Essential Retrieval Medicine Toolkit

November 25, 2011 by  
Filed under All Updates

Australian retrieval medicine guru and Flying Doctor Dr Minh Le Cong sent me a copy of the ‘Prehospital Anaesthesia and Airway management Syllabus 2012′ that he’d authored, a thorough and evidence-based approach to airway management for practioners involved in pre-hospital care and critical care transport.

In the surgical airway section, Minh describes the use of ultrasound as an adjunct to the identification of the cricothyroid membrane. It includes this image of Minh ultrasounding his own neck in his office.

I couldn’t help but be distracted by an object on his desk, which on closer inspection, appears to be a rubber chicken.

I emailed Minh to find out about that chicken. He replied:

..even I did not pick that my rubber chicken was visible in the shot!

A great tip from an ex SAS soldier…always carry a rubber chicken into high stress, high risk situations. You would be surprised how well it works in defusing high tension, arguments and standoffs as well as personally allowing you to take a moment and ground yourself when the shit is flying.

The chicken comes with me, along with my king vision, portable USS and Leatherman Multitool and head torch.I used all of those items recently on the same patient!

Minh Le Cong
Medical Education Officer
RFDS Queensland Section

What are the essential items you have with you on every shift? Is your list anything like Minh’s Retrieval Toolkit?

Comments

10 Responses to “Essential Retrieval Medicine Toolkit”

  1. Tim Leeuwenburg on November 25th, 2011 20:13

    Gotta get me a chicken.

    Remind me though, exactly WHAT does he do with it? Could be a prize for most imaginative use in prehospital clinical setting…

  2. Minh Le Cong on November 26th, 2011 15:34

    Have you ever had to enter the property of an agitated psychotic patient who has a very large pitbull terrier on guard duty?

  3. Tim Leeuwenburg on November 27th, 2011 03:17

    That’s what the medical student is for…..

    I’ll get my coat.

  4. Doug Lynch on November 27th, 2011 20:08

    I just bring my comedy Irish accent along!
    That generally raises a laugh.
    A decent dose of self deprecating humour always helps one lighten the situation up.
    I’m liking the tiny hand held U/S.
    I also use a pressure bag behind the neck to act as an adjustable pillow and to allow fast administration of drugs from my “intubator” position.
    My phone/comms package is also a major part of my retrieval combo!
    I make a lot of calls.
    Communication is almost everything.
    I usually call the nurse receiving an incubated patient in a given ICU to give them the essentials.
    CVC and Art Line positions, types of infusions etc
    They are usually very receptive. This makes for a positive start to my impending arrival in an ICU, avoids some annoying errors and delays and gives me an ally during Handover.
    I make their job easier, I make them look good, they usually reciprocate and my patient is better off!

    On a Kit fetish point;

    I’ve worked in multiple retrieval systems but am never happy with the luggage.

    I have been searching around for the ideal bag/case solution.

    What do you guys use?

    What would you use if money etc was no issue?

    I hope to find a light weight modular case a bit like a Pelican Hardigg style case that is more user friendly but can clip together like Lego!

    The whole stack could then function as a trolley using wheels integrated in the bottom case?!

    Any comments?

    Doug

  5. Daniel on November 28th, 2011 12:09

    where can I get a copy of that must have??

  6. Minh Le Cong on November 29th, 2011 00:34

    Hi Doug
    In answer to your question about retrieval bags and luggage, I personally use a military style backpack. On all night missions I wear a head torch during retrieval phase and outdoor handovers.
    However the best retrieval bag I have ever seen used on a primary retrieval was an ordinary laundry basket that a remote nurse turned up with during a road trauma case out in the middle of nowhere in Cape York.
    She had everything in there from IV stuff to RSI stuff to even sandwiches and cold water! And you could instantly see what was in it due to its open topped design!

    I asked one of the health workers with her about it and he said she had been using it for years as she found it much better to use than the standard issued Thomas trauma packs…much easier to find things with the basket than the Thomas pack! lol

  7. Tim Leeuwenburg on November 30th, 2011 05:40

    The UK bergen-style bacpack (which also converts to a field stretcher) is quite good.

  8. Gunnar Farstad on December 3rd, 2011 18:36

    Cute rubber chicken!

    Agree completely with Minh’s head torch comment. I personally prefer the Petzl “Tac-Tikka” which has a red “flipable cover” useful to avoid completely blowing your night-vision all those times you don’t really need the bright white light. A practical detail is pulling the head torch down around your neck (still lit or not as appropriate) when you don your flighthelmet/headset. That way you know where it is at all times and don’t have to waste time positively closing the pocket you put it in (because if you don’t close the pocket- you’ll soon be missing your head torch…).

    My little contribution to the “essentials” list:
    The left upper arm pocket in my flight suit is always filled with 1 meter long flat cotton endotracheal tube ties (nonflexible/static 1 cm wide woven material). We buy this in large rolls from a local sewing store (I believe it is usually used for “edging” fraying-prone cloth). In my experience this method of securing (ADULT!!!) ET-tubes in the prehospital setting is superior to anything else I have come across. It’s quick, solid and almost free. For anyone unfamiliar with this- just a couple of tips: Start with tying the tie around the tube at the level of the patients front teeth (tightly enough to make an impression on the tube walls so the tie won’t slide along the tube when it gets wet and/or stretches). Then pass one end of the tie around the back of the patient’s neck and tie the two ends together on one side of the head.
    As time permits (and ones neurotic personality dictates) this setup can be further enhanced by taping the tube in the usual in-hospital manner with the part of the tape going around the ET-tube itself ending up on the outside of the cotton tie as an extra insurance against sliding.
    A word of caution- never use this technique on narrow thin-walled (pediatric) ET-tubes as even the smallest impression/reduction in tube-diameter will seriously impede airflow.

    The outside of the same arm pocket is designed to hold pens with a little velcro-flap covering the top. A single-use scalpel with a (large curved) #10 blade fits nicely into the widest of the pen-pockets even in its sterile plastic cover. Next to it resides a pair of artery forceps (not sterile but close ;-) This way the preparation time for an emergency finger thoracostomy or an immediate cricothyrotomy is close to zero.
    My pens are in my breast pen-pocket…

  9. Minh Le Cong on December 4th, 2011 14:59

    great ideas Gunnar. does anyone carry their own laryngoscope handle and blades?

  10. Matthew Mac Partlin on December 7th, 2011 00:11

    I’m not a retrievalist (yet), but I work pre-hospital at motorsports events; WRC, F1GP, V8SC, etc. The Thomas pack that you get depends on the group you work with, so I have a small tote bag (getting smaller) that I carry a few security toys in:
    - Tradies wrap-around safety glasses with side LEDs to light the way. Bought at Supercheap Auto for about $20
    - Clip on LEDs that attach to the brim of my cap for extra lighting
    - Pair of mechanics gloves – flexible, heat resistant and protection against glass and bits of shattered carbon fibre. Again <$40 at Supercheap Auto or Repco
    - Trauma shears for cutting through seatbelts, race suits and HANS device strapping. No trackside clamshells, heaven forbid!
    - An i-Gel LMA and a green Airtraq (though I'm keen to get my hands on a KingVision or an AWS as they seem much more user friendly)
    - A multitool similar to Minh's

    Other clinical equipment that I like to have readily to hand I'll usually raid from the event medical centre. I had a play with the pocket GE U/S during the WRC Rally Australia this year and wouldn't mind investing in one for outback events like the WRC or Australian Safari Rally, though I suspect it would not get the same volume of use as with a full time retrieval service to justify the cost.