bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.
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 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.