Pub Date : 2025-02-12DOI: 10.1016/j.auec.2025.01.003
Benjamin Aston , Gideon de Jong , Sarah Tillott
Since the outbreak of the COVID-crisis almost five years ago, Emergency Departments (EDs) in Australian hospitals have increasingly been confronted with the phenomenon of "access block" in which the flow of patients to inpatient units is delayed or obstructed. This creates tension between ED staff and health professionals employed in inpatient units. With the current political discourse, there is little reason to hope that this problem will be solved in the short term. As long as no radical changes are made at the political level to combat the issue of access block, the hands of individual clinicians are tied to existing models of care. In this letter to the editor, we outline how the problem of access block occurs in the ED of a Queensland-based hospital and the impact it generates. But also how healthcare leaders can adequately manage the tension between ED and inpatient staff, underscoring the crucial role of emotional intelligence.
{"title":"Mitigating conflict between emergency department and inpatient staff due to access block","authors":"Benjamin Aston , Gideon de Jong , Sarah Tillott","doi":"10.1016/j.auec.2025.01.003","DOIUrl":"10.1016/j.auec.2025.01.003","url":null,"abstract":"<div><div>Since the outbreak of the COVID-crisis almost five years ago, Emergency Departments (EDs) in Australian hospitals have increasingly been confronted with the phenomenon of \"access block\" in which the flow of patients to inpatient units is delayed or obstructed. This creates tension between ED staff and health professionals employed in inpatient units. With the current political discourse, there is little reason to hope that this problem will be solved in the short term. As long as no radical changes are made at the political level to combat the issue of access block, the hands of individual clinicians are tied to existing models of care. In this letter to the editor, we outline how the problem of access block occurs in the ED of a Queensland-based hospital and the impact it generates. But also how healthcare leaders can adequately manage the tension between ED and inpatient staff, underscoring the crucial role of emotional intelligence.</div></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"28 2","pages":"Pages 73-75"},"PeriodicalIF":2.1,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-05DOI: 10.1016/j.auec.2025.01.004
Ali Jaber Alqahtani , Geoffrey Keith Mitchell , Lisa Crossland , Hanan Mesfer Alyami
Background
Providing care for patients nearing the end of life who have advanced heart failure presents significant challenges, especially in emergency settings where the primary focus is on life-saving interventions. Exploring the perceptions of emergency department staff is essential for identifying barriers and improving care delivery in this critical context.
Methods
A qualitative study was conducted in two hospitals in Saudi Arabia. Semi-structured interviews were completed with thirty emergency staff. A thematic analysis was used to identify the challenges in delivering care for patients nearing the end of life.
Results
Seven themes were identified: current practices for advanced heart failure patients, communication barriers, inadequate training in end-of-life care, limitations in emergency department design, heavy workloads, the influence of cultural and religious factors, and the importance of psychological and emotional support for patients and families. The findings highlight the need for structured training, cultural sensitivity, and improved environments to address these challenges.
Conclusions
This study emphasizes the complexities of providing care for patients nearing the end of life in emergency settings. Addressing gaps in communication, training, and cultural competence is critical. Tailored strategies for Saudi Arabia’s unique context are essential to enhance care for advanced heart failure patients.
{"title":"Enhancing end-of-life care for advanced heart failure patients in Saudi Arabian emergency departments (EDs): Perspectives of ED staff on challenges","authors":"Ali Jaber Alqahtani , Geoffrey Keith Mitchell , Lisa Crossland , Hanan Mesfer Alyami","doi":"10.1016/j.auec.2025.01.004","DOIUrl":"10.1016/j.auec.2025.01.004","url":null,"abstract":"<div><h3>Background</h3><div>Providing care for patients nearing the end of life who have advanced heart failure presents significant challenges, especially in emergency settings where the primary focus is on life-saving interventions. Exploring the perceptions of emergency department staff is essential for identifying barriers and improving care delivery in this critical context.</div></div><div><h3>Methods</h3><div>A qualitative study was conducted in two hospitals in Saudi Arabia. Semi-structured interviews were completed with thirty emergency staff. A thematic analysis was used to identify the challenges in delivering care for patients nearing the end of life.</div></div><div><h3>Results</h3><div>Seven themes were identified: current practices for advanced heart failure patients, communication barriers, inadequate training in end-of-life care, limitations in emergency department design, heavy workloads, the influence of cultural and religious factors, and the importance of psychological and emotional support for patients and families. The findings highlight the need for structured training, cultural sensitivity, and improved environments to address these challenges.</div></div><div><h3>Conclusions</h3><div>This study emphasizes the complexities of providing care for patients nearing the end of life in emergency settings. Addressing gaps in communication, training, and cultural competence is critical. Tailored strategies for Saudi Arabia’s unique context are essential to enhance care for advanced heart failure patients.</div></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"28 2","pages":"Pages 150-156"},"PeriodicalIF":2.1,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-29DOI: 10.1016/j.auec.2025.01.002
Jordan J. Hill , Brooke L. Hill , Brett Williams
Background
Paramedics in Australia present as the opportune medical personnel to initiate medical intervention of seizure presentations and perform a fundamental role in the prevention of seizure associated morbidity and mortality. Despite being well equipped to manage seizures, no literature exists regarding their confidence to recognise, differentiate, or manage seizures.
Methods
An online cross-sectional survey was undertaken by 168 paramedics practicing clinically for the Queensland Ambulance Service in Australia. The survey assessed paramedic perceived self-confidence surrounding seizure presentations. Non-parametric Kruskal-Wallis H-Test and post hoc pairwise comparisons were conducted to assess between group differences in relation to practicing qualifications, and years of service.
Results
Paramedics were confident in generalised convulsive seizure recognition and management, however, displayed less confidence surrounding non-convulsive, focal, and psychogenic seizure classifications. Critical care paramedics reported higher confidence than advanced care and graduate paramedics across various seizure presentation elements (p < 0.05). Paramedics with greater than 10 years of service reported higher confidence than those with fewer years of service, particularly less than two years.
Conclusion
Future education and professional development opportunities for paramedics require a greater focus on the development of self-confidence, with mechanisms implemented to increase paramedics’ exposure to the broad spectrum of seizure presentations.
{"title":"How confident are Queensland paramedics with seizure recognition, differentiation, and management? A pilot study","authors":"Jordan J. Hill , Brooke L. Hill , Brett Williams","doi":"10.1016/j.auec.2025.01.002","DOIUrl":"10.1016/j.auec.2025.01.002","url":null,"abstract":"<div><h3>Background</h3><div>Paramedics in Australia present as the opportune medical personnel to initiate medical intervention of seizure presentations and perform a fundamental role in the prevention of seizure associated morbidity and mortality. Despite being well equipped to manage seizures, no literature exists regarding their confidence to recognise, differentiate, or manage seizures.</div></div><div><h3>Methods</h3><div>An online cross-sectional survey was undertaken by 168 paramedics practicing clinically for the Queensland Ambulance Service in Australia. The survey assessed paramedic perceived self-confidence surrounding seizure presentations. Non-parametric Kruskal-Wallis <em>H</em>-Test and post hoc pairwise comparisons were conducted to assess between group differences in relation to practicing qualifications, and years of service.</div></div><div><h3>Results</h3><div>Paramedics were confident in generalised convulsive seizure recognition and management, however, displayed less confidence surrounding non-convulsive, focal, and psychogenic seizure classifications. Critical care paramedics reported higher confidence than advanced care and graduate paramedics across various seizure presentation elements (<em>p</em> < 0.05). Paramedics with greater than 10 years of service reported higher confidence than those with fewer years of service, particularly less than two years.</div></div><div><h3>Conclusion</h3><div>Future education and professional development opportunities for paramedics require a greater focus on the development of self-confidence, with mechanisms implemented to increase paramedics’ exposure to the broad spectrum of seizure presentations.</div></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"28 2","pages":"Pages 142-149"},"PeriodicalIF":2.1,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-22DOI: 10.1016/j.auec.2025.01.001
Rebecca Sedgman , Noah Pallot , Annette Peart , Sebastian Wrobel , Joseph Miller , Liam Hackett , Katrina Maybury , Emogene Aldridge , Patrick J. Owen , Paul Buntine
Background
Emergency department pre-triage waiting periods have received limited attention. We aimed to explore the pre-triage experiences and perspectives of consumers attending emergency departments.
Methods
This mixed-methods cross-sectional study included 92 participants (patients, carers, and guardians) who attended one of three public hospital emergency departments in metropolitan Melbourne (Victoria, Australia). Quantitative self-report outcomes were waiting time (minutes) and number of previous emergency department visits. Qualitative outcomes (explored through content analysis) were consumer experiences and perspectives of emergency departments in general and the pre-triage waiting period specifically.
Results
Participants reported a median (IQR) waiting time since triage of 45 (100) minutes and 65 % (n = 60) experienced a pre-triage waiting time of 3–90 minutes. The most common perception of the pre-triage waiting period was an expectation to wait (n = 16, 17 %), yet 46 % (n = 42) reported difficulties during this period, such as other patients cutting in queue (n = 6, 6.5 %). Few positives were associated with the pre-triage waiting period and suggestions to improve this period tended to focus on facilitating a queuing system (n = 18, 20 %).
Conclusion
Consumers expected and understood triage, yet reported various difficulties and few positives during the pre-triage waiting period and suggested improvements to the current system, warranting investigation of interventions to improve queuing.
{"title":"Consumer experiences of emergency department pre-triage waiting period: A mixed-methods study","authors":"Rebecca Sedgman , Noah Pallot , Annette Peart , Sebastian Wrobel , Joseph Miller , Liam Hackett , Katrina Maybury , Emogene Aldridge , Patrick J. Owen , Paul Buntine","doi":"10.1016/j.auec.2025.01.001","DOIUrl":"10.1016/j.auec.2025.01.001","url":null,"abstract":"<div><h3>Background</h3><div>Emergency department pre-triage waiting periods have received limited attention. We aimed to explore the pre-triage experiences and perspectives of consumers attending emergency departments.</div></div><div><h3>Methods</h3><div>This mixed-methods cross-sectional study included 92 participants (patients, carers, and guardians) who attended one of three public hospital emergency departments in metropolitan Melbourne (Victoria, Australia). Quantitative self-report outcomes were waiting time (minutes) and number of previous emergency department visits. Qualitative outcomes (explored through content analysis) were consumer experiences and perspectives of emergency departments in general and the pre-triage waiting period specifically.</div></div><div><h3>Results</h3><div>Participants reported a median (IQR) waiting time since triage of 45 (100) minutes and 65 % (n = 60) experienced a pre-triage waiting time of 3–90 minutes. The most common perception of the pre-triage waiting period was an expectation to wait (n = 16, 17 %), yet 46 % (n = 42) reported difficulties during this period, such as other patients cutting in queue (n = 6, 6.5 %). Few positives were associated with the pre-triage waiting period and suggestions to improve this period tended to focus on facilitating a queuing system (n = 18, 20 %).</div></div><div><h3>Conclusion</h3><div>Consumers expected and understood triage, yet reported various difficulties and few positives during the pre-triage waiting period and suggested improvements to the current system, warranting investigation of interventions to improve queuing.</div></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"28 2","pages":"Pages 136-141"},"PeriodicalIF":2.1,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-30DOI: 10.1016/j.auec.2024.12.003
Reuben Sutton , Natalie Elizabeth Anderson , Merryn Gott
Background
With aging and comorbid populations and healthcare services under pressure, emergency department presentations related to palliative care needs are increasing. Little is known about patient and family experiences of care in this context. This study explores the emergency department care experiences of palliative patients and their family members.
Methods
Semi-structured interviews with patients known to palliative care services who had presented to an urban emergency department within the study recruitment period. Six patients and five family members were interviewed. Reflexive thematic analysis methodology was underpinned by social constructivism.
Findings
Participants often described misalignment between emergency care priorities and their own, which was sometimes associated with challenges, including dehumanisation. However, participants also shared stories of supported self-advocacy, associated with positive care experiences.
Conclusion
This research identifies challenges patients and their family experience when accessing emergency department care. Symptom management, time, environment, and advocacy were impactful aspects of patient and family experience. There is a need to develop and support palliative care skills and knowledge within EDs, and adapt the environment to provide a safe space for sensitive communication and person-centred care.
{"title":"Emergency care experiences of patients known to palliative care services and their family: A qualitative interview study","authors":"Reuben Sutton , Natalie Elizabeth Anderson , Merryn Gott","doi":"10.1016/j.auec.2024.12.003","DOIUrl":"10.1016/j.auec.2024.12.003","url":null,"abstract":"<div><h3>Background</h3><div>With aging and comorbid populations and healthcare services under pressure, emergency department presentations related to palliative care needs are increasing. Little is known about patient and family experiences of care in this context. This study explores the emergency department care experiences of palliative patients and their family members.</div></div><div><h3>Methods</h3><div>Semi-structured interviews with patients known to palliative care services who had presented to an urban emergency department within the study recruitment period. Six patients and five family members were interviewed. Reflexive thematic analysis methodology was underpinned by social constructivism.</div></div><div><h3>Findings</h3><div>Participants often described misalignment between emergency care priorities and their own, which was sometimes associated with challenges, including dehumanisation. However, participants also shared stories of supported self-advocacy, associated with positive care experiences.</div></div><div><h3>Conclusion</h3><div>This research identifies challenges patients and their family experience when accessing emergency department care. Symptom management, time, environment, and advocacy were impactful aspects of patient and family experience. There is a need to develop and support palliative care skills and knowledge within EDs, and adapt the environment to provide a safe space for sensitive communication and person-centred care.</div></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"28 2","pages":"Pages 129-135"},"PeriodicalIF":2.1,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Effective staff-to-staff and patient-provider communication in the Emergency Department (ED) is essential for safe, quality care. Routine wearing of Personal-Protective-Equipment (PPE) has introduced new challenges to communication. We aimed to understand the perspectives of ED staff about communicating while wearing PPE, and to identify factors contributing to communication success, breakdown, and repair.
Methods
Study design was a descriptive cross-sectional online survey with convenience sampling. Categorical data were analysed using descriptive statistics and qualitative data analysed using content thematic analysis.
Results
Across nursing, medical and allied health, 78 staff responded with mean age= 38.8 years and mean ED clinical experience= 8.8 years). Respondents reported PPE impacted communication with patients/family members (81 %) and staff (61 %), with almost three-quarters of patient interactions rated as “somewhat difficult” or “extremely difficult”. Content themes were: (i) impacts of mask-wearing on communication, (ii) impacts of mask-wearing on patient care quality and safety, and (iii) strategies for repairing communication breakdown. Health impacts of communicating in PPE (50 %) included voice fatigue, skin irritation, and throat dryness.
Conclusion
ED staff perceived that wearing PPE impacted communication and compromised safe and efficient quality care delivery. Staff reported using increased voice volume, repetition, gestures, increased proximity, and emphasised facial movements to enhance their communication.
{"title":"RESCUE - Rapid, Effective, Safe Communication in Emergency Departments: A cross-sectional e-survey","authors":"Amy Freeman-Sanderson , Nicola Clayton , Margaret Fry , Rebecca Sullivan , Bronwyn Hemsley","doi":"10.1016/j.auec.2024.12.002","DOIUrl":"10.1016/j.auec.2024.12.002","url":null,"abstract":"<div><h3>Background</h3><div>Effective staff-to-staff and patient-provider communication in the Emergency Department (ED) is essential for safe, quality care. Routine wearing of Personal-Protective-Equipment (PPE) has introduced new challenges to communication. We aimed to understand the perspectives of ED staff about communicating while wearing PPE, and to identify factors contributing to communication success, breakdown, and repair.</div></div><div><h3>Methods</h3><div>Study design was a descriptive cross-sectional online survey with convenience sampling. Categorical data were analysed using descriptive statistics and qualitative data analysed using content thematic analysis.</div></div><div><h3>Results</h3><div>Across nursing, medical and allied health, 78 staff responded with mean age= 38.8 years and mean ED clinical experience= 8.8 years). Respondents reported PPE impacted communication with patients/family members (81 %) and staff (61 %), with almost three-quarters of patient interactions rated as “somewhat difficult” or “extremely difficult”. Content themes were: (i) impacts of mask-wearing on communication, (ii) impacts of mask-wearing on patient care quality and safety, and (iii) strategies for repairing communication breakdown. Health impacts of communicating in PPE (50 %) included voice fatigue, skin irritation, and throat dryness.</div></div><div><h3>Conclusion</h3><div>ED staff perceived that wearing PPE impacted communication and compromised safe and efficient quality care delivery. Staff reported using increased voice volume, repetition, gestures, increased proximity, and emphasised facial movements to enhance their communication.</div></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"28 2","pages":"Pages 123-128"},"PeriodicalIF":2.1,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-18DOI: 10.1016/j.auec.2024.12.001
Kathleen M. O’Leary , Rebecca Henderson , Joanne N. Caldwell Odgers , Benjamin N. Meadley
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.
引言：低温可增加某些患者的死亡率。医护人员使用棉和箔“太空”毯取暖，但其效果仍不确定。本初步研究旨在评估在院外模拟中棉毯与自温毯的组合与棉毯与箔毯的组合。方法：8名参与者被分配到使用两个棉毯和一个铝箔毯或两个棉毯和一个自温毯进行加热，并在随后的会议中使用替代方法。参与者使用冰背心和风扇降温，直到开始发抖，之后使用升温方法。模拟涉及三种环境的转换：基线（22°C）、冷却/升温（16°C）和“救护车”（27°C）。通过食管探头监测核心温度，通过热敏电阻监测皮肤温度（每分钟记录一次），每5分钟记录鼓室温度和热感觉及舒适度。结果：两组患者热感觉差异较小。对于主要结局，毯子方法之间无显著差异（核心：箔36.98±0.08°C vs自温36.95±0.10°C, P > 0.05）。结论：在院外模拟中，棉与自温毯组合并不比棉与箔毯组合具有优势。未来的研究应该探索其他的变暖方法来优化恒温维持。
{"title":"Maintenance of normothermia in the out-of-hospital setting: A pilot comparative crossover study of a foil blanket versus self-warming blanket","authors":"Kathleen M. O’Leary , Rebecca Henderson , Joanne N. Caldwell Odgers , Benjamin N. Meadley","doi":"10.1016/j.auec.2024.12.001","DOIUrl":"10.1016/j.auec.2024.12.001","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"28 2","pages":"Pages 116-122"},"PeriodicalIF":2.1,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142856911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-09DOI: 10.1016/j.auec.2024.11.002
Arwen Wilkinson , Haley Findlay , Jayne Lawrence , Linda Deravin
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.
{"title":"First Nations women’s experiences of out-of-hospital childbirth: Insights for enhancing paramedic practice – A scoping review","authors":"Arwen Wilkinson , Haley Findlay , Jayne Lawrence , Linda Deravin","doi":"10.1016/j.auec.2024.11.002","DOIUrl":"10.1016/j.auec.2024.11.002","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"28 2","pages":"Pages 89-95"},"PeriodicalIF":2.1,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-04DOI: 10.1016/j.auec.2024.11.001
Jake A. Muller, Elizabeth M. Forster, Katina Corones-Watkins, Belinda Chaplin
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.
{"title":"The experiences of trans (binary and non-binary) people accessing emergency department care in Australia: A grounded theory study","authors":"Jake A. Muller, Elizabeth M. Forster, Katina Corones-Watkins, Belinda Chaplin","doi":"10.1016/j.auec.2024.11.001","DOIUrl":"10.1016/j.auec.2024.11.001","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to explore the experiences of trans (binary and non-binary) people accessing emergency department care in Australia.</div></div><div><h3>Method</h3><div>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.</div></div><div><h3>Results</h3><div>Following thematic analysis, four key themes were identified: <em>1. identity; 2. clinical care; 3. communication; and 4. perceptions of health professional education, beliefs and experience in caring for trans people.</em></div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"28 2","pages":"Pages 96-102"},"PeriodicalIF":2.1,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-02DOI: 10.1016/j.auec.2024.11.003
Geoffrey Currie , Johnathan Hewis , Phillip Ebbs
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.
{"title":"Gender bias in text-to-image generative artificial intelligence depiction of Australian paramedics and first responders","authors":"Geoffrey Currie , Johnathan Hewis , Phillip Ebbs","doi":"10.1016/j.auec.2024.11.003","DOIUrl":"10.1016/j.auec.2024.11.003","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Method</h3><div>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.</div></div><div><h3>Results</h3><div>Among first responders, 90.8 % (<em>N = 296</em>) were depicted as male, 90.5 % (<em>N = 295</em>) as Caucasian, 95.7 % (<em>N = 312</em>) as a light skin tone, and 94.8 % (<em>N = 309</em>) 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 (<em>N = 32</em>), DALL-E 3 depicted 100 % as male, 100 % as Caucasian and 100 % with light skin tone.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"28 2","pages":"Pages 103-109"},"PeriodicalIF":2.1,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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