Australasian Emergency Care最新文献

Background

Out-of-hospital births (OOHBs) are rare representing ∼0.05% of prehospital callouts. OOHBs are at increased risk of complications including life-threatening conditions such as postpartum haemorrhage and neonate resuscitation. This research investigated Australian paramedics perceptions of’ training, experience, and confidence with OOHBs.

Methods

Semi-structured qualitative interviews were undertaken in late 2021 via online conference or face-to-face. Sessions were audio-recorded and transcribed. Data was analysed and coded into over-arching themes using thematic analysis.

Results

Fourteen participants were interviewed from military, industrial, and jurisdictional ambulance services. Nine participants were female, and experience ranged from 1.5 to 20 years. Six Australian states were represented, incorporating rural and metropolitan regions. Participants reported sporadic or infrequent training. No participant had exposure to OOHBs during their undergraduate degree, with the most experienced paramedic only attending six births. Participants with little/no experience reported low confidence, and even more experienced participants reported anxiety when attending OOHBs, particularly if there were long distances to definitive care or potential complications.

Conclusion

Many paramedics expressed low confidence and high anxiety regarding OOHBs, especially regarding complications. Many felt insufficient time was dedicated to OOHBs during education and training. This has the capacity to impact on patient care and outcomes.

Background

Over the past 60 years since its inception, the Anglo-American Paramedic System has continued to grow and evolve. While brief and fragmented accounts of the differences between systems have been noted in the literature, until recently there has been a paucity of research that explores and identifies sub-models of paramedicine within the Anglo-American Paramedic System.

Objectives

This article describes a conceptual framework that sets a roadmap for defining and comparing two newly identified sub-models of the Anglo-American Paramedic System.

Methods

A conceptual framework for the exploration of these novel sub-models was developed on the basis of the work completed by Donabedian as well as Turncock and Handler. These two sub-models worked to develop a model for quality assessment and performance measurement in the public health system.

Results

The conceptual framework consists of six components that are strongly related to each other: system design, macro context, mission and purpose, structure, service delivery models and quality outcome measures. While this framework relates specifically to two novel paramedic systems known as the Professionally Autonomous an Directive paramedic systems, it can be used to measure any integrated health model.

Conclusion

The conceptual framework described in this paper provides a stepwise roadmap for the definition and comparison of the newly identified paramedic systems to better inform future research that defines and compares paramedic system design and performance.

Background

Emergency Departments are stressful work environments that can adversely affect clinicians’ wellbeing. The purpose of this scoping review was to report wellness interventions evaluated in Emergency Departments and clinicians’ experience of these interventions.

Methods

Five data bases were searched using a modification of Arksey and O’Malley’s framework. PRISMA guidelines for scoping reviews were employed to report the findings. The review included only peer-reviewed articles and had no date or language restrictions applied.

Results

Nine studies met inclusion criteria. Interventions included tactile massage, hypnosis, mindfulness, happiness practice, resiliency, meditation, and video-based debriefing. Three key themes emerged following data extraction and analysis: The value of mindfulness; One size doesn’t fit all; and Enablers and Barriers.

Conclusions

Successful wellness programs must be relevant to Emergency Departments and staff need to be involved in the development and application of these programs to achieve maximum benefit. For long term benefits and sustainability, the strategies must be supported by senior hospital management.

Background

Emergency nurses are experienced specific stress factors. To evaluate stressors of emergency nurses effectively is useful to improve quality of nursing care.

This study aimed to translate the stressor scale for emergency nurses into Chinese (C-SSEN) and carry out the reliability and validity test among Chinese emergency nurses.

Methods

A total of 358 emergency nurses from four hospitals in Tianjin, Henan, and Shandong province of China are recruited through a convenience sampling. The C-SSEN was translated into Chinese applying a classic ‘forward-backward’ translation method. Reliability (internal consistency, test-retest reliability) and validity (content validity, construct validity) were assessed.

Results

The final version of C-SSEN was rated by the expert panel, indicating good content validity (I-CVI ≥ 0.83, S-CVI = 0.96). The scale had satisfactory content validity, internal consistency (Cronbach’s α coefficient = 0.958), and test-retest reliability (intra-class correlation coefficient = 0.824).

Conclusion

The C-SSEN is a useful and reliable scale to evaluate stressors among emergency nurses.

Introduction

Intravenous cannulation is a common procedure for paramedics. Difficulty is often encountered and may result in escalation of care to an intensive care paramedic (ICP). Ultrasound-guided peripheral intravenous access (USGPIVA) is used in-hospital as an alternative approach. Historically limited to physicians, it is increasingly embraced by non-physicians, with point of care ultrasound (POCUS) devices more affordable, portable, and suited to the out of hospital environment.

Objective

To explore the utility of ICP-performed USGPIVA for patients who are predicted to be difficult according to a difficult intravenous access scoring tool.

Methods

This was a prospective observational pilot study of ICPs who used the adult difficult intravenous access (A-DIVA) scale to predict difficulty and perform USGPIVA using a contemporary POCUS device.

Results

For the 32 patients enroled, the overall success rate was 50% of which 87% were successful on the first attempt. Mean A-DIVA score was 4.1/5, and paradoxically, success improved with A-DIVA-predicted difficulty.

Conclusion

ICPs can perform USGPIVA with moderate success. The A-DIVA score could be useful for paramedics to predict difficult cannulation. Future research should focus on increasing exposure, training time and enhancing feedback to paramedics performing USGPIVA.

Background

The growing frequency of disasters increases health system demands, increasing the need for emergency departments to provide public health messaging to prevent illness and reduce risk. This study aims to explore emergency nurse practice and attitudes in providing public health messages from the emergency department during disasters in Australia.

Methods

Quantitative phase of a mixed methods study, using an explanatory sequential design. Australian emergency nurses were surveyed using a validated online questionnaire. Data was analysed using descriptive and inferential statistics, an enumerative content analysis, participant profiling and a factor analysis.

Results

Disaster experience varied in 143 nurse participants. The perception of the emergency nurse’s role in providing public health messages is influencing practice. Embracing teachable moments and health promotion responsibilities, attributes to positive attitudes and practice. In contrast, negative attitudes, lack of confidence, time, policy, and training, are barriers to public health messages being provided in the emergency setting.

Conclusions

These barriers suggest that Australian emergency nurses may not have the capability, the opportunity, nor the motivation, to provide preventative messages to their patients during disasters. Intrinsic and extrinsic factors need to be addressed, ensuring nurses are confident and supported in their public health messaging practice during disasters.

Objective

To identify predictors of longer-term outcomes from adult out-of-hospital cardiac arrest of presumed cardiac aetiology.

Methods

In this retrospective cohort study, three large routinely collected databases were linked: 1)QAS Out-of-Hospital Cardiac (OHCA) Registry; 2)Queensland Hospital Admitted Patient Data Collection; and 3)Queensland Registrar General Death Registry. Participants were adult (18years+) residents of Queensland, who suffered an OHCA of presumed cardiac aetiology and had resuscitation attempted by QAS paramedics between 2002 and 2014. Four mutually exclusive outcomes were analysed: 1) No pre-hospital return of spontaneous circulation (ROSC) sustained to the Emergency Department (ED) or ROSC in ED; 2) Survival< 30 days (Pre-hospital ROSC sustained to ED or ROSC in ED but death within 30 days; 3) survival between 30 and 364 days; and 4) survival to 365 + days. Multinomial logistic regression was used to calculate odds ratios and 95 % confidence intervals.

Results

Variables significantly predictive of survival to 365 + days after adjusting for all measured confounders are: an initial shockable rhythm; bystander witnessed events with bystander CPR; paramedic witnessed events; intubation placement; time of day (midday-2.59 pm); and attendance by Critical Care Paramedic (CCP).

Conclusion

From a service provision perspective, attendance of a CCP at an OHCA may be an important factor to achieve preferred long-term outcomes. Enhanced experience, exposure and expertise, together with extended clinical practice, may explain this finding.

Background

Out-of-hospital cardiac arrest often occurs at home, requiring paramedics to interact with family members and bystanders during resuscitation and inform them should the patient die. This study explores how paramedics navigate interactions and the changing needs of the patient and the bereaved.

Methods

Phenomenological methodology inspired individual, semi-structured interviews. Data was then coded using reflexive thematic analysis.

Results

Ten individual interviews with working paramedics with an average of 7.2 years of experience were analysed and resulted in four overarching themes. These themes encompassed communication goals and factors affecting their implementation. Four themes emerged: maximising patient outcome, minimising psychological trauma for significant others, paramedic engagement and communicating across cultures. Communication goals shift from maximising patient outcome to minimising psychological trauma for significant others during the resuscitation. Implementation of those goals is affected by paramedic engagement and communicating across cultures.

Conclusions

Paramedics used communication techniques based on personal and professional experiences, attempting to navigate limited resources, factors affecting paramedic engagement and a perceived lack of education and support in matters of grief and death.

Purpose

Task interruptions (TI) are frequent disturbances for emergency professionals performing advanced life support (ALS). The aim of our study was to evaluate a specific training intervention with TI on the quality of simulated ALS.

Methods

During this multi centered randomized controlled trial, each team included one resident, one nurse and one emergency physician. The teams were randomized for the nature of their training session: control (without interruption) or intervention (with TI). The primary outcome was non-technical skills assessed with the TEAM score. We also measured the no flow time, the Cardiff score and chest compression depth and rate.

Results

On a total of 21 included teams, 11 were randomized to a control training session and 10 to the specific TI training. During training, teams’ characteristics and skills were similar between the two groups. During the evaluation session, the TEAM score was not different between groups: median score for control group 33,5 vs 31,5 for intervention group. We also report similar no flow time and Cardiff score.

Conclusion

In this simulated ALS study, a specific training intervention with TI did not improve technical and non-technical skills. Further research is required to limit the impact of TI in emergency settings.

Background

Remote Australian women in labour often rely on retrieval services to allow birthing in specialist obstetric centres. However, there is currently debate over when not to transfer a woman in labour, for risk of an in-transit birth, associated with worse neonatal outcomes.

Methods

A scoping review methodology was undertaken, to define the scope of published literature on the topic and identify gaps in the current knowledge.

Results

A total of seven full texts were deemed suitable for synthesis, which were all retrospective observational studies. Four themes from the studies’ findings were identified: population features, predicting time-to-birth, use of tocolysis and birth during medical evacuation.

Conclusion

The evidence identified in this review was of low methodological quality and heterogenous. The key findings were that births in-flight are rare, despite geographical distances and long transport times, with a knowledge gap on predictors of time-to-birth.