Volume 11 | Issue 6 | Abstracts

Paramedics Australasia International Conference: Abstracts and Poster Presentations

1 Conference Abstracts Australasian Journal of Paramedicine: 2014;11(6)

Training Private Paramedics Jane Armstrong,1 Ben Hamlin1 1Clinical Training, Aspen Medical, Australia, [email protected]

Introduction This survey will focus on a synopsis of novel approaches utilised to deliver training to Intensive Care Paramedics (ICPs) employed to work in isolated sites, often in solo practitioner roles. Aspen Medical (AM) is an RTO and under AM’s scope of registration a range of accredited and non-accredited training is provided to health professionals from various craft groups, including ICPs, that are employed on Defence sites and within the Oil & Gas, Mining & Resource sectors across Australia.

Methods ICPs that meet AM credentialing requirements are employed on mine sites located in Queensland, the Northern Territory and Western Australia as well as the Solomon Islands. AM requires that ICPs meet AM minimum credentialing as well as provide annual evidence of a current Certificate to Practice (CTP) or Authority to Practice (ATP) from a state or territory based Australian Ambulance Service. An additional credentialing requirement for AM ICPs is the completion of 20 hours of Continuous Professional Development (CPD) annually.

Result Clinical skills advancement, skills maintenance and primary health care education to meet the training needs of ICPs are delivered through: Paramedic in-service (three day session) covering clinical skill set assessment, simulated emergency scenarios and presentations; Paramedic clinical skills assessment day (one day session); On-site simulated emergency response training; Webinar presentations (three weekly); Patient safety meeting case presentations (two weekly); and My Aspen portal online eLearning (platform agnostic).

Conclusion Novel approaches to training development and delivery support the steady growth in full, part time and casually employed AM ICPs.

Prehospital airway management: Tips and tricks to improve out-of-hospital airway management

Jason Bendall1 1Department of Anaesthesia, Gosford Hospital, New South Wales, Australia, [email protected]

Airway management skills are a suite of clinical fundamental skills for all paramedics. The majority of paramedics however initially were taught airway skills on manikins with very few with the opportunity to develop airway skills on patients under “expert” supervision. The majority of paramedics provide advanced airway management infrequently making the retention of skills difficult. As a paramedic who has transitioned into specialist anaesthetic training over the past 2 years I have spent considerable time reflecting on airway management skills for paramedics. This presentation will review fundamental airway management skills, will present novel airway management techniques and will challenge various airway dogma. I aim to present various strategies to improve basic and advanced airway management skills of students, paramedics and intensive care paramedics.

01 Conference Abstracts Australasian Journal of Paramedicine: 2014;11(6) Patient Centric Care Where Jurisdictional Intersections Occur In Paramedic Practice

David Burns,1 1Retrieval Paramedic/Flight Paramedic - MSS Strategic Medical and Rescue/BHP Billiton Pilbara HEMS, Australia, [email protected]

Paramedic Practitioners operate in a wide, and sometimes, under acknowledged range of environments. The traditional jurisdictional State/Territory based construct of Ambulance Service is now so much more with Paramedic Practice models of last century having developed to become a complex and high performance plexus of health services in a wide range of industry and community health service models. State/Territory legislative differences can constrain emergency and primary health services to communities and theoretically worsen morbidity for those that are sick or injured when distant from a traditional “Ambulance Service’ Model of care or service delivery areas. With well- qualified, credentialed and clinically governed Paramedics providing service outside historical models there is health service opportunities to capitalise through ‘mutual aid’ agreements and formalised recognition of service capacity. New thinking should reflect practice across the professions full reach as a “Paramedic Service” and the term “Ambulance Service” should in a contemporary context perhaps describe the maintenance of Ambulance vehicles only. Across Australia levels of clinical practice and the level of qualification to practice are not consistent and provide no minima, this congests the forward movement of Paramedic practice and the position Paramedics hold in the broader Health context. Cardiovascular Disease in the prehospital setting: Importance of day of week analysis

Kate Cantwell,1,2 Amee Morgans,2,3 Karen Smith,2,4,5 Michael Livingston,6,7 Paul Dietze1 1Burnet Institute, Victoria, Australia. [email protected] 2Ambulance Victoria, Victoria, Australia 3Department of Healthy Ageing, Monash University, Victoria, Australia 4Emergency Medicine Department, University of Western Australia, Western Australia, Australia 5Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia 6Drug Policy Modelling Program, National Drug and Alcohol Research Centre, University of New South Wales, Australia 7Centre for Alcohol Policy Research, Turning Point Alcohol and Drug Centre, Victoria, Australia

Introduction Cardiovascular disease is the leading cause of death in Australia with 45,600 deaths recorded in 2011. Whilst Monday is the most common day for presentations related to cardiovascular disease in the health system no study has reported demand distribution partitioned across different hours of the day and different days of the week. The aim of this study was to report temporal patterns of presumptive cardiovascular disease cases as determined after ambulance assessment and to examine the demand distribution by day of the week.

Methods Between January 2008 and December 2011, all cases attended by Ambulance Victoria in metropolitan Melbourne were extracted from the Ambulance Victoria clinical data warehouse. Data included time of call, incident mechanism, location type, final assessment (paramedic “diagnosis”) and patient age.

Results The 182,983 cases of presumptive cardiovascular disease observed during the study period constituted 15.2% of total demand. The median age of persons attended was 72 and there was an almost even split between genders (51% female). Most cardiovascular case types had their peak number of cases between 09.00 and 11.00, the only exception was acute pulmonary oedema which had peak case numbers at 06.00. Fourier analysis showed that there are 2 distinct time of day distribution patterns.

Conclusions This study showed that there are two distinct distribution patterns for cardiovascular disease, one pattern for weekends, another for weekdays. Weekends have fewer cases than weekdays however this is not seen across all hours of the day. Compared to weekdays, weekends have fewer cases per hour during the day by similar numbers of cases at night which has important implications for ambulance resource management.

02 Conference Abstracts Australasian Journal of Paramedicine: 2014;11(6) Consensus of items and quantities of clinical equipment required to deal with a mass casualties big bang incident: a national Delphi study Keith Colver,1 Dr Edward A.S Duncan,2 Nadine Dougall,2 Kevin Swingler,3 Dr John Stephenson,4 Dr Purva Abhyanker,2 1National Risk and Resilience Department, Scottish Ambulance Service, United Kingdom, [email protected] 2Nursing Midwifery and Allied Health Professions Research Unit, University of Stirling, United Kingdom 3School of Natural Sciences, University of Stirling, United Kingdom 4National Ambulance Resilience Unit, West Midlands Ambulance Service NHS Trust, Oldbury, United Kingdom

Introduction Though big-bang mass casualties incidents are rare, health and ambulance services must be prepared to respond appropriately. In order to do so they require access to the right type and quantities of clinical equipment. However planning for such unforeseeable events is challenging. Historically the types and quantities of stocked equipment has varied across the United Kingdom (UK) and lacked an explicit evidence-base. This study developed an expert consensus on the types and quantities of clinical equipment required for a big-bang mass casualties incident.

Methods A three round Delphi study using a be-spoke web-based platform was undertaken in the UK. Participants had clinical experience or responsibility for pre-hospital response to mass casualties, or were in a position of authority in health emergency planning. Items’ importance were measured on a 5 point Likert scale. Consensus was deemed to have been achieved when at least 80% of respondents rated an item as unimportant/very unimportant or important/very important. Item quantities were measured numerically. Data were analysed using nonparametric statistics.

Results Thirty-two experts achieved consensus on 134 items (54%), consensus was not reached on 114 (46%) items. Median quantities and interquartile ranges of each item were reported.

Conclusions This is the first time an evidence-based list of the types and quantities of clinical equipment that are required for big-bang mass casualty events has been developed. The findings are currently being implemented throughout the UK and provide an important resource for countries with similar systems and planning assumptions for responding to big-bang mass casualties events.

Taking off: The Pilot Programme of Ireland’s Emergency Aeromedical Service

Niamh Cummins,1 Cathal O’Donnell,2 Damien Ryan1 1Centre for Prehospital Research, Graduate Entry Medical School, University of Limerick, Ireland, [email protected] 2National Ambulance Service, Health Service Executive, Ireland

Prior to the launch of the Emergency Aeromedical Service (EAS) in 2012 aeromedical support in Ireland was limited to Coast Guard search and rescue missions . The EAS is a collaboration between the Irish Air Corps and the National Ambulance Service. “Medevac 112” operates in an AW139 and clinical practitioners include an emergency medical technician and an advanced paramedic. The objective of this study is to describe the activity of the Irish EAS during its first six months of operation. Ethical approval for the research was granted from University Hospital Limerick. The attending advanced paramedic recorded all relevant demographic, clinical and transport information on a separate data-sheet for every call responded to during the study period. Additional comparative data was obtained from the National Aeromedical Control Centre, Patient Care Reports and Air Corps records. Primary missions comprised 86% of calls with the remainder entailing inter-hospital transfers. Most patients were male (67%) and mean age was 53 ± 23 years. Age ranged from neonate to 86 years and 12% of patients were aged <18 years. Cardiovascular conditions comprised 47% of EAS calls while trauma patients also made up a significant proportion of cases (35%). Mean patient transport time was 22 minutes (± 11) and ranged from 3 - 55 minutes. The establishment of an Irish Aeromedical Service has increased the number of patients reaching definitive care who require time-sensitive therapies such as percutaneous coronary interventions and thrombolysis. Preliminary analysis suggests that these findings are in line with previous international studies.

03 Conference Abstracts Australasian Journal of Paramedicine: 2014;11(6) Airway adjunct use in cardiac arrest: A St John New Zealand Out-of-Hospital Cardiac Arrest Registry Study Paul Davey,1 Bernard Doo,2 Dr Bridget Dicker,3 1Paramedicine and Emergency Management, Auckland University of Technology, New Zealand, [email protected] 2Clinical Audit and Research Unit, St John, New Zealand, [email protected] 3Clinical Audit and Research Unit, St John, New Zealand, [email protected]

Introduction Out of hospital cardiac arrest (OHCA) is a significant health burden.There has been controversy in recent times as to which airway adjunct is associated with best clinical outcome. Greater survival benefit has been demonstrated for endotracheal tube (ETT) over supraglottic devices (SGA) such as the laryngeal mask (LMA) and also for patients that received no advanced airway care to those that received ETT or SGA. There is a dearth of literature describing airway management during OHCA in New Zealand

Methods Data from the St John New Zealand OHCA Registry was analysed retrospectively (1/10/13 to 30/4/2014 to identify the type of airway adjunct used during resuscitation. The analysis was performed independently by two researchers and cross matched for accuracy.

Results Of 2011 OHCA’s resuscitation was attempted in 1014 cases. In 404 cases more than one airway adjunct was used, in this group the airway adjunct frequency was OPA: 505, LMA: 510 and ETT: 349. In 610 cases a single airway adjunct was used, OPA: 167, LMA: 217, ETT: 96, no airway adjunct was used in 130 cases. Of the 130 cases of OHCA where no adjunct was used 41 were witnessed by paramedics (ROSC 34), the remainder were resuscitation attempts that were terminated within minutes.

Conclusion The airway adjunct with the highest frequency of use during OHCA is the LMA, followed by the oropharyngeal airway. Endotrachael intubation was the least frequently used airway adjunct during the airway management of OHCA. Further study is needed to identify clinical outcomes. The future Australian paramedic workforce: a snapshot of undergraduate paramedic students Anthony Laing,1 Scott Devenish,2 David Lim,2 Vivienne Tippett,2 1Queensland Ambulance Service, Australia, [email protected] 2School of Clinical Sciences, Queensland University of Technology

Introduction Describe the demographics of undergraduate paramedic students enrolled at a major Queensland University and explore the potential impact of demographic change in the paramedic workforce of the future.

Method A retrospective, descriptive analysis of de-identified, routinely collected administrative data on students enrolled in the paramedic undergraduate degree program at Queensland University of Technology was undertaken for the period 2005-2013. Quantitative data were examined using the Statistical Package for Social Science version 21.

Results A total of 914 students had commenced the paramedic degree since 2005, of whom slightly more than a third (33.4%; SD 9.5%) were enrolled in the double degree with nursing beginning from 2009. Half of the student cohort (52.1%; SD 4.8%) were female, with the majority (82.9%; SD 3.4) aged under 25 years old. Most (45.2%; SD 13) of the student admissions were for graduate entry [i.e. prior tertiary education had been completed], while secondary education entry represented 35.9% (SD 14.9%).

Conclusion By contrasting the results of our study to the most recent demographic data of the Australian paramedic workforce, a significant difference in the demographic characteristics of the current and future paramedic workforce is noted. Due to these differences, the need for increased flexibility in employment arrangements should be anticipated.This presentation will explore these characteristics and provide a complementary evidence base on which workforce planning within ambulance services can be conducted.

04 Conference Abstracts Australasian Journal of Paramedicine: 2014;11(6) Endotracheal tube cuff pressure in pre-hospital emergency care: are estimation techniques adequate? Mark Disney,1 Wayne Loudon,2 Emma Bosley,3 Denise Bunting,3 1Queensland Ambulance Service, Australia, [email protected] 2Queensland Ambulance Service & Queensland University of Technology, Australia 3Information Support, Research & Evaluation, Queensland Ambulance Service, Australia.

Introduction Endotracheal intubation is frequently performed in the pre-hospital setting. Overinflation of ETT cuffs (> 30cm H2O) may result in tracheal damage, previous studies suggesting that emergency clinicians commonly overinflate above the safe level.This study evaluated the ability of different levels of pre-hospital clinicians to accurately inflate and assess endotracheal cuff pressure by estimation techniques.

Methods A convenience sample of QAS workforce participated in the study and consisted of 9.4% (n =24) of ICPs; 85.0% (n = 6) of doctors; and 100.0% (n = 14) of current ICP students. Tracheal simulation aids were used and participants were asked to inflate three cuffs and attain a safe pressure (25-30 cm H2O) via estimation techniques. Seven ETT cuffs were pre-inflated to seven different pressures in random order. Participants assessed the cuffs and categorised each into one of three pressure groups; Low, Safe and High.

Results The majority of participants (77.3%) overinflated the ETT cuff, with an overall mean pressure of 67.4 cm H2O (95%CI; 55.8 -79.0). There was no significant correlation between the mean ETT cuff pressure and years of experience, the number of intubations or qualification level. Overall, the percentage of correct cuff pressure estimation for the preset simulation aids was 64.6%.

Conclusion Palpation of the pilot balloon as an estimation technique is inadequate. Further work is required to evaluate the effectiveness of manometer use in the pre-hospital environment.

New Psychoactive Substances: cannabinoids and NBOs Alan Eade,1 1Melbourne, Australia. [email protected]

Substance use has been evolving at an increasingly rapid rate since the mid-1990s. The variety of substances available for use has increased progressively each year, with new agents being ‘created’ at an ever increasing rate and appearing in clinical practice almost every month. The latest substances associated with clinical presentations include; synthetic cannabinoids, and NBOMe agents.

Unlike many of the previously available substances both the cannabinoids and the NBOMe agents are collective terms that cover numerous families of substances. They do not relate to a single substance or substance family group. Sample analysis reveals that some products are being sold containing more than one family of each substance. These substances are loosely defined as research chemicals. The effects of these substances are not previously described, as such the clinical presentations are the first human studies that we have to determine effects and establish management plans.

Cannabinoid presentations are associated with a hyper-emesis syndrome, multiple organ failure, and significant emotional and psychological distress. The NBOMe agents are unpredictable, often sold to unsuspecting users as other agents, and increase the potency effect of their source chemical. Stimulatory effects (including hyperthermia) resulting in organ failure and agitation are reported. Both substance groups have been attributed to hospitalisation, critical care admission, and adverse outcomes including death.

There is no antidote to these substances, care is supportive and may involve resuscitation. Hyper-emesis has variable responses to pharmacological options. Agitation is best managed with benzodiazepine medications. Resuscitation must be focused on the risk of electrolyte abnormality.

05 Conference Abstracts Australasian Journal of Paramedicine: 2014;11(6)

A Systematic Review on the Effect of Emergency Medical Service Practitioners’ Experience and Exposure to Out-of-Hospital Cardiac Arrest on Patient Survival and Procedural Performance

Kylie Dyson,1,2 Janet Bray,1 Karen Smith,1,3,4 Stephen Bernard,1,5,6 Judith Finn,1,7,8 1Department of Epidemiology and Preventive Medicine, Monash University, Australia, [email protected] 2Operations Department, Ambulance Victoria, Australia 3Research and Evaluation Department, Ambulance Victoria, Australia 4Emergency Medicine Department, University of Western Australia, Australia 5Intensive Care Unit, Alfred Hospital, Australia 6Medical Advisor, Ambulance Victoria, Australia 7Faculty of Health Sciences, Curtin University, Australia 8St John Ambulance, Western Australia, Australia

Introduction Emergency medical service (EMS) practitioners’ experience and exposure to out-of-hospital cardiac arrest (OHCA) and complex resuscitation procedures could be an important factor in patient survival and procedural success. We systematically reviewed the literature to examine these associations.

Methods We searched for publications using MEDLINE, EMBASE, CINAHL, CENTRAL and Web of Science. We included studies examining any type of EMS practitioner (e.g. paramedics, physicians) and OHCA patients of all ages and aetiologies. Two reviewers independently extracted data.

Results The search identified 1658 citations of which 11 observational studies of varying quality were included. The majority of studies did not adjust for important confounding factors and reported across different EMS personnel structures. OHCA survival was not associated with varying definitions of practitioner experience in two of three studies, or with previous exposure (≤5/>5 OHCA cases) in one study. The only resuscitation procedure studied was endotracheal intubation (ETI) and one study, which adjusted for confounders, found a significant association between very high ETI exposure (>50) and increased odds of survival to discharge. Four out of five studies showed the previous number of ETIs performed on OHCA was positively associated with procedural success rates.

Conclusions There is no clear evidence of an association with EMS practitioner career experience or exposure to OHCA cases and resuscitation procedures, with the exception of the association of exposure with procedural success of ETI. Most of the studies had substantial risk of bias. Therefore, further high quality observational studies are required before any conclusion can be drawn. .

06 Conference Abstracts Australasian Journal of Paramedicine: 2014;11(6) Bruises and bondage: the lustre comes off the spineboard

Alan Eade,1 1Melbourne, Australia. [email protected]

The spineboard or long spineboard as it is also referred has been a part of paramedic practice for decades. It is almost ubiquitous in the setting of trauma, any trauma, and to transport a trauma patient to hospital without using one would be considered unthinkable by many.

However, change is upon us. Finally, after years of use without evidence that it has clinical benefit, questions are being asked of the spineboard and it is being found wanting. There is no published evidence that immobilisation on a spineboard has any benefit to the patient, what evidence does exist is overwhelmingly negative.

Immobilisation on a spinebaord is associated with: • Respiratory compromise, increased risk of aspiration • Tissue ischaemia, pressure injury • Development or exacerbation of pain, including neck and back pain • Increased radiological investigations • No benefit or increased mortality in penetrating trauma populations

The belief that immobilisation on a spineboard for transport will protect the patient’s spine has been evaluated and the results revealed that the rate of disability in the spineboard group was double that of the group that was not immobilised.

Immobilisation with a spineboard is overused in paramedic practice, is time and human resource consuming, reduces access to the patient for clinical procedures that are demonstrated to be useful, and is associated with actual patient harm.

It is time to end the myth, the spineboard has no place in patient transportation, it is solely an extrication device. Preceptor, Mentor, Clinical Instructor, Clinical Supervisor: What am I, what do I do?

Dale Edwards,1 1School of Medicine, University of Tasmania, Australia, [email protected]

Background In a clinical learning environment, the role of the clinical educator is vital to student success. Depending on the jurisdiction, the clinical educator role may be titled as mentor, preceptor, clinical instructor or clinical supervisor. No formal definition of this role exists in Paramedicine leading to potential confusion as to the responsibilities of the clinical educator. This abstract reports on a section of a larger research project investigating the role preparedness of on the job paramedic clinical educators and the self-reported understanding paramedics have of the role and titles used for the role they fulfil.

Methods This research involved a grounded theory approach, using semi-structured interviews to identify theories of preparedness, and understanding of the on the job educator role. Participants were sourced from both Tasmania and NSW.

Results This research identified a wide variation in understanding of the role of the clinical educator in Paramedicine, a lack of definition of the role, and a broad variation in how paramedics define the terms Mentor, Preceptor, Clinical Instructor or Clinical Supervisor.

Conclusions The lack of definition of the on the job clinical education role, along with the variation in perceived meaning in role titles leads to a wide variation in on the job performance. This lack of clarity has a direct impact on the student learning experience, and potential for student success as well as job satisfaction for the clinical educator. It is essential therefore, for universities and employing organisations to clearly define the on the job educator role.

07 Conference Abstracts Australasian Journal of Paramedicine: 2014;11(6) Birth before arrivals requiring Paramedic Care in Queensland

Belinda Flanagan

Introduction The aim of this research was to conduct an epidemiological study concerning unplanned birth in the out-of-hospital setting and the paramedic management of intra-partum care. Three research questions were identified:

1. What is the frequency of babies born prior to or during paramedic care? 2. What are the outcomes described in the patient care documentation? 3. What are the factors that may complicate the care given?

Methods A retrospective analysis of Queensland Ambulance Service de-identified patient care records, generated by VACIS, between the 1st of Jan 2010 and the 31st of Dec 2011 (2 years) was undertaken.

Results From 5873 records, antenatal complications occurred in 27.3% (n=1563). Risk factors (no antenatal care, hypertension, gestational diabetes, smoking, age, obesity, alcohol and drug abuse) represented 6.2% (n=354) of mothers. Records where a birth was identified (10.6%, n= 605) included cases where a birth occurred prior to ambulance arrival at the scene (4.5%, n= 257) and cases where the birth occurred in paramedic care (6.1%, n=348). Of maternal observations 31.7% (n= 1814) were abnormal, neonatal observations were difficult to evaluate as only 25% (n=87) of babies born in paramedic care received anAPGAR score with 30.5% (n=46) ≤7. Continuing care of the newborn was also difficult to evaluate as only 25% (n=151) held a patient care record that described the newborns health status, and 57.6% (n=87) of these records reported neonates with abnormal vital signs.

Conclusion This research identified areas of clinical management that require further analysis to determine a need for improvements in care delivered. Can Near-Peer Teaching Improve Academic Performance? James Fowler,1 Assoc Prof Brett Williams,1 1Department of Community Emergency Health and Paramedic Practice, Monash University, Australia, [email protected]

Introduction Near peer teaching is becoming increasingly popular within tertiary healthcare education. The experiences and effects of near-peer teaching upon the near-peer teachers’ academic performance are not fully understood. The objective of this study was to examine whether or not a near-peer teaching program improved the overall clinical unit scores of undergraduate paramedic near-peer teachers.

Methods Students in their final year of an undergraduate nursing-paramedic degree were given the opportunity to volunteer as near-peer teachers in a first year clinical skills unit. Across three years, the overall unit scores in a final year clinical unit of 74 students involved in the near-peer teaching program were compared with a randomly selected sample not involved.

Results 74 students participated in this study between 2011-2013 (n=23 in 2011, n=18 in 2012, n=33 in 2013). In each year, the median clinical unit grade of students who participated in the near-peer teaching program was significantly higher than that of the students who did not (71 vs 67, p=0.006 in 2011; 76 vs 72, p=0.007 in 2012; 75 vs 71, p=0.004 in 2013).

Conclusions This study has demonstrated that participation in a near-peer teaching program can result in significantly improved overall clinical unit grades for undergraduate paramedic near-peer teachers. This study has added objective data to the variety of subjective information within the literature evaluating the effects of near-peer teaching upon the teachers themselves.

08 Conference Abstracts Australasian Journal of Paramedicine: 2014;11(6) International ambulance placements: A reflection of student experiences in Israel

Harley Gillon,1 1Department of Community Emergency Health & Paramedic Practice, Monash University, Australia, [email protected]

Ambulance placement programmes aim to expose students to a diverse range of patients, case types and environments. In an endeavour to gain as much diverse exposure as possible a Bachelor of Emergency Health (Paramedic) student from Monash University participate in a placement with a Mobile Intensive Care Unit (MICU) in the city of Tel Aviv-Jaffa, Israel. During January 2014 he spent 2 days with MICU as an observer. They responded signal 1 through modern streets and ancient alleyways to numerous cases including; cardiac arrests, chest pains, arrhythmias, seizures and falls. Several striking differences in models of pre-hospital care, organisational structure, equipment and approach to patients were evident. Most ambulances in Israel are staffed by an Emergency Medical Technician (EMT) driver and two medics who offer basic life support. These crews can request support from MICU advanced life support paramedics, who have a comparable capacity to Victorian Mobile Intensive Care Ambulance (MICA) paramedics. The Israeli paramedics also displayed a far more frank and direct approach towards patient communication than is often seen in Australia.

The insight gained into Muslim and Jewish cultural differences, and general patient care whilst on this international placement was invaluable. Whilst services, policies and protocols may differ to those in Australia, essentially patients experience the same physical, psychological and emotional ailments worldwide and look to paramedics for reassurance, support and clinical care. This experience and subsequent reflection has been instrumental in the development of this student’s practice and is highly recommend for other students. The helping profession: What motivates people to choose a career in paramedicine? Julian Hannah1 1Department of Community Emergency Health and Paramedic Practice, Monash University, Australia, [email protected]

Introduction Paramedic practice is widely known for its dynamic, exciting and challenging place within health care. It is therefore understandable that paramedic practice provides an attractive career prospect for many young people. Despite this, the precise underlying motivating factors in pursuing this career path remains unclear. The objective of this study was to examine what motivates individuals to pursue a career in paramedicine.

Method First year students enrolled in, the Bachelor of Emergency Health (Paramedic) at Monash University, Melbourne, Australia, were eligible to participate in this study. A cross-sectional method utilising a paper based survey to determine motivating factors for students pursuing a paramedic career was used.

Results Of the 182 students eligible n=168 participated in the study; a 93% response rate. Three factors; ‘wanting to help people’, ‘exciting career’ and ‘saving lives’, emerged as the most important motivating factors in the participant’s choice to pursue a paramedic career each achieving the highest possible median score of 5 on the Likert Scale. ‘Interest in medicine’, ‘giving back to the community’, ‘an admired & trusted profession’ and ‘working environment’ also rated as important with medians of 4. Not considered important were ‘wearing a uniform’, ‘obtainable ATAR’ and ‘campus location’, all with a median of 2.

Conclusion Results for this study indicate some unique differences in the factors the motivated first year paramedic students to pursue a career in paramedicine. These findings can be utilised by prospective tertiary education providers and potential employers to further entice, engage and retain student paramedics.

09 Conference Abstracts Australasian Journal of Paramedicine: 2014;11(6) Near peer teaching in paramedic education: Results from 2011-2013 Kate Hardy,1 Assoc Prof Brett Williams1 1Department of Community Emergency Health and Paramedic Practice, Monash University, Australia. [email protected]

Introduction Near-peer teaching (NPT) involves senior students teaching junior students, and provides opportunities for peer teachers to develop a number of skills such as public speaking, mentoring and facilitation. These skills are important for paramedic students to develop throughout their tertiary education. The objective of this study was to examine the perceptions and satisfaction levels of students participating in NPT over a three-year period.

Methods A cross-sectional study using a paper-based self-reporting questionnaire was administered to second and third year peer teachers during October 2011-2013. All students were invited to complete the Peer Teaching Experience Questionnaire (PTEQ). The PTEQ consists of fourteen items using a five-point Likert scale for responses.

Results A total of n=74 peer-teachers participated in the study, n=23 (31.1%) in 2011, n=18 (24.3%) in 2012, and n=33 (44.6%) in 2013. Eighty percent (n=60) of students had experienced being taught by peers in the past, while 33% (n=25) of students had experience of teaching peers. A significant portion of participating students (n=69) thought the NPT project would help to achieve better grades in their clinical units of study. Overall, results were positive with the majority of items reflecting high levels of satisfaction.

Conclusions Results have shown that the NPT program was been beneficial to the education of the paramedic students who participated. A formal inclusion of NPT programs into the paramedic curriculum would allow all students to experience the benefits of NPT and ensure the development of paramedic students teaching abilities for their future career. Factors associated with clinically important pain reduction in children: A retrospective cohort study Paul Jennings,1,2 Bill Lord,3 and Karen Smith,2,4,5 1Department of Community Emergency Health and Paramedic Practice, Monash University, Australia, [email protected]; 2Ambulance Victoria, Australia 3School of Health and Sport Sciences, University of the Sunshine Coast, Australia 4Department of Epidemiology and Preventive Medicine, Monash University, Australia 5Discipline – Emergency Medicine, University of Western Australia, Australia

Introduction Pediatric pain is a common presenting symptom in the prehospital setting however there is a lack of data identifying the factors associated with effective pain management in this setting. We sought to identify the factors associated with clinically important pain reduction in this population.

Methods An analysis of electronic patient care records of all patients aged less than 15 years presenting with pain to the emergency medical service (EMS) of Victoria, Australia over a 4 year period (2008-2011). Data was analyzed using descriptive statistics and multivariate regression. The primary outcome measure was the odds of receiving a clinically important pain reduction (2/10 or more).

Results 92,378 children were transported of whom 38,167 (41.3%) met the inclusion criteria. The median age was 10 years and 59.2% were male. Patients aged > 9 years were less likely (AOR 0.4, 95% CI 0.3-0.7) and males were more likely (AOR 1.2, 95% CI1.1-1.3) to have a clinically important reduction in pain. Patients with pain that was classified as musculoskeletal were more likely to achieve a reduction in pain score of 2 or more when compared with pain due to other medical causes (UOR 1.8, 95% CI 1.6-2.1).

Conclusion Factors other than the type of analgesia are important determinants of pre-hospital pain relief and are likely to impact on clinical care and research. Clinical audit and research projects should stratify patients according to patient as well as management factors to maximise service improvement.

10 Conference Abstracts Australasian Journal of Paramedicine: 2014;11(6) Reducing paramedic occupational risks Brian Maguire1 1School of Medical and Applied Sciences, Central Queensland University, Australia. [email protected]

Introduction Australian ambulance personnel respond to three million calls for assistance each year; each of those calls present unique risks. Australian ambulance personnel have a risk of serious injury that is more than seven times higher than the national average and a fatality rate six times higher than the national average. The objective of this study is to determine methods that can be used to reduce occupational risks among this group.

Methods We reviewed the literature on methods that have been used to reduce risks for paramedics and other similar professions. We did a Medline search using terms: injury prevention, occupational injury, lifting injury, assault and transportation.

Results Numerous studies have demonstrated ways of reducing occupational risks. We particularly examined risk reduction interventions for paramedics, firefighters, police officers and nurses. One of the few paramedic-specific papers was Maguire’s intervention study that demonstrated a 50% reduction in ambulance collisions.

Conclusions Recent research has shown that paramedics have higher injury and fatality rates than any other profession in Australia. This high rate of injury and fatality among paramedics is serious public health emergency. These risks cost over 12 million dollars a year in direct costs. In addition to the devastating individual consequences, the problem likely results in poorer care, longer response times and higher costs for the millions of people who call for ambulance personnel every year. Investment in risk reduction typically yields a three-dollar saving for every dollar spent. Ambulance agencies should work with researchers to develop and test risk-reduction interventions. Standards and Quality Indicators for Best Practice in Paramedic and Inter-Professional Experiential Practica Brian Maguire,1 Richard Brightwell,2 Moira Sim,2 William Lord,3 1School of Medical and Applied Sciences, Central Queensland University, Australia. [email protected] 2Edith Cowan University 3University of the Sunshine Coast

Introduction The objective of this project was to develop recommendations for ‘standards’ within paramedic experiential inter-professional clinical practice at the undergraduate level. The project aims to improve the capacity of Australian paramedic graduates to work effectively, through the development of quality indicators for paramedic and inter-professional clinical practica, to achieve best practice, as well as to align paramedic clinical practica nationally with each university and with inter-professional clinical standards. The long-term goal of the work is to inform the development of a standard national curriculum.

Methods We examined national and international standards through interviews and did a review of the literature on methods that have been used to evaluate and improve inter-professional clinical practica.

Results Based on the interviews and literature review, the project team developed a standardized list of definitions and constructed quality indicators of best practice approaches for inter-professional paramedical practica. We developed: recommendations related to curriculum development; recommendations for the scope of university support needed for effective practica; recommendations related to clinical training sites including developing agreements and specifying standards for clinical supervision. We also describe the core competencies needed by each student before undertaking clinical practica.

Conclusions Adapting these new recommendations can help ensure that paramedic students have safe and educational clinical practica. maximise service improvement. 11 Conference Abstracts Australasian Journal of Paramedicine: 2014;11(6) Defibrillation Safety: An Examination Using Eye-Tracking Technology Mariah McClounan,1 Linda Ross,2 Dr Malcolm Boyle,2 Assoc Prof Brett Williams2 1Department of Emergency Health & Paramedic Practice, Monash University, Australia. [email protected] 2Department of Emergency Health & Paramedic Practice, Monash University, Australia

Introduction Access to early defibrillation for patients in cardiac arrest is a critical part of the chain of survival, if not performed correctly and safely, defibrillation is potentially harmful to bystanders and emergency personnel.The objective of this study was to assess visual and verbal safety checks of students prior to defibrillation utilising eye tracking technology.

Method This was an observational study of student safety in performing defibrillation during resuscitation. Participants rated their defibrillation safety using a Defibrillation Safety Self-Assessment form (DSSA) immediately after completing a defibrillation scenario and 4 weeks later, after viewing the eye-tracking footage of their scenarios. Independent examiners also rated participant defibrillation safety using a Defibrillation Scoring Rubric (DSR) at the time of the scenario.

Results For scenario one, agreement between the student and assessor proved significant for “scanning the incident scene” for all three defibrillation attempts, agreement ranging from 29% (p=0.044) to 47% (p=0.007), and stating “stand clear” for defibrillation attempt one and three, agreement ranging from 47% (p=0.007) to 100% (p <0.001). For scenario two agreement between the student and assessor proved significant for “charging eye contact” for all three defibrillation attempts, agreement ranging from 40% (p=0.043) to 53% (p=0.003), and “scanning the scene – all persons clear” before defibrillation attempt one and two, agreement ranging from 29% (p=0.044) to 46% (p <0.007).

Conclusion Results of this study provide students and educators with evidence that student perceptions of their actions during defibrillation are not necessarily a true reflection of what occurred. Mental health legislation and clinical practice guidelines in Australian ambulance services: What do they tell us about policy and practice? Dr Louise Roberts,1 1Paramedic Unit, School of Medicine, Flinders University, South Australia. [email protected]

The aim of this study is to investigate how mental health related guidelines and policies have been developed and implemented in Australian ambulance services. The key objectives are to investigate the evidence-base that underpins these policies and guidelines and how they are used in practice. Clinical practice guidelines are statements developed in a systematic fashion to assist practitioners to make decisions about appropriate care for a given clinical circumstance. They are the means by which organisational and clinical expectations are transmitted from available evidence to frontline care. The changing demands and greater responsibility for clinical decision making and treatment requires clinical guidelines and policies that are responsive and relevant to current practice.

Mental health legislation, reports and clinical practice guidelines were coded for how they defined mental illness, the paramedic role and their provision of powers. This provided insight into major themes and relationships between policy and current mental health reform.

Analysis revealed that mental health legislation differs across jurisdictions in how mental illness, the paramedic role and their powers are defined. The lack of consistent national mental health legislation influences guideline development and translation into practice. The focus on acute ‘disturbed behaviour’ with an emphasis on risk and risk aversion suggests predominantly a relationship to legal frameworks governing practice but with limited provision of alternative pathways of care for paramedics in these cases. This affects both patient outcomes and the way clinical care is provided by paramedics as alternatives to transporting to emergency departments are increasingly being sort.

12 Conference Abstracts Australasian Journal of Paramedicine: 2014;11(6) Outcomes of patients who are not transported following EMS attendance: A systematic review Samuel Perillo,1 Alexander Olaussen,2 Paul A Jennings,3 1Department of Community Emergency Health and Paramedic Practice; Monash University; Australia; [email protected]. au 2Department of Community Emergency Health and Paramedic; Monash University, Australia 3Monash University, Frankston, Australia

Introduction A proportion of patients attended by emergency medical services (EMS) are not transported, however their outcomes remain largely unknown. This study aims to review the literature surrounding the outcomes of patients who are left at home following EMS attendance.

Methods A database search was conducted using Medline, Embase and CINAHL. The databases were searched from their beginning until May 2014. Articles were included if they analysed the outcomes of patients who were left at home or refused prehospital transport, and excluded if they were not published in English or were not prehospital based.

Results The search yielded 373 potential articles, of which 10 met the inclusion criteria. There were 6 retrospective studies and 4 prospective studies; all from the United States. Follow-up study periods ranged from 24 hours to 7 days. Despite low rates of ambulance re-attendance and hospital admission for patients who are left at home, a significant proportion of these patients still accessed the emergency department; rather than accessing more appropriate primary care pathways.

Conclusions Few EMSs follow up the outcomes of patients not transported. There is no data outside the U.S. regarding patients who are not transported. Although patients are being left at home, they are still accessing emergency departments within a short time after ambulance attendance. This suggests that referrals by EMS to other forms of primary care are not being appropriately utilised. Forty-eight hours appears to be the most appropriate follow-up timeframe for patients who are not transported by EMS.

Private Paramedicine Australia James Ross,1 1President, Private Paramedicine Australia, Medical Director, Aspen Medical. [email protected];

Paramedic employment has traditionally been in the Public Ambulance sector. However, this has changed remarkably in recent years, with a greatly expanded private sector employment. At the same time the increasing professionalisation of Paramedicine, increasing societal expectations of quality health care and broadening roles and scope of practice are all impacting on how Paramedics can be governed. There has been no integrated voice for private employers of Paramedics in Australia until very recently. In 2013, Private Paramedicine Australia (PPA) was established, to represent the private sector to ensure the needs of private employers are considered and those employers and paramedics are not disadvantaged. This is particularly important when engaging in policy and advocacy matters, such as workforce and registration. This presentation will discuss the current and planned role of PPA, and how it can work with organisations such as Paramedics Australasia to promote mutually beneficial outcomes.

13 Conference Abstracts Australasian Journal of Paramedicine: 2014;11(6) Sedation during Cardio Pulmonary Resuscitation: A systematic review Matthew Shepherd,1 Alexander Olaussen,2 Biswadev Mitra,3,4 1Air Ambulance Victoria, Australia, [email protected] 2Department of Community Emergency Health and Paramedic Practice, Monash University, Australia 3Emergency & Trauma Centre, The Alfred Hospital, Australia 4Department of Epidemiology & Preventive Medicine, Monash University, Australia

Introduction Cardio Pulmonary Resuscitation (CPR) may be perceived by some patients. Agitation in this setting presents an uncommon clinical challenge to the rescuer. Ambulance Victoria guidelines recommends the use of a small dose sedation to overcome the gag reflex. The aim of this study was to review the literature on the use sedation during CPR.

Methods We searched Medline, PubMed, EMBASE, Cinahl, Google scholar, and the Cochrane Library from their commencement to the 27th of February 2014. We combined MeSH terms for CPR with MeSH terms and text words for sedation. Two blinded reviewers reviewed the title-list.

Results The search yielded 1,294 unique records, of which only 3 single case reports met the inclusion criteria. One patient received sedation (11mg Midazolam and 155mg Suxamethonium), one was physically restrained with no sedation, and one had no management directed towards the awareness. Patients were reportedly performing purposeful movements or responding to verbal stimuli. Two of the three located cases involved the use of fatigue-resistant CPR machines. All three patients died after 36 to 195 minutes of resuscitation.

Conclusion The administration of sedation to assist effective delivery of CPR is infrequently reported. The International Liaison Committee on Resuscitation has no guideline for the management of patients awake or moving during CPR. With an increased effectiveness of resuscitation being reported, future research should prospectively monitor awareness during CPR and explore effective methods of sedation during CPR. THE WELLINGTON LIFE FLIGHT HELICOPTER EMERGENCY MEDICAL SERVICE (HEMS): A RETROSPECTIVE AUDIT AGAINST ANTS DISPATCH CRITERIA

Callum Thirkell,1 Dr Andrew Swain,2 Kate Gordon3 1Clinical Services, Wellington Free Ambulance, New Zealand, [email protected] 2Department of Surgery and Anaesthesia, University of Otago, New Zealand 3University of Otago, Wellington, New Zealand

The aim was to analyse the clinical and operational indications for activating the Wellington Life Flight helicopter emergency medical service (HEMS) against the ANTS (Access, Number, Time & Skill) criteria for helicopter dispatch. Methods involved reviewing the Wellington HEMS records for three years. Details of mission location, timings, medical procedures, patient demographics, and primary reasons for dispatch were analysed. Four Hundred and Seventy missions were reviewed. The main reasons for helicopter dispatch were anticipated time savings (47%), geographical access (36%), provision of skills (7%), or a combination (10%). In 62% of total missions, a road ambulance and helicopter were both dispatched. The helicopter was dispatched after the road ambulance had arrived at the scene in 52% of these cases, with a median lag time of 11 minutes and 12 seconds, and median waiting on scene time of 27 minutes 28 seconds. The road ambulance arrived first in 77% of cases. The median arrival time by air was 26 minutes compared to 11 minutes 45 seconds by road. In contrast, the transfer to hospital by helicopter was quicker in 99% of cases, with a median flight time of 15 minutes compared to 49 minutes by road. ellingtonW HEMS offers advantage over the road ambulance when dispatched and utilized appropriately. The majority of missions satisfied the ANTS activation criteria but time-saving issues became apparent in lower acuity patients. Changes to the Helicopter Dispatch Flowchart have been proposed as a result as well as an ‘air desk’ allocating the role of helicopter dispatch to aviation trained paramedics.

14 Conference Abstracts Australasian Journal of Paramedicine: 2014;11(6) Non-Transport Of Older Fallers Following Paramedic Attendance Is Associated With Increased Mortality: A Linked Data Analysis Paul Simpson,1,6 Therese Carroll,2 Sandy Muecke,2 Anne Tiedemann,3 Jason Bendall,4 Stephen Lord,5,6 Jacqueline Close,5 1School of Science and Health, University of Western Sydney, Australia, [email protected] 2Ambulance Service of New South Wales, Australia 3George Institute for Global Health, Australia 4Department of Anaesthetics, Gosford Hospital, Australia 5Neuroscience Research Australia, Australia 6School of Public Health and Community Medicine, University of New South Wales, Australia

Introduction Non-transport of older fallers following paramedic attendance has been associated with poor health outcomes in several small observational studies. The objective of this study was to compare the health outcomes of non-transported older fallers with those transported but then discharged from the emergency department without hospital admission.

Methods Three years of ambulance service data were linked with hospital data and the state deaths registry using probabilistic linkage methods. Survival analysis methods were used to assess the primary outcome of mortality at 28 days, and the secondary outcomes of ambulance re-attendance and ED-representation. Survival curves were generated, and multivariate proportional hazards (PH) regression used to model the risk of occurrence for each outcome.

Results Of 85,626 index falls cases, 14,601 were not transported and 19,712 were transported then discharged. At 28 days, the non- transported group had a higher rate of mortality (3.3% versus 1.7%; p<0.0001) and ambulance re-attendance (15.6% versus 9.4%; p<0.0001), but a lower rate of ED representation (14% versus 16.5%; p<0.01). Piece-wise multivariate PH regression revealed non-transported fallers to be at 2.7 times greater risk of death (HR 2.7; 95%CI 1.96-3.75) in the first 5 days, then 12% greater risk thereafter (HR 1.12; 95%CI 1.07-1.18).

Conclusion This study indicates that older fallers not transported to ED following ambulance attendance have an increased risk of death compared to those transported then discharged from ED. Strategies aimed at providing rapid primary healthcare and community- based support for this group should be prioritized by ambulance and fall prevention services.

15 Conference Abstracts Australasian Journal of Paramedicine: 2014;11(6) Decision Making By Paramedics When Caring For Older People Who Have Fallen: A Qualitative Grounded Theory Study Paul Simpson,1,6 B Lord,2 Sandy Muecke,3 Ric Thomas,4 Jason Bendall,5 Stephen Lord,6,7 Jacqueline Close6 1School of Science and Health, University of Western Sydney, Australia, [email protected]; 2University of Sunshine Coast, Australia. 3Ambulance Service of New South Wales, Australia 4University of Tasmania, Australia 5Department of Anaesthetics, Gosford Hospital, Australia 6Neuroscience Research Australia, Australia 7School of Public Health and Community Medicine, University of New South Wales, Australia

Introduction Older fallers constitute a large proportion of ambulance work, and as many as 25% are not transported to hospital following paramedic assessment. The objective of this study was to develop a substantive theory explaining the decision making process used by paramedics when caring for older fallers.

Methods A qualitative study was conducted using constructivist grounded theory methodology. Purposive sampling was used to recruit paramedics to participate in semi-structured interviews and focus groups. Data analysis commenced with line-by-line coding, developing into formation of theoretical categories. Theoretical sampling was then used to clarify emerging theoretical concepts, with data collection and analysis continuing until theoretical saturation was achieved.

Results A total of 33 paramedics participated in 13 interviews and 4 focus groups. When caring for older fallers, paramedic decision making is profoundly affected by ‘role perception’, in which the individual paramedic’s perception of what the role of a paramedic is determines the nature of the decision making process. Transport decisions are heavily influenced by a sense of ‘personal protection’, or their confidence in the ambulance service supporting their decisions. ‘Education and training’ impacts on decision making capacity, and the nature of that training subliminally contributes to role perception. Role perception influences the sense of legitimacy a paramedic attaches to cases involving older fallers, impacting on patient assessment routines and the quality of subsequent decisions.

Conclusion Paramedic decision making processes may be explained by their perception of what their role should be, and the perceived legitimacy incidents involving older people who have fallen. A comparison of two ambulance systems: Queensland, Australia and New York City Amanda Walsh,1 1School of Medical and Applied Sciences, CQ University, Australia. [email protected]

This study aimed to compare and contrast the Emergency Medical Service (EMS) systems of Queensland, Australia and New York City, USA and to gain an understanding of the differences in scope between personnel. In 2013, ten CQUniversity paramedic students visited New York City with CQU Professor Brian Maguire. All areas of the EMS system in New York City were explored through on-road tours and visits to EMS headquarters, the training academy and the emergency communications centre. Both systems have their strengths and weaknesses, are designed for their unique environment, and could learn from each other. New York would benefit greatly from Queensland’s interagency cooperation and broader clinical scope. Interagency cooperation in the field seems far more consistent in Queensland than in NYC. Clinically, every 000 call in Queensland receives an Advanced Care Paramedic response, whereas in NYC the majority of calls are responded to by basic life support personnel. Queensland could benefit greatly from the multi-service centre of communications utilised in NYC; the NYC communications system houses dispatchers for EMS, Fire and Police in the one room and allows for better cohesion in the dispatch process. However, there is no possibility of direct contact between the call taker and the dispatcher in NYC as there is in Queensland. The scope of practice, protocols, equipment and environment might change but the most important lesson for both services remains the same; no matter where you go, emergency medical services personnel and the people they aim to help are fundamentally identical.

16 Conference Abstracts Australasian Journal of Paramedicine: 2014;11(6) Utilising the Masked Educator to better prepare paramedic and nursing students for clinical practice John Slater,1 1Australian Catholic University, Antill Street, Watson, Australian Capital Territory. [email protected]

Introduction The Mask Ed (KRS Simulation) is an innovative simulation teaching approach which involves an educator who has undergone specific simulation training in character development and debriefing.This educator then dons highly realistic silicone body props and through constructively aligning the learning outcomes, develops scenarios. These scenarios challenge the students in areas of psychomotor skills with vital sign assessments and cannulation, interpersonal communication, pharmacology and clinical guidelines interpretation. Sessions incorporated the students to carry out cardiac and, chest pain scenarios and one where the students needed to resuscitate the character “Colin”. These sessions are often humorous, allow for positive reinforcement and have the students learning and engaging.

Methods Two focus groups were held from the Nursing and Paramedicine undergraduate 1st year cohorts. The method of information collection was through online and in class questionnaires using a Likert- type scale, surveys and individual student interviews. The students responded to a serious of questions relating to the simulations that they were involved in throughout the semester.

Results The results of the information collected showed a sense of engagement and made learning fun through simulation. The characters made the simulation more lifelike with most students strongly agreeing that it made it easier to communicate with patients on clinical placement.

Conclusion The patient experience is irreplaceable but the closer we come to mirroring that in simulation, the better we can prepare the paramedics and nurses of tomorrow. Are there specific prehospital triage criteria for mass casualties with chemical, biological, radiological or nuclear exposure? Lynsey Smit,1 Dr Malcolm J Boyle2 1Monash University, Dept of Community Emergency Health and Paramedic Practice, Victoria, Australia. [email protected] 2Monash University, Dept of Community Emergency Health and Paramedic Practice, Victoria, Australia. [email protected]

Introduction There are a variety of prehospital and mass casualty triage algorithms but there appears to be little in the way of specific triage criteria in these algorithms to handle patients exposed to chemical, biological, radiological or nuclear (CBRN) events. The objective of this study was to determine whether there are specific triage criteria for CBRN exposure in a mass casualty situation.

Methods A literature search of the electronic medical databases CINAHL, Cochrane Collaboration, EMBASE and Medline was conducted with databases reviewed from their beginning until the end of May 2014. An existing prehospital search filter was applied to each database with additional search terms “triage”, “triage models”, “treatment”, “radiation exposure”, “chemical exposure”, “biological exposure”, and “nuclear exposure”. Articles of any study design were included if their primary aim was to examine the mass casualty triage of patients with CBRN exposure by healthcare providers. The reference lists of the articles included were also reviewed. Articles were excluded if they were not related to mass casualty triage done by healthcare personnel, not written in English, or involving animals.

Results A total of 15,008 articles were identified in the search with four meeting the inclusion criteria. Of the four articles only one suggested modification of existing mass casualty triage criteria, SMART, to suit CBRN exposure. The suggested modifications to the SMART algorithm lack significant testing in multiple mass casualty exercises internationally.

Conclusion There appears to be a lack of specific CBRN triage criteria for mass casualty situations internationally. 17 Conference Abstracts Australasian Journal of Paramedicine: 2014;11(6) Effectiveness of clinical practice guideline change in the pre-hospital management of supraventricular tachycardia Gavin Smith, Victoria University; Monash University

Introduction To evaluate the effect of changes to the pre-hospital management of patients with supraventricular tachycardia (SVT) following intervention with a revised Clinical Practice Guideline (CPG). The major CPG revisions were removal of verapamil, addition of adenosine, and an emphasis on Valsalva Manoeuvre.

Methods We undertook a retrospective case study using data collected by paramedics. All adult patients attended by paramedics from the periods 14/2/2012 to 14/9/2012 (old CPG) and 14/2/2013 to 14/9/2013 (revised CPG) were included. Patients were excluded if SVT was not recorded during initial assessment on a hardcopy ECG. Management guided by the old and revised CPGs was compared: reversion effectiveness, elements of therapy associated with reversion effectiveness, and adverse events. Linear regression determined patient factors significantly associated with reversion.

Results Patients were predominantly female, aged approximately 57 years old, and most lived in the Victorian metropolitan region. Of the 823 cases, paramedics correctly identified SVT in 119/123 (96.7%, 95%CI 91.5 to 99.0) cases sampled for accuracy of rhythm identification. Vagal manoeuvre use and effectiveness decreased in the post-intervention group. Fewer patients in the post-intervention group (141/420, 33.6%) remained in SVT upon arrival at hospital compared to the pre-intervention group (210/403, 52.1%). Initial heart rate > 170bpm and longer scene time were 2.6 and 1.05 times more likely to result in reversion, respectively.

Conclusion The revised CPG improved pre-hospital SVT reversion success. The expansion of authority to practice has not demonstrated anticipated improvements to Valsalva Manoeuvre utilisation or effectiveness. Adenosine is safe and effective for pre-hospital use. EMS Systems in Low-Middle Income Countries: A Review of the Literature Suryanto,1,2, Virginia Plummer,1 Malcolm Boyle,3 1School of Nursing and Midwifery, Monash University, Australia. [email protected] 2School of Nursing, Brawijaya University, Indonesia 3Department of Community Emergency Health and Paramedic Practice, Monash University, Australia

Introduction Approximately 90% of global injuries occur in low-middle income countries (LMICs), however, prehospital care in these countries has been, and still is under developed. The objective of this study was to identify the implementation and development of emergency medical service systems in LMICs.

Methods A search was undertaken using three electronic databases CINAHL Plus, EMBASE, and Ovid Medline from their commencement date until the end of October 2013. Articles were included if they reported on the establishment of an EMS system and were excluded if they were letters to editors, focusing on disaster management, a combination of more than one country, written in a language other than English and/or focusing only on in-hospital care.

Results There were a total of 125,782 articles identified with 81 articles meeting the inclusion criteria.A further 29 articles were removed due to duplication leaving 52 articles to be reviewed. The implementation and development of an EMS system is varied among LMICs. Many LMICs lack an organised EMS system with most ambulances used only for transport not as an emergency care vehicle. Hence most LMICs rely on an unorganised system of private cars or other transport modes to take patients to hospital. Financial issues are one of the most common deterrents faced by LMICs with multiple types of support from developed countries a necessity.

Conclusion This review found that most low-middle income countries lack an EMS structure with prehospital care provided ‘ad hoc’ at best and financial issues a major deterrent. 18 Conference Abstracts Australasian Journal of Paramedicine: 2014;11(6) How is peer-teaching perceived by first year paramedic students? A three-year review Jaime Wallis,1 Associate Professor Brett Williams,2 1Department of Community Emergency Health and Paramedic Practice, Monash University, Australia. [email protected] 2Department of Community Emergency Health and Paramedic Practice, Monash University, Australia.

Introduction Near-Peer Teaching (NPT) can create a cooperative learning environment, providing benefits to all students involved. While there is a large pool of research exploring NPT amongst other healthcare students, less is known about NPT and paramedics. The objective of this study was to examine the perceptions of first year paramedic peer learners over a three-year period.

Methods A cross-sectional study using the Clinical Teaching Preference Questionnaire (CTPQ) was administered to first year peer learners during October 2011-2013.

Results Over a three year period, 361 peer learners participated in this study. The mean item-level result for each item was highest in the 2013 cohort compared to the earlier two years. Item 1 “Teaching is an important role for paramedics” reflected the highest mean score of the eleven items (4.46 in 2011; 4.52 in 2012; 4.60 in 2013) while item 2 “I feel freer to approach my instructor for help than I do my peers” reflected the lowest mean score (2011: 3.61; 2012: 2.99; 2013: 3.72).

Conclusions First year paramedic students over a three year period reported item-level results on the modified CTPQ which indicate that NPT is a valuable teaching method. This is consistent with previous research on NPT using students from other health disciplines. Results suggest peer learners believe teaching is an important role for paramedics, and communication between peer learners and teachers was slightly better compared with their tutors. Further mixed methodology work is required to explore other facets of paramedic NPT.

Paramedic service delivery in Vanuatu Judy Willie,1 1ProMedical Ambulance Service, Vanuatu Emergency Medical Services Association (VEMSA), Vanuatu. [email protected]

The purpose of this presentation is to provide an understanding of the challenges in delivering a world class ambulance service in a small Pacific Island judged as one of the least developed countries in the Pacific. Information presented here has been gathered from both interviews with ambulance paramedics employed by the Vanuatu Emergency Medical Services Association (VEMSA) and observation of practice. Paramedics in Vanuatu face considerable challenges when attending to a patient, including treating and transporting them from a high level of care to a low level of care in the public hospital. The health system in Vanuatu struggles to provide an adequate service due to a severe lack of skilled professionals as a result of inadequate medical and nursing health education systems, a decrease in government funding, increasing use of health services, lack of basic equipment and supplies and increasing levels of non-communicable diseases (NCD). Until 2000 there was no ambulance service in Vanuatu. The hospital ambulance drivers have no first responder training. In the whole country there are only six qualified paramedics and four assistant/ students (Ni-Vanuatu) staffing a 24-hour service. The key challenges faced by paramedics relate to quality of formal hospital care available, language issues, custom medical practices and beliefs and lax vehicle safety-road/driving laws. This presentation will look at the different challenges and detail how ProMedical paramedics respond to these challenges.

19 Conference Abstracts Australasian Journal of Paramedicine: 2014;11(6) Can Mild Traumatic Brain Injury risk score predict for positive CT brain result in high risk of mild head injury patients? Chaiyaporn Yuksen, MD,1 Thavinee Trainarongsakul, MD,1 1Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Introduction The most common presentation of traumatic brain injury in Emergency Department is Mild traumatic brain injury (Mild TBI). Brain CT scan is not necessary in all Mild TBI patient. Objective : To investigate the impact of risk factors involving brain abnormalities on CT scan ,and document the effectiveness of MTBI risk score to used in Mild TBI.

Methods Retrospective data from medical records and divided patients into 2 groups; those with abnormal brain CT results and those without brain CT abnormalities. Then, analyzing the risk factors and conditions of these two groups in order to indicate the risk factors related to an abnormality in the brain.

Result Total numbers of patients were 350 persons, comprise of 89 persons with abnormal brain CT (25.43%) and 261 persons without brain abnormalities (74.57%). The result showed only 13 risk factors that have the important effect on brain abnormalities. Throughout the multivariate analysis, there was a clearly result indicate that only 7 risk factors significantly caused the abnormalities of brain. From these 7 risk factors, we formulated for MTBI risk score. Each risk factors (Clinical sign of skull fracture, multi-system trauma with GCS 13-14, history of loss of consciousness, dangerous mechanism, post traumatic amnesia, GCS 13-14) was given 1 point except for focal neurological signs that given 2 points. Patient with MTBI risk score greater or equal to 1 point suggested to be evaluated by brain CT scan. The sensitivity and specificity of MTBI risk score were 92.13% and 34.10%.

Conclusion MTBI risk score may be used in Mild TBI patients to indication for Brain CT scan. Exploring the motivation, anxiety levels, experiences, clinical exposure, and satisfaction of paramedic students participating in a study tour to Asia

Joe Acker,1 Tania Johnston1 1Charles Sturt University, School of Biomedical Sciences, Port Macquarie, NSW, Australia. [email protected] Introduction Universities across Australasia are increasingly offering international study opportunities to paramedic students. This study aims to explore paramedic student’s motivation to participate in a short-term study program in Asia and their anxiety levels prior to travelling. In addition, the research will identify the experiences these students are gaining overseas, develop an inventory of the clinical skills they practice, and gauge their satisfaction with an overseas study experience.

Methods Two groups of 11 paramedic students from Charles Sturt University are travelling to Asia in 2014. One group is touring hospitals and ambulance services in Thailand, while the other group is touring hospitals, ambulance services, and a medical university in China. A mixed-methods approach using online questionnaires before and after the trip will be conducted. In addition, focus groups will be conducted after the trips to add richness to the data collected through the surveys. Ethical approval has been granted by the Charles Sturt University Human Research Ethics Committee.

Results The trips are scheduled from the 20 June to the 11 July 2014. Responses to the pre-departure online survey have been strong and we predict a very high return rate.

Conclusion The outcomes of this research will help inform universities when considering international study tours for paramedic students. Not only will the education and experience value be quantified, but also the student’s motivation and pre-departure anxiety can be better understood and supported. 20 Conference Abstracts Australasian Journal of Paramedicine: 2014;11(6) Clinical placements: a student paramedic’s perspective Ryan Benett,1 Linda Ross1 1Department of Community Emergency Health and Paramedic Practice, Monash University, Australia. [email protected]

Introduction Clinical placements are crucial to the development of undergraduate paramedic students. Through placements students have the opportunity to consolidate and enhance their clinical skills while being exposed to the “real pressures” of the pre hospital environment. It is imperative that educators gain an understanding of and what students experience and learn from these placements. The objective of this study was to examine the clinical themes identified by paramedic students following clinical placements.

Methods Second year undergraduate paramedic students entered into online discussion forums to reflect on their experiences during clinical placements.

Results The entire cohort agreed to have their discussion posts included in the analysis for this study (n=116). The authors conducted thematic analyses of these reflections and identified three major clinical themes; cannulation, resuscitation and experience. Students commented on the differences between performing skills on mannequins as opposed to real people. “I’m really glad to hear I’m not the only one that found it much more difficult cannulating a real person compared to the fake practise arms at uni.”As for experience students felt their skill and confidence grew over time. “It is very nerve wracking at first but after you get into the swing of asking questions and going through your structured approach it gets much easier.”

Conclusion This study has identified key clinical themes students encounter during clinical placement.These results build a more complete picture of what students experience and learn during these placements which educators can draw on for future curriculum and placement planning. The paramedic as educator: Student perspectives of the Pathway to Paramedicine Program Jessica Bertucci,1 Linda Ross,1 1Department of Community Emergency Health & Paramedic Practice, Monash University, [email protected]

Introduction Paramedic practice has evolved significantly with a greater emphasis now being placed on paramedics as educators to junior paramedics, patients and the wider community. The Pathway to Paramedicine Program used a peer assisted learning (PAL) model to expose paramedic students to the educator role. The aim of this pilot study was to evaluate the student paramedic’s perspectives of the Pathway to Paramedicine Program.

Methods Fourteen Bachelor of Emergency Health (Paramedic) students from Monash University acted as educators and mentors to during an eight week program aimed at giving the secondary school students an insight into paramedic studies. The Pathway to Paramedicine Evaluation (PPE) survey was used to determine the participant’s perspectives at the completion of the program.

Results The results were overwhelmingly positive with students finding the program enjoyable, satisfying and well organised.All 12 Likert scale questions on the PPE achieve a median score of 4 or higher with one third of the items achieving a maximum median of 5 (strongly agree). A thematic analysis of the free text questions found that the participants enjoyed teaching and this helped to reinforce their own knowledge and skills. “Teaching others has really reinforced my own knowledge.” (Student 12)

Conclusions Through this program paramedic students gained a greater understanding of the role they can play as educators whilst improving their own knowledge and skills along the way. They had an overwhelmingly positive perspective of The Pathway to Paramedic Program and would happily recommend it to others.

21 Conference Abstracts Australasian Journal of Paramedicine: 2014;11(6) Gaining an insight into paramedicine: secondary school student perspective of the Pathway to Paramedicine Program Jessica Bertucci,1 Linda Ross,1 1Department of Community Emergency Health & Paramedic Practice, Monash University, [email protected]

Introduction The Pathway to Paramedicine Program offered secondary school students with an interest in the paramedic disciple a unique opportunity to gain insight into the profession and the training required, an opportunity unlike any other. This study aimed to evaluate the secondary school student’s perspectives of the program.

Methods Fourteen year 10, 11 or 12 students from various secondary schools in Melbourne, Victoria were the subjects of this study. The paper based Pathway to Paramedicine Evaluation (PPE) survey was used to determine the secondary school student’s perspective of the program. The PPE survey consisted of a combination of Likert and free text questions.

Results Ten items which included, ‘the program has given me a good introduction to the paramedic degree’ and ‘the paramedic students were supportive and encouraging’ achieved a maximum median score of 5 (strongly agree). The remaining items achieved no lower than a 4 (agree). A thematic analysis of the free text responses revealed four major positive themes; the program gave them an insight into paramedic practice; helped them decide on career paths; reinforced CPR and first aid skills; and the paramedic students were knowledgeable and easy to talk to. Furthermore, 50% of the year 12 participants gained enrolled into a paramedic degree in the following year.

Conclusions The results showed that the secondary school students had a tremendously positive perspective of The Pathway to Paramedic Program. It greatly assisted them in determining their future career paths in addition to gaining valuable lifesaving skills. Narrowing the ‘Theory-Practice Gap’: a review of the evidence supporting cased based learning and clinical placement in pre-employment paramedic education

Samuel Bianchi Introduction Undergraduate paramedic education is a rapidly evolving field in the world of emergency medicine. One area of discussion in paramedic research is the evolution of the theory-practice gap, a phenomenon that describes graduate paramedics experiencing difficulty in applying theoretical knowledge to actual patient presentations within the pre-hospital environment.This review aims to provide a summary of the best available evidence that underpins the delivery of the aspects of paramedic education that aim to link theory to clinical practice; case based learning (CBL) and clinical placement.

Methods A literature search on this topic was conducted and the relevant sources were categorised, analysed and synthesised for the purposes of this review.

Results It was found that there was not an overwhelming amount of research available that related specifically to this aspect of paramedic education. However, this is a commonly encountered phenomenon in paramedic science, perhaps due its relatively recent academic origin. Due to this limitation, relevant literature from bodies of evidence from both nursing and medicine has been included in the research for this article. Of the literature that was sourced, a number of conclusions were reached as to how best facilitate case based learning and clinical placement in an academic paramedic context.

Conclusion Undergraduate paramedic programs should aim to design practical curriculum utilising the best available evidence so as to maximise student learning and student learning satisfaction, as outlined in the discussion contained in this review.

22 Conference Abstracts Australasian Journal of Paramedicine: 2014;11(6) Paramedic Course Accreditation in Australia and New Zealand – Faculty Perspectives Ingrid Brooks,1 Frank Archer,2 1School of Nursing and Midwifery, Faculty of Medicine Nursing and Health Sciences, Monash University, Australia. ingrid.brooks@ monash.edu 2Disaster Resilience Initiative, Monash Injury Research Institute, Monash University, Australia.

Introduction The progression of paramedic education into the higher education sector has seen the introduction of an external professional accreditation process for university based entry-level paramedic programs. Since 2011 entry-level paramedic programs offered by Australian and New Zealand universities have been progressively evaluated through an accreditation process developed by the Council of Ambulance Authorities and Paramedics Australasia. This paper will report on the experience and perspectives of academics participating in the accreditation process.

Method Following ethics approval, permission to invite heads of paramedic departments to participate in semi-structured interviews was sought from all sixteen universities offering entry-level paramedic programs in Australia and New Zealand.

Results Analysis of interview data from this purposeful sample of eight heads of departments and four course coordinators who participated in this study revealed themes of quality improvement, consistency and standards, accountability, external validation, collaboration and support. Respondents viewed accreditation as promoting quality educational outcomes by means of program evaluation against explicit statements of standards for paramedic education that meet the expectations of industry and the profession. Standards and the accreditation process were identified as needing improvement, but valued as enabling heterogeneity in curricula. Changes to curriculum were made both in response to and separate to the accreditation process. Universities use their accreditation status to market their programs to prospective students.

Conclusion These results suggest that professional accreditation is accepted by academics as supporting quality outcomes in paramedic education. Resolution of areas identified as requiring further strengthening and refining of the process is required.

Identifying what makes paramedic students anxious about pharmacology Matthew Caffey,1 James Crane,2 Matthew Ireland,3 1School of Biomedical Sciences, Charles Sturt University, Australia, [email protected] 2School of Biomedical Sciences, Charles Sturt University, Australia 3Charles Sturt University, Australia

Previous studies have established that student anxiety has a significant impact on engagement and motivation.This in-turn has considerable affects on academic performance and course attrition rates. While the sources of anxiety in health-related courses such as nursing have been well documented, the sources of anxiety experienced by paramedic students have not been investigated. Evidence from other health-related fields has identified pharmacology as a significant source of stress and anxiety for students and practitioners. However, the extent or nature of this anxiety has not been characterised in paramedics. Using a student survey before the start of an applied pharmacology subject, questions were asked regarding how anxious each student was regarding particular areas of pharmacology and their reasons why. Our observations suggest that paramedic students also experience anxiety related to learning and applying pharmacology. Areas such as drug mechanism and dosage showed particular anxiety, which provides insight into topics that need further focus for student development. Determining the extent and nature of pharmacology-related anxiety in paramedic students may improve the ability of academics to design subjects that target these areas of perceived weakness and can potentially lead to improved outcomes.

23 Conference Abstracts Australasian Journal of Paramedicine: 2014;11(6) A Current and Historic Look at the Antiemetic Practices of New Zealand Paramedics Matthew Caffey,1 Sonja Maria,2 Lyle Brewster,3 1School of Biomedical Sciences, Charles Sturt University, Australia, [email protected] 2School of Biomedical Sciences, Charles Sturt University, Australia 3Charles Sturt University, Australia

Introduction Antiemetic management has varied over the last twenty years in paramedic practice and there is currently no published research regarding paramedic medication options for nausea and vomiting. In order to capture a snapshot of antiemetic usage in paramedic practice, a survey was conducted to review current and previous antiemetic management preferences and practices for New Zealand paramedics.

Methods A cross-sectional survey was developed that asked questions regarding each paramedic’s demographics, years of experience, current scope of practice and then specific questions regarding their antiemetic preferences, previous medication choices and beliefs regarding antiemetics. The survey was approved through St John NZ internal ethics and administered voluntarily through their intranet website and staff bulletin.

Results The survey received 135 responses of the approximate 3700 ambulance officers working with St John NZ. Ondansetron is the only current antiemetic in general practice, but within the last ten years of practice, both metoclopramide and ondansetron were available while prochlorperazine, promethazine and cyclizine being also available to some paramedics from over ten years ago. Ondansetron was found to be generally preferred over the previous antiemetics with exceptions being only in cases involving nausea with motion sickness, vertigo or migraines. Beliefs behind their preference for ondansetron were its perceived superior efficacy and the side effect profiles of other antiemetics.

Conclusions New Zealand paramedics have had a variety of antiemetics available over their careers. Five antiemetics have been available with their current general antiemetic option of ondansetron being the most preferred. The Professional Socialisation of Paramedics: The Transition from Intern to Qualified Paramedic Scott Devenish,1 Michele Clark,2 MaryLou Fleming,3 1School of Clinical Sciences, Queensland University of Technology, Australia, [email protected] 2School of Clinical Sciences, Queensland University of Technology, Australia 3School of Public Health and Social Work, Queensland University of Technology, Australia

The professional socialisation of paramedics encompasses preconceptions developed during childhood and early adulthood, and subsequent changes in perceptions resulting from university studies, clinical placements and encountering the professional workplace as an employee. This study investigates the professional socialisation of university educated paramedics making the transition from paramedic intern to qualified paramedic. Participants were sought from several ofAustralia’s larger ambulance services and UK NHS Ambulance Trusts to take part in this study. Participants were recruited through Ambulance Service Research Institutes, Clinical Governance Departments and university databases. To be included in this study, participants were required to be university educated, have completed a professional internship year and achieved qualified or registered paramedic status. Data collection was via face-to-face semi-structured interviews. Transcripts were analysed using socialisation models from the nursing and allied health disciplines and a grounded theory approach. The study found that participants initially enjoyed their new professional status after completing their internship and becoming qualified paramedics. However, for many the excitement of becoming a qualified paramedic was short lived. Newly qualified paramedics experienced increased levels of responsibility and were required to develop mentoring skills while still adjusting to their new roles. Participants had to contend with inner conflicting views about the reality of paramedic work which were developed though preconceptions and experiences as paramedic interns. The transition from paramedic intern to qualified paramedic is reportedly a challenging experience, as newly qualified paramedics are required to deal with added complexities while still adjusting to their new roles.

24 Conference Abstracts Australasian Journal of Paramedicine: 2014;11(6) Facilitators of expanded and extended scope of paramedic practice – what makes them work? Jakki Germann,1 David LIM,1 Leo Mc Namara,1 Vivienne Tippett1 1School of Clinical Sciences, Queensland University of Technology, [email protected] Introduction Better integration of health services and redefinition of health workforce roles through expanding and extending traditional scope of clinical practice have been explored nationally and internationally. This paper aims to extend our earlier work by examining models of expanded and extended scope of paramedic practice for attributes which facilitate such a practice.

Methods An exploratory multi-case study analysis of Australia, New Zealand, Canada and the United Kingdom expanded and extended paramedic practices were analysed.

Results Successful models of advanced practice harness the capacity and personality of the paramedic practitioner, and are supported by enabling infrastructures, specifically: professional development/ education; clinical guideline and policy (boundary); access to physical infrastructure and clinical support from senior medical practitioners; and, ability to directly refer to other health services (service integration). The scope of advanced practice is however influenced by individual employers’ capacity, perceived needs and preference/ prioritises. The potential for advanced paramedic practice is equally applicable to urban as well as rural Australia. The Council of Ambulance Authorities’ Professional Competency Standard provides the form and functions for building on advanced paramedic practice. Recognition of such advanced paramedic practice provides a structure for professional growth, process for career progression and will support workforce retention.

Conclusion The achievement of advanced knowledge and skills has positioned the paramedic profession to be recognised as a valuable clinician. The Council of Ambulance Authorities’ Professional Competency Standards provides the form and function for supporting advanced paramedic practice. Outcomes from cardiac arrest: A St John New Zealand Out-of-Hospital Cardiac Arrest Registry Study Bridget Dicker,1,2 Bernard Doo,1 Jeannette Perez,1 Colin Tan,1 Graham Howie,2 Tony Ward,1,2 Paul Davey,1,2 1St John, Auckland, New Zealand 2Auckland University of Technology, Auckland, New Zealand

Introduction St John is New Zealand’s largest emergency ambulance service provider with a jurisdiction that encompasses nearly 4 million people, ninety percent of New Zealand’s population. In September 2013 the St John New Zealand Out-of-Hospital Cardiac Arrest (OHCA) Registry was established as a method of reporting New Zealand OHCA data uniformly so as to facilitate international comparisons. This study will present the inaugural results from registry covering the first nine months of data collection.

Methods The data for the St John New Zealand OHCA Registry was acquired from three separate collection points: Computer Aided Dispatch (CAD) data and supporting systems, on-scene by the ambulance officers in attendance and District Health Board patient outcome data. Data quality was maintained through cross-checking by independent researchers and incorporation of data validation tools within the database application.

Results Data Collection is ongoing. An analysis of nine months of OHCA data collected between 1 October 2013 and 30 June will be presented. Outcomes will be presented for the following data variables, response times by ambulance, rate of hospital admission and survival to hospital discharge.

Conclusion This study will present the inaugural outcome results from the St John New Zealand OHCA Registry. This presentation will cover the first nine months of data collection encompassing the period spanning 1 October 2013 to 30 June 2014.

25 Conference Abstracts Australasian Journal of Paramedicine: 2014;11(6) Telemedicine in out-of-hospital diagnosis and treatment Roy Franklin,1 Sean Thompson,2 1ILS Paramedic, Wellington Free Ambulance, New Zealand. [email protected] 2BHSc Paramedic Degree Tutor, Whitireia New Zealand, ALS Paramedic, Wellington Free Ambulance New Zealand.

Traditionally, medical equipment used to diagnose and guide clinical treatment is designed for and held at central medical facilities. The specialists who operate the equipment and interpret the results are also located were the equipment is and patients typically must travel to a central facility for diagnosis and treatment. This can cause treatment delays, impacting on patient outcomes. We review international trials in which ambulances are equipped with live video, voice communication, and patient data transmission. With improved communication technology and reduced size and weight, modern medical diagnostic equipment can now be taken to the patient and the results transmitted to a central location. Consultation between paramedics and hospital-based doctors ensures correct diagnosis and effective treatment either pre-hospital, or in place of transport to emergency departments (ED). This reduces time to treatment and decreases overall ED presentations. Telemedicine technology with specialist consultation guiding the out-of-hospital treatment is a key aspect in the future of paramedical care. Such technology should be developed and introduced for ambulance services, especially for rural areas where it will have a greater impact on healthcare provision and patient outcomes.

Community Ambulance Response Trolleys (CARTs): Building Peer Relationships in Paramedicine Practical Classes Heath Gangell,1 Georgia Clarkson,2 1School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Australia. [email protected]; 2School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Australia.

This project explored the value of using CARTs in paramedicine laboratory classes. A trolley system was introduced into paramedicine laboratories on one Australian Catholic University (ACU) campus. Trolleys were used to house routinely used paramedicine equipment which effectively mirrored an ambulance branch. Students across all year levels were assigned to a trolley or ‘branch’. Students were responsible for maintaining all core equipment utilised in classes. It was hypothesised that students would be effectively made stakeholders in management of their equipment. The system was also thought to encourage intra and inter-year level communication in order to ensure equipment maintenance. A further goal was to foster the relationships essential to underpin peer learning and establish an internal university ‘Community of Practice (CoP)’. Furthermore, it was postulated that students would come to better understand the standards and behaviours of the ambulance industry, encouraging their engagement in an external ‘CoP’, the ambulance workplace. This is hoped to improve transition into the workplace.

Two evaluation strategies were used. Firstly, to enable comparisons, a survey was used to capture quantitative data relating to the student experience at the site where CARTs were used in addition to a site where CARTs were not used. The second component of evaluation was by means of a cross-campus focus group discussion. Discussion of the suitability of the CART system for use in paramedicine laboratory classes and the implications for health simulation will be presented. Researchers in this project concluded that paramedicine educators could consider the use of the CART system.

26 Conference Abstracts Australasian Journal of Paramedicine: 2014;11(6) Introducing a Community Volunteer Program to Complement Paramedic Student Ambulance Placements Tania Johnston,1 Joseph Acker,1 Alexander MacQuarrie,1 Amanda Hlushak,1 1School of Biomedical Science, Charles Sturt University, Australia. [email protected]

Introduction Universities are exploring how workplace learning can serve to develop soft skills to better prepare graduates for contemporary roles that focus on primary health and community care. The objective of this study was to explore paramedic student’s perceptions of a community services placement introduced as a pilot project to supplement traditional ambulance placements and facilitate the development of non-technical skills such as communication and emotional intelligence.

Methods A convenience sample of 191 first year Charles Sturt University paramedic students was used in this descriptive study to ascertain the students’ attitudes and reflections upon completion of a community-based placement. The 17 question survey instrument using a likert scale was developed to determine demographic data and explore student reflections on the value of the placement, perceptions of volunteerism and the impact on soft skill development. The data were analysed using SPSS.

Results There were 88 students from a possible 191 who participated in the survey (46%). 58% of respondents were male while 79.5% were 25 years old or younger. 81% of students reported improvement in their communication skills while 80% gained confidence talking to people of different ages, cultures and socioeconomic status. There was a significant correlation between student age and perceived development of soft skills with students under 25 reporting the highest levels of improvement.

Conclusion This study demonstrates that non-ambulance placements can be used to supplement traditional workplace learning and improve students’ soft skills. Additionally, universities should consider inventorying student soft skills and tailor placement opportunities to better suit student needs. Socioeconomic Status and its Effect on Pregnancy and Childbirth: Paramedic considerations in the prehospital setting

Sarah Lightowler,1 Scott Devenish,2

1Student Paramedic at Queensland University of Technology, Australia, [email protected] 2School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Australia.

This presentation aims to identify the role that socioeconomic status plays in determining poor health outcomes in pregnancy and childbirth. It brings to light the limitations and complications that a person in a lower socioeconomic society may face, and the effect that this possibly has on the health of the mother and child. A review of the peer reviewed literature was undertaken which identified three key areas relating to pregnancy in lower socioeconomic areas. These were social and emotional matters, lifestyle factors and financial issues. Particular focus has been put on understanding these issues from a paramedic perspective and how this can assist in both the treatment and education of patients in the pre-hospital environment. While there has been sufficient research into the three individual areas highlighted in the literature which affect pregnant patients living in lower socioeconomic communities, this presentation has drawn these topics together to create an overview of a subject which is complex and multifaceted.

27 Conference Abstracts Australasian Journal of Paramedicine: 2014;11(6) Patient presentations to onsite health providers, ambulance paramedics and hospital emergency departments from a mass gathering: a case study

Jamie Ranse,1 Mr Shane Lenson,2 Mr Toby Keene,3 Mr Matt Luther,4 Dr Brandon Burke,5 Dr Alison Hutton,6 1University of Canberra, University Drive, Bruce ACT 2617 2Australian Catholic University, Antill Street, Watson ACT 2602 3ACT Ambulance Service, Amberley Avenue, Majura ACT 2609 4Calvary Health Care ACT, Mary Potter Circuit, Bruce ACT 2617 5Canberra Hospital, Yamba Drive, Garran ACT 2605 6Flinders University, Sturt Road, Bedford Park SA 5042

Introduction Health providers at mass gatherings aim to minimising the disruption to the health services of the surrounding community. The mass gathering literature focusses on patients presenting to onsite care providers at events, and scantly reports on patients presenting to prehospital care providers and hospitals. In 2012, an outdoor music festival with approximately 20,000 participants was held in Canberra. The festival had one first aid post, and a medical assistance team staffed by doctors, nurses and paramedics. This research describes the characteristics of patients and health service usage from this event.

Methods Data was collected retrospectively from patient records from onsite care providers (St John Ambulance Australia), which were linked to both prehospital (ACT Ambulance Service) and hospital (Canberra Hospital and Calvary Health Care ACT) records. A pre-existing minimum data set was used to code patient characteristics. Data analysis included descriptive statistics, such as frequencies and means of central tendency. Ethics approval was obtained for this research.

Results In total, 197 (9.86/1,000) patients presented for onsite clinical assessments and/or management. Two patients who required hospitalisation bypassed the onsite care providers directly to the ambulance service for transport to hospital. The medical assistance team managed 22 patients (1.1/1,000), of whom two were referred to police, five transported to hospital and 15 who were discharged home from the event. In total, seven patients were transported to hospital by ambulance (0.35/1,000). Hospital presentation rate and patient characteristics are currently being determined at the time of this abstract submission.

Conclusion This is the first research to describe patient presentations to onsite care providers, prehospital and hospitals from a mass gathering. This research provides insight into the health service usage. Strategies to minimising the disruption to the prehospital and hospital health services of the surrounding community will be discussed.

28 Conference Abstracts Australasian Journal of Paramedicine: 2014;11(6) “Expert in my Pocket”: The development of clinical skills videos and associated learning resources for paramedic, nursing and allied health students

Bill Lord,1 Nigel Barr,1 Florin Oprescu,1 Terri Downer,2 Helen Forbes,3 Nicole M Phillips,3 Lauren McTier,3 Peter Bright,4 Vilma Simbag,1 Kristel Alla1 1University of the Sunshine Coast, School of Health and Sport Sciences, Sippy Downs QLD 2University of the Sunshine Coast, School of Nursing, Sippy Downs QLD 3School of Nursing and Midwifery, Deakin University, Melbourne VIC 4School of Medicine, Deakin University, Melbourne VIC

Introduction Paramedic, nursing and allied health students must be able to perform assessment, diagnostic and procedural skills to provide safe and effective patient care. Videos that demonstrate evidence-based clinical skills may enhance clinical skill development by enabling learning at a time and place that suits learning needs. This project developed an online repository of 30 standardised clinical skills videos filmed from a first person point of view (1PPoV) as well as supplementary resources to support clinical teaching and learning.

Methods Expert consensus produced an initial list of 87 clinical skills for nursing and paramedic science. An online survey was subsequently developed to rank the perceived importance of each skill to paramedic and nurse educators, clinicians and students. The resulting data enabled the identification of the final set of 30 skills and also provided critical feedback on the project aims.

Results 53 respondents attempted the survey, with 46 complete responses. The top 15 skills for nursing and paramedics were tabulated to produce a set of thirty skills. Videos that demonstrated these skills from the 1PPoV were produced based on established practice and best available evidence. A second survey of educators then sought expert opinion on the accuracy of the skills, technical quality and educational value of the videos. Feedback from survey respondents informed re-editing and final production.

Conclusions The outcome is a peer reviewed, free, publicly accessible, web-based repository of learning resources comprising videos and supporting materials developed to enhance student development of key clinical skills. Importantly the videos were presented from a first person view by expert health clinicians and are specific to theAustralian practice setting. Epidemiological Analysis of Adult Patients of the Queensland Ambulance Service Who Experience Out-of-Hospital Cardiac Arrest Katherine Pemberton,1 Emma Bosley,1 Kerrianne Watt,2 1Clinical Performance & Service Improvement Unit, Queensland Ambulance Service, Australia [email protected]. gov.au 2James Cook University, Townsville, Australia

The Queensland Ambulance Service (QAS) is an emergency medical service which operates a two-tiered system of response to the people of Queensland. This includes the dispatch of Advanced Care Paramedics (ACPs) and Intensive Care Paramedics (ICPs) to over 4500 out-of-hospital cardiac arrest (OHCA) cases per year. The presented epidemiological analysis is aimed at providing crucial information for the QAS to inform future initiatives and the development of clinical practice guidelines for the management of OHCA patients. The study is a retrospective cohort design including all patients in Queensland aged 18 years or over who experienced a confirmed cardiac arrest of presumed cardiac aetiology and were attended by QAS paramedics over a 12 year period (2002–2013). Variables collected include demographic characteristics, operational parameters, clinical parameters and outcome measures up to the point of hospital handover. Analyses are underway and being carried out in 2 steps: 1) Descriptive statistics to summarise the sample and outcomes; 2) Inferential statistics to identify differences between outcome groups. Logistic regression models will be built to identify epidemiological and clinical factors that are independently strongly associated with patient outcome. The findings of this study will be valuable in informing strategy development for the primary, secondary and tertiary prevention of cardiac arrest within the Queensland community.

29 Conference Abstracts Australasian Journal of Paramedicine: 2014;11(6) Standards and Quality Indicators for Best Practice in Paramedic and Inter-Professional Experiential Practica Brian Maguire,1 Richard Brightwell,2 Moira Sim,2 William Lord,3 1School of Medical and Applied Sciences, Central Queensland University, Australia. [email protected] 2Edith Cowan University 3University of the Sunshine Coast Introduction The objective of this project was to develop recommendations for ‘standards’ within paramedic experiential inter-professional clinical practice at the undergraduate level. The project aims to improve the capacity of Australian paramedic graduates to work effectively, through the development of quality indicators for paramedic and inter-professional clinical practica, to achieve best practice, as well as to align paramedic clinical practica nationally with each university and with inter-professional clinical standards. The long-term goal of the work is to inform the development of a standard national curriculum.

Methods We examined national and international standards through interviews and did a review of the literature on methods that have been used to evaluate and improve inter-professional clinical practical.

Results Based on the interviews and literature review, the project team developed a standardized list of definitions and constructed quality indicators of best practice approaches for inter-professional paramedical practica. We developed: recommendations related to curriculum development; recommendations for the scope of university support needed for effective practica; recommendations related to clinical training sites including developing agreements and specifying standards for clinical supervision. We also describe the core competencies needed by each student before undertaking clinical practica.

Conclusions Adapting these new recommendations can help ensure that paramedic students have safe and educational clinical practical. Intoxicated patients: prehospital impact; assessment and transport decisions Kirsty Mann,1 1Paramedicine and Emergency Management, Auckland University of Technology, New Zealand, [email protected] Introduction Intoxicated patients are frequently encountered by ambulance crews. Accurate prehospital assessment of intoxication and associated risks to the patient is crucial in determining the need for ambulance transport to hospital. The aim of this study was to establish whether a triage tool could reliably identify intoxicated patients and assist paramedics to triage them appropriately to hospital, tertiary, or community care.

Methods A literature search was undertaken searching the following databases: Medline and CINAHL, Cochrane, and Scopus. Studies were selected for inclusion if they were published within the last five years (2008-2013) and discussed the management of acutely intoxicated patients. Studies were excluded if they were case reviews, public health awareness campaigns, related to a specific clinical skill, or were not written in English. Ethics committee approval was not required but studies were examined to ensure approval had been granted if necessary.

Results Nine articles were identified for systematic review: one executive summary, one cross-sectional descriptive survey and seven retrospective analyses. Key findings include that alcohol intoxication contributes significantly to ambulance workload; paramedics can safely and effectively assess intoxicated patients prehospitally; and detoxification facilities can prevent emergency resources being used for low-acuity presentations.

Conclusion In order to manage intoxicated patients paramedics require specific training, clinical support, and procedural guidance. Prehospital triage tools for this cohort exist for high demand occurrences such as sporting events and music festivals, however further development would allow them to be successfully applied to normal operations. . 30 Conference Abstracts Australasian Journal of Paramedicine: 2014;11(6) Thiamine use in hypoglycaemia – myths & realities James Pearce,1 Anna Pearce,2 1School of Nursing, Midwifery & Paramedicine, Australian Catholic University, Australia, [email protected] 2Graduate School of Medicine, University of Wollongong, Australia.

Introduction The use of thiamine prior to intravenous (IV) glucose administration in hypoglycaemic patients is prevailing practice in many areas. This is based on the theory that a rapid increase in the blood glucose level can precipitate Wernicke’s Encephalopathy (WE), especially in patients who abuse alcohol. There is a paucity of evidence to support this theory, especially in the setting of acute paramedic care. What little evidence exists is based on dubious links abstracted from unique case, unrelated to the modern Australian pre-hospital context. The aim of this study is to identify the myths and realities of thiamine use in hypoglycaemia and its links to WE.

Methods A comprehensive review of the literature was undertaken which included published studies and other articles. Paramedic guidelines from Australian and international providers were analysed for pertinent data. Initial searches retrieved literature from PubMed, CINAHL, EMBASE and the Cochrane database. Reference lists of appropriate literature were searched for additional studies.

Results There is no evidence for the practice of routinely giving thiamine prior to IV glucose administration in all hypoglycaemic patients. It may in fact be harmful by delaying the delivery of the required glucose. Paramedics should certainly be aware of WE, and should encourage all potentially malnourished patients who have had an episode of hypoglycaemia to consult a medical practitioner or attend an emergency department. There is also scope for paramedic initiated vitamin replacement treatment.

Conclusion Further study is required in this area to guide evidence based best practice. Paramedic students’ perceptions of non-clinical experiences during placements Chantal Perera,1 Linda Ross,1 Ryan Bennett,1 1Department of Community Emergency Health and Paramedic Practice, Monash University, Australia. [email protected]

Introduction Undergraduate paramedic students’ participation in clinical placements is considered an essential component of paramedic education. Clinical placements are often cited as providing opportunities for students to apply knowledge and practice clinical skills. Clinical placements also serve to inform students about the realities of the paramedic profession. The purpose of this study was to identify non-clinical themes described by students on clinical placement.

Methods This study employed a cross-sectional methodology, using online discussion forums to elicit non-clinical themes encountered by students during placements. A convenience sample of 116 second year Bachelor of Emergency Health (Paramedic) students from Monash University participated in the study. A thematic analysis of the online posts revealed three main themes based on the frequency of discussion: dealing with death, logistical issues and interpersonal skills.

Results In describing their experiences of these themes, students identified clinical placements as an important extension of their higher education: ‘At uni we practice compressions on mannequins….but communicating with the family of the deceased was something I never practiced in scenarios’. This study demonstrates that a variety of non-clinical themes emerge from involvement in clinical placements. Interpersonal communication skills, the ability to manage a case in a logistical sense, and coping styles pertaining to death and dying were identified by students as important facets of their practice, and as potentially impacting upon their perception of the role of a paramedic in the community.

Conclusion Educators may use these results to better inform and prepare students for the realities of paramedic practice.

31 Conference Abstracts Australasian Journal of Paramedicine: 2014;11(6) What are the factors of organisational culture that act as barriers to the implementation of evidence-based practice? A scoping review Samuel Perillo,1 Assoc. Prof. Brett Williams1 1Dept of Community Emergency Health and Paramedic Practice, Monash University; Australia. [email protected]

Introduction Organisational barriers relate to the workplace setting, administrational support and facilities available for research utilisation. A health care organisation needs to provide an environment conducive to the implementation of EBP in order for its employees to effectively provide the highest level of care. This study sought to identify the organisational barriers to the implementation of EBP by way of a scoping review.

Methods This scoping review uses a six stage methodology: 1) Identify the research question; 2) Identify relevant studies; 3) Study selection; 4) Charting the data; 5) Collating, summarising and reporting the results; and 6) Consultation

Results Forty-nine articles were selected for inclusion. The articles were analysed and five broad organisational barriers were identified. Of the 49 articles included: 29 were cross-sectional surveys, 6 descriptions of specific interventions, 7 literature reviews, 4 narrative reviews, 9 qualitative studies, 1 ethnographic study and one systematic review. The majority of studies were undertaken in the U.S. (25) with studies also conducted in the U.K. (7), Europe (5), Canada (4), Australia (5) and Asia (3).

Conclusions This scoping review sought to map the breadth of information available on the organisational barriers to the use of EBP in health care. There were five major organisational barriers which emerged from the selected studies. Even for an individual who is motivated and competent in the use of EBP; all of these barriers will impact their ability to increase and maintain their use of EBP in the workplace. . BUILDING PARAMEDIC RESILIANCE THROUGH COGNITIVE BEHAVIOURAL MODALITIES

Buck Reed1 1Ambulance Service of New South Wales

Paramedics are a profession exposed to stressful events which can be both acutely traumatic and chronically fatiguing in their nature. Psychological injury has been identified as a significant risk to paramedics and is prevalent in the profession. While ambulance services have traditionally focused on the provision of support services in response to stressors experienced by paramedics, there is significant scope for improving the capacity of paramedics to cope with a range of stressful experiences through improving their general resilience. A range of cognitive based modalities commonly used in the treatment of various psychiatric conditions can also be learned prophylactically to build resilience and assist paramedics in coping and decision making in situations which are both acutely stressful and in response to ongoing psychological fatigue experiences as part of the delivery of paramedic care. Key examples of these are Dialectical Behaviour Therapy and Acceptance and Commitment Therapy. Modalities such as these encourage paramedics to establish key values which underpin their response to situations. Likewise the practicing of mindfulness skills allows them to operate within the context of the situation they are facing and accept the situation as it is. Programs based on DBT skills have been used in the US to build resilience in police officers with good results. Designing and implementing strategies which build resilience and improve the acceptance and navigation of complex situations may have significant benefits in reducing psychological fatigue and injury, reducing incidents of PTSD and improving the capacity of paramedics to make decisions in traumatic situations.

32 Conference Abstracts Australasian Journal of Paramedicine: 2014;11(6) Towards a national standard Jamie Rhodes,1 1Queensland Ambulance Service, Australia, [email protected]

At present, each state and territory within Australia operates using a different set of clinical practice guidelines, none of which have been endorsed by the National Health and Medical Research Council. Whilst many of these guidelines are developed with the best intentions, and with significant investment to ensure the guidelines are consistent with best practice, considerable differences still exist in the management of various conditions between different states and territories. A recent article published in Academic Emergency Medicine highlights the current dependency on expertise-based guidelines in the United States and the lack of a framework for developing prehospital guidelines that take into consideration the uniqueness of prehospital emergency medicine. This article publishes a framework for the development of a set of national clinical practice guidelines developed by a multitude of stakeholders from across the United States. It is important to highlight that the purpose of developing a set of national guidelines is not to replace individual service guidelines, but to provide individual services with a set of evidence based guidelines that can be analysed in light of the individual services requirements and capabilities, and implemented accordingly to ensure that practice within the service is consistent with the best available evidence. This ensures that providers not only provide care in the best interest of the patient, but also provides for greater efficiency and cost effectiveness within a service. Developing an Australian National Research Agenda Peter O’Meara,1 Brian Maguire,2 Paul Simpson,3 Paul Jennings,4 Brian Sengstock,5 1La Trobe University, Victoria, Australia 2Central Queensland University, Queensland, Australia 3University of Western Sydney, Sydney, Australia [email protected] 4Monash University, Victoria, Australia 5University of Sunshine Coast, Queensland, Australia

Australia needs a national prehospital research plan for the following reasons:

1. The consensus process involved in developing a strategic plan for research will encourage researchers, ambulance services and the profession to develop common research goals; 2. Prioritization of research topics will be useful to funding bodies and researchers; 3. Creating and promoting a common agenda will create a unity of purpose within the prehospital field and make more effective use of the existing and future research capacity within the discipline; and, 4. To ensure that critical and emerging areas are allocated resources.

The project study design uses a mixed-methods approach, as used to develop the EMS Research Agenda for Canada in 2011/12 and modified for Australia. In common with the Canadian inquiry, success will depend on: ensuring a representative sample of expert stakeholders; fostering an open and collaborative discussion; and, adhering to a predefined approach to measure consensus on each topic. Expert informants from five sub-groups will be the project participants: active prehospital researchers; early career paramedic researchers; paramedics undertaking HDRs; ambulance service staff with responsibility for research governance; and representation from professional, industrial and provider organisations. The purpose is to gain a baseline understanding of the perspective of expert stakeholders of the landscape of prehospital research in Australia. The development of a national Prehospital Research Agenda for Australia will help foster a more vibrant and productive prehospital research culture. The subsequent research will help ensure that Australia is on the cutting edge of prehospital research worldwide.

33 Conference Abstracts Australasian Journal of Paramedicine: 2014;11(6) Epidemiology and effectiveness of paramedic management of unstable pulsatile ventricular tachycardia

Simon Singer,1 Scott Stewart,1 Gavin Smith,1,2 1College of Health and Biomedicine, Victoria University, Victoria, Australia. [email protected] 2Ambulance Victoria, Australia.

This study examined the patient demographic, patient characteristics, effectiveness and safety of current prehospital unstable pulsatile Ventricular Tachycardia (VT) management by ambulance paramedics in Victoria. A retrospective case series study was undertaken of all cases attended by Victorian paramedics where unstable pulsatile VT was the assessed arrhythmia, or subsequently occurred in care, excluding those patient with implanted Cardioverter-defibrillators and those patients in ROSC post cardiac arrest. All cases between 01/07/2007 and 31/12/2013 where unstable pulsatile VT was the initial assessment, final assessment, or appeared within the patient history, taking into account the exclusions, were extracted from the VACIS® data warehouse. Descriptive statistics were used to analyse demographic and patient characteristics. Multivariate statistical analysis were used to analyse factors affecting reversion rate of synchronised cardioversion as well as side effects stemming from paramedic management. Results and Conclusion are currently pending as this is a current study, expected to be completed September 2014. Does wound irrigation in the prehospital environment affect infection rates? – A Review of Literature Lynsey Smit,1 Dr Malcolm Boyle1 1Department of Community Emergency Health & Paramedic Practice, Monash University

Introduction Historically it has been shown in the military combat setting that early irrigation of open wounds/fractures effectively assists in the prevention of infection. The objective of this study was to determine whether wound irrigation alone in the civilian prehospital environment affects wound infection rates.

Methods A literature search of the electronic medical databases CINAHL, Cochrane Collaboration, EMBASE and Medline was conducted. The databases were reviewed from January 1950 until the end of March 2014. An existing prehospital search filter was applied to each database with additional search terms “wound”, “traumatic wound”, “simple wound”, “irrigation”, “fluid irrigation”, and “infection rate”. Articles of any study design were included if a specific evaluation of wound irrigation on wound infection rates was undertaken.The reference lists of included articles were also reviewed. Articles were excluded if they were not written in English.

Results A total of 16 articles were identified in the search with 7 meeting the inclusion criteria. A further 2 articles were identified through reviewing of reference lists. No specific studies were identified from the civilian prehospital setting. Studies on wound irrigation and infection rates in the emergency department have not produced conclusive outcomes. These studies covered different solutions, including those with a bacterial agent in them, irrigation pressure, different volumes of solution, and a range of patient ages. Only one study compared the results of irrigation versus no irrigation on infection rates.

Conclusion The literature does not clearly prove that irrigation alone decreases infection rates, nor does it prove that not irrigating a wound will impact on infection rates

34 Conference Abstracts Australasian Journal of Paramedicine: 2014;11(6) It’s “time” to reflect on competency assessment in paramedicine Anthony Smith,1 1Queensland Ambulance Service, Australia. [email protected]

Competency can be viewed as having numerous meanings and definitions in relation to educational processes. For example, competency frameworks can be used as tools to measure achievements and grading a student’s performance. Competency frameworks have been used by various professional bodies as standards for registration. As the paramedic profession moves towards registration, paramedics will be required to demonstrate competency to practise to achieve registration similar to that of other professions. Assessors perform a major role in assessing student competencies. The assessor can be influenced by their own experiences, subjectivity and biases which may impact on assessment outcomes. A framework to guide competency assessment and to provide a consistent and reliable approach to the assessment of paramedics would be beneficial.This presentation will examine the notion of competence and identify 12 key factors for consideration when using professional competencies as an assessment framework for determining if an undergraduate paramedic university student is competent. This presentation will open debate around the use of competencies in the assessment process in paramedicine and will be of interest to academics and paramedic practitioners involved in the assessment of undergraduate paramedic university students. The challenges of meeting the needs of children with Autism Spectrum Disorders during out of hospital interactions with Paramedics

Jo Stephens,1 Vivienne Tippett,1 Suzanne Carrington,2 1Paramedic Science, School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Australia. [email protected]; 2School of Learning and Professional Studies, Faculty of Education, Queensland University of Technology, Australia

This poster presents the results of a critical review of the literature on the intersection between paramedic practice with Autism Spectrum Disorder (ASD) and previews the clinical and communication challenges likely to be experienced with these patients. Paramedics in Australia provide 24/7 out-of-hospital care to the community. Although their core business is to provide emergency care, paramedics also provide care for vulnerable people as a consequence of the social, economic or domestic milieu. Little is known about the frequency of use of emergency out-of-hospital services by children with ASD and their families. Similarly, little is known about the attitudes and perceptions of paramedics to children with ASD and their emergency health care. However, individuals with ASD are likely to require paramedic services at some point across the life span and may be more frequent users of health services as a consequence of the challenges they face. The high rate of co-morbidities of people diagnosed with ASD is reported and includes seizure disorders, gastro-intestinal disorders, metabolic disorders, hormonal dysfunction, ear, nose and throat infections, hearing impairment, hypertension, allergies/anaphylaxis, immune disorders, migraine and diabetes, gross/fine motor skill dysfunction, premature birth, birth defects, obesity and mental illness. Individuals with ASD may frequently experience concurrent communication, behaviour and sensory challenges. Consequently, Paramedics can encounter difficulties gathering important patient information which may compromise sensitive care. These interactions occur often in high pressure and emotionally challenging environments, which add to the difficulties in communicating the treatment and transport needs of this population.

35 Conference Abstracts Australasian Journal of Paramedicine: 2014;11(6) A case study of non-traditional paramedic clinical placements Liz Thyer,1 Paul Simpson,1 1School of Science and Health, University of Western Sydney, Australia. [email protected]

Provision of clinical placements for clinical health science degrees is increasingly challenging as capacity within health services approaches saturation. Paramedicine degree students represent a relatively new addition to this crowded market. Initially small in number, student paramedic cohorts are rapidly increasing as more universities commence paramedic programs and current programs grow. This case study addresses the barriers and opportunities encountered when sourcing and providing non-traditional paramedic placements for a new degree program. The scope of practice of contemporary paramedicine is evolving as it transitions into a recognised health profession aiming to clarify its role in an adapting health system. Traditional clinical placement opportunities with state ambulance services, whilst providing crucial exposure to a unique environment and culture, are no longer sufficient as a sole strategy for providing the required clinical or educational experience. There is a need for traditional ambulance learning experiences to be supplemented by additional placements that reflect the current and future role of paramedics.This case identifies the increasing need to articulate into inter-professional health teams in the emergency department, primary healthcare, and allied health care settings and well as provide students opportunities to develop graduate attributes such as global citizenship and teamwork as part of a work integrated learning (WIL) experience. This case study reflects on constraints, enablers and integration of non-traditional clinical placement opportunities into the distinctive course pedagogy underpinning Australia’s newest paramedic program at the University of Western Sydney (UWS). Māori participation in EMS Timothy Aperahama Morrison,1 Bronwyn Tunnage,1 1Paramedicine and Emergency Management, Auckland University of Technology, NZ. [email protected]

Māori have poorer health outcomes and are under-represented in the general healthcare workforce in New Zealand. The aim of this investigation is to: i) quantify Māori participation in paramedic education and the Emergency Medical Service (EMS) workforce in New Zealand, ii) compare these with reported Māori participation rates across healthcare education and the general healthcare workforce, and iii) identify factors that may promote or inhibit their engagement in the sector. Two methods were used in this study. Firstly, providers of tertiary paramedic education and EMS systems were surveyed and secondly, relevant literature was reviewed. Māori averaged 7.5% of total enrolments in tertiary paramedic education over a five year period and in 2013 represented 5% of the EMS workforce. The literature review included 14 publications. Māori participation across the general healthcare workforce is low. Factors promoting Māori tertiary enrolment include the desires to attain a career, enhance Māori health and have a steady income. Barriers inhibiting academic studies include inadequate support, low academic and socio-economic backgrounds and the absence of a culturally safe learning environment. Aspects promoting workforce engagement include clear career pathways, support for workforce development, having role-models, mentors and leaders in the profession, and working in a culturally supportive environment. Māori are significantly under-represented in paramedic education enrolments and the EMS workforce, as in the general health workforce. Further research is required to determine whether similar factors promote and inhibit Māori participation in EMS education and the EMS workforce as are evident across the entire healthcare sector. The application and implementation of an ePortfolio in paramedic education Jaime Wallis,1 Associate Professor Brett Williams,1 1Department of Community Emergency Health and Paramedic Practice, Monash University, Australia. [email protected]

The use of ePortfolio-based assessment in higher education has grown rapidly in areas such as Art, Engineering, Teaching, Architecture, and Medicine. However the use in paramedicine has not yet been fully explored within the Australian higher education context. This paper will explore and examine the application and implementation of an ePortfolio used in a paramedic undergraduate program at an Australian university. Students were required to develop a number of digital pages (artifacts) that provided evidence that the specified graduate attributes had been demonstrated. The four graduate attributes used by the students in their assessment ePortfolio included: 1) Critical Thinking and Critical Reasoning; 2) Enquiry and Research; 3) Interpersonal Skills; and 4) Domain Knowledge. General descriptive feedback indicated that the ePortfolio was well received by the students. The artifacts prepared by the students included; Flow-charts, retrospective case reviews, scenario feedback, and teaching aids. This format of assessment provided the students with a platform that was engaging and allowed them to take charge of their learning. It has also allowed faculty to examine and measure attributes that are often difficult to measure using traditional assessment methods.

36 Conference Abstracts Australasian Journal of Paramedicine: 2014;11(6) Defence Relationship Health – deployment impact experience. A prospective study of the impact of deployment on the intimate relationships of Australian Army personnel

Kerri-Ann Welch,1 Vivienne Moyle1 1School of Clinical Sciences, Queensland University of Technology, Australia, [email protected]

A comprehensive literature review has been undertaken exploring the stressors placed on the personal relationships of Australian Army personnel, through service life and also overseas deployments. This work is the first step in a program of research aimed at developing a screening tool, aimed at acting as an early warning system to enable the right assistance to be given to affected personnel at the earliest possible time. It is envisioned that this tool will be utilised by the day-to-day managers of Australian Army personnel, of whom the vast majority are not health practitioners. This review has identified the commonalities of relationships that last through service life and/or deployments, and those that fail. These factors are those which will aid the development of the screening tool, and enable the early identification of Australian Army personnel who are at risk of having their personal relationship break down. Several of the known relationship stressors are relevant to other ‘high intensity’ professions, such as paramedics. Personal experience as an Army Officer has helped to highlight the importance of this research, and the benefits of developing a tool tailored to the unique social microclimate that is theAustralian Army are clear. This research is, to the author’s knowledge, unique in the Australian context Mental health training for paramedic students: optimum methods of teaching Howard Wills, BHSc Paramedic Degree Tutor. Whitireia New Zealand (WNZ). [email protected]

Training on how best to treat Mental Health (MH) patients is commonly neglected in New Zealand undergraduate paramedic training. Paramedic education has centred on medical and trauma issues, reflecting our traditionally emergency medical focus. Paramedics deal with the mentally unwell with little or no training in delivering appropriate care. Also poorly treated and understood are medical patients with MH co-morbidities. With an ever-increasing workload, paramedics must be better equipped to manage MH patients effectively. Improved education is the key to providing paramedics with adequate tools to deal with this challenging patient cohort. In collaboration with WNZ’s highly-regarded MH nursing educators we intend to deliver improved MH education to paramedic students. The challenge is how best to teach this subject. A stand-alone paper may be comprehensive but may also risk a silo effect whereby students see mental illness in isolation of other co-morbidities. Inclusion in a clinical paper may help reinforce MH as a co-morbidity to be considered but may risk diluting the gravitas of the conditions. We will identify and discuss various effective methods to deliver MH training to paramedic students.

37 Conference Abstracts Australasian Journal of Paramedicine: 2014;11(6) Videolaryngoscope Versus Macintosh Laryngoscope in Stimulated Patients With Limitation of Neck Movements Yuksen C, MD,1 Chinsupaluk W, MD,1 Trainarongsakul T, MD.1 1Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital,Mahidol University, Bangkok 10400, Thailand

Introduction Endotracheal intubation in patients with suspect cervical spine injury must be done with carefulness because it could cause injury to the cervical spine . Modern equipment are used to help intubation, especially for patients who suspect cervical spine injury. Purposes of the study were to compare the Glidescope video laryngoscope (GVL) with the Macintosh laryngoscope (ML) in manikin with cervical collars.

Methods 2 groups of participants (Emergency resident: experienced in intubation and 5th year medical students: inexperience in intubation) were randomized to intubate by Glidescope video laryngoscope (GVL) and Macintosh laryngoscope (ML) on a manikin wearing a cervical collar . The time required to intubate, the success rate, the number of intubation attemps and Cormack-Lehane classification (CL) were recorded.

Results The mean time to intubation was significantly shorter with ML than with GVL especially in experienced group . But for inexperienced group ,time to intubation was not different. There was no difference in the success rate of tracheal intubation between GVL and ML. The view of the glottis (CL) was significantly better with the GVL than with the ML especially in inexperienced medical student.

Conclusions GVL provided better laryngeal view than ML, but it took an additional 6 seconds for tracheal intubation.It had potential advantages over ML for difficult intubation especially in inexperienced medical student. But it had a longer time to intubation. .

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