bluuebunny/crossref_metadata_2025 huggingface dataset:
Development and Implementation of Victorian Prehospital Clinical Practice Guidelines: The Supraventricular Tachycardia Example
Authors: Smith Gavin , Kenneally Jeff
Published: December 2018

Introduction

In order to provide an evidence-based approach to practice, the Ambulance Victoria (AV) Clinical Practice Development Committee (CPDC) is tasked with periodic review of all of the AV Clinical Practice Guidelines (CPG's). This paper will highlight the framework underpinning CPG development in a Victorian prehospital emergency care system, and explore the development of CPG A0403 (supraventricular tachycardia) as an example of the process.

Methods

The CPDC applied a newly developed process, based upon national and internationally accepted methods of guideline assessment and development. Literature review, analysis of current practice data and extensive expert consultation were also used to formulate Guidelines.

Results

The CPDG delivered a revised CPG which removed calcium channel blocker therapy, introduced adenosine, and expanded the use of vagal manoeuvres to all operational paramedics. The VACIS data highlighted low intervention rates using pharmacology and vagal manoeuvres, with accepted reversion rates where applied. No logistic or safety issues were identified for the proposed changes, and expert consultation also supported changes to the guideline.

Conclusion

The development and implementation of new clinical guidelines in Victoria has evolved to embrace evidence based practice. The paucity of available prehospital-specific evidence means that consensus is still relied upon to complete the process, yet the evolution of further research will help to reduce reliance on this aspect and improve the quality and effectiveness of the process.
Simulation in Paramedic Education – is it the Panacea?
Authors: Boyle Malcolm
Published: December 2018

In the first main issue of 2014 we present the theme of simulation in paramedic education with three articles covering different aspects of simulation
From Stretcher Bearer to “Paramedic”
Authors: Wallis Jaime , Boyle Malcolm
Published: December 2018

In Australia and New Zealand we have recently commemorated ANZAC (Australian and New Zealand Army Corps) Day, a day where we honour and respect past and present service men and women who have served for both Australia and New Zealand. The day itself marks the anniversary of the landing of troops at ANZAC Cove, Gallipoli Peninsula, Turkey (formally part of the Ottoman Empire) on April 25th 1915. Sadly, this campaign was poorly planned and resourced, nevertheless, it was seen as one of the defining days of the two countries young existence (1, 2). One of the many stories that most Australians or New Zealanders would be able to recount from this landing is that of Simpson and his donkey and that of Henderson and his donkey.
Operational Aspects of Health Care Delivery at World Youth Day 2008: Lessons Learnt by An Emergency Management Organisation
Authors: Moutia Didier , Ranse Jamie , Banu-Lawrence Helen
Published: December 2018

Hundreds of thousands of people attended World Youth Day 2008 [WYD08] in Sydney. Pilgrims from over 170 nations attended the week-long event (15-20th July) culminating in one of the largest mass gatherings in Australia. St John Ambulance Australia was the primary health care agency chosen for the provision of health services to WYD08 participants and officials. WYD08 posed a number of challenges during the planning and deployment stages of operational activities; due to the extremely large number of participants and varying location of WYD08 events. This article provides an overview of WYD08, the involvement of an emergency management organisation with a focus on their experiences and lessons learnt. These experiences and lessons are useful for any health care agency or emergency management organisation, tasked with planning similar large-scale mass gathering events.
Job Satisfaction Level and Its Main Determinants among Iranian Emergency Medical Service Personnel: A Population-Based Survey
Authors: Roshanaei Ghodratollah , Khatiban Mahnaz , Hosseini Saboor , Bikmoradi Ali , Karampourian Arezou
Published: December 2018

Introduction

Few research studies exist regarding the job satisfaction of Iranian emergency medical services personnel. This study aimed to explore job satisfaction levels of these personnel in the two western provinces of Iran.

Methods

Participants in this study were emergency medical personnel working (n=260) at medical emergency centres in the two western provinces of Iran (Kermanshah and Hamadan) in 2011. Job satisfaction was measured by a self-administered questionnaire consisting of questions about demographic characteristics and job components, as well as verbal or physical violence with other staff and the greater community. There were 10 experts who confirmed the questionnaire content and face validity. A Cronbach's alpha of 0.84 and a Pearson r for test-retest (r=0.88) showed a reasonable reliability. The gathered data was analysed using SPSS 16 software.

Results

Overall, job satisfaction was found to be at a moderate level (99.3% in Kermanshah and 98.2% in Hamadan). The highest satisfaction score was in the autonomy to provide care to patients. There was verbal and physical violence between personnel and their supervisors, patients and patients’ caregivers, which was perceived as a low to moderate level of satisfaction. Most participants experienced very low verbal and physical violence with their colleagues.

Conclusion

The majority of the Iranian emergency medical personnel in this study perceived their overall job satisfaction at a moderate level, the autonomy of patient care at the highest level and the fairness of the annual performance appraisal system at the lowest level of satisfaction.
Comparison of Anaphylaxis Diagnostic Criteria and Management Guidelines for the Prehospital Setting
Authors: Chang Yu-Tung , Boyle Malcolm J
Published: December 2018

Introduction

Anaphylaxis is a potentially life-threatening medical emergency and a challenge for emergency healthcare providers. There appears to be a lack of consistency in the international definition and management of anaphylaxis. The objective of this study was to review current international guidelines in diagnostic and management of anaphylaxis in the pre-hospital setting.

Methods

A literature search was conducted of the medical related electronic databases, Ovid MEDLINE, Cinahl, Cochrane CENTRAL and EMBASE from 1980 to the end of May 2013. A previously published pre-hospital search filter was used in each of the databases including additional keywords, ‘anaphylaxis’, ‘diagnosis’, ‘hypersensitivity’, ‘allergy’, ‘allergic reaction’, ‘adrenaline’, ‘epinephrine’ and ‘antihistamine’. Articles were included if their primary aim was to report of the evidence used to create international guidelines of anaphylaxis diagnosis and management. The references of retrieved articles were also reviewed. Articles were excluded if they were not written in English.

Results

There were 128 articles located by the search with 18 meeting the inclusion criteria. Of these, three were literature reviews and six reported on the introduction of anaphylaxis guidelines, including medical treatment in different countries. Three retrospective studies evaluated the efficiency of current diagnostic and management in hospital setting. Two questionnaire surveys were conducted internationally. There were two articles proposing diagnostic criteria and a rating method for anaphylaxis. Two were relevant to pre -hospital studies.

Conclusion

The inconsistency of definition and diagnosis criteria increases the risk of under-diagnosis and under-treatment of patients with anaphylaxis. Emergency healthcare providers need a more explicit set of diagnosis criteria and guidelines for treatment to rapidly relieve patients’ anaphylactic reaction and potentially life-threatening situation.
Reporting MāOri Participation in Paramedic Education and the Ems Workforce in New Zealand
Authors: Morrison Timothy A , Tunnage Bronwyn
Published: December 2018

Introduction

Indigenous people have poorer health outcomes and are under-represented in the general healthcare workforce. This study aims to: i) quantify Māori participation in paramedic education and the Emergency Medical Service (EMS) workforce in New Zealand, ii) compare these with reported Māori participation rates across healthcare education and the general healthcare workforce, and iii) identify factors that may promote or inhibit Māori engagement in the sector.

Methods

Providers of tertiary paramedic education and EMS systems were surveyed and relevant literature was reviewed.

Results

Māori averaged 7.5% of total enrolments in tertiary paramedic education over a 5 year period and, in 2013, represented 5% of the total EMS workforce. The literature review included 14 publications. Māori participation across the general healthcare workforce is low. Factors promoting Māori tertiary enrolment include the desires to attain a career, enhance Māori health and have a steady income. Barriers inhibiting academic studies include inadequate support, low academic and socio-economic backgrounds and the absence of a culturally safe learning environment. Aspects promoting workforce engagement include clear career pathways, support for workforce development, having role-models, mentors and leaders in the profession, and working in a culturally supportive environment.

Conclusions

Māori are significantly under-represented in the EMS sector and further research is required to determine which factors promote and inhibit participation. Recruitment and retention processes should be reviewed by employers and educators and teaching strategies within paramedic programmes reconsidered. Initiatives aimed at engaging Māori in the health workforce should ensure they promote paramedicine as a potential career choice.
Reply to Australian Resuscitation Council and Lord Letter
Authors: Fouche Pieter F , Zverinova Kristina M
Published: December 2018

This letter replies to the issues raised in the letter by A/Prof Morley and Lord.
Is There An Ideal Prehospital Drug Treatment for Acute Cyanide Poisoning?
Authors: Barraclough Craig B
Published: December 2018

Introduction

Cyanide, due to its toxicity and prevalence in a variety of industries, is a suitable agent for terrorists or disaffected persons to use as a weapon of terror. New Zealand's National Poisons Centre lists five cyanide antidotes. This review aimed to identify whether there is an ideal pre-hospital drug treatment for acute cyanide poisoning.

Methods

Literature less than 10 years old was selected after a keyword search. The articles were reviewed for specific positive and negative properties of each antidote.

Results

Thirty-nine articles were reviewed of which four were excluded. Results varied, with hydroxocobalamin scoring highly on effectiveness, with limited negative effects. It also demonstrated positive haemodynamic effects, suitability in cases involving trauma, carbon monoxide (CO), smoke inhalation casualties and was safe for pre-hospital use. Sodium nitrite, followed by dicobalt edetate had the next highest scores for efficacy. However, both scored negatively for their effects on blood, causing hypotension and toxicity, and they are unsuitable for trauma, CO or smoke inhalation casualties. Sodium thiosulphate, with a moderate level of efficiency, remained most effective when co-administered with other antidotes. 4-dimethylaminophenol and amyl nitrite rated the lowest, with negative effects similar to sodium nitrite. Adrenaline was tested as an antidote in one study where two novel antidotes both demonstrated promising results.

Conclusion

Hydroxocobalamin had the highest success rate and its safety profile make it the most suitable pre-hospital drug treatment for acute cyanide poisoning.
Freedom House: A Rich History and a Continuing Legacy: An Interview with George Mccary
Authors: Williams Brett
Published: December 2018

This interview with George McCary was conducted by Associate Professor Brett Williams in 2014.

I first came to learn about Freedom House from one of my US colleagues Dave Page. I guess what struck me most about this amazing story was that it seemed very little was known about the early work of Freedom House and how this played a part in the professionalisation of the US pre-hospital system. In many ways, it is these types of historical examples that are critical in understanding our discipline as we forge towards becoming a legitimate health care profession. I wonder if there are other similar examples in Australia or other parts in the world?

I would like to acknowledge Dave Page for allowing me to meet a number of the original members of Freedom House and being able to arrange an interview with George McCary while I was in Pittsburgh.

This interview will be followed by invited commentaries from Professor Walt Stoy, University of Pittsburgh and Professor Peter O'Meara, La Trobe University.
Paramedics and Act Mental Health Legislation
Authors: Bradley Ellen J , Townsend Ruth , Eburn Michael
Published: December 2018

Introduction

On 15 May 2014, the Minister for Health, The Hon Katy Gallagher presented the Mental Health (Treatment and Care) Amendment Bill 2014 (‘the Bill’) to the Australian Capital Territory Legislative Assembly (1). The Bill was subsequently passed on 30 October 2014. One recommendation contained in the proposed Bill is to extend powers of apprehension, which are currently only held by police officers, to approved ACT paramedics. The power may be exercised without regard to the patient's decision making capacity. This paper explores some of the legal and ethical issues associated with the proposed legislation.

Methods

This paper reviews the Bill in light of underlying legal and ethical principles that are relevant to the treatment of the mentally ill and paramedic practice.

Results

It is demonstrated that there are arguments both in favour of, and against the proposal to grant paramedics powers of apprehension.

Conclusion

Whether allowing paramedics to detain a person who is mentally ill will work in the best interests of the patients remains to be seen but caution must be exercised to protect the paramedic/patient relationship.
Integrating a Community Paramedicine Program with Local Health, Aged Care and Social Services: An Observational Ethnographic Study
Authors: O'Meara Peter , Ruest Michel , Martin Angela
Published: December 2018

We used an observational, ethnographic research approach to identify the nature of the relationship between public engagement and the successful integration of a community paramedicine program with local health, aged care and social services in rural Ontario. Data were collected through a combination of direct observations of practice, informal discussions, interviews and focus groups. We found evidence of public engagement during the planning and implementation stages of the program, with strong participatory processes evident. There was some evidence of a culture of inclusiveness, despite the strength of the command and control heritage in emergency health services. The community paramedicine model is well placed to facilitate greater integration between paramedic services and health, aged and social services. Public engagement incorporating both participation and inclusiveness can lead to a closer alignment and integration between paramedic services and other services. This ‘grass-roots’ approach to interacting with local communities has the potential to better integrate paramedic services as part of a less-fragmented system across the health, aged care and social service sectors.
What Motivates Students to Pursue a Career in Paramedicine?
Authors: Ross Linda , Hannah Julian , Van Huizen Pheona
Published: December 2018

Introduction

This study aimed to determine the motivations behind students’ decisions to enrol in a degree in emergency health (paramedic) or double degree emergency health (paramedic) and nursing.

Methods

Students were surveyed to determine the importance of different motivations influencing their decision to enrol in their current university course.

Results

There were 168 surveys returned from 182 students (93% response rate). The most important motivations for students were ‘wanting to help people’, ‘saving lives’ and ‘exciting career’. Older respondents rated ‘giving back to the community’, ‘wearing a uniform’, ‘employment prospects’, ‘pay rate’ and ‘job security’ slightly higher. Males considered ‘ pay rate’, ‘ working environment’ and ‘ job security’ slightly more important than females.

Conclusions

Findings suggest that like other health professional students, those studying paramedicine do so for intrinsic motives including ‘wanting to help people’, ‘saving lives’ and an ‘exciting career’.
Exploring New Zealand Paramedic Attitudes towards Advance Directives: An Ethical Analysis
Authors: Davey Paul J , Lees Amanda B , Godbold Rosemary
Published: December 2018

Introduction

Advance directives are known to present challenging ethical issues in health care practice, however there is a paucity of research paramedic perspectives. When a cardiac arrest occurs in the community, end of life provisions have often not been considered by patients or the patients are unable to communicate their wishes and these are not usually known to the attending paramedic crew. These factors contribute to an ethically complex decision-making environment. Ethical deliberation contributes to practitioners’ critical thinking skills and helps prepare them for decision-making under uncertainty. This research aims to highlight and explore underlying values present within practice-based decisions.

Methods

An exploratory, interpretive study, using the Values Exchange, a web-based ethical decision-making tool, explored eighteen urban-based New Zealand paramedics’ deliberative perspectives on an ethically controversial end of life scenario.

Results

Thematic analysis of participants’ free text responses ascertained the breadth of views on advanced directives, with the emergence of three dominant themes; legal tensions, multiple constructs of dignity and seeking solutions that support clinical practice.

Conclusion

Findings revealed that when considering situations involving advance directives, participants regarded the duty to uphold patient dignity as paramount. There was a desire for greater legal guidance and a call for increased professional education in law and ethics. This study provides insight into New Zealand urban-based paramedics’ views and experiences of this ethically challenging aspect of patient care.
Abstracts of the 2016 Student Paramedics Australasia Conference
Authors: Webley Duncan
Published: December 2018

These are posters from the Student Paramedics Australasia (SPA) Conference in Sydney, New South Wales, 2016.
Use of Supraglottic Airway Devices by Paramedics in the Management of Adult Prehospital Cardiac Arrest Patients
Authors: Barr Stephen , Smith Gavin , Darroch Shaunagh
Published: December 2018

Introduction

Current best practice for paramedic airway management of prehospital cardiac arrest is being continually reviewed following changes to the emphasis on intubation as a primary intervention within international resuscitation guidelines. Subsequently, there is increased enthusiasm for the use of next generation supraglottic airway devices. This review aimed to identify the current evidence for the safety and effectiveness of supraglottic airways for the management of prehospital cardiac arrest.

Methods

A search of the electronic databases Medline, PubMed, Science Direct and Cochrane Library was conducted. Papers were excluded if they did not examine airway management in the prehospital cardiac arrest setting, involved the use of sedative or paralysing agents, involved paediatric patients, animals or cadavers.

Results

Of the 689 articles identified, 22 peer-reviewed articles were included for analysis. All 22 articles were from the following countries: United States of America, United States of America and Canada, Australia, Austria, Finland, Germany, Korea, Japan, The Netherlands, Norway, Taiwan and the United Kingdom.

Discussion

This review revealed large variances in both device effectiveness and patient outcome, particularly between geographical locations. Second-generation supraglottic airway devices demonstrated considerable improvement in effectiveness over their predecessors. Interestingly, the use of bag-valve mask ventilation reported better outcomes than any other form of advanced airway intervention. Studies also highlighted the diversity of airway management techniques and devices across global EMS systems.

Conclusion

Despite favourable indications of the effectiveness and safety of the next generation supraglottic airway devices, the paucity of pre-hospital specific research (particularly randomised controlled trials) challenges decision-making regarding pre-hospital airway management best practice.
Decompressive Craniectomy in the Emergency Setting: A Historical Review, Summary of Published Evidence and Review of Implications for Pre-Hospital Emergency Care
Authors: Kirby Hannah Adele , Burchell Jacki , Taylor Jack
Published: December 2018

Introduction

Decompressive Craniectomies (DC) are a controversial treatment for increased intracranial pressure resulting from traumatic head injuries. The technique has been around for approximately 5000 years, but only now are researchers beginning to unlock its true potential. This article aims to summarize history, review current knowledge and identify the implications of pre-hospital emergency care.

Methods

An electronic search was conducted using the databases; Medline (via EBSCOHost), BioMed Central and Cochrane Database of Systematic Reviews.

Results

One hundred and thirty-one articles were identified. Articles excluded from analysis were those unavailable as full text, not available in English and review articles. Twenty articles were included in the analysis.

Conclusion

Decompressive craniectomy is a comparable treatment to alternative techniques. Until recently mortality rates have been misinterpreted and unfairly reported due to the severity of brain injuries patients had already suffered. Timing of decompressive craniectomy is a crucial factor of patient outcome, and it is of popular belief that the best chance of optimal recovery relies on a reduced injury to treatment time. Introducing decompressive craniectomy into the pre-hospital setting may see an increase in favourable outcomes and has the potential to save the health care system millions of dollars in associated costs for patients with traumatic brain injury.
Community Ambulance Response Trolleys (Cart): Preparing Students for the Paramedic Workplace
Authors: Clarkson Georgia , Gangell Heath
Published: December 2018

Introduction

The curriculum of undergraduate paramedicine programs invariably includes clinical placement experiences. Engagement in learning in the workplace is however constrained by lack of familiarity with workplace cultural expectations. Strategies assisting students to understand workplace expectations have the potential to enhance engagement on placements and with workplace transition. This study examines whether one classroom practice initiative heightens students’ understanding of specific paramedic workplace expectations.

Methods

Community ambulance response trolleys (CART) (a system developed to mimic equipment management strategies of the paramedic workplace) was introduced on one campus of an Australian university. Another university campus was selected as a comparison site and did not operate CART. The CART campus students were assigned to a team and made responsible for maintaining and restocking all equipment utilised in practical classes, simulating strategies used within the paramedic workplace where a paramedic team shares responsibility for stocking and upkeep of equipment. Both cohorts completed a questionnaire exploring their experiences in the classroom and preparation for clinical placements.

Results

The CART system had a positive influence on the ability of students to collaborate within the classroom and become familiar with industry expectations around equipment management. This increased confidence with transition to learning within the workplace environment.

Conclusion

The CART strategy was effective in mimicking workplace practices and expectation and evidence indicated that CART can assist students with their ability to transition into a vocational environment.
Evaluation of the Health and Physical Activity Characteristics of Undergraduate Paramedic and Nursing Students
Authors: Micalos Peter S , MacQuarrie Alexander J. , Haskins Brian A. , Barry Eileen , Anderson Judith K.
Published: December 2018

Introduction

Levels of physical activity and health status are substantially influenced during the early adulthood years. The purpose of this research was to evaluate the health and physical activity characteristics of undergraduate paramedic and nursing students.

Methods

This research comprised a descriptive and inter-discipline survey of a sample of university students enrolled in healthcare programs. The health status and physical activity patterns of paramedic and nursing undergraduate students were assessed using the 36-item Short Form Health Survey (SF-36) and the International Physical Activity Questionnaire (IPAQ), respectively. Statistical comparisons for health status — total, eight health dimensions and weekly metabolic equivalent were performed.

Results

A total of 226 undergraduate students were surveyed with 66.4% enrolled in the paramedic, 17.7% in the nursing, and 15.9% enrolled in the double degree nursing/paramedic Bachelor programs. Results for the SF-36 total show a significant difference in health status between the undergraduate programs (p=0.001). Reduced health dimensions were also revealed among first year students. Results for the IPAQ shows a significant difference in physical activity between the programs (p=0.03). Comparison between IPAQ and year of study show a significant difference between groups (p=0.03).

Conclusion

Substantially reduced health status and physical activity patterns were shown in nursing students compared to paramedic students and among first year university undergraduates. This research highlights the need to further investigate the health status and physical activity patterns within university healthcare students.
Accuracy of Stroke Identification by Paramedics in a Metropolitan Prehospital Setting: A Cohort Study
Authors: Williams Teresa A , Blacker David , Arendts Glenn , Patrick Emily , Brink Deon , Finn Judith
Published: December 2018

Introduction

Acute stroke is a medical emergency. Identifying patients suffering a stroke is crucial if paramedics are to maximise delivery of appropriate management. One suggested screening tool to identify stroke is ‘FAST’ (Face, Arms, Speech, Time), but the accuracy of identifying pre-hospital stroke is unknown.

Objectives

We aimed to: a) examine how well stroke is identified by paramedics using the emergency department (ED) discharge diagnosis as the comparator; and b) assess compliance with ambulance clinical practice guidelines.

Methods

A retrospective cohort study was conducted in the Perth metropolitan area in Western Australia between July 2012 and June 2014 using linked data from ambulance and ED databases. Patients aged 45 years and over, transported to the ED by road ambulance and assigned the ambulance problem code or ED discharge diagnosis of stroke, were selected. Positive predictive value (PPV), negative predictive value (NPV), specificity and sensitivity were calculated. Text fields were examined for documentation that patients met FAST criteria.

Results

There were 2,217 patients were identified as stroke by paramedics. Of 1834 patients diagnosed as stroke in ED, 876 patients were not identified as stroke by paramedics. Sensitivity for identification of stroke was 958/1834 (52.2%). Of 2,096 patients who were identified as stroke by paramedics and had an ED record, 958 patients were identified as stroke by paramedics and in ED. PPV was 958/2096 (45.7%), NPV 99.5% and specificity 99.4%. Paramedics recorded 2 or 3 stroke signs and symptoms in 1,137 (51%) patients.

Conclusion

A systematic approach is needed to better identify patients with stroke in the prehospital setting.
Student Paramedic Anticipation, Confidence and Fears: Do Undergraduate Courses Prepare Student Paramedics for the Mental Health Challenges of the Profession?
Authors: Holmes Lisa , Jones Russell , Brightwell Richard , Cohen Lynne
Published: December 2018

Introduction

This study explores the preparedness of undergraduate student paramedics for the mental health challenges of the paramedic profession from the perspective of course coordinators and their students.

Methods

Two surveys were developed and administered to course coordinators and students of the 16 undergraduate degree paramedicine courses across Australia and New Zealand. Sixteen course coordinators and 302 students responded.

Results

Results illustrate there was widespread recognition for the need to include preparation for the mental health challenges of the profession within undergraduate courses. Furthermore, most course coordinators and students had a preference for this topic to be taught using multiple teaching modes with particular preference for teaching the topic via discussion and activity based education. Teaching the topic as a standalone unit was supported by more than a third of course coordinators (43%) and a third of students (32%).

Conclusion

Six themes were identified as positive by anticipants: caring for people, high acuity work, diversity of work and patients, making a difference to patients and their families, using clinical skills and knowledge and engaging with the community. Students were most confident about communicating with patients and using clinical skills and knowledge. Students were least confident about clinical decision making and the most commonly cited fear was making a clinical mistake. A significant proportion of students (16%) feared for their personal mental wellbeing and 14% reported they were least confident about personal mental health within the profession.
The Challenges of Paramedic Education in the New Millennium: Chasing the Evolution of Paramedic Practice
Authors: Smith Gavin
Published: December 2018

Across university campuses nationally, the final semester of the final year of study for hundreds of aspiring paramedics is coming to a close. With lectures completed and exams just around the corner, students are already engaged in jumping through the many hoops required to ensure their best possible chance of selection as a graduate paramedic with any one of Australia's ambulance services, and indeed international employers such as London Ambulance Service.
Pre-Hospital Advanced Life Support Education – Core Components for Pre-Hospital Professionals
Authors: Reid David , Jones Russell , Sim Moira
Published: December 2018

Introduction

There is a broad evidence base supporting advanced life support (ALS) education to health care professionals to be structured, realistic and inclusive of a range of human factors. However, published literature largely focusses on ALS education within institutional settings such as hospitals and associated health care facilities, with typically predictable human and material resources. The aim of this paper is to explore the literature on ALS education and report the results of an international survey undertaken to identify those educational elements which differ in the pre-hospital setting compared to the institutional setting. High quality education in pre-hospital resuscitation is important because it is critical that pre-hospital professionals provide high quality ALS to maximise the likelihood of patient survival.

Methods

MEDLINE was searched using MESH terms ‘resuscitation’, ‘advanced life support’ and ‘prehospital’ as core terms. Fifteen articles relating specifically to pre-hospital resuscitation and a further 91 articles on resuscitation education were reviewed. Articles ranged in publication year from 1987 to 2016. An online survey on ALS education was developed and administered and attracted 177 responses from a range of health care professionals nationally and internationally. A total of 83 respondents completed the full survey.

Results

The literature identifies that best practice ALS education should (a) be taught in the environment in which ALS will be performed, (b) involve team members who are similar to those they will encounter while providing ALS, and (c) use equipment the provider uses in their workplace. Human factors, in particular leadership and communication, are important components of ALS education. However, results of the survey demonstrate that best practice is not well incorporated into pre-hospital ALS education.

Conclusion

To improve pre-hospital patient outcomes and maximise the chances of patient survival, ALS education to pre-hospital providers should incorporate the context of their workplace (that is, the environment in which they function), the team members they regularly work with and the equipment they use in the pre-hospital setting. Human factors, in particular leadership, should be considered as part of pre-hospital resuscitation education.
The Conundrum of Defining Paramedicine: More than Just What Paramedics ‘Do’
Authors: Long David Nicholas , Lea Jakki , Devenish Scott
Published: December 2018

The term ‘paramedicine’ is an ever-increasing part of the lexicon in numerous ambulance services and stakeholder organisations across the globe. However, it is unclear if a consensus exists on the definition of paramedicine that transects international boundaries. This editorial intends to stimulate a robust discussion to find an international consensus on the definition of paramedicine.
Preparing for the Real Thing with Practice Interviews: A Graduate Paramedic Perspective
Authors: Ross Linda , Moffatt Nicholas
Published: December 2018

Introduction

Behavioural interviews are a critical component of the job application process for ambulance services in Australia. They involve role specific open-ended questions that are designed to test an applicant's skills, eligibility and experience. It is a process that is standardised and can be practised to increase familiarity and performance. Existing literature supports the benefits of practice interviews ahead of real interviews to improve applicant performance and subsequent employment success. The objective of this study was therefore to examine paramedic graduates’ perceptions on the value of participating in practice interviews before seeking employment with an ambulance service.

Methods

Students enrolled in the Bachelor of Emergency Health (Paramedic) at Monash University in Victoria took part in a cross-sectional pilot study. Three paper-based surveys were created to assess the value of practice interviews. Both quantitative and qualitative methods were used.

Results

Fourteen (n=14) students participated. All participants agreed or strongly agreed that practice interviews would help them gain employment. All participants perceived that practice interview helped improve their confidence and preparation for their actual interview.

Conclusion

Practice interviews were found to be a positive and worthwhile undertaking. They increased confidence and improved preparation through practise and feedback. Participants agreed that they were valuable and perceived that they led to improved performance in their real interviews and subsequent employment success.
Young Adults’ Perception of Mandatory Cpr Training in Australian High Schools: A Qualitative Investigation
Authors: Andrews Tiana , Price Luke , Mills Brennen , Holmes Lisa
Published: December 2018

Introduction

Bystander cardiopulmonary resuscitation (CPR) can be performed by any member of the public who witnesses a cardiac arrest and has the knowledge, training and skills to perform it. Even though bystander CPR has been shown to greatly improve the victim's chance of survival, its training and performance rates are alarmingly low.

Methods

One potentially effective intervention to tackle this issue is to implement mandatory CPR training programs in high schools. We undertook in-depth qualitative interviews with 28 recent Australian high school graduates. The interviews were transcribed and then analysed, with participants’ answers used to draw conclusions on the acceptability of mandatory CPR high school training.

Results

Results suggested those that had undertaken basic first aid training in high school would be more open and confident to perform bystander CPR. Among those who had not undertaken training, cost and access were identified as the key barriers. Regardless of whether participants had or had not previously undertaken training, they understood the importance of CPR for the treatment of cardiac arrest victims.

Conclusion

Among our sample, there was overwhelming support for the concept of mandatory CPR training being implemented in high schools. Should such a program be applied, there is the potential for this to have an impact on bystander CPR provision, and hence cardiac arrest survival rates, within the wider Australian community.
Kounis Syndrome: A Case Report and Literature Review of Pre-Hospital Treatment
Authors: Di Toro Matthew Luke , Stub Dion
Published: December 2018

Introduction

Kounis syndrome is an uncommon clinical presentation of acute coronary syndrome secondary to an allergic or hypersensitivity reaction, especially anaphylaxis. It results when inflammatory mediators are released following mast cell activation, some of these mediators cause coronary artery vasospasm and may initiate thrombus formation in susceptible individuals. Although Kounis syndrome is becoming more widely known, many clinicians are still unaware of its existence. We present a case report and a literature review of the pre-hospital treatment of Kounis syndrome by emergency medical services.

Methods

A literature search of the EMBASE, MEDLINE and PubMed electronic medical databases was conducted using the terms ‘Kounis syndrome’, ‘allergic acute coronary syndrome’ and ‘allergic myocardial infarction’. The purpose of the literature search was to identify the pre-hospital treatment of Kounis syndrome by emergency medical services. We included case reports of Kounis syndrome that described the medical treatment provided by emergency medical services, published any time up to October, 2017.

Results

Anaphylaxis is the most commonly treated component of Kounis syndrome by emergency medical services (66% of reported cases). Both components of Kounis syndrome, anaphylaxis and acute coronary syndrome, were treated in 16% of reported cases. No specific treatment was provided for either component of Kounis syndrome in 16% of reported cases.

Conclusion

The pre-hospital treatment of Kounis syndrome by emergency medical services is infrequently reported in the literature. Kounis syndrome involves two distinct clinical conditions, both of which should be considered during treatment.
Operationalising the Multidimensional Role of the Paramedic Preceptor
Authors: Carver Hamish , Lazarsfeld-Jensen Ann
Published: December 2018

Introduction

This study reports on a subset of findings from a recent doctoral study by the first author, which explored the lived experience of being a paramedic preceptor to novice paramedics in their first year of on-road practice.

Methods

A qualitative methodology underpinned by Gadamerian hermeneutics was chosen for this study. Semi-structured interviews were undertaken with a purposive sample of 11 paramedic preceptors from an Australian government-funded ambulance service. Interviews were audio-recorded and data analysis proceeded from the interview transcripts.

Results

Analysis revealed the paramedic preceptor to be a complex, multidimensional role that is operationalised within four key domains: coach, role model, socialiser and protector. Expectedly, a core function of being a paramedic preceptor is that of coach, supporting and scaffolding novices as they learn to apply theoretical knowledge in practice. Preceptors also appear to play an integral role in the professional socialisation of new employees, and are an important role model of professional behaviours and an empathetic healthcare provider. The paramedic preceptors in this study also viewed their role as a critical advocate for patient safety in the clinical practice environment. Advocacy and protection by the preceptor extended to the novice too, safeguarding their physical and emotional wellbeing during the learning process.

Conclusion

To our knowledge, this is the first study to specifically explore paramedic preceptorship from the perspective of preceptors in an Australian context. Therefore it provides an important contribution to understanding how paramedic preceptors operationalise this educative role in the clinical practice environment.
Managing mass casualty events is just the application of normal activity on a grander scale for the emergency health services. Or is it?
Authors: Wong Diana
Published: December 2018

Disasters, whether they are caused by natural events, infectious diseases, technological catastrophes or terrorist incidents have been increasing around the world and more and more people continue to be affected
Memory, Trauma and the Securitization of Migration in Contemporary Hungary
Authors: Ferreira Maria João Militão
Published: December 2018

This article discusses discursive strategies employed by Hungary’s Prime Minister Viktor Orbán that embody the securitization of migration through mnemonic elements, namely, memory and trauma. The discursive policies that have been identified were produced in the context of the European refugee crisis. Literature in International Relations has debated the discursive and non-discursive practices that result in the securitization of migration, yet there exist few studies that articulate the junctions of (in)security, migration, memory and trauma. This article draws from Critical Discourse Analysis and critical geopolitics to discuss how political discourse can frame migration from a security perspective through the use of mnemonic arguments. Textual categories corresponding to intersections of migration, (in) security, memory and trauma were identified. I argue that linking migration to these topics has allowed Orbán to (re)construct Hungarian ontological location, relocating the country in relation to Central and Eastern Europe and placing it within the arena of Russian influence.
Databases of information agencies for journalists and analysts. (Analytical characterization)
Authors: Pomerantseva N. A. , Delitsyn L. L.
Published: December 2018

Using databases simplifies significantly the preparation of journalistic and analytical materials and complements online information search and verification practice. Introducing databases into everyday work of the mass-media results in the rise of the “data-driven journalism”.

The authors analyze in brief the most popular foreign and Russian databases being maintained by news agencies (Bloomberg, Dow Jones Risk and Compliance, Interfax, ITAR-TASS) and by other information services (LexisNexis, Integrum, Kartoteka, Factiva, Dun & Bradstreet). Their history is discussed; they are defined by types and classified according to their content and access method (open/closed). In several cases, the database management system specifications are provided. Scenarios for use are given for journalists and analysts, for the latter the practical use is exemplified.

Based on the classification they are suggesting, the authors compares the pros and drawbacks in using databases by news agencies (closed information systems) and Internet-based information retrieval systems (open systems) in journalism and analytics.
New achievements in academic performance. (On the 80-th anniversary of Yury Stolyarov)
Authors: Kushnarenko N. N. , Solyanik A. A.
Published: December 2018

Based on bibliometric analysis, the flow of publications by Yury Stolyarov in 2013-2018 is examined. The flow volume is determined with standard criteria; its typical, genre, semantic, geographical organization and corporation structure, Hirsch index citation rate are given. Review authorship for Stolyarov’s works is characterized: his contribution into the development of theory and methodology of general and special library studies (mainly library collection studies, documentology, book studies), gain of knowledge in these disciplines is evaluated. Thematic character of his personalia papers dedicated to over 20 figures of book industries and library science is discussed. Rubakiniana dedicated to the 155-th anniversary of the encyclopedist, educator and father of bibliopsychology hold a special place in Y. Stolyarov’s work.

The authors argue that high rates and reviews of Stolyarov’s works, geographic scope of publications (by journals, digests, and the publishers’ in Russian regions and worldwide), as well as the increasing number of doctoral dissertations passed under his scientific supervision prove Stolyarov’s authority and the demand for his ideas.
Degenerative xanthate transfer to olefins under visible-light photocatalysis
Authors: Kaga Atsushi , Wu Xiangyang , Lim Joel Yi Jie , Hayashi Hirohito , Lu Yunpeng , Yeow Edwin K L , Chiba Shunsuke
Published: December 2018

The degenerative transfer of xanthates to olefins is enabled by the iridium-based photocatalyst [Ir{dF(CF3)ppy}2(dtbbpy)](PF6) under blue LED light irradiation. Detailed mechanistic investigations through kinetics and photophysical studies revealed that the process operates under a radical chain mechanism, which is initiated through triplet-sensitization of xanthates by the long-lived triplet state of the iridium-based photocatalyst.
The Nature of Turbulence in the Outer Regions of Protoplanetary Disks
Authors: Gole Daniel. A. , Simon Jacob B.
Published: December 2018

We carry out a series of local, shearing-box simulations of the outer regions of protoplanetary disks, where ambipolar diffusion is important due to low ionization levels, to better characterize the nature of turbulence and angular momentum transport in these disks. These simulations are divided into two groups, one with far-ultraviolet (FUV) ionization included, and one without FUV. In both cases, we explore a large range in diffusivity values. We find that in the simulations without FUV, the properties of the turbulence are similar to the unstratified simulations of Bai & Stone; for a given diffusivity, the magnetorotational instability (MRI) can still be present so long as the magnetic field is sufficiently weak. Furthermore, the dynamics of the midplane in these simulations are primarily controlled by the MRI. In the FUV simulations on the other hand, the MRI-active FUV layers transport strong toroidal magnetic flux to the midplane, which shuts off the MRI. Instead, angular momentum transport at the midplane is dominated by laminar magnetic fields, resulting in lower levels of turbulent Maxwell stress compared to the no-FUV simulations. Finally, we perform a temporal correlation analysis on the FUV simulations, confirming our result that the dynamics in the midplane region is strongly controlled by the FUV-ionized layers.