Rural Emergency Medicine

Well my Rural Adventure is well and truly over and I've been chipping away at this post for weeks, as I've found the time.

When people (city-folk, urbanites, whatever you would like to call them) think of country life, I find they often think of a slow and ambling lifestyle, with fields of green, fresh air and the ability to see the sky (clearly). Well at least half of that is true depending on locality. One thing rural medicine is not though, is a walk in the park. It's no little old country lane, it's rough round the edges, has regular road trains (i.e. really big semi-trailers) zooming by and forms the heart of the community.

So I'll take you on a walk down my Country Lane.

What's a typically day like in Yeppoon Hospital?
A day at Yeppoon Hospital (or the Capricorn Coast Hospital & Health Service as they now preferred to be called) is not quite like any other. Although a hospital, there is also a strong community health presence within the facility.

My first thought was that I had basically been sent out to one of those Super GP Clinics, which had allied health services on the side.

I quickly came to realise however, how wrong I was. This was a bustling hospital, which just happened to have a fantastic Community Health service integrated into it. We were truly the centre of Healthcare for the Capricorn Coast. Some days in the emergency department we would see 60+ patients, between two doctors and myself, with the fantastic support of the nursing team. These weren't all trivial cases either like, 'I have a rash' or 'My throat is sore'. There were plenty of chest pains, traumas, acute abdomens (ranking as Category 2s & 3s) too deal with.

2.5 patients per hour

As many would know though, patients don't arrive at a steady rate or to our convenience.

To put this in some perspective our nearest referral centre, Rockhampton Base Hospital (otherwise known as Rocky Base or RBH. A ~30 min drive in a quick Ambulance) sees roughly 120 patients (on a comparable day), with a similar distribution throughout the triage categories, but has 15 doctors in their emergency department.

Transfers Galore
Another common part of our day was transferring patients, whether it was off to Rocky Base or to the local private imaging facility for tests. Transfers are a part of Rural Medicine and it was fortunate for us, we were both close in proximity to a large healthcare facility and we had a great ambulance team running things on the ground.

Tricks of the Trade
Rural Practitioners are quite ingenious (as they sometimes need to be), and come up with the most interesting solutions to everyday problems.

A few lessons I learnt (some of which may be obvious);

  1. Ear Wax
    Can not afford good old Waxsol (Docusate Sodium) for that ear wax? Then try some warm olive oil to loosen it up and hopefully clear it.
  2. No Bloods
    It common to have no form of blood biochemistry (or any access to any form of investigations for that matter). A simple one for doing a  Coagulation profile; put the blood of the patients and someone you know who has a roughly normal Coag profile (e.g. yourself) into separate tubes, and then compare clotting time. Clotting time should ideally be less than 10 minutes.
  3. The Ventolin Syringe
    The Ventolin Syringe was something we kept round in our emergency tray. Two quick squeezes and you could deliver some Salbutamol into someone's airway, plus it was hard to miss a 20ml syringe.

  4. Eye Irrigation
    Simply hook up a saline bag to the plastic end of a cannula (i.e. remove needle). Gives you control of flow and direction.

Beaches, Wildlife and Fun times
Life in the Country Lane was not all hard labour though, it came with a handful of perks too. Rather than spend too much time on this, I will just share some personal highlights.

Swimming with a Turtle around Great Keppel

Festival of Wind at Emu Park

Capricorn Caves

Rural Health Project
The Rural Health Project is a way in which we as medical students can give back something to the community, and learn lessons from healthcare engagement at the front-line. To be honest, this project was initially a struggle for me. I had many ideas, but no clear plan of how I was going to achieve them.

I initially settle on developing a mental health program for kids of parents with mental illnesses. Drawing from the works of organisations like COPMI (Children of Parents with a Mental Illness) and COMIC (Children of Mentally Ill Consumers). However, I soon began to realise that there were many health issues in the community that were going unaddressed. That was when I realised that the Health Service needed someway of getting their message out and provide resources to the greater public.

So after a bit of thought, I settle on a communication avenue I felt familiar with, Social Media.

The aim of which was to provide a platform whereby the Health Service could disseminate reliable and pertinent information to the local community. The development of the digital strategy focused on the key messages to be delivered to the public, communication methods to deliver these messages in a timely and cost-effective manner, and managing risks associated with such a platform.

In the end, we finished up with a prototype Facebook Page, a Twitter Account (@CapCoastHealth), a Wikipedia entry and a clear way forward. 

Where are we going too from here?
The next step is to get the tick of approval from the higher-ups and start getting these communication avenues going.The principle behind the strategy is that every member of the healthcare team can contribute, and it will be interesting to see how a small hospital can deliver timely and effective health information. I'm sure there will be some hiccups along the way, but too succeed you must accept small failures.

Finally I would like to thank all the staff at Capricorn Coast Hospital, but most importantly the two Doctors who made it such an enjoyable experience, Dr Kumari & Dr Smith. 

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