Our catchment area is over 1 million square kilometres and the catchment population is 45,000 people in Northern Territory. The Retrieval Service also flies into the adjacent areas of Western Australia, South Australia and Queensland. Most trips are by fixed wing aircraft (and rarely ambulance) and some round trips are well over 2000 km. There are over 600 retrievals to, and 100 transfers from Alice Springs Hospital per year.
The disease pattern is unlike other Australian Medical services. Most patients are indigenous and young. Triage acuity is high on arrival at hospital. The high acuity in a young population is a result of a disadvantaged population who have multiple co-morbidities; cardiomyopathy from Rheumatic Fever (as well as DM and IHD), ESRF on dialysis, severe bronchiectasis, and chronic liver disease from alcohol use and endemic hepatitis B. Some patients present in septic shock and require intensive resuscitation. Infectious disease is rife in children and young adult patients. Multiple rollover MVAs are common, as are truncal stabbings and other assaults. Interpersonal violence is common. There is a paucity of diseases of the elderly although we see some 'grey nomads'. Practical interventions done out of hospital include resuscitation, intubation, chest drains, thrombolysis, and inotropic support.
For support, there are 5 full-time specialist FACEMs, with 1 on leave. Supervision and teaching are thus at a high level. There is normally on site specialist cover till after 10.30 pm including weekends with 24 hour on-call cover including advice for retrievals. There is compulsory protected teaching time for ED registrars and Retrieval Medicine staff.
The Retrieval Service at Alice Springs Hospital collects adults and children. Most are picked up from community clinics, a few picked up from a small feeder hospital and a very small number are picked up from roadside motor vehicle crashes. Help is available for small babies and neonates. The nurses on the planes are all certified midwives.
The responsibility of the inter-hospital transfers from Alice Springs to other centres primarily falls to the Retrieval Team who co-ordinate this aspect of the service with input from other specialists. Most inter-hospital transfers occur in daylight hours as semi-planned procedures. Emergency (out of hours) inter-hospital transfers are rare as Alice Springs Hospital is equipped to deal with most emergencies including craniotomies. Inter-hospital transfers of neonates and small babies are usually the responsibility of more specialised teams from elsewhere (usually Adelaide).
The Retrieval Medicine personnel are frequently attached to different departments when on duty but not flying. During the week, this can include ED or ICU or theatre depending on skills. The idea is to improve the skills of the Retrieval Medicine staff.
Retrieval Medicine doctors must have experience in Anaesthetics, Emergency Medicine and Intensive Care Medicine. Paediatric experience is essential. Most doctors doing these posts have been Specialists or Trainees in Emergency Medicine, Anaesthetics, Intensive Care or General Practitioners with anaesthetic experience. The post is recognised as an advanced skills post by the ACEM and has also been used towards training for RACGP trainees.