ANDREW MILLER: Bureaucrat bungling is the real reason we’re low on IV fluid, and it’s getting dangerous

We came from salt water; we still are salt water.

As complicated as things have become since we emerged from the primordial oceans and adapted to life on land, we are still mostly salt water on the inside.

My father was an army doctor. One of his withering phrases, prompted by the relentless mediocrity of the world, was “I don’t ask for much, just basic competence”.

This applied in all operational contexts, from the hospital to the backyard, where as a teen my reluctant attempts at gardening were a thorn in his side.

“Why would anyone rake into the wind? I don’t actually need help, just try not to sabotage.”

He had a khaki army medic’s bag — fascinating with its many zips, pockets and sliding boxes. There were Commonwealth of Australia shell dressings — compressed bandages with a cloth cover of instructions — “Do not handle wound or pad”; many coloured ampoules of drugs, some kept in the butter tray in the fridge between camping trip deployments; an eye irrigation apparatus for blast wounds and kids with sand-eye, and intravenous cannulas and syringes of various sizes.

There was a surgical kit for suturing wounds, emergency amputations, tracheostomies, and even a chest tube. The latter he once augmented with some cup hooks screwed into the ribs of a motorcyclist’s flailing, sucking chest wound, to MacGyver a batten splint. The unhappy ex-biker could then move enough air to survive to the next town.

“Without their tools, even the most skilled tradesman is just a spectator,” Dad would say.

He always carried several bags of normal saline and administered these to rollover victims in the ditch of treacherous country roads. “Never jerk the steering wheel,” he redundantly told one of them, so I would hear.

The “golden hour” principle of trauma — developed in war — includes aggressive resuscitation with fluids in the critical first 60 minutes.

Delay blood volume restoration, and a spiral of disordered bleeding and organ damage might make further efforts futile. We have to be prepared to act fast, be decisive, and in the case of planned surgery, avoid ever getting into that hole.

Modern surgery that might lose large amounts of blood is accomplished routinely, because we proactively handle fluids.

This is why Australian doctors are unamused that our access to intravenous fluid stocks, here in our allegedly developed country, is currently being curtailed, with a restrained outlook for the rest of the year.

Our governments are peddling porky pies that this is an international problem — force majeure — but our many contacts overseas deny having similar issues. Frankly, it’s embarrassing.

It looks like warnings of market shortfalls have been ignored, bureaucracy has been buck-passing, and we have a good old-fashioned national procurement bungle.

We saw during the pandemic that our heavy reliance on overseas suppliers for medical supplies was a serious weak point in national preparedness. Australia is famously girt by sea, so we cannot relax, thinking we will always be able to access things that are on the other side of it.

Sentences beginning with the word “surely” usually betray the innocent ignorance of the speaker. “Surely it can’t be that hard to put salt water in plastic bags?”

It takes an expensive, high-tech sterile facility, special bags, and testing to ensure predictable integrity.

We are now being told to reduce the amounts of IV fluid that we use for routine procedures, but we will not disadvantage our patients. We use fluids for a reason, and have not been wasting any significant quantities before now, so if supplies run low, some elective operations will have to be delayed as we quarantine enough for emergencies.

Hopefully someone will bypass the red tape and get intravenous fluids from across the sea, stat.

No one will accept responsibility for this spectacular display of mediocrity, but it’s reasonable for patients to demand that governments have sufficient basic competence to supply the simplest tools for our struggling health system.