bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Systems Approach to Learning, Practice and Reflection in Emergency Primary Health Care: Student Perspectives
Authors: Mellifont Daniel , Barr Nigel , Dunn Peter 
Published: December 2018

Introduction Clinical decision making skills are essential for professional practice in primary emergency healthcare and are an intended outcome of clinical and professional programs. This article documents an interdisciplinary exploration of learning and teaching of clinical decision making and critical dialectical reflection (the systems approach) at The University of the Sunshine Coast (USC), Australia. Methods Using an online survey we explored students’ perspectives on how working with the systems approach impacted upon their confidence and capacity to engage in emergency clinical scenarios. Results USC's systems approach, integrated with a focus on critical reflection and case-based learning, is strongly associated with improved student confidence to engage in emergency primary health care scenarios. Most participants reported increased confidence post intervention and believed that the systems approach helped them to improve their capacity for other critical components. Conclusion This study indicates the beneficial nature of a systems approach to the learning and teaching of clinical decision-making. The tool could be further developed, to improve perceived ability to communicate more effectively.
Student Paramedic Attitudes towards the Elderly: A Cross-Sectional Study
Authors: Ross Linda , Duigan Tom , Boyle Malcolm J , Williams Brett 
Published: December 2018

Introduction It is well known that Australia has an aging population and that the elderly are disproportionately overrepresented in the patients seen by ambulance paramedics. While research to date has primarily focussed on the attitudes towards the elderly held by nursing and medical students, there is a current paucity of research about the perspective of paramedic students. The objective of this study was to identify the attitudes of paramedic students from a large Australian university towards the elderly. Methods In 2013, second year paramedic students from Monash University, Melbourne, Australia were invited to participate in this cross-sectional study and record their attitudes towards the elderly (age >65) using the Aging Semantic Differential (ASD) questionnaire. The ASD utilises a 7 point bipolar Likert scale questionnaire consisting of 32 items and three subscales: Instrument—Ineffective; Autonomous—Dependent; Personal Acceptability—Unacceptability. Results Fifty six second year paramedic students participated in the study. The participants were predominantly <26 years of age n=48 (85.7%) and female n=36 (64.3%). Subscale results produced the following mean scores: Instrument—Ineffective (mean=35.05, SD=5.01); Autonomous—Dependent (mean=34.25, SD=4.26); Personal Acceptability—Unacceptability (mean=49.47, SD=6.44). Conclusion These results suggest that while student paramedics possess a healthy respect for the elderly, they also harbour some preconceived negative ideas about them. Ultimately, these attitudes may impact on a paramedic's interaction with, and management of the elderly patient, which raises questions about whether students are being adequately prepared for clinical practice.
Perceptions of Student Paramedic Interpersonal Communication Competence: A Cross-Sectional Study
Authors: Ross Linda , Boyle Malcolm , Williams Brett , Fielder Christopher , Veenstra Rebecca 
Published: December 2018

Introduction Interpersonal communication skills are essential to the healthcare practitioner aiding in high quality, effective and safe clinical practice. Effective communication exerts a positive influence on the patient's physical and emotional status resulting in better patient outcomes and satisfaction. By identifying strengths and weaknesses, self-assessment of interpersonal communication skills can be used as an intervention tool to inform future curriculum renewal. The objective of this study was to identify paramedic students’ perceptions of their interpersonal communication competence. Methods Second year paramedic students from Monash University (Victoria) were invited to participate in a survey that asked them to record perceptions of their interpersonal communication skills using the Interpersonal Communication Competence Scale (ICCS). The ICCS is a 30-item unipolar questionnaire using a Likert scale ranging from 1 (almost never) to 5 (almost always). Mean and standard deviations (SD) were used to report results. Results Fifty-six second year paramedic students participated in the study. Participants were predominantly aged less than 25 years (85.7%) and male n=36 (64.3%). Students reported ‘often’ or ‘almost always’ for the items: ‘I put myself in others’ shoes’, n=46 (82%), mean=3.98 (SD 0.59); and, ‘I let others know that I understand what they say’, n=45 (80%), mean=3.96 (SD 0.66). Students reported ‘sometimes’, ‘often’ or ‘almost always’, for the items: ‘I have trouble convincing others to do what I want them to do’, n=55 (98%), mean=3.5 (SD 0.63); and, ‘My mind wanders during conversations’, n=41 (73%), mean=3.05 (SD 0.88). Conclusion Preliminary results suggest that student paramedics self-report their interpersonal communication skills highly apart from areas related to assertiveness and listening skills. These results could be indicative of student age, personality or experience level and warrant further research with larger sample sizes.
Antibiotic Prophylaxis in Pre-Hospital Trauma Care: A Review of the Literature
Authors: Smit Lynsey , Boyle Malcolm 
Published: December 2018

Introduction Penetrating and open wounds expose an otherwise sealed and protected body to foreign bodies, leaving the patient vulnerable to potentially fatal infection. The objective of this study was to determine if the administration of systemic prophylactic antibiotics by paramedics for penetrating and/or open wounds leads to decreased infection rates and improved patient outcomes. Methods A literature search of the electronic medical databases CINAHL, Cochrane, EMBASE and MEDLINE was conducted. The databases were reviewed from January 2000 to March 2013. A pre-hospital search filter was applied to each database with additional search terms of ‘open wound’, ‘penetrating wound’, ‘prophylactic antibiotic’. References of retrieved articles were also reviewed. Articles were included if they reported on the administration of prophylactic antibiotics by paramedics for penetrating or significant open wounds. Results A total of 1280 articles were identified in the search with four articles meeting the inclusion criteria. All four articles focused on the combat setting and management of soldiers with combat-related open or penetrating wounds. Two studies supported the use of prophylactic antibiotics whereas the third did not, stating that the evidence was low level and the practice of antibiotic administration was more opinion based. Conclusion This study identified that there is scant evidence to support the use of systematic antibiotic prophylaxis in the civilian pre-hospital setting for open wounds. There is a need for further research to identify if this view may change in the future.
Rural People's Use of Ambulances to Reach Emergency Departments in Potentially Serious Health Emergencies: Identifying Patterns of Use and Non-Use
Authors: Reed Buck , Bendall Jason 
Published: December 2018

Introduction Ambulance use in rural and remote parts of Australia has been reported anecdotally to be lower than urban areas. Experiences of paramedics in rural locations gave rise to questions of whether this phenomenon was occurring and to what degree. Methods Data from Emergency Department (ED) records was obtained from the Hunter New England Area Health Service from 1 July 2008 to 30 June 2009. In total, 354,909 records were obtained. These records were de-identified and analysed to determine the method of arrival to ED, specifically in high acuity patients. Results People from Inner Regional areas are 41.5% less likely overall and 27.7% less likely in serious health emergencies to attend EDs by ambulance compared to people in Major Cities. People from Outer Regional and Remote areas are 55.1% less likely overall and 27.9% less likely in serious health emergencies to attend EDs by ambulance compared to people living in Major Cities. Logistic regression modelling indicated rurality was a significant factor in ambulance use in adults in areas outside Major Cities and in children in Inner Regional areas. Age was a significant predictor of ambulance demand with older people using ambulance more. Conclusion This study indicates disparity between rates of ambulance use in urban and non-urban areas. The concept of unmet need should be considered as a more complex phenomenon than simply a utilisation gap and exploration of unmet need is warranted. A clearer understanding of how rurality affects ambulance use has a number of implications for ambulance services.
The Administration of Prehospital Ketamine for Chemical Restraint Does Not Prolong On-Scene Times Compared to Haloperidol Based Sedation
Authors: Burnett Aaron , Panchal Dolly , Peterson Bjorn , Ernest Eric , Griffith Kent , Frascone Ralph J , Engebretsen Kristin 
Published: December 2018

Introduction Agitated patients who present a danger to themselves or emergency medical services (EMS) providers may require chemical restraints. Haloperidol is employed for chemical restraint in many EMS services. Recently, ketamine has been introduced as an alternate option for prehospital sedation. On-scene time is a unique metric in prehospital medicine which has been linked to outcomes in multiple patient populations. When used for chemical restraint, the impact of ketamine relative to haloperidol on on-scene time is unknown. Objective To evaluate whether the use of ketamine for chemical restraint was associated with a clinically significant (≥5 minute) increased on-scene time compared to a haloperidol based regimen. Methods Patients who received haloperidol or ketamine for chemical restraint were identified by retrospective chart review. On-scene time was compared between groups using an unadjusted Student t-test powered to 80% to detect a ≥5 minute difference in on-scene time. Results 110 cases were abstracted (Haloperidol = 55; Ketamine = 55). Of the patients receiving haloperidol, 11/55 (20%) were co-administered a benzodiazepine, 4/55 (7%) received diphenhydramine and 34/55 (62%) received the three drugs in combination. There were no demographic differences between the haloperidol and ketamine groups. On-scene time was not statistically different for patients receiving a haloperidol based regimen compared to ketamine (18.2 minutes, [95% CI 15.7-20.8] vs. 17.6 minutes, [95% CI 15.1-20.0]; p = 0.71). Conclusions The use of prehospital ketamine for chemical restraint was not associated with a clinically significant (≥5 minute) increased on-scene time compared to a haloperidol based regimen.
Pre-Hospital Use of Intravenous In-Line Fluid Warmers to Reduce Morbidity and Mortality for Major Trauma Patients: A Review of the Current Literature
Authors: Collins Nicholas , Daly Stuart , Johnson Patricia , Smith Gavin 
Published: December 2018

Introduction In-line fluid warmers are an established treatment for delivering warmed intravenous (IV) fluid in the hospital setting. Recently their potential application within the pre-hospital setting has been highlighted to potentially reduce mortality and morbidity. Currently ambulance paramedics only administer warmed fluid to patients assessed as hypothermic, and this fluid is subject to further cooling on exposure to ambient environmental conditions. This review examined the peer-reviewed literature to determine the available evidence for in-line fluid warmer effectiveness and potential inclusion in pre-hospital emergency care. Methods A review of the electronic literature, including the Medline and Ebscohost databases was conducted using the terms “intravenous fluid warmers” “hypothermia”, “ trauma”, “ fluid”, “coagulopathy”, “ acidosis”, “hypothermia and trauma patients”, “accidental hypothermia”, “lethal triad” and “trauma care”. Articles were included if they represented a study of in-line fluid warmers within the surgical, general hospital or pre-hospital emergency care settings. Articles not available in English or as full text were excluded. Results The review identified 23 relevant articles for analysis. Of note, up to 40% of trauma patients with signs of hypoperfusion were reported to arrive at hospital in a hypothermic state post-incident. Hypothermia plays a significant role in contributing to the ‘triad of death’- a condition that results in poor patient outcomes and high mortality rates. Conclusion This review identified that current pre-hospital practice does not prescribe warmed fluid to the normothermic trauma patient. The review also identified that there is a need for in-line fluid warmers in ambulance practice to prevent or limit hypothermia and reduce patient morbidity and mortality associated with trauma.
Characteristics and Outcomes of Patients Assessed by Paramedics and Not Transported to Hospital: A Pilot Study
Authors: Keene Toby , Davis Megan , Brook Carol 
Published: December 2018

Introduction Patients seen by ambulance paramedics but not transported to hospital have not previously been studied in Australia. The purpose of this pilot study is to determine the feasibility of telephone interviews to describe and analyse patient factors, and determine short term patient outcomes associated with paramedic no-transport decisions. Method Twenty (20) patients participated in semi-structured telephone interviews 13-30 days following an episode of care from an Australian urban ambulance service. Data analysis was conducted in two phases; firstly, a quantitative description of the patient characteristics and their outcomes; and secondly, a qualitative analysis using a thematic framework to determine if there were any common themes emerging from the interviews. Results Only three (3) patients refused to participate in the interviews and none were unable to be located. The reasons patients expressed for not accepting transport were varied, though a common factor related to patient expectations of the service provided by paramedics. Patients had poor recall of advice provided by paramedics. All except one patient were successfully diverted from the emergency health system. Overall, patients expressed high satisfaction with their experience. Conclusion The reasons patients choose for not being transported require further study but appear to be driven by their expectations of the service provided by Paramedics. Telephone interviews are a viable method for collecting data on non-transported ambulance patients.
Paramedic Capstone Education Model: Building Work Ready Graduates
Authors: Thompson James , Grantham Hugh , Houston Don 
Published: December 2018

Summary In Australia, the last decade has witnessed considerable changes to both the scope of paramedic practice and the education of these practitioners. Notably within education, there has been a national trend to move from on-the-job training, towards a pre-employment, undergraduate university qualification. Despite increases in depth, breath and consistency to the curriculum and delivery by subject experts with training in education, criticism remains targeted at the preparation of the graduate for readiness to undertake the paramedic role. Australian undergraduate courses are currently experiencing unprecedented enrolment numbers, with complex student learning expectations and requirements. Producing work ready graduates within traditional curriculum frameworks is a challenge. Capstone courses target the final preparation of the graduating student, with a strong emphasis on articulating them successfully with their chosen industrial settings. While widely accepted in other disciplines, such as engineering, capstone is a new concept to paramedicine. This paper discusses how a capstone topic was created and implemented at Flinders University within the Bachelor of Paramedic Science degree. It describes the differentiated student learning methodology employed and the strategies used to respond to specific student and industry concerns regarding university teaching.
Critical Incident Technique – a Useful Method for the Paramedic Researcher's Toolkit
Authors: Mulholland Peter , Barnett Tony , Woodroffe Jess 
Published: December 2018

Introduction Critical Incident Technique (CIT) is a research method which has been used to investigate activities across many fields including psychology, medicine, nursing, counselling, education, learning and marketing. This paper explores this potential by investigating the use of CIT as a research method for the paramedic and pre-hospital environment. Methods A search using the term ‘Critical Incident Technique'was conducted using the University of Tasmania ‘Megasearch’ facility. Some 2935 papers were then filtered to include one or more of the terms ambulance, pre-hospital, paramedic, transport, retrieval, emergency medical service/s (EMS), emergency medical technician/s (EMT) and emergency. Using these terms, four research articles used CIT as a methodological approach. Searching CINAHL, SCOPUS and MEDLINE via PubMed individually, contributed one further article. A further search with the same terms was conducted using ‘Google Scholar’, and identified a further seven relevant papers. Results Although Critical Incident Technique has been used as a research method since 1954, its use in the examination and study of paramedic work (pre-hospital care) was limited and quite new. An analysis of the articles indicated five distinct themes relating to how CIT was used: physical dimensions of job performance (equipment and technology), teamwork and communication (how team members work and communicate), psychological dimensions of work (how paramedics felt about their work), student learning and experience and patient care. Conclusion CIT is a research method that has been used effectively to inform various psychological and physical dimensions of paramedic work. Paramedic work is about caring for those who require pre-hospital care, and further consideration of the application of CIT in pre-hospital research may increase our understanding of this work to improve service delivery and patient outcomes.
Should Civilian Pre-Hospital Emergency Care Provision Include Tourniquets for the Management of Uncontrolled Traumatic Haemorrhage?
Authors: Wright Georgia , Mcdonald Samantha , Smith Gavin 
Published: December 2018

Introduction Tourniquets are used extensively in military settings, where they have proven to be an effective means of controlling major traumatic haemorrhage. This review aims to determine the value of tourniquets in the civilian pre-hospital setting. Method A literature search was performed using the following electronic databases from inception to June 2014: Medline, Academic Search Premier and Cochrane Library. Additional searches were conducted in the Victoria University Library search engine. Key search terms included pre-hospital, tourniquet, military, complications, failure, ischemia, metabolic changes, history, and paramedics. Using the search terms outlined above, 236 articles were identified. With further examination 220 were excluded, leaving 16 for review (dated from 1974 - 2014). Of the 16 articles, 2 were determined to be relevant, published and peer reviewed case reports whilst the other 14 were peer reviewed and published studies. Results Tourniquet use for controlling major haemorrhage is more accepted for military rather than civilian applications. Factors contributing to this include: lack of education and training, variation and incidence of specific mechanisms of injury, complications such as ischemia, decreased civilian scene times, and decreased civilian transport times to definitive care. Civilian research was inhibited by study numbers, with much of the data emanating from military research. Conclusion To date, there is little evidence of tourniquet use in civilian environments. They are considered controversial due to complications and shortfalls. These factors contribute to user apprehension.
Paramedics’ Perceptions and Educational Needs with Respect to Palliative Care
Authors: Rogers Ian R , Shearer Freya R , Rogers Jeremy R , Ross-Adjie Gail , Monterosso Leanne , Finn Judith 
Published: December 2018

Introduction To identify and measure paramedics’ perspectives and educational needs regarding palliative care provision, as well as their understanding of the common causes of death. Methods All St John Ambulance Western Australia paramedics were invited to complete a mixed methods qualitative and quantitative survey using a tool previously validated in studies involving other emergency care providers. Quantitative results are reported using descriptive statistics, while Likert-type scales were converted to ordinal variables and expressed as means +/- SD. Qualitative data was analysed using content analysis techniques and reported as themes. Results Completed surveys were returned by 29 paramedics. They considered palliative care to be strongly focussed on end-of-life care, symptom control and holistic care. The dominant educational needs identified were ethical issues, end-of-life communication and the use of structured patient care pathways. Cancer diagnoses were overrepresented as conditions considered most suitable for palliative care, compared with their frequency as a cause of death. Conditions often experienced in ambulance practice, such as heart failure, trauma and cardiac arrhythmias were overestimated in their frequency as causes of death. Conclusions Paramedics have a sound grasp of some important aspects of palliative care including symptom control and the holistic nature of the palliative approach. They did however tend to equate palliative care with that occurring in the terminal phase and saw it as being particularly applied to cancer diagnoses. Paramedic palliative care educational efforts should focus on ethical issues and end-of-life communication, as well as increasing understanding of the common causes of death and those where a palliative approach might be beneficial.
Undergraduate Paramedic Students’ Perception of Mental Health Using a Pre and Post Questionnaire
Authors: Emond Kate , Furness Susan , Deacon-Crouch Melissa 
Published: December 2018

Introduction It is well recognised that mental illness causes significant morbidity and mortality, and has been identified as a national health priority. Despite this, there is a paucity of research about paramedic student perceptions and attitudes toward those experiencing mental health presentations. The objective of this study was to explore the mental health perceptions of a final year cohort of paramedic students from a regional Victorian university. Methods Final year undergraduate paramedicine students enrolled in the core subject Advanced Mental Health Practice were invited to participate in both pre- and post-subject surveys and record their perceptions of mental health using electronic questionnaires. The questionnaires used nine 5-point Likert scale questions and three multiple option questions using declarative statements. Results Of the 25 eligible students, 16 completed the pre-subject questionnaire and 12 completed both the pre- and post-subject questionnaires. The results indicated that this cohort held common myths and misconceptions relating to mental health combined with a lack of general knowledge about mental illness and its paramedic management. These perceptions altered following the introduction of the mental health subject. Conclusion The results suggest that the implementation of a mental health subject into paramedicine undergraduate curriculum has the ability to positively alter perceptions of mental health. This may lead to students acquiring the knowledge and attitudes required to manage mental health presentations.