INTENSIVE CARE SNAKEBITE AMBULANCE
One of the major contributors to snakebite deaths pre-hospital in PNG is the lack of emergency medical retrieval services capable of reaching remote health centres or aid posts to assess, treat and stabilise critically ill snakebite patients, and then safely transport them to Port Moresby General Hospital for ongoing care in an Intensive Care Unit environment.
TAKING THE EMERGENCY ROOM TO THE BUSH
Since 2012 we have worked to improve the capacity of health centres to deliver basic life support through the donation of airway kits (bag/valve/mask resuscitators, Guedel airway devices and portable foot-operated suction pumps) and at the same time support them with specialist medical retrievals using our customised 4WD Toyota Troopcarrier Mobile Intensive Care Ambulance (MICA). Designed with upgraded suspension, front and rear differential locks, winch and recovery equipment, as well as a modern rear compartment equipped with patient monitoring, suction, precision fluid delivery equipment and a Dräger Oxylog 3000+ ventilator, our vehicle carries up to 5,200 litres of medical oxygen, enabling us to effect retrievals from anywhere accessible by road or track within a 200 kilometres radius of Port Moresby.
We currently carry out 50-60 retrievals each year, with a team of volunteer PMGH doctors assisting our own medical team to ensure that a doctor, nurse and driver attend each incident.
HOW WE OPERATE
Our retrieval service operates on a strict referral basis.Snakebite victims must first present to their closest health facility for assessment and diagnosis, and in many cases can be treated successfully on site, with no need for referral to Port Moresby. This avoids a number of problems for patients, especially those who may not have the resources to be able to be away from home and family, if it is not necessary. A small proportion of very severely ill patients do require transfer to Port Moresby for effective treatment, but unfortunately they may sometimes be so seriously ill that the chances of surviving the trip in a conventional ambulance or in a public vehicle are very slim. This is where we come in. At the request of a health facility our team which includes a doctor and support staff will go out to the health centre, or conduct a transfer on the road. Upon arriving on scene our team can treat the patient, and if necessary take steps to secure their airway and preserve their breathing with our specialised equipment. We can then safely transport the patient back to hospital for ongoing care.
In the future we would like to expand the service further so that a vehicle and a team can be available to attend snakebite emergencies on both the Hiritano and Magi Highway routes at the same time if necessary, and to enable us to conduct medical clinic visits to health centres and aid posts, providing patient follow-up and community education.
As we develop our MICA retrieval services further, CCTC aims to eventually have two vehicles, fitted out with dedicated medical and support equipment to meet the needs of as many people in NCD, Central and the east of Gulf Province as possible. We work with volunteer paramedics from the Queensland Ambulance Service (QAS) who assist us with the training of local staff, the design of our vehicles, and the sourcing of surplus QAS ambulance equipment. We hope to expand our links with QAS to further enhance the development of modern emergency retrieval services in Papua New Guinea.