The Queensland Ambulance Service (QAS) provides out-of-hospital medical services to approximately 900,000 patients annually, and as the publicly funded provider of prehospital emergency care is called to respond to persons incarcerated within correctional facilities. The primary complaint of patients attended by QAS in this setting are minor orthopaedic injuries to the upper arm and hand. In current practice, paramedics provide short-lasting analgesia and temporary limb splinting or bleeding control, before conveying the patient to an emergency department for further management. Transport of patients from correctional facilities to public hospitals is complex, presenting potential risks to staff and the public, and is time consuming and resource intensive. As these injuries are predominately uncomplicated fractures or simple lacerations, it has been postulated these patients may be more appropriately managed by enhancing the care that can be provided onsite by the QAS, with the patient subsequently managed through an outpatient clinic and thereby avoiding an unnecessary presentation to hospital. This project proposes developing a new collaborative treatment pathway involving the QAS, QLD Health and QCS for patients with minor orthopaedic injury. The aim is to reduce unnecessary, time and resource intensive transports to hospital emergency departments for this cohort of patients. Grant funding is sought to undertake an evaluation of this initiative. This model of care provision, if proven effective, could potentially be considered for implementation in other correctional facilities or austere healthcare settings where primary health care resources are stretched, and consequently additional demands are placed on emergency care settings.READ MORE
There have been significant increases in system pressure for unscheduled public healthcare in Australia. Likewise, ambulance services have seen an unprecedented increase in demand for services along with a change in ambulance utilization. These pressures affect all aspects of patient flow, from triple zero call through to hospital admission and discharge. Improvements in the integration of prehospital services into the healthcare system can reduce time delays at their interface. Triage and clinical deterioration tools guide clinicians' decisions when directing patients to clinical streams within the emergency department whilst balancing patient safety. Paramedics are highly trained clinicians, that are well placed to assess and determine a patient’s clinical priority and potential for deterioration. If paramedics can demonstrate their application of validated triage and clinical deterioration tools to efficiently and safely direct patients to the most appropriate facility and/or clinical stream within a facility, then there would be potential time savings across the system. Furthermore, this would provide a validated tool to identify patients that are safe to be referred to the virtual emergency department. This study proposes to assess paramedics' ability to apply triage and clinical deterioration tools to identify the clinical stream either within an emergency department or via the virtual emergency department. If successful, this process could improve patient safety while reducing delays at the ambulance and emergency department interface.READ MORE
Queensland Ambulance Service (QAS) Critical Care Paramedics are authorised to perform reduction of displaced fractures and dislocations in the presence of neurovascular compromise. This is frequently facilitated by procedural sedation with ketamine. Performance of this procedure in the prehospital setting is not well reported in the medical literature
Using the QAS database of electronic Ambulance Report Forms we will identify all cases where fracture or dislocation reduction was performed and report on the efficacy of this procedure using resolution of neurovascular compromise as the primary endpoint. We will use the requirement for further sedation and reduction in the emergency department as a secondary measure of the success of the procedure. The incidence of adverse events related to the sedation or to the procedure will also be reported.READ MORE
Injuries confer a substantial burden on ambulance services. Ensuring optimal pain management for injured patients in the out-of-hospital setting is imperative, and even more so for those living in rural/remote areas, where transportation times to hospital may be longer. There is evidence for the potential for improvement in pain relief in the out-of-hospital setting. Inadequate pain relief has lasting negative physiological and psychological implications and decreases overall quality of life. While there is little research focusing specifically on management of pain incurred through trauma in regional/rural/remote environments, there are several reasons that pain management may be suboptimal in rural/remote trauma patients, compared with patients in major cities. This research aims to describe pre-hospital pain management for trauma patients in regional/rural/remote Queensland and to compare this with pain management provided in major cities. Secondarily, we aim to identify and describe perceived barriers/facilitators of optimal pain management among paramedics in rural/remote areas, compared with those in major cities. This study will incorporate three components:
1) Data from the Queensland Ambulance Service(QAS) will be used to describe current pain management practices for those sustaining injury;
2) Queensland paramedics will be surveyed to gather information on pain management and whether/how this differs across major cities/rural/remote settings;
3) Interviews with rural and remote paramedics will be conducted about their experiences and perceptions in managing pain in trauma patients
Ultimately our goal is to identify explicit opportunities to mitigate barriers and enhance enablers to optimise pain management for those experiencing trauma in rural/ remote settings.READ MORE
Head injury results in a high degree of ongoing disability. Risk of Traumatic Brain Injury (TBI) is higher in the 15-19 and 75+ age groups with older Australians having a three times greater incidence compared to the general population (Pozzato, Tate, Rosenkoetter, & Cameron, 2019).
There are two distinct aspects to a severe head injury - the primary injury and the secondary injury that occurs as a result of deranged brain functioning. Treatments are targeted at minimising the damage occurring during the secondary stage and to protect damaged brain tissue by optimising blood flow, oxygen delivery and reducing the metabolic needs of the brain.
There is currently no way to closely monitor the 'real-time' physiologic changes beyond clinical symptoms such as changes in pupil size, heart rate, blood pressure etc. and, in the case of rising pressure in the brain, treatment is initiated on clinical suspicion alone. Electroencephalograms (brain wave monitors) have shown promise in their ability to detect brain oxygen starvation, seizure presence and increased pressure in the brain.
This pilot of Quantitative EEG (qEEG) will measure these changes during prehospital care of TBI, the results of this research would be used to guide larger studies into the use of this technology.READ MORE
Peripheral intravenous cannulation (PIVC) is a vital part of modern medicine, however the use of cannulas has become prolific, with many never used. The patient risks that are associated with PIVC are well documented, including pain and infections, which can be severe and lead to death.
Reducing the rate of idle PIVCs (inserted but never used) may reduce the overall rate of risks, side-effects and infections associated with PIVC, but may also lead to patients who require PIVC not receiving one.
This study aims to describe: I) the proportion of PIVCs placed that do not get used within 24 hours (idle PIVCs), II) differences between the pre-hospital setting and the emergency department and III) the factors associated with clinicians’ decision making regarding PIVC insertion.READ MORE