Australasian Emergency Care最新文献

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.

Objective: To examine the relationship between prehospital Advanced Life Support (ALS) and survival to hospital for major trauma patients in New Zealand and explore its implications for Emergency Medical Service (EMS) practice.

Methods: A mixed-methods explanatory design was used. Data on major trauma patients attended by road EMS (December 2016-November 2018) was analysed. A multivariable model with propensity scores estimated the odds of survival for patients receiving Advanced versus Basic Life Support (BLS). Semi-structured interviews conducted with EMS stakeholders were analysed using thematic analysis.

Results: Among 1118 patients, 661 (59 %) received ALS. Only 52 (5 %) did not survive to hospital. Multivariable modeling estimated ALS recipients had 1.5 times higher odds of survival than BLS-only recipients (OR 1.49, 95 % CI 0.66-3.35). Interviews with five EMS clinical leaders highlighted two likely influences: clinical judgment and evidence use. Despite imprecise quantitative findings, stakeholders supported ALS based on clinical judgment.

Conclusions: A tension between population-level results and provision of care based on clinical judgement exists. Quantitative analysis found no evidence that ALS offers a survival benefit, although considerable uncertainty exists, whereas stakeholders perceive ALS has clinical and equity benefits. Future research should assess equity, disability, and quality of life outcomes of ALS.

Background: Patients with advanced heart failure often present to hospital emergency departments during acute health crises near the end of life. While emergency departments focus on medical stabilization, they may not adequately address the emotional, spiritual, and personal needs of patients during this critical period.

Methods: This qualitative study was conducted at a major tertiary hospital in Saudi Arabia. Semi-structured interviews were conducted with twelve patients diagnosed with advanced heart failure to explore their experiences of end-of-life care in the emergency department. Thematic analysis was used to interpret the data.

Results: Four key themes emerged. Cultural and religious influences shaped how patients perceived their illness and guided medical decisions, often involving strong reliance on faith and family. Patient readiness and awareness varied, influencing communication preferences and attitudes toward treatment. Care experiences in the emergency department reflected both appreciation for acute interventions and concerns about inadequate communication, privacy, and spiritual care. System-level barriers such as overcrowding, limited staffing, and the absence of structured advance care planning restricted the delivery of holistic, person-centered care.

Conclusions: These findings highlight the need for culturally informed, communication-focused, and system-responsive approaches to end-of-life care in emergency departments, particularly within Saudi Arabia and comparable healthcare systems.

Purpose: Triage is a critical process for patient prioritisation in emergency departments (EDs) that aims to rapidly allocate patients to the appropriate level of emergency care commensurate with clinical urgency. Triage completion is expected within two to five minutes while ensuring patient safety. The purpose of this review is to identify the facilitators and barriers to triage efficiency in EDs and provide an overview of how these factors impact the triage process.

Procedures: An integrative literature review was conducted with a structured search across six databases, including CINAHL, Embase, Medline, Scopus, ProQuest, and PubMed. Twenty studies met the inclusion criteria and were narratively synthesised.

Findings: Factors affecting triage efficiency were grouped under four themes. Process-related factors such as workflow designs, electronic triage support decision tools, "quick look" triage approaches, and system inefficiencies; nurse-related factors like experience, educational attainment, cognitive approach, and fatigue; environmental and system-related pressures such as interruptions, high patient volume, overcrowding, and availability of adequate triage spaces and equipment; and patient factors, including patient complexity, all shaped triage efficiency.

Conclusion: Triage efficiency is a dynamic and context-sensitive outcome shaped by multiple factors. Some factors are modifiable, and further studies are needed to explore targeted interventions and their impact on triage efficiency in emergency care.

Background: With emergency departments (EDs) facing growing demand to provide end-of-life care (EOLC), it has become more important to identify the factors that influence the EOLC practices of ED nurses. This study examined the effects of nursing professional values, the nursing work environment, and compassion competence on the EOLC practices of ED nurses.

Methods: This cross-sectional descriptive study was conducted with 136 ED nurses in Korea. Statistical analysis was conducted to examine the relationships among key variables and identify significant predictors of EOLC practices.

Results: EOLC practices exhibited a significant positive correlation with nursing professional values (r = .43), the work environment (r = .42), and compassion competence (r = .60; all p < .001). Compassion competence was the strongest predictor of EOLC practices (β = 0.497, p < .001), explaining 39 % of the variance.

Conclusions: Compassion competence was the most influential factor affecting EOLC practices among ED nurses. These findings highlight the need to incorporate compassion training into ongoing education and create supportive environments that promote emotionally attuned care, even in high-pressure emergency settings.

Background: The COVID-19 pandemic affected frontline Healthcare Workers (HCWs) immensely, subjecting them to extreme psychological distress. The current study assesses the burnout, anxiety, depression, PTSD, and resilience levels among HCWs and analyses the efficacy of institutional mental health interventions.

Methods: A cross-sectional longitudinal study design that combined quantitative surveys and qualitative interviews was employed. There were 500 HCWs from public hospitals, private hospitals, primary healthcare centres, and emergency response teams who took part. Validated measures included the Maslach Burnout Inventory (MBI), Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), PTSD Checklist (PCL-5), and Connor-Davidson Resilience Scale (CD-RISC). Descriptive statistics, chi-square tests, t-tests, and logistic regression were used in data analysis.

Results: Psychological distress was common, with 42.5 % burnout, 35.2 % anxiety, 29.8 % depression, and 21.4 % PTSD. Long hours (OR = 1.85, p < 0.001), high patient volume (OR = 1.67, p < 0.001), and absence of PPE (OR = 1.52, p = 0.002) were major contributors, and robust workplace support (OR = 0.75, p = 0.037) was protective. Qualitative interviews revealed key themes, including persistent sleep disturbances, Mental Health Support, Emotional and Social consequences, Impact on relationships and fear of infecting family members.

Conclusion: HCWs experienced extreme psychological distress throughout the pandemic, which requires additional mental health policies, organizational support, and greater access to digital interventions.

Aims: To synthesise findings from randomised controlled trials (RCTs) on vascular access devices (VADs) in emergency departments (EDs).

Background: VADs play a critical role in EDs, enabling rapid delivery of supportive therapies to address urgent medical needs. This scoping review will map current evidence and determine areas to focus future research priorities.

Methods: Following Arksey and O'Malley's scoping review framework, a comprehensive search was conducted (2012-2024) across four databases. RCTs that focused on peripheral intravenous catheters, central venous catheters, arterial catheters, or intraosseous catheters in an ED setting were included.

Results: 48 RCTs were included, a majority focused on peripheral intravenous catheters (n = 41, 85 %), followed by central venous catheters (n = 4, 8 %), arterial catheters (n = 2, 4 %), and intraosseous catheters (n = 1, 3 %). The findings were categorised by intervention type, including vessel visualisation technology, catheter design, dressing and securement design, distraction techniques, topical anaesthetics, inserter models, and other related techniques. The top three most frequently reported outcomes were insertion success (n = 21), time to successful insertion (n = 20), and catheter-related complications (n = 19).

Conclusion: This review provides ED clinicians with current evidence on VAD technologies and techniques, enabling them to select and implement the most effective options into daily practice reduce costs and improve patient satisfaction.