Journal articles: 'Emergency medical services Victoria'

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Boyle, Malcolm J., M. ClinEpi, Erin C. Smith, and Frank L. Archer. "Trauma Incidents Attended by Emergency Medical Services in Victoria, Australia." Prehospital and Disaster Medicine 23, no. 1 (February 2008): 20–28. http://dx.doi.org/10.1017/s1049023x00005501.

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AbstractIntroduction:International literature describing the profile of trauma patients attended by a statewide emergency medical services (EMS) system is lacking. Most literature is limited to descriptions of trauma responses for a single emergency medical service, or to patients transported to a specific Level-1 trauma hospital. There is no Victorian or Australian literature describing the type of trauma patients transported by a state emergency medical service.Purpose:The purpose of this study was to define a profile of all trauma incidents attended by statewide EMS.Methods:A retrospective cohort study of all patient care records (PCR) for trauma responses attended by Victorian Ambulance Services for 2002 was conducted. Criteria for trauma categories were defined previously, and data were extracted from the PCRs and entered into a secure data repository for descriptive analysis to determine the trauma profile. Ethics committee approval was obtained.Results:There were 53,039 trauma incidents attended by emergency ambulances during the 12-month period. Of these, 1,566 patients were in physiological distress, 11,086 had a significant pattern of injury, and a further 8,931 had an identifiable mechanism of injury. The profile includes minor trauma (n = 9,342), standing falls (n = 20,511), no patient transported (n = 3,687), and deceased patients (n = 459).Conclusions:This is a unique analysis of prehospital trauma. It provides a baseline dataset that may be utilized in future studies of prehospital trauma care. Additionally, this dataset identifies a ten-fold difference in major trauma between the prehospital and the hospital assessments.

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Cox, Shelley, Renee Roggenkamp, Stephen Bernard, and Karen Smith. "The epidemiology of elderly falls attended by emergency medical services in Victoria, Australia." Injury 49, no. 9 (September 2018): 1712–19. http://dx.doi.org/10.1016/j.injury.2018.06.038.

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Bloom, Jason E., Emily Andrew, Luke P. Dawson, Ziad Nehme, Michael Stephenson, David Anderson, Himawan Fernando, et al. "Incidence and Outcomes of Nontraumatic Shock in Adults Using Emergency Medical Services in Victoria, Australia." JAMA Network Open 5, no. 1 (January 26, 2022): e2145179. http://dx.doi.org/10.1001/jamanetworkopen.2021.45179.

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McDonald, Paul. "From Streets to Sidewalks: Developments in Primary Care Services for Injecting Drug Users." Australian Journal of Primary Health 8, no. 1 (2002): 65. http://dx.doi.org/10.1071/py02010.

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Primary Health Care for the Injecting Drug User (IDU) has been established in Victoria in recognition of the serious health needs of IDUs, which require a relevant and effective response. Research shows the medical consequences that flow from drug abuse, ranging from the onset of blood borne viruses to cardiovascular conditions, and the propensity of drug users to access health services only through accident and emergency areas of hospitals. In 1999, the Victorian government announced the funding of five Local Drug Strategies in five of Melbourne's 'hotspot' street drug areas to address both the needs of users and communities in relation to substance abuse. This funding was an impetus to establish and trial the concept of primary health services, combining both a fixed site and a mobile outreach service. These services are designed to meet the primary health needs of street-based injecting drug users who are at high risk of experiencing overdose or other forms of drug-related harm.

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Finch, Alexandra, Shelley Cox, Stephen Bernard, Warwick Teague, and Karen Smith. "The epidemiology of paediatric off-road motorcycle trauma attended by emergency medical services in Victoria, Australia." Injury 51, no. 9 (September 2020): 2016–24. http://dx.doi.org/10.1016/j.injury.2020.03.036.

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Gao, Crystal, Zheng Jie Lim, Sabrina Yeh, Scott Santinon, Scott De Haas, and Kristy Austin. "Assessing the Efficacy of a One-day Structured Induction Program in Orienting Clinical Staff to a Novel Prehospital Medical Deployment Model." Prehospital and Disaster Medicine 34, s1 (May 2019): s102—s103. http://dx.doi.org/10.1017/s1049023x19002127.

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Introduction:St. John Ambulance Victoria provides first aid and medical services at a variety of mass gathering events (MGEs) throughout Victoria. Volunteer healthcare professionals and students (termed “volunteers”) form Medical Assistance Teams (MAT) at these MGEs. MAT deployments manage a variety of patient presentations which include critically ill patients. This reduces high acuity patient transfers to the hospital and, where possible, avoid ambulance and hospital utilization.Aim:To determine the effectiveness of interdisciplinary prehospital simulation workshops in preparing volunteers for MAT deployment at MGEs.Methods:A one-day, simulation-based training session within the MAT environment was implemented to introduce volunteers to the management of various scenarios faced at MGEs. All volunteers were provided an orientation to the equipment and setting up MAT deployments at MGEs. Volunteers then participated in interdisciplinary group-based scenarios such as cardiac arrest management, drug intoxication, spinal injuries, agitated patients, and airway management. To determine the effectiveness of this training session, volunteers were invited to participate in a post-training survey, comprising of Likert scores and open-ended responses.Results:Seventeen volunteers attended the training session with 10 (58.8%) completing the post-training survey. Volunteers were satisfied with environment familiarization in the MAT (Average 4.47/5.00) and found the simulation-based training helpful (Average 3.67/4.00). The induction overall was well-received (4.60/5.00) with volunteers feeling more confident in being deployed at MGEs (4.20/5.00).Discussion:The results of the simulation-based training session were positive with volunteers receptive to the need for a training day prior to MAT deployment at MGEs. The simulation session enables volunteers to be comfortable with working in MAT and managing a diverse range of patients at MGEs. This session is likely to improve interdisciplinary communication and teamwork in the MAT. Future research is aimed at following these volunteers after several MAT deployments to improve the training session for future participants.

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Eastwood, Kathryn, Stuart Howell, Ziad Nehme, Judith Finn, Karen Smith, Peter Cameron, Dion Stub, and Janet E. Bray. "Impact of a mass media campaign on presentations and ambulance use for acute coronary syndrome." Open Heart 8, no. 2 (October 2021): e001792. http://dx.doi.org/10.1136/openhrt-2021-001792.

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ObjectiveBetween 2009 and 2013, the National Heart Foundation of Australia ran mass media campaigns to improve Australian’s awareness of acute coronary syndrome (ACS) symptoms and the need to call emergency medical services (EMS). This study examined the impact of this campaign on emergency department (ED) presentations and EMS use in Victoria, Australia.MethodsThe Victorian Department of Health and Human Services provided data for adult Victorian patients presenting to public hospitals with an ED diagnosis of ACS or unspecified chest pain (U-CP). We modelled changes in the incidence of ED presentations, and the association between the campaign period and (1) EMS arrival and (2) referred to ED by a general practitioner (GP). Models were adjusted for increasing population size, ACS subtype and demographics.ResultsBetween 2003 and 2015, there were 124 632 eligible ED presentations with ACS and 536 148 with U-CP. In patients with ACS, the campaign period was associated with an increase in ED presentations (incidence rate ratio: 1.11; 95% CI 1.07 to 1.15), a decrease in presentations via a GP (adjusted OR (AOR): 0.77; 95% CI 0.70 to 0.86) and an increase in EMS use (AOR: 1.10; 95% CI 1.05 to 1.17). Similar, but smaller associations were seen in U-CP.ConclusionsThe Warning Signs Campaign was associated with improvements in treatment seeking in patients with ACS—including increased EMS use. The increase in ACS ED presentations corresponds with a decrease in out-of-hospital cardiac arrest over this time. Future education needs to focus on improving EMS use in ACS patient groups where use remains low.

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Parkinson, Debra, Alyssa Duncan, Jaspreet Kaur, Frank Archer, and Caroline Spencer. "Gendered aspects of long-term disaster resilience in Victoria, Australia." January 2022 10.47389/37, no. 37.1 (January 2022): 59–64. http://dx.doi.org/10.47389/37.1.59.

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Research conducted in 2018 documented the disaster experiences of 56 women and men in Australia aged between 18 and 93 years. This paper draws out the gendered factors that affected their resilience, and in so doing, begins to address the dearth of research related to gendered aspects of long-term disaster resilience. It is unique in capturing the voices of survivors who spoke of events 9 years after the 2009 Black Saturday fires and of earlier fires and floods in Victoria more than 50 years ago, including the 1983 Ash Wednesday fires. Over decades, gendered expectations of men and women significantly hindered resilience. Men spoke of the long-term cost to them of demands to ‘be strong’ in the worst of disasters and reasons they were reluctant to seek help afterwards. Women spoke of their contributions holding a lesser value and of discrimination. Discussions of violence against women and children after disaster, and suicide ideation in anticipation of future disasters offered critical insights. Protective factors identified by informants were not wholly intrinsic to their character but were also physical, such as essential resources provided in the immediate aftermath, and psychological and community support offered in the long-term. Factors that helped resilience departed from the ‘masculine’ model of coping post-disaster by moving away from a refusal to admit trauma and suffering, to community-wide resilience bolstered by widespread emotional, social and psychological support. Genuine community planning for disasters before they strike builds trust and offers insights for emergency management planners.

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Meadley, Ben, Stefan Heschl, Emily Andrew, Anthony de Wit, Stephen A. Bernard, and Karen Smith. "A Paramedic-staffed Helicopter Emergency Medical Service's Response to Winch Missions in Victoria, Australia." Prehospital Emergency Care 20, no. 1 (May 20, 2015): 106–10. http://dx.doi.org/10.3109/10903127.2015.1037479.

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Cartledge, S., J. Bray, D. Stub, P. Ngu, L. Straney, M. Stewart, W. Keech, H. Patsamanis, J. Shaw, and J. Finn. "Factors Associated with Emergency Medical Service Use for Acute Coronary Syndrome Patients in Victoria." Heart, Lung and Circulation 25 (August 2016): S45. http://dx.doi.org/10.1016/j.hlc.2016.06.103.

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Andrew, E., A. de Wit, B. Meadley, S. Cox, S. Bernard, and K. Smith. "Characteristics of Patients Transported by a Paramedic-staffed Helicopter Emergency Medical Service in Victoria, Australia." Prehospital Emergency Care 19, no. 3 (February 17, 2015): 416–24. http://dx.doi.org/10.3109/10903127.2014.995846.

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Gao, Crystal, Zheng Jie Lim, Brendan Freestone, Kristy Austin, and Rob McManus. "Use of a Novel Electronic Patient Care Record System at Mass Gathering Events by St. John Ambulance Victoria." Prehospital and Disaster Medicine 34, s1 (May 2019): s88. http://dx.doi.org/10.1017/s1049023x19001845.

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Introduction:The growing number of mass gathering events (MGEs) in Victoria has seen an increase in demand for event health services and the need for real-time reporting of medical incidents at these events.Aim:Since 2016, St. John Ambulance Victoria has introduced an electronic patient care record (ePCR) system with the aim of improving patient care and satisfaction. It appears that this ePCR system is the first of its kind to be trialed at MGEs by a volunteer organization.Methods:A qualitative study was conducted to determine strengths and limitations of the ePCR system by compiling results of surveys and interviews and through anonymous feedback from volunteers and patrons (event organizers, patients). This study is ongoing.Results:It was found that the use of ePCR: 1.Allowed for collection of relevant data to assist in future planning of MGEs2.Aids the overall coordination of first aid delivery at MGEs -faster relaying of patient information to event commanders-reduction of paperwork-improved ability to locate first aid crews using GPS tracking3.Received positive feedback from first aiders, event organizers, and patrons4.Was deemed easy-to-use (4/5), acceptable (4.3/5), and helpful (4.1/5) by our membersDiscussion:These experiences demonstrate that ePCR is well-received, easy to use, and leads to improved patient satisfaction and treatment outcomes at MGEs. Furthermore, the ability to collect and analyze real-time data such as GPS location tracking, incidence heat maps, and patient demographics facilitate future event planning and resource allocation at MGEs. It is acknowledged that this study is preliminary, and the trialed use of an ePCR system has been limited to metropolitan areas and MGEs with <1 million patrons. The intent is to continue this study and explore the use of ePCRs at larger MGEs and events in rural or regional areas.

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Levitan, Mark, Madelyn P. Law, Richard Ferron, and Karen Lutz-Graul. "Paramedics’ Perspectives on Factors Impacting On-Scene Times for Trauma Calls." Prehospital and Disaster Medicine 33, no. 3 (May 6, 2018): 250–55. http://dx.doi.org/10.1017/s1049023x18000389.

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AbstractIntroductionAccording to Ontario, Canada’s Basic Life Support Patient Care Standards, Emergency Medical Services (EMS) on-scene time (OST) for trauma calls should not exceed 10 minutes, unless there are extenuating circumstances. The time to definitive care can have a significant impact on the morbidity and mortality of trauma patients. This is the first Canadian study to investigate why this is the case by giving a voice to those most involved in prehospital care: the paramedics themselves. It is also the first study to explore this issue from a complex, adaptive systems approach which recognizes that OSTs may be impacted by local, contextual features.ProblemResearch addressed the following problem: what are the facilitators and barriers to achieving 10-minute OSTs?MethodsThis project used a descriptive, qualitative design to examine facilitators and barriers to achieving 10-minute OSTs on trauma calls, from the perspective of paramedics. Paramedics from a regional Emergency Services organization were interviewed extensively over the course of one year, using qualitative interviewing techniques developed by experts in that field. All interviews were recorded, transcribed, and entered into NVivo for Mac (QSR International; Victoria, Australia) software that supports qualitative research, for ease of data analysis. Researcher triangulation was used to ensure credibility of the data.ResultsThirteen percent of the calls had OSTs that were less than 10 minutes. The following six categories were outlined by the paramedics as impacting the duration of OSTs: (1) scene characteristics; (2) the presence and effectiveness of allied services; (3) communication with dispatch; (4) the paramedics’ ability to effectively manage the scene; (5) current policies; and (6) the quantity and design of equipment.ConclusionThese findings demonstrate the complexity of the prehospital environment and bring into question the feasibility of the 10-minute OST standard.LevitanM,LawMP,FerronR,Lutz-GraulK.Paramedics’ perspectives on factors impacting on-scene times for trauma calls.Prehosp Disaster Med.2018;33(3):250–255.

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Sullivan, Elise, Karen Francis, and Desley Hegney. "Review of small rural health services in Victoria: how does the nursing-medical division of labour affect access to emergency care?" Journal of Clinical Nursing 17, no. 12 (June 2008): 1543–52. http://dx.doi.org/10.1111/j.1365-2702.2007.02087.x.

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Alrawashdeh, Ahmad, Ziad Nehme, Brett Williams, Karen Smith, Michael Stephenson, Stephen Bernard, Peter Cameron, and Dion Stub. "Factors associated with emergency medical service delays in suspected ST‐elevation myocardial infarction in Victoria, Australia: A retrospective study." Emergency Medicine Australasia 32, no. 5 (May 9, 2020): 777–85. http://dx.doi.org/10.1111/1742-6723.13512.

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Dufty, Neil. "Understanding and improving community flood preparedness and response: a research framework." April 2021 10.47389/36, No 2 (April 2021): 19–25. http://dx.doi.org/10.47389/36.2.19.

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Many social research projects identify issues with community disaster preparedness and response but struggle to attribute these issues to underlying causes and recommend possible ways to address them. A research framework that considers the underlying causes of preparedness and response and possible interventions was developed for the Wimmera region of Victoria, Australia. The research framework was developed in conjunction with the Wimmera Catchment Management Authority and tested in a social research project across 6 communities in the Wimmera region. This paper provides an outline and rationale for the components of the research framework. It also summarises the regional flood insight afforded by the research framework. The research framework, albeit with some limitations, has universal appeal not only in the examination of community flood preparedness and response, but also for other hazards and other parts of the disaster management cycle.

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Jan Forbes, Rouve, and Julie Williams. "The role of acknowledgment in the psychosocial recovery of young adults in disaster events." April 2021 10.47389/36, No 2 (April 2021): 42–47. http://dx.doi.org/10.47389/36.2.42.

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In 2009, 4 major bushfires destroyed vast areas of Gippsland in eastern Victoria including the areas around Delburn, Bunyip, Churchill and Wilsons Promontory. These are collectively known as the 2009 Gippsland bushfires. Research was conducted to investigate the psychosocial recovery of young adults in these areas. Twenty young adults participated in the study and, while these young adults are not an homogenous group, commonalities were identified across their stories. Asked what would have helped their recovery, the participants all said that acknowledgment of their personal and age-specific needs was the single most important factor that enabled or impeded recovery. This paper describes some of their stories. The paper looks at how participants viewed acknowledgment and the effects of its absence on their psychosocial recovery and how they felt unacknowledged in local recovery supports. The paper reports on the findings of this research and suggests an approach for management and longer-term recovery support that is inclusive of the specific needs of young adults.

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Gibney, Katherine B., Lucy O. Attwood, Suellen Nicholson, Thomas Tran, Julian Druce, Julia Healy, Janet Strachan, Lucinda Franklin, Robert Hall, and Gail B. Cross. "Emergence of Attenuated Measles Illness Among IgG-positive/IgM-negative Measles Cases: Victoria, Australia, 2008–2017." Clinical Infectious Diseases 70, no. 6 (May 16, 2019): 1060–67. http://dx.doi.org/10.1093/cid/ciz363.

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Abstract Background Waning measles immunity among vaccinated individuals may result in an attenuated illness. This study compares the epidemiological, clinical, and laboratory profile of measles cases with waning immunity with other measles cases. Methods Polymerase chain reaction–positive (+) measles cases notified to Victoria’s Department of Health and Human Services from 2008 to 2017 with immunoglobulin (Ig) M and IgG tested at diagnosis were classified according to serology at diagnosis: IgG negative (−) (nonimmune), IgM+/IgG+ (indeterminate), or IgM−/IgG+ (waning immunity). Results Between 2008 and 2017, 297 measles cases were notified, of whom 190 (64%) were included; 151 of 190 (79%) were nonimmune at diagnosis, 26 (14%) were indeterminate, and 13 (7%) had waning immunity. Between 2008–2013 and 2014–2017, the proportion of cases with waning immunity increased from 0 of 87 (0%) to 13 of 103 (13%) (P < .001) and the diagnostic sensitivity of initial IgM fell from 93% to 81% (P = .012), respectively. Seven (54%) waning immunity cases reported receiving measles-containing vaccines; 1 case had 2 documented doses. Compared with nonimmune and indeterminate cases, waning immunity cases were more likely to be male; less likely to report fever, coryza, and cough; and had lower burden of virus (higher cycle threshold values). Waning immunity cases had higher IgG titers than indeterminate cases (mean optical density values, 1.96 vs 0.71; P = .004). Onward transmission from 1 waning immunity case was documented. Conclusions Waning immunity among measles cases, associated with secondary vaccine failure and modified clinical illness, is emerging in Victoria with transmission potential.

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Lijovic, Marijana, Marijana Lijovic, Karen Smith, Karen Smith, and Karen Smith. "The impact of increasing emergency medical services response time over a 10 year period on survival from out-of-hospital cardiac arrest in Victoria, Australia." Resuscitation 96 (November 2015): 29. http://dx.doi.org/10.1016/j.resuscitation.2015.09.067.

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Mercier, E., E. Andrew, Z. Nehme, M. Lijovic, S. Bernard, and K. Smith. "LO73: Long-term functional outcome and health-related quality of life of elderly out-of-hospital cardiac arrest survivors." CJEM 19, S1 (May 2017): S53. http://dx.doi.org/10.1017/cem.2017.135.

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Introduction: This study aims to describe the long-term functional outcome and health-related quality of life of elderly (≥65 years old) out-of-hospital cardiac arrest (OHCA) survivors in Victoria, Australia. Methods: Elderly OHCA patients who arrested between January 1st, 2010 and December 31st, 2014 were identified from the Victorian Ambulance Cardiac Arrest Registry (VACAR). Living status, Glasgow Outcome Scale-Extended (GOS-E), Euro-QoL (EQ-5D) and Twelve-item Short Form (SF-12) Health Survey were collected by telephone 12 months following the OHCA. Results: Emergency medical services attended on 14,678 elderly OHCA during the study period, 6,851 (46.7%) of which received a resuscitation attempt. Of these, 668 patients (9.8%) survived to hospital discharge. The mean age of the survivors was 75 (standard deviation (SD) 7.4) years and 504 (75.4%) were male. Eighty-five patients subsequently died within 12 months of their OHCA. A total of 483 patients were interviewed (response rate 82.9%). At 12 months, 313 responders (64.9%) were living at home without care. Most responders (n=324 (67.2%)) had a good long-term functional recovery with a GOS-E ≥7. The proportion of patients with a GOS-E≥7 progressively decreased with increasing age (65-74 years: 66.1%, 75-84 years: 53.0%,≥85 years: 27.3%). On the EQ-5D, the majority of survivors reported no problem with mobility (n=266 (55.1%)), self-care (n=403 (83.4%)), activity (n=293 (60.6%)), pain (n=335 (69.3%)) and anxiety (n=358 (74.1%)). On the SF-12, the mean mental component summary was 56.3 (SD 6.6) while the mean physical component summary was 44.7 (SD 11.4) (both measures range from 0-100). Among the 1,951 patients who arrested in a supported accommodation, 849 (43.5%) had a resuscitation attempt, and of these, 21 survived to hospital discharge (2.5%). Only eight (1.0%) of these patients were still alive 12 months after the OHCA and one survivor (0.12%) had a good functional outcome (GOS-E≥7). Conclusion: Most elderly OHCA survivors have an adequate long-term functional status and health-related quality of life. However, the likelihood of having a good functional recovery decreases with increasing age, and is rare for patients arresting in a supported accommodation.

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Considine, Julie, Anastasia F. Hutchison, Helen Rawson, Alison M. Hutchinson, Tracey Bucknall, Trisha Dunning, Mari Botti, Maxine M. Duke, and Maryann Street. "Comparison of policies for recognising and responding to clinical deterioration across five Victorian health services." Australian Health Review 42, no. 4 (2018): 412. http://dx.doi.org/10.1071/ah16265.

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Objectives The aim of the present study was to describe and compare organisational guidance documents related to recognising and responding to clinical deterioration across five health services in Victoria, Australia. Methods Guidance documents were obtained from five health services, comprising 13 acute care hospitals, eight subacute care hospitals and approximately 5500 beds. Analysis was guided by a specific policy analysis framework and a priori themes. Results In all, 22 guidance documents and five graphic observation and response charts were reviewed. Variation was observed in terminology, content and recommendations between the health services. Most health services’ definitions of physiological observations fulfilled national standards in terms of minimum parameters and frequency of assessment. All health services had three-tier rapid response systems (RRS) in place at both acute and subacute care sites, consisting of activation criteria and an expected response. RRS activation criteria varied between sites, with all sites requiring modifications to RRS activation criteria to be made by medical staff. All sites had processes for patient and family escalation of care. Conclusions Current guidance documents related to the frequency of observations and escalation of care omit the vital role of nurses in these processes. Inconsistencies between health services may lead to confusion in a mobile workforce and may reduce system dependability. What is known about the topic? Recognising and responding to clinical deterioration is a major patient safety priority. To comply with national standards, health services must have systems in place for recognising and responding to clinical deterioration. What does this paper add? There is some variability in terminology, definitions and specifications of physiological observations and medical emergency team (MET) activation criteria between health services. Although nurses are largely responsible for physiological observations and escalation of care, they have little authority to direct frequency of observations and triggers for care escalation or tailor assessment to individual patient needs. Failure to identify nurses’ role in policy is concerning and contrary to the evidence regarding nurses and MET activations in practice. What are the implications for practitioners? Inconsistencies in recommendations regarding physiological observations and escalation of care criteria may create patient safety issues when students and staff work across organisations or move from one organisation to another. The validity of other parameters, such as appearance, pain, skin colour and cognition, warrant further consideration as early indicators of deterioration that may be used by nurses to identify clinical deterioration earlier. A better understanding of the relationship between the sensitivity, specificity and frequency of monitoring of particular physiological observations and patient outcomes is needed to improve the predictive validity for identification of clinical deterioration.

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Brown, Ashlee Maree, Dara M. Twomey, and Anna Wong Shee. "Evaluating mild traumatic brain injury management at a regional emergency department." Injury Prevention 24, no. 5 (June 4, 2018): 390–94. http://dx.doi.org/10.1136/injuryprev-2018-042865.

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BackgroundEmergency departments (EDs) are usually the first point of contact, and often the only medical service available, for patients with mild traumatic brain injury (mTBI) in rural and regional areas. Clinical practice guidelines (CPGs) have been created to ensure best practice management of mTBI in EDs. Adherence to mTBI CPGs has rarely been evaluated in rural and regional areas.AimThe aim of this paper was to assess a regional health service’s adherence to their mTBI CPG.MethodsThis was a 12-month retrospective audit of 1280 ED records of patients ≥16 years presenting with mTBI to a regional Australian ED. Case selection used the Victorian Admitted Episodes Dataset codes for suspected head injury: principal diagnosis codes (S00-T98), concussive injury recorded in diagnosis codes (S06.00-S06.05) and unintentional external cause code (V00-X59). The data were collected to determine 4-hour observation rates, CT scan rates, safe discharge and appropriate referral documentation.ResultsFewer people received a CT scan than qualified (n=245, 65.3%), only 45% had 4-hour observations recorded, safe discharge was documented in 74.1% of cases and 33% received educational resources.Discussion/conclusionSeveral key elements for the management of mTBI were under-recorded, particularly 4-hour observations, safe discharge and education. Acquired brain injury clinic referrals were received in overwhelmingly fewer cases than had a CT scan (n=19, 6.3%). Overall, this study suggests that the regional health service does not currently fully adhere to the CPG and that the referral services are potentially underutilised.

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Peukert, Thomas. "285 Piloting and implementing an acute neurology service." Journal of Neurology, Neurosurgery & Psychiatry 89, no. 10 (September 13, 2018): A43.2—A43. http://dx.doi.org/10.1136/jnnp-2018-abn.149.

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Over the past decade, the number of patients attending the emergency department (ED) at the Royal Victoria Hospital Belfast, with neurological symptoms, has doubled. Typically, over 50% of these patients would subsequently be admitted to hospital. In 2013, a pilot project was conducted with the aim of evaluating the effectiveness of a rapid access neurology clinic on reducing such admissions.A dedicated neurology clinic was set up offering 12 slots per week. Patients were seen within 10 days of ED staff booking them into the clinics. Early results indicated that within the first month 28 admissions were avoided. As a result rapid access neurology clinics were rolled out. Two acute neurologists were appointed and since 2015, 3 rapid access clinics run per week (15 slots). In addition to the rapid access clinics, the acute neurology team also offer two additional services:Reviewing all patients who have been admitted under the medical take with neurological symptomsPatients who attend ED overnight but require urgent evaluation/tests can be sent home and will be seen the next morning by the acute neurology teamAnalysis indicates approximately 1250 admissions are avoided each year with an estimated cost saving of over £2 million.

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Nguyen, Tu Q., Pamela M. Simpson, Sandra C. Braaf, Peter A. Cameron, Rodney Judson, and Belinda J. Gabbe. "Level of agreement between medical record and ICD-10-AM coding of mental health, alcohol and drug conditions in trauma patients." Health Information Management Journal 48, no. 3 (April 19, 2018): 127–34. http://dx.doi.org/10.1177/1833358318769482.

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Background: Despite the reliance on administrative data in epidemiological studies, there is little information on the completeness of co-morbidities in administrative data coded from medical records. Objective: The aim of this study was to quantify the agreement between the International Classification of Diseases, Tenth Revision, Australian Modification (ICD-10-AM) administrative coding of mental health, drug and alcohol co-morbidities and medical records in a severely injured patient population. Method: A random sample of patients ( n = 500) captured by the Victorian State Trauma Registry and definitively managed at the state’s adult major trauma services was selected for the study. Retrospective medical record review was conducted to collect data about documented co-morbidities. The agreement between ICD-10-AM data generated from routine hospital coding and medical record–based co-morbidities was determined using Cohen’s κ and prevalence-adjusted bias-adjusted kappa (PABAK) statistics. Results: The percentage of agreement between the medical record and ICD-10-AM coding for mental health, drug and alcohol co-morbidities was 72.8%, and the PABAK showed moderate agreement (PABAK = 0.46; 95% confidence interval (CI): 0.37, 0.54). There was no difference in agreement between unintentional injury patients (PABAK = 0.52; 95% CI: 0.42, 0.62) compared with intentional injury patients (PABAK = 0.36, 95% CI: 0.23, 0.49), and no change in agreement for patients admitted before (PABAK = 0.40; 95% CI: 0.30, 0.50) and after the introduction of mandatory co-morbidity coding (PABAK = 0.46; 95% CI: 0.37, 0.54). Conclusion: Despite documentation in the medical record, a large proportion of mental health, drug and alcohol conditions were not coded in ICD-10-AM. Acknowledgement of these limitations is needed when using ICD-10-AM coded co-morbidities in research studies and health policy development. Implications: This work has implications for researchers of drug and alcohol abuse; mental health; accidents and injuries; workers' compensation; health workforce; health services; and policy decisions for healthcare, emergency services, insurance industry, national productivity and welfare costings reliant on those research outcomes.

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Hasson, Ruairi, Eoin McDermott, Karena Hanley, Camilla Carroll, and Claire Collins. "Assessing patient satisfaction with a microsuction service in general practice: a comparative study." BJGP Open 3, no. 2 (June 11, 2019): bjgpopen19X101649. http://dx.doi.org/10.3399/bjgpopen19x101649.

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BackgroundIn the UK, about 2.3 million people each year require intervention for wax impaction, while otitis externa accounts for just over 1% of general practice consultations. Aural microsuction of debris from the ear canal is a commonly performed procedure within the ear, nose, and throat (ENT) outpatient clinic. This article examines the patient acceptability of an aural microsuction service delivered in general practice.AimTo determine patient satisfaction following the introduction of a new microsuction service in general practice compared with a hospital-delivered service.Design & settingThis is a prospective comparative study in two rural general practices in Ireland and the emergency department (ED) of the Royal Victoria Eye and Ear Hospital (RVEEH), Dublin.MethodA 3-month period of data collection on usual care of 56 patients in general practice was followed by a 3-month period of GP-intervention data collection on 67 patients. Comparative data were collected on 37 patients who attended the RVEEH for the same intervention procedure. Patients completed a validated patient satisfaction questionnaire (PSQ-18).ResultsBoth general practice groups scored significantly higher in all seven aspects of medical care than the RVEEH cohort. Patients in the GP-intervention group scored significantly higher in terms of satisfaction with procedure technique compared with the usual care GP group.ConclusionThe provision of microsuction as a service in general practice confers as much or more patient satisfaction as the provision of the service in a hospital setting.

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Nehme, Z., E. Andrew, J. E. Bray, P. Cameron, S. Bernard, I. T. Meredith, and K. Smith. "The significance of pre-arrest factors in out-of-hospital cardiac arrests witnessed by emergency medical services: A report from the Victorian Ambulance Cardiac Arrest Registry." Resuscitation 88 (March 2015): 35–42. http://dx.doi.org/10.1016/j.resuscitation.2014.12.009.

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Drosdowsky, A., K. Gough, M. Grewal, A. Dabscheck, N. Tebbutt, J. Philip, O. Spruyt, M. Michael, and M. Krishnasamy. "Does Care for Australians With Pancreatic Cancer Compare Favourably to a Consensus-Based Standard of Optimal Care?" Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 82s. http://dx.doi.org/10.1200/jgo.18.58800.

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Background: Pancreatic cancer has one of the lowest survival rates of all cancer types, with an incidence to mortality ratio approaching one. People with pancreatic cancer experience a rapid decline in health characterized by pain, nausea, fatigue and weight loss. For most people, the disease is detected at an advanced stage and the focus of treatment is palliative. In Victoria, Australia, knowledge regarding patterns of care for people with pancreatic cancer is out-of-date, but central to quality improvement initiatives targeting unwarranted variations in care and improvement in supports that are consistent with patient preferences. Aim: Our aim was to compare care received by patients with pancreatic cancer with a consensus-based standard representing optimal care to identify deviations from best practice and highlight processes that may improve the quality and safety of care provided. Methods: Eligible patients included those with pancreatic cancer, first treated in 2015, at one of three tertiary hospitals in Victoria, Australia. Once identified, dates and details of events indicated by the optimal care pathway were extracted from the medical record of each patient. Data were summarized using descriptive statistics and process maps: a visualization method that illuminates gaps, duplication, deviations from best practice and processes that may be amenable to improvement. Results: Thirty-two of 165 care pathways have been mapped to date. The nature and timing of care received appears highly variable. Only nine of 32 patients (28%) received all of their cancer care at a single institution; the remainder (n=23, 72%) received care in multiple tertiary and community facilities. Apart from four (13%) emergency presentations, referrals for specialist care came from general/primary practitioners (n=26, 81%). The timeframe for general/primary practitioner investigations ranged from one to 57 days. Once referred to a tertiary setting, most patients (n=23, 72%) were discussed at a multidisciplinary team meeting and received standard therapies. Only four had resectable disease. Nineteen patients (60%) had documented referrals to hospital- or community-based palliative care services. Where observed, deviations from the consensus-based standard tended to be related to the difficult nature of diagnosing pancreatic cancer, and determining appropriate care for patients with an advanced cancer with nonspecific symptoms. Conclusion: Process mapping provided a useful and efficient means of comparing care received with a consensus-based standard; however, the assessment of adherence to optimal timeframes and specific care events was complicated by missing data. Implications for quality improvement activities will be considered in the context of study limitations. We will also emphasize the importance of engaging patients and carers in setting improvement priorities.

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Duckett, Stephen, and Amanda Kenny. "Hospital outpatient and emergencyservices in rural Victoria." Australian Health Review 23, no. 4 (2000): 115. http://dx.doi.org/10.1071/ah000115.

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Outpatient and emergency services in rural hospitals have rarely been studied. This paper analyses routinely collecteddata, together with data from a survey of hospitals, to provide a picture of these services in Victorian public hospitals.The larger rural hospitals provide the bulk of rural outpatients and emergency services, particularly so for medicaloutpatients. Cost per service varies with the size of the hospital, possibly reflecting differences in complexity. Fundingpolicies for rural hospital outpatient and emergency services should be sufficiently flexible to take into account thedifferences between rural hospitals.

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Mueller, Jessica A., and Laura M. Stanley. "Emergency Medical Services." Proceedings of the Human Factors and Ergonomics Society Annual Meeting 57, no. 1 (September 2013): 1546–50. http://dx.doi.org/10.1177/1541931213571344.

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Arndt, Sharon Doyle. "Emergency medical services." American Journal of Medicine 102, no. 5 (May 1997): 104–5. http://dx.doi.org/10.1016/s0002-9343(97)00071-5.

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Boyle, Malcolm, Stephen Burgess, Mark Chilton, Brian Fallows, Bill Lord, David Shugg, Brett Williams, and Andrea Wyatt. "Monash University Centre for Ambulance and Paramedic Studies (MUCAPS) Submission to the Department of Human Services (DHS), in response to the DHS Discussion Paper examining the regulation of the Health Professions in Victoria." Australasian Journal of Paramedicine 1, no. 3 (October 6, 2003). http://dx.doi.org/10.33151/ajp.1.3.208.

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This submission will primarily address the regulation of the health professions from the perspective of an education institution, and is made in response to the Discussion paper examining regulation of the health professions in Victoria, dated October 2003 which was issued by the Policy and Strategic Projects Division of the Victorian Department of Human Services, Melbourne, Victoria.

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Lim, Shir Lynn, Karen Smith, Kylie Dyson, Siew Pang Chan, Arul Earnest, Resmi Nair, Stephen Bernard, et al. "Incidence and Outcomes of Out‐of‐Hospital Cardiac Arrest in Singapore and Victoria: A Collaborative Study." Journal of the American Heart Association 9, no. 21 (November 3, 2020). http://dx.doi.org/10.1161/jaha.119.015981.

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Background Incidence and outcomes of out‐of‐hospital cardiac arrest (OHCA) vary between communities. We aimed to examine differences in patient characteristics, prehospital care, and outcomes in Singapore and Victoria. Methods and Results Using the prospective Singapore Pan‐Asian Resuscitation Outcomes Study and Victorian Ambulance Cardiac Arrest Registry, we identified 11 061 and 32 003 emergency medical services‐attended adult OHCAs between 2011 and 2016 respectively. Incidence and survival rates were directly age adjusted using the World Health Organization population. Survival was analyzed with logistic regression, with model selection via backward elimination. Of the 11 061 and 14 834 emergency medical services‐treated OHCAs (overall mean age±SD 65.5±17.2; 67.4% males) in Singapore and Victoria respectively, 11 054 (99.9%) and 5595 (37.7%) were transported, and 440 (4.0%) and 2009 (13.6%) survived. Compared with Victoria, people with OHCA in Singapore were older (66.7±16.5 versus 64.6±17.7), had less shockable rhythms (17.7% versus 30.3%), and received less bystander cardiopulmonary resuscitation (45.7% versus 58.5%) and defibrillation (1.3% versus 2.5%) (all P <0.001). Age‐adjusted OHCA incidence and survival rates increased in Singapore between 2011 and 2016 ( P <0.01 for trend), but remained stable, though higher, in Victoria. Likelihood of survival increased significantly ( P <0.001) with arrest in public locations (adjusted odds ratio [aOR] 1.81), witnessed arrest (aOR 2.14), bystander cardiopulmonary resuscitation (aOR 1.72), initial shockable rhythm (aOR 9.82), and bystander defibrillation (aOR 2.04) but decreased with increasing age (aOR 0.98) and emergency medical services response time (aOR 0.91). Conclusions Singapore reported increasing OHCA incidence and survival rates between 2011 and 2016, compared with stable, albeit higher, rates in Victoria. Survival differences might be related to different emergency medical services practices including patient selection for resuscitation and transport.

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Huggins, Chris, and David Shugg. "Non-Emergency Patient Transport in Victoria: An overview." Australasian Journal of Paramedicine 6, no. 4 (July 16, 2015). http://dx.doi.org/10.33151/ajp.6.4.473.

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The non-emergency patient transport system (NEPT) in Victoria, Australia evolved out of an identified need in the latter part of the 20th century. This system is growing and maturing as the health system evolves. The emergency and non-emergency systems will slowly diverge over time as the needs and responsibilities of the two systems further develop. This paper discusses the evolution of the non-emergency patient transport system (ambulance) in Victoria and its current role in the health system in Victoria Australia.

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Williams, Brett. "Removal of Invasive Devices from Deceased Persons: Forensic implications for Paramedics – a Victorian perspective." Australasian Journal of Paramedicine 3, no. 4 (July 14, 2015). http://dx.doi.org/10.33151/ajp.3.4.339.

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Professor Cordner is Professor of forensic medicine at Monash University Institutes of Health and Director of the Victorian Institute of Forensic Medicine His work in the area of forensic medicine and human rights has seen him take tours of duty in East Timor and Kosovo, as well as a year-long stint consulting to the International Committee of the Red Cross in Geneva. The following interview was conducted to invite Professor Cordner’s professional opinion in relation to practices and implications with respect to the removal of invasive clinical devices from deceased persons, as they currently apply to paramedics of Metropolitan Ambulance Service in Melbourne, and Rural Ambulance Victoria.

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Smith, Gavin, and Jeff Kenneally. "Development and implementation of Victorian prehospital Clinical Practice Guidelines: The supraventricular tachycardia example." Australasian Journal of Paramedicine 10, no. 4 (November 4, 2013). http://dx.doi.org/10.33151/ajp.10.4.51.

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Introduction In order to provide an evidence-based approach to practice, the Ambulance Victoria (AV) Clinical Practice Development Committee (CPDC) is tasked with periodic review of all of the AV Clinical Practice Guidelines (CPG’s). This paper will highlight the framework underpinning CPG development in a Victorian prehospital emergency care system, and explore the development of CPG A0403 (supraventricular tachycardia) as an example of the process. Methods The CPDC applied a newly developed process, based upon national and internationally accepted methods of guideline assessment and development. Literature review, analysis of current practice data and extensive expert consultation were also used to formulate Guidelines. Results The CPDG delivered a revised CPG which removed calcium channel blocker therapy, introduced adenosine, and expanded the use of vagal manoeuvres to all operational paramedics. The VACIS data highlighted low intervention rates using pharmacology and vagal manoeuvres, with accepted reversion rates where applied. No logistic or safety issues were identified for the proposed changes, and expert consultation also supported changes to the guideline. Conclusion The development and implementation of new clinical guidelines in Victoria has evolved to embrace evidence based practice. The paucity of available prehospital-specific evidence means that consensus is still relied upon to complete the process, yet the evolution of further research will help to reduce reliance on this aspect and improve the quality and effectiveness of the process.

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Lee, Chung, Rami Fezai, Rachel Kluck, and Michael Toussaint. "Abstracts of the 2015 Student Paramedics Australasia Conference." Australasian Journal of Paramedicine 12, no. 4 (September 3, 2015). http://dx.doi.org/10.33151/ajp.12.4.490.

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Smith, Jeremy, Emily Andrew, and Karen Smith. "Prehospital early warning scores are associated with requirement for medical retrieval services." Australasian Journal of Paramedicine 19 (April 10, 2022). http://dx.doi.org/10.33151/ajp.19.956.

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Objective: Prehospital early warning scores (EWSs) can accurately identify patients at risk of clinical deterioration. We hypothesised that EWSs can identify patients during the prehospital phase who will subsequently require clinical escalation via medical retrieval. Methods: A retrospective observational study of adult patients attended in 2018 by Ambulance Victoria in rural regions was conducted. We calculated EWSs using National Early Warning Score 2 (NEWS2) and Rapid Emergency Medicine Score (REMS) methods. Primary outcome was activation of Adult Retrieval Victoria (ARV) within 24h of ambulance attendance. We evaluated sensitivity and specificity for each score, and used multivariable logistic regression analysis to assess the independent association between EWSs and ARV activation. Results: 71 401 patients were included, of which 607 (0.9%) required ARV activation within 24h. Sensitivity and specificity of NEWS2 were 0.484 (95% CI 0.444–0.525) and 0.806 (95% CI 0.803–0.809) respectively, compared with 0.552 (95% CI 0.511–0.592) and 0.508 (95% CI 0.504–0.512) respectively for REMS. After adjustment for remoteness, distance to hospital, sex, age and hospital service level, a medium/high risk score according to the NEWS2 (OR 4.12; 95% CI 3.50–4.85, p<0.001) and REMS (OR 2.92, 95% CI 2.26–3.77) was associated with ARV activation. Odds of ARV activation increased with remoteness and decreasing service level of the receiving hospital. Conclusions: Prehospital NEWS2 and REMS were associated with medical retrieval within 24h of ambulance attendance. EWSs may allow early identification of ambulance patients requiring medical retrieval, thus facilitating earlier activation and reduced time to definitive care.

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Hotchin, Les. "Abstracts of the 2014 Australian College of Ambulance Professionals National Conference." Australasian Journal of Paramedicine 6, no. 3 (July 16, 2015). http://dx.doi.org/10.33151/ajp.6.3.465.

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These are the conferences abstracts for oral and poster presentations at the Australian College of Ambulance Professionals National Conference, Melbourne, Victoria, Australia, on 4th to 6th of September 2008.

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Shugg, David, and Les Hotchin. "Response - The origins and history of the Institute of Ambulance Officers’ (Australia) official magazine." Australasian Journal of Paramedicine 1, no. 1 (August 28, 2014). http://dx.doi.org/10.33151/ajp.1.1.69.

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Dyson, Kylie, Janet Bray, Karen Smith, Stephen Bernard, Lahn Straney, and Judith Finn. "Abstract 269: How Much Exposure to Resuscitation Do Emergency Medical Services Personnel Get?" Circulation 130, suppl_2 (November 25, 2014). http://dx.doi.org/10.1161/circ.130.suppl_2.269.

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Objectives: The exposure of emergency medical service personnel (paramedics) to out-of-hospital cardiac arrest (OHCA) and resuscitation procedures could be an important factor in skill maintenance and quality of care. This study aims to describe paramedic exposure to OHCA resuscitation in the state of Victoria, Australia (population 5.8 million). Methods: We extracted and linked data from the Victorian Ambulance Cardiac Arrest Registry (VACAR) and Ambulance Victoria’s employment dataset for the period 2003-2012. Paramedics were considered to have ‘exposure’ to OHCA if they attended a case where resuscitation was attempted. Individual rates were calculated for annual exposure (number of OHCA exposures for each paramedic/years employed in study period) and days between exposures (total paramedic days/total number of exposures). Results: Over the 10-year period, there were 49,107 OHCAs and 5,673 paramedics employed. Resuscitation was attempted in 44% of patients. An average of 3.2 (SD±1.1) paramedics attended each case. The median average exposure of paramedics was 2.2 (IQR=1.2-3.5) OHCAs/year. The proportion with no exposures in a year increased from 39% in 2003 to 43% in 2012 (p=0.036). OHCA exposure was significantly less in those employed part-time or casual (p<0.001), in a rural area (p<0.001) or with a lower qualification (p<0.001) (Table). Annual exposure to pediatric and traumatic OHCAs was particularly low (Table). Paramedics were exposed to an average of 0.006 OHCAs/day, meaning it would take an average of 163 days be exposed to OHCA and up to 12.5 years for rare cases, such as pediatric OHCAs. Conclusion: Our study identified paramedic exposure to resuscitation is low and has decreased over time. This highlights the importance of supplementing paramedic exposure with other methods, such as simulation, to maintain resuscitation skills. This may be particularly important to paramedics with low exposure and for rare case types, such as pediatric OHCA.

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Murcott,, Pauline. "Second Annual JEPHC Symposium." Australasian Journal of Paramedicine 8, no. 2 (May 3, 2010). http://dx.doi.org/10.33151/ajp.8.2.99.

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Over 140 delegates attended this year’s 2nd Annual Journal of Emergency Primary Health Care (JEPHC) Symposium which was held at the Alfred Hospital’s Monash Clinical Schoolon 8th April 2010. The Symposium was once again co-hosted by JEPHC, Monash University Department of Community Emergency Health and Paramedic Practice (DCEHPP), the Australian College of Ambulance Professionals (ACAP) and Ambulance Victoria (AV).

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O’Meara, Peter. "Ambulance satisfaction surveys: Their utility in policy development, system change and professional practice." Australasian Journal of Paramedicine 1, no. 3 (October 6, 2003). http://dx.doi.org/10.33151/ajp.1.3.212.

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This study surveyed general practitioners, registered nurses, ambulance officers and members of the public to determine satisfaction levels in rural ambulance services in the Australian State of Victoria. It was part of a larger study developing rural models of ambulance service delivery. Respondents were asked to complete a survey about their satisfaction with their local ambulance services and their confidence in local emergency medical systems. Satisfaction levels were very high and associated with direct experience as patients or as immediate family members of patients. Focusing on specific elements of the ambulance system in future satisfaction surveys may improve the capacity of managers and policy makers to develop appropriate policies and implement changes in system design and professional practice.

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Kerr, Debra, Paul Jennings, Anne-Maree Kelly, Tony Walker, and John Edington. "Pilot of Prehospital Thrombolysis in ST Elevation Myocardial Infarction." Australasian Journal of Paramedicine 6, no. 1 (July 16, 2015). http://dx.doi.org/10.33151/ajp.6.1.447.

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Based on data from overseas and local case modelling, Rural Ambulance Victoria [RAV] implemented a pilot study of prehospital thrombolysis [PHT] for patients with ST Elevation Myocardial Infarction [STEMI] in the Bendigo region. The purpose of this report is to provide the background to the pilot, describe the PHT model, report the outcome of the single enrolled case and discuss various barriers to PHT implementation.

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Walker, Tony. "Pre-hospital paramedic administration of Ceftriaxone for suspected meningococcal septicaemia in Victoria, Australia." Australasian Journal of Paramedicine 3, no. 1 (July 14, 2015). http://dx.doi.org/10.33151/ajp.3.1.305.

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Meningococcal septicaemia is not common in Australia. The disease does however have a rapid onset and relatively high levels of mortality and morbidity, particularly in children and adolescents. An effective vaccine has been introduced to protect against Group C disease, however no commercially available vaccine exists to protect against Group B which accounts for the majority of cases in Australia. Australian authorities recommend the early administration of antibiotics to cases of suspected meningococcal septicaemia. Ambulance services are important providers of primary healthcare with strong clinical governance processes. They are well placed to assist in meeting the goal of early antibiotic therapy particularly in rural and remote areas where there may be prolonged ambulance transport times and variable access to medical practitioners and other primary healthcare providers. In late 2003 Rural Ambulance Victoria introduced clinical practice guidelines which authorised ambulance and intensive care paramedics to administer the antibiotic Ceftriaxone in cases of suspected meningococcal septicaemia. This paper reviews meningococcal disease in Australia, explores the drivers and processes leading to the development of these guidelines, outlines experiences with the program to date, and identifies the need for further research in this area.

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Thuma, Ev. "Australian Asthma Conference - 2004 “A fresh breath – looking to the future”." Australasian Journal of Paramedicine 1, no. 3 (October 6, 2003). http://dx.doi.org/10.33151/ajp.1.3.203.

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The Australian Asthma Conference held this year in Melbourne, was hosted by the Asthma Foundation of Victoria. The conference attracted over 300 participants from all states and internationally, and was headed by a range of keynote speakers representing national and international leaders in the various aspects of asthma management from prevention through to clinical care. Participants included the full spectrum of health professionals, with a large number of asthma educators represented.

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Smith, Gavin, and Kathryn Eastwood. "Reflections in the research pool – a paramedic experience in clinical research and the Master of Emergency Health degree." Australasian Journal of Paramedicine 7, no. 1 (February 5, 2009). http://dx.doi.org/10.33151/ajp.7.1.154.

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This paper provides a simple guide to clinical research in the prehospital arena and suggests a framework to enable and encourage paramedics to become involved in the future direction and evolution of their clinical practice and professionalism. It is also a reflection of the authors’ personal experiences as the first two Mobile Intensive Care Ambulance (MICA) Paramedics in Victoria, to complete the Monash University Master of Emergency Health degree in 2008.

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Smith, Gavin. "Examination of undergraduate paramedic clinical placement within a traditional and novel setting." Australasian Journal of Paramedicine 13, no. 2 (May 1, 2016). http://dx.doi.org/10.33151/ajp.13.2.509.

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IntroductionIncreasing student enrolments and limited capacity within traditional placements have defined a need to reassess the format of clinical placement programs. This study aimed to compare traditional and novel clinical placement experience of third year paramedic science students at Victoria University in order to report elements that may contribute to identifying an optimum model for future clinical placement programs.MethodsA descriptive study of final year paramedic student clinical placement case exposure, with comparative analysis of local (Ambulance Victoria (Australia)) and international (Magen David Adom (Israel)) student cohorts. Descriptive statistics were used to report patient and student experience factors. Specific case exposure, demonstration of skills and use of pharmacological agents are reported as proportions. Statistical analysis employed SPSS (Statistical Package for the Social Sciences Version 20.0, SPSS Inc., 20.0.0.2 (IBM Corporation, Armonk, New York, U.S.A.).ResultsA total of 441 cases were analysed: 206 and 235 in the local and international study groups respectively. Mean caseload per paramedic student was not significantly different between study groups (1.2 cases (95%CI -2.8 to 0.4, p = 0.1)). The international group engaged in a greater range of shifts, including more afternoon shifts and the opportunity to experience night shifts. ConclusionThis study provided the first descriptive analysis of a traditional and international clinical placement experience for paramedic undergraduate students, identifying benefit in both programs. Future studies incorporating a mixed methods design measuring practical exposure will add important depth and understanding to clinical placement optimisation.

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Boyle, Malcolm, and Peter O’Meara. "From roadside to hospital: A pilot study to investigate the factors influencing the time taken to deliver trauma patients to a regional hospital." Australasian Journal of Paramedicine 6, no. 3 (July 16, 2015). http://dx.doi.org/10.33151/ajp.6.3.463.

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IntroductionOne of the trauma system objectives for the ambulance service is to get the right patient to the right hospital in a timely manner. The Review of Trauma and Emergency Services in Victoria, Australia, identified prolonged prehospital scene times of greater than 20 minutes for non trapped patients as a deficiency that may have adverse outcomes for severely injured trauma patients. The objective of this pilot study was to identify the factors that impact on the timely transfer of trauma patients from the scene of an incident to a regional hospital emergency department and justification for the delays, as the basis for a further detailed study.MethodsA retrospective pilot cohort study of trauma patients transported by ambulance to the emergency department of the Latrobe Regional Hospital over a six-month period who had an emergency department triage category of 1, 2 or 3 was undertaken. Data relating to the prehospital care of trauma patients with scene times > 20 minutes and transport times > 30 minutes were extracted from Rural Ambulance Victoria patient care records and hospital patient records. Ethics approval was granted.ResultsThere were 70 trauma patients transported to the hospital during the collection period. Of these 49 patients were available for analysis, 21 cases were excluded due to incomplete time or ED triage details. There were 12 cases where scene times were > 20 minutes. Only one paramedic crew spent an unjustifiably long time at the scene and only one patient had a transport time to hospital > 30 minutes.ConclusionThis pilot study confirms that there are prolonged prehospital scene times involving paramedics, however, the study suggests that most of the extended times are explained by factors outside the control of the attending paramedics. There was only one case where the scene time was not justified. One patient had a transport time > 30 minutes which was due to the patient being taken to a higher level of care. Experiences from this pilot study have led to changes in subsequent prehospital trauma studies.

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Citraningtyas, Theresia, Elspeth Macdonald, and Beverley Raphael. "Disaster experience in the context of life: Perspectives five to six years after the 2003 Canberra Bushfire." Australasian Journal of Paramedicine 8, no. 2 (May 3, 2010). http://dx.doi.org/10.33151/ajp.8.2.102.

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Introduction To gain deeper understanding of the long-term lived experiences of adults affected by the 2003 Canberra bushfire, approximately five to six years after the disaster. Methods We present an overview of themes that emerged from thematic analysis of transcripts of in-depth semi-structured interviews of 25 adults directly affected by the 2003 Canberra bushfire interviewed from April 2008 to March 2009. Coincidentally, six of these participants were interviewed following the 2009 Victorian Bushfires and, where relevant, this is noted. Results The overarching themes that emerged were sensory memory from the day of the fires, emotions, relationships, and other life events. Participants reported an extraordinary sensory experience. They also reported and demonstrated mixed emotions over five years after the incident, such as fear, grief and anger, intertwined with gratitude and a sense of achievement. The disaster experience bonded some relationships, strained others, and often simultaneously supported and caused difficulties in close relationships. In terms of other life events, participants gauged the impact of the fires in relation to other significant personal life events before or after the fire. A few reported a sense of having to face a series of hardships; however, others reported that experiencing other hardships put the bushfires in perspective. Those interviewed following the 2009 Victorian bushfires also presented an interplay between emotions relating to their own experience and their thoughts and feelings relating to the more recent bushfire in Victoria. Conclusion Findings highlighted how the subjective experiences, perceived supportive and unsupportive factors, and meaning-making of people affected by disaster are embedded in the context of their lives in a dynamic and multi-dimensional way. People's thoughts and feelings cannot be solely attributed to the disaster in question, and arguably it would not be relevant to do so, as disasters always occur in the context of people's lives. Other life events not only add to the disaster experience, but the various life events can become lenses in which other life events are perceived, experienced, and processed. Grief, loss, fear, anxiety, and guilt can be intertwined with, and thus balanced by, a sense of gratitude and achievement. The role of life events and other factors such as relationships, thus cannot be simply categorised as supportive or risk factors. Subsequent disasters act as painful reminders of one's own experiences, but can also provide an opportunity to work through and relate to them as one who has gone through a similar experience and survived several years down the track.

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Boyle, Malcolm. "The 2007 Shepparton Research Conference, “Moving Forward: Rural Research & Knowledge Transfer”, Shepparton Victoria, Australia. 27 November 2007." Australasian Journal of Paramedicine 6, no. 1 (July 16, 2015). http://dx.doi.org/10.33151/ajp.6.1.448.

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Journal articles on the topic 'Emergency medical services Victoria'

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