Paramedicine : a new research-focused international journal committed to advancing and transforming the profession

The Australasian College of Paramedicine is pleased to introduce Paramedicine, its relaunched, official peer-reviewed scientific journal. Paramedicine is the culmination of two decades of research publishing in paramedicine, and represents a game-changing evolution in partnership with Sage Publishing. Paramedicine’s vision is to advance and transform the discipline of paramedicine through high-quality research dissemination and discourse. Paramedicine’s mission is to deliver excellence in paramedicine through an international research forum that inspires robust discussion, enables research translation, encourages innovative thinking and informs leadership. Paramedicine will be distinctively different in what it will offer authors and how it will impact the profession internationally. It is a paramedic-led journal that has a clear focus on high-quality research underpinned by excellent science, embraces diverse quantitative and qualitative methodologies and seeks to create an uplift in the paramedicine research publishing experience for authors and readers. Through its professional publishing partnership with Sage Publishing, Paramedicine will pursue an international agenda that brings together the diverse systems, models of care, practice settings and professional philosophies that characterise paramedicine internationally, creating a connected dialogue aimed at advancing the profession

Enhancing quality of scoping reviews in paramedicine research : guidance for authors

Scoping reviews are an increasingly common method for conducting evidence synthesis in paramedicine. Over the past decade clear methodological guidance has emerged, adding rigour and credibility to this review approach. Paramedicine receives many scoping review submissions, and views these as valid evidence synthesis capable of helping the journal achieve its strategic vision and mission. However the Editorial Board has noted that submissions frequently fail to adhere to essential elements of scoping methodology and reporting standards. This editorial aims to provide guidance to authors regarding Paramedicine’s expectations and requirements for scoping review submissions, with the hope of contributing to a greater understanding of scoping review science and enhancement of quality

Development and testing of Australian prehospital care quality indicators : study protocol

Introduction: Historically, ambulance services were established to provide rapid transport of patients to hospital. Contemporary prehospital care involves provision of sophisticated ‘mobile healthcare’ to patients across the lifespan presenting with a range of injuries or illnesses of varying acuity. Because of its young age, the paramedicine profession has until recently experienced a lack of research capacity which has led to paucity of a discipline-specific, scientific evidence-base. Therefore, the performance and quality of ambulance services has traditionally been measured using simple, evidence-poor indicators forming a deficient reflection of the true quality of care and providing little direction for quality improvement efforts. This paper reports the study protocol for the development and testing of quality indicators (QIs) for the Australian prehospital care setting. Methods and analysis: This project has three phases. In the first phase, preliminary work in the form of a scoping review was conducted which provided an initial list of QIs. In the subsequent phase, these QIs will be developed by aggregating them and by performing related rapid reviews. The summarised evidence will be used to support an expert consensus process aimed at optimising the clarity and evaluating the validity of proposed QIs. Finally, in the third phase those QIs deemed valid will be tested for acceptability, feasibility and reliability using mixed research methods. Evidence-based indicators can facilitate meaningful measurement of the quality of care provided. This forms the first step to identify unwarranted variation and direction for improvement work. This project will develop and test quality indicators for the Australian prehospital care setting. Ethics and dissemination: This project has been approved by the University of Adelaide Human Research Ethics Committee. Findings will be disseminated by publications in peer-reviewed journals, presentations at appropriate scientific conferences, as well as posts on social media and on the project’s website

Pelvic circumferential compression devices for prehospital management of suspected pelvic fractures : a rapid review and evidence summary for quality indicator evaluation

Background: Pelvic fractures, especially when unstable, may cause significant haemorrhage. The early application of a pelvic circumferential compression device (PCCD) in patients with suspected pelvic fracture has established itself as best practice. Ambulance services conduct corresponding performance measurement. Quality indicators (QIs) are ideally based on high-quality evidence clearly demonstrating that the desirable effects outweigh the undesirable effects. In the absence of high-quality evidence, best available evidence should be combined with expert consensus. Objectives: The aim of the present study was to identify, appraise and summarize the best available evidence regarding PCCDs for the purpose of informing an expert panel tasked to evaluate the validity of the following QI: A patient with suspected pelvic fracture has a PCCD applied. Methods: A rapid review of four databases was conducted to identify relevant literature published up until 9 June 2020. Systematic reviews, experimental, quasi-experimental and observational analytic studies written in English were included. One author was responsible for study selection and quality appraisal. Data extraction using a priori extraction templates was verified by a second reviewer. Study details and key findings were summarized in tables. Results: A total of 13 studies were assessed to be eligible for inclusion in this rapid review. Of these, three were systematic reviews, one was a randomized clinical trial (crossover design), two were before-after studies, and seven were retrospective cohort studies. The systematic reviews included mostly observational studies and could therefore not be considered as high-level evidence. Overall, the identified evidence is of low quality and suggests that PCCD may provide temporary pelvic ring stabilization and haemorrhage control, although a potential for adverse effects exists. Conclusion: Given the low quality of the best available evidence, this evidence would need to be combined with expert consensus to evaluate the validity of a related quality indicator before its implementation

Paramedic management of back pain : a scoping review

Background: Research examining paramedic care of back pain is limited. Objective: To describe ambulance service use and usual paramedic care for back pain, the effectiveness and safety of paramedic care of back pain, and the characteristics of people with back pain who seek care from paramedics. Methods: We included published peer-reviewed studies of people with back pain who received any type of paramedic care on-scene and/or during transport to hospital. We searched MEDLINE, EMBASE, CINAHL, Web of Science and SciELO from inception to July 2022. Two authors independently screened and selected the studies, performed data extraction, and assessed the methodological quality using the PEDro, AMSTAR 2 and Hawker tools. This review followed the JBI methodological guidance for scoping reviews and PRISMA extension for scoping reviews. Results: From 1987 articles we included 26 articles (25 unique studies) consisting of 22 observational studies, three randomised controlled trials and one review. Back pain is frequently in the top 3 reasons for calls to an ambulance service with more than two thirds of cases receiving ambulance dispatch. It takes ~ 8 min from time of call to an ambulance being dispatched and 16% of calls for back pain receive transport to hospital. Pharmacological management of back pain includes benzodiazepines, NSAIDs, opioids, nitrous oxide, and paracetamol. Non-pharmacological care is poorly reported and includes referral to alternate health service, counselling and behavioural interventions and self-care advice. Only three trials have evaluated effectiveness of paramedic treatments (TENS, active warming, and administration of opioids) and no studies provided safety or costing data. Conclusion: Paramedics are frequently responding to people with back pain. Use of pain medicines is common but varies according to the type of back pain and setting, while non-pharmacological care is poorly reported. There is a lack of research evaluating the effectiveness and safety of paramedic care for back pain

Consultation, cooperation and collaboration : the emergence of the Australasian Council of Paramedicine Deans

In March 2019, the paramedicine tertiary education sector reached another important milestone with the emergence of the Australasian Council of Paramedicine Deans (www.paramedicinedeans.com). The Council is a collaborative group representing the interests of the paramedicine tertiary education sector and the discipline more broadly. In what is a clear demonstration of the increasing maturity of the sector, the Council received the unanimous support from the Vice Chancellors and paramedicine leads of all 17 universities offering paramedicine degree programs. Council membership is restricted to university programs identified as ‘recognised approved programs’ by the Paramedicine Board of Australia or, in the case of New Zealand programs, accredited by the Council of Ambulance Authorities. Each university delegates its academic lead to represent their program on the Council

Use of the Ottawa Ankle Rule by paramedics in the out-of-hospital setting

Objective The Ottawa Ankle Rule (OAR) is extensively documented in the emergency department setting and has been subjected to repeated validation. However, the prehospital experience in implementing this clinical decision rule appears poorly described. The objective of this study is to identify evidence (of any level) describing the use of the OAR by paramedics. Methods A literature search was conducted of the following key electronic databases; Medline (1950 to March Week 1 2010); EMBASE (1980-Week 10 2010) and CINAHL (1981-March 2010). The keywords 'ankle injury', 'clinical decision rule', 'paramedic', 'ambulance', 'prehospital', and 'emergency care' were used to frame the search, while a prehospital and emergency care search filter was used to maximise the sensitivity of the search. A review was conducted of the reference lists accompanying each relevant article to identify other potentially relevant citations. The search criteria included published articles which were both primary research and secondary review papers, and conference abstracts of any research design. We excluded non-English articles and letters. The abstracts of all citations in the search results were reviewed and full text articles for studies of interest were retrieved for examination. Results The search yielded 98 citations, with 80 relating directly to the OAR. After reviewing the abstracts of all citations, no articles of any study design, discussing the use of the OAR by paramedics in the out-of-hospital setting were identified. Conclusion Whilst there is no published evidence describing the use of the OAR by paramedics in the prehospital setting, it is feasible that paramedics could implement the rule safely and with equivalent sensitivity and specificity to other settings. This clinical decision rule may have good utility as a triage tool that could be used to stream suitable patients into non-emergency department alternatives. Research is needed to validate the use of the OAR when used within EMS jurisdictions

Quantifying and evaluating research in paramedicine : why our own field of research code matters

On 1 June 2020, the Australian Research Council (ARC) released the outcomes of the recent review of the Australian and New Zealand Standard Research Classification (ANZSRC). In what constitutes a significant milestone for paramedicine in Australia and New Zealand, we have been allocated our own paramedicine ‘Field of Research’ (FOR) code for the first time. So, what is a FOR code and why is getting our own of such significance? The ANZSRC allows measurement and analysis of research and experimental development undertaken in Australia and New Zealand. These data have a wide range of applications in government, industry and tertiary sectors, nationally and internationally. A prominent example is the ARC’s Excellence In Research (ERA) research evaluation framework. ERA uses the ANZSRC to identify excellence in research by comparing Australia’s university research effort against international benchmarks, identifying emerging research areas and opportunities for further development, and creating incentives to improve Australian research quality. ANZSRC-informed frameworks such as ERA therefore impact on research grant funding availability and prioritisation, which of course is critical to the conduct of quality research capable of achieving meaningful impact. For universities, ANZSRC data allows evaluation of institutional performance in relation to their strategic research priorities, links to external research funding income success, and facilitates prioritisation and allocation of that funding

Improving the quality and transparency of prehospital case reports using CARE

Clinical case reports play an important role in supporting evidence-based paramedicine. When research on a topic is limited and there is no robust evidence, a case report may be the best available, especially for rare or unusual presentations or in novel clinical practice. Case reports in paramedicine journals are common. However, adherence to the published consensus-based reporting guideline is rare, which may weaken the evidence arising from this body of case report literature. There is a need for greater awareness of the structured reporting guideline for case reports, and for the development of a paramedicine-specific extension. The objectives of this paper are to: describe the current state of case reports in paramedicine; promote the adoption of an internationally accepted, consensus-based reporting guideline; and propose an extension to that guideline, adapted to the unique characteristics of prehospital practice

Thinking about ethics in research

Recent decades have seen a rapid expansion of paramedicine research as paramedics continue to establish a body of evidence to describe, support and evolve the discipline. Irrespective of the type of research being conducted, consideration of ethical issues presents the same challenges faced by researchers in other healthcare disciplines. While research ethics frameworks and guidance exist, application of these to the dynamic emergency context of paramedicine can be difficult. A paramedicine researcher can best prepare themselves for managing ethical considerations by developing a strong grounding in the broad foundational principles underpinning all human research in healthcare. In this chapter, we provide an orientation to research governance and ethics frameworks and an overview of general principles and values central to ethical research practice