B. Williams, Christine King, M. Boyle, Lisa Clegg, S. Devenish, Catherine Kamphuis, James King, David Reid
Background Although bullying and harassment among academic staff has been well researched, research on students bullying and harassing academic teaching staff (ie, contrapower harassment) is less common. Contrapower harassment has been on the rise in academia over the last decade, partly attributable to changes in the student-faculty staff relationship. This study aimed to understand better the extent and impact of students’ contrapower harassment on paramedic academic teaching staff within Australian universities, as well as actions and interventions to address it. Methods This study used a two-phase mixed methods design. In phase 1, a convenience sample of paramedic teaching academics from 12 universities in Australia participated in an online questionnaire. In phase 2, an in-depth interview was conducted with nine participants from phase 1. Results Seventy-six academic teaching staff participated in the study. Survey results showed that most academics surveyed had experienced harassment from paramedic students, with the highest incidence of harassment occurring during student assessment periods. Alarmingly, over 30% of the academics surveyed had been ‘stalked’ by a student and over 50% had felt powerless and helpless when students had attacked them on social media. Problematic students were identified as those who presented with an over-inflated sense of entitlement or with psychological states and traits that find it challenging to accept feedback and failure, and look to externalise their failures. Reasons for increases in contrapower harassment included a complex mix of consumer and demand-driven education, on-demand (and demanding) instant gratification and degree self-entitlement, and an increase in social media and online learning (particularly during the COVID-19 pandemic of 2020). Conclusion Although most of the academics in this study experienced contrapower harassment by students, they also report that most students are level-headed and supportive, and do not carry out this type of harassment. Promoting student professionalism and reassessing student evaluations are starting points for addressing this type of harassment. Further research on the broader systemic issues that influence the contributors to contrapower harassment is needed.
{"title":"Contrapower Harassment in Paramedicine: Experiences of Academic Staff in Australian Universities","authors":"B. Williams, Christine King, M. Boyle, Lisa Clegg, S. Devenish, Catherine Kamphuis, James King, David Reid","doi":"10.33151/ajp.19.1006","DOIUrl":"https://doi.org/10.33151/ajp.19.1006","url":null,"abstract":"Background Although bullying and harassment among academic staff has been well researched, research on students bullying and harassing academic teaching staff (ie, contrapower harassment) is less common. Contrapower harassment has been on the rise in academia over the last decade, partly attributable to changes in the student-faculty staff relationship. This study aimed to understand better the extent and impact of students’ contrapower harassment on paramedic academic teaching staff within Australian universities, as well as actions and interventions to address it. Methods This study used a two-phase mixed methods design. In phase 1, a convenience sample of paramedic teaching academics from 12 universities in Australia participated in an online questionnaire. In phase 2, an in-depth interview was conducted with nine participants from phase 1. Results Seventy-six academic teaching staff participated in the study. Survey results showed that most academics surveyed had experienced harassment from paramedic students, with the highest incidence of harassment occurring during student assessment periods. Alarmingly, over 30% of the academics surveyed had been ‘stalked’ by a student and over 50% had felt powerless and helpless when students had attacked them on social media. Problematic students were identified as those who presented with an over-inflated sense of entitlement or with psychological states and traits that find it challenging to accept feedback and failure, and look to externalise their failures. Reasons for increases in contrapower harassment included a complex mix of consumer and demand-driven education, on-demand (and demanding) instant gratification and degree self-entitlement, and an increase in social media and online learning (particularly during the COVID-19 pandemic of 2020). Conclusion Although most of the academics in this study experienced contrapower harassment by students, they also report that most students are level-headed and supportive, and do not carry out this type of harassment. Promoting student professionalism and reassessing student evaluations are starting points for addressing this type of harassment. Further research on the broader systemic issues that influence the contributors to contrapower harassment is needed.","PeriodicalId":340334,"journal":{"name":"Australian Journal of Paramedicine","volume":"19 1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120952917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Belinda Delardes, S. Chakraborty, Karen Smith, K. Bowles
Introduction Currently, non-transported patients who are attended to by a state-funded ambulance service in Victoria and are advised to visit their general practitioner (GP) do not have informational continuity of care, as there is no communication between the referring paramedic and GP. This research aimed to develop a functional electronic referral (e-referral) proforma from paramedics to GPs that can be used to support handover of patients’ clinical information for non-transported patients. Methods Paramedics, GPs and digital health experts were invited to participate in the study. The study design utilised an online Delphi technique, where participants responded to three rounds of surveys relating to the pertinence, feasibility, content and presentation of an e-referral tool. Questions were open-ended or requested responses on a 5-point Likert scale. Results A total of 21 clinicians participated in the study and developed an e-referral proforma. After three rounds, participants agreed the proforma should contain the following information: the patients’ identifying information, presenting complaint, social concerns, vital sign survey, management or advice given to the patient and reason for referral. Stakeholders stressed that the mode and timing of delivery must be flexible enough so that implementing the e-referral proforma does not become burdensome for clinicians. Conclusion A structured e-referral system between paramedics and GPs is feasible and offers a method to improve informational continuity of care and in turn, patient safety.
{"title":"Development of An Electronic Referral Proforma from Paramedics to General Practitioners: A Delphi Study","authors":"Belinda Delardes, S. Chakraborty, Karen Smith, K. Bowles","doi":"10.33151/ajp.19.918","DOIUrl":"https://doi.org/10.33151/ajp.19.918","url":null,"abstract":"Introduction Currently, non-transported patients who are attended to by a state-funded ambulance service in Victoria and are advised to visit their general practitioner (GP) do not have informational continuity of care, as there is no communication between the referring paramedic and GP. This research aimed to develop a functional electronic referral (e-referral) proforma from paramedics to GPs that can be used to support handover of patients’ clinical information for non-transported patients. Methods Paramedics, GPs and digital health experts were invited to participate in the study. The study design utilised an online Delphi technique, where participants responded to three rounds of surveys relating to the pertinence, feasibility, content and presentation of an e-referral tool. Questions were open-ended or requested responses on a 5-point Likert scale. Results A total of 21 clinicians participated in the study and developed an e-referral proforma. After three rounds, participants agreed the proforma should contain the following information: the patients’ identifying information, presenting complaint, social concerns, vital sign survey, management or advice given to the patient and reason for referral. Stakeholders stressed that the mode and timing of delivery must be flexible enough so that implementing the e-referral proforma does not become burdensome for clinicians. Conclusion A structured e-referral system between paramedics and GPs is feasible and offers a method to improve informational continuity of care and in turn, patient safety.","PeriodicalId":340334,"journal":{"name":"Australian Journal of Paramedicine","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114362675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction Healthcare students are often required to perform predetermined numbers of clinical skills to prove competence. The pressures of meeting predetermined clinical skill numbers may result in students overtreating patients. Overtreatment is not without consequence to the patient. This study aimed to investigate perceptions related to possible overtreatment of patients by emergency medical care students in three South African higher education institutions (HEIs). Methods This cross-sectional study used a purpose-designed, anonymous online questionnaire to collect data on possible patient overtreatment from emergency medical care student participants at three South African HEIs. Results Of the participants, 45 self-reported reasonably low incidences of overtreatment of patients. The prescribed skill requirements were deemed appropriate as were practical shift numbers, but there was concern about achieving prescribed skill numbers. Participants generally considered risk versus benefit and clinical mentors generally agreed with student decisions without permitting overtreatment practices. Intravenous (IV) cannulation, oxygen administration and spinal immobilisation were the most common forms of overtreatment with advanced airway management and IV cannulation the most difficult to achieve. Lack of appropriately qualified practitioners and low patient numbers were the most common barriers to achieving required skill numbers. Conclusion There was concern among participants about not reaching prerequisite skill numbers. Self-reported overtreatment of patients by participants was uncommon. The list of self-reported procedures most often forming part of overtreatment seemed to contradict this. The most common forms of overtreatment were clinical procedures that posed potential risk to the patient. There is a need to further explore overtreatment within healthcare student populations.
{"title":"Potential Overtreatment by Paramedic Students: A Study from Three South African Higher Education Institutions","authors":"A. Makkink, E. Barnard","doi":"10.33151/ajp.19.977","DOIUrl":"https://doi.org/10.33151/ajp.19.977","url":null,"abstract":"Introduction Healthcare students are often required to perform predetermined numbers of clinical skills to prove competence. The pressures of meeting predetermined clinical skill numbers may result in students overtreating patients. Overtreatment is not without consequence to the patient. This study aimed to investigate perceptions related to possible overtreatment of patients by emergency medical care students in three South African higher education institutions (HEIs). Methods This cross-sectional study used a purpose-designed, anonymous online questionnaire to collect data on possible patient overtreatment from emergency medical care student participants at three South African HEIs. Results Of the participants, 45 self-reported reasonably low incidences of overtreatment of patients. The prescribed skill requirements were deemed appropriate as were practical shift numbers, but there was concern about achieving prescribed skill numbers. Participants generally considered risk versus benefit and clinical mentors generally agreed with student decisions without permitting overtreatment practices. Intravenous (IV) cannulation, oxygen administration and spinal immobilisation were the most common forms of overtreatment with advanced airway management and IV cannulation the most difficult to achieve. Lack of appropriately qualified practitioners and low patient numbers were the most common barriers to achieving required skill numbers. Conclusion There was concern among participants about not reaching prerequisite skill numbers. Self-reported overtreatment of patients by participants was uncommon. The list of self-reported procedures most often forming part of overtreatment seemed to contradict this. The most common forms of overtreatment were clinical procedures that posed potential risk to the patient. There is a need to further explore overtreatment within healthcare student populations.","PeriodicalId":340334,"journal":{"name":"Australian Journal of Paramedicine","volume":"85 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132750596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Courtney-Pratt, C. Eccleston, Peter Lucas, Laura T Tierney, Wayne Harris, Briony Campbell, K. Lawler
Paramedics are key to the provision of emergency care in the community. Those living with dementia use paramedic services at a high rate, due to a range of issues related to comorbid conditions and other acute events which mean care cannot continue in the home. There is a paucity of literature related to care provided in such instances. Anecdotally, a perception exists that providing care to this group of people is challenging for paramedics in situations where high level assessment and emergency care are paramount. Paramedics in one Australian state were sought to participate in an exploratory study to enhance understanding of how they currently worked with people who lived in the community and had dementia. Sixteen participants were recruited to the study, and they worked in a number of areas, including urban and rural. Experience was broad, ranging from one to 36 years in the paramedic role. Inductive thematic analysis of interviews revealed key themes that framed the paramedic role and permeated interactions, assessment and decision-making. Paramedics participating in this study recognised people living with dementia who had high level impacts of the condition, suggesting those with less visible symptoms may remain hidden. With the projected increase of people diagnosed with dementia it is imperative that paramedics are aware of, and integrate dementia knowledge, skills and confidence into their practice. Deeper exploration of the area that includes volunteer ambulance personnel and further inquiry of the role of paramedics in relation to those living with dementia is needed. A focus on education and professional development to equip paramedics to work with people living with dementia is recommended. The findings suggest that greater work in this area is required.
{"title":"Experience of Paramedics Providing Care to People Living with Dementia: The Working with Uncertainty","authors":"H. Courtney-Pratt, C. Eccleston, Peter Lucas, Laura T Tierney, Wayne Harris, Briony Campbell, K. Lawler","doi":"10.33151/ajp.19.929","DOIUrl":"https://doi.org/10.33151/ajp.19.929","url":null,"abstract":"Paramedics are key to the provision of emergency care in the community. Those living with dementia use paramedic services at a high rate, due to a range of issues related to comorbid conditions and other acute events which mean care cannot continue in the home. There is a paucity of literature related to care provided in such instances. Anecdotally, a perception exists that providing care to this group of people is challenging for paramedics in situations where high level assessment and emergency care are paramount. Paramedics in one Australian state were sought to participate in an exploratory study to enhance understanding of how they currently worked with people who lived in the community and had dementia. Sixteen participants were recruited to the study, and they worked in a number of areas, including urban and rural. Experience was broad, ranging from one to 36 years in the paramedic role. Inductive thematic analysis of interviews revealed key themes that framed the paramedic role and permeated interactions, assessment and decision-making. Paramedics participating in this study recognised people living with dementia who had high level impacts of the condition, suggesting those with less visible symptoms may remain hidden. With the projected increase of people diagnosed with dementia it is imperative that paramedics are aware of, and integrate dementia knowledge, skills and confidence into their practice. Deeper exploration of the area that includes volunteer ambulance personnel and further inquiry of the role of paramedics in relation to those living with dementia is needed. A focus on education and professional development to equip paramedics to work with people living with dementia is recommended. The findings suggest that greater work in this area is required.","PeriodicalId":340334,"journal":{"name":"Australian Journal of Paramedicine","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115338912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Heulwen Spencer-Goodsir, Judith Anderson, C. Sutton
Introduction Access to emergency healthcare services and specialist care – particularly paramedic services – is more restricted in the rural and remote areas of Australia, and this disparity is amplified further as remoteness increases. This review aims to investigate the availability of current research regarding both the expanding nature of paramedicine roles in rural environments, and the impacts of rurality on the quality of out-of-hospital care provided to patients. Methods Arksey and O'Malley's six-step methodological approach was used to perform a scoping review to assess the availability of literature. Key words including paramedic*, regional, rural, remote and role were inputted into the search engines Scopus, CINAHL and PubMed. Titles and abstracts of the 864 results were screened by all authors and inclusion/exclusion criteria applied, resulting in 13 remaining articles. Results The final 13 articles comprised differing data collection types and methodologies from nine separate studies conducted in either Canada, Australia, the United Kingdom, the United States, Saudi Arabia or Qatar. Approximately 2.5 million patients, 534 paramedics, 331 other healthcare professionals and 35 case studies were included in the total combined results of these studies. Conclusion Rural communities demonstrated increased mortality rates in out-of-hospital patients due to several factors including rostering, specialist service locations and limited resource availability. Factors which were beneficial to the outcomes of patients in rural settings included enhanced paramedic scopes of practice, the implementation of community paramedicine programmes and wider roles within the community for paramedics. A lack of research on the exact nature of these changing roles in rural paramedicine is evident.
{"title":"The Nature of Paramedic Practice in Rural and Remote Locations: A Scoping Review","authors":"Heulwen Spencer-Goodsir, Judith Anderson, C. Sutton","doi":"10.33151/ajp.19.978","DOIUrl":"https://doi.org/10.33151/ajp.19.978","url":null,"abstract":"Introduction Access to emergency healthcare services and specialist care – particularly paramedic services – is more restricted in the rural and remote areas of Australia, and this disparity is amplified further as remoteness increases. This review aims to investigate the availability of current research regarding both the expanding nature of paramedicine roles in rural environments, and the impacts of rurality on the quality of out-of-hospital care provided to patients. Methods Arksey and O'Malley's six-step methodological approach was used to perform a scoping review to assess the availability of literature. Key words including paramedic*, regional, rural, remote and role were inputted into the search engines Scopus, CINAHL and PubMed. Titles and abstracts of the 864 results were screened by all authors and inclusion/exclusion criteria applied, resulting in 13 remaining articles. Results The final 13 articles comprised differing data collection types and methodologies from nine separate studies conducted in either Canada, Australia, the United Kingdom, the United States, Saudi Arabia or Qatar. Approximately 2.5 million patients, 534 paramedics, 331 other healthcare professionals and 35 case studies were included in the total combined results of these studies. Conclusion Rural communities demonstrated increased mortality rates in out-of-hospital patients due to several factors including rostering, specialist service locations and limited resource availability. Factors which were beneficial to the outcomes of patients in rural settings included enhanced paramedic scopes of practice, the implementation of community paramedicine programmes and wider roles within the community for paramedics. A lack of research on the exact nature of these changing roles in rural paramedicine is evident.","PeriodicalId":340334,"journal":{"name":"Australian Journal of Paramedicine","volume":"76 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121814781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cecilia Ostman, C. Garcia-Esperon, T. Lillicrap, K. Alanati, B. Chew, Jennifer Pedler, S. Edwards, M. Parsons, C. Levi, N. Spratt
Aims The Hunter-8 and the ACT-FAST are stroke scales used in Australia for the pre-hospital identification of large vessel occlusion (LVO) stroke but have not previously been compared. Moreover, their use in identifying distal arterial occlusions has not previously been assessed. We therefore aimed to describe the area under the receiver operating curve (AUC) of the Hunter-8 versus the ACT-FAST for the detection of classic LVO. Methods Both scales were performed on consecutive patients presenting with stroke-like symptoms within 24 hours of symptom onset presenting to the emergency department at a tertiary referral hospital between June 2018 and January 2019. The AUC of the Hunter-8 and the ACT-FAST was calculated for the detection of LVO using different definitions [classic LVO (proximal segment of the middle cerebral artery (MCA-M1), terminal internal carotid artery (T-ICA), or tandem occlusions) and extended LVO (classic LVO plus proximal MCA-M2 and basilar occlusions)]. Results Of 126 suspected stroke patients, there were 24 classic LVO and 34 extended LVO. For detection of classic LVO, the Hunter-8 had an AUC of 0.79 and the ACT-FAST had an AUC of 0.77. For extended LVO, the AUC was 0.71 and 0.70 respectively. Conclusion Both scales represent a significant opportunity to identify patients with proven potential benefit from thrombectomy (classic LVO), however M2 and basilar occlusions may be more challenging to identify with these scales.
{"title":"Comparison of Two Pre-Hospital Stroke Scales to Detect Large Vessel Occlusion Strokes in Australia: A Prospective Observational Study","authors":"Cecilia Ostman, C. Garcia-Esperon, T. Lillicrap, K. Alanati, B. Chew, Jennifer Pedler, S. Edwards, M. Parsons, C. Levi, N. Spratt","doi":"10.33151/ajp.19.989","DOIUrl":"https://doi.org/10.33151/ajp.19.989","url":null,"abstract":"Aims The Hunter-8 and the ACT-FAST are stroke scales used in Australia for the pre-hospital identification of large vessel occlusion (LVO) stroke but have not previously been compared. Moreover, their use in identifying distal arterial occlusions has not previously been assessed. We therefore aimed to describe the area under the receiver operating curve (AUC) of the Hunter-8 versus the ACT-FAST for the detection of classic LVO. Methods Both scales were performed on consecutive patients presenting with stroke-like symptoms within 24 hours of symptom onset presenting to the emergency department at a tertiary referral hospital between June 2018 and January 2019. The AUC of the Hunter-8 and the ACT-FAST was calculated for the detection of LVO using different definitions [classic LVO (proximal segment of the middle cerebral artery (MCA-M1), terminal internal carotid artery (T-ICA), or tandem occlusions) and extended LVO (classic LVO plus proximal MCA-M2 and basilar occlusions)]. Results Of 126 suspected stroke patients, there were 24 classic LVO and 34 extended LVO. For detection of classic LVO, the Hunter-8 had an AUC of 0.79 and the ACT-FAST had an AUC of 0.77. For extended LVO, the AUC was 0.71 and 0.70 respectively. Conclusion Both scales represent a significant opportunity to identify patients with proven potential benefit from thrombectomy (classic LVO), however M2 and basilar occlusions may be more challenging to identify with these scales.","PeriodicalId":340334,"journal":{"name":"Australian Journal of Paramedicine","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114554908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Andrew J. Milne, Rory Saggers, T. Hurst, Christine L. Henry, Michael Christian
Introduction The societal changes triggered by the COVID-19 pandemic and resultant lockdowns have the potential to alter the incidence and nature of injuries within affected populations. We aimed to investigate these changes within Metropolitan London and the impact lockdown had on London's Air Ambulance's (LAA) response to incidents. Methods This retrospective cohort study compared data from all LAA missions in the two-month period following instigation of the 1st UK national lockdown in 2020 to the equivalent period in 2019. Patient demographics, nature and severity of injuries, incident details and LAA mission parameters were assessed. Results LAA saw a significant reduction in the mean (standard deviation) of activations per week under lockdown (32.75 [4.95] versus 54.25 [4.53], p<0.001). The distribution of patients across different trauma aetiologies differed significantly under lockdown, with proportionately more injuries resulting from domestic violence (0.7% versus 3.8%) and deliberate self-harm (DSH [16.5% versus 12.4%]), although the absolute number of DSH fell. Significantly fewer incidents occurred in central areas of London, but injury severity was unaffected by lockdown. After adjustment for confounders, lockdown was associated with shorter drive times, but not overall response times. There was no association between lockdown and aetiology or severity of injuries. Conclusion The COVID-19 pandemic and ensuing UK national lockdown had a substantial impact on major trauma patterns within London and the subsequent LAA response. The feared rise in suicide was not observed, but there was a notable increase in domestic violence frequency.
{"title":"Impact of the UK National Lockdown on Trauma Patterns and the Prehospital Advanced Trauma Team Response within Metropolitan London","authors":"Andrew J. Milne, Rory Saggers, T. Hurst, Christine L. Henry, Michael Christian","doi":"10.33151/ajp.19.985","DOIUrl":"https://doi.org/10.33151/ajp.19.985","url":null,"abstract":"Introduction The societal changes triggered by the COVID-19 pandemic and resultant lockdowns have the potential to alter the incidence and nature of injuries within affected populations. We aimed to investigate these changes within Metropolitan London and the impact lockdown had on London's Air Ambulance's (LAA) response to incidents. Methods This retrospective cohort study compared data from all LAA missions in the two-month period following instigation of the 1st UK national lockdown in 2020 to the equivalent period in 2019. Patient demographics, nature and severity of injuries, incident details and LAA mission parameters were assessed. Results LAA saw a significant reduction in the mean (standard deviation) of activations per week under lockdown (32.75 [4.95] versus 54.25 [4.53], p<0.001). The distribution of patients across different trauma aetiologies differed significantly under lockdown, with proportionately more injuries resulting from domestic violence (0.7% versus 3.8%) and deliberate self-harm (DSH [16.5% versus 12.4%]), although the absolute number of DSH fell. Significantly fewer incidents occurred in central areas of London, but injury severity was unaffected by lockdown. After adjustment for confounders, lockdown was associated with shorter drive times, but not overall response times. There was no association between lockdown and aetiology or severity of injuries. Conclusion The COVID-19 pandemic and ensuing UK national lockdown had a substantial impact on major trauma patterns within London and the subsequent LAA response. The feared rise in suicide was not observed, but there was a notable increase in domestic violence frequency.","PeriodicalId":340334,"journal":{"name":"Australian Journal of Paramedicine","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127416481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction Non-technical skills (NTS) are a causative factor in many adverse events in healthcare. Although this is the case, NTS have been explored in the paramedic literature in isolation, with no current list of desirable paramedic NTS within the literature. This study aims to gather consensus opinions on which NTS are considered important for an operational paramedic. Methods A modified Delphi technique was utilised to achieve the study aim. Participants were required to rate each NTS on a ten-point Likert scale. For an NTS to reach a consensus, it was required to be rated within two Likert scale points of the mode score by 80% of participants. Results There were 17 participants in the Delphi study (n=17). The study ran for a total of three rounds, and 33 of 35 NTS reached consensus. The top five NTS were communication, problem-solving, situational awareness, professionalism, and interpersonal skills. Two NTS did not reach consensus; these were empathy and cognitive offloading. These two did not reach consensus despite being rated six or higher by all participants. Conclusions The results of this Delphi study have created the first expert-based list of important NTS for a paramedic. This will have significant implications for the paramedic field as we now have a foundation of which NTS is vital for a paramedic to complete their duties. These results can begin to form the foundation of a future paramedic behavioural marker systems will improve paramedic performance and ultimately lead to improved patient safety.
{"title":"Desirable Non-Technical Skills for Paramedicine: A Delphi Study","authors":"R. Bennett, B. Williams","doi":"10.33151/ajp.19.855","DOIUrl":"https://doi.org/10.33151/ajp.19.855","url":null,"abstract":"Introduction Non-technical skills (NTS) are a causative factor in many adverse events in healthcare. Although this is the case, NTS have been explored in the paramedic literature in isolation, with no current list of desirable paramedic NTS within the literature. This study aims to gather consensus opinions on which NTS are considered important for an operational paramedic. Methods A modified Delphi technique was utilised to achieve the study aim. Participants were required to rate each NTS on a ten-point Likert scale. For an NTS to reach a consensus, it was required to be rated within two Likert scale points of the mode score by 80% of participants. Results There were 17 participants in the Delphi study (n=17). The study ran for a total of three rounds, and 33 of 35 NTS reached consensus. The top five NTS were communication, problem-solving, situational awareness, professionalism, and interpersonal skills. Two NTS did not reach consensus; these were empathy and cognitive offloading. These two did not reach consensus despite being rated six or higher by all participants. Conclusions The results of this Delphi study have created the first expert-based list of important NTS for a paramedic. This will have significant implications for the paramedic field as we now have a foundation of which NTS is vital for a paramedic to complete their duties. These results can begin to form the foundation of a future paramedic behavioural marker systems will improve paramedic performance and ultimately lead to improved patient safety.","PeriodicalId":340334,"journal":{"name":"Australian Journal of Paramedicine","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128802455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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 A total of 71,401 patients were included, of which 607 (0.9%) required ARV activation within 24 hours. 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.
目的院前预警评分(ews)能准确识别有临床恶化风险的患者。我们假设ews可以在院前阶段识别出随后需要通过医疗检索进行临床升级的患者。方法对2018年农村地区维多利亚救护车接诊的成年患者进行回顾性观察研究。我们使用国家预警评分2 (NEWS2)和快速急诊医学评分(REMS)方法计算EWSs。主要终点是在救护车送达后24小时内成人维多利亚检索(ARV)的激活。我们评估了每个评分的敏感性和特异性，并使用多变量逻辑回归分析来评估ews与ARV激活之间的独立关联。结果共纳入71,401例患者，其中607例(0.9%)需要在24小时内激活ARV。NEWS2的敏感性和特异性分别为0.484 (95% CI 0.444-0.525)和0.806 (95% CI 0.803-0.809)，而REMS的敏感性和特异性分别为0.552 (95% CI 0.511-0.592)和0.508 (95% CI 0.504-0.512)。在调整偏远程度、到医院的距离、性别、年龄和医院服务水平后，根据NEWS2 (OR 4.12;95% CI 3.50-4.85, p < 0.001)和REMS (OR 2.92, 95% CI 2.26-3.77)与ARV激活相关。ARV激活的几率随着接收医院的偏远程度和服务水平的降低而增加。结论院前NEWS2和REMS与救护车就诊后24h内的医疗检索相关。ews可以早期识别需要医疗救护的救护车患者，从而促进早期启动并缩短最终护理时间。
{"title":"Pre-Hospital Early Warning Scores are Associated with Requirement for Medical Retrieval Services","authors":"Jeremy Smith, E. Andrew, Karen Smith","doi":"10.33151/ajp.19.956","DOIUrl":"https://doi.org/10.33151/ajp.19.956","url":null,"abstract":"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 A total of 71,401 patients were included, of which 607 (0.9%) required ARV activation within 24 hours. 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.","PeriodicalId":340334,"journal":{"name":"Australian Journal of Paramedicine","volume":"200 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116152564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Australasian College of Paramedicine Scientific Committee
{"title":"Australasian College of Paramedicine International Conference (Acpic) 2021 Abstracts","authors":"Australasian College of Paramedicine Scientific Committee","doi":"10.33151/ajp.19.1030","DOIUrl":"https://doi.org/10.33151/ajp.19.1030","url":null,"abstract":"","PeriodicalId":340334,"journal":{"name":"Australian Journal of Paramedicine","volume":"99 2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125969582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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