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Making an impact in emergency medicine

As an Emergency Medicine registrar at The Townsville University Hospital, Dr Julia De Boos noticed a lot of her patients were coming in from Mount Isa.

Despite being attached to her tropical lifestyle, once she became an Emergency Medicine Physician, she found herself heading west for two shifts at the Mount Isa Emergency Department, one of the most remote in the country.  Two and a half years later, she still hasn’t left.

“We have the coolest patients in the Australia, they’re amazing.  With their patience, resilience, blunt honesty and determination, North West Queenslanders endure and survive illness and trauma, like few others in the country could.”

“Their pain tolerance is so high.  About half of the people with septic joints will walk in using them.  I’ve had people with ruptured spleens reporting no pain in the abdomen. 

 “If trauma is your thing come during rodeo season.  You’ll be amazed at what a hoof can do to any part of the body.  You’ll be amazed at what a person can survive and still be determined to beat their record at the next event.”

However, Dr De Boos is aware that much of what brings her patients to the hospital outside of rodeo injuries stems from extreme poverty and incredible levels of disempowerment.

She finds the ability to make a difference in the lives of those people deeply rewarding.

 “We have very high levels of serious illness in north west Queensland.  Possibly except for Alice Springs, you will never make as big an impact anywhere in the country as you can here.”

Now the Director of Emergency Medicine Training at the hospital, Dr De Boos believes Mount Isa provides registrars with a training experience second to none. 

Those training through the Australian College of Emergency Medicine can complete six months in Mount Isa, with the hospital soon applying to increase that to 12 months.

“It's totally different to training in cities. In metropolitan areas when a trauma arrives the trauma team might take over, or a person with chest pain may go straight to the Cath lab.  That can’t happen here.  We lyse STEMIs, reduce fractures, we do all of the sedation in the ED. 

“If a patient needs an art line or a central line, we put it in.  If a patient has a foreign body in their eye, you take it out.  Whether it be sepsis with acute pulmonary oedema, or severe renal failure with fluid overload, irrespective of the condition, with the exception of some surgical presentations, the initial stabilisation needs to be done by the ED, not by a flood of inpatient teams. 

“We also see diseases that a rarely seen in cities such as syphilis, rheumatic fever, and TB. Working here requires a different mindset.  If the patient walks in the door, we sort them out.  If they can’t walk in the door, we sort them out anyway.”

Despite the hands on nature and geographic isolation, registrars are fully supported with a team of specialists at the Townsville University Hospital on hand to give advice. 

“As a team we have to be very practical, flexible and good at discussing cases and performing procedures.  Townsville backs us up and gives us plans and suggestions, but we are the ones who actually have to do it.”

It’s not just the scope of practice that makes remote emergency medicine so enjoyable in Mount Isa.  Dr De Boos believes the size of the Department also ensures trainees get more hands on experience.

“Because we are a small ED we work with them on the areas they want to improve and they get good access to procedures.  You'll never have such good access to consultants as you do in Mount Isa because of our ratio of junior to senior doctors.”

Dr De Boos said the community in Mount Isa is very social and supportive and offers a lifestyle many junior doctors and registrars find hard to resist.

“We’re a very social bunch, that’s just how Mount Isa is.  There are lots of places to go, especially if you are into outdoor sports, mountain biking, climbing, and a surprising proportion of our junior doctors end up with four wheel drives.”

“Bluntly, cool patients, access to procedures, strong consultant support and support from a tertiary referral centre, with an amazing array of medical conditions.  It doesn’t get any better. 

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