Attention
- Make sure you know how clinic/vehicle radio or satellite phone works in case there
are problems with normal phones. Keep instruction manuals handy for new staff
In every consultation, including emergencies
- Speak clearly and slowly
- Allow for time delay after each sentence if needed
- Use simple terms, and numbered body/hand charts Figure 1.1 Figure 1.5 to describe issue, eg
- Position of lump
- Position of pain
- Place (site) of injury
- Always recheck management plan with consulting doctor, especially at night when everyone is tired
What you do
Before ringing doctor on call
Use ISBAR to help work through consultation logically and communicate clearly
- I dentify
- Who you are talking to (name and role for file notes)
- Who you are (name, role), community where you are calling from, contact details
- Person you are talking about — name (and carer's name if child), date of birth, patient
record number, their location if different from yours, eg they could be at an outstation
and calling the clinician for a consult
- S ituation — why you are calling
- Is it urgent
- Any abnormal observations, POC test results
- B ackground
- Patient's story — name, age, current complaint, relevant history
- Procedures or treatments already tried, any outcomes
- A ssessment
- What you think the problem is — be clear, state the obvious, indicate how concerned
you are
- R equest
- What do you want them to do — advice, review, refer, evacuate
- Repeat back — ask doctor to repeat all management and medicine orders, confirm roles
and responsibilities and restate plan
- If not happy with advice
- Tell doctor straight away and explain why. Always try to maintain a professional relationship
and to come to a mutually agreed plan
- If still concerned — ask the doctor to involve their senior medical officer within
the retrieval service — follow local policy/practices
- If the above is not facilitated, ring the on-call doctor service call intake and ask
to be put through to the senior medical officer on call to resolve disagreement
- Record in file notes — full name of consulting doctor, their advice, what you have agreed to do
If person being evacuated
- Get permission from person and/or family for evacuation
- Consider local conditions that may affect evacuation — weather, condition of road/airstrip,
night lighting on airstrip
- Which mode of evacuation is most suitable
- Emergency — aerial medical service, road ambulance
- Non-emergency — mail or charter plane, bus, private car, ferry, other transport
- Is medical and/or family escort needed
- Any risks for person, escort or transport provider — alcohol, sniffing volatile substances,
risk of violence, risk of condition deteriorating
- Medical consult about
- Will this problem, or underlying condition make person unwell if they fly
- Antiemetic to stop vomiting, especially if hot weather, windy conditions, rough or windy road,
choppy seas. Best given at least 20 minutes before travelling
- Pain relief if needed
- Check you understand evacuation plan before you finish phone/radio call
- See Evacuations for how to prepare
Numbered body and hand charts