Mission Impossible Lorna Leonard CNS Urology Surgery Harry Harris Anaesthetist from Adelaide South Australia Inspirational speaker at Urological Society of Australia and Australian New Zealand Urology Nurse Society Conference April, 2019 Saturday 23rd June 2018 • 13 lost in Thai cave – 12 boys (the Wild Boars football team) and their coach • Tham Luang Cave more than 10kms long • Boys all found alive 9 days later 2.6km from cave entrance Boys found alive 9 days later Found by British Navy Seals lead by Rick Stanton Rick emailed Harry to ask if Ketamine would be an option for sedation of the boys during extraction from the cave system. Planning • Craig Challen – diving buddy and retired vet • Accreditation by Thai authorities to practice in Thailand • Priorities – make a plan ! • - The boys safety • A 3 hour transit from the entrance to the Tham Luang cave for the experienced divers Nern Nom Sao • The air quality in the boys cave was horrendous due to the number of Chamber people and faecal contamination • Constant chill in cave Rescue options • All rescue plans were discussed by a team of British navy seals, divers and the boys families • Final plan needed to be checked and approved by the Thai government officials before the rescue could go ahead • Leave the boys in the cave until monsoon season ends • Other helpers had looked at the possibility of another entrance and abseiling the team out • Bring them out ASAP • Preparation: • Harry and Craig had discussed with the parents the weight of each boy. Nothing like • Harry and Craig went to back to check on the this had been team in the cave • The boys were fitted with special wetsuits with done before! hoods • Face mask had to be absolutely water tight • Oxygen and air cylinders placed in cave system Sedation • It was decided Ketamine was the only sedation option as spontaneous ventilations and cardiac stability are maintained • Harry had pre drawn up Ketamine syringes labelled with the amounts, strength and the body weights they were suitable for then placed in 3 ziplock bags • Each boy was given Xanax (Alprazolam) an anti anxiety drug by mouth to calm them • Ketamine was injected each leg • One at a time each boy to be taken out would swallow the Xanax tablet to make him feel a bit strange but relaxed and be helped into his wetsuit. • Ketamine injected Rescue • Mask tested Continue… • Hands tied • Each boy had their own air tank and were transported face down in underwater sections Almost out… • Each boy was brought out with one diver with assistance from others • Chamber 3 was relatively huge and there was no more under water dives • Each boy was checked by a doctor before being loaded in a sked stretcher for the last part of the journey • This was repeated 12 times over the next 3 days until all safely removed! Rescued Boys • After the monsoon season divers have returned to the cave and removed all equipment, the pulley system and anything that had been left there. Richard (Harry) Harris and Craig Challen “Real life heroes can be middle aged men with a touch of the trainspotter about them.” Well done lads! References • Harris, H.(2019). Harry Harris Oration – Annual Scientific Meeting, Brisbane, April, 2019. USANZ/ANZUNS • Massola, J. (2018). The Great Cave Rescue. Crows Nest NSW, Australia. Allen & Unwin.