Minh Le Cong's presentation (recorded in an aircraft hangar in Northern Queensland) on the aeromedical retrieval of the disturbed, agitated or violent patient.

1. Disturbed patient
retrievals
By Dr Minh Le Cong
RFDS Cairns, February 2012

2. •WHAT WE ARE GOING TO TALK ABOUT
TODAY
•Legalities
•Risk assessment
•Restraint
•Sedation
•Emergencies

3. Online survey of Australian retrieval doctors’ opinion of disturbed
patient management
•Emailed survey invitation to
32 retrieval doctors,
December 2011
•3 question anonymous
survey
•17 respondents

7. •Open comments from respondents
were...

9. Legalities of aeromedicine
•Mental Health Act
•Guardianship Act
•Civil Aviation Act

10. Risk Assessment

11. RFDS QLD Revised Risk
Assessment tool ,2010

13. What is the risk here?
• 40 yo man with chronic back pain in rural
hospital
• Referred for investigation ? Disc
prolapse..can’t sit due to pain
• Agitated and demanding analgesia and wish
to smoke frequently

14. Why don’t we use this?

15. Physical restraints in aeromedical
setting • RFDS QLD protocol
• Restraints – quick
release, velcro
fasteners, 4 points
• RFDS SA – body net
• Patient explanation if
possible prior to use
• Police restraints
• Careful medical
monitoring during use
• Avoid prone position
• Avoid patient struggling
against restraints
(SEDATE!!)

17. RFDS Central section
restraint

18. Check out www.emcrit.org

19. Sedation

20. Sedation trivia questions
• What was the DORM study?
• What are the recommended acute
sedatives in Queensland mental health
units?
• What is the safest route of sedation : oral,
intranasal, intramuscular , intraosseous or
intravenous??

21. Air Med J, 31:1, 2012

22. What would you prepare and how would you give it?

23. DOES FASTING MATTER AND
DRUG CHOICE??

24. Let’s try an example
•37yo woman with acute
suicidal ideation, refusing
admission
•PMH – antisocial personality
disorder, past conviction for
stabbing police officer

25. •PMH : sleep apnoea, obesity
•OE: BMI 40, BP 120/60,
SaO2 99% on air
•Handover : cooperative
with IV access, demanding
cigarette

26. My approach

27. Run it like procedural
sedation
•Set up for RSI..you may
need it
•Ketamine infusion
(adjunctive midazolam prn)
•Non invasive capnography

29. ON ketamine 80mg/hr

30. Restraints on, infusion running, more sedation ready

31. Use a sedation score

37. Inflight emergencies

38. “No one f#$@s with a 100 of sux”
•Yes or no?
•Is ketamine IMI as good?
•Is midazolam IMI as good?

39. DO YOU HAVE TO INTUBATE ALL HIGHLY
COMBATIVE PATIENTS FOR FLIGHT?

40. Check out the following
presentation
•http://www.isas.org.au/img.
ashx?f=f&p=christchurch_2
010%2fExtreme+Psychiatric
+Patient+-
+David+Bowie.pdf

42. •WHAT WE TALKED ABOUT TODAY
•Legalities
•Risk assessment
•Restraint
•Sedation
•Emergencies

43. Thankyou!