Guest guest Posted September 25, 2003 Report Share Posted September 25, 2003 Thanks to everybody who has contributed to the malaria scenario. We will wrap it up now as it has run its course. As I was saying it is the first scenario that I have done. The reasons that i did it were many ranging from the list being quiet, I wanted to learn by doing it (I have, thank you) and I wanted to do one specifically on PF malaria. This is a subject that could touch anybody on the list. With the increase in air travel more and more people are potentially getting exposed to this parasite. Prior to my present job I had not come across it and it has ben a steep learning curve. PF malaria is a horrendous disease. It is rapidly progressive and the potential complications are absolutely horrible. they include: - Cerebral malaria - this can kill non immune people in less than 24 hours! Acute renal failure - the old black water fever Cardiac failure Pulmonary oedema Acute anemia and hypoxia to the extent that they can arrest and die. DIC leading to gangrene and amputation If the malaria develops into a chronic condition late complications such as tropical splenomegaly syndrome and nephrotic syndrome can result. Unfortunately every year we hear of expats dying from this disease. Many times this is not in the countries where they work (as we are on the look out for it), it is when they return home. They often see a family doctor who may not even think about malaria and diagnoses a virus or " the flu " . By the time the mis diagnosis is realised the situation is advanced and tragically it is often too late. The biggest factor in surviving this disease is early diagnosis and correct treatment. It is probably appropriate to suspect malaria in in anyone who returns from a malarious area (even if the plane just stopped there and they did not get off) if they develop a fever within three months of return (and possibly up to 1 year after return). If in doubt treat for malaria. World wide it has been estimated that between 100 million and 150 million people suffer from malaria and it kills an estimated 1 million people a year. (puts SARS into perspective doesn't it!) Malaria is in many cases a preventable disease and a death from malaria is a preventable death. Protect yourselves and if necessary seek early treatment. Keep safe, Gareth _________________________________________________________________ Find a cheaper internet access deal - choose one to suit you. http://www.msn.co.uk/internetaccess Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 25, 2003 Report Share Posted September 25, 2003 shoot him for being a waste of space and a oxygen thief! Cheers Tom g >From: " GARETH THOMAS " <gareththomas1@...> >Reply- > >Subject: Re: Scenario >Date: Wed, 24 Sep 2003 09:15:40 +0000 > >OK Guys, > >A lot of you are on the correct track. > >Our casualty was on shore for 4 days prior to coming out to the rig. > >He is not on any antimalarial despite being advised what to take because a) >they upset his stomach, he heard that they can send you nuts and c) it >will never happen to him / if it happens it happens and that is what the >medic is here for! > >The BBQs were in the evening and they stayed outside drinking until in to >the night. He was wearing a short sleeved shirt ( " it was hot " ) and he >didn't >use an insectacide. > >His temp is now soaring to over 39'C and he is having occasional rigors. He >is complaining of a more severe headache. He is getting drowsy and >lethargic. A neuro exam reveals hyper reflexia. There is protein and blood >in his urine. A BM stick of his blood sugar reveals him to be mildly >hypoglycaemic > >You perform a rapid diagnostic malaria test (e.g. OptiMal) and it is >positive for plasmodium falciparum. > >He is still vomiting. > >The question is what do we do now (apart from asking to change places with >our back to backs). > >Gareth > > > >From: " GARETH THOMAS " <gareththomas1@...> > >Reply- > > > >Subject: Re: Scenario > >Date: Tue, 23 Sep 2003 11:56:31 +0000 > > > >In answer to a few of the questions on initial presentation his BP was > >normotensive. The country that you are off the coast of is Equatorial > >Guinea. The patient has no past medical history and is not allergic to > >anything. > > > >You take him off duty and he is tolerating oral fluids although he is >still > >vomiting from time to time and has diarrhea (no blood observed from >either > >end). > > > >Something about his story does not ring true however and you check the > >personnel on board (POB) list. You find that although he is a new start >in > >that this is his first trip he has already been on board for a week. Yet > >his > >symptoms are new. > > > >You go to check up on him and find that he has upper left quadrant > >abdominal > >pain and on examination there is a possible splenomegaly. His temperature > >is > >now 38.8'c and he has a headache. > > > >Gareth > > > > > > >From: " GARETH THOMAS " <gareththomas1@...> > > >Reply- > > > > > >Subject: Scenario > > >Date: Mon, 22 Sep 2003 16:46:47 +0000 > > > > > >OK guys this is my first attempt at writing a scenario so be gentle >with > > >me..... > > > > > >You are spending a constructive if boring afternoon preparing the >flight > > >lists in the installations clinic, somewhere off the coast of west > >africa. > > >The drilling program keeps changing so your lists are no sooner >completed > > >than you have to start them all over again! To top matters off it is > >again > > >raining heavily and you have to go outside shortly to do the T cards >and > > >lifeboat lists. > > > > > >You are interrupted by the appearance of one of the ex pat new-starts >on > > >board. He is looking rather pale and is complaining of having " gastric > >Flu " > > >Which he blames on the barbeques that he had whilst undergoing his > > >induction > > >at the shore base. > > > > > >He complains of feeling " achy " like when he had the flu last year. > > > > > >On examination you note that his airway is clear and patent, > > > > > >His breathing is 18 breaths per min. normal pattern no difficulty, > > > > > >He has a good circulation capillary refill is <2 seconds with a >palpable > > >radial pulse of 92 beats per min. It is regular and otherwise > >unremarkable. > > > > > >He is pyrexial with a temperature of 38.2'C. > > > > > >He complained of mild generalised abdominal pain with Diarrhea 3 times > > >today > > >and moderate vomiting. > > > > > >The question is where do you go from here? > > > > > >Gareth > > > > > >_________________________________________________________________ > > >Find a cheaper internet access deal - choose one to suit you. > > >http://www.msn.co.uk/internetaccess > > > > > > >_________________________________________________________________ > >Express yourself with cool emoticons - download MSN Messenger today! > >http://www.msn.co.uk/messenger > > > >_________________________________________________________________ >Stay in touch with absent friends - get MSN Messenger >http://www.msn.co.uk/messenger > _________________________________________________________________ Get McAfee virus scanning and cleaning of incoming attachments. Get Hotmail Extra Storage! http://join.msn.com/?PAGE=features/es Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 26, 2003 Report Share Posted September 26, 2003 OK, we will rap up the PF malaria scenario now as most people seam to have the correct idea. Thanks to everyone who contributed to this fictional scenario, as I said it is the first one that I have done. I wanted to do a scenario for a number of reasons; a) the list was quiet, I wanted to learn (I have, thank you) and c) This subject is one that could affect us all no matter where we are based. Prior to my current job I had never come across a case of malaria despite being involved in health care for about 15 years (my current posting had a very steep learning curve on it!). However with the increase in international air travel it is something that we could come across back home as well as at work. Those of us who work in malarious regions unfortunately regularly hear of people dying from malaria. In the case of expats it is often not when they are at work (people are watching for the early signs and catch it early). It is often when they return home, develop flu like symptoms possibly with a headache + / - GI upset, they go to see the family doctor. Often malaria is not thought of and it is put down to a virus or the flu. By the time the mis- diagnosis is realised things are advanced often with tragic results. The greatest factor in ensuring survival from malaria is early diagnosis and treatment. Plasmodium Falciparum malaria is a rapidly progressive and horrible disease. The complications are horrendous and include: - Cerebral malaria (it can kill you in less than 24 hours) Acute renal failure (the old black water fever) Cardiac failure Pulmonary oedema acute anemia leading to hypoxia to the extent that they can arrest and die DIC possibly leading to amputation If they survive but it is not adequately treated the long term complications include tropical splenomegaly syndrome and nephrotic syndrome. It is estimated that between 100 million and 150 million people in the world have malaria and every year it kills about 1 million people. (puts SARS into perspective doesn't it!) Yet malaria is a largely preventable disease and a death from malaria is a preventable death. The general rule of thumb is that if someone has been exposed to a malarial region even if their plane only stopped there to load / unload and they did not get off, if they develop a fever between 1 week and 3 months of exposure (possibly up to 1 year post exposure) they should be tested for malaria. If in doubt treat as malaria and seek expert help. Once again thanks for every ones help, I realise that I may be preaching to the converted in a lot of cases on this list. Unfortunately the attitude of the fictional patient in the scenario is one that you do come across and whilst there are many times when I would like to take toms advice and put a certain patient down to put me out of my misery this is unfortunately not an argument that would stand up in the real world;-) Take care and keep safe Gareth _________________________________________________________________ Use MSN Messenger to send music and pics to your friends http://www.msn.co.uk/messenger Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 26, 2003 Report Share Posted September 26, 2003 Sorry for the double posting. For some reason I did not receive yesterdays post. I assumed that it had not got through so I resubmitted it. Once again thanks to everyone who took part in the PF Malaria scenario. An interesting point I have just been emailed the latest stats on Malaria and my origional ones are now out of date. The situation has deteriorated and there are now about 300 million people world wide suffering from malaria. WHO expect this to increase by about 16% a year. The estimated death rate for malaria is now 1.5 - 2 million deaths a year. (thanks to Mark Forrest for the stats). Keep safe, Gareth _________________________________________________________________ Use MSN Messenger to send music and pics to your friends http://www.msn.co.uk/messenger Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 17, 2004 Report Share Posted October 17, 2004 Scenario Now come on chaps if we are now talking a scenario where small arms are involved, personally would be looking at bringing the Helevac to me. As an exHHI I woud say contact heli crew give them a grid ref and bring them in on either smoke!! Crossed head light if night time, or just stick your hands in the air to indicate that you are their marshaller. And for that matter if this is a hostile environment what the hell is the ambulane doing out without an armed escort anyway? Ross over to you. Ian Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 17, 2004 Report Share Posted October 17, 2004 Ian, Fair comments. When we started putting the scenarios together it was with a UK prehospital focus of a rapid responder. The new scenarios are based on a remote medic situation. So to clarify: " You are the medic in charge for an onshore oil facility and mining corporation in a developing country near to the equator. The country is politically unstable and rebels are active. There is a large number of locals employed on your sites and you have rain forest nearby as well as some desert areas. Natives are on the whole very friendly, in some cases too friendly as HIV and various other ailments are commonplace. Part of your duties are as medical support for local workers and their families, in addition to managing healthcare and emergency cover for the work sites and expat employees. Each scenario will provide details of available resources and manpower in the location and timespan of the event. " I will try and publish alongside each part of any future scenario. Cheers, Ross > > > Now come on chaps if we are now talking > a scenario > where small arms > are involved, personally would be looking at > bringing the Helevac to > me. As an exHHI I woud say contact heli > crew give > them a grid ref and > bring them in on either smoke!! Crossed > head light > if night time, or > just stick your hands in the air to > indicate that > you are their > marshaller. And for that matter if this is a > hostile environment what > the hell is the ambulane doing out without an > armed escort anyway? > > Ross over to you. > > Ian > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 17, 2004 Report Share Posted October 17, 2004 On the 17/10/04 Ian Denton wrote: - " As an exHHI I woud say contact heli.............. " Pardon my ignorance but what is a HHI? A brief explanation would be appreciated as well as just what the letters stand for. Thanks in advance, Gareth Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 17, 2004 Report Share Posted October 17, 2004 Sorry Gareth, I forgot that there are a lot of non ex-military medics on this site. The Initials (HHI) stand for Helicopter Handling Instructor. There are various ways in which you can identify a safe landing zone to a pilot in an emergency. 1) Stand in a well cleared area with the wind in to your back and your hands straight up in the air. As the pilot decends on that position Bring your arms down horizontal and make the flapping motion with the arms lowering to your sides. The pilot in theory should land about 10m back and to you left. 2) a coloured smoke grenade, inform the pilot which colour you are going to use to indicate the area you would like him to land. 3) If you have them a two helicoter landing panels pegged out to form the shape of a " T " . One green the other bright pink normally. 4) Crossed vehical headlights with the vehicals about 60m apart forming a sort of V. 5) Finally you can use either right angle torches on tent pegs or a thing called a bardick light set to form a thing called a Nato T which will also indicate where to land. In any event most pilots will totally ignor where you want them and land where they want in the general area even if it means blowing your casualties half way down the field. Best Regards Ian. - > > " As an exHHI I woud say contact heli.............. " > > > Pardon my ignorance but what is a HHI? A brief explanation would be > appreciated as well as just what the letters stand for. > > Thanks in advance, > > Gareth Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 17, 2004 Report Share Posted October 17, 2004 Ian, Thanks for the input ....... there are so many abbreviations about that it is sometimes hard to keep track of what means what. I suppose the closest offshore analogy would be a HLO (Helicopter Landing Officer) although they tend to use a purposely designed helideck and radios as opposed to a conveniently flat and clear piece of bush. I had read about most of the methods that you state but fortunately have not had to use them in practice. In the UK at the moment in some ways air ambulances are becoming the flavor of the month (despite all the american stats that fail to show benefits from urban / near urban use with SHORT transport times). As a result although hopefully we will never be in the situation where we will have to use these signals it is potentially far more relevant to a civilian medic than it was 5 or 10 years ago. Gareth >From: " Ian Denton " <ianjamesdenton@...> >Reply- > >Subject: Re: FW: Scenario >Date: Sun, 17 Oct 2004 17:35:35 -0000 > > > > >Sorry Gareth, I forgot that there are a lot of non ex-military medics >on this site. The Initials (HHI) stand for Helicopter Handling >Instructor. There are various ways in which you can identify a safe >landing zone to a pilot in an emergency. > >1) Stand in a well cleared area with the wind in to your back and >your hands straight up in the air. As the pilot decends on that >position Bring your arms down horizontal and make the flapping motion >with the arms lowering to your sides. The pilot in theory should land >about 10m back and to you left. > >2) a coloured smoke grenade, inform the pilot which colour you are >going to use to indicate the area you would like him to land. > >3) If you have them a two helicoter landing panels pegged out to form >the shape of a " T " . One green the other bright pink normally. > >4) Crossed vehical headlights with the vehicals about 60m apart >forming a sort of V. > >5) Finally you can use either right angle torches on tent pegs or a >thing called a bardick light set to form a thing called a Nato T >which will also indicate where to land. In any event most pilots will >totally ignor where you want them and land where they want in the >general area even if it means blowing your casualties half way down >the field. > >Best Regards >Ian. > - > > > > " As an exHHI I woud say contact heli.............. " > > > > > > Pardon my ignorance but what is a HHI? A brief explanation would be > > appreciated as well as just what the letters stand for. > > > > Thanks in advance, > > > > Gareth > > > > > > Quote Link to comment Share on other sites More sharing options...
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