Imagine your 5-year-old boy is playing in a river. Suddenly, he falls off a log and goes under, submerged in one-and-a-half meters of water. A frantic three to five minute search begins. Is he caught under the log? Will you find him in time? What will you do if you do find him?
A bystander runs to find someone who knows first aid and another bystander notices the brightly colored board shorts your boy was wearing. He is found! The first aider orders him onto a sandbank in the middle of the riverƒ eight meters from the riverbank ƒ and orders another bystander to call triple zero (Australia_s equivalent of 9-1-1).
Now imagine that you are located in a remote aboriginal mission community of about 200 people more than 18 miles from the closest rural township and hospital. That rural township, Goondiwindi (or Gundy as the locals call it), has a population of around 5,000 and is located on the border of two Australian States: Queensland and New South Wales (NSW). Gundy is more than 228 miles from the nearest capital city of Brisbane in Queensland and its major hospitals.
Photo credit: David Martinelli, Courier Mail
McIntyre River at Toomelah Community; scene of Daniel's near drowning.
Now, back to the sandbank. The 5-year-old, named Daniel, is unconscious and not breathing; there_s no pulse. The first aider clears his airways, administers CPR and gets him breathing. He takes turns with other first-aid trained members of the community in performing CPR. Another triple-zero call is made to inform the rapidly approaching ambulance units that Daniel has been found and CPR is being administered. The two ambulance units travel more than 18 miles from Goondiwindi to the Aboriginal community of Toomelah in just 13 minutes. Daniel is saved; but the story doesn_t end there.
Only four years ago this would have been a very different scenario. If someone from the Toomelah community were sick or injured, they would be thrown in the back of the nearest car and sped frantically to Goondiwindi hospital. Many lives were lost and injuries became more serious because basic health education was lacking.
Illustration of the Toomelah scenario
Click here for a larger, higher-quality version of the illustration
Not only was education an issue, there was also the issue of money. Who would pay if an ambulance were called to such a community? Toomelah is in New South Wales (NSW), but the closest ambulance station and hospital is located in Goondiwindi in Queensland. Any triple-zero call taken at this time would go to the NSW Ambulance Communications Centre in Dubbo, then be relayed to the Queensland Communications Centre in Toowoomba, then onto the Queensland Ambulance Service (QAS) in Goondiwindi; thus, more costly delays.
So how did we get from that scenario to today_s fantastic ˙chain of survivalÓ example? The story continuesÚ
Matt Steer, the Officer in charge (OIC) at Goondiwindi Ambulance Station, gave a thorough background on the situation.
Rodney Bourke, Extended Care Paramedic, Daniel and Angus
McIntosh, and Matt Steer, OIC, in Gundy.
˙About four years ago we had a situation with Toomelah and the Aboriginal community which saw some catastrophic events arriving at hospital. What we needed to do was to educate and talk to the community and find out how to change their way of thinking. How to equip the community to manage emergencies in their own right and to trust that calling triple zero would bring them assistance and not to worry about the cost.
˙We did this a number of ways: through my contacts with the local rugby league football club (a lot of the Toomelah community play football boasting former Australian football heroes in their ranks); as well as Mission Australia, which set up what it calls the ˙Border Rivers Parenting ProjectÓ for Indigenous communities. We got together with the community at these parenting groups and literally sat under the tree and talked to them and got them to tell us how we can help, and from that, what they want from us.
˙From that, we did a bit of an informal education process in partnership with Indigenous Health; keeping NSW Ambulance informed as it is their backyard, so to speak. What we did initially was find 10 or 15 people within the community who were willing to take first-aid training. The QAS OIC in Inglewood, Mike Price, who is a qualified first aid and community education instructor, did a lot of work with us in adapting the program for indigenous people. You can_t line these people up in a classroom: this is practically based and conducted in the community, staged anywhere from under the gum tree to whatever environment they were comfortable in.
˙So it has been not only Gundy, but regional and QAS in partnership with NSW Ambulance, Queensland Health and Indigenous Health; very much a collaborative effort. We commenced that training about four years ago, and as a result we have up to 30 people out of a community of about 200 who are trained in first aid and are now coming back and doing their certification. So the interest is there to see the dramatic benefits, and they_ve been able to respond to many emergencies. Obviously the most dramatic and wonderful outcome has been the rescue of little Daniel.
˙The other thing we_ve been working on is communicating with the elders and the people in the community the importance of using triple zero. We had to convince a few people to do it, and when they started to do it it caused a ripple effect. People started thinking this wasn_t a bad idea. We also negotiated with NSW Ambulance and the NSW government so that when a triple zero call was made from Toomelah and other NSW communities that are closer to us, it would come directly to our Queensland Communications centre in Toowoomba and then to us. There was also the question of payment, which the NSW government has taken responsibility for.Ó
On October 29, 2005, the four years of training and education all fell into place when Daniel Connors fell off a log in the McIntyre River and was submerged for three to four minutes.
Toomelah resident Angus McIntosh was awakened and rushed to Daniel_s aid.
˙I was actually home in bed and a little girl came and told me that Daniel had fallen in the river and they couldn_t find him. He was still underwater and they were looking for him when I got there. Then they found him and lifted him out and they didn_t know what to do with him, so I told them to put him on the sandbank. He wasn_t breathing; he was unconscious. That_s when I jumped on him and remembered all my first-aid training.
"I only learned CPR at the beginning of the year. I cleared the airways, did the compressions on chest ƒ water came out of mouth and nose ƒ a then few of us took turns doing mouth-to-mouth and the compressions. I told them to ring triple zero. His parents were in Gundy and all that was on my mind was to go and tell them. I thought he was in trouble; I didn_t think he_d make it.Ó
As Steer explained, two QAS units were immediately dispatched.
˙At 13:51 p.m. Toowoomba Communications Centre received a triple-zero call with information that a young boy was walking on a log in the river and slipped and was in about one-and-a-half metres worth of water. We were dispatched at 13.52 p.m. and, while en route, received more information from the Communications Centre that Daniel had been found and they were doing CPR on him, a fairly ominous sign.
˙We then notified Gundy Hospital and provided a Situation Report (SITREP) to the Queensland Emergency Management System (QEMS). When we arrived at Toomelah, there was a line up of people showing us exactly where to go from the main road to the riverbank. We were confronted with roughly 10 meters worth of water waist deep that we had to get across. Daniel, still unconscious, was on his left-lateral position on the sandbank in the middle of the river. He certainly had a pulse and diminished respiratory function, and he wasn_t breathing very well at all.
˙We got him on the stretcher and made our way back across the river; he was quite cyanosed. We intubated, ventilated and sedated him on the riverbank and left the scene 28 minutes after arriving.
˙Daniel was doing very well on the way to Gundy Hospital, his vital signs were improving, we had a team waiting to meet us at the hospital to continue ventilation and resuscitation. The Retrieval Team arrived via the Royal Flying Doctor Service (RFDS) within three hours of the incident to take him to the Mater Children_s Hospital in Brisbane.
˙In the case of Daniel, the incident happened about to 2:10 p.m. and I think it was 5:30 p.m. that evening when he was in the Mater Children_s Hospital. He has no neurological damage, due in no small part to the fact that the whole time, from the very beginning of the incident, he was cared for properly by his rescuers.Ó
"Chain of survival" graphic used for community education leaflets
Improving emergency medical care in aboriginal communities has been a slow process. Quite simply, they had to see it to believe it. Once the Toomelah community saw the benefit, they started to dial triple zero in the first instance. Now it_s a common occurrence and there has been a significant decrease in people using their own vehicles to transport patients to a hospital. The community now know who is trained in first aid and that they should be their next port of call in an emergency. Thus, there is pre hospital support and QAS are arriving and continuing with care and utilizing QEMS if needed. It creates a full continuum of care, from notification, to getting these people into tertiary-care hospitals.
Perhaps the last word should go to aboriginal elder Aunty Ada, who was instrumental in changing people_s attitudes to dialing triple zero and trusting QAS.
˙I am full of praise for the ambulance officers, hospital workers and my community for working together to save Daniel_s life,Ó she said. ˙It_s a long way to town when something goes wrong. I really believe this was a miracle. Our prayers were answered and I am very proud of the young people, though I think the kids have had a bit of a scare; they haven_t been back down the river yet.ÓAn explanation of the Queensland Emergency Management System (QEMS)
The Queensland Emergency Medical System (QEMS) ensures an integrated and coordinated system to care for the acutely ill and injured. QEMS provides high quality primary health care, prehospital patient care and definitive medical care in Queensland through a continuum of care process utilizing all emergency health care services. It focuses on a system, rather than organizational approaches to the delivery of patient-care services.
This approach is necessary as emergency health care services are achieved through a series of focused sub-systems including private and public health care providers and emergency services agencies. These sub-systems, as summarized below, operate within a complex and extensive network of arrangements that together form QEMS.
High quality primary health care, prehospital patient care and definitive medical care is provided in Queensland through a continuum of care process, which reflects the QEMS concept.
The basic elements of this continuum of care:
* Health Promotion and Injury Prevention
* First Aid
* A Â000_ Access system
* Response Coordination
* First Responders (community members in rural or remote areas trained by QAS to respond until ambulances can arrive)
* Prehospital Response, Care and Transport; (provided by QAS)
* Retrieval and Inter-hospital Transfers (IHT)
* Medical care