There in a Heartbeat

Left in photo John Kearney Director WCRR, and right is Dr. Jason van der Velde volunteer on-call doctor with WCRR.

The West Cork Rapid Response Service is revitalising emergency treatment and fast

Article written by Ailin Quinlan, Irish Independent.

Health & Living Feature, published Monday, 4th April, 2011.

Nurse Arelene Duggan and her two small children had just finished lunch at her Mother’s house when their conversation was pierced by a series of horrifying shrieks.  As the adults rushed back into the kitchen a hair-raising sight met their eyes.   Arlene’s 12 month old son Daniel had crawled into the room and pulled the flex of the deep-fat fryer, overturning it and sending a river of boiling fat coursing down his tiny body.   The gadget, which had been used to cook lunch had just been turned off.   Oil poured down the baby’s back, arms and neck sending him into paroxysms of excruciating pain.   The child tried to escape by crawling through the fat, burning his hands and feet.  “The whole back of his body was very badly burned – he had third-degree burns” explains Areleen.

While her Mother rang the doctor,  Areleen put Daniel into the sink, took off his clothes and poured cold water on him.   The tiny tot was then rushed to the doctor’s surgery and an ambulance was called.   But somebody else came too – the award winning, community-funded West Cork Rapid Response service (WCRR), in the form of Dr. Jason van der Velde.

EMERGENCY

Set up in February 2009 through a mixture of fundraising methods, the initiative, which supports the existing HSE medical emergency services, keeps a Toyota Hilux 4  x 4 stationed a few miles outside the West Cork town of Dunmanway where the accident happened.

“Dr. Jason treated Daniel on the spot, putting him under anaesthetic and onto IV fluids” recalls Areleen.  “Daniel was getting intensive care treatment in the surgery and in the back of the ambulance”.   The priority for the WCRR is to get to the scene and provide a first-class medical treatment within the crucial “golden hour” – the period after an accident when the patient responds best to treatment.   “Sometimes the ambulance can’t get there in that time”  explains John Kearney one of the service founders.  “Even if it did, the patient still has to be brought  to a centre of excellence such as Cork University Hospital, which could be an hour or more away.   “What we are doing is bringing a doctor to the scene of a casualty – the doctor will treat the person on site and stay with them until the ambulance comes”.

“West Cork is a huge area and not always readily accessible.  We could be called to emergencies in remote farmhouses, or to the scene of a farming accident in a field a long way from the main road”.   Although only in operation for a little over 24 months, WCRR which last year won a prestigious Social Entrepreneur award, has now attracted significant attention from other parts of the country – communities in Tipperary, Limerick and Kerry have already been in touch with a view to implementing something similar.

“A number of other rural communities are interested in the WCRR model and  and how it’s funded.   We’ve had enquiries from communities in South Tipperary, Newcastlewest Co. Limerick and from people in South  Kerry area”, says John Kearney.   “These could be remote communities who would be consious of their distance  from centres of excellence.   They want a system to back up the existing frontline service”.   Some, he says, have visited the West Cork Rapid Response team and seen the 4 x 4, while  others are already negotiating with the HSE on the logistics of setting up a similar service, which costs about €50,000 a year to run – money that comes solely from fundraising. The “golden hour” intervention certainly worked for little Daniel.   Arelene Duggan believes WCRR may have saved her son’s life on that sunny afternoon in June 2009.   Daniel was rushed to Cork University Hospital for treatment – about an hour’s drive from Dunmanway – before being sent to Our Lady’s Children’s Hospital Crumlin, where he remained for nearly two months.   “He got skin grafts on most of his back and his foot.  It was a shocking experience – only for Dr. Jason’s experience and equipment, and the medication he had with him Daniel would have been awake throughout and suffering the most excruciating pain”.   “He may not have lived without Dr. Jason’s intervention – his body swelled to almost four times his normal size, and his neck swelled enormously, I think his airways could have closed only for Dr. Jason”.  

Little Daniel is one of 186 patients who have been treated through WCRR since it was established.   To date the service has saved 24 lives and prevented serious or permanent disibility in more than twice that number of people.   Dr. van der Velde (35) who works as an emergency department physician at the Mercy Hospital in Cork, is currently the only volunteer doctor operating the part-time service.   WCRR supports the whole West Cork area,  a sprawling region stretching from the tourist town of Kinsale, to remote Dursey Sound, a solid two hours away.

ADVANCED

However, the organisers expect to have several more volunteer medics on board within 18 months after a number of local GP’s, who have expressed an interest in donating their time to the service, complete an advanced trauma care course in the UK.   “Some of these doctors are already based in very remote areas of the West Cork region and would be very familiar with the territory and a lot closer than even we would be”, explains Kearney.    “Over the next 18 months we’re hoping to expand the service from just one man to a group of about five doctors who would be on call”.   Meanwhile the South-African born medic, who has a background in anaesthetics and intensive care, gives up three or four days a week to the service, responding to emergencies relayed to him through ambulance control.   “I’m generally available in my free time.   You have to do something for your community.  I could be out any time of day or night”, says the father of two, who keeps the 4 x 4 at his home in the West Cork countryside between Clonakilty and Dunmanway.   “The most calls I’d have done in a month would have been about 15, but it could go as low as 5 or 6.   I’ve treated people all over West Cork at all times of the day and night”.   Callouts can take anything from 20 mins to six hours.   “I deal with everything from road traffic accidents to heart attacks, burns, strokes, sepsis, farm machinery accidents, allergic reactions, pregancy and child birth.   I have attended childbirths on the roadsides”.   “The Gardai are generally surperb.  I go as part of a team and there are always Paramedics and the Gardai and the Fire Brigade.   I drive myself but there’s always someone there to meet me.”  says the Cape Town native, known locally as “Dr. Jason”.   The jeep has everything an ambulance has in terms of communication equipment so I’m constantly being updated by paramedics enroute to the scene.   I get directions and attend the scene or else intercept the ambulance enroute to CUH and provide intensive care enroute to the hospital”.   He is intrigued by the tendency of rural dwellers to downplay their injuries.  “You could have a farmer saying ‘I’ve hurt my arm’,  and when the paramedics get ther they could find the arm is severly injured or may even have been torn off.  A lot of people in rural communities tend to underplay the significance of their injuries”, observes van der Velde who has attended emergencies everywhere from mountain tops to remote farms.  ” I don’t think I’d have lived without Dr. Jason’s intervention”, says Joan Murphy** who suffered horrific injuries and had to be cut out of her car following a road traffic accident.   “I was lucky that Dr. Jason was there because he’s specially trained in pre hospital care.  By the time I got to hospital I was a lot further advanced in terms of treatment than if he hadn’t been there”.   ” The way I look at it, I’m lucky to be here.  I was told later on that I’d probably have died at the scene if he hadn’t been there with his expertise and equipment”.

However, Dr. van der Velde says it’s not just about life and death, “it’s about preventing permanent disability by having the right resources in place”.  It’s a constant battle to keep the service going.  “We are funded primarily by donations and fundraising.   We have a stall at a lot of major events and run coffee mornings, charity swims, triathlons, cycles, and businesses throughout the area have the old-style collection boxes for us”, says John Kearney.  “But it’s worth it”.

“A grandmother came up to me recently and said her baby grandchild would not be there only for our efforts.  When someone says something like that to you it’s very powerful.   It makes the struggle worthwhile”.

** not her real name.