Australasian Emergency Care最新文献

Over the past decade, health care and ambulance organisations worldwide have reported increasing paramedic attrition rates, with many of these leavers exiting the profession entirely. Retaining experienced paramedics is necessary to improve patient outcomes, decreasing onboarding costs, and to continue the progression of the profession. Understanding paramedic attrition has gained more interest in the literature; however, studies have mainly focussed on paramedics leaving their place of employment rather than the profession altogether. It is important that this distinction is made as the influencing factors likely vary, requiring different retention strategies. This scoping review aimed to determine the main factors influencing paramedics to leave the profession and identify areas for further research. A total of 1026 articles were screened, of which 28 were included in the final review. Content analysis of their key findings led to the identification of three main themes and 14 subthemes that illustrate the main factors influencing paramedics' decisions to leave the profession. This review found that paramedic attrition is driven by a complex combination of organisational, occupational, and personal factors. More research, especially from outside the United States, is needed to better understand why paramedics are leaving the profession and to identify targeted retention strategies.

Background: Adolescents with mental health concerns are increasingly presenting to emergency departments (EDs). Understanding psychosocial triggers that contribute to presentation may improve patient management. This study aimed to identify these psychosocial factors using the HEEADSSS assessment framework for adolescents. HEEADSSS is an acronym for the topics it incorporates; Home; Education/Employment; Eating/Exercise (Sleep); Activities/Peer Relationships (Hobbies); Drug use; Sexuality (Sexual orientation/Gender); Suicide (Self-harm/Depression/ Mood); Safety and Spirituality.

Methods: This was a retrospective chart review of electronic medical records (eMR) of mental health presentations in 10-24-year-olds to three metropolitan EDs during 2021. Trained nurses collected data from the ED clinical notes. De-identified data were categorically indexed to the topics of the HEEADSSS framework and analysed qualitatively to identify psychosocial factors and themes relating to MH presentation.

Results: 1748 presentations were analysed. The categories of Home, Mood, Sleep, Suicide and Peer Relationships identified high rates of issues amongst the study population. Common issues included difficult family dynamics (30.0 %), trauma (26.4 %), low mood (30.3 %), poor sleep (30.8 %) as well as themes of loneliness (7.6 %) and feeling socially isolated (18.2 %).

Conclusion: Using the HEEADSSS assessment framework allowed capture of unique psychosocial factors that contributed to mental health concerns for adolescents presenting to ED. Further research is needed to determine the importance of each factor as a precipitating reason for ED presentation.

Background: Australia has a nursing shortage. Emergency Departments (EDs) are particularly affected, necessitating interventions to support and retain new emergency nurses. This study evaluates "In from the Beginning," a framework designed to improve the experience of new emergency nurses.

Methods: A 12-month longitudinal study was conducted in 2023-2024 at three Australian EDs with 72 nurses. Surveys administered at baseline, six and 12 months were used to assess ascent to competence and belonging. Differences between groups were assessed using nonparametric tests, changes over time with linear mixed-effects models and content analysis for free text.

Results: All 72 nurses participated, 15 received the intervention, 50 (70 %) completed 12 m follow-up. Participants reported high levels of feeling welcomed (median 26.5/30). The intervention group reported lower baseline self-confidence, but greater rate of improvement compared to control group (β=8.95, SE=3.75, p = 0.019). There were no differences in belonging, learning and competency. Qualitative data emphasised importance of mentorship. Retention at 12 months was 87 % in the intervention group and 65 % in control group (Χ²₍₁₎ = 1.72. p = 0.19).

Conclusion: The "In from the Beginning" framework provided support to new emergency nurses and resulted in improved self-confidence. Future research will explore long-term impacts on retention.

Background: Internationally, rural areas tend to have prolonged emergency medical service (EMS) response times, associated with a lower survival from out-of-hospital cardiac arrest (OHCA). We examined how the components of EMS response time to OHCA vary according to rurality in Western Australia (WA), and estimated the effect that reducing rural mobilisation times might have on OHCA survival.

Methods: Using a retrospective cohort of medical OHCAs in WA with EMS-resuscitation attempted, from 2015 to 2022, we compared the components of response time (Triage, Mobilisation, Travel to the scene and Total Response), stratified by regional remoteness and proximity to nearest town. Using only the rural subgroup, we then used counterfactual simulation methodology to estimate the number of 30-day survivors if response times were reduced in rural areas.

Results: Total EMS response time increased with increasing regional remoteness. Mobilisation time also increased with regional remoteness, even among OHCAs occurring within towns; in rural areas, median mobilisation time was 3.32 mins (1.43, 10.00) (mean 6.24, sd 6.61), with metropolitan areas having a median of 0.97 mins (0.63, 1.48) (mean 1.43, sd 2.65). If rural areas had the same mean mobilisation time as metropolitan areas, the relative increase in the estimated number of rural survivors (16.9 %) was not statistically significant.

Conclusion: Mobilisation times were significantly longer in rural areas of WA than metropolitan. These results demonstrate that the effects of rurality on OHCA response time are not simply due to rural patients having increased distance from emergency services. Efforts to improve rapid bystander interventions may be particularly beneficial in rural towns for the crucial minutes before EMS personnel arrive.