Critical Care Readiness in Rural Emergency Departments in Western NSW CritRED-WNSW

Description

Critically unwell patients represent a minority of presentations in rural emergency departments. A recent study of presentations to the Western NSW virtual critical care support service “vCare” showed that only 4.8% of calls were for “high urgency” presentations, and only a small number of ED presentations are escalated to vCare.
Appropriate immediate management and initiation of critical care interventions is often lifesaving for this cohort. Rural emergency departments (defined as Modified Monash Model [MMM] 4-7) utilise a varied skill mix with rural generalists, registrars, and locum doctors with varying degrees of experience forming the on-site medical workforce.
Despite a trend towards advancing virtual critical care services, many lifesaving procedures, best practices and initial management protocols can only be managed by onsite practitioners. This includes insertion of various lines and drains, management of fluid, medication, and vasopressor infusions, and cardiac arrest management. Further, medical retrieval can often be delayed for many hours and critically ill patients often require extended periods of support in rural environments.
As such, doctors working in rural EDs should be supported to develop and maintain a skillset to manage the first hours of care of critically unwell patients. This includes the knowledge, practical skills, equipment, and support structures to manage trauma, sepsis, shock, cardiac arrest, STEMI, stroke, respiratory emergencies, and burns.
There is a small amount of data on rural generalist critical care skillsets, with concerningly only 80% confident in Advanced Life Support and 67% able to deliver thoracostomy. Rich data is lacking to guide supported development of a targeted skillset for rural emergency practitioners.
This study aims to gauge the frequency of different types of critical emergency presentations and the procedures and interventions required for their immediate management prior to the arrival of retrieval services. This will be used as the basis to guide a series of semi-structured interviews with rural medical staff to explore the experiences of rural staff in preparing for and performing critical care interventions, with the ultimate aim of informing rural health systems about how to better support practitioners to deliver critical care interventions in a structured and safe manner.

Period	Jun 2023 → Dec 2024
Examinee
Examination held at	Australian College of Rural and Remote Medicine
Degree of Recognition	National