Way back in 1998 in the depths of winter through the smoke-filled (now smoke-free) haze in the doctor’s res’ room I spotted a poster inviting junior doctors to come to the Land of Oz. It was during that year in Queensland that I knew I wanted to do EM training. I reached a crossroads in 2003: should I train in Ireland/UK or retrace my steps to Australia? I chose the latter. The tertiary Sydney ED I trained in was well staffed, well resourced and there was a collegiate atmosphere within the hospital. The ED had 4 times the number of ED consultants of it’s Irish equivalent. I was trained to be an Emergency Physician (EP). There were some key highlights that stand out from that training:
- EPs provide critical care and advanced resuscitation in the ED. This is supported by specifically trained ‘resus’ nurses in ED.
- Australia has a mature trauma system with physician-staffed HEMS and designated trauma centres with trauma teams.
- Patients are referred for admission directly to the specialist that best serves the patient’s needs.
- Access to radiology (CT) is rapid and allows fast decision-making and disposition.
- The presence of an EP on the shop floor from 0800-midnight 7 days a week in a tertiary ED meant patients are reviewed by a senior decision maker early.
- ED trainees like other trainees have protected hours and teaching time. This mitigates against fatigue and burnt-out.
In Australia, EM, ICU and anaesthetics fall under the critical care umbrella and have a large crossover. Besides EM core training, I was rotated through anaesthesia, adult and paediatric ICU and prehospital and retrieval medicine (PHARM). Australia has a mature aeromedical retrieval service. This has largely been driven by geography and inequity to access of care in the rural/remote settings. It was during this challenging but very privileged and enjoyable rotation that I knew I would also like to pursue a career in PHARM. I finished my training in 2008.
In Australia, specialists can often choose fractional appointments in different hospitals and settings. I commenced work as an EP in Liverpool Hospital, the busiest and highest acuity trauma centre in NSW and also started with Sydney HEMS (sydneyhems.com). Sydney HEMS, part of NSW Ambulance Service is a government funded service that operates 3 bases, 4 helicopters (24/7) and performs over 3,000 rotary, fixed-wing and road retrievals per annum. It is consultant (EM / Anaesthetics / ICU) lead and performs prehospital and inter-hospital critical care missions. There is no doubt in my mind that Ireland badly needs an integrated physician-HEMS capable of performing the same role. By the same token, this will only work with the development of a trauma system, trauma centres and a default ICU transfer matrix. The Australians like any other country suffer pressure of rising costs of living and yet still manage to maintain focus on quality of living. Sport is a big part of my downtime and is a release valve from the intensity of work.