Australasian Emergency Care最新文献

Background: Linking routinely collected patient-level health data supports service planning and research while protecting privacy, though it poses several challenges. This paper demonstrates the process used to produce high-quality linked data for early pregnancy complication care for patients presenting to the Emergency Department (ED).

Methods: Ten years of regional health data were merged using deterministic linkage in five steps: 1) applying strict inclusion/ exclusion criteria via extraction code, 2) collecting data, 3) refining and pre-processing, 4) preparing datasets, and 5) linking to create the final dataset. Many challenges arose throughout this process, and pragmatic solutions were co-developed with the research team and data custodian.

Results: Challenges included handling multi-supply of encrypted, complex datasets; inconsistent health data systems; limited formal support for data interpretation; incomplete and conflicting records; and misalignment between data and research questions. Solutions involved automated data management, clinically guided extraction and exclusions, and a time-based grouping method to improve linkage yield, address missing data and absent linking terms.

Conclusion: Using an exemplar, methods of data collection, pre-processing and linking have been described. A transferable multi-step process and key lessons support efficient use of health data and data driven local policy decisions for the care of patients presenting with early pregnancy complications to the ED.

Background: For over 30 years ambulance services have used the community paramedic (CP) model, in which paramedics receive additional education and deliver specialist interventions to manage non-emergency patients. This study empirically quantifies their actions with patients.

Methods: An independent observer conducted continuous time-and-motion workflow observations of CPs over 22 consecutive days. Results were bootstrapped, descriptive and inferential statistics reported, and the structure of the standard case mapped.

Results: A total of 77 patients were observed for 5496 minutes. Mean on-scene time was 55 min (range 20-98, 95 %CI 54-56). Time was 56 % spent either completing paperwork or transporting, 28 % gathering data, 9 % discussing options, and 7 % providing interventions. The most common vital signs were heart rate/Sp0₂ (96 %), blood pressure (90 %), and temperature (81 %); others were measured in under 40 % of patients. Specialist scope was utilised in 16 % of patients, involving 8 of 24 available interventions. Overall, 57 % of patients were transported (51 % ED, 6 % urgent care), and 13 % were referred onwards.

Conclusions: This study provides insight into how CPs spend their time with patients. Results suggest that interactions focus on assessment and decision-making rather than specialist interventions; that this is a 'thinking' rather than a 'doing' role.

Background: To better align with the evolving needs of the community, Australian ambulance services are increasingly required to develop innovative care models. The dual-qualified emergency nurse-paramedic has skills and knowledge that align with these models yet is underutilised as a flexible workforce group available to meet specific needs. This research explored the lived experience of dual-qualified emergency nurse-paramedics working for Australian jurisdictional ambulance services to gain their perspectives.

Method: A descriptive phenomenological approach, informed by the works of Husserl was adopted for this study. Individual interviews were conducted with dual-qualified emergency nurse-paramedics (N = 13). Data was analysed according to Colaizzi.

Results: Participants described frustration with the current lack of acknowledgement of, and potential to therefore apply their knowledge, skills and experience. They voiced a desire for dual regulatory support and for an emergency nurse-paramedic role to be established. Beneficiaries of such a role were perceived to include the health system, ambulance services, the community, and the individual practitioner, whilst barriers included regulatory and organisational challenges.

Conclusion: The introduction of an emergency nurse-paramedic role in Australian jurisdictional ambulance services is timely and could contribute to improving care and health service delivery.

Oleander is an imported ornamental shrub occurring across the majority Australia with two main species Nerium oleander (common or pink oleander) and Cascabela thevetia (yellow oleander) seen. Oleander is a highly toxic plant containing cardiac glycosides that can lead to life-threatening cardiac and gastrointestinal complications. All parts of the plant are toxic. Accidental and intentional ingestion of the plant is reported throughout the world involving both humans and animals. Published case reports from Australia are historical and do not reflect current conventional management. This case report details the intentional ingestion of oleander leaves as a food source and the differing presentations of two family members. The report describes the presentation, diagnosis, and successful management of both patients. This report aims to enhance awareness among healthcare professionals regarding the clinical features, diagnosis, and current treatment of oleander toxicity especially in the pre-hospital and emergency settings.

Background: The implementation of palliative care nursing (PCN) in emergency departments (ED) is challenging, particularly in developing countries. There were several barriers faced by ED nurses. However, the specific barriers to the provision of PCN in the ED of developing countries' hospitals remained unclear. This scoping review aimed to explore the barriers to the provision of palliative nursing care in the ED of developing countries' hospitals.

Methods: This scoping review utilized five databases: Scopus, PubMed, ScienceDirect, Medline, and ProQuest, in addition to a Google Scholar search and backward and forward citation tracking. The articles included must have been published between 2014 and 2025, be available as full text, and be written in English. Two authors independently performed the article selection process, adhering to the PRISMA protocol.

Results: We included eight articles from six developing countries: China, Brazil, Uganda, Thailand, Indonesia, and Ghana. We identified and classified barriers to the provision of PCN in the ED in developing countries into several themes, including lack of knowledge and skills, lack of health facilities, practical issues, ethical issues, and family boundaries.

Conclusions: Understanding the barriers to the provision of PCN is expected to provide a foundation for evaluating and enhancing its implementation in the ED, particularly in developing countries' hospitals.

Background: First-line pharmacological management of acute renal colic pain may vary influenced by preference, structural and staffing issues with emergency departments. The aim of this study was to explore the variation in renal colic pain management and contributing factors within emergency departments in Australia METHODS: A specifically designed survey was sent to relevant national professional colleges and organisations for distribution. The survey presented respondents with four acute renal colic scenarios. Descriptive statistics summarised quantitative data, while free text responses were explored using content analysis.

Results: Responses from 180 nurses, paramedics and medical doctors were analysed. Opioids were the most commonly prescribed analgesia (4 scenarios) in combination with either paracetamol (3 scenarios) or rectal NSAIDs (1 scenario). Free text responses provided context to the preference of opioids and identified workload, clinician availability and scope of practice limitations to timely analgesia provision. Most respondents (91.2 %) would support research into non-pharmacological alternatives to opioids.

Conclusion: Opioids remain the first line preference for many clinicians in managing acute renal colic pain despite current guideline recommendations for NSAIDs. Departmental and clinician capacity, and practice limitations contribute to delays in providing analgesia. Greater consistency and predictability in prescribing, review of limitations on nurse prescribing and exploring novel low risk first line non-pharmacological analgesics may improve management of acute renal colic.

Background: Intimate partner violence (IPV) is a global public health problem that causes acute and chronic adverse impacts on victim-survivors' physical and psychological well-being. For many, the emergency department is the first point of contact when seeking support. Yet the provision of emergency care to victim-survivors of IPV is often focused on biomedical care, which fails to meet the needs of this at-risk patient cohort.

Methods: This review aims to synthesise evidence to guide the provision of emergency healthcare to patients experiencing IPV with the goal to improve the quality of holistic care, through a standardised response. A scoping review was undertaken. Search terms and phrases were employed to search six healthcare databases and open-access materials. Literature was not excluded by study design. A critical appraisal using the PRISMA checklist was employed. Data was then analysed using a developed framework to ensure relevance to the stated aim and context.

Results: There were 29 studies included in this review, which provided clinical practice recommendations surrounding the following elements of emergency healthcare provision: Screening, Assessment, Interventions, Referrals, Safety Planning and Patient Education. An interdisciplinary approach that considers both physical and psychosocial needs was developed.

Conclusions: This review provides recommendations to standardise the provision of patient-focused emergency healthcare to patients experiencing IPV with a focus on the Australian context. The need for guidance on specific elements to consider within each aspect of the victim-survivors' healthcare journey was emphasised and provided within a clear framework. This guidance may aid in developing clear, structured frameworks for the provision of quality interdisciplinary care to victim-survivors of IPV.

Objective: To collate assessment tools, diagnostic/screening methods, referral pathways, and clinical practice guidelines (CPGs) available to paramedics managing suspected or confirmed COVID-19 patients in the out-of-hospital (OOH) setting, and to examine the evidence cited in these resources.

Introduction: COVID-19 presents with varied severity and has caused over seven million deaths since 2020. Ambulance Health Services (AHSs) have faced sustained demand and implemented new measures for patient care, often without evidence-based guidance. This review explores how paramedics assess, diagnose, and refer these patients, and what evidence supports these practices.

Inclusion criteria: Sources from January 2020 to October 2024 were included, with grey literature from six countries eligible until April 2025. Participants were patients of any age assessed or referred by paramedics in OOH settings.

Methods: Following JBI methodology and PRISMA-ScR, literature was sourced from databases and ambulance organisations. Data were extracted using Covidence and customised tools, then synthesised narratively and in tables.

Results: Sixty-seven sources from 20 countries were included. Six screening tools, 29 assessment tools, and 13 referral pathways were identified. Few AHS resources cited evidence.

Conclusions: Paramedic practice is significantly heterogenous and most CPGs lack supporting evidence. This review can aide further evidence-mapping and validation of clinical tools and patient pathways.

Objectives: This scoping review investigates Intensive Care Paramedic (ICP) crewing configurations within road-based Anglo-American paramedic systems, aiming to map and describe the existing literature and guide future research.

Methods: Following Joanna Briggs Institute methodology and PRISMA-ScR guidelines, a comprehensive database and grey literature search was conducted up to May 2025.

Results: The search yielded 3442 articles, of which 19 met inclusion criteria. Four categories emerged: patient outcomes, operational outcomes, provider experiences, and clinical performance. Most studies focused narrowly on OHCA, with limited attention to other patient outcomes. Operational outcomes emphasized response times and on-scene intervals; provider experiences highlighted professional isolation and limited support. Clinical performance centered on error rates, time to intervention, and deviations from guidelines.

Conclusions: This synthesis indicates that literature on ICP crewing has traditionally focused on OHCA, and ICPs may be associated with improved outcomes in this cohort. The literature inferred tiered response models may facilitate faster response intervals. ICPs working in Professionally Autonomous systems operating within single-response structures report feelings of professional isolation, and dual ICP crews are not consistently linked to enhanced clinical performance. Future research should investigate ICP crewing configurations within the context of tailored healthcare frameworks, prioritizing meaningful outcome measures that optimize patient care, provider experiences, and operational efficiency.

Background: Changes in service delivery and Australian mental health legislation have expanded the role of paramedics in caring for persons experiencing a mental health crisis. The expanded role of paramedics is reflected in Clinical Practice Guidelines (CPGs) and varies across ambulance services.

Methods: We examine Australian paramedic CPGs to identify guidelines for managing mental health crises, citations, assessment tools, treatment options (e.g. de-escalation, restraint), and recommendations.

Results: Mental health is outlined in a range of CPGs, but is most often associated with agitation and disturbed behaviour. Legislation and legal documents are frequently cited in the CPGs, reflecting the significant influence of legislation on paramedic practice. There are differences between ambulance services in their approaches to mental status assessment, de-escalation, and restraint; however, there are commonalities in the underlying principles. There is limited publicly available evidence to enable evaluation of CPG development.

Conclusion: Care of persons experiencing a mental health crisis requires flexibility and clinical judgment on the part of the paramedic, making it a challenge to be prescriptive. Ambulance services operate under the current mental health legislation in their jurisdictions, resulting in variations in practice, as documented in the CPGs.