A community of practice to strengthen pre-hospital interventions and post-discharge care for mental health crises in north Queensland hospitals

Communities of practice (CoP) are widely used to strengthen and enhance healthcare, by generating and sharing knowledge and improving organisational performance. In Australia CoPs have been used in fields such as healthcare improvement, mental health and mental health literacy, and workplace health and wellbeing and more recently in response to COVID 19.

This project will assess the possible scope for a CoP, and the extent to which a CoP might find support among collaborating service organisations, to focus attention on issues surrounding emergency mental health presentations to hospital emergency departments (EDs) in north Queensland.

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.

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.

Emergency Examination Authorities and their impacts on North Queensland Hospitals

Emergency Departments (EDs) receive persons suffering major disturbances in their mental capacities, detained and transported by police or ambulance. The Public Health Act 2005 (Qld) (‘PHA’) – amended and in force 5 March 2017 – requires police and ambulance officers to make out an Emergency Examination Authority (EEA) at handover.1 Previously, Emergency Examination Orders (EEOs) were made out under Queensland’s Mental Health Act 2000 (‘MHA’). At handover, police and ambulance officers must make out an EEA. From handover at the ED, the PHA prescribes specific responsibilities, e.g. a doctor or health practitioner must explain to the person that they may be detained for 6-12 hours, the ED Director can order their forced return if they abscond and must take reasonable steps to return patients to a place requested.

Using qualitative and quantitative information the study focuses on the time and personnel resources required to investigate how EDs in north Queensland have responded.

No study has assessed the impacts on Queensland EDs of increasing numbers of mental health related presentations in light of legislative changes governing emergency assessment

Capacity Building Grant: Cairns Base Hospital

Cairns Base Hospital Emergency Department is committed to attracting the best emergency physicians and trainees. Our research commitment over the years, particularly the ability to provide 4.10.70 direction and opportunities, has been recognised by our peers as significant, particularly in an environment of heavy clinical \workloads and limited funding opportunities. In the past two years the CBH executive has worked to balance this by increasing staff numbers and allowing more academic opportunities for Emergency Physician and trainees alike.

This Capacity building grant allows the Hospital to appoint, for three years, Associate Professor Jamie Seymour from the James Cook University, School of Medicine and Tropical Biology, as a Research Fellow. A/Prof Seymour has a history of involvement in research with the Hospital's ED -- primarily, but not restricted to, toxinology and advice in study design and analysis. This grant enabled the Hospital to considerably expand and formalise the collaboration.

In his role as Senior Research Fellow, A/Prof Seymour will provide the experience and expertise need to help the Department apply for successful grant applications and help attract and immerse Emergency Medicine trainees in a fertile research environment that actively encourages them with their 4:10:70 as well as research in thelr ongoing career. The department believes that this approach will also increase its attractiveness to emergency physicians in relation to job placement and has unanimous support from the consultants in the department.

The department envisages that the Research Fellow would conduct research training on a weekly basis as part of the present teaching protocol where research ideas and published studies are discussed and examined, where experimental design and statistical analysis of proposed research projects can be developed.

Development of a human cardiac myocyte assay for the production of lethal dose response curves for box jellyfish venoms: Can heat and intralipids be used as a treatment for cubozoan envenomings?

The problem of box jellyfish stings is an issue of medical and commercial importance to tropical Australia, notably in Queensland, Northern Territory and Western Australian coastal communities, threatening the perception of Australia as a safe destination. For example, approximately 160 people from Queensland resorts, including many international visitors, were hospitalized following envenoming during the summer of 2001-02 closing much of the frequented north Queensland coastline.
Fatalities from Irukandji and Chironex box jellyfish stings and the loss of tourism to affected areas present both a medical and economic challenge. Although cubozoan envenoming in Australia may be seen as a minor "medical" concern (compared to other tropical diseases), it represents a major cost to northern Australian communities in terms of public health, leisure and tourism
We aim to
i) produce dose response curves for various concentrations of cubozoan venoms (namely Chironex fleckeri and the irukandji jellyfish, Carukia barnesi) on human cardiac myocytes.
ii) to determine the lipid solubility of Chironex and Irukandji venom in ILE and its effectiveness in decreasing the lethality of these venoms in human cardiac myocytes assays.
iii) to test the hypothesis that irukandji venom is heat labile and can be de-activated at thermal loads that do not cause permanent damage to the tissues of envenomed victims.
These aims will be achieved by testing jellyfish venoms on human heart cells, to determine the relationship between the concentration of jellyfish venoms to death rate of the cells. Using this data we will then be able to determine if new and novel approaches to treatment, i.e. the use of heat and intralipids, may benefit jellyfish envenomed patients.

Envenomation, first aid and critical care of tropical jellyfish stings

Queensland is currently recognised as the leader in the field of jellyfish envenoming treatment. Many of the treatments for jellyfish stings are not evidence based and data is emerging that suggests that some of the treatments may do more harm to jellyfish sting victims than good.
This project will investigate three major areas of present contention:
• Is vinegar a suitable first aid for jellyfish stings?
• Can the survival rate of victims stung by big box jellyfish be increased by simply continuing CPR for extended periods?
• Can readily available and used drugs be the answer to the ever-increasing Irukandji Syndrome?