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ambulance victoria

Stefan Heschl, Ben Meadley, Emily Andrew, Warwick Butt, Stephen Bernard, Karen Smith
INTRODUCTION: Prehospital airway management of the paediatric patient with traumatic brain injury (TBI) is controversial. Endotracheal intubation of children in the field requires specific skills and has potential benefits but also carries potentially serious complications. We aimed to compare mortality and functional outcomes after six months between children with TBI who either underwent prehospital rapid sequence intubation (RSI) by trained Intensive Care paramedics (ICP) or received no intubation...
February 12, 2018: Injury
Jacinta Waack, Matthew Shepherd, Emily Andrew, Stephen Bernard, Karen Smith
OBJECTIVE: Delayed sequence intubation (DSI) involves the administration of ketamine to facilitate adequate preoxygenation in the agitated patient. DSI was introduced into the Clinical Practice Guideline for Intensive Care Flight Paramedics in Victoria in late 2013. We aimed to describe the clinical characteristics of patients receiving DSI. METHODS: A retrospective analysis was undertaken of patients who received DSI between January 1, 2014, and December 31, 2016, during both primary response and retrieval missions...
February 6, 2018: Prehospital Emergency Care
Ashleigh Delorenzo, Toby St Clair, Emily Andrew, Stephen Bernard, Karen Smith
OBJECTIVE: Rapid sequence intubation (RSI) is an advanced airway procedure for critically ill or injured patients. Paramedic-performed RSI in the prehospital setting remains controversial, as unsuccessful or poorly conducted RSI is known to result in significant complications. In Victoria, intensive care flight paramedics (ICFPs) have a broad scope of practice including RSI in both the adult and pediatric population. We sought to describe the success rates and characteristics of patients undergoing RSI by ICFPs in Victoria, Australia...
February 6, 2018: Prehospital Emergency Care
Gayle McLelland, Lisa McKenna, Amee Morgans, Karen Smith
BACKGROUND: Over the previous two decades the incidence and number of unplanned out of hospital births Victoria has increased. As the only out of hospital emergency care providers in Victoria, paramedics would provide care for women having birth emergencies in the community. However, there is a lack of research about the involvement of paramedics provide for these women and their newborns. This research reports the clinical profile of a 1-year sample caseload of births attended by a state-wide ambulance service in Australia...
January 8, 2018: BMC Pregnancy and Childbirth
David R Vinson, Dustin W Ballard, Jie Huang, Mary E Reed, James S Lin, Mamata V Kene, Dana R Sax, Adina S Rauchwerger, David H Wang, D Ian McLachlan, Tamara S Pleshakov, Matthew A Silver, Victoria A Clague, Andrew S Klonecke, Dustin G Mark
STUDY OBJECTIVE: Outpatient management of emergency department (ED) patients with acute pulmonary embolism is uncommon. We seek to evaluate the facility-level variation of outpatient pulmonary embolism management and to describe patient characteristics and outcomes associated with home discharge. METHODS: The Management of Acute Pulmonary Embolism (MAPLE) study is a retrospective cohort study of patients with acute pulmonary embolism undertaken in 21 community EDs from January 2013 to April 2015...
December 13, 2017: Annals of Emergency Medicine
Michael Tieland, Janne Beelen, Anna C M Laan, Shirley Poon, Lisette C P G M de Groot, Ego Seeman, Xiaofang Wang, Sandra Iuliano
OBJECTIVE: Although it has been established that sufficient protein is required to maintain good nutritional status and support healthy aging, it is not clear if the pattern of protein consumption may also influence nutritional status, especially in institutionalized elderly who are at risk of malnutrition. Therefore, we aim to determine the association between protein intake distribution and nutritional status in institutionalized elderly people. DESIGN: Cross-sectional study among 481 institutionalized older adults...
January 2018: Journal of the American Medical Directors Association
Stefan Heschl, Emily Andrew, Anthony de Wit, Stephen Bernard, Marcus Kennedy, Karen Smith
OBJECTIVE: The optimal volume and type of intravenous fluid for the treatment of blood loss in the prehospital setting is controversial. The use of red cell concentrates (RCCs) may be associated with improved outcomes; however, the administration of blood products is limited to physicians in many jurisdictions. We sought to describe the characteristics of RCC transfusions in a paramedic-staffed helicopter emergency medical system in Victoria, Australia. METHODS: We performed a retrospective analysis of all cases where paramedics consulted the responsible physician for approval of RCC transfusion between July 2011 and December 2015 in Victoria, Australia...
November 17, 2017: Emergency Medicine Australasia: EMA
Carolyn Pinto, Peter A Cameron, Belinda Gabbe, Susan McLellan, Tony Walker
The aim of the present study was to describe the trauma case review process and its role in a regionalised trauma system. Victoria has a population of 5.9 million people, accounting for 26% of Australia's population. Victoria has been serviced by an inclusive, organised trauma system since 2000 comprising 138 health services with trauma designations and three major trauma services. Pre- and interhospital guidelines prescribe the timely transport of patients to the appropriate level of trauma service. A review of the role and contribution of 10 years of operation of the trauma case review group (CRG) was undertaken to describe the aims, processes and governance surrounding the implementation of an individual case review for specified major trauma patients...
November 7, 2017: Emergency Medicine Australasia: EMA
Owoicho Adogwa, Aladine A Elsamadicy, Victoria D Vuong, Jessica Moreno, Joseph Cheng, Isaac O Karikari, Carlos A Bagley
OBJECTIVE Geriatric patients undergoing lumbar spine surgery have unique needs due to the physiological changes of aging. They are at risk for adverse outcomes such as delirium, infection, and iatrogenic complications, and these complications, in turn, contribute to the risk of functional decline, nursing home admission, and death. Whether preoperative and perioperative comanagement by a geriatrician reduces the incidence of in-hospital complications and length of in-hospital stay after elective lumbar spine surgery remains unknown...
December 2017: Journal of Neurosurgery. Spine
Owoicho Adogwa, Aladine A Elsamadicy, Amanda R Sergesketter, Collin Black, Aaron Tarnasky, Michael O Ongele, Victoria D Vuong, Syed Khalid, Joseph Cheng, Carlos A Bagley, Isaac O Karikari
BACKGROUND: The aim of this study was to assess whether the Koenig Depression Scale (KDS) can identify depressed elderly patients undergoing elective spine surgery for deformity at risk for inferior postoperative outcomes including complication rates, ambulation ability, and patient-reported outcomes. METHODS: The medical records of 92 elderly patients (≥65 years) undergoing a planned elective spinal surgery for correction of adult degenerative scoliosis were reviewed for this study...
November 2017: World Neurosurgery
Melanie Villani, Natalie Nanayakkara, Sanjeeva Ranasinha, Arul Earnest, Karen Smith, Georgia Soldatos, Helena Teede, Sophia Zoungas
AIMS: This study examines prehospital Emergency Medical Service (EMS) utilisation and patterns of demand for hyperglycaemia management, including characteristics of individuals and factors related to hospital transport. MATERIALS AND METHODS: A state-wide, community-based observational study of all patients requiring prehospital EMS for hyperglycaemia during a 7 year study period (Jan 2009-Dec 2015) using electronic data from the Ambulance Victoria data warehouse was conducted...
2017: PloS One
Ashleigh J Delorenzo, Jeremy W Abetz, Emily Andrew, Anthony de Wit, Brett Williams, Karen Smith
OBJECTIVE: Air medical transport is important for the transfer of patients in the prehospital and interhospital environment. Few studies have described the services provided by fixed wing ambulances or the broader clinical profiles of patients they transport. Such information may be useful for the planning and allocation of resources, assistance with training, and refining clinical protocols. We sought to describe the characteristics of patients transported by fixed wing aircraft at Air Ambulance Victoria (AAV) and the service AAV provides in Victoria, Australia...
July 2017: Air Medical Journal
Brett Williams, Bronwyn Beovich, Geoff Flemming, Grant Donovan, Ian Patrick
Previous studies indicate that healthcare professionals find it challenging to engage in difficult conversations regarding concerning behavior of colleagues. As a result, these conversations are often avoided. The inability to have these difficult conversations is associated with poorer patient outcomes, staff commitment, discretionary effort, and employee satisfaction. This descriptive study used an online questionnaire to examine responses of paramedics employed by Ambulance Victoria (Australia) regarding difficult conversations between colleagues about concerning behavior of co-workers...
September 2017: Nursing & Health Sciences
Pieter Francsois Fouche, Paul Andrew Jennings, Karen Smith, Malcolm Boyle, Gabriel Blecher, Jonathan Knott, Mani Raji, Pamela Rosengarten, Michael Roberto Augello, Stephen Bernard
INTRODUCTION: Rapid sequence intubation (RSI) is not only used in traumatic brain injuries in the out-of-hospital setting, but also for non-traumatic brain pathologies (NTBP) such as brain tumors, meningitis, encephalitis, hypoxic/anoxic brain injury, stroke, arteriovenous malformations, tumors, aneurysms, brain hemorrhage, as well as brain injury due to diabetes, seizures and toxicity, metabolic conditions, and alcohol and drug overdose. Previous research suggests that RSI is common in non-traumatic coma, but with an unknown prevalence of NTBP in those that receive RSI...
November 2017: Prehospital Emergency Care
Janet E Bray, Lahn Straney, Karen Smith, Susie Cartledge, Rosalind Case, Stephen Bernard, Judith Finn
BACKGROUND: Bystander cardiopulmonary resuscitation (CPR) more than doubles the chance of surviving an out-of-hospital cardiac arrest. Recent data have shown considerable regional variation in bystander CPR rates across the Australian state of Victoria. This study aims to determine whether there is associated regional variation in rates of CPR training and willingness to perform CPR in these communities. METHODS AND RESULTS: We categorized each Victorian postcode as either a low or high bystander CPR region using data on adult, bystander-witnessed, out-of-hospital cardiac arrests of presumed cardiac etiology (n=7175) from the Victorian Ambulance Cardiac Arrest Registry...
June 5, 2017: Journal of the American Heart Association
Janet E Bray, Sonia Denisenko, Bruce C V Campbell, Michael Stephenson, Jason Muller, Grant Hocking, Peter J Hand, Christopher F Bladin
BACKGROUND: In 2010, rapid access to stroke thrombolysis centres was limited in some regional areas in the Australian state of Victoria. These results, and planning for endovascular clot retrieval (ECR), have led to the implementation of strategies by the Victorian Stroke Clinical Network, the Victorian Stroke Telemedicine Program and local health services to improve state-wide access. AIMS: To examine whether access to stroke reperfusion services (thrombolysis and ECR) in regional Victoria have subsequently improved...
August 2017: Internal Medicine Journal
Kate Cantwell, Amee Morgans, Karen Smith, Michael Livingston, Paul Dietze
OBJECTIVE: To describe the clinical presentation and temporal variation in ambulance service cases involving patients aged 65 years or older (older adults) from residential aged care facilities and those who are community dwelling (CD). METHODS: This study used four years of electronic case records from Ambulance Victoria in Melbourne, Australia. Trigonometric regression was used to analyse demand patterns. RESULTS: Residential aged care facility cases included proportionally more falls and infection-related problems and fewer circulatory-related incidents than CD cases...
May 7, 2017: Australasian Journal on Ageing
Melanie Villani, Arul Earnest, Natalie Nanayakkara, Karen Smith, Barbora de Courten, Sophia Zoungas
BACKGROUND: Acute diabetic emergencies are often managed by prehospital Emergency Medical Services (EMS). The projected growth in prevalence of diabetes is likely to result in rising demand for prehospital EMS that are already under pressure. The aims of this study were to model the temporal trends and provide forecasts of prehospital attendances for diabetic emergencies. METHODS: A time series analysis on monthly cases of hypoglycemia and hyperglycemia was conducted using data from the Ambulance Victoria (AV) electronic database between 2009 and 2015...
May 5, 2017: BMC Health Services Research
Alaa O Oteir, Karen Smith, Johannes Stoelwinder, James W Middleton, Shelley Cox, Lisa N Sharwood, Paul A Jennings
OBJECTIVES: To identify the predictors of traumatic spinal cord injury (TSCI) and describe the differences between confirmed and potential TSCI cases in the prehospital setting. METHODS: A retrospective cohort study including all adult patients over a six-year period (2007-12) with potential TSCI who were attended and transported by Ambulance Victoria (AV). We extracted potential TSCI cases from the AV data warehouse and linked with the Victorian State Trauma Registry to compare with final hospital diagnosis...
September 2017: Prehospital Emergency Care
Daniel Hind, James Parkin, Victoria Whitworth, Saleema Rex, Tracey Young, Lisa Hampson, Jennie Sheehan, Chin Maguire, Hannah Cantrill, Elaine Scott, Heather Epps, Marion Main, Michelle Geary, Heather McMurchie, Lindsey Pallant, Daniel Woods, Jennifer Freeman, Ellen Lee, Michelle Eagle, Tracey Willis, Francesco Muntoni, Peter Baxter
BACKGROUND: Standard treatment of Duchenne muscular dystrophy (DMD) includes regular physiotherapy. There are no data to show whether adding aquatic therapy (AT) to land-based exercises helps maintain motor function. We assessed the feasibility of recruiting and collecting data from boys with DMD in a parallel-group pilot randomised trial (primary objective), also assessing how intervention and trial procedures work. METHODS: Ambulant boys with DMD aged 7-16 years established on steroids, with North Star Ambulatory Assessment (NSAA) score ≥8, who were able to complete a 10-m walk test without aids or assistance, were randomly allocated (1:1) to 6 months of either optimised land-based exercises 4 to 6 days/week, defined by local community physiotherapists, or the same 4 days/week plus AT 2 days/week...
2017: Pilot and Feasibility Studies
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