Retrieval of Rural and Remote Paracetamol Poisoning in Queensland

Paracetamol is commonly taken in overdose. Australian and New Zealand guidelines include specific recommendations on transferring patients with paracetamol poisoning, supporting local treatment of ingestions < 30 g in rural facilities, limiting need for transfer. We aim to investigate paracetamol overdose presentations attended by aeromedical retrieval services and the appropriateness of transfer.

This is a retrospective observational series of paracetamol overdose retrievals in Queensland, performed by LifeFlight Retrieval Medicine, Retrieval Services Queensland, and Royal Flying Doctors Service from January 2017 to December 2023. Cases were identified through each services' databases. Data extracted included details of ingestion, investigations, management, and the reason for patient transfer.

There were 272 cases retrieved during the study period. Retrieval data were available for 174, for inclusion. Paracetamol was taken in isolation in 65 (37%) cases. The median ingestion was 15.0 g (IQR: 10.0-25.0 g). An overdose of ≤ 30 g of paracetamol was taken in 100 (57%) presentations. The most commonly assigned primary reason for transfer was lack of pathology services (87, 50%); insufficient stocks of acetylcysteine occurred in 13 (8%) cases. Over the seven-year period, there were 60 (35%) potentially avoidable transfers, according to the ANZ guideline. Of these, 52 (30%) were retrieved due to unavailable pathology services and eight (5%) for insufficient acetylcysteine.

Increased availability of acetylcysteine in rural facilities paired with better alignment of treatment with ANZ toxicology guidelines may reduce the rate of transfer for paracetamol overdoses in Queensland.