Queensland Ambulance Service Research Articles

Prevalence of clinical deterioration in the pre-hospital setting.

Improved understanding of the deteriorating patient in the pre-hospital setting may result in earlier recognition and response. Considering the effects of undetected deterioration are profound, it is fundamental to report the prevalence of pre-hospital clinical deterioration to advance our understanding. The present study investigated the prevalence of pre-hospital clinical deterioration and adverse events (AEs) within 3 days of the pre-hospital episode of care. This retrospective cohort study was based on pre-hospital incidents involving adult patients attended by Queensland Ambulance Service between 1 January 2018 and 31 December 2020. Due to lacking a standardised definition of pre-hospital clinical deterioration, established early warning scores (NEWS, MEWS and Q-ADDS) were calculated from pre-hospital vital signs to identify clinical deterioration. Linked hospital data were used to identify the occurrence of an AE. Some degree of physiological derangement was initially observed in over half of the patients, and pre-hospital clinical deterioration was seen in 2.7%-4% of patients. The prevalence of AEs was 3.2%. Patients that experienced an AE were more likely to be male, elderly, suffering from a medical (non-trauma) condition, and had a greater burden of disease. Concerningly, almost 50% of patients that suffered an AE did not meet escalation thresholds of NEWS, MEWS or Q-ADDS. The present study found the prevalence of pre-hospital clinical deterioration and AEs subsequent to pre-hospital episodes of care to be low. Future research should prioritise using standardised criteria to define pre-hospital clinical deterioration and evaluate the performance of early warning scores.

Effect of Fentanyl Compared to Morphine on Pain Score and Cardiorespiratory Vital Signs in Out-of-Hospital Adult STEMI Patients

Objective: ST-elevation myocardial infarction (STEMI) is a leading cause of mortality in Australia. Paramedics treating adults with STEMI in the out-of-hospital environment can use fentanyl or morphine to manage the patient’s pain, although there is little research comparing the efficacy and safety of these drugs. Therefore, the objective of this study was to compare the effects of fentanyl to morphine on cardiac chest pain and cardiorespiratory vital signs in adult STEMI patients in the out-of-hospital environment. Methods: We conducted a retrospective analysis of records of 1902 STEMI cases attended by Queensland Ambulance Service paramedics during the 4-year interval from 2013 to 2016. We compared pain score, blood pressure, respiratory rate, and pulse rate between patients administered intravenous fentanyl and intravenous morphine. We used a two-way mixed effects model (drug, time) to assess for main and interaction effects, and where the interaction effect was significant, applied Mann-Whitney U tests to further analyze between-group differences at each time point. Results: We observed a significant main effect of time on pain score (p < 0.001), respiratory rate (p < 0.05), and pulse rate (p = 0.025), such that these variables all decreased over time. Additionally, we observed a significant drug-time interaction for systolic and diastolic blood pressures (both p < 0.01), such that blood pressures decreased over time in the morphine, but not fentanyl, group. Conclusion: We compared the effects of fentanyl to morphine on cardiac chest pain and cardiorespiratory vital signs in out-of-hospital adult STEMI patients and observed differences in blood pressures only. Morphine appeared to have a depressive effect on systolic and diastolic blood pressure, whereas fentanyl did not. An unanticipated behavioural finding of this research is that, in the absence of a definitive guideline, paramedics appear to use fentanyl when patients may be at risk of developing hypotension.

A prediction model for prehospital clinical deterioration: The use of early warning scores.

Various prognosticative approaches to assist in recognizing clinical deterioration have been proposed. To date, early warning scores (EWSs) have been evaluated in hospital with limited research investigating their suitability in the prehospital setting. This study evaluated the predictive ability of established EWSs and other clinical factors for prehospital clinical deterioration. A retrospective cohort study investigating adult patients of all etiologies attended by Queensland Ambulance Service paramedics between January 1, 2018, and December 31, 2020, was conducted. With logistic regression, several models were developed to predict adverse event outcomes. The National Early Warning Score (NEWS), Modified Early Warning Score (MEWS), Queensland Adult Deterioration Detection System (Q-ADDS), and shock index were calculated from vital signs taken by paramedics. A total of 1,422,046 incidents met the inclusion criteria. NEWS, MEWS, and Q-ADDS were found to have comparably high predictive ability with area under the receiver operating characteristic curve (AUC-ROC) between 70% and 90%, whereas shock index had relatively low AUC-ROC. Sensitivity was lower than specificity for all models. Although established EWSs performed well when predicting adverse events, these scores require complex calculations requiring multiple vital signs that may not be suitable for the prehospital setting. This study found NEWS, MEWS, and Q-ADDS all performed well in the prehospital setting. Although a simple shock index is easier for paramedics to use in the prehospital environment, it did not perform comparably to established EWSs. Further research is required to develop suitably performing parsimonious solutions until established EWSs are integrated into technological solutions to be used by prehospital clinicians in real time.

Cost-effectiveness analysis of an ambulance service-operated specialised cardiac vehicle with mobile extracorporeal cardiopulmonary resuscitation capacity for out-of-hospital cardiac arrests in Queensland, Australia.

Extracorporeal CPR (E-CPR) has been primarily limited to the in-hospital setting. A few systems around the world have implemented pre-hospital mobile E-CPR in the form of a dedicated cardiac vehicle fitted with specialised equipment and clinicians required for the performance of E-CPR on-scene. However, evidence of the outcomes and cost-effectiveness of mobile E-CPR remain to be established. We evaluated the cost-effectiveness of a hypothetical mobile E-CPR vehicle operated by Queensland Ambulance Service in the state of Queensland, Australia. We adapted our published mathematical model to estimate the cost-effectiveness of pre-hospital mobile E-CPR relative to current practice. In the model, a specialised cardiac vehicle with mobile E-CPR capability is deployed to selected OHCA patients, with eligible candidates receiving pre-hospital E-CPR in-field and rapid transport to the closest appropriate centre for in-hospital E-CPR. For comparison, non-candidates receive standard ACLS from a conventional ambulance response. Cost-effectiveness was expressed as Australian dollars ($, 2021 value) per quality-adjusted life year (QALY) gained. Pre-hospital mobile E-CPR improves outcomes compared to current practice at a cost of $27 323 per QALY gained. The cost-effectiveness of pre-hospital mobile E-CPR is sensitive to the assumption around the number of patients who are the targets of the vehicle, with higher patient volume resulting in improved cost-effectiveness. Pre-hospital E-CPR may be cost-effective. Successful implementation of a pre-hospital E-CPR programme requires substantial planning, training, logistics and operational adjustments.

Epidemiology and survival outcomes of out-of-hospital cardiac arrest following volatile substance use in Queensland, Australia

Introduction The deliberate inhalation of volatile substances for their psychotropic properties is a recognised public health issue that can precipitate sudden death. This study aimed to describe the epidemiological characteristics and survival outcomes of patients with out-of-hospital cardiac arrests following volatile substance use. Methods We conducted a retrospective cohort analysis of all out-of-hospital cardiac arrest attended by the Queensland Ambulance Service over a ten-year period (2012-2021). Incidents were extracted from the Queensland Ambulance Service cardiac arrest registry, which collects clinical information using the Utstein-style guidelines and linked hospital data. Results During the study period, 52,102 out-of-hospital cardiac arrests were attended, with 22 (0.04%) occurring following volatile substance use. The incidence rate was 0.04 per 100,000 population, with no temporal trends identified. The most commonly used product was deodorant cans (19/22), followed by butane canisters (2/22), and nitrous oxide canisters (1/22). The median age of patients was 15 years (interquartile range 13–23), with 14/22 male and 8/22 Indigenous Australians. Overall, 16/22 patients received a resuscitation attempt by paramedics. Of these, 12/16 were bystander witnessed, 10/16 presented in an initial shockable rhythm, and 9/16 received bystander chest compressions. The rates of event survival, survival to hospital discharge, and survival with good neurological outcome (Cerebral Performance Category 1–2) were 69% (11/16, 95% CI 41–89%), 38% (6/16, 95% CI 15–65%) and 31% (5/16, 11–59%), respectively. Eight patients in the paramedic-treated cohort that used hydrocarbon-based products were administered epinephrine during resuscitation. Of these, none subsequently survived to hospital discharge. In contrast, all six patients that did not receive epinephrine survived to hospital discharge, with 5/6 having a good neurological outcome. Conclusion Out-of-hospital cardiac arrest following volatile substance use is rare and associated with relatively favourable survival rates. Patients were predominately aged in their adolescence with Indigenous Australians disproportionately represented.

Suicide-Related Out-of-Hospital Cardiac Arrests in Queensland, Australia: Temporal Trends of Characteristics and Outcomes over 14 Years

Background Research into suicide-related out-of-hospital cardiac arrests (OHCA) using OHCA registries is scant. A more complete understanding of methods, patient characteristics, and outcomes is essential to inform prehospital management strategies and public health interventions. Methods Included were all OHCA attended by Queensland Ambulance Service (Australia) paramedics between 1 January 2007 and 31 December 2020, where suicide-related causes could be identified. Age- and sex-standardized incidence rates were calculated. Suicide methods, patient characteristics, and survival outcomes were described. Factors associated with survival outcomes were investigated. Results Seven thousand three hundred and fifty-six suicide-related OHCA cases were included. The incidence rates increased from 9.0 per 100,000 population in 2007 to 12.4 in 2020. The incidence rates for males were four times those for females; however, incidence rates for females have increased faster than for males. Hanging was the most common suicide method (63%). Twenty-three percent of patients received resuscitation attempts by paramedics. Among those, the rates of return of spontaneous circulation (ROSC) sustained to hospital arrival, survival to hospital discharge, and survival to 30 days were 28.6, 8.5, and 8.0%, respectively. Over time, the rates of ROSC upon hospital arrival increased, whereas the rates of survival to discharge and 30-day survival remained stable. Conclusion The incidence of prehospital-identified suicide-related OHCA in Queensland has increased over time. The prognosis of suicide-related OHCA is poor. Prevention measures should focus on early identification and treatment of individuals having a high risk of suicide. Emergency medical services need to have sufficient training for telecommunicators and paramedics in suicide risk assessment and identification.

Achieving, enhancing and maintaining airway competence in the emergency department.

Emergency Medicine AustralasiaEarly View Trainee Focus Achieving, enhancing and maintaining airway competence in the emergency department Robbie Ley Greaves MBBS, BSc, MRCEM, Corresponding Author Robbie Ley Greaves MBBS, BSc, MRCEM Pre-Hospital Registrar [email protected] High Acuity Response Unit, Queensland Ambulance Service, Brisbane, Queensland, Australia LifeFlight Retrieval Medicine, Brisbane, Queensland, Australia Correspondence: Dr Robbie Ley Greaves, High Acuity Response Unit, Queensland Ambulance Service, GPO Box 1425, Brisbane, QLD 4001, Australia. Email: [email protected]Search for more papers by this author Robbie Ley Greaves MBBS, BSc, MRCEM, Corresponding Author Robbie Ley Greaves MBBS, BSc, MRCEM Pre-Hospital Registrar [email protected] High Acuity Response Unit, Queensland Ambulance Service, Brisbane, Queensland, Australia LifeFlight Retrieval Medicine, Brisbane, Queensland, Australia Correspondence: Dr Robbie Ley Greaves, High Acuity Response Unit, Queensland Ambulance Service, GPO Box 1425, Brisbane, QLD 4001, Australia. Email: [email protected]Search for more papers by this author First published: 15 April 2023 https://doi.org/10.1111/1742-6723.14212Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Early ViewOnline Version of Record before inclusion in an issue RelatedInformation

Emergency examination authorities in Queensland, Australia.

In Queensland, where a person experiences a major disturbance in their mental capacity, and is at risk of serious harm to self and others, an emergency examination authority (EEA) authorises Queensland Police Service (QPS) and Queensland Ambulance Service (QAS) to detain and transport the person to an ED. In the ED, further detention for up to 12 h is authorised to allow the examination to be completed. Little published information describes these critical patient encounters. Queensland's Public Health Act (2005), amended in 2017, mandates the use of the approved EEA form. Data were extracted from a convenience sample of 942 EEAs including: (i) patient age, sex, address; (ii) free text descriptions by QPS and QAS officers of the person's behaviour and any serious risk of harm requiring urgent care; (iii) time examination period commenced; and (iv) outcome upon examination. Of 942 EEA forms, 640 (68%) were retrieved at three 'larger central' hospitals and 302 (32%) at two 'smaller regional' hospitals in non-metropolitan Queensland. QPS initiated 342 (36%) and QAS 600 (64%) EEAs for 486 (52%) males, 453 (48%) females and two intersexes (<1%), aged from 9 to 85 years (median29 years, 17% aged <18 years). EEAs commonly occurred on weekends (32%) and between 2300 and midnight (8%), characterised by 'drug and/or alcohol issues' (53%), 'self-harm' (40%), 'patient aggression' (25%) and multiple prior EEAs (23%). Although information was incomplete, most patients (78%, n =419/534) required no inpatient admission. EEAs furnish unique records for evaluating the impacts of Queensland's novel legislative reforms.

Epidemiology of open limb fractures attended by ambulance clinicians in the out-of-hospital setting: A retrospective analysis

BackgroundOpen limb fractures are a time-critical orthopaedic emergency that present to jurisdictional ambulance services. This study describes the demographic characteristics and epidemiological profile of these patients MethodsWe undertook a retrospective analysis of all patients that presented to Queensland Ambulance Service with an open limb fracture (fracture to the humerus, radius/ulna, tibia/fibula or femur) over a two-year period (January 2018 – December 2019). ResultsOverall, 1020 patients were included. Patients were mainly male (65.9%) and middle-aged (age 41 years, IQR 22–59). Fractures predominately occurred in the lower extremities (64.9%) with transport crashes the primary mechanism of injury (47.8%). The location of the fracture varied depending on the cause of injury, with femur fractures associated with motorcycle crashes, and fractures to the radius/ulna attributed to falls of greater than one metre (p = 0.001). The median prehospital episode of care was 83 min (IQR 62–144) with aeromedical air ambulance involvement and the attendance of a critical care paramedic or emergency physician, both independent factors that increased this time interval. ConclusionOpen limb fractures are a relatively infrequent injury presentation encountered by ambulance clinicians. The characteristics of these patients is consistent with previously described national and international out-of-hospital trauma cohorts

Understanding compensable and non-compensable patient profiles, pathways and physical outcomes for transport and work-related injuries in Queensland, Australia through data linkage

IntroductionIn many jurisdictions, people experiencing an injury often pursue compensation to support their treatment and recovery expenses. Healthcare costs form a significant portion of payments made by compensation schemes. Compensation...

Mastering linked datasets: The future of emergency health care research

Objectives The aim of this work is to describe routine integration of prehospital emergency health records into a health master linkage file, delivering ongoing access to integrated patient treatment and outcome information for ambulance-attended patients in Queensland. Methods The Queensland Ambulance Service (QAS) data are integrated monthly into the Queensland Health master linkage file (MLF) using a linkage algorithm that relies on probabilistic matches in combination with deterministic rules based on patient demographic details, date, time, and facility identifiers. Each ambulance record is assigned an enduring linkage key (unique patient identifier) and further processing determines whether each record matches with a corresponding hospital emergency department, admission, or death registry record. In this study, all QAS electronic ambulance report form (eARF) records from October 2016 to December 2018 where at least one key linkage variable was present (n = 1,771,734) were integrated into the MLF. Results The majority of records (n = 1,456,502; 82.2%) were for transported patients, and 90.1% (n = 1,312,176) of these transports were to public hospital facilities. Of these transport records, 93.9% (n = 1,231,951) matched to ED records and 59.3% (n = 864,394) also linked to admitted patient records. Of ambulance non-transport records integrated into the MLF, 23.6% (n = 74,311) matched with ED records. Conclusion This study demonstrates robust linkage methods, quality assurance processes, and high linkage rates of data across the continuum of care (prehospital/emergency department/admitted patient/death) in Queensland. The resulting infrastructure provides a high-quality linked dataset that facilitates complex research and analysis to inform critical functions such as quality improvement, system evaluation, and design.

Cervical spine immobilisation is only required in drowning patients at high risk of axial loading of the spine.

Wave forced impacts are known to result in cervical spine injuries (CSI) and approximately 20% of drownings in Australia occur at the beach. The most common mechanism of injury in studies examining the frequency of CSI in drowning patients is shallow water diving. The aim of the present study was to determine what proportion of CSIs occurring in bodies of water experienced a concomitant drowning injury in a location where wave forced impacts are likely to be an additional risk factor. Electronic medical records at the Sunshine Coast Hospital and Health Service EDs, Queensland Ambulance Service case records and Surf Life Saving Queensland data between 1 January 2015 and 21 April 2021 were manually linked. Outcomes recorded included victim demographics, scene information, hospital course and patient disposition. Ninety-one of 574 (15.9%) CSIs occurred in a body of water with risk of drowning. However, only 4 (4.3%) had a simultaneous drowning injury, representing 0.8% (4/483) of drowning presentations. Ten (10.9%) patients reported loss of consciousness, including the four with drowning. The principal mechanism of CSI was a wave forced impact (71/91, 78%). Most injuries occurred at the beach (79/91, 86.8%). Delayed presentation was common (28/91, 31%). A history of axial loading was 100% sensitive when indicating imaging. The combination of CSI and drowning is uncommon. Cervical spine precautions are only required in drowning patients with signs or a history, or at high risk of, axial loading of the spine. This paper supports the move away from routine cervical spine precautions even in a high-risk population.

Cervical spine injuries occurring at the beach: epidemiology, mechanism of injury and risk factors

ObjectiveSurf zone injuries include cervical spine injuries (CSI). Risk factors for CSI have not been extensively investigated. The objective was to examine risk factors associated with diagnosed CSI that occurred in a beach setting.MethodsThis retrospective case series used manually linked data from Sunshine Coast Hospital and Health Service Emergency Departments, Queensland Ambulance Service, Surf Life Saving Queensland (SLSQ), and Bureau of Meteorology data from 01/01/2015-21/04/2021. Variables included victim demographics, mechanism of injury, scene information, and patient course.ResultsSeventy-nine of the 574 (13.8%) confirmed CSI occurred at the beach. Local residents and visitors were injured equally. Females represented a minority (12.7%) of those diagnosed with CSI but were a higher proportion of suspected spinal incidents reported to SLSQ (45%). Surfers were more likely to be injured through shallow water diving than swimmers (27.6% vs 2.2%). Females were more likely to be injured by shallow water diving than males (30.0% vs 8.7%). Visitors were more likely to be injured swimming and local residents surfing (68.2% vs 77.8% respectively). CSI occurred most commonly (40.0%) with a below average ocean wave height (0.75-1.25 m) and were most likely (45.3%) to occur in the second half of the outgoing tide. One beach had a statistically significant greater incidence of spinal incidents (OR 3.9, 95% CI: 2.1-7.2) and of CSI (OR 10.7, 95% CI: 1.5-79.5).ConclusionsRisk factors for CSI at the beach include male sex, smaller wave height and an outgoing tide. Shallow water diving among surfers and females should be addressed urgently.

Hypofibrinogenaemia and hypocalcaemia in adult trauma patients receiving pre-hospital packed red blood cell transfusions: Potential for supplementary pre-hospital therapeutic interventions.

To report the arrival ionised calcium (iCa) and fibrinogen concentrations in trauma patients treated with packed red blood cells by the road-based high-acuity response units of a metropolitan ambulance service. A retrospective review of trauma patients treated with packed red blood cells by high-acuity response units between January 2012 and December 2016. Patients were identified from databases at southeast Queensland adult trauma centres, Pathology Queensland Central Transfusion Laboratory, Gold Coast University Hospital blood bank and the Queensland Ambulance Service. Patient characteristics, results of laboratory tests within 30 min of ED arrival were analysed. A total of 164 cases were analysed. The median injury severity score was 33.5 (interquartile range 22-41), with blunt trauma the commonest mechanism of injury (n=128, 78.0%). Fifty-eight of the 117 patients (24.4%) with fibrinogen measured had a fibrinogen concentration ≤1.5g/L; 79 of the 123 patients (64.2%) with an international normalised ratio (INR) measurement had an INR >1.2; 97 of 148 patients (63.8%) with an iCa measured, had an iCa below the Pathology Queensland reference range of 1.15-1.32 mmol/L. Arrival fibrinogen concentration ≤1.5g/L and arrival iCa ≤1.00 were associated with in-hospital mortality with odds ratio11.90 (95% confidence interval 4.50-31.65) and odds ratio4.97 (95% confidence interval 1.42-17.47), respectively. Hypocalcaemia and hypofibrinogenaemia on ED arrival were common in this cohort. Future work should evaluate whether outcomes improve by correction of these deficits during the pre-hospital phase of trauma care.

Epidemiology, management and survival outcomes of adult out-of-hospital traumatic cardiac arrest due to blunt, penetrating or burn injury

BackgroundSurvival from out-of-hospital traumatic cardiac arrest (TCA) is poor. Regional variation exists regarding epidemiology, management and outcomes. Data on prognostic factors are scant. A better understanding of injury patterns and...

Recent amendments to Queensland legislation make mental health presentations to hospital emergency departments more difficult to scrutinise.

The Queensland Police Service (QPS) and Queensland Ambulance Service may detain and transport persons experiencing major disturbances in their mental capacity to an ED for urgent care. Queensland's new mental health legislation (March 2017) makes this legal intervention difficult to scrutinise. For a large non-metropolitan region, QPS records for emergency examination orders (EEOs) and emergency examination authorities (EEAs) were compared with annual reports of Queensland's Director of Mental Health and Chief Psychiatrist. From 2009-2010 to March 2017, QPS-registered EEOs totalled 12 903 while annual reports attributed 9441 to QPS (27% fewer). From March 2017 to 2019-2020, QPS-registered EEAs totalled 6887. Annual reports declared 1803 EEAs in total for this period, without distinguishing those registered by QPS from the Queensland Ambulance Service. Past year proportions of EEOs, however, indicate perhaps ~1100 originated with QPS (84% fewer). Information crucial for considered emergency mental healthcare responses for thousands of people is no longer readily available.

Queensland Health’s CKN celebrates 20 years of service

In March 2021, Queensland Health’s state-wide Clinical Knowledge Network, CKN, celebrated a remarkable 20 years of continuous service – supporting over 77,000 clinicians, including Queensland Ambulance Service paramedics, working in all areas of Queensland’s public health system, across the entire state.

Time to amiodarone administration and survival outcomes in refractory ventricular fibrillation.

International guidelines recommend amiodarone for out-of-hospital cardiac arrest (OHCA) in refractory ventricular fibrillation (VF). While early appropriate interventions have been shown to improve OHCA survival, the association between time to amiodarone and survival remains to be established. Included were adult OHCA in refractory VF, between January 2015 and December 2019, who received a resuscitation attempt with amiodarone from Queensland Ambulance Service paramedics. Patient characteristics and survival outcomes were described. Factors associated with survival were investigated, with a focus on time from arrest to amiodarone administration. Optimal time window for amiodarone administration was determined, and factors influencing whether amiodarone was given within the optimal time window were examined. A total of 502 patients were included. The average (range) time from arrest to amiodarone was 25 (4-83) min. Time to amiodarone was negatively associated with survival (adjusted odds ratio 0.93 for event survival; 95% confidence interval 0.89-0.97). The optimal time window for amiodarone was within 23 min following arrest. Patients receiving amiodarone within the optimal time had significantly better survival than those receiving it outside this window (event survival 38.3% vs 20.6%, P < 0.001; discharge survival 25.5% vs 9.7%, P < 0.001; 30-day survival 25.1% vs 9.7%, P < 0.001). Paramedic response time (adjusted odds ratio 0.96; 95% confidence interval 0.92-0.99) and time from arrest to intravenous access (0.71; 0.67-0.76) were independent factors determining whether patients received amiodarone within the optimal time. Earlier amiodarone administration was associated with improved survival. Strategies aimed at reducing delay to amiodarone administration have the potential to improve outcome.

The impact of late-night alcohol restrictions on ambulance call-outs in entertainment precincts.

In July 2016, the Queensland Government introduced the Tackling Alcohol-Fuelled Violence (TAFV) policy to address alcohol-related harm in entertainment precincts [safe night precincts (SNP)]. Additional measures were introduced in February and July 2017. We aim to examine the impact of the policy on Queensland Ambulance Service call-outs in Fortitude Valley, Surfers Paradise, all 15 SNP suburbs combined and statewide. Auto-regressive integrated moving average (ARIMA) models and seasonal ARIMA (SARIMA) models were developed to test the impact of TAFV policy stages on monthly number of ambulance call-outs during high alcohol hours (HAH; Friday and Saturday nights, 20:00-05:59) over an 8-year period (July 2011-June 2019). The average number of monthly call-outs in HAH reduced by 26.2% in Fortitude Valley, 21.1% in Surfers Paradise and 4.3% in all 15 SNP suburbs combined. In Fortitude Valley, there was a significant decline in the monthly number of call-outs between 00:00 and 02:59 and across all HAH combined when examining the cumulative effect of the policy stages; and significant declines between 03:00 and 05:59 after each stage and cumulatively. Across the 15 SNP suburbs combined, there was a significant decline in call-outs between 03:00 and 05:59 after the third policy stage (July 2017). There were no significant declines in Surfers Paradise or statewide. Overall, the introduction of the TAFV policy stages in Queensland had a limited effect on ambulance call-outs during HAH. However, there were some notable declines in HAH ambulance call-outs in some of the state's key nightlife suburbs.

Suicide crisis calls to emergency services: Cohort profile and findings from a data linkage study in Queensland, Australia.

Police and paramedics play a crucial role in responding to suicide crises in the community. However, little is known about the nature, extent, precipitating factors, pathways and outcomes of a suicide-related call to emergency services and what responses will most effectively and compassionately meet the needs of those in crisis. Partners in Prevention: Understanding and Enhancing First Responses to Suicide Crisis Situations (PiP) was established to address these knowledge gaps. This article describes (1) the methodology used to construct the PiP dataset, a population-wide linked dataset that investigates the characteristics and health pathways of individuals in Queensland who were the subject of a suicide-related call to police or paramedics; and (2) preliminary findings on service demand, demographics and health services utilisation. We identified 219,164 suicide-related calls to Queensland Police Service or Queensland Ambulance Service that were made over the 3-year period 1 February 2014 to 31 January 2017. A total of 70,893 individuals were identifiable via records linkage. The cohort linked to more than 7,000,000 health records. We estimated that police or paramedics in Queensland received on average 209 calls per day, with increases year on year over the study period. Analysis of demographic data highlighted the heterogeneous nature of this cohort and important demographic variations between individuals in contact with police versus ambulance services. The PiP dataset provides a strong foundation for a multi-modal dataset that can be built on over time, both cross-sectionally and longitudinally. Further linkages to Medicare Benefits Schedule, Pharmaceutical Benefits Scheme and social care datasets are planned. Detailed population-level analysis that data linkage can provide is critical to improving understanding and responses to suicide crisis situations. The PiP study is a world first and provides a unique opportunity to improve responses to this public health problem.