Queensland Ambulance Service Research Articles

Is unplanned out-of-hospital birth managed by paramedics \u2018infrequent\u2019, \u2018normal\u2019 and \u2018uncomplicated\u2019?

BackgroundUnplanned out-of-hospital birth is often perceived as precipitate in nature, ‘infrequent’, ‘normal’ and ‘uncomplicated’. However, international studies report unplanned out-of-hospital birth is associated with increased rates of maternal and neonatal morbidity and mortality. This research describes intrapartum, immediate postpartum and neonatal care provided by paramedics in Queensland, Australia. The objectives were to (1) determine the number of cases where the paramedic documented birth or imminent birth during the study period (2) to describe the incidence of births prior to or during paramedic care (3) to detail any risk factors and/or complications recorded by paramedics during these cases, (4) identify paramedic pain management practices for intrapartum care, and (5) to examine the maternal and neonatal outcomes as documented by paramedics.MethodA retrospective analysis of Queensland Ambulance Service (QAS) de-identified patient care records, generated from clinical case data between the 1st of Jan 2010 and 31st of Dec 2011, was undertaken. Descriptive analysis and x2 tests were used to test associations between categorical variables, and the Wilcoxon rank-sum for associates between continuous variables which were not normally distributed. Content analysis was utilised to code free text fields.ResultsSix thousand one hundred thirty-five records were identified as intrapartum cases. This represented approximately 0.5% of the annual QAS caseload; 5722 were classified as maternal records and 413 were neonatal records. Paramedics recorded antenatal and/or intrapartum complications in 27.3% (n = 1563) of cases. Abnormal maternal vital signs were recorded in 30.1% (n = 1725) of cases. Of the 5722 women attended by paramedics during their labour, a birth occured in 10.8% (n = 618) of cases. Parity was documented in 41.4% (n = 256) of mothers who birthed. Neonatal records were available for 66.8% (n = 413) of actual births, 60.0% (n = 248) recorded a full set of neonatal vital signs and an Apgar score. When an Apgar score was recorded, 21.8% (n = 91) scored ≤7 out of 10.ConclusionsThe research described intrapartum, immediate postpartum and neonatal care provided by paramedics and identified factors that may complicate paramedic clinical management of labouring and birthing women. Further research is required to determine if there are opportunities to improve the paramedic management of such cases.

Temporal trends (2002-2014) of incidence and shockable status of adult emergency medical service attended out-of-hospital cardiac arrest of presumed cardiac aetiology in Queensland.

To describe trends in incidence and shockable status of adult out-of-hospital cardiac arrest (OHCA) of presumed cardiac aetiology attended by Queensland Ambulance Service (QAS) paramedics between 2002 and 2014. The QAS cardiac arrest registry was used to collect data. Analyses included age-standardised rates by gender for all adults and older adults only (65 years+); age-specific incidence rates of young adults (18-49), middle age adults (50-64) and five groups of older adults (65-69, 70-74, 75-79, 80-84 and 85+); and proportions of shockable versus non-shockable initial rhythm together and by age group (young, middle age and older adults). Temporal trends were analysed. Over the 13 years, 32 346 cases of adult OHCA of presumed cardiac aetiology were recorded on the QAS OHCA registry. Age-standardised incidence reduced significantly over time overall and in males only, in all adults and independently in older adults. A significant reduction independently in females was observed only in older adults. Age-specific rates reduced in the 18-49, 70-74, 75-79 and 80-84 year age groups, increased in the 50-64 age group (largely attributable to females) and no significant trends were found in the 65-69 and 85+ age groups. The proportion of cases with an initially shockable rhythm significantly decreased overall. This trend was observed independently in older adults, but not in young or middle age adults. Age-standardised incidence has reduced with a period of stagnation in the middle age and early older years. These factors require consideration in data interpretation and strategy planning.

Supporting Patient Outcomes through Organised Networks (SPOT ON)

Introduction: In 2014-15 the Sunshine Coast Hospital & Health Service (SCHHS) has 113,029 Emergency Department (ED) presentations, of which 55,729 were triaged as a category 4 or 5 (Australasian Triage Scale). SPOT ON aimed to find a solution to this issue which presented a significant risk to patients and clinicians within the ED. Many of these low acuity patients were self-presenters however a significant number were brought in by ambulance. SPOT ON is a new and innovative integrated care strategy targeting lower acuity patients in the Sunshine Coast community who call the Queensland Ambulance Service (QAS) for assistance. A six month pilot commenced March 2016 to demonstrate the benefits of the strategy which aimed to ensure that each patient is transported or referred to the right place based on clinical decision making by the paramedic at the point of care. SPOT ON provides clinical pathways to assist the paramedic and General Practice (GP) to provide evidence based care that will continue along each point of the patient journey, avoiding duplication of tests and procedures should the patient require escalation to an Emergency Department. Consideration has also been given to supporting the Royal Australian College of General Practitioners (RACGP) ‘medical home’ concept[1] and avoiding fragmentation of care by the provision of a two tier GP model. Tier 1 GPs are the patient’s usual GP (where one exists) and is the first option of care for patients who meet the SPOT ON criteria. Where no relationship exists or the usual GP is not in a position to accept the patient, a number of Tier 2 GPs have been contracted by the HHS to provide care to these patients, avoiding an unnecessary trip to the Emergency Department. The collaboration by these key groups: SCHHS, QAS, the PHN, General Practice, Healthcare Improvement Unit, University of the Sunshine Coast and Silverchain (Hospital in the Home) as well as a consumer representative ensures that each group involved in the SPOT ON project is supported to provide quality health care to the Sunshine Coast community resulting in enhanced patient journey and benefits to each of the health care groups involved. The involvement of a consumer representative ensured the model considered person centred care and the needs and wishes of the patient. Involvement of the University assisted in initial and ongoing research requirements for the project. An initial literature search was unable to identify any similar models of care. Ethics approval and Public Health Act approvals were obtained as part of the project to ensure our research results could be published to inform others about the structure and benefits of this project. Methods and Target Group: QAS patients are the primary target of the project, and clinical pathways have been developed to identify appropriate patients to have their care met by GPs rather than the ED. GPs are identified as either Tier 1 or Tier 2, and clinically suitable patients are referred to or transported to one of these clinics rather than an ED. QAS will first attempt transport to a Tier 1 GP where one exists and if unsuccessful then transport will occur to a Tier 2 clinic in the area. Tier 2 clinics have been contracted by the HHS (through a rigorous selection process) to accept these additional patients and have KPI that must be met. Data is being collected from QAS, Tier 2 GPs, SCHHS and patients (through a post care survey). Results: Full results are pending however interim results are showing a positive trend. Measurements include: patient experience; clinician experience; clinical outcomes (measured through re-presentations); and value for money (to SCHHS, GPs, and QAS). Initial results: >90% positive patient experience 25% reduction in Category 5 patients to SCHHS EDs 30 minute reduction in median case time for QAS 500% increase in patients transported to GPs by QAS on the previous year’s figures Conclusions: The project will aim to conclude that through a collaborative approach and specific guidelines the health sector can provide quality health care options for the low acuity patient that will better suit their specific health needs, and avoid an unnecessary visit to the ED. This patient centred model of care encourages the development of a ‘patient-GP’ relationship for continuity of ongoing health needs that is close to where the patient lives and avoids long waiting times that are often experienced in an ED. This same concept is transferable to other Health services as it is based on the collaborative and supportive approach between the key health providers within an area.

Description of the ambulance services participating in the Aus-ROC Australian and New Zealand out-of-hospital cardiac arrest Epistry.

The present study aimed to describe and examine similarities and differences in the current service provision and resuscitation protocols of the ambulance services participating in the Aus-ROC Australian and New Zealand out-of-hospital cardiac arrest (OHCA) Epistry. Understanding these similarities and differences is important in identifying ambulance service factors that might explain regional variation in survival of OHCA in the Aus-ROC Epistry. A structured questionnaire was completed by each of the ambulance services participating in the Aus-ROC Epistry. These ambulance services were SA Ambulance Service, Ambulance Victoria, St John Ambulance Western Australia, Queensland Ambulance Service, St John Ambulance NT, St John New Zealand and Wellington Free Ambulance. The survey aimed to describe ambulance service and dispatch characteristics, resuscitation protocols and details of cardiac arrest registries. We observed similarities between services with respect to the treatment of OHCA and dispatch systems. Differences between services were observed in the serviced population; the proportion of paramedics with basic life support, advanced life support or intensive care training skills; the number of OHCA cases attended; guidelines related to withholding or terminating resuscitation attempts; and the variables that might be used to define 'attempted resuscitation'. All seven participating ambulance services were noted to have existing OHCA registries. There is marked variation between ambulance services currently participating in the Aus-ROC Australian and New Zealand OHCA Epistry with respect to workforce characteristics and key variable definitions. This variation between ambulance services might account for a proportion of the regional variation in survival of OHCA.

The impact of missing or incorrect addresses

The impact of missing or incorrect addresses

Establishing the Aus-ROC Australian and New Zealand out-of-hospital cardiac arrest Epistry

IntroductionOut-of-hospital cardiac arrest (OHCA) is a global health problem with low survival. Regional variation in survival has heightened interest in combining cardiac arrest registries to understand and improve OHCA outcomes....

Prehospital paediatric burn care: New priorities in paramedic reporting.

The present study evaluates the prehospital care of paediatric burn patients in Queensland (QLD). As first aid (FA) treatment has been shown to affect burn progression and outcome, the FA treatment and the risk of associated hypothermia in paediatric patients were specifically examined in the context of paramedic management of burn patients. Data were retrospectively collected from electronic ambulance response forms (eARFs) for paediatric burn patients (0-5 years) who were attended by Queensland Ambulance Service (QAS) from 2008 to 2010. Data were collected from 117 eARFs of incidents occurring within the Brisbane, Townsville and Cairns regions. Initial FA measures were recorded in 77.8% of cases, with cool running water FA administered in 56.4% of cases. The duration of FA was recorded in 29.9% of reports. The duration of FA was significantly shorter for patients in Northern QLD (median = 10 min, n = 10) compared with Brisbane (median = 15 min, n = 18), P = 0.005. Patient temperatures were recorded significantly more often in Brisbane than in other regions (P = 0.041); however, in total, only 24.8% of all patients had documented temperature readings. Of these, six (5%) were recorded as having temperatures ≤ 36.0°C. Burnaid(TM) was the most commonly used dressing and was applied to 55.6% of all patients; however, it was applied with a variety of different outer dressings. Brisbane paramedics applied Burnaid significantly less often (44.3%) compared with paramedics from Northern QLD (72.7%) and Far Northern QLD (60.9%), P = 0.025. Despite FA and patient temperatures being important prognostic factors for burn patients, paramedic documentation of these was often incomplete, and there was no consistent use of burns dressings.

Unfit for Duty? Evaluation of 4 Years of Paramedic Preemployment Fitness Screening Test Results

Background. Preemployment testing is utilized by many ambulance services. Surprisingly, there is limited published research on the efficacy of this testing in determining an employee's ability to complete the requirements of this physically demanding occupation. Objectives. The purpose of this study was to analyze the preemployment fitness test results from a 4-year cohort of paramedic students from an Australian university. To date, no published studies have reported on the fitness test scores for paramedic students or on whether overall test score is biased toward any particular test components. Similarly, no data have been presented on whether there are gender differences in scores for individual test components or overall test score. Methods. Retrospective cohort study of de-identified data from 4 years of data from Paramedic Science students (n = 251) (mean age = 24.9 years). Data were recorded from the Queensland Ambulance Service (QAS) Health Related Fitness Test (HRFT), a preemployment fitness test used by an Australian state ambulance service. HRFT score is calculated out of a possible 100 points and is based on performance scores in nine component fitness tests. Raw test scores for each of these component tests are ranked on a 0–4 scale prior to these data being scaled and summed to generate the overall HRFT score. An overall score >24.99 is awarded a “Pass.” Results. Five individuals failed to “Pass” the HRFT. Overall HRFT scores were influenced significantly by performance in the strength tests, with males also recording significantly (p < 0.005) higher scores in all of the strength tests than females. Similarly, approximately 40% of the female participants, compared to 6% of males, achieved an overall test “Pass” and yet gained a ranked score of 0 in at least three of the component tests. Conclusions. It was concluded that the scoring system did not exclude participants with poor fitness levels, as many participants recorded low scores in several test components yet still passed the test. We recommend that before redesigning the HRFT, studies should be first conducted on the occupational demands and physical standards required for this important profession.

Characteristics and outcomes of patients administered blood in the prehospital environment by a road based trauma response team

ObjectiveTo describe the characteristics, clinical interventions and the outcomes of patients administered packed red blood cells (pRBCs) by a metropolitan, road based, doctor-paramedic trauma response team (TRT).MethodsA retrospective cohort study...

Communicating in the pre-hospital emergency environment

To develop and evaluate the implementation of a communication board for paramedics to use with patients as an augmentative or alternative communication tool to address communication needs of patients in the pre-hospital setting. A double-sided A4-size communication board was designed specifically for use in the pre-hospital setting by the Queensland Ambulance Service and Disability and Community Care Services. One side of the board contains expressive messages that could be used by both the patient and paramedic. The other side contains messages to support patients' understanding and interaction tips for the paramedic. The communication board was made available in every ambulance and patient transport vehicle in the Brisbane Region. A total of 878 paramedics completed a survey that gauged which patient groups they might use the communication board with. The two most common groups were patients from culturally and linguistically diverse backgrounds and children. Staff reported feeling confident in using the board, and 72% of interviewed paramedics agreed that the communication board was useful for aiding communication with patients. Feedback from paramedics suggests that the board is simple to use, reduces patient frustration and improves communication. These results suggest that a communication board can be applied in the pre-hospital setting to support communication success with patients. WHAT IS KNOWN ABOUT THE TOPIC? It is imperative that communication between patient and paramedic is clear and effective. Research has shown that communication boards have been effective with people with temporary or permanent communication difficulties. WHAT DOES THIS PAPER ADD? This is the first paper outlining the development and use of a communication board by paramedics in the pre-hospital setting in Australia. The paper details the design of the communication board for the unique pre-hospital environment. The paper provides some preliminary data on the use of the communication board with certain patient groups and its effectiveness as an alternative communication tool. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS? The findings support the use of the tool as a viable option in supporting the communication between paramedics and a range of patients. It is not suggested that this communication board will meet the complete communication needs of any individual in this environment, but it is hoped that the board's presence within the Queensland Ambulance Service may result in paramedics introducing the board on occasions where communication with a patient is challenging.

The feasibility of civilian prehospital trauma teams carrying and administering packed red blood cells

ObjectiveTo evaluate the feasibility, limitations and costs involved in providing prehospital trauma teams with packed red blood cells (pRBCs) for use in the prehospital setting.MethodsA retrospective cohort study, examining 18...

Universal access to ambulance does not increase overall demand for ambulance services in Queensland, Australia

To determine the impact of the introduction of universal access to ambulance services via the implementation of the Community Ambulance Cover (CAC) program in Queensland in 2003-04. The study involved a 10-year (2000-01 to 2009-10) retrospective analysis of routinely collected data reported by the Queensland Ambulance Service (QAS) and by the Council of Ambulance Authorities. The data were analysed for the impact of policy changes that resulted in universal access to ambulance services in Queensland. QAS is a statewide, publically funded ambulance service. In Queensland, ambulance utilisation rate (AUR) per 1000 persons grew by 41% over the decade or 3.9% per annum (10-year mean=149.8, 95% CI: 137.3-162.3). The AUR mean after CAC was significantly higher for urgent incidents than for non-urgent ones. However projection modelling demonstrates that URs after the introduction of CAC were significantly lower than the projected utilisation for the same period. The introduction of universal access under the Community Ambulance Cover program in Queensland has not had any significant independent long-term impact on demand overall. There has been a reduction in the long-term growth rate, which may have been contributed to by an 'appropriate use' public awareness program.

Nonfatal drowning in children and young people in Queensland (Australia) 2002–2008

Literature exists on fatal drowning events, however, the incidence, mechanisms and consequences of nonfatal drowning episodes remain largely unexplored. Additionally, drowning episodes among adolescents have not been previously studied in...

Queensland Emergency Medical System: A structural and organizational model for the emergency medical system in Australia

The emergency medical system (EMS) can be defined as a comprehensive, coordinated and integrated system of care for patients suffering acute illness and injury. The aim of the present paper is to describe the evolution of the Queensland Emergency Medical System (QEMS) and to recommend a strategic national approach to EMS development. Following the formation of the Queensland Ambulance Service in 1991, a state EMS committee was formed. This committee led the development and approval of the cross portfolio QEMS policy framework that has resulted in dynamic policy development, system monitoring and evaluation. This framework is led by the Queensland Emergency Medical Services Advisory Committee. There has been considerable progress in the development of all aspects of the EMS in Queensland. These developments have derived from the improved coordination and leadership that QEMS provides and has resulted in widespread satisfaction by both patients and stakeholders. The strategic approach outlined in the present paper offers a model for EMS arrangements throughout Australia. We propose that the Council of Australian Governments should require each state and Territory to maintain an EMS committee. These state EMS committees should have a broad portfolio of responsibilities. They should provide leadership and direction to the development of the EMS and ensure coordination and quality of outcomes. A national EMS committee with broad representation and broad scope should be established to coordinate the national development of Australia's EMS.

An exploratory study to examine the phenomenon and practice of ‘Ambulance Ramping’ at hospitals within the Southern Health Service Districts of Queensland and Queensland Ambulance Service

An exploratory study to examine the phenomenon and practice of ‘Ambulance Ramping’ at hospitals within the Southern Health Service Districts of Queensland and Queensland Ambulance Service

Growing demand for emergency health services in Queensland, Australia

Introduction: The demand for emergency health services (EHS), both in the prehospital (ambulance) and hospital (emergency departments) settings, is growing rapidly in Australia. Broader health system changes have reduced available health infrastructure, particularly hospital beds, resulting in reduced access to and congestion of the EHS as demonstrated by longer waiting times and ambulance “ramping”. Ambulance ramping occurring when patients have a prolonged wait on the emergency vehicle due to the unavailability of hospital beds. This presentation will outline the trends in EHS demand in Queensland compared with the rest of Australia and factors that appear to be contributing to the growth in demand. Methods: Secondary analysis was conducted using data from publicly available sources. Data from the Queensland Ambulance Service and Queensland Health Emergency Department Information System (EDIS) also were analyzed. Results: The demand for ambulance services and emergency departments has been increasing at 8% and 4% per year over the last decade, respectively; while accessible hospital beds have reduced by almost 10% contributing to the emergency department congestion and possibly contributing to the prehospital demand. While the increase in the proportion of the elderly population seems to explain a great deal of the demand for EHS, other factors also influence this growth including patient characteristics, institutional and societal factors, economic, EHS arrangements, and clinical factors. Conclusions: Overcrowding of facilities that provide EHS are causing considerable community concern. This overcrowding is caused by the growing demand and reduced access. The causes of this growing demand are complex, and require further detailed analysis in order to quantify and qualify these causes in order to provide a resilient foundation of evidence for future policy direction.

Retrospective Review of Reperfusion Therapy for ST-elevation Myocardial Infarctions (STEMIs)—A Comparison of Primary Percutaneous Coronary Intervention (PPCI) and Queensland Ambulance Service (QAS) Pre-hospital Thrombolysis (PHT)

Retrospective Review of Reperfusion Therapy for ST-elevation Myocardial Infarctions (STEMIs)—A Comparison of Primary Percutaneous Coronary Intervention (PPCI) and Queensland Ambulance Service (QAS) Pre-hospital Thrombolysis (PHT)

Ambulance Call-Taking and Dispatch Data: New Approaches to Population-Based, Infectious Disease Surveillance and Triage

In Australia, traditional strategies for infectious disease surveillance are based on data reported from Emergency Departments and General Practice and Locum Services. To date, little attention has been paid to the potential utility of emergency prehospital call taking and dispatch data to contribute to infectious disease surveillance. In early 2006, a collaborative national and international team led by the Australian Centre for Pre-hospital Research, commenced a national study of paramedics and their partners to examine the perceptions and expectations of these groups to working and living in pandemic conditions and to examine the utility of ambulance call taking and dispatch data to inform population-based models for surveillance and triage. Using data secured from the Melbourne Ambulance Service and the Queensland Ambulance Service, researchers mapped the ability of these data to mirror data provided by the Victorian Infectious Disease Reference Laboratory on influenza-like illness (ILI). The results demonstrate the potential utility of using emergency prehospital data to complement existing infectious disease surveillance systems. In addition, these results provide a platform for the development and testing of a model of syndromic surveillance at the point of call-taking. The results from this study will be described and the importance of emergency prehospital data to public health applications will be demonstrated.

Management of sharps in ambulance care: a State-wide survey of paramedic knowledge and reported practice

Paramedics are at high risk of exposure to infectious diseases because they frequently undertake procedures such as the use and disposal of sharps as components of everyday practice. While the literature demonstrates that the management of sharps is problematic across all health disciplines, there is a paucity of research examining sharps management practices in the Australian pre-hospital paramedic context. This study examines knowledge and practices of sharps control among paramedics in Queensland, Australia. A mail survey focusing on infection control knowledge and practices was sent to all clinical personnel of the Queensland Ambulance Service (QAS) (N=2274). A total of 1258 surveys were returned, a response rate of 55.3%. Participants responded to 12 true/false statements on the management of sharps and three questions about recapping practices. Most respondents were knowledgeable about the correct management of sharps, with a mean of 11.28 (out of 12, SD=1.32). When gauging reported practices, more than half (59.1%, n=736) of participants reported recapping a needle, and 38.5% (n=479) reported never having done so.These results reflect good knowledge of general management of sharps among respondents, but suggest deficits regarding reported practices. The results suggest that a comprehensive ambulance in-service education programme focusing particularly on sharps management is required. The study highlights the need for further research on sharps management practices in the field, identification of barriers to safe sharps practices in pre-hospital settings, and ’best practice’ for translating good sharps management knowledge into practice.

Taking on a New Role: The Health Information Manager in the Queensland Ambulance Service.

Taking on a New Role: The Health Information Manager in the Queensland Ambulance Service.