bluuebunny/crossref_metadata_2025_split huggingface dataset:
Community Presentations of Anaphylaxis in Tasmania: Who is Administering the Adrenaline?
Authors: Edwards Dale , Blackhall Melanie , Berry Rachael 
Published: December 2018

Background Anaphylaxis is a significant health concern within the community. The early administration of adrenaline to patients experiencing anaphylaxis has long been recognised as the cornerstone of treatment. Health-care providers, including general practitioners, nurses and paramedics, are well equipped to manage anaphylaxis through the administration of adrenaline. Patients themselves also often have adrenaline auto injectors, allowing early self-management. The objective of this study was to determine the rates of adrenaline administration and identify the administering persons for all anaphylaxis patients presenting to ambulance services in Tasmania from January 1st 2008 until December 31st 2011 by using a retrospective chart review. Methods Ambulance Tasmania electronic case reports (n=226 421) from the period January 1st 2008 to December 31st 2011 were searched for all cases fitting the parameters of anaphylaxis, allergy or allergic reaction. Of these cases, 373 were given a final paramedic diagnosis of anaphylaxis and constituted the primary data for this report. Results Ambulance Tasmania attended 373 patients during the study period that were given a final primary diagnosis of anaphylaxis - of these 59 (15.8%) were excluded, leaving 314 electronic records for analysis. Of the cases identified, 71.7% (n=225) were administered adrenaline according to paramedic records. Adrenaline was administered by a range of health professionals, including general practitioners (n=27), paramedics (n=159), ambulance volunteers (n=4), nurses (n=1) and other health professionals (n=3). Adrenaline was self-administered by 12.4% (n=28) of patients, with an additional 11.6% (n=26) receiving adrenaline from a non-health care worker (layperson). In 10.2% of cases (n=23) adrenaline was administered by more than one provider. Administration of adrenaline prior to paramedic arrival was evident in fewer than 10% of cases treated with adrenaline (n=22). Conclusion The early administration of adrenaline in anaphylaxis is often vital for patient recovery. This study shows that adrenaline is administered by a number of different providers, with early administration accounting for only 9.8% of presentations treated with adrenaline. These findings raise the question, is adrenaline being administered early enough and often enough to improve health outcomes?
Protective Effect of Paramedics’ Sense of Personal Accomplishment at Work: Mitigating the Impact of Stress on Sleep
Authors: Kukowski Charlotte , King David B , DeLongis Anita 
Published: December 2018

Introduction Paramedics are at high risk for the development of post-traumatic stress disorder (PTSD), trauma-related symptoms, and burnout. Despite the multitude of research linking both PTSD and burnout with poor sleep quality, there has been no research linking all three variables, in emergency workers or otherwise. Given the importance of sleep in a profession that is largely reliant on shift work, the goal of the current study was to examine the moderating effect of burnout on the association between post-traumatic stress and average sleep quality. Methods A sample of 87 paramedics from major urban centres across Canada completed the Maslach Burnout Inventory and the PTSD Checklist Civilian Version, in addition to reporting sleep quality for a period of one week. Results In support of our hypotheses, post-traumatic stress was associated with lower average sleep quality. Standard regression analyses further revealed that this effect was moderated by burnout, such that higher burnout exacerbated the effect of post-traumatic stress on sleep. In examination of the subscales of the MBI, this effect was maintained for personal accomplishment only, which interacted with stress so as to further impair quality of sleep. Conclusions These findings offer important considerations regarding the mitigating role of more positive workplace variables in paramedics suffering from post-traumatic stress, PTSD, and/or sleep problems. Interventions aimed at fostering a sense of personal accomplishment on the job may improve the health of emergency medical personnel via multiple pathways.
Examination of Undergraduate Paramedic Clinical Placement within a Traditional and Novel Setting
Authors: Smith Gavin 
Published: December 2018

Background Increasing student enrolments and limited capacity within traditional placements have defined a need to reassess the format of clinical placement programs. This study aimed to compare traditional and novel clinical placement experience of third year paramedic science students at Victoria University in order to report elements that may contribute to identifying an optimum model for future clinical placement programs. Design A descriptive study of clinical placement case exposure with comparative analysis of local and international student cohorts. Setting A paramedic student clinical placement program in two ambulance services: Ambulance Victoria (Australia) and Magen David Adom (Israel). Methods Descriptive statistics were used to report patient and student experience factors. Specific case exposure, demonstration of skills and use of pharmacological agents are reported as proportions. Results A total of 441 cases were analysed: 206 and 235 in the local and international study groups respectively. Mean caseload per paramedic student was not significantly different between the study groups at 1.2 cases (95% CI: -2.8-0.4, p=0.1)). The international group engaged in a greater range of shifts, including more afternoon shifts and the opportunity to experience night shifts. Conclusion This study provided the first descriptive analysis of a traditional and international clinical placement experience for paramedic undergraduate students, identifying benefit in both programs. Future studies incorporating a mixed methods design measuring practical exposure will add important depth and understanding to clinical placement optimisation.
What’s in a name? The confusion in nomenclature of low-acuity specialist roles in paramedicine.
Authors: Long David Nicholas , Clark Michele , Lim David , Devenish Scott 
Published: December 2018

A significant paradigm shift in the care of non-urgent, low-acuity patients by paramedics has been gathering momentum over the last two decades. However the current nomenclature to define paramedics who specialise in the low-acuity setting is confusing, inconsistent and arguably misrepresentative. This commentary contends that two discernible paradigms lie along the spectra of low-acuity service delivery in paramedicine and argues that the nomenclature should also reflect this difference. Consistency in nomenclature has implications for the evolving professionalism in paramedicine and the movement towards national registration.
Experiencing Emergency Medical Services at Hajj
Authors: Leggio William J , Mobrad Abdulmajeed , D'Alessandro Kenneth J , Krtek Michael G , Alrazeeni Daifallah M. , Sami Mohammed A. , Raynovich William 
Published: December 2018

Introduction This article is a first-hand report on the experience of paramedic students providing emergency medical services (EMS) at Hajj, an annual mass gathering of Muslim pilgrims in Makkah, Saudi Arabia. Previous quantitative research on Hajj has primarily reported on demographic descriptive data. A qualitative approach to understanding Hajj was not discovered in the literature. This qualitative phenomenological study was conducted to investigate the experiences of EMS students providing patient care at Hajj. Methods This research was conducted using a qualitative phenomenological methodology. Focus group interviews were conducted on Bachelor degree students studying EMS at a public college in Riyadh, Saudi Arabia, who were all required to serve as support providers at Hajj as part of their paramedic training. Results Participants described their experiences as honorable and beneficial to their EMS education. Participants encountered medical and trauma patients and this provided opportunities to apply their EMS knowledge and medical skills. They reported an increase in motivation, confidence and ability to think critically. Common challenges included language barriers and difficulty reaching patients due to massive crowds. Participants provided recommendations for improving the EMS provided at Hajj, which were generally focused on increasing utilisation of EMS students, development of standards and scope of practice for EMS at Hajj and a preceptor-training program. Conclusion Attending the Hajj mass gathering was found to have significant educational value for EMS students. Specific recommendations on how to improve this education experience and provided emergency care at Hajj are made. These recommendations hold practical implications for EMS training programs and Hajj organizers.
Inquiry into the Establishment of a National Registration System: A Response to New South Wales
Authors: Moritz Dominique Lee 
Published: December 2018

Introduction The potential national registration of paramedics is a significant issue. Despite widespread support of paramedics joining other registered health practitioners under the National Registration and Accreditation Scheme, New South Wales continues to oppose. Methods This paper considers the New South Wales submission to the Senate Committee's inquiry into the establishment of a national registration system for Australian paramedics. It evaluates the reasons for New South Wales Health's opposition to national registration. Aim This paper considers the New South Wales submission to the Senate Committee's inquiry into the establishment of a national registration system for Australian paramedics. It evaluates the reasons for New South Wales Health's opposition to national registration. Conclusion New South Wales Health's reasons for opposing national paramedic registration include the cost to implement a registration scheme, the desire to maintain vocational entry to employment and the purported efficiency of their current regulatory system. However, their position fails to address the challenges of employer-based regulation and the significant public protection benefit, among other things, of national statutory regulation.
The Pre-Hospital and Healthcare System in Malang, Indonesia
Authors: Suryanto Suryanto , Boyle Malcolm , Plummer Virginia 
Published: December 2018

Introduction Malang is the second largest city in East Java and consists of three districts: Malang Regency, Malang City and Batu City. Malang has the most advanced emergency care education in East Java, and possibly Indonesia. The recent launch of the 119 Emergency Medical Service may influence pre-hospital care in Malang and assist in developing a more organised emergency medical system in the area. Objective This paper describes the pre-hospital care and healthcare structure in Malang and focuses on the health facilities, pre-hospital care service and healthcare providers. Discussion There are two major types of healthcare facilities in Malang, hospitals and primary healthcare centres called ‘puskesmas’. Ambulance service provision in Malang is either hospital-based or puskesmas-based. There is no organised emergency medical system in Malang. In the case of an emergency, the patient or bystander calls the hospital emergency department or puskesmas. The use of ambulances in Malang is low due to the perceived prohibitive cost of the service. Ambulance service fees for emergency cases outside of the hospital or puskesmas are not covered by the universal health insurance in the country. There is no specific pre-hospital trained staff in Malang. Nurses are responsible for staffing the ambulance, and there is no formal pre-hospital care education for those nurses working in an ambulance.
Paramedic identification and management of victims of intimate partner violence: A literature review
Authors: Mackey Breanna 
Published: December 2018

IntroductionIntimate partner violence (IPV) occurs between adults of the same or opposite sex in a current, or past, intimate relationship. The aim of this paper is to review the literature regarding paramedic confidence, capacity and accuracy when identifying adult victims of IPV and subsequent management of the scene when IPV is suspected or identified.MethodsA review of the literature using Ovid MEDLINE was conducted; five articles met the inclusion and exclusion criteria. ResultsResults show a consistency in findings across research areas in Australia, Canada and the United States and are clear in four separate areas: paramedics demonstrate a high degree of accuracy in identifying IPV victims; professional training effectively increases paramedic knowledge of IPV; greater than 50% of the paramedic population surveyed felt underprepared to deal with an IPV scene; and the majority of surveyed paramedics attend between one and 10 IPV scenes per year.ConclusionThis review indicates that paramedics have the capacity to accurately identify IPV victims, and that paramedics recognise a deficit in their professional IPV training. Further research is required, using a robust sample size, to construct appropriate training packages and guide improvement to paramedic clinical practice guidelines.
The Bachelor of Nursing/Bachelor of Emergency Health (Paramedic) Degree: How well does it Align with Course Objectives?
Authors: Plummer Virginia , Tozer-Jones Jennie , Williams Brett 
Published: December 2018

Introduction The Bachelor of Nursing/Bachelor of Emergency Health (Paramedic) Degree (BN/BEH-P) is a four-year on-campus double degree, combining essential units from both the accredited Bachelor of Nursing and Bachelor of Emergency Health courses. Graduates of this course are expected to be well equipped to manage the complexity of emergency care out-of-hospital, in-hospital and at the interface of these settings. The aim of this study was to explore student views of their preparation and intentions towards future practice and the alignment with course objectives. Methods A cross-sectional study was employed with a sample of first, second, third and fourth year undergraduate students of the BN/BEH-P. The results were mapped to course objectives by researchers. Results Written responses varied considerably making generalisations difficult; however, some common themes did emerge such as a need for greater flexibility in course delivery options, not enough simulation, a need for more clinical placements and better communication between the two schools. The level of satisfaction with course content and delivery was high. Timetabling problems and the allocation of clinical placements were a source of concern for many students and were found to be common to double degrees in general. There was alignment between student perspectives of course delivery with half of eight course objectives, but not in areas such as ethics, evidence based practice, professional communication and cultural values in practice. Conclusion The findings are important for students, universities and health services, informing a pedagogical alignment between student preparation and expectations. The findings are expected to provide valuable insight into the student view of undergraduate interprofessional education, how it shapes their intentions for future practice and how students and other stakeholders know if they will receive what is offered and funded.
Impact of Loading and Transport on Effectiveness of External Chest Compressions – a Simulation Study
Authors: Chew Reyna , Price Clare , Moqadassi Hamed , Talbert Shaun , Hilliar Tim , Thyer Elizabeth , Simpson Paul M 
Published: December 2018

Introduction Effective external chest compressions (ECC) are recognised as being critical for increasing chances of survival in out-of-hospital cardiac arrest. The aim of this study was to: 1) determine the impact of movement and transport on effectiveness of ECC performed by student paramedics; 2) provide results to inform a future larger study; and 3) validate teaching methods in an undergraduate paramedicine program. Methods A prospective cohort design was utilised. Student paramedics performed ECC on a manikin under three different conditions: at ground level on a hard floor surface (ground ECC); at waist-height on a moving ambulance stretcher (extrication ECC; and during transport in the rear of a moving ambulance (transport ECC). Three minutes of ECCs was performed under each condition, with periods of rest between phases. The primary outcome was the composite ‘compression score’ (CS) (%). Results Twenty-seven student paramedics performed chest compressions under all three conditions. For the primary outcome comparison of CS, there were clinically significant differences in ECC quality across the three conditions. Ground ECC produced the highest CS (89%; IQR 46), followed by transport ECC (54%; IQR 40). Extrication ECC was least effective (CS 0%; IQR 14). Conclusion The conditions under which ECC are performed significantly affects ECC quality. The quality of ECC is substantially reduced if performed in the back of a moving ambulance, and futile if performed on a moving ambulance stretcher. Paramedics should consider these findings when deciding whether or not to move or transport patients before return of spontaneous circulation. Lower than expected CS on hard ground surfaces may indicate a need to review teaching of ECC in this cohort of students.
A Comparative Taxonomy of Australasian Paramedic Clinical Practice Guidelines
Authors: Colbeck Marc , Maria Sonja 
Published: December 2018

Background There are 10 state-run ambulance services in Australia and New Zealand, all of which are members of the Council of Ambulance Authorities (CAA). These CAA services use nine unique sets of clinical practice guidelines (CPGs) to direct the care that their paramedics deliver to patients. Although there are many similarities in these guidelines there are also notable differences in both structure and content. This paper is a comparative analysis of these CAA CPGs that contrasts the differences in organisation and also discusses the similarities and differences between the various CPGs themselves. This comparison was done as a preparatory exercise for the creation of a set of national CPGs by Paramedics Australasia. Methods The complete set of CPGs were obtained and analysed. All CPGs intended for operational road paramedics were examined. These included extended care paramedic, retrieval and intensive/critical care paramedic CPGs, and first responders. The 10 tables of contents were synthesised into one document and then restructured into a unique taxonomy determined by consensus of the authors. The authors reviewed the taxonomy to ensure the organisation was consistent and logical. Each CPG was then reviewed to ensure that it was appropriately placed in the new taxonomy. The CAA CPGs were further examined for similarities and differences independently by each author according to a predefined list of characteristics. Results A new taxonomy for Australasian CPGs is presented with a discussion of various issues of interest that became apparent during the development of the taxonomy. This taxonomy can provide guidance in the creation of a unified set of CPGs that can be used as a reference for developers, educators, clinicians, researchers, managers and industry representatives interested in consulting and developing a clear statement of the scope and standards of Australasian paramedics. The comparative analysis could be of interest to developers of CAA CPGs, and others. Conclusion This paper presents a novel taxonomy, or scheme of classification, that incorporates all CAA CPGs in preparation for the development of a uniform set of Australasian CPGs, which will be of use to various individuals and organisations.
The Carnegie-Chicago Hubble Program: Calibration of the Near-infrared RR Lyrae Period–Luminosity Relation with HST
Authors: Rich Jeffrey A. , Madore Barry F. , Monson Andrew J. , Freedman Wendy L. , Beaton Rachael L. , Clementini Gisella , Garofalo Alessia , Hatt Dylan , Hoyt Taylor , Jang In-Sung , Kollmeier Juna A. , Gyoon Lee Myung , Neeley Jillian R. , Scowcroft Victoria , Seibert Mark 
Published: December 2018

Abstract
We present photometry of 30 Galactic RR Lyrae variables taken with HST WFC3/IR for the Carnegie-Chicago Hubble Program. These measurements form the base of the distance-ladder measurements that comprise a pure Population II base to a measurement of H

o
at an accuracy of 3%. These data are taken with the same instrument and filter (F160W) as our observations of RR Lyrae stars in external galaxies so as to minimize sources of systematic error in our calibration of the extragalactic distance scale. We calculate mean magnitudes based on one to three measurements for each RR Lyrae star using star-by-star templates generated from densely time-sampled data at optical and midinfrared wavelengths. We use four RR Lyrae stars from our sample with well-measured HST parallaxes to determine a zero-point. This zero-point will soon be improved with the large number of precise parallaxes to be provided by Gaia. We also provide preliminary calibration with the TGAS and Gaia DR2 data, and all three zero points are in agreement, to within their uncertainties.
Spectroscopy of the K0 Binary Giant α UMa
Authors: Gray David F. 
Published: December 2018

Abstract
High-resolution spectroscopic observations of the K0 II–III star α UMa were taken at the Elginfield Observatory over 11 years. Radial velocities were measured for nine of these years. They do not cover enough of the 44.5 year orbital period to give definitive elements on their own, but combined with published visual orbits, the spectroscopic-orbit parameters are well constrained. The spectra show no evidence of the secondary star, which remains an unsolved puzzle. Line-depth ratios show that α UMa has temperature variations ∼3 K, possibly periodic, over the 2001–2010 interval. Fourier analysis of the line broadening gives the projected rotation velocity of 2.66 ± 0.15 km s−1 and a radial-tangential macroturbulence dispersion of 4.97 ± 0.08 km s−1. The third-granulation signature shows the granulation velocities of α UMa to be essentially solar, with a scale factor of 0.98 ± 0.10. The absolute radial velocity of the star, with granulation blueshifts removed is −10,035 ± 100 m s−1 at the mean time of the observations, 2005.2544. The line bisector of Fe i
λ6253 is normal and shows the classic “C” shape with the blue-most point commensurate with its absolute magnitude. Mapping this bisector on to the third signature gives a flux deficit similar to those of other giants, with a fractional area of 0.131, suggesting a temperature difference between granules and lanes of 127 K. The velocity position of the deficit is slightly higher than that for previously analyzed giants, extending the correlation with absolute magnitude.