Abstracts of the 2011 Paramedics Australasia Conference
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Australasian Journal of Prehospital Care: 2013;10(2) Conference Abstracts Abstracts of the 2011 Paramedics Australasia Conference Sydney, New South Wales, Australia 7th and 8th October 2011 Conference Presentation Abstracts that may influence clinical decision making and subsequent actions when assessing patients with A model of paramedic decision making in a complaint of pain. cases involving pain. Bill Lord Conclusions This model of clinical decision making may help Monash University, Victoria, Australia. guide the education of paramedics to enable an Objectives awareness of factors that have the potential to Patients have a right to pain relief on humanitarian adversely influence their clinical decision making. grounds. In addition, unrelieved pain may be associated with morbidity such as the development of chronic pain syndromes. Epidemiology of acute heart failure Paramedics have an important role in relieving presentations and prehospital treatment pain. However, therapeutic interventions that aim by paramedics in New South Wales, to reduce pain depend on clinical judgments that Australia: a retrospective analysis of over involve assessment of the of the patient's reported 7000 patients. symptoms. As pain is a symptom that is difficult to 1 2 Paul Simpson and Jason Bendall objectively validate it is conceivable that clinician's beliefs and attitudes may modify clinical 1Ambulance Research Institute, Ambulance judgements and consequently influence decisions Service of New South Wales, Sydney, New to withhold or initiate care. To investigate factors South Wales, Australia influencing paramedics' clinical judgments in 2University of Sydney, Sydney, New South cases involving pain the following research Wales, Australia questions were developed: 1) What are paramedics' beliefs about pain and attitudes Objective towards the assessment and management of pain To describe the epidemiology of ambulance in a community-based health setting; and 2) How responses to patients with presumed acute could these beliefs and attitudes influence cardiogenic pulmonary oedema (ACPO), their paramedics' clinical judgements in cases involving initial clinical presentation, and the impact of patients reporting pain. prehospital treatment on physiological vital signs. Methods Methods Paramedics and student paramedics were invited A retrospective analytic epidemiological study was to participate in focus group discussions that conducted into patients treated by paramedics for addressed pain and pain management in presumed ACPO between 1 July 2006 and 30 paramedic practice. Grounded Theory June 2008, utilising ambulance patient health care methodology was used to analyse transcripts of records (PHCR) linked with Medical Priority the focus group discussions, enabling the Dispatch System (MPDS) and Computer Aided development of theories of decision making in the Dispatch (CAD) data. Analysis was performed context of pain. using SAS 9.2 to calculate descriptive statistics and differences between groups. Results Four major thematic categories emerged from the Results data: expressing pain, assessing the patient, There were 7,243 presentations included in the believing the patient, and managing the patient final analysis. The median age of patients was 81 with pain. Sub themes from each category were years (IQR 74-87) and 53% were female. Median analysed to identify paramedic beliefs and scene time was 19 minutes (IQR 14-25) and total attitudes that may influence clinical judgements. A care time 31 minutes (IQR 24-40). Responses model of clinical decision making was occurred most commonly between 0600 and 0900 subsequently developed that uses an input- hours (19%) and during the colder, winter process-outcome taxonomy to illustrate variables months. Seventy percent of patients received The Official Journal of Paramedics Australasia © 2013 Paramedics Australasia 2011 Conference Abstracts nitrates, 44% diuretics, and 22% morphine. The mmol/L was higher following 10% dextrose when most common drug regime was nitrates alone compared to 50% dextrose (p<0.001) whereas the (70%), followed by nitrate/frusemide (19%) and proportion of patients with a post-treatment BGL nitrate/frusemide/morphine (19%). No drug of > 11.1 mmol/L was higher following 50% therapy was administered in 18% of cases. dextrose when compared to 10% dextrose. Overall, there were statistically significant improvements in all vital signs, particularly systolic Conclusions BP (mean 159 to 141 mmHg) and SpO2 (median There appears to be no difference in the efficacy 88% to 98%). of 50% dextrose solutions compared to 10% dextrose solutions in restoring consciousness Conclusion following hypoglycaemia. The time to restore ACPO is a common presentation with a distinct consciousness was modestly faster with 50% temporal pattern of presentation. Prehospital dextrose than 10% dextrose and this may have treatment appears to generally improve operational benefits. A BGL below the optimal physiological variables; however its effect on range was more frequent following 10% dextrose longer term outcomes after leaving ambulance whereas a BGL above the optimal range was care is unclear and should be the subject of future more frequent following 50% dextrose. It is research. unclear which dextrose solution is optimal for the prehospital management of hypoglycaemia. Irrespective of solution chosen, titration of the A comparison of 10% and 50% dextrose in dextrose dose to within an ‘optimal' range may the management of prehospital improve clinical practice. hypoglycaemia: A before-and-after study James M Bews1, Bernard L Champion1 ,3, Jason C Bendall2 ,4 Mathematical ability of first year undergraduate paramedic students - A 1University of Sydney, NSW, Australia 2 before and after study Ambulance Service of NSW, Rozelle, NSW, Malcolm Boyle, Kathryn Eastwood, Nathan Australia Stam 3The Nepean Hospital, Kingswood, NSW, Australia Monash University, Frankston, Victoria, 4Ambulance Research Institute, Rozelle, NSW, Australia Australia Objectives Objectives An ability to accurately perform drug calculations To compare the efficacy of 10% and 50% unassisted is an essential skill for all health dextrose concentrations in the treatment of professionals, with various occupational-specific prehospital hypoglycaemia. stressors exacerbating mathematical deficiencies. The scientific literature reveals Methods practicing paramedics have alarmingly low levels This retrospective before-and-after study of of accuracy when performing unaided patients with hypoglycaemia (blood glucose level mathematical drug calculations. The objective of (BGL) < 4mmol/L) was conducted in a large this study was to determine the unaided Australian ambulance service. Patients were mathematic ability of first year undergraduate administered either 10% dextrose or 50% paramedic students before and after a dextrose. The main outcome measures were time mathematical and drug calculation program. taken for hypoglycaemia to be reversed, post treatment conscious level and post treatment Methods blood glucose level (BGL). Students were administered a demographic, drug calculation and arithmetic questionnaire in the first Results: The study population comprised 2316 week of semester and before starting the program patients who met the inclusion criteria. There were to establish baseline performance. During the no statistically significant differences between the semester students participated in three tutorials two groups in baseline measures of patient age, which included both mathematical and drug gender, pre-treatment blood glucose level and calculation sessions without assistance of pre-treatment GCS. Consciousness was restored computational devices. The effectiveness of the faster following 50% dextrose than 10% dextrose program was assessed in a formative drug (p<0.001). Post treatment BGL was significantly calculations examination at the end of semester. lower in patients treated with 10% dextrose than Descriptive statistics were used to describe the in patients treated with 50% dextrose (6.9 mmol/L demographic and calculation answers with a versus 10.2 mmol/L p<0.001). The proportion of paired t-test comparing the questionnaire and patients with a post-treatment BGL of < 6.7 exam results. The Official Journal of Paramedics Australasia © 2013 Australasian Journal of Prehospital Care: 2013;10(2) Findings FICB may ultimately benefit patients by Conceptual, arithmetical, and computation ability minimising the unwanted systemic effects was significantly improved following this education associated with conventional pain management program and when comparing the correct results protocols. for the same question type (n=63), there were statistically significant differences in four of five Conclusion different drug calculations: volume of drug drawn To date, the emergency medical community up 10 v 57 p <0.0001, infusion rate 29 v 31 involved have shown great support for the trial, as p=0.717, drip rate 16 v 54 p <0.0001, volume from they are witnessing firsthand the benefits patients a syringe 30 v 59 p <0.0001, and drug dose 42 v are receiving from this intervention in their initial, 62 p <0.0001. but critical phase of care. The results of the prospective randomised controlled trial will better Conclusions inform the role of paramedic performed FICB. First year undergraduate paramedic students initially demonstrated a poor ability to complete mathematical and drug calculations without the Identification of out-of-hospital cardiac assistance of computational