Evaluating the effectiveness of pre-hospital fibrinogen concentrate administration for major haemorrhage

Fibrinogen is a component of blood that is vital in the formation of blood clots, and low levels are often found in trauma patients who are bleeding. Low levels of fibrinogen cause problems with blood clotting and result in ongoing bleeding. Replacement fibrinogen has only been available in major hospitals which has been a problem given that the majority of trauma patients (most from the result of road accidents) treated by pre-hospital medical services are in rural and remote areas where this has not been available. Fibrinogen concentrate (FibC) is being introduced into Queensland’s pre-hospital and retrieval services to improve equity of access and facilitate early administration to patients that are critically bleeding. This study aims to evaluate the effectiveness of early FibC administration for bleeding trauma patients in the pre-hospital and retrieval setting and is the first study of its kind to do so. Should the study find a significant benefit of this early administration it will result in improved outcomes for such trauma patients, and has the potential to modify international medical practice in the management of bleeding trauma patients.

Aeromedical Retrieval of people with Acute Behavioural Disturbance in Queensland – ELEVATE Study

The burden of mental illness on the Australian community and public health care system is substantial. (1) Every year in Queensland, approximately 300 people who present to a rural or remote ED location with acute behavioural disturbances (ABD) require aeromedical retrieval to an Authorised Mental Health Service (AMHS). ABD is “combined physical actions made by an individual which are in excess of those considered contextually appropriate and are judged to have the potential to result in significant harm to the individual themselves, other individuals or property” of rapid onset and a severe nature.(2)The transfer of people experiencing ABD is challenging due to difficulties in balancing patient rights and safety against that of the retrieval team. The aeromedical retrieval environment is restrictive, both in physical size and in relation to resource access, necessitating a heavy emphasis on risk-mitigation. Whilst research has established a safe approach to the sedation of people with ABD, other aspects of their retrieval remain lacking in evidence, and may contribute to suboptimal care and delayed access to specialist mental health services. This programme of research aims to explore those areas to ensure the management of people with ABD requiring aeromedical retrieval is optimal. Should changes in practice be required as a result, operating procedures and policies with Queensland's aeromedical network will occur.

Coronary Artery Disease in Aboriginal and Torres Strait Islander People

The current assessment for emergency department (ED) patients with chest pain focuses on the short-term risk of heart attack, to differentiate low risk patients from those at high risk and requiring further treatment. This has been shown to be safe and effective for non-Indigenous patients, however, deaths from heart attack in Indigenous Australians occur, on average, at younger ages than non-Indigenous Australians.

Due to the high lifetime prevalence of heart attack in Indigenous Australians, ED investigations that focus on both short- and long-term risks may improve outcomes. Understanding rates of, and the types of patients who have coronary artery disease in this cohort would provide additional information about who requires further testing.

The aim of this study is to measure the rate of coronary artery disease in Aboriginal and Torres Strait Islander people who present to the ED with chest pain. By identifying how many Indigenous patients with chest pain in the ED have coronary artery disease, researchers aim to establish foundational knowledge to develop a heart attack risk assessment that is specific to Indigenous patients.

Classifying the type and severity of traumatic injury in North Queensland: a multicentre retrospective study

Queenslanders living in regional, rural and remote areas have a higher incidence of traumatic injury and poorer access to health services than their urban counterparts.

Researchers propose to undertake a first-of-its-kind study to classify and characterise trauma patients from these areas serviced by Townsville, Cairns, Mt Isa, and Mackay Hospitals over the three-year period 2016-2018. Using patient records, researchers will examine the clinical therapies and interventions used and patient outcomes from point-of-injury through to hospital discharge.

The study will capture, collate and compare patient data from Queensland Health, Retrieval Services Queensland (RSQ), LifeFlight Retrieval Medicine (LRM) and the Royal Flying Doctor Service (RFDS) to assess the current state of emergency trauma care in the Queensland Tropics, and any potential gaps in aeromedical healthcare delivery. The results will also provide a springboard for a wider system and processes assessment of emergency trauma care for the benefit of patients in North Queensland.

Coronary Artery Disease in Aboriginal and Torres Strait Islander People

Aboriginal and Torres Strait Islander people die from heart attacks at younger ages than non-indigenous Australians. The factors that increase risk of death from heart attack in young Aboriginal and Torres Strait Islander people are unknown.

Most patients who present to an Emergency Department (ED) with chest pain do not have a heart problem but all are assessed for their risk of having a life-threatening cause, such as heart attack. The level of risk determines which tests are performed so that a final diagnosis can be obtained as quickly as possible. Due to the lack of knowledge about risk factors in the Aboriginal and Torres Strait Islander population there is uncertainty about how best to use chest pain risk assessments in indigenous patients.

In this study, we will determine the rate of coronary artery disease (a hardening of arteries and the underlying cause of heart attacks) in Aboriginal and Torres Strait Islander people who present to the ED with chest pain. We will also compare the characteristics of patients who do and do not have heart attacks to identify potential risk factors for heart attack in this population.

The findings from this study will: 1) allow ED doctors to determine a baseline level of risk of heart attack for the Aboriginal and Torres Strait Islander patient population, and 2) provide preliminary information necessary for the design of large-scale research studies with the goal of determining specific risk factors for heart attack in Aboriginal and Torres Strait Islander people.

The Queensland Aeromedical Retrieval System: A Review of Current Status and the Impact of State-wide System Developments.

Aeromedical retrievals and transfers are an essential component of modern Emergency Medicine. These services provide high quality emergency care to the patient and facilitate transport from the roadside or smaller hospitals to larger centres able to perform potentially life saving treatments and provide definitive care. Thus they help ensure equity of access to high quality medical care regardless of physical isolation. This is especially important in Queensland, the most decentralised Australian state.

Until recently aeromedical clinical coordination and retrieval services in Queensland were provided by a several different organizations. In 2005 a system restructure was commenced and a state-wide centralised Queensland Emergency Medical System (QEMS) Clinical Coordination Centre and dedicated medical retrieval and transfer service was established. Standardised retrieval service data has been collected centrally since February 2007 with over 18,000 patients transported each year.

The project will review in detail five years of state-wide aeromedical retrieval system activity to describe the nature and extent of services provided.