rural remote

Rural and Remote Ultrasound Services in Australia

September 3, 2018

What is the FIFO Sonographer?  

Many of you may be familiar with the term FIFO in a mining sense –  A fly in fly out mine worker.  These are people who generally live in a large city or town and commute (Fly) to their place of work, generally a remote location; either a mining site or small township.  People generally work for a period of time (Say 2 weeks) and then return home for a rest period (say one week).

In Western Australia FIFO is a common phenomon, considering the state is large in expanse (bigger than France and Germany combined) and that one of our biggest industry’s and employers is the mining sector. The majority of our population lives in and around the big centres such as Perth, Bunbury, Albany, Geraldton and to the North Broome, on the coast, but a number of the smaller remote communities are inland either being based around mining enterprises, river system or indigenous communities, thus FIFO is a way of life.

We are a state of beautiful and magnificent extremes.  Beautiful coast lines, inland deserts, rainforests and everything in-between.

coast - desert - forest

The Australian government has made a committed to providing those people residing in remote locations with the same or equivalent medical services (Health care) as those people living in the city areas.

How is this achieved in Western Australia?

Well a portion is supported by FIFO Sonographers.

Here is a day in the life of a FIFO sonographer –  it is hard work, yet interesting, and worthwhile.  You really feel like you are making a difference in the healthcare of every patient you see.

420 am the alarm goes off, up and dressed off to the airport.  It’s still dark on the drive to the airport and on boarding the flight, the sun is only just starting to rise.

In Perth early in the morning the airport is bustling with activity. There are hundreds of other people heading off to work also. Generally, FIFO workers head of early and arrive back into Perth late. Is generally a sea of orange and yellow high visibility shirts, with a scattering of holiday makers throw in.

Today is a relatively short flight just One and half hours to our destination.  A townsite built predominantly around the mining sector, it is in fact one large open cut iron ore mine.  This town does however house a number of indigenous communities to its peripheries.

As an experienced FIFO sonographer this flight time is generally used as additional “Catch-up” sleep time…. A ‘rest before the storm’ so to speak!

As the piolet announces we are arriving, you are awoken with a jolt, looking out the window is a beautiful yet arid landscape. A stark contrast of scenery to where we left from in Perth city.  No skyscrapers, no city lights; just arid beautiful remote Australian bush. Red dirt, small scrubs, ravines, gorges and mountain ranges.

Its only short drive to the hospital, driven by a friendly taxi driver.  You are filled in on all of the happenings of the town over the past few weeks.  The taxi drivers are always keen to say “ Hi Ultrasound lady, how have you been”.   They are a wealth of knowledge, eyes and ears of the town; knowing the in’s and outs of everything…. Who and what was affected by the recent storm cell, How the mining company shares are going, and that a new Doctor has just arrived in town, which everyone is excited about.

“Small beautiful communities that always make us feel welcome”.

On arrival at the hospital, walking through the emergency department to Radiology; you are generally presented with a large (long); wide and varied list of Ultrasound examinations.  Generally, 20 minute appointments, with slightly longer time slots for extensive examinations. No two days are the same.  You must be resilient, autonomous and hard working.  There is not a lot of assistance with only a sole radiography and the FIFO sonographer onsite.

The Ultrasound Clinic only runs 2 times per week, Tuesday and Friday.    Generally, three to four appointments are left for Urgent/Emergency cases.  But over the course of the weekend these emergency cases can back up and you are often faced with a wad of urgent cases.  Who should be prioritises?? Who is on the ward?? Who is being flown out?  Who can wait till later in the week? These are the critical decisions to be made on the day.

There is a huge responsibility as a FIFO sonographer, in remote locations.  There is no radiologist or sonologist on site, generally no surgeons or consultants. Just general practitioners with a special interest in areas such as Obstetric, emergency medicine and anaesthetics.  The Royal Flying Doctors (RFDS) are also close by; often on standby for transfers out of town to larger tertiary sites if necessary.

This means that the Sonographer has a great deal more sovereignty and responsibility than those in city regions.  The sonographer generally operates as an all-rounder; diagnostic sonographer, orderly, administration personal, councillor, and service technician.   Discussing what is required with the General practitioner, organising appointments and preparation; prioritizing urgency, performing the examination and then providing an initial verbal diagnosis to the referrer.  Whilst all imaging is sent down the computer line to a PACS system for remote Radiologist for reporting.

The Australian RFDS Service is one of the largest and most comprehensive aeromedical services in the world. Flying patients to tertiary centres for advanced medical care. Twin jet Hawker 800 aircraft are used to transfer patients within WA.  At least one Registered Nurse and a Doctor will accompany the patients on their transfer.   They often in remote locations land on small airstrips or single lane roads, and/or dirt fields; all working towards transferring patients to either a large secondary or tertiary hospital in Western Australia.  Always ensuring optimal, specialised health care.

“The variety, challenge and experience that remote Ultrasound brings is amazing”.

The range of examinations and diagnosis’s in a day can be extremely varied from ectopics, to torn Achilles tendons, cholecystitis, to rose thorn (foreign body) localisation, and gynaecology assessment for fertility.  Follow-up arterial stents and twin pregnancy growth assessments.

Today starts with some general abdominal ultrasound examinations.  First emergency slot is filled with a query deep vein thrombosis (DVT) examination; the patient states that he has had swelling in his lower limb for 3 weeks, and has actually experienced general weight loss for 3 months.  There is no other medical history or trauma.  As an experienced sonographer I like to attain as much clinical history as possible, this helps both myself and the reporting radiologist provide an extensive report, and can aid in providing recommendations for further imaging.  The ultrasound examination demonstrates an extensive DVT arising from the common femoral vein (CFV) and extending down the femoral vein to the Popliteal vein.  Due to the extent of the DVT; the reporting radiologist was phoned, and with the associated clinical history an Abdominal ultrasound was performed (This site does not have CT and the closest machine is a 5-hour drive away).  Providing as much additional information to the referring practitioner is always advantageous to the outcome for the patient. A large solid mass was identified on the left kidney.  Results where phoned through to the GP.  The GP requested the patient be sent straight over to the clinic for further assessment, treatment and specialist referrals.

The next emergency patient of the day was an IVF patient with live Intra uterine pregnancy (IUP), but ongoing pelvic pain.  The ultrasound request queried Ovarian torsion.  On speaking with the patient, she had recently had ovulation stimulation, harvesting and a live embryo transfer. The ultrasound demonstrated a live 5 weeks 5 day Intra uterine pregnancy; with enlarged ovaries 300cc + bilaterally, with free fluid in the pelvis.  There was no ultrasound evidence of torsion, which was a relief to both the patient and referring doctor and Consultant Obstetrician/gynaecologist, based in Perth.  This patient was rebooked for the following week to reassess the ovaries and ensure their size were decreasing.

After completing multiple musculoskeletal cases; including shoulders, feet and knees, arterial studies, dating scans, anatomy scans and 3rd trimester Obstetrics examinations; and after missing my lunch break due to report write ups and discussions with the referring doctors, and physiotherapists; the end of the day is fast approaching.

But before the taxi returns, one of the general practitioner’s phones to ask whether a patient could be fitted in; they are querying abscess on a lateral right thigh.  The referring doctor is so concerned about the patient that they come in to view the examination and work out the plan of action.  The scan is performed; the assessment is made, and the practitioner is notified that the appearances are consistent with a large drainable abscess.  Following the referrers request the lesion is marked to ensure an adequate drainage position at a later date, measuring skin thickness and size of the lesion.

It can definitely be said that there is a never a dull moment working as a FIFO sonographer.  It is a hard-relentless role, but very rewarding. Both the patients and the broad medical team are always grateful for your hard work and effort.

“this is a gratifying feeling”

Finally the day is complete; I can finalise written reports; and provide verbals to the radiologist over the phone; clean up the room and power off the hard working Ultrasound machine.

When sitting in the taxi on the way to the airport; I take a deep breath.  Just a short one and a half hour flight home, a 45 minute car journey and bed awaits.

What a day!

Written by : Gail Crawford (Sonographer)

References:

  1. Royal Flying Doctors Service (RFDS) accessed 18.10.2017 https://www.flyingdoctor.org.au
  2. Australian Government Geo Science accessed 20.10.2017 http://www.ga.gov.au/scientific-topics/national-location-information/dimensions/australias-size-compared