In August- September 2024, I traveled to Melbourne, Australia, to participate in a toxicology rotation at The Austin Hospital.
As an emergency medicine resident, it is imperative that we learn how to evaluate and treat toxicologic overdoses, chemical and environmental exposures, and substance withdrawal, so I was very excited to do this month-long rotation. I worked in both the toxicology consultation service as well as the Victorian Poison Information Center (VPIC), which made for a robust training experience.
The toxicology service in Australia is rather different than in the United States. The environment is quite extreme, with multiple venomous snakes, spiders, and ants. In the state of Victoria, there are Brown, Tiger, and Black snakes. In other states of Australia, there are Taipans and Death Adder snakes. Venomous spiders include Red Belly (Black Widow), Brown Recluse, Trapdoor, Mouse, and Funnel-Web spiders. Venomous ants include Jack Jumper and Bull Dog ants. Exposure to these venoms can cause a host of neurologic issues, coagulation disturbance, and even death. Patients with these concerns are evaluated nearly daily, either through the emergency department or via phone calls to VPIC. Many of these phone calls come from ambulance crews who call the poison center en route with a patient. I thought this was a great way to start the patient’s care before even arriving in the emergency department. I believe adopting a similar practice in the United States would be beneficial in expediting definitive patient treatment.
Further, in Australia, abuse of gamma hydroxybutyrate (GHB) is common. Patients use GHB for its euphoric effects; however, many patients overdose and lose consciousness. Patients will present in the emergency department with a classic presentation of GCS 3, bradycardia, and constricted pupils. Because GHB abuse is so common, physicians will wait several hours to see if a patient spontaneously wakes up before doing any testing such as basic laboratory studies, CT head imaging, or even intubation. Drug screening for GHB by blood or urine is not available in the emergency department, so many times a patient’s drug exposure is determined by their clinical appearance and report of what they took. VPIC collects blood samples from overdose patients to monitor for novel adjuncts being introduced into the Australian street drug supply. At this time, fentanyl and carfentanyl have not yet been seen in the street drug supply.
Certain aspects of medicine in Australia are quite similar to the United States. Emergency department waiting room times can be very long, up to 8 hours or more. Further, at one point during my rotation, there were 60 patients in the waiting room, which is a record for me. At times, patients can be gridlocked in the emergency department due to no available beds or limited nursing staff on the ward. Since the COVID pandemic, these issues have plagued The Austin Hospital just as much as here in the United States.
One of my favorite aspects of this rotation was learning the different names for medical terminology. Acetaminophen is paracetamol or Panadol. There is also a modified release paracetamol, which can make using the Rumack- Matthew nomogram more tricky. Levophed or noepinephrine is called noradrenaline. When calling an ambulance, the phone number 000 is used instead of 911. Instead of medications coming in cylindric containers, most medications come in blister packs or Webster packs. When needing a doctor’s note for an excuse from work or school, patients would ask for a medical certificate. There were so many other interesting medical subtleties that I noted during my month in Australia, but these were my favorite highlights.
For other residents who still have time to schedule their away elective, I strongly recommend this rotation! Whether you are in emergency medicine, internal medicine, family medicine, or pediatrics, this rotation will serve you tremendously.