Australasian Emergency Care最新文献

Introduction: Hypothermia can increase mortality in certain patients. Paramedics apply cotton and foil "space" blankets for warming, yet their effectiveness remains uncertain. This pilot study aimed to evaluate combining cotton blankets with a self-warming blanket versus a combination of cotton blankets and a foil blanket in an out-of-hospital simulation.

Methods: Eight participants were allocated to warming with either two cotton blankets and one foil blanket, or two cotton blankets and one self-warming blanket, with the alternate method applied in a subsequent session. Participants were cooled using an ice-vest and fan until shivering onset, after which the warming method was applied. Simulation involved transitioning through three environments: baseline (22 °C), cooling/warming (16 °C), and "ambulance" (27 °C). Core temperature was monitored via oesophageal probe, skin temperature via thermistors (recorded every minute), and tympanic temperature and thermal sensation and comfort were recorded five minutely.

Results: There were minor differences in thermal sensation. For the primary outcome there was no significant difference between blanket methods (core: foil 36.98 ± 0.08 °C vs. self-warming 36.95 ± 0.10 °C, P > 0.05).

Conclusion: The combination of cotton and self-warming blankets did not exhibit superiority compared to cotton and foil blankets in out-of-hospital simulation. Future research should explore alternative warming methodologies to optimise normothermia maintenance.

Background: Birthing on Country principles in Australia have seen a revitalisation in midwifery care over the last decade with it being seen as a metaphor for the best start to life for First Nations peoples. This scoping review aimed to explore the extent of evidence of Australian First Nations women's experiences of out-of-hospital childbirth and the alignment with Birthing on Country principles to inform paramedic practice.

Methods: Four databases were searched including MEDLINE, CINAHL, EBSCOhost Health and Scopus utilising the Joanna Briggs Institute (JBI) methodology for Scoping Reviews. Inclusion and exclusion criteria were identified. All articles were reviewed in a two stage process.

Results: Fifty two papers were yielded with 6 meeting the inclusion criteria. Using reflective thematic analysis four key themes were generated; Birthing on Country and identity, inequitable access to healthcare, trusting relationships and medicalisation of birth.

Conclusions: There is a large gap in the literature surrounding delivery of care by paramedics to First Nations women birthing out-of-hospital in Australia. This review proposes supports and actions required to implement Birthing on Country principles into paramedicine. Further, standard maternity care has been found to be insufficient for First Nations women due to a lack of culturally safe care.

Background: This study aimed to explore the experiences of trans (binary and non-binary) people accessing emergency department care in Australia.

Method: This qualitative descriptive study utilised a grounded theory approach. Seven people who identified as trans were recruited through social media and trans support groups. Individuals participated in an in-depth narrative interview. Interview transcriptions were analysed using a constant comparative approach.

Results: Following thematic analysis, four key themes were identified: 1. identity; 2. clinical care; 3. communication; and 4. perceptions of health professional education, beliefs and experience in caring for trans people.

Conclusion: This study is the first in Australia to explore the experiences of trans people utilising emergency department services. The findings of this study are similar to international data whereby the delivery of gender affirming care in emergency departments is inconsistent, health professionals are perceived as poorly educated and gender identity is inadequately recognised.

Introduction: In Australia, almost 50 % of paramedics are female yet they remain under-represented in stereotypical depictions of the profession. The potentially transformative value of generative artificial intelligence (AI) may be limited by stereotypical errors, misrepresentations and bias. Increasing use of text-to-image generative AI, like DALL-E 3, could reinforce gender and ethnicity biases and, therefore, is important to objectively evaluate.

Method: In March 2024, DALL-E 3 was utilised via GPT-4 to generate a series of individual and group images of Australian paramedics, ambulance officers, police officers and firefighters. In total, 82 images were produced including 60 individual-character images, and 22 multiple-character group images. All 326 depicted characters were independently analysed by three reviewers for apparent gender, age, skin tone and ethnicity.

Results: Among first responders, 90.8 % (N = 296) were depicted as male, 90.5 % (N = 295) as Caucasian, 95.7 % (N = 312) as a light skin tone, and 94.8 % (N = 309) as under 55 years of age. For paramedics and police the gender distribution was a statistically significant variation from that of actual Australian workforce data (all p < 0.001). Among the images of individual paramedics and ambulance officers (N = 32), DALL-E 3 depicted 100 % as male, 100 % as Caucasian and 100 % with light skin tone.

Conclusion: Gender and ethnicity bias is a significant limitation for text-to-image generative AI using DALL-E 3 among Australian first responders. Generated images have a disproportionately high misrepresentation of males, Caucasians and light skin tones that are not representative of the diversity of paramedics in Australia today.

Background: There is no published literature on the predictive ability of the Clinical Frailty Scale (CFS) for falls risk specific to the Emergency Department (ED) population. This study aims to develop a prognostic model to determine the predictive ability of the CFS for ED falls' re-presentation in community-dwelling older people.

Methods: A retrospective observational cohort study was completed from July 2019 to July 2022 on community dwelling people aged 75 years and over who presented to the ED with an extrinsic fall and had a CFS score recorded. The primary outcome was fall-related re-presentation to ED; the secondary outcome was mortality. A flexible parametric survival model was applied with time to falls re-presentation, and post-estimation, used to predict the probability of another fall re-presentation within 6 months. Calibration was assessed and a decision support curve generated.

Results: The model demonstrated reasonable calibration-in-the-large (Slope = 0.999) and fit between CFS and probability of fall re-presentation. The CFS model displayed negligible discriminant ability (C-statistic = 0.534) for identifying older people at risk of falls-related ED re-presentations within 6 months of index presentation.

Conclusions: The CFS cannot be used to prognosticate an individual's risk of ED re-presentation within 6 months of an index extrinsic fall.

Purpose: In the recovery phase of COVID-19 disaster management, Emergency Department (ED) nurses are attempting to return to normal workforce operations, despite significant impacts on personal and professional lives. This review aims to examine and synthesise current literature for the learnings and recommendations from the lived experiences of ED nurses during the COVID-19 pandemic.

Procedures: Electronic databases CINAHL Complete, Web of Science, Scopus (Elsevier) and PubMed were utilised using a 5-year timeframe that aligned with COVID-19 in Australia. Final date of accepted papers was 28th February 2024. A JBI Mixed Methods Convergent Integrated Approach was used.

Findings: A total of 15 studies were included in the final review, representing seven countries of origin and included 649 ED nurses. Seven major themes related to learnings and recommendations were generated from data synthesis including (1) professional identity, (2) wellbeing support, (3) camaraderie, (4) effective communication, (5) working conditions and professional boundaries, (6) education and training, and (7) external support.

Conclusion: With the likelihood of future epidemic and pandemic events globally, it is vital to explore and collate evidence on the learnings and recommendations from ED during the COVID-19 pandemic to continue to build a sustainable, resilient, and supported workforce.

Background: Low urgency, non-traumatic musculoskeletal presentations are common in emergency departments. Although care is safe, it is expensive, and low priority. Pathways diverting these patients from emergency departments to physiotherapy care may improve hospital outcomes. Identifying the suitable patient profile for these pathways is important.

Methods: A mixed prospective and retrospective, descriptive, cross-sectional study investigated adults aged 18-65 presenting to two emergency departments. Suitable patients were diverted directly to a physiotherapy outpatient diversion pathway. Three groups were compared, diverted patients, patients suitable but not diverted, and patients unsuitable for diversion.

Results: Diverted patients were aged 43 (median, inter-quartile range 34-53.5) years, triaged as low-urgency, self-referred, self-transported, and had few concerning features of serious pathology. Diverted patients had a 113-minute shorter emergency stay at 79 (median) minutes compared to suitable but not diverted patients, and both groups had a similar profile. Most (93.4 %) diverted patients were discharged within 4- hours, compared to suitable but not diverted patients (72.9 %). Key factors preventing diversion were concern for serious pathology or diversion capacity restraints.

Conclusion: A group of patients with non-traumatic musculoskeletal conditions who can be safely diverted to physiotherapy outpatients are described. Diversion impact was high quality care and improved emergency department metrics.

Background: Increased demand, wait times and length of stay have seen many emergency departments implement nurse-initiated protocols In New South Wales, Australia, 74 nurse-initiated protocols have been developed for implementation. The aim of this paper is to identify the barriers and enablers to nurses' use of these protocols to inform and maximise future implementation.

Methods: Data were collected via surveys informed by the theoretical domains' framework and the Practice Environment Scale of the Nursing Work Index (PES-NWI). Descriptive statistics summarised quantitative data and content analysis was performed on qualitative data. Results were integrated and classified as barriers or enablers to nurses' use of protocols.

Results: The nurses' response rate was 82 % (n = 76) and doctors 72 % (n = 34) Six categories were generated; one barrier (lack of resources), three enablers (patient and organisational benefits, nurses' motivation, nurses' desire to develop their practice) and two were both a barrier and enabler ( nurse confidence and the work environment).

Conclusion: Emergency nurses are highly motivated to use nurse-initiated protocols to positively impact patient outcomes. However, a lack of resources, time, access to education and confidence are barriers to use that need to be addressed when designing implementation.

Background: Screening for frailty in the emergency setting may be useful in directing patients to appropriate management pathways. The main aim of this study was to assess the inter-rater reliability of the Clinical Frailty Scale between paramedics and emergency department staff (doctors and allied heath) for patients after a fall. Secondarily, to assess how these scores correlate with patient outcomes.

Methods: A prospective study of older patients arriving by ambulance to a single hospital in Western Australia following a fall. The inter-rater reliability was assessed using a weighted Cohen's κ. The relationship between Clinical Frailty Scale and secondary outcomes were assessed using chi-squared and Kruskal-Wallis tests.

Results: Data from 94 patients were included, the mean age was 82 years and 64 % were female. The inter-rater reliability between paramedics and emergency department staff using the Clinical Frailty Scale was moderate (κ 0.48 (95 % CI 0.36-0.59)).

Conclusions: There is only moderate agreement between emergency department staff and paramedics when screening for frailty in patients who present after a fall. The findings indicate the need to improve reliability as a pre-requisite to the use of frailty screening in emergency settings.

Evaluation of the Australian Triage Scale in patients who present to the emergency department with upper gastrointestinal bleeding BACKGROUND: Upper gastrointestinal bleeding (UGIB) is a common presentation to the emergency department (ED). Study aims were to evaluate the utility of the Australasian Triage Score (ATS) in patients presenting to the ED with UGIB.

Methods: This retrospective observational study included 356 patients over a 2-year period who presented to a metropolitan hospital ED. The ATS was categorised into three groups, ATS 1/2, ATS 3 and ATS 4/5. Primary outcomes explored the relationship between ATS and haemodynamic parameters. Secondary outcomes evaluated the proportion of patients with suspected variceal bleeding and allocated a non-life-threatening ATS category.

Results: The study population were distributed by ATS 1/2 (28.7 %), ATS 3 (46.6 %) and ATS 4/5 (24.7 %). Over half of patients with some haemodynamic compromise were allocated an ATS 3 or 4/5. Additionally, 56 % with suspected variceal bleeding and 51 % with syncope were also allocated an ATS category (3 or 4/5).

Conclusions: The utility of the ATS recognises most patients presenting with UGIB at high-risk of adverse outcomes. Additional screening at triage maybe beneficial for those patients with a history of cirrhosis or varices, and UGIB-related syncope. Consideration of an ATS category of 2 for these patients may enable them to access earlier time-critical therapies.