Tropical Paediatric Sepsis on a Dark and Stormy Night
Melissa Green / Donal Watters
Royal Flying Doctors Service, Freshwater, Australia
Melissa is currently a Nursing Education Officer and Flight Nurse with the Royal Flying Doctors Service QLD section. She has been flight nursing for over 10 years in both Western Australia and Queensland and enjoys the daily challenges this job brings.
Severe adverse weather, fatigue management, a critically ill paediatric patient, multiple transfer modalities, fuel weight and range balancing, to bring or not to bring an escort and vast distances culminating in a paediatric resuscitation at 26,000 ft.
This case study will dissect the interplay of the above factors that contributed to this situation.
In this instance, the night crew whilst already on high priority tasking, were tasked with a very high priority critically ill child on a remote but skilled Island hospital, 700Km from the aeromedical base, 1100Km from paediatric ICU. This was during the wet season with severe weather.
A number of critical decisions needed to be made within tight timelines:
- Safety of mission taking into account transport modalities, weather and crew fatigue. Go now or later?
- Escort. High chance of poor outcome for patient, limited staff resources and privacy in aircraft, and unknown emotional state of escort
- Retrieve to nearest ICU or more distant Paediatric ICU
- Management of a deteriorating ventilated septic child during flight in poor weather conditions
Individually there are well defined pathways to manage these issues, but combined they caused a high degree of cognitive effort.
This presentation will attempt to deliver topical discussion on the logistical involvement that made this complex case a logistical balancing conundrum. Is there ever a right answer?
Would this case have been managed much differently 30 years ago, and what would it look like 30 years from now?