Air Transport of Patients with Mental Illness in Western Australia

1
Air Transport of Patients with Mental Illness in
Western Australia

• Dr Stephen Langford
• Medical Director
• RFDS Western Operations

2
How were patients moved in the past?

• Road transport, straight-jacket
• Huge time frame
• Poor care
• Commissioner of Health directive 1982
• Dept of Aviation Air Navigation Orders
• Implemented due to incidents
• Repealed in 1991 as limited incidents
• General principles adopted in Flying Operations

3
(No Transcript)
4
Review of our Data

• Retrieval Database - 1 Jan 1986 to 1 Jan 2004
• Retrospective Audit - 1 Jan 2004 to 30 Jun 2004
• Clinical Incidents - 1 Jan 1999 to 30 Jun 2004

5
Retrieval Data1 Jan 86 1 Jan 04 (18 years)

• Total Cases 76,249
• Trauma 27
• Cardiac 15
• Obstetric 11
• Mental Illness 3,210 4.2

6
Trauma Cardiovascular Mental Health
7
1 Jan 1986 1 Jan 2004 (18 years)

• Total Mental Health Cases 3,210
• Sub-classification (ICD9)
• Psychoses 67
• Organic Psychoses 9
• Non-psychotic disorders 24

8
(No Transcript)
9
(No Transcript)
10
(No Transcript)
11
(No Transcript)
12
(No Transcript)
13
(No Transcript)
14
(No Transcript)
15
Retrospective Case Audit Jan-Jun2004

• Aims
• To audit gt100 consecutive mental health transfers
  by RFDS from 1 Jan 2004.
• To determine the basic demographics of patients,
  where and when transferred, presence of escorts,
  forms, violence.
• Chart review to summarize the drugs and doses
  administered prior to and during flight and the
  duration of transfer.

16
Retrospective Case Audit Jan-Jun2004

• No of separate flights 139
• Patients with two flights crews 16
• Patients with three flights crews 1
• No of individual patients 122
• Frequent flyers 1 (X3)

17
(No Transcript)
18
Retrospective Case Audit Jan-Jun2004

• Patients
• Age 14 89 yrs (median 33)
• Gender M 95, F 44 (6832)
• Ethnicity ATSI 55 (40)
• Caucasian 79 (57)

19
(No Transcript)
20
Retrospective Case Audit Jan-Jun2004

• Flight Details
• All transfer during day 100
• Some or all at night 39 (28)
• Duration of flight 0.25 - 12.5 hrs
• Median 200 hrs
• Overall care duration 4.0 -15.5 hrs
• Median 6.14 hrs

21
Retrospective Case Audit Jan-Jun2004

• Other features
• Mental Health forms 115
• Police Escort 111
• Restraint used 117
• Other patients on flight 98 (70)

22
Study Period 2004
23
Study Period 2004
24
Pre-flight Sedation (Referral Site)
25
In-flight Sedation
26
(No Transcript)
27
In-flight Sedation Yes 76 (55) No 63 (45)
28
Retrospective Case Audit Jan-Jun2004

• Respiratory depression Nil
• Violence in flight Nil

29
Clinical Hazard Reports

• 1 Jan 1999 to 30 Jun 2004
• Violence flagged 20
• Not psychiatric patient 8
• Loading unloading only 4
• Not transported 4
• In-flight Police escort assisted 4
• 1,395 carried over this time-gt incidence 1350
  in-flight
• No incidents in 2003 or 2004.

30
Basic Principles

• Two legal considerations
• Air Safety
• Mental Health Act
• If at risk of disturbance in-flight
• Sedation
• Restraint
• Additional escort
• Dont embark if not adequately prepared

31
Key Features for Successful Transport(Applies to
most other cases too)

• Accurate pre-flight assessment
• Good patient preparation (esp. sedation)
• Experienced staff
• Appropriate equipment and procedures

32
Current Workload-Emergency Treatment
Report-Transfer of Patients from Authorized
Hospitals
33
(No Transcript)
34
(No Transcript)
35
Emergency Treatment

• Notification to Mental Health Review Board
• Only required for Emergency Treatment under the
  Act where patient does not consent.

36
Form 7

• Transfer of involuntary patients between
  authorized hospitals.
• Albany, Bunbury Kalgoorlie.
• Form 1 not required.
• Correctly Form 7 and Form 3 (Transport Order)

37
(No Transcript)
38
(No Transcript)
39
(No Transcript)