Saturday 19 August 2017

Helicopter heroes - the Emergency Service stars are in the sky

The stars of our Emergency Services are in the skies above, says Maurice Gueret, as he examines helicopter medicine
The Coastguard helicopter (Stock picture)
The Coastguard helicopter (Stock picture)
Dr Maurice Gueret

The dangerous nature of helicopter rescue was brought home last month with the tragic loss of a crew off the Mayo coast. There are many unsung heroes in the defence and emergency services, but few place their lives on the line like these crews.

The Irish Medical Journal has just published a review of one year's helicopter admissions to Tallaght Hospital. Emergency Aeromedical Services are still in their infancy in Ireland, and Tallaght is one of few hospitals to have a ground-level helipad. There were 39 transfers there by helicopter in one year. Two patients died and a dozen were discharged without admission, some by transfer to other hospitals. The majority of cases were orthopaedic and trauma. Tallaght is the national centre for pelvis injuries, but there were also chest pains, palpitations and acute abdomens among the helicopter arrivals.

The United States has been to the fore in the study of cost-effective helicopter use. One recent study wondered whether transfer of ankle fractures by air is justified. The cost of a helicopter transfer could be ten times the $1,000 average price of a ground ambulance trip. It's not always easy to weigh up the seriousness of injuries before deciding on a mode of transport. There's also the fact that ground transfer can sometimes be quicker than air. It's planned to have a helicopter roof high up at the new Children's Hospital at St James's. But because it is elevated and not ground-based, the sort of large Sikorsky helicopter that was lost in Mayo will not be able to land there. Instead, these big helicopters would have to go to Tallaght Hospital, where the patients would transfer by road, or try to get permission to land at Kilmainham. This is far from ideal, but perhaps par for the course with health planning in Ireland. At the current time, St James's cannot accommodate any landings at all, and helicopters must use open land half-a-mile away in the old Royal Hospital.

* Many patients complain that when hospital reminders arrive by text, they are unable to get through to landlines to confirm their appointments. The obvious solution is to allow a text-back service, just as you would text back your electricity or gas reading. But the simple solution seems to be beyond the powers-that-be. The Castletroy Physiotherapy Clinic in Limerick is an exception. They wrote to tell me about Createtext.ie, which allows the recipient of a text alerting him or her to tomorrow's appointment to immediately text back whether attendance is possible. They tell me that their use of this Ennis-based service has led to a huge decline in no-shows, and there is no cost to the patient either for the return text. Sounds like a technological 'win-win'. Anybody listening at the Department of Health?

* There are some regimes in the world that you don't want to get on the wrong side of. Airport hospitality North Korean-style can be poisonous and hasn't much to recommend it. But at least the exit door comes sooner than with the heavy-metal poisoning of dissident Russians. Another assassination method came to light recently, when Alexander Perepilichny, a UK-based Russian businessman, died shortly after enjoying a bowl of sorrel soup. It's a popular dish this side of the Volga, green in colour and sour borscht by taste. There is a theory around that somebody may have substituted gelsemium for his sorrel. Gelsemium is a flowering plant with an alkaloid poison related to strychnine. One variety is aptly named 'heartbreak grass'. Like all the best poisons, it was once used by doctors for the treatment of neuralgias, facial tics, and as a heart stimulant. It didn't last long, and neither did some of the patients. Perhaps the most famous doctor associated with gelsemium was Arthur Conan Doyle, creator of Sherlock Holmes. In the late 1870s, as a young medical student in Scotland, he began experimenting on himself with it, gradually increasing the dose each day. Botany was a big part of a medical education in those days, and he may have become interested in the plant at the Royal Botanic Garden in Edinburgh. Luckily, side effects of headache, diarrhoea and giddiness got the better of him before its lethality did. Conan Doyle stopped before the dosage became fatal, and, as you do, wrote up his experiences for peers in a medical journal.

* Every so often, the newspapers publish a list of nurses who have been struck off by their regulator, An Bord Altranais. Others are lucky enough only to be admonished or have conditions attached to their continuing practice. But those who have their names erased are unable to work again in this country as registered nurses. Many must wish their names could be erased from the newspapers, too. Deciding that someone is unfit to practice for the rest of their lives is a big deal, and not a decision taken lightly. Names are erased by direction of the High Court. There is a pattern to these regular reports. It's often ward or nursing-home negligence. There may be a case of pilfering from patients, and the misuse of drugs associated with an addiction is another regular citing. I sometimes wonder which is the biggest punishment - not being able to work, or having the whole country knowing about your indiscretion. Some of those struck off must wish that the permanent record of a stain on their once proudly worn uniform could be erased, too. Would it be too liberal to suggest that we make more effort to rehabilitate fallen nurses and doctors, rather than publishing and damning them for eternity?

Dr Maurice Gueret is editor of the Irish Medical Directory.

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