Location: Dunedin Public Hospital, South Island, New Zealand.
Type of experience: Six Month Registrar Post. Intensive Care Medicine and Aero-Medical Retrieval Medicine
Training recognised? Yes, my post was prospectively approved by Mersey Deanery, CEM and PMETB for six months out of programme training to complete my competencies in Intensive Care Medicine and Anaesthesia as an Emergency Medicine Trainee (This post was recognised for specialist training by the Australasian Colleges.)
Contact details: firstname.lastname@example.org
In 2009 I completed six months out of programme training in Intensive Care and Aero-Medical Retrieval Medicine based in the Intensive Care Unit at Dunedin Public Hospital (DPH) and on the Otago Regional Rescue Helicopter.
DPH is a 350-bed tertiary level teaching hospital with a 10 bedded ICU plus Cardiothoracic and Neurosurgical specialities. In ICU, I worked alongside 5 other Registrars in a post recognised for specialist training by the Australasian Colleges.
In addition to this I worked on the Otago Rescue Helicopter - A 24/7 Aero-medical service providing medical attendance for primary helicopter missions and inter-hospital ICU patient transfers by air and ground. The team includes 3 dedicated pilots and 2 highly experienced paramedics permanently assigned to the rescue base. Added to this are the specially trained consultants, registrars (of which I was one) and nurses of DPH Intensive Care Unit.
Since 1998 the Otago Rescue Helicopter Trust has provided a dedicated intensive care rescue helicopter service for the entire population of the lower South Island of New Zealand.
How I did it – who to contact, and what order to do it in
I was fortunate in that my Educational Supervisor in my Emergency Medicine training post in Mersey Deanery had completed this same post several years prior as part of his registrar training and was still in contact with the team in Dunedin. He gave me the email contact details for Dr Mike Hunter the Clinical Director of Dunedin ICU whom I contacted in the first instance to find out more about the post and the application process.
It took approximately one year to organise my OOPT. The post commenced in June 2009 and so I requested to discuss this with the Head of School at my training review ARCP in July 2008 so that the departments that would be lacking a trainee from June to July and August to December respectively in 2009 both had plenty of time to make adjustments. Following this I set about completing numerous forms for the Training Programme Director and Deanery and The College of Emergency Medicine (as I was determined to have prospective training approval) as well as the GMC/PMETB and the New Zealand Medical Council. It was only once I had been accepted by both Dunedin Hospital and by the New Zealand Medical Council that I was actually able to apply for my Visa as this is very specific in terms of your exact post and the exact dates you will be working. That was a further laborious process but did not require CXR etc as I have heard some colleagues required to work in Australia.
At this stage I felt happy to book flights and arrange accommodation through the hospital and I looked into other things like car hire and bank accounts etc in New Zealand. I was able to rent out my home in Liverpool to some friends who were already my housemates and I made other allowances for bills, home insurance etc. At the time I did not have a partner or children or pets so that made life a little simpler.
I had to arrange medical indemnity whilst I was resident in New Zealand and so I temporarily halted my indemnity here in the UK. Other things like arranging for your pay to be halted in the UK whilst you are away can be tricky to arrange with local payroll, this led to some difficulties for me on my return to the UK.
Despite the time required and the seemingly endless forms to complete - it was ALL completely worthwhile and the inconvenience at the time of preparation is FAR outweighed by the experiences I gained from my OOPT.
What I had to do to prepare
I revised the Oxford Handbook of Intensive Care! I was at ST4 level and so was relatively clinically competent at this time and had already finished my MCEM.
I knew that I would be completing a training course on my arrival to Dunedin in order to be able to be a team member on the Rescue Helicopter so there was little else I could do to prepare for this from home in Liverpool. I do remember completing the “ISAC” - Incident Scene Assessment Course with Cheshire Fire and Rescue, this was helpful in dealing with roadside emergencies.
What I learnt when I was out there – specific educational skills
In the first week I completed the Otago Aero-medical Evacuation Course. This encompassed in-flight physiology, the management of in-flight emergencies (medical, surgical, trauma, obstetrics, paediatrics), practical transfer skills and in-flight emergency drills at Taieri airfield.
As a registrar I was then able to begin undertaking primary and retrieval missions as the sole doctor with nurse and/or paramedic support. Thereafter, I regularly undertook the transfer, retrieval and primary rescue of both adults and children, with direct advice form the consultant in ICU –but at the other end of the telephone.
In addition I gained experience in anaesthesia when opportunities arose to attend emergency theatre, neurosurgery and cardiothoracic theatres. ICU registrars were encouraged to perform elective intubations and central venous line / arterial line insertions in theatre for elective postoperative admissions, as well as rapid sequence induction and emergency intubation of new patients in ICU/ED.
I did several presentations at hospital meetings and was granted study leave to attend the World Interactive Network of Critical Ultrasound Congress in Sydney.
When I returned to the UK I presented a poster entitled “Otago Rescue Helicopter, New Zealand: The Value of Out of Programme Training Opportunities for UK Emergency Medicine Trainees” at the College of Emergency Medicine Annual Conference 2010 and National Annual Conference of Pre-hospital & Critical Care Transfer 2010.
How I am different now and why it was worth it
Out of programme training opportunities for UK Emergency Medicine trainees can be viewed as non-essential or undesirable, perhaps due to trainee absence impacting on local service provision. However, the value of such training experience for the individual trainee should not be overlooked. By participating in the rescue, retrieval and ongoing ICU care of both adult and paediatric patients I gained multiple new skills, including confidence in performing independently with limited equipment in challenging prehospital environments. This was an invaluable and very enjoyable experience and did lead me to pursue further training in Prehospital Care later in my career.
None that I can think of to be honest!