Monday, March 26, 2007

The adventure continues...

Medevac's usually all follow a similar script: A nurse calls from a community health centre for advice about an ill patient they are seeing. The doctor taking the call then decides if an evacuation is required, and if a doctor needs to go on the flight. The flight crew then get the plane ready and fly out. Scripts are good, they help organize otherwise chaotic situations. This past weekend I had a medevac that was a little off script.

A call came in about a man who was, for some reason, out in the wilderness, about 200km from any settlement. He was in poor radio contact, but apparently said he needed an evacuation. He gave some GPS coordinates, and that was all. It was decided that the regular air ambulance could likely not land at his location, so a helicopter was arranged. It seemed to be part search and rescue, and part medevac, but as the information available was so limited the decision was made to send a doctor with the flight, and the next thing I knew I was getting ready to fly.

Since the helicopter had no medical supplies, I tried to gather up what I might need from the hospital, meds, IV supplies, etc, and packed them into my duffel bag. I also grabbed 2 units of O negative blood, thinking that having blood on an unknown call is always better than not having it.


The helicopter used for the foray was a Sikorsky S-92.




Flying in a helicopter is a great experience, you get to fly much lower than in a plane and the views are great. I snapped a few pictures of the scenery on the way out.




As we neared the GPS coordinates we got into thick clouds and had to climb above them. The pilots circled for about 20 minutes looking for a way down to land, but there was not a break in the clouds to be found, and a blind descent into unknown terrain was far too dangerous. Here is a shot of the clouds over top of our target.


The idea of going down through them was enough to make you review the evacuation procedures! In all medevacs, safety is the top priority, and so with no safe way to land we were forced to turn for home.


As we returned to Iqaluit the weather cleared again for our final touch down.




Overall it was a very mixed experience. On the one hand, it is always interesting to head out on a medevac, and riding in a helicopter is a fantastic experience. On the other hand I felt very bad for the fellow we were trying to rescue. Even though I knew almost nothing about him, I could picture him down below, hearing the helicopter arrive, circle and leave. Medevacs always make me think about the safety of the people involved in the evacuation (myself included). It is sometimes tempting to take risks for the patient, but in the long run it's not at all prudent. The experience also made me think about how vulnerable a person that far is from civilization. There is never any guarantee of rescue...

6 comments:

Anonymous said...

And then the doctor decides if a medevac is warranted.....sigh. That made me laugh. Here we go again. Guess what! if I am on the other end of the phone, one of those brave nurses you mentioned in an earlier post and I know my guy/baby/lady needs to be medevaced to a tertiary centre (aka more staff and better diagnostic equipment - yes, I know everyone in Iqaluit is stretched to the max) then I have already made the decision that there will be a medevac. I don't call unless I need one and your cooperation with my well researched, diplomatic and colleagial dialogue, while valued, is NOT the deciding factor of an evacuation or not. I have overrode physicians objections and saved a few lives (and probably averted a few law suits to boot). We all try to do our bit. We are all only human after all. I can learn from you and vice versa.

Zippy said...

And then what happened? This is like a short story! I need an ending! Did you ever hear from this poor guy again?

Dr. J. said...

I have to say that I am not a big fan of anonymous comments that try to flame up a conversation. If you want to have a debate, at least log in so we know who you are....

With that being said....This post is not supposed to be about whether a nurse or a doctor should be making the call. Like I have said before, most nurses up here are very good and sensible, and if they tell me a patient needs to be medevac'd I pretty much always activate the medevac....after all, the patient is in front of them.
The 'usual script' I mention at the front of this post, is not of my making, and regardless if you or I agree with it or not, it's a fact that that is how the system here in Iqaluit works.

I really have no idea how you interpret a description of how the system works, as an unwillingness on my part to learn from my nursing collegues. That is simply untrue.

There is lot's more in your comment that I think is open for debate, but I will leave it off there for now. If you'd like to continue the debate, please log in first, I'd prefer to know who I am speaking with...

Dr. J. said...

Zippy: Unfortunately it is a short story for me as well, and without ending (I'm simply not a clever enough writer to make up a cliff hanger like that!). I never really found out his name, what was actually going on with him, or what happened in the end...

Theresa Blackburn said...

Wonderful blog.
Spent six years in the "Big Fish".
We lived in Green Row - 681B from Feb 94 to Feb 2000.

I think everyone should live above the treeline for at least six months of their lives.

Enjoy....it can be frustrating...but it is beautiful, mysterious, and wonderful...like no place on earth!

Cheers,

Theresa Blackburn
former Nunavut resident

PS> We also lived in Labrador for seven - that's a wonderful place too..and with summers warm enough to swim!

Dr. J. said...

Thanks for reading the blog Theresa! Iqaluit is definetely an experience worth writing about!