Implementation of Nasal High Flow: A Remote Context

In this study, the clinician-researchers are exploring whether nasal high flow (NHF) therapy can be safely and effectively used to improve health outcomes for infants with bronchiolitis in isolated remote communities, in particular for remote Indigenous Australians who have a higher incidence rate of bronchiolitis than non-Indigenous Australians. There is a desire by clinicians to implement NHF in remote areas, but this should undergo similar scientific scrutiny as previous published data.

NHF is a respiratory support system that provides support for people with respiratory conditions and is applied by high flow oxygen through nasal prongs. The therapy can avoid an escalation of care during hospitalisation. The safety of NHF has been widely studied in tertiary areas and regional hospitals, however, there is a lack of evidence to support safe use in remote settings.

In this study, the researchers are employing a two-phased approach: Firstly, an expert working party establishing agreed safe clinical boundaries for the NHF implementation and utilising expert viewpoints for implementation when managing infants with bronchiolitis. Secondly, a comparison of the outcomes before and after implementation to observe a reduction in escalation of care leading to reduced transfers. A community engagement process, with the focus to keep community members in their country/home environment, will be established to measure psychological, social-emotional and economic benefits of NHF.

Point-of-care testing for better management of acutely ill remote patients.

Australians living in rural and remote areas experience a significantly higher burden of acute care episodes compared to those living in metropolitan and urban areas. A contributing factor is the effect of geographical isolation and its impact on access to health services including pathology testing. We aim to assess the benefits of using point-of-care testing at remotely located health centres of the Northern Territory. Point-of-care testing enables pathology testing to be performed on-site, with results available during the patient consultation. We will investigate the clinical benefits of using point-of-care testing to either rule-out a potential acute medical problem, stabilise an acutely ill patient, and/or to confirm an emergency medical evacuation is required for patient care. The project will also determine the cost savings associated with point-of-care testing preventing unnecessary emergency medical retrievals, which come at a high cost to the Northern Territory Government.

Ketamine vs Propofol in Sedation of Psychiatric/Psychotic Patients requiring Retrieval.

The research aim is to conduct as a randomised clinical trial comparing the use of Ketamine and Propofol in sedating acute psychiatric patients for safe aeromedical retrieval. The inherent dangers of the aviation environment combined with the potential and unpredictable behaviour of acute psychiatric patients presents a challenge to even the most experienced aeromedical retrieval clinician. An efficacious sedation drug is vital in this environment to ensure patient and crew safety and to minimise patient distress. The outcomes of this research will highlight the potential complications, the safety profile and efficacy of different sedation agent utilised in the sedation of acute psychiatric patients in the aeromedical retrieval setting. This research has the potential to establish sedation guidelines in the aeromedical retrieval of acute psychiatric patients for Australia and internationally.

Using a modified blood pressure cuff to prevent cell death for rural people suffering a heart attack or stroke.

Stroke and heart attacks (HA) are caused by blocked brain or heart blood vessels. The impact of stroke or HA depends in part on time taken to unblock occluded blood vessels. Rural people with stroke or HA receive treatment to unblock vessels later than city folk. The delay to re-perfusion causes damage and worse outcomes for country people experiencing stroke or HA. Late re-perfusion is associated with increased brain or heart injury. A treatment called "remote-ischaemic-conditioning" (RIC) involves a modified blood-pressure cuff that occludes limb blood flow for short periods, is known to protect against re-perfusion injury. The aims of this study are: investigate the feasibility, safety and efficacy of RIC in preventing re-perfusion injury for rural people experiencing a stroke or HA. The expected outcomes of RIC include: lower levels of brain or heart damage and disability following a stroke or HA amongst rural people.