Working with young dynamos: the benefits of patient public involvement in research design [Abstract only]

This study examined the attitudes and perceptions towards continuous professional development (CPD) of Australasian paramedics working in private and state or territory ambulance services. For the purpose of the study, CPD is described as commitment to both formal and informal life-long learning (LLL) opportunities which are linked to clinical advancements, practitioner competence, professionalism, and the delivery of gold standard patient care. Constructivist grounded theory was used as the methodological framework for this study. Study participants (n = 10) completed their paramedic qualification through two main pathways, namely a postemployment in-house Vocational Education and Training (VET) diploma or a preemployment university degree and had worked as a paramedic for a minimum of 2 years. Ethical approval was obtained from the Queensland University of Technology, and the participants signed consent forms prior to participating in the study. Data were collected by semistructured interviews, which were recorded digitally for transcription and analysis purposes. The study found there was not a considerable step up for paramedics to engage in CPD and LLL, as this was already expected prior to professional registration for paramedics commencing late 2018. Some older paramedics expressed fear about keeping up to date with new technologies and a shift in the paramilitary paramedic culture was identified, where education is forming a new hierarchical stigmatisation. A framework of paramedic CPD has been created from the study’s findings and builds on the extant literature. The framework acknowledges professional, industrial, social, personal, political, organisational, and economic factors which influence or change engagement in CPD

Paramedic disaster health management competencies: a scoping review

Study/Objective: This scoping review aims to identify, categorise and explore the existing range of paramedic disaster health management competencies that have been developed internationally. The objective of the study is to assist EMS agencies to develop core competencies specific to their own environments in order to standardise teaching in the area of paramedic disaster health management response. Background: Paramedics play an essential role in all phases of disaster health management. Previous research has identified potential gaps in content and challenges to the sustainability of knowledge acquired through occasional disaster response training by paramedics. For paramedics to respond competently, they must be equipped with the necessary skills to provide comprehensive care to the populations affected by disasters. Despite this the literature shows that education and training for disaster response is variable and that an evidence based study specifically designed to outline sets of core competencies for Australian paramedics has never been undertaken. Methods: A systematic scoping review will be conducted using the Joanna Briggs Institute (JBI) methodology. The review will use information from four databases: PubMed, MEDLINE, ScienceDirect, and Scopus. Keywords and inclusion and exclusion criteria will be identified as strategies to use in this review. Results: Results will be extracted, mapped, and categorised from appropriate studies. The identified core competencies will be sorted into common domains such as communication, operations, planning, logistics, incident command systems and ethics. A descriptive analysis of the results will then be undertaken. Conclusion: Further research is needed to develop core competencies specific to Australian paramedics in order to standardise teaching in the area of disaster health management response. This study will assist agencies from all jurisdictions in evaluating or creating disaster curricula that adequately prepares and maintains paramedics for an effective all hazards disaster response

Factors impacting the decision-making processes of qualified paramedics moving to a specialist role in community paramedicine

Community paramedicine continues to evolve as a stream of paramedic specialisation. However, little is known about the transition from a 'traditional' role to that of an Extended Care Paramedic (ECP) or Community Paramedic (CP). Moreover, few studies have explicitly examined the rationale for the articulation of an experienced practitioner to an advanced practice role. This research illuminated the events or circumstances participants identified as necessary prior to the active engagement in the transition process. Methods ECPs (n=25) from two Australian jurisdictions and CPs (n=11) from a Canadian provincial health service, participated in a qualitative study exploring their experiences of transition. The data from the three study sites was pooled and interpreted using constructivist grounded theory methodology. Results Qualified Paramedics entered a junctional point in their careers in which the reasons for pursuing a career in community paramedicine were rationalised. The decision-making process involved satisfying two career 'wants': seeking new career options and improving patient outcomes. Subsequently, the paramedic’s perception of the community paramedicine role determined whether the paramedic entered the active phases of transition. Conclusion This study is the first of its kind to qualitatively examine the transition from one clinical specialist stream to another. The findings of this study have the potential to inform the selection criteria of prospective ECP/CP candidates and be utilised as a workforce recruitment tool for community paramedicine programs

Expanded scope roles in primary health – what makes them work?

Introduction The demand for better integration between primary and secondary healthcare frequently leads to discussion about expanded scope of practice for nursing, paramedic and allied health professionals and the role these clinicians could play in facilitating improved access to timely and appropriate healthcare. From workforce perspective, expanded scope of practice has also been advocated as a mean of fostering workforce retention. Models of expanded scope roles in nursing and paramedicine have been trialled nationally and internationally in both acute and community care settings. Where they have been successful, trials have resulted in reduction in hospital presentation and admission; improved patient access and timeliness; and patient satisfaction. This paper will examine the characteristics of successful expanded scope programs. Method Exploratory case-study analysis of successful integration of expanded health care roles across primary healthcare settings in rural Australia. Results & Conclusions One size does not fill all. Successful models of integrated expanded health care roles in primary health care settings are built on stakeholder’s capacity and preference; community need; and political will. Collaborative, congruent, multi-disciplinary care teams that prioritise patient-centred care within a dynamic primary care setting have merit and are more likely to foster flexibility and sustainability

Improved outcomes for emergency department patients whose ambulance off-stretcher time is not delayed

Abstract Objective To describe and compare characteristics and outcomes of patients who arrive by ambulance to the ED. We aimed to (i) compare patients with a delayed ambulance offload time (AOT) >30 min with those who were not delayed; and (ii) identify predictors of an ED length of stay (LOS) of >4 h for ambulance-arriving patients. Methods A retrospective, multi-site cohort study was undertaken in Australia using 12 months of linked health data (September 2007–2008). Outcomes of AOT delayed and non-delayed presentations were compared. Logistic regression analysis was undertaken to identify predictors of an ED LOS of >4 h. Results Of the 40 783 linked, analysable ambulance presentations, AOT delay of >30 min was experienced by 15%, and 63% had an ED LOS of >4 h. Patients with an AOT 4 h included: hospital admission, older age, triage category, and offload delay >30 min. Conclusion Patients arriving to the ED via ambulance and offloaded within 30 min experience better outcomes than those delayed. Given that offload delay is a modifiable predictor of an ED LOS of >4 h, targeted improvements in the ED arrival process for ambulance patients might be useful

The 'golden hour': an examination of mortality from major trauma in an informal, decentralised state-wide emergency medical system

ABSTRACT Key words: major trauma, mortality, emergency pre-hospital, performance indicators. Australian and New Zealand Standard Research Classifications: Division 11 (Medical and Health Sciences); Group 1117 (Public Health and Health Services) Background Response times are a common performance measure for many ambulance services and emergency medical response systems and are considered to be a standard measure of emergency medical services quality. The development of formalised Emergency Medical Systems in Australia and internationally have almost universally assumed a link between shorter response times and improved patient outcome measured by survival. While the evidence to support time-criticality for patients who experience a cardiac arrest is considered unequivocal, the assumption that response and scene times are universally important across all patient groups is not consistently supported by the research evidence. Little is known about whether or not the importance of time-dependent performance measures vary as a function of the Emergency Medical System arrangements to which they apply, the skill set of attending paramedics or the epidemiology of the target population. Despite this, response times continue to be one of the key performance measures for ambulance services regardless of the wider health services system in which they operate. Given the significant investment in paramedic training and increasing levels of clinical responsibility witnessed in the last decade, the development of a robust body of evidence about whether this investment and expertise alters outcomes for patients is yet to develop and there has been little shift in measures of performance. Major traumatic injury is associated with significant disease burden in Australia as elsewhere in the world. An estimated 1,500 Queenslanders die each year as a result of major traumatic injury and injury remains the single most common cause of death in Queenslanders between the ages of 1 and 35 years. As such, injury has a massive impact on the health of Queenslanders. Each year, around 10% of Queenslanders will suffer from an injury of some kind and it is known that injury results in 10% of all hospital admissions and 40-60% of attendances at hospital Emergency Departments. In Australia, injury is recognised as one of the seven National Health Priority Areas by the Australian Government. While this document provides for the setting of broad targets for reduction in injury and its social, economic and health corollaries, little advice is provided regarding health service performance with this target group. The emergency pre-hospital environment is absent in this and most strategic policy documents of this ilk in Australia. This thesis has two core aims: • to provide for the first time a descriptive analysis of major trauma in Queensland for the period 1998-2001 including description of the systemic factors influencing patient mortality; and in the light of these findings to • examine the utility of emergency pre-hospital time-dependent performance indicators as predictors of mortality in this patient group. The period of interest 1998-2001 was selected to provide a baseline for the development of the Queensland Trauma Plan implemented by government in 2007. Methods This thesis involved three key activities: (1) a review of the literature on the basis for time-dependent measures of pre-hospital performance in trauma, impacts of system design and emergency pre-hospital skill set on mortality from major trauma; (2) a descriptive quantitative analysis of linked patient data over a four year period (1998-2001) of the relationship between pre-hospital time and mortality; and (3) the theoretical development of alternative emergency pre-hospital performance measures for trauma. Results Of the 23,462 patients in the study population, 29.0% (n= 6,793) died as a consequence of their injuries. Fifteen percent (15.0%) of the patients died in the pre-hospital environment. After adjustment for age, sex and severity (GCS10 minutes (OR 1.11; 95%CI 0.98-1.26) was noted in the pre-hospital period. Scene time >20 minutes (OR 0.75; CI 0.65-0.86) improved the chance of survival to hospital by comparison to scene time

Problems with a great idea: referral by prehospital emergency services to a community-based falls-prevention service

Background and aim Falls are the leading cause of injury in older adults. Identifying people at risk before they experience a serious fall requiring hospitalisation allows an opportunity to intervene earlier and potentially reduce further falls and subsequent healthcare costs. The purpose of this project was to develop a referral pathway to a community falls-prevention team for older people who had experienced a fall attended by a paramedic service and who were not transported to hospital. It was also hypothesised that providing intervention to this group of clients would reduce future falls-related ambulance call-outs, emergency department presentations and hospital admissions. Methods An education package, referral pathway and follow-up procedures were developed. Both services had regular meetings, and work shadowing with the paramedics was also trialled to encourage more referrals. A range of demographic and other outcome measures were collected to compare people referred through the paramedic pathway and through traditional pathways. Results Internal data from the Queensland Ambulance Service indicated that there were approximately six falls per week by community-dwelling older persons in the eligible service catchment area (south west Brisbane metropolitan area) who were attended to by Queensland Ambulance Service paramedics, but not transported to hospital during the 2-year study period (2008–2009). Of the potential 638 eligible patients, only 17 (2.6%) were referred for a falls assessment. Conclusion Although this pilot programme had support from all levels of management as well as from the service providers, it did not translate into actual referrals. Several explanations are provided for these preliminary findings