Evaluating the coverage, characteristics, and enablers of the Royal Flying Doctor Service (Queensland Section)’s telehealth, medical chest and aeromedical retrieval model of trauma care

People living in regional, rural, and remote areas are more likely to experience poor health outcomes and to suffer traumatic injuries than those living in cities. When help is needed, patients, their families or carers can contact the Royal Flying Doctor Service(Queensland Section) (‘RFDS(QLD)’) directly using their 24/7 telehealth service. Doctors are available to provide advice remotely, and if needed, prescribe medications and potentially lifesaving treatments that are immediately accessible from the 1,300+ medical chests located across the state while an air retrieval is arranged. Between July 2022 – June 2024, RFDS(QLD) received 9,700+ calls of this kind. To ensure that people are getting the best care available, we need to better understand, who, when, and why people called RFDS(QLD) directly including how many needed help because of traumatic injuries and motor accidents. This research will conduct large-scale analyses of all these patients, their clinical presentations, treatments provided by the RFDS(QLD), and retrieval outcomes. Front-line emergency clinicians will also share their experiences about what works well and what could improve trauma management in regional, rural, and remote areas. Results will be used to improve what is known about trauma management and inform how the RFDS(QLD) designs and monitors its services on an ongoing basis. A RFDS(QLD) Trauma Research Network will also be established. This Network will increase research capability and capacity by supporting knowledge generation and skills development. Doing so, will enable clinicians to evaluate and influence RFDS(QLD) services beyond the life of this project.

Most clinical staff working in the ED are clinical facing, allowing little to no time to develop research or their skills in research. The primary aim of the CBG is to support, develop, and undertake research of importance for Robina ED with Robina ED staff, HHS Executives, and consumers.

Our strategic vision for the CBG is to have research an integral part of clinical practice and education at Robina ED and that guidelines and policies are informed by our research. It will be guided by the GCH ED Research Strategy which has 4 goals: 1) Organise emergency care research; 2) Build and streamline research capacity; 3) Promote excellence, relevance, and impact of research; and 4) Develop, strengthen, and sustain research partnerships.

Structure: To build research capacity specifically for Robina ED staff, the structure will involve the employment of a Robina-based ED Research Fellow (part-time) and Research Nurse (part-time), as well as consultancy from a consumer advisor, and health economist/statistician (see budget); Engagement of health service executives, local and international university academics, collaborators from other agencies; and specific mentorship from other ED research leaders using tested frameworks (NASEM, 2019).

Expected benefits of the CBG include: active research engagement and collaboration leading to partnerships between Robina ED clinicians, researchers, HHS Executive, consumers and external collaborators in the development of 2 projects led by staff at Robina with support from researchers; the development and sustainment of capacity building mechanisms for: research involvement opportunities for Robina ED clinicians, dissemination of research updates and findings, and research mentorship.

PINNACLE: Physiotherapists INjectiNg the AnaesthetiC Lidocaine in Emergency

Emergency Departments (EDs) are under considerable strain with increasing demand for services by consumers (1,2). In 2020-2021, there were approximately 8.8 million presentations to Australian public hospital EDs, a 6.9% increase compared to 2019-2020 (2). Increasing patient presentations into already crowded EDs drives the search for alternative approaches to patient care that might expedite treatment. At The Prince Charles General Emergency Department (TPCH-GED), a process for advanced scope Emergency Physiotherapy Practitioners (EPP) by certifying them to perform digital ring blocks to assist more timely management of finger/toe fractures/dislocations has been developed. This study aims to compare EPP performed digital ring blocks versus the current standard of care within TPCH-GED (medical officer (MO) administration) with respect to pain score of injection, adequate analgesia, first pass success; need for escalation, with secondary outcomes of time to block, patient satisfaction and ED length of stay between the EPP group and the MO group.

Improved Respiratory Support in Remote Settings for Children: A Paediatric Acute Respiratory Intervention Study (PARIS), PARIS on Country

The next phase of studies, titled "Paris on Country," represents a continuation of efforts in Australia and New Zealand to enhance care for infants and children presenting with acute respiratory issues in emergency departments. Through these studies, we have successfully implemented changes in treatment protocols, aimed at alleviating respiratory distress and reducing anxiety for both patients and their parents.
In rural and remote areas of Queensland, approximately 38 percent of the state's total population resides. However, access to healthcare and emergency services in these areas can significantly differ from urban regions. The primary goal of this project is to elevate the standard of care for children experiencing acute respiratory distress in remote and regional settings to match the level of care available in larger cities.

Does a Vascular Access Specialist Model in the Emergency Department (VAS-ED) improve peripheral intravenous catheter outcomes? A Randomised Controlled Trial

More than 6 million peripheral intravenous catheters (PIVCs) are inserted in patients' veins in Australian emergency departments (EDs) annually. These devices can be challenging to insert, and over half will fail before the treatment is finished. Although ED clinicians regularly insert PIVCs, most inserters are junior medical or nursing staff who often default to short PIVCs because that is what they were trained to insert. These “generalist” inserters often don’t have the skills or knowledge to select alternate vascular access devices appropriate to the patient's needs. In contrast, Vascular Access Specialists (VAS) are experts with advanced assessment and expertise in inserting and managing vascular access devices, a model that has proven successful in inpatient wards, but hasn’t yet been tested in the ED setting.

In this study, we will compare the effectiveness and cost of using VAS specialists versus generalist inserters for peripheral IV device selection and insertion. In total, 320 ED patients will be recruited and randomly allocated to receive either a VAS or generalist inserter (standard care). We will compare outcomes including first-time insertion success, device failure rates, complications, patient satisfaction, and cost between the two groups. Additionally, we will interview clinicians to better understand the barriers and facilitators to implementing and using a VAS model.

We expect that patients who have a peripheral IV device inserted by a VAS will have higher first-time insertion success, and be more satisfied with their care than patients allocated to the generalist group.

Efficacy of pressure pad vs pressure bandage immobilisation for snake bite first aid

Snake bite affects thousands of Australians every year, but few die as a result due to high quality first aid and timely medical care. Good first aid should be simple, standardised, use minimal or readily available equipment, and be able to be utilised effectively with no or minimal training by the rescuer. Over time the first aid methods used to manage snake bite in Australia have been questioned due to issues with efficacy, and some emerging evidence of harm from their use. There is little experimental data in the literature to support current first aid practices, and what exists suggests further research is required. Our study aims to examine and compare the effectiveness of two first aid methods by tracking the movement of a mock venom through the body when each first aid method is used. This will provide important information about the suitability of current techniques used in Australia and whether a proposed simpler alternative technique is as effective. If this is demonstrated to be correct it provides a basis for modifying current snake bite first aid recommendations.

The feasibility of point-of-care ultrasound conducted by physiotherapists for the diagnosis of ankle syndesmosis injuries in the Emergency Department: A diagnostic study

Syndesmosis injuries, also known as a high ankle sprain, due to ligamentous injury are relatively uncommon but can have devastating outcomes when missed. This includes chronic pain, instability and osteoarthritis. Early surgical fixation of these injuries is recommended in some cases. Magnetic Resonance Imaging (MRI) is the most accurate way to diagnose these, but not ordered in the emergency department (ED) due to its cost and poor availability. Although clinical tests can help to narrow down who needs an MRI, they are often inaccurate in the acute phase. Ultrasound performed by sonographers can visualise ligament to components of the syndesmosis complex to streamline MRI referrals but is under demand during the day and not available afterhours. Point of Care Ultrasound (POCUS) performed by clinicians is an alternative option for imaging.

Emergency physiotherapy practitioners (EPP) typically manage patients with musculoskeletal injuries in the ED and are well placed to perform musculoskeletal POCUS. This study will evaluate the feasibility and accuracy of ED physiotherapist-performed POCUS for the diagnosis of ligament injury in the ED, indicative of a syndesmosis injury, against radiology-performed ultrasound. This could guide MRI patient selection to allow for earlier detection of unstable ankle injuries and expedite outpatient orthopaedic expert review and management. If POCUS by ED physiotherapists is demonstrated to be feasible and accurate for these syndesmosis injuries, the results of this study could inform the development of a diagnostic pathway that could be implemented in EDs locally and throughout Australia.