Her life in my hands – the Robyn Neilson story

[Robyn] Glen Avon Station was a beautiful property. It was 40,000 acres; we ran approximately 6,000 herd of Brahman cross breeders. Well, we were 360 kilometres from Mackay and 100 kilometres from Moranbah, and they were our two nearest towns. So, we were between 15 and 20 kilometres from our nearest neighbours. We were all getting up and just about to have breakfast, a fellow who worked for our neighbours rang and said that there'd been a terrible accident on the property, that somebody had been caught in a post hole digger and had damaged their forearm. My first question was, are they alive? The answer was, yes. Are they conscious? And I didn't receive another answer after that. I had no idea of what I was going to walk into, so I called the Royal Flying Doctor 24 hour Service, and their response was, thank God you've rung because we've had a call about this accident, but we have no idea where to go. How do we get there?

[Cliff] It was about mid-morning. I recall getting a call saying they'd been an incident on a farm in which there appear to be a traumatic amputation. We were required to be tasked to an area which was pretty remote. I quickly managed to establish that it was going to take us a minimum of two hours from wheels up to wheels on the ground, before we were going to be able to provide medical assistance. The town of Moranbah was also about two hours away by car. We'd made contact with the local general practitioner and activated him, and we got hold of the rescue helicopter service out of Mackay 'cause I knew that the flying distance from Mackay would also be roundabout two hours, but could they get there before we got there to render support?

[Robyn] The impact of what I saw was horrific. I saw blood on the ground and then I then followed the trail of blood to the house, and I found my neighbour lying on the bed in the spare room, only semi-conscious. I was absolutely shocked, physically and mentally shocked. There was a sheet right up to the neck, the husband and the worker walked in at that time and the worker started to tell me about the injuries to the arm, and he was whispering to me that the arm was completely gone. The emotions with the injury being attached to somebody that you know, and care for, and respect, and work with, compound the impact that it has on the first responder. Her life was in my hands, I had to do everything that I could to sustain her until they got there. I snapped into what we used to call intensive care mode. Now, it had been 20 years since I'd practise clinically but it's a bit like riding a bike. I knew what I needed to do. After I clamped the blood vessels and they appeared to have clotted, I very gently rolled them over an ice cube. Most of the bleeding stopped. The only way that I could hydrate her was to ask her to follow my prompts, she was in and out of consciousness. I put my finger into her cheek and I made a pocket in her cheek, and I trickled water down into her cheek, and then I asked her to swallow. And over a period of two hours, I was able to administer about 450 mls of water to her, which was life-saving, yes, without that she would not have survived either. I called the Royal Flying Doctor Service number, and I gave them my assessment. Based on the information that I had given them they did not expect her to survive. I got a fairly big lump in my throat at that stage.

[Cliff] When I arrived at the scene, I felt as if I'd known Robyn my whole life. She remained constantly part of the rescue operation, and there is no doubt in my mind that the only reason the patient was alive still, was because of the care that Robyn had provided, as well as trying to provide some sense of calm in a situation in which was really chaotic and traumatic. Once we evacuated, that was the first time the reality was going to set in and as to the gravity of the situation.

[Robyn] I thought, I'm fine, but as soon as they left it was like this invisible wall went up around that room, I couldn't move. I was sort of frozen and I looked around the room and I thought, wow, did that really just happen or am I waking up from a dream? This is surreal. I don't remember how I got home, but I did get home and I remember having a discussion with my husband about the fact that the children were coming home from boarding school that afternoon. About 15 minutes after he left to go pick them up, I started to vomit, and just uncontrollably vomit and cry for no apparent reason. And I didn't know at the time, but that was the beginning of post-traumatic stress disorder.

[Sam] At the time, the way that I saw it as a teen was, ahh you know, understandable. It had been a big shocking event and our neighbour was a friend of ours, I perceived that as just being emotional about an impact that it had had on a friend and less so the impact that it had had on mum. Now, as a doctor and clinician, it's much easier to understand the impact that it has had on her. I think she went through a really acute stress response. It's a really unique situation to be in as a first responder in that instance, umm ahh and you know a lot of the focus is obviously on the patient and less so on the people that go through that process with the patient.

[Robyn] No, I couldn't talk about it. I didn't talk about it. All I could do was- I couldn't talk, umm I just cried, and the best thing they could do for me was hug me, which they did because they'd never seen mum like that. Mum was always the doer, she was the one who took control when things went wrong and I think it really shocked them to see me in that emotional state, particularly because I didn't understand what was happening to me, and I was able to say that to them, I don't know what's going on here.

[Nicole] Work related trauma really has a ripple effect. For most of us, that level of distress will decrease over time and revert back to a normal level of functioning. Post-traumatic stress is different in that it's more enduring, and a person is gonna experience ongoing distress and impact on functioning beyond a four week period, or a month. It's really important to learn about trauma and learn about normal responses. Listening is really important as well, and to offer practical help, and that practical help might be assisting that person to seek professional help and also just allowing the person time to adapt.

[Robyn] When the psychiatrist, who was the RFDS trauma counsellor, told me that I had post-traumatic stress disorder I could not understand it. Her explanation as to why I was so severely impacted was, number one, the lady was a neighbour and a friend of mine. The second thing was that I had been totally responsible for her life for what was considered a very long time, and that was two hours. Thirdly, that I had to really, really suppress all my emotions simply to be able to function. That has a massive impact. I think it's absolutely vital that everybody on rural cattle properties has their first aid certificate and that they practise it until it becomes second nature, because if it's not second nature, when you're called to do it, you'll freeze. It's really vital that machine guards are not taken off. If they're taken off for servicing, they must be replaced, or look for alternative machinery. Knowing the coordinates of the nearest airstrip is absolutely vital. I think a really big thing that I ask people now when I hear them talking about a near miss is, so if that wasn't a near miss and it was a catastrophe, do you have an evacuation plan? How will you tell emergency services how to get here? Where will they go? What will they use? Knowing your location is absolutely vital to a quick response from emergency services. And when you hear people working on your property say, we've always done it like that, my question to you is, if you're not prepared to be a first responder in a critical situation, then whose life are you prepared to sacrifice?

[Fiona] Robyn's message is very, very clear and really, it's the same as the message that we have with Workplace Health and Safety, Queensland. We want people to stop and think about their workplace, their workplace environment, put good steps in place to prevent a workplace incident, but also be so prepared that if one happens you know how to respond and respond properly. To minimise the risk of a workplace incident we need to ensure that our workplace environment can be as safe as it possibly can be. That means we have to have well-designed equipment that is properly maintained and only used for its intended purpose. When we're looking at the people using the equipment, we have to make sure they've got the right skillset to do the job properly. When we're looking at workplace environment, it's not just about if it's hot or if it's cold, it's all about that supportive environment. So, if I'm doing a job and I don't know how to do it properly, I know who to reach out to and say, mate, I need a hand. That is so critical. We need those supportive workplace environments which support good learning and good practise.

[Cliff] The first is that each person who lives on a rural property has a plan to say, in the case of a medical emergency, who do we call? What are our coordinates? Where is the nearest landing strip? Where is the closest medical outpost where I could potentially activate medical help? Are we in distance of a road transport emergency service? The exact coordinates are really, really important. Secondly is access to properties. How easy it is to unlock a gate. Is there a padlock on a gate? Is my property signposted and numbered easily enough to be seen? Are there any specific directions that need to be given? Are the roads actually named? Properties that have got RFDS landing strips, are these landing strips being inspected on a regular basis to ensure that they are safe to land on? And then, lastly is that constant ability to communicate. Where's your closest neighbour? Because that might be your first port of call, the next person that can provide you with emergency assistance.

[Fiona] When there's an incident in a rural community, it has a ripple effect through the whole community. It's not just the injured person, it's the first responders and all of those community members who rally around, and one thing the agriculture industry is really good at doing is rallying around.

[Cliff] Robyn has become an advocate for rural and farm safety. She's become a huge advocate in ensuring that people that live on the land have an evacuation plan, have a medical plan. And she's not only influenced many, many communities, she's influenced her entire family.

[Sam] Personally, I did go into medicine because of this incident. Even now, as a trained clinician, I don't know whether I would have responded the same way that she did. I'm very proud of the way in which she has taken a very challenging situation for herself and transformed it into such a wide reaching lesson to prevent that happening to someone else's family member, who may not be fortunate enough to have my mother living next door.

[Robyn] I think before people are prepared to become prepared for the unexpected, they have to see safety as a very serious issue. Everybody can save a life, and preparedness is absolutely vital.