bluuebunny/crossref_metadata_2025 huggingface dataset:
Starting the Conversation: What are the Issues for Paramedic Student Clinical Education?
Authors: O'Meara Peter , Hickson Helen , Huggins Chris
Published: December 2018

Objectives

This paper examines the issues that affect the quality of paramedic student clinical placements. Participants included paramedics, paramedic educators, paramedic students and ambulance service managers who had gathered for an Australian conference in Bendigo in central Victoria. The aim of this paper is to highlight issues identified by the participants and to start a conversation about the importance of clinical placement for paramedic students.

Methods

This was a qualitative study utilising ‘Community conversations’ as a research methodology. ‘Community conversations’ is an action research approach. This study had 53 participants, who spent around 5 hours in conversation throughout a 3-day conference. The conversation initiated was to discuss and raise issues that related to paramedic student clinical placements, and identify creative and innovative solutions.

Results

In this paper, we focus on three themes that emerged from the conversations: planning and preparation of the placement; continuity of placement experience; and diversity of placements. We argue that better communication is required between the university, the ambulance service, the paramedic educator/clinical instructor and the student.

Conclusions

Clinical education is an essential element of student learning and skill development, yet in Australia there are no mandatory requirements in relation to duration, content or measurement of quality in student clinical placements. We strongly recommend that continuity is an essential element of a quality clinical placement and argue that students should be allocated to work in one location for 1–2 week blocks.
Twelve Months On
Authors: Boyle Mal
Published: December 2018

Twelve months ago the Australasian Journal of Paramedicine (AJP) published the first issue in the resurrection of the former Journal of Emergency Primary Health Care, as an international prehospital care open source journal, supported by Paramedics Australasia (PA).

In the last 12 months many things have happened, the journal has published at least four articles in each of the main issues and has published the PA conference abstracts as supplementary issues. The appointment of an editorial assistant has made the management of the journal more efficient. We are still receiving regular manuscripts for consideration and will continue with the four issues per year plus special issues for conference abstracts. The journal now has a logo which will be displayed on the journal home page and articles.

Over the last 12 months paramedics have been voted as the most trusted profession in Australia and New Zealand, again, yet paramedics are still not registered, what else do we need to do?

From this issue the journal will have its own dedicated site which will be totally managed by the AJP with no branding other than PA and the AJP. I would like to thank Monash University and Edith Cowan University for hosting the journal over the past years.

This issue concentrates mainly on studies involving students during their education process.
The Australasian Consultant Paramedic – An Idea Whose Time Has Come
Authors: Colbeck Marc
Published: December 2018

Drawing on examples of paramedic practice from around the world the author describes the developing role of the Consultant Paramedic internationally and advocates for development of the role in Australia.
Out of Hospital Cardiac Arrest Management by First Responders: Retrospective Review of a Fire Fighter First Responder Program
Authors: Winship Christian , Boyle Malcolm , Williams Brett
Published: December 2018

Introduction

Over 9,500 people die annually in Australia from sudden cardiac arrest, with strong evidence suggesting early high quality CPR and early counter shock being paramount for improving survival from cardiac arrest. It has also been shown that first responder programs have been able to reduce response times and increase survival rates for out-of-hospital cardiac arrest. The objective of this study was to examine data from the first seven years of an Australian out-of-hospital cardiac arrest first responder program where fire fighters provided basic life support.

Methods

This study was a retrospective cohort study of all cardiac arrests attended by the Metropolitan Fire and Emergency Services Board (MFESB) as part of the Emergency Medical Response program over a seven-year period in Melbourne, Victoria, Australia.

Results

The MFESB attended 4,450 cardiac arrests. The majority of patients presented in asystole 669 (63.7%) with just 243 (23.1%) presenting in a shockable rhythm. The majority of patients in cardiac arrest were males (64.2%) and the mean age of the patients was 67.5 years. The MFESB median response time during the study period was 5.7 minutes (IQR 2.25 minutes), range of 0.15 minutes to 31.7 minutes, which remained stable over the seven years. Patients spent a median time of 4.6 minutes (0.02 seconds to 36.5 minutes) in the care of fire fighters prior to the arrival of EMS. The rhythm on handover to paramedics was asystole in 787 (75.1%) cases with no shockable rhythms. One in three (31.3%) patients received bystander CPR, with a significant rise in the rate of bystander CPR occurring over the last two years.

Conclusion

This study demonstrated acceptable response times to cardiac arrests and a low bystander CPR rate prior to arrival of the MFESB. The incidence of a shockable rhythm on arrival of the MFESB was low with the main rhythm being asystole. The main rhythm on handover to paramedics was asystole with non-shockable rhythms. Further research is required to determine the effect on patient outcomes.
An Appraisal of the Australian Resuscitation Council Arrhythmia Guideline
Authors: Fouche Pieter F , Zverinova Kristina
Published: December 2018

Introduction

Arrhythmias are a significant health burden in Australia, responsible for about 1% of deaths annually. The Australian Resuscitation Council (ARC) ‘Guideline 11.9 Managing Acute Dysrhythmias’ was designed to guide doctors, paramedics and nurses in the emergency management of arrhythmias. It is important to have high quality clinical practice guidelines to aid the treatment of these arrhythmias. The AGREE II tool utilised is widely used to asses clinical practice guidelines for quality. The objective of this study was to assess the quality of the ARC clinical practice guideline ‘Guideline 11.9 Managing Acute Dysrhythmias’.

Methods

Two raters assessed the six domains of quality of the ARC arrhythmia guideline using the AGREE II tool. The inter-rater agreement between the raters was measured with the intraclass correlation coefficient (ICC 2, 1).

Results

Inter-rater agreement was good at 0.73 (95% CI 0.45 to 0.88). Both raters assigned the ARC guideline 11.9 Managing Acute Dysrhythmias a score of three, for a combined score of three out of a possible seven on the AGREE II rating scale.

Conclusions

The use of the ARC guideline 11.9 Managing Acute Dysrhythmias is not recommended based on this assessment with the AGREE II tool. Emergency departments and prehospital systems should consider not using this arrhythmia guideline to guide their practice, but to look elsewhere for a higher quality guideline.
Effectiveness and Safety of Paramedic Administration of Verapamil and Adenosine for the Treatment of Supraventricular Tachycardia: A Review of the Literature
Authors: Smith Gavin
Published: December 2018

Introduction

Adenosine and verapamil are the most commonly used pharmacological agents to treat supraventricular tachycardia (SVT). This review aims to identify the effectiveness and safety of pre-hospital use of adenosine and verapamil by paramedics.

Methods

A comprehensive electronic literature search was conducted. Studies of pre-hospital comparative effectiveness of adenosine and verapamil were included for further analysis. Studies where individual effectiveness of either verapamil or adenosine was reported in either the medical or pre-hospital setting were excluded. Animal studies and those articles unavailable in English were also excluded.

Results

Two pre-hospital studies were identified. Verapamil demonstrated greater reversion effectiveness across both studies, with side effects more commonly reported in the adenosine arm of each. The duration and severity of side effects resulting from verapamil administration was greater than that of adenosine. Paramedic electrocardiogram (ECG) interpretation was questionable, resulting in a number of errors across both studies.

Conclusion

Available studies report that verapamil is more effective for pre-hospital SVT reversion. Effective pre-hospital drug therapy for SVT must incorporate a measure of patient impact with regard to severity, duration and interventions required to correcting adverse effects. A larger contemporary study is required to further evidence paramedic use of pharmacological agents to treat SVT. Paramedic ECG interpretation is a key factor influencing correct treatment, and adequate education must form the basis of pre-hospital guidelines for SVT management.
Pathway to Paramedicine Program Perspectives – Part 1 Paramedic Students
Authors: Ross Linda , Bertucci Jessica
Published: December 2018

Introduction

Paramedic practice has evolved significantly with a greater emphasis now being placed on paramedics to perform educator type roles to junior paramedics, patients and the wider community. Paramedic training and education should therefore include preparing students for this important role. The Pathway to Paramedicine Program used a peer assisted learning (PAL) model to expose paramedic students to the educator/mentor role. The aim of this study was to evaluate the student paramedic's perspectives of the Pathway to Paramedicine Program.

Methods

Fourteen paramedic students enrolled in either Monash University's Bachelor of Emergency Health (Paramedic) degree or the Bachelor of Nursing/Emergency Health (Paramedic) degree were the subjects of this pilot study. The paramedic students acted as mentors/educators to secondary school students, teaching them theory and practical skills common to paramedic practice during weekly tutorials. The Pathway to Paramedicine Evaluation (PPE) survey was used to determine the participant's perspectives at the completion of the program.

Results

All 12 Likert scale questions on the PPE achieve a median score of 4 or higher with four items achieving a maximum median of 5 (strongly agree). A thematic analysis of the free text questions found that the participants enjoyed teaching and this helped to reinforce their own knowledge and skills.

Conclusions

This pilot study showed that the paramedic student's had an overwhelmingly positive perspective of The Pathway to Paramedic Program and would happily recommend it to others.
Review by Fouche and Zverinova
Authors: Lord Bill
Published: December 2018

This letter raises issues about the study conducted by Fouche and Zverinova.
When Should An Article be Retracted?
Authors: Boyle Mal
Published: December 2018

This editorial looks at the issues that may cause an article to be retracted.
Residential Aged Care Facility Clinical Placements for Undergraduate Paramedic Students: An Evaluation of the Australian Experience
Authors: Stratton Brigit , Lea Emma , Bramble Marguerite , Eccleston Claire , McCall Mike , Lucas Peter , Robinson Andrew
Published: December 2018

Introduction

This paper presents an evaluation of the pilot aged care clinical placement undertaken by undergraduate paramedic students in the university-based Wicking Dementia Research and Education Centre's Teaching Aged Care Facilities Program. The objective is to examine the learning experiences of students taking part in the first paramedic student clinical placement in Tasmania to be situated in the residential aged care environment. The students’ interactions with residents with dementia and with older people requiring a palliative approach to care are discussed, as key strategies to enhance paramedic student learning.

Method

Twenty-one final year undergraduate paramedic students completed a 5-day (40 hour) clinical placement in September/October 2011, in two participating residential aged care facilities in Tasmania, Australia. Qualitative data were obtained from weekly feedback meetings with students, which were audio-recorded, transcribed, and subjected to content analysis. Quantitative data from pre and post-placement questionnaires were collected and descriptive analyses performed.

Results

The data showed that students enjoyed interaction with residents and that this built their communication skills, particularly with residents with dementia. Students also learnt about the importance of a palliative approach to care and improved their knowledge of dementia.

Conclusion

A supported placement program for paramedic students in residential aged care facilitates student learning in a number of areas, particularly around working with people with dementia, which is likely to enhance student readiness for the graduate paramedic role.
Incidence and Patient Demographics of Pre-Hospital Anaphylaxis in Tasmania
Authors: Blackhall Melanie , Edwards Dale
Published: December 2018

Introduction

Anaphylaxis is widely accepted to be an increasing problem worldwide. This inquiry into pre-hospital incidence and patient demographics is useful to determine status of anaphylaxis in Tasmania. Our main goal was to determine the incidence of pre-hospital anaphylaxis in Tasmania and identify trends in characteristics of affected patients.

Methods

Raw data was searched and extracted from Ambulance Tasmania electronic recording system and case records for the period 1st January 2007 to 31st December 2011. This involved data mining 279,482 cases with the search parameters of anaphylaxis and allergy/ allergic reaction.

Results

There were 1,570 patients were classified as having allergic reaction (including the most severe form of anaphylaxis). 379 (24.1%) of the atopic group were given a final primary diagnosis of anaphylaxis. The adult cases distribution was female at 219 (57.8%) versus males at 160 cases (42.2%). Interestingly 21.1% of the total anaphylaxis cases were paediatric (n=80) with a greater percentage of male (n=46) to female (n=34) paediatric patients. Aetiology was identified in 85.5% of the cases accordingly: envenomation (insects) 141 (37.2%), food 118 (31.1%), medication 58 (15.3%), known other 4 (1.1%), exercise 3 (

Conclusion

These findings suggest that almost a quarter of all calls for allergy or allergic reaction are of a severe potentially life-threatening nature, with the most common aetiology envenomation from insects (jack jumper bites).
Resuscitative Endovascular Balloon Occlusion of the Aorta (Reboa) as a Potential Pre-Hospital Procedure for the Control of Non-Compressible Haemorrhage: A Literature Review
Authors: Valkenburg Alana , Bennett Daniel , Bishop Jack , Smith Gavin
Published: December 2018

Introduction

Resuscitative endovascular Balloon Occlusion of the Aorta (REBOA) has evolved as a potentially life-saving therapy for the control of non-compressible haemorrhage. With the development of a fluoroscopy free method, the feasibility of introducing REBOA to the pre-hospital setting may lessen the impact of trauma related morbidity and mortality and enhance the level of care provided by emergency services.

Method

A comprehensive search of the electronic databases was conducted using MEDLINE with Full Text (via EBSCOHost), PubMed and Science Direct. The search included the following keywords: “Resuscitative Endovascular Balloon Occlusion of the Aorta”, “REBOA”, “thoracotomy”, “aortic clamping”, “Trauma”, “hypovolaemia” and “pre-hospital”. Cross-referencing using the reference lists of the found articles was used to identify further relevant articles. Studies involving paediatric patients or rats were excluded. Only those articles published after the year 2000 were included.

Results

From the examined literature, it can be determined that there is a definitive absence of pre-hospital attention given towards REBOA, despite its proven benefits in central aortic pressures, mean systolic pressures and overall brain oxygenation. When compared against thoracotomy, as an alternative technique of aortic occlusion, REBOA provided an enhanced metabolic profile and required less resuscitation thereby inducing a greater survivability rate.

Conclusion

The REBOA procedure has reported benefit over aortic cross clamping as a method of proactive aortic control of exsanguinating haemorrhage in porcine and human studies, yet its effectiveness as a pre-hospital technique for reducing mortality and morbidity in trauma patients is yet to be demonstrated within clinical studies.
Does Wound Irrigation in the Prehospital Environment Affect Infection Rates? – a Review of the Literature
Authors: Smit Lynsey , Boyle Malcolm J
Published: December 2018

Introduction

Historically it has been shown in the military combat setting that early irrigation of open wounds/fractures effectively assists in the prevention of infection. The objective of this study was to determine whether wound irrigation alone in the civilian prehospital environment affects wound infection rates.

Methods

A literature search of the electronic medical databases CINAHL, Cochrane Collaboration, EMBASE and Medline was conducted. The databases were reviewed from January 1950 until the end of March 2015. An existing prehospital search filter was applied to each database with additional search terms “wound”, “traumatic wound”, “simple wound”, “irrigation”, “fluid irrigation”, and “infection rate”. Articles of any study design were included if they reported on the effect of wound irrigation and wound infection rates. Reference lists of included articles were also reviewed. Articles were excluded if they were not written in English, involving animals, or were from the military setting.

Results

A total of 1,648 articles were identified in the search with eight meeting the inclusion criteria. The eight articles were from the military combat setting were excluded. There were no civilian prehospital specific articles identified in the search therefore hospital ED and military data was used as a substitute to investigate the effectiveness of wound irrigation in decreasing wound infection rates.

Conclusion

Evidence from the civilian prehospital setting does not clearly prove that irrigation alone prevents infection, nor does it prove that removing irrigation from wound care increases wound infection rates. Extrapolation of data from the military and hospital setting is inconclusive. Therefore wound irrigation should remain part of civilian prehospital wound care until further high-level studies can be undertaken.
The Importance of Student Paramedic Contributions to Prehospital Research
Authors: Smith Gavin
Published: December 2018

This is an editorial for the special student issue.
The Accuracy of Manual Blood Pressures Obtained by Paramedic Students in a Quiet Simulated and Roadside Environment
Authors: Ramothwala Lucas M , Stassen Willem , Stein Christopher
Published: December 2018

Introduction.

It is well-recognised that ambient noise impacts on the accuracy of auscultation. Often, paramedics are required to manually obtain blood pressures on the side of the road where ambient traffic noise might impact on its accuracy. This study aimed to determine the level of agreement between manual blood pressure results obtained in a quiet and simulated roadside environment.

Methods.

An experimental prospective study in the repeated measures design was utilised to determine whether emergency care students could accurately determine the manual blood pressure in a quiet and simulated roadside environment. A roadside environment was simulated by looping road traffic noise at constant volume. A cross-over control was employed. The accuracy of the blood pressure recorded in the quiet environment was contrasted to that obtained in the simulated roadside environment using the Bland-Altman plot.

Results.

The data of 60 students (120 measurements) were analysed. The mean bias (95% CI; standard error) for the Systolic Blood Pressures (SBPs) was -1.28 (-2.83;-2.64; 5.99) while the mean bias for the Diastolic Blood Pressures (DBPs) was -1.2 (-3.12; 0.71; 7.39). The 95% limits of agreement are -13.02 to 10.46 and -15.68 to 13.28 for the SBPs and DBPs respectively.

Conclusions.

This experimental study found that emergency care students are able to accurately obtain a manual blood pressure in a simulated roadside environment. However, a clinically significant discrepancy of 20-28mmHg in SBP or DBP might still be appreciable in some cases. Further, more robust studies in a variety of different prehospital settings are recommended to corroborate these findings.
Paramedical Ethics during Acute Emergency Medical Service (Ems) Referral
Authors: Campeau Anthony
Published: December 2018

Introduction

Ethical dilemmas comprise an important non-technical aspect of paramedicine but have not received significant research attention. This study explores the nature of paramedical ethics during the high-stakes referral of emergency ambulance patients, and relates findings to accepted concepts of professionalism.

Methods

Grounded Theory Methodology was used to analyse interview data from paramedics in Ontario, Canada, who had experience making field-referrals for patients suffering from ST elevation myocardial infarction and acute stroke.

Results

Paramedics describe extensive use of an ethic of applied beneficence, and patient advocacy during calls on a borderline for inclusion in referrals to medical specialists.

Conclusion

The management of complex ethical dilemmas is often cited as an example of professionalism. Paramedics have developed a unique type of ethicality to address the complexities of emergency field-referrals that reflects their field of practice, and is consistent with the literature on professional level ethical practice.
Creutzfeldt-Jakob Disease: A Review of Current Available Evidence and the Implications for Prehospital Emergency Care
Authors: Kirby Hannah Adele
Published: December 2018

Introduction

Creutzfeldt-Jakob Disease effects 1 in 1 million people globally per year. It is an invariable fatal neurodegenerative disease belonging to the group of transmissible spongiform encephalopathies. This review aims to examine the current clinical evidence surrounding CJD, as well as present management techniques to assist in minimizing the effect of symptoms. This review also highlights the important role of paramedics in reducing mortality and morbidity.

Methods

An electronic search was conducted using Medline (Via EBSCOHost), CINAHL, and the Cochrane Database of Systematic Reviews.

Results

This search resulted in 265 articles. Articles unavailable as full text, those not available in English, those articles not peer reviewed, and review articles were all excluded from analysis. The remaining 16 articles met the search criteria and were included in this report.

Conclusion

Scientific advancements are bringing a cure closer to reality, however further scientific research needs to be conducted. Training and education programs should be made available to prehospital workers to prevent further spread of infection.
Continuing Professional Development for Paramedics: A Systematic Literature Review
Authors: Gent Philippa
Published: December 2018

Introduction

Paramedic practice in Australia has evolved significantly over the past 20 years. With the expansion of the paramedic scope of practice and absence of registration, there is a need to determine what is known about continuing professional development (CPD) for paramedics.

Method

Selected search terms were entered into three electronic databases to identify relevant publications. Inclusion/exclusion criteria was applied and full texts were reviewed for potential papers. Eight publications were identified as relevant and included in the systematic literature review.

Results

Initial search yield was 875 publications, removal of duplicate articles and application of the inclusion/exclusion criteria to title and abstract reduced this to 20 publications requiring review. This number was further reduced to eight publications, two of which were qualitative studies, a further five were quantitative design and the final study included both quantitative and qualitative data. Seven of the eight publications highlighted the importance of CPD for paramedics. The remaining article did not yield statistically significant data to conclude improved clinical practice or knowledge through the delivery of the educational intervention.

Conclusion

The availability of publications relating to CPD for paramedics is extremely limited. The reviewed publications reported highly variable clinical exposure and infrequent reaccreditation processes which are not currently adequately supplemented by CPD. Among the key findings in the literature was the need for increased CPD to supplement the limited clinical exposure, and for paramedics to take ownership of their own professional development. It is evident that further research into paramedicine and CPD is required.
Paramedic Diagnosis of Acute Coronary Syndrome in the Out-of-Hospital Patient with Acute, Non-Traumatic Chest Pain: The RSVP3 Heart Exam
Authors: Colbeck Marc
Published: December 2018

Background

The accurate diagnosis of acute coronary syndrome in the out-of-hospital patient experiencing acute, not-traumatic chest pain remains an important challenge both clinically and financially. As both a high frequency and high impact occurrence, it is rightly considered to be a high-risk situation.

Methods

In order to recommend an evidence-based approach to paramedic diagnosis of this condition, the author conducted a scoping study, reviewing over 70 sources relevant to the topic from 1984 to 2015, and then summarised the findings.

Results

The evidence suggests that most of the current methods taught to paramedics to identify acute coronary syndrome patients are not in accord with findings that have been reported in the literature over the past 20 years. Areas where current teaching is not in accord with the evidence are highlighted, traditionally taught assessments that are non-diagnostic are identified, and those that are most diagnostic are listed and explained.

Conclusion

Research suggests that paramedics follow the HEART assessment (History, EKG, Age, Risk factors, Troponin) and this work offers a novel, evidence-based method to assess the patient's history using the acronym RSVP3 (Radiation, Similarity, Variation, Pleuritic, Positional, Palpation), which is meant to replace other commonly used, but non-diagnostically sensitive, acronyms such as OPQRST, DOLOR, SOCRATES and CHEST PAIN. An emphasis is also placed on performing a thorough physical examination and so the novel mnemonic ‘RSVP3 Heart Exam’ is introduced. Evidence to support these recommendations is given.
Teaching Students to Think like a Paramedic: Improving Professional Judgement through Assessment Conversations
Authors: Thompson James , Houston Don , Dansie Kathryn
Published: December 2018

Introduction

The ability to self-assess is essential to the practitioner who often works independently, and reflective practice is entrenched within the paramedic process of care. In order to develop these practices a paramedic student must be able to self-identify mistakes and learn from their errors. However, student assessment has traditionally focused heavily on outcomes, with errors being penalised. Justification for traditional approaches to assessment of paramedic students acknowledges the potentially catastrophic consequences associated with mistakes being repeated in the real world out-of-hospital setting. Responding to the challenge of balancing the reflective practice skills set with ‘real world’ implications of a paramedic's mistakes, an assessment process was re-designed. The ‘Student-Tutor Consensus Assessment’ (STCA) was created to rebalance assessment weighting from being exclusively outcomes focussed, and encourage students to apply similar critical lens to events as the paramedics who are assessing them. Parallel tutor and student self-assessments are applied to simulated scenarios, with scores awarded to criteria where consensus has been reached between student and tutor judgements.

Methods

Final year undergraduate Bachelor of Paramedic Science students enrolled in a capstone topic were invited to complete a paper-based questionnaire at the end of their studies. Questions sought student perceptions about the STCA features and effectiveness.

Results

There was a 95% response rate (n=90). Responses to the six different questions showed a range of 85.6–95.6% broad agreement regarding the value, effectiveness and suitability of the method.

Conclusion

The pilot STCA approach proved highly successful, with student endorsement for the continued and expanded application of this teaching approach.
A Review of the Literature: The Transition of Entry-Level Paramedic Education in Australia from Vocational to Higher Education (1961–2017)
Authors: Brooks Ingrid Ann , Grantham Hugh , Spencer Caroline , Archer Frank
Published: December 2018

Introduction

Today in Australia, university degree programs provide the education pathway into the paramedic profession reflecting a more than 50-year process of transition from on-the-job first aid training. The formal organisation of paramedic education began in the early 1960s with the establishment of ambulance service training centres. The factors that contributed to this transition are poorly described when compared with that of paramedics in other parts of the world such as the United States and England. The history of Australian paramedic education is important to capture for the benefit of the profession in Australia and to situate it within a global context of modern emergency medical services. This paper examines the peer reviewed and grey literature to chart the transition of Australian paramedic education from vocational to higher education and uncovers signposts of change leading to this transition.

Methods

Following a systematic search of MEDLINE and CINAHL Plus databases, the university library collection, Google and the websites of Australian ambulance services, Paramedics Australasia (PA) and the Council of Ambulance Authorities (CAA), 31 reports, 12 journal articles and three texts are included in this review.

Results

Advances in emergency medicine, vocational education training sector reform in the 1970s and 1980s, reviews into ambulance services, health workforce reform and the efforts of PA and CAA contributed to the transition to university-based education, development of university paramedic program accreditation standards and, ultimately, progression towards registration and professionalisation. These signposts of change that chart developments in Australian paramedic education however, proved difficult to uncover in the literature.

Conclusion

Unexpectedly, this review finds peak Australian ambulance and paramedic professional bodies perceive difficulty in influencing policy direction that impacts the profession. Absence of thorough and detailed accounts of Australian paramedic education keeps hidden a unique and important history. We invite further research to preserve the history of paramedic education in Australia within the public domain, to assist the profession to understand what went before and to inform its future directions.
Subconscious Passive Learning of CPR Techniques through Television Medical Drama
Authors: Eisenman A. , Rusetski V. , Zohar Z. , Avital D. , Stolero J.
Published: December 2018

A cardiac arrest victim's chances of survival are largely dependant on the availability at the scene, of a witness familiar with CPR skills. Many efforts have been invested in teaching CPR skills to as many people as possible and new ways are constantly being researched to distribute and extend these skills to the wider population. We report a case whose survival was due to CPR performed by a lay family member with no previous official training in resuscitation. The rescuer admitted that she had recalled the CPR technique from a popular medical drama on television (TV) and that she was absolutely unaware of her CPR potential capabilities. TV producers and health policy makers should exploit highly rated TV feature programs such as medical dramas to transmit useful hidden messages such as CPR skill to the public. In due time this policy may prove to be a life saver.
Paramedic Identification of Ecg J Point and St Segments: A Pilot Study
Authors: Williams Brett , Boyle Malcolm , Lord Bill
Published: December 2018

Objective

To identify if undergraduate paramedic students are accurate at identifying J Point and ST segments on electrocardiograms.

Methods

A prospective single-blinded observational pilot study asking students to identify ST segment and J point location on four different ECG complexes

Results

Of 32 students that participated in the study the findings demonstrated variations in students’ accuracy with both J Point and ST segment identification. Undergraduate paramedic students in most cases were able to recognise ST segment elevation; however, definition of the amount of ST segment elevation varied greatly. A quarter of students did not complete all 4 J Point estimations. Overall the student's estimations varied considerably.

Conclusion

Results from this pilot study have identified significant variation in students’ interpretation of J Point and ST Segment in ECG analysis.
Issues of Infection Control in Prehospital Settings
Authors: McDonell Angus
Published: December 2018

This paper considers infection control issues relevant to prehospital care providers. Specifically it examines practices related to the routine cleaning of patient monitoring cables between patients and, the cleaning and disinfection of respiratory equipment, in particular laryngoscope blades, facemasks and self-inflating resuscitation bags. The infection control issues are identified and an analysis of the operational, human resource and management practices relevant to these issues are discussed. Recommendations for best practice are explored.
Simtect Health 09 Simulation Conference - beyond Technical Skills
Authors: Boyle Malcolm
Published: December 2018

This was the 5th SimTect conference which was held over three days with pre-conference and post-conference workshops. The pre-conference workshops commenced on the Monday.
Rescuer Fatigue in Cardiopulmonary Resuscitation: A Review of the Literature
Authors: Gutwirth Hendrik , Williams Brett , Boyle Malcolm
Published: December 2018

Introduction

Provision of adequate chest compressions remains a standard of care for optimal outcome in cardiopulmonary arrest. Given the recent changes to CPR rates and a greater emphasis on pushing faster and deeper, this has raised questions surrounding rescuer fatigue and efficacy of compressions. While a body of work has been undertaken on previous CPR rates and associated fatigue levels, there is a shortage of literature on the latest CPR rates and associated rescuer fatigue in the hospital and prehospital settings. The objective of this paper was to determine the extent of fatigue associated with CPR in both the hospital and prehospital settings.

Design

A review of the literature using a variety of medical databases, including Cochrane Database of Systemic Reviews, Ovid MEDLINE, EMBASE, and CINAHL electronic databases. The following MeSH terms were used in the search: CPR fatigue, chest compression, compression depth, out of hospital, in-hospital, prehospital, emergency medical services.

Results

21 articles met the inclusion criteria, with three of these papers being from the prehospital setting. Currently, there is low level evidence determining the most appropriate length of time in providing quality chest compression before rescuer fatigue occurs. Overall chest compressions were shallower at least half of the time due to fatigue, and the mean compression rate was found to be higher than recommended.

Conclusion

The findings of this study suggest that the quality of chest compressions deteriorates soon after commencing CPR, and that high quality prehospital studies are lacking.
Effect of Road Traffic Accident Contaminants on Pulse Oximetry among Normoxaemic Volunteers
Authors: Kamaras Gyorgyi , Geller Tamas , Dioszeghy Csaba
Published: December 2018

Objectives

Pulse oximetry is a simple and reliable non-invasive method used widely in emergency care. Signal strength is usually easy to interpret in most monitors and is used as a simple validation tool for the reliability of the readings. However it is known from the literature that in certain circumstances the oxygen saturation readings could be false in spite of a deceptively normal signal. The aim of this study was to compare the pulse oximetry readings on fingers contaminated with natural contaminants which might appear in a road traffic accident (RTA) scenario.

Methods

50 healthy volunteers were included. Beside the control fingers, the others were contaminated by (1) dried blood (B), (2) soil (S), (3) oil grease (O) and (4) green extract from natural leaves (G).

Results

The average control reading was 99.1% (SD 1.11). The average readings on the contaminated fingers were as follows: B: 98.6% (SD 1.27); S: 98.7% (SD 1.17); O: 98.5% (SD 1.09); G: 98.7% (SD 1.06). There was a statistically different decrease in the readings between the B and O groups compared to control.

Conclusion

Pulse oximetry could give unreliable readings despite a normal signal when a patient's fingers are contaminated - especially with dried blood or black oil grease which are both common in road traffic accidents. Cleaning the fingers before pulse oximetry therefore should be considered.
Use of the Ottawa Ankle Rule by Paramedics in the Out-of-Hospital Setting
Authors: Simpson Paul
Published: December 2018

Objective

The Ottawa Ankle Rule (OAR) is extensively documented in the emergency department setting and has been subjected to repeated validation. However, the prehospital experience in implementing this clinical decision rule appears poorly described. The objective of this study is to identify evidence (of any level) describing the use of the OAR by paramedics.

Methods

A literature search was conducted of the following key electronic databases; Medline (1950 to March Week 1 2010); EMBASE (1980-Week 10 2010) and CINAHL (1981-March 2010). The keywords ‘ankle injury’, ‘clinical decision rule’, ‘paramedic’, ‘ambulance’, ‘prehospital’, and ‘emergency care’ were used to frame the search, while a prehospital and emergency care search filter was used to maximise the sensitivity of the search. A review was conducted of the reference lists accompanying each relevant article to identify other potentially relevant citations. The search criteria included published articles which were both primary research and secondary review papers, and conference abstracts of any research design. We excluded non-English articles and letters. The abstracts of all citations in the search results were reviewed and full text articles for studies of interest were retrieved for examination.

Results

The search yielded 98 citations, with 80 relating directly to the OAR. After reviewing the abstracts of all citations, no articles of any study design, discussing the use of the OAR by paramedics in the out-of-hospital setting were identified.

Conclusion

Whilst there is no published evidence describing the use of the OAR by paramedics in the prehospital setting, it is feasible that paramedics could implement the rule safely and with equivalent sensitivity and specificity to other settings. This clinical decision rule may have good utility as a triage tool that could be used to stream suitable patients into non-emergency department alternatives. Research is needed to validate the use of the OAR when used within EMS jurisdictions.
The Exploration of Physical Fatigue, Sleep and Depression in Paramedics: A Pilot Study
Authors: Sofianopoulos Sarah , Williams Brett , Archer Frank , Thompson Bruce
Published: December 2018

Ambulance paramedics are members of a discipline that forms a unique part of the emergency services. As pre-hospital providers they are constantly and increasing faced with heavy workloads that are physically, mentally and emotionally tiring. Fatigue and sleep disturbance are factors which can compromise the effectiveness of these workers, and as a result not only hamper patient safety but can have detrimental consequences on the paramedics‟ health and overall well-being. The objective of this study was to investigate the impact shift work on physical fatigue, sleep and psychological factors among paramedics in Australia.

Methods

A convenience sample of paramedics was asked to complete a number of self-reporting standardised questionnaires: The Epworth Sleepiness Scale (ESS) (8-items), Berlin Questionnaire (BQ) (10-items), Pittsburgh Sleep Quality Index (PSQI) (19-items) and the Beck Depression Inventory (BDI) (21-items). Ethics approval was granted.

Results

The study recruited 60 participants, the majority of which were male 77% (n=46), > 45 years of age 31% (n=19), and having worked shift work between 5-10 years 35% (n=21). Nine out of ten (92%, n=55) of paramedics reported having experienced fatigue in the last 6 months, with 88% (n=53) believing it had affected their performance at work. The ESS reported 30% (n=18) of people had excessive daytime sleepiness, and 10% (n=6) being dangerously sleepy. Statistical significance was observed in the ESS items „chance of dozing while sitting and talking to someone‟ (p<0.05), and „whilst stopped in traffic for a few minutes‟ (p<0.05) between males and females. Almost half (48%, n=29) of paramedics answered yes to having nodded off or fallen asleep whilst driving. The PSQI found 68% (n=41) of participants suffered poor quality sleep, while 21 % (n=13) of respondents were at high risk for sleep apnoea (BQ). Depression was found to be mild among 27% (n=16) and moderate among 10% (n=6) of respondents

Conclusion

Shift work affects health and well-being both physiologically and psychologically, which translates from work into home. Further research using a larger sample size is warranted to prevent the issues of patient safety, work-related fatigue and the cumulative effects of shift work in paramedic employees.
APPLICATION OF DOLOMITE AS A HETEROGENEOUS CATALYST OF BIODIESEL SYNTHESIS
Authors: Sendžikienė Eglė , Makarevičienė Violeta , Kazancev Kiril
Published: December 2018

Some of the more recent methods of obtaining biodiesel are based on heterogeneous catalysis, which has the advantage of multiple uses of a catalyst. Natural minerals, such as dolomite, opoca and serpentinites, could be promising for use in biodiesel synthesis. The purpose of this study was to optimise the reaction conditions for biodiesel synthesis from sunflower oil and methanol using dolomite as a catalyst. Optimum reaction conditions for the transesterification of sunflower oil with methanol, using dolomite calcined at the temperature of 850 °C, have been identified: the amount of the catalyst – 6%, the molar ratio of methanol to oil – 8:1, the reaction duration – 5 hours and the reaction temperature – 60 °C. The amount of Fatty Acid Methyl Esters (FAME) of the sunflower oil obtained – 97.6%. FAME is in conformity with the EN 14214:2003 standard, when 500 ppm of antioxidant Ionol and 500 ppm of depressant Infineum R-442 are added. The Cold Filter Plugging Point (CFPP) of FAME is reduced to7 °C by adding 500 ppm of Infineum R-442. This product can be used in summer in the countries that are placed in Class E, including Lithuania. It has been established that dolomite without regeneration can be used for the transesterification of sunflower oil 2 times.
G337.342–0.119 (The “Pebble”): A Cold, Dense, High-mass Molecular Cloud with Unusually Large Line Widths and a Candidate High-mass Star Cluster Progenitor
Authors: Jackson James M. , Contreras Yanett , Rathborne Jill M. , Whitaker J. Scott , Guzmán Andrés , Stephens Ian W. , Sanhueza Patricio , Longmore Steven , Zhang Qizhou , Allingham David
Published: December 2018

How high-mass star clusters form, especially young massive clusters (YMCs: age <100 Myr; mass >104

), remains an open problem, largely because they are so rare that examples of their cold, dense, molecular progenitors continue to be elusive. The molecular cloud G337.342−0.119, the “Pebble,” is a candidate cold progenitor. Although G337.342−0.119 was originally identified as four separate ATLASGAL clumps, the similarities in their molecular line velocities and line widths in the MALT90 data set demonstrate that these four clumps are in fact one single, coherent cloud. This cloud is unique in the MALT90 survey for its combination of both cold temperatures (T
dust ∼ 14 K) and large line widths (ΔV ∼ 10 km s−1). The near/far kinematic distance ambiguity is difficult to resolve for G337.342−0.119. At the near kinematic distance (4.7 kpc), the mass is 5000

and the size is 7 × 2 pc. At the far kinematic distance (11 kpc), the mass is 27,000

and the size is 15 × 4 pc. The unusually large line widths of G337.342−0.119 are difficult to reconcile with a gravitationally bound system in equilibrium. If our current understanding of the Galaxy’s Long Bar is approximately correct, G337.342−0.119 cannot be located at its end. Rather, it is associated with a large star-forming complex that contains multiple clumps with large line widths. If G337.342−0.119 is a prototypical cold progenitor for a high-mass cluster, its properties may indicate that the onset of high-mass star cluster formation is dominated by extreme turbulence.
Multi-epoch Proper Motion Magnetic Field Comparison of SiO Masers around R Cas
Authors: Assaf K. A.
Published: December 2018

We imaged silicon monoxide masers toward the asymptotic giant branch star R Cas at 23 intervals covering almost 2 pulsation cycles. The masers are concentrated in a shell within 4 stellar radii. Between 19 and 62 features were identified per epoch and 184 of these were matched at 3 or more epochs, forming 38 series. The features probably survive more epochs than their detectable masers. We compared the proper motions and polarization of these clumps, providing the first complete assessment of the net expansion velocity over more than one cycle and the significance of the magnetic field. Proper motions are irregular, dominated by outflow (infall) in the first (second) cycles. Sixty-five matched pairs had maser polarization angles consistent within π/8. A small excess (22) of this subsample has proper motion vectors within ±22.°5 of being parallel to the inferred magnetic field, 10 of which have approximately radial proper motions. The average field strength needed to provide a magnetic energy density equivalent to the bulk kinetic and thermal energy densities of a clump is ∼2 G, similar to direct magnetic field measurements. While some clumps possess a consistent magnetic field, capable of influencing the direction of motion, only a minority flow along magnetic field lines. The resultant SiO expansion proper motion over the entire periods is ∼0.4 km s−1 (taking ∼67 yr to cross the shell), which, compared with the mass in the shell, implies a wind similar to mass-loss rates from the literature measured on larger scales.
A Possible Explanation of Vanishing Halo Velocity Bias
Authors: Zhang Pengjie
Published: December 2018

Recently, Chen et al. accurately determined the volume weighted halo velocity bias in simulations and found that the deviation of velocity bias from unity is much weaker than the peak model prediction. Here we present a possible explanation of this vanishing velocity bias. The starting point is that halos are peaks in the low redshift non-Gaussian density field with smoothing scale R
Δ (virial radius), instead of peaks in the high-redshift initial Gaussian density field with a factor of

larger smoothing scale. Based on the approximation that the density field can be Gaussianized by a local and monotonic transformation, we extend the peak model to the non-Gaussian density field and derive the analytical expression of velocity dispersion and velocity power spectrum of these halos. The predicted deviation of velocity bias from unity is indeed much weaker than the previous prediction, and the agreement with the simulation results is significantly improved.