But it sparked the beginning of an incredible 20-person, almost 14-hour operation by Ambulance Retrieval Victoria, one of the longest they’ve done, to save Rory and bring him from Bairnsdale Hospital on life support to The Alfred in Melbourne.
“They suspected I had COVID-19 because of my lungs. I don’t know how many times I got COVID-tested but it’s not pleasant.”
Rory was put into isolation, but his condition rapidly deteriorated.
“In Rory’s case we were concerned both about an autoimmune disease like Wegener’s and about the coronavirus infection,” said The Alfred’s intensive care specialist Aidan Burrell.
Dr Burrell received a distressed phonecall from a Bairnsdale doctor describing Rory’s condition and was then among a crew who flew out to Rory to assess and treat him.
It was 3.50am on May 8 when Rory’s case was referred to Ambulance Retrieval Victoria, Dr John Daley was the third coordinator in a long chain who began working to organise that crew. ARV is a branch of Ambulance Victoria and conducts complex movements of critically ill patients, which has included sending specialists to New Zealand to treat and transport two Melbourne patients injured in the White Island volcano tragedy in December last year.
ARV receives about 4000 referrals each year, providing specialist advice for patients, about half of whom are moved. An ARV coordinator assembles a crew that could include critical care nursing staff, paramedics, MICA paramedics, flight paramedics and sometimes medical registrars.
Dr Daley first considered sending a helicopter from The Alfred, but the weight of the life-saving equipment and the crew meant that wouldn’t work. So they diverted to a 50-minute flight at Essendon Airport to Bairnsdale Airport, where two ambulances were waiting for them. If they’d got to Rory much later he would have gone into cardiac arrest.
“Our job is often like running an emergency department with a blindfold on, with doctors you don’t know and patients that you can’t examine,” he said.
“Our job is often like running an emergency department with a blindfold on with doctors you don’t know and patients that you can’t examine,” he said.
It keeps him on his toes, Dr Daley says. After nine years with ARV he’s been to most – if not all – of the hospitals, landing strips and ambulance bays in Victoria.
“You just have to get yourself into the space of that hospital,” he said.
COVID-19 has brought its own complexity to ARV jobs.
Communicating with doctors in Bairnsdale was difficult, Dr Daley said, because Rory was in isolation, so Dr Daley couldn’t communicate directly with the people who were in the room performing procedures on him.
“It’s a real challenge, it’s doable, it just slows us down and makes us think a bit more.”
ARV has been central to planning for COVID-19. Director John McClure said the group received funding to expand their state-based platform REACH, a live dashboard that monitors the activity of every single intensive care unit in Victoria, to operate nationally.
“Our coordinators use this platform to decide where the best location is to move a patient in need,” he said.
The Critical Health Resource Information System (CHRIS) was developed in about three weeks and had every intensive care unit in Australia reporting their up-to-date information on bed capacity, ventilation capacity and how many COVID patients they had in their unit.
When Dr Burrell got to Rory, he already had a breathing tube in his mouth, was in a coma in deep sedation, and despite that, his respiratory function was still severely impaired.
His lungs had progressively filled with blood, and he was breathing at five to 10 per cent of his lung function.
“We converted him from being on a mechanical ventilator to adding in an additional pump, an oxygenator called ECMO (Extracorporeal membrane oxygenation) without that, he probably would have died,” Dr Burrell said.
A special ambulance (Complex Patient Ambulance Vehicle), one of only four or five in the state, transported Rory by road on full life-support from Bairnsdale to Melbourne.
He was later diagnosed with a rare autoimmune disease called Wegener’s.
Granulomatosis with polyangiitis (also known as Wegener’s) is a branch of vasculitis, in which the body’s own immune system attacks the blood vessels and it can present with bleeding and inflammation from the lungs, nose, throat, sinuses or cause kidney failure. In Rory’s case, it caused severe haemorrhaging in his lungs.
Rory’s life-saving journey
- May 8, 3.50am: Case referred to Ambulance Retrieval Victoria.
- 9am: ARV and doctors from The Alfred leave Air Ambulance Base at Essendon Fields.
- 10.15am: Crew flies for about an hour and arrives at Bairnsdale Hospital.
- Complex Patient Ambulance (CPAV) drives to Bairnsdale Hospital from Heyfield.
- 2.40pm: Rory loaded into CPAV vehicle.
- 5.30pm: He is driven about 280 kilometres to The Alfred, a journey that took nearly three hours.
Dr Burrell said it was a very rare condition.
“The hard problem is diagnosing it. People can follow the wrong pathway and get confused about the wrong diagnosis,” he said.
“Over a 10-year time span, we’ve had one other patient with Wegener’s who has needed full ECMO support.”
Rory remained in a coma for two-and-a-half weeks, during that time his 23rd birthday passed without fuss. “I was sedated so I wasn’t aware it was my 23rd birthday and no one could be there, not that I would have known anyway. I think I was in isolation.”
It took about five days for Rory to understand why he was in hospital once he was woken from his coma.
“I actually thought I was in a car accident. I was a bit confused as to why I was at The Alfred, all I remember was going to Bairnsdale hospital,” he said.
He also had to relearn how to eat, to walk and to get his strength back.
“Day by day as I got better, I could understand more and learnt I was going to have this condition for the rest of my life,” he said.
“There’s a lot of unknowns about it. It’s not curable but it is manageable.”
The volunteer paramedic, who had previously met Dr Daley when supporting other critically ill patients, has already had a hard year.
Living in Gippsland, this year his friends and family had dealt with droughts, landslides, the impact of COVID-19 on tourism as well as the Gippsland bushfires – which Rory fought as a CFA firefighter.
“Yeah, it’s been a hectic year for everybody. It affects everybody, especially in small communities.”
Despite being discharged for a day, in which he coughed up blood and had to return, he’s been in hospital for more than seven weeks.
“I keep asking myself, why did I get this disease, but they have no explanation of how people get it. It just happens,” he said.
Rory looks at Dr Burrell and shakes his head telling him just how grateful he is to them, Bairnsdale Hospital and the ARV crew for saving his life.
“I’ve never had anything like that before. I’ve never really been sick ever,” he said.
“I got told my chances of survival were very dim, and I made it and I’m just forever thankful. If it wasn’t for their quick thinking and getting down to Bairnsdale so fast, I wouldn’t be alive today.”
Nicole Precel is a journalist and audio video producer at The Age. She is also a documentary maker.