Telehealth service supports local nurses to save Perth pre-schooler after Coral Bay snakebite

Pre-schooler Emilia Barnard is with us today thanks only to the combined efforts of a team of about a dozen medical professionals – including three on a video screen.

After the four-year-old was bitten by a snake in Coral Bay on WA Day, two nurses at the local nursing post were supported by a team including a doctor and two nurses from the Emergency Telehealth Service (ETS) in Perth, three local volunteer ambulance workers, an RFDS doctor and nurse, Poisons Information Service doctor and even the little girl’s parents.

Following Telehealth Awareness Week June 25-29, the case brings to light the expert and sometimes life-saving care families are receiving in rural and remote parts of WA thanks to the support of telehealth services such as the ETS.

One of the two Coral Bay nurses, Caroline Cordy-Hedge, said as a country nurse she couldn’t praise the ETS enough for providing this support to rural doctors and nurses 24 hours a day, seven days a week.

“They’ve really got your back,” she said.

Emilia and her parents were on the second day of a family holiday to Coral Bay on WA Day when, on their way to the beach, the little girl was bitten by a brown snake.

Her parents, Kari and David, raced her to the nursing post where they found two nurses doing handover for the start of a shift – Caroline and fellow Registered Nurse Jan Saxton.

While Jan called the ETS to ask them to “dial in” on a video link, Caroline quickly applied a pressure immobiliser bandage to stop the venom from spreading and talked Kari through calling 000.

The 000 call centre put out the call and three local ambulance volunteers left work and were at the nursing post within minutes.

Just as ETS doctor Peter Leman dialled into the room by video Emilia stopped breathing, screaming out “my head, my head!” before she collapsed on the gurney and stopped breathing.

While Caroline worked to ventilate Emilia, Dr Leman was within minutes able to fax through the paediatric resuscitation calculator to ensure the nurses had the correct dose of life-saving medications for her weight.

The little girl soon started breathing again, and still under the watchful eye of Dr Leman, the nurses managed to get intravenous drips into each arm to administer saline and then give her medications to control the pain and vomiting.

At this point and while the nurses were working on the upper part of her body, the doctor saw across the video link from his desk in Perth that Emilia’s legs were starting to thrash about as she regained consciousness, increasing the chance of the venom spreading through her body.

The ambulance volunteers were called on to locate a splint to restrain her, which they then helped secure. 

While Dr Leman was directing events in Coral Bay, he also instructed the two ETS nurses with him in Perth to call the Poisons Information Service to get advice from their on-call registrar about expert treatment, and the Royal Flying Doctor Service to arrange an evacuation.

Even with a Priority 1 evacuation, it was going to take the RFDS more than two hours to reach Coral Bay with the antivenom.

Fortunately, with the pain medications taking effect and the splint in place to settle her movements, the path of the venom slowed and Emilia began to stabilise.

It was at this point – only about 20 minutes after Emilia first arrived at the nursing post – that the medical staff realised she would be OK, and that the worst was over.

When the RFDS arrived, the little girl was sucking away on an icey pole.

The antivenom was administered by the RFDS and Emilia was flown to Princess Margaret Hospital where she spent a night under observation before being discharged.

But without the calm guidance and reassuring voice of Dr Leman – and the help of the ambulance volunteers and ETS nurses – the Coral Bay nurses are unlikely to have been able to make this happen.

Caroline, who worked for 12 years in Emergency at Princess Margaret Hospital, said the two Registered Nurses were buoyed by the support.

“Even with everything that was going on, I had such a high level of confidence in what I was doing because the ETS doctor was like that expert voice at the end of the bed who could see everything and was directing what was going on,” she said.

“It is an amazing feeling to know that there is also a team of highly experienced nurses running around behind the scenes organising the RFDS retrieval and expert consultations, in this case the toxicologist.

“I only became aware later of all the things that were going on and also how emotionally invested in Emilia’s care every one of them was.”

Dr Leman, who has worked at the ETS since its inception in 2012 and has almost two decades’ experience as an Emergency specialist, said though it was very much a team effort – including that of the “very diligent” RFDS doctor and nurse – he believed the nurses were largely to credit.

“This child’s outcome could have been very different without the brilliant and very skilful local nurses who were able to apply all their years of experience in this scenario,” he said.

The last word goes to Caroline.

“I have nursed many, many children in my long career in emergency nursing – some I will never forget and Emilia is certainly going to be one of those,” she said.

Healthcare delivered closer to home was under the spotlight last week as part of Telehealth Awareness Week, 25–29 June.

The week was organised by the WA Country Health Service and its service partners to highlight that healthcare delivered by telehealth is now widely available to country patients.

The ETS supports about 400 consultations a week at its 79 rural and remote nursing posts and hospitals across WA.

Its 60 emergency doctors provide support to rural and remote doctors and nurses 24 hours a day, seven days a week.

In addition to the ETS, people in most rural and remote towns across WA can access healthcare appointments using telehealth for more than 30 specialities including cancer services, surgical follow-up, respiratory medicine, blood-related disorders, orthopaedics as well as education for chronic conditions like diabetes and asthma.

Telehealth Awareness Week included the launch of a 1300 number for telehealth inquiries, a statewide regional advertising and social media campaign, new information materials for patients and healthcare professionals, and displays in hospitals and health centres across the State.

People can enquire about having an appointment by telehealth by asking their health professional or calling 1300 367 166.

More information about telehealth is available at

 www.healthywa.wa.gov.au/telehealth

Do you have a good telehealth story? Share it on your favourite social media channel with the hashtag #telehealthwa or on Patient Opinion

Fact File

• More than 17,000 Emergency Telehealth Service consultations in total were conducted in 2017 across the State.
• More than 65,000 patient consultations have been conducted via the ETS since its introduction in 2012.
• Around 75 per cent of the patients accessing ETS are discharged home or access care locally without needing to be transferred to another facility for further treatment.
• The ETS’s most distant site is Wyndham at 3,200km from Perth, the same distance as London to Athens.