MICA

Victoria's MICA (Mobile Intensive Care Ambulance) concept was initially established in Victoria in 1971 under a trial program running out of the Royal Melbourne Hospital (RMH) with a single vehicle staffed by an Ambulance Officer and a Medical Registrar (from the hospital's Emergency Department). It was the first MICA system in Australia and the 3rd such system to be set up in the world, following behind Belfast & Seattle.

The concept of Mobilie Intensive Care Ambulances (MICA) was a development that was realised during the Vietnam War, where it appeared to show that the early stabilisation of seriously injured soilders at the battlefront by highly trained field medics, and the rapid transport to front line hospitals by medivac helicopters significantly increased survival rates. Cardiologists during the early 1960's believed that patients were dying before reaching hospital. Untreated coronary patients usually died within 2 to 4 hours, and often before arriving at Hospital. Moves were made for the establishment of "flying squads" or Mobile Coronary Care Units in conjunction with the then Victorian Civil Ambulance Service, emphasising the treatment of ventricular fibrillation following cardiac arrest or electric shock.

The ever-increasing road toll was also a great concern. In 1969, a seminar addressing the Management of Road Traffic Casualties was held by the the Royal Australasian College of Surgeons. During this seminar, Ambulance Officers were recognised as having the greater knowledge of caring for road accident victims at the scene. A sub-committee was formed which included the President of the Committee Of Management of Ambulance Service Melbourne (Mr Howard Toyne) to report on the conduct of emergency services and recommended the Mobile Intensive Care Ambulance concept, as well as a periodic review of accident statistics and the placing of Ambulance Stations in close proximity to hospital facilities.

in May 1971, the Victorian Government approved a three month feasibility trial. Two Ambulance Officer's - Assistant Superintendent Wall Ross (Training) and Assistant Superintendent Wal Byrne (Operations) were chosen for the trial. The training program consisted theoretical training in clinical sciences, cardiology, coronary care, respiratory and endocrine disorders, followed by four weeks of practical training at the Royal Melbourne Hospital developing skills in I V. therapy, fluid resuscitation, advanced cardiac respiratory resuscitation procedures; and a range of emergency surgical procedures including tension pneumothorax. A final week of training at the Royal Melbourne Hospital (RMH) was undertaken to familiarise the Officers with the required assistance that the Doctor would need at a case.

A Dodge Day Care Clinic Bus - 208 was converted for the trial as it provided additional space and head room compared to the current Ford F100 emergency ambulance vehicles in use. It was converted by the local Ambulance workshop to keep costs down as funding was extremely limited. All equipment purchased for the trial was to be privately funded by the Strathmore Lions Club.

The trial began on the 9th September 1971 with a crew of two - a Resident Medical Officer from RMH Emergency Department and a senior Ambulance Officer. During the trial, the Unit operated in a radius of ten kilometres of RMH. The unit attended 93 cases during this 3 month period and proved its worth with a number of lives saved. It was immediately apparent that all equipment had to be portable to allow it to be taken to the patient in the first instance rather than bringing the patient to the vehicle and changes were subsequently made.

Due to a lack of financial assistance, the MICA Unit ceased operations following the 3 month trial. Due to public response to the closing down of the Unit, the 'Hospitals and Charities Commission' intervened and guaranteed permanent funding and the Unit reopened two weeks later.

A review of the first six months of work demonstrated that the majority of work were cardiac cases. It was also realised that the increasing caseload was placing significant pressure on the Doctors, who also had their normal duties to perform in the Hospital, thus delaying the Unit from responding immediately as the Ambulance Officer would have search for an available Doctor to respond. The Doctors involved in the trial felt that Ambulance Officers with appropriate training were more than capable of replacing the Doctor on the unit.

As a result, 5th March 1973 saw the introduction of a second trained Ambulance Officer on each shift, replacing the Doctor. This allowed for improved response times and greater flexibility of the MICA Unit, knowing that a Doctor did not need to be found. This also saw a significant increase in the workload with dispatching to cases increasing by 500% in the month of March as Control Officers were more willing to activate the Unit knowing it would not require a Doctor to be found.

Melbourne's newly established MICA was the second "paramedic only" service in the world. In 1967 a similar service using Doctors was established in Belfast, Northern Ireland, and a paramedic-only service began in Seattle, Washington, USA in 1969. The first vehicle was joined by a second based at the Alfred Hospital, then a third at Western Hospital - Footscray.

Whilst the MICA system was developed within Victoria's Metropolitan region over the next 25 years with 10 dedicated MICA Branches established, it was not until 1995 that MICA Paramedics were officially able to begin practicing their skills in country areas.

In 2011, the Ambulance Victoria - a totalof 480 MICA Officers are employed in Victoria. The Metro region employs approx 200 MICA Paramedics stations at 8 dedicated MICA Units, and 16 additional MICA Rapid Response Units in Ford Territories, with an additional 30 MICA Clinical Support Officers also operating in rapid response Sedans. AV - Rural employs some 50 MICA Paramedics at it's 4 dedicated MICA Branches in Ballarat, Bendigo, Geelong and Morwell, 10 additional MICA Rapid Response Units in Ford Territories in selected areas across the State, and employs an additional 137 MICA Paramedics rostered at many other Branches throughout the state to give excellent state wide MICA coverage.

MICA Paramedics are able to perform the following advanced skills:

Capnography

CPAP

Cricothyrotomy

Defibrillation

ECG 12 Lead Monitoring

Endotracheal Intubation

Rapid Sequence Intubation

Intramuscular Injections

Intravenous Access

Intra-Osseous Needle Placement

Laryngeal Mask Insertion

Pulse Oximetry

Synchronised Cardioversion

MICA Paramedics are able to administer the following 25 drugs:

Adrenaline (for anaphylaxis, bradycardia, cardigenic shock, asthma & cardiac arrest)

Amiodarone (for Ventricular Tachycardia & Ventricular Fibrillation)

Anginine (for cardiac chest pain, pulmonary oedema & hypertension)

Aramine (for hypotension of SVTs & Viagra /Anginine induced hypotension)

Aspirin (for cardiac chest pain)

Atropine (for bradycardia & organophosphate overdose)

Atrovent (for asthma)

Ceftriaxone (for meningococcal septicemtia and septic shock)

Dextrose 5 % (for drug dilutions)

Dextrose 50% (for hypoglycaemia)

Fentanyl (for sedation to intubate and pain relief)

Glucagon (for hypoglycaemia)

Glutose Paste (for hypoglycaemia)

GTN Patches (for Chest Pain)

Hydrocortisone (for asthma and septic shock)

Lasix (for acute pulmonary oedema)

Lignocaine (for local anasthesia)

Maxalon (for nausea & penetrating eye injuries)

Midazolam (for seizures, chemical sedation and sedation to intubate)

Morphine (for pain relief & sedation to intubate)

Normal Saline (for fluid replacement and post cardiac arrest cooling)

Pancuronium (to maintain paralysis following intubation)

Narcan (for narcotic overdoses)

Penthrane (for pain)

Salbutamol (for asthma)

Sodium Bicarbonate (for cardiac arrest and TCA overdose)

Stemetil (for nausea)

Suxemethonium (for paralysing to intubate)

Verapamil (for SVTs)