate. I think the biggest polarizing factor when you ask emergency doctors if they’d like to work the with RFDS is that some would love the challenge and others are absolutely horrified that you’d leave yourself without a support network around you.
“That is probably the biggest hurdle to get over as on transfers or retrievals it is just yourself and a nurse, no trauma teams or fancy investigations. You learn to rely on signs and symptoms and history taking. And that’s how it is. You can only send in one doctor to any case, so if there’s someone better than you, they should be the ones going. You must get the most complete set of skills, and no one knows everything so you can only take what you’ve got to the scene and pray it’s enough.”
Doctors and nurses in the RFDS look after 200,000 isolated patients over 12 million square kilometres of the Australian outback. David’s first encounter with a ‘flying doctor’ was in 2006 while working in Emergency Medicine at the Royal Darwin Hospital. “The doctor involved brought in a intubated, ventilated patient with drains and lines everywhere and it was one of those moments where you think I'd love to do that, or be good enough to do that.”
In January 2007 the young doctor from Larne in Co Antrim realised his ambition and signed up with the RFDS.
“I think this job is probably the best mix of cases and challenges you can get in medicine. I am training as an Emergency Specialist so the very acute exciting stuff is more natural to me, but we also do clinic work, which is more GP orientated.
“One of the earlier cases that sticks in my mind was a young lady who got caught in some farm machinery and lost an arm and badly damaged a leg. She was only 19 years old. I was struck not by the extent of her injuries, which were pretty horrific, but by how stoical she was, unbelievably matter of fact. This is common in outback folk as they seem to put up with more than most of us,” David remarks.
“By the time they met our plane they had had already travelled more than 200 kilometres over rough roads. This is just how tough she was: with her right arm off and her right leg mangled, probably worst than her arm, I asked her: ‘you look like you’re in a fair bit of pain, what would you say your pain was out of ten’ and she said ‘it was 7 but it’s gone up to about an 8’. And I had to think ‘I wonder what ten is on your scale?’ I would give that a minimum of ten.
“It was a two-hour flight to the hospital. She remained really, really calm during the whole thing, absolutely genuine and matter of fact.
In 2007 the RFDS performed an average of 96 daily aeromedical emergency evacuations, totalling more than 35,000 that year. The Service also consults with rural and remote doctors and flies a regular clinic circuit to areas without doctors. These free clinics are the equivalent of visiting a local GP and are as much about health education and prevention as they are about addressing immediate health issues.
Remote control medicine became a reality for the flying doctors when medical chests were introduced to outback stations in 1942. Over 3500 RFDS medical chests are located at remote locations across Australia, such as isolated pastoral properties, Indigenous communities, out-stations, remote mining sites and lighthouses.
Each chest is identical and contains numbered drugs, bandages and other first aid materials, allowing the doctor to instruct the caller to use medication or treatment by referring to numbered items on the lid list of the chest.
Many tall stories grew up around the service and one about the medical chests is typical. A station manager was told to give his wife a number nine tablet. Later he told the doctor, "We'd run out of number nines, but I gave her one five and one four and she came good right away!"
And of course David has his own story to recall, one that brought the medical MacGyver in him to the surface
“We do a lot of advice calls and these medical chests can provide an invaluable lifeline for people who are hundreds or thousands of miles away from medical assistance. When I was in Meekatharra, there was a young kid had a very severe croup and I could hear him on the phone with his mother, really horrible sounding breathing with inspiratory stridor and wheeze and she described a kid that was basically getting towards its last legs.
“It was going to be 90 minutes before I was going to be able to get to them but I was fairly sure the kid would have died within the next hour if he didn’t have treatment. His mum told me that there was an old nebulizer from the grandmother when she’d lived on the farm so I asked them to get that and see if it still worked. There’s adrenalin in the chest’s anaphylaxis kit, so I got them to take all the adrenalin out, break the ampoules, put it in the nebulizer, and mix it with a bit of water or saline and nebulize the kid some adrenalin.
“There’s some dexamethasone in the chest and also everything you need to give an injection. I talked mum through how to drop the injection and how to give it, so mum gave a big dose of the steroid into her kid’s leg, and when I landed about 90 minutes later at the station, the kids was almost better from the treatment that mum had given.
“I blew up a glove and drew a face on it and the kids played with it all the way back. I had nothing to do, it was one of the easiest flights I have ever had and it was only because mum treated the child before we got there.
“This is the sort of job where you have to think outside the box. You look at the list of what they’ve got in the medical chest and around them and who can help you to do what has to be done before you get there.”
David has no plans to return to Ireland as of yet, although by mid 2009 he will have to leave the RFDS for a period to finish his training in Emergency Medicine and sit his consultant exams. But after that, he is adamant that his path will return him to the RFDS “long term, because I love it”
Although an allure of an adventurous and stimulating lifestyle can make it easier to recruit new doctors to the RFDS, due to the remote and lonely living conditions, and sometimes dangerous situations associated with night flying, these recruits often do not stay on past twelve months. David may prove an exception, as another Irish man, the famous Royal Flying Doctor pioneer Dr Tim O'Leary did for 27 years.
The late Dr O'Leary was a legend in his own lifetime, famous for his compassion, sense of humour, and medical skill. A born raconteur, he published two books of memoirs describing some of his adventures in the provision of health services to the Australian Outback: North and Aloft, and Western Wings of Care.
His son, Bill O'Leary, has written a screenplay “The Flying Doctor” based on the amazing story of his father's adventures, and is offering first option on the script to Mel Gibson’s ICON Productions.
Opening scenes are Tim’s steeplechase accident as a teenager in Ireland that nearly cost him his leg, to working alongside Mother Theresa in India prior to taking post as Ship's Surgeon bound for Australia in 1951. He landed penniless in Sydney, and 'picking' the Flying Doctor Job out of a cup.
The script covers three decades of adventure including surviving the fatal RFDS plane crash in 1953 that killed his first wife Renee, only six weeks after their wedding, and his best friend Captain Martin Garrett.
Over the next 30 years Tim was an outback legend - surviving fatal plane crashes, being attacked by spear-throwing aboriginals, swimming through flooded crock-infested rivers and flying thousands of miles to save the lives of isolated Australians.
“The story is so amazing it needs to be told and we are certain the world will love it,” says Bill, who resides in Thailand with his family. “A charismatic hero's journey sweeping two generations and three continents filled with highflying adventure, tragic plane crashes, riveting life-saving stories and an unexpected 'twist' buried so deep even the most astute sleuths will be blown away. The final scenes reveal that Doctor Tim was......Nah, sorry - you'll have to read it yourself or see the movie.”

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