OB in possible labor
Refer immediately to inpatient emergency RMT provider
Other than the 3 recognized truly Orthopedic Emergencies
- compartment syndrome
- compound fracture
- knee dislocation
that should likely require both a call to ANMC Ortho + medevac activation, you can likely send an ortho patient to Bethel ER with splint-sling-ice-elevation-pain control-crutches as indicated once you establish an intact neuro-vascular exam. For some cases, like a hip fracture for example, the patient may go directly to ANMC. You might be able to save one leg of a medevac (instead of a ramp-to-ramp transfer) and send the patient directly to ANMC. To do this, get an accepting doc at ANMC and then you can have LifeMed activate the Anchorage team instead of the Bethel team.
Sick patients that probably need to come in
These patients either have a compelling initial presentation or they have worsened in village follow-up. If vitals and exam are reassuring and spO2 is not <90%, they can probably come to Bethel ER or clinic on the next commercial flight or boat-ice road vehicle. If transport is unlikely or the clinical situation does not allow it, the next decision that needs to be made in conjunction with the CHA’s comfort level and resources available as well as weather conditions, is whether a medevac or more local treatment is indicated. Sometimes weather forces decision-making.
These patients can usually go in to Bethel ER commercially, sometimes requiring an escort after the pain is treated neither with IM morphine or PO TC3 or Tylenol-Motrin.
Fever in Infants less than 90 days
Infants under 3 months of age with a fever of 100.4° or greater must be evaluated in Bethel for a sepsis and/or meningitis work up and treatment if indicated. Infants with fevers 100.4° or greater with a normal exam, who are clinically stable, need to be evaluated within 12 hours in Bethel. These patients can come in by commercial flight, if there is one available in less than 8-10 hours. If it is after hours the patient can be monitored closely by the family at home and be rechecked by a CHA in the morning (or sooner if worse) to make sure the patient is still stable for commercial flight in. It is best not to pretreat these infants with Ceftriaxone unless there are weather delays or the patient is getting worse. Please consult the pediatrician on call if there is any question about what to do in these challenging RMT cases.
If the patient gets worse in the village…see emergency RMT section
Need more examples of sick patients that need to come in here…