Australasian Journal of Paramedicine

Australasian College of Paramedicine International Conference (ACPIC) 2021 Abstracts

Australasian College of Paramedicine Scientific Committee — 2022-06-13

A new era of opportunity – securing excellence for our Journal

Paul Simpson — 2022-04-08

“Change is the law of life, and those who look only to the past or present are certain to miss the future.”

John F Kennedy

The Australasian College of Paramedicine (ACP) has a distinguished history of supporting, promoting and disseminating research in paramedicine. Central to that outcome has been its longstanding commitment to scientific journal publishing by way of what is currently our journal, the Australasian Journal of Paramedicine.

In November 2021, AJP commenced a hiatus on new submissions that will continue until mid-2022. An interim Editor in Chief, Associate Professor Paul Simpson, was appointed to oversee the operations concurrent to a transition strategy being developed. A Journal Advisory Committee (‘JAC’) with international membership was tasked to advise the College on the future direction of the College’s Journal. The JAC have consulted widely with researchers in and outside of paramedicine, and with experienced leaders in the journal publishing space, to identify best practice models that will be sustainable and give the Journal the best opportunity to grow and prosper into the future.

It is expected that the new Journal will launch in early 2023, heralding a new decade of excellence and progression with a stronger international focus and a resolute commitment to progressing the scientific discourse in paramedicine. The reopening of submissions for the first edition of the relaunched journal is expected in October 2022.

Investigating the anatomy learning experiences of undergraduate paramedic students

Anthony Carnicelli — 2022-08-24

Introduction

The study of human anatomy forms a foundational knowledge base essential for healthcare professional practice including paramedicine. However, little is known about the experiences and perceptions of undergraduate student paramedics towards learning anatomy. The aim of this study was to investigate this, utilising a questionnaire previously validated in medical students.

Methods

To explore anatomy learning experiences, a 32-item anatomy learning experiences questionnaire (ALEQ) modified for use with paramedicine students was distributed online to students enrolled in the Bachelor of Paramedic Practice at the University of Tasmania. Quantitative statistics were used to identify differences in responses between student groups. Cronbach’s alpha assessed the reliability of the modified ALEQ.

Results

Fifty-one usable responses were obtained (20% response rate). Psychometric analysis demonstrated good overall reliability (Cronbach’s alpha of 0.88). The students perceived several learning activities as positive including textbooks, online learning and practical classes. However, it was generally felt the amount of content to learn was daunting. Furthermore, the students indicated working with cadavers would be highly beneficial for their learning. The relevance of anatomy was also recognised as being important to future clinical practice.

Conclusion

Despite the low response rate, the modified ALEQ was a reliable instrument to investigate the anatomy learning experiences and perceptions of paramedicine students. Further research with a larger cohort is required to confirm the reliability and generalisability of the results.

Overcoming Stigma of Mental Illness in Paramedicine – A Model for Future Practice

Lyle Brewster — 2022-10-30

Introduction

Mental health presentations are a rapidly growing proportion of cases seen by paramedics who are often at the frontline of care delivery. How paramedics perceive persons with mental illness is vital as their experiences in providing care can significantly impact decision-making. This article aims to investigate these paramedics' experiences and how these influence patient care.

Methods

This qualitative research study uses a narrative design where the researchers conducted two focus groups with operational paramedics (six paramedics), and the data recorded and transcribed. The team closely examined the data using thematic analysis to identify, analyse, and interpret patterns of meaning within transcribed data. After thematic analysis, a model for future practice was generated, which pictorially demonstrates the overlap of the common themes.

Results

Five themes ultimately were identified that profoundly appeared to be important to the paramedics within the focus groups. Paramedics have varying experiences when caring for people with mental illness. They are empathetic towards the circumstances of the person with mental illness. They perceive that the stigmatisation of persons with mental illness occurs in some cases. Paramedics are also affected in their clinical decision-making by the training and education they have received and the profession's cultural influences.

Conclusion

The stigmatisation of people with mental illness is apparent in paramedic practice. Despite mental illness being a common presenting problem, paramedics feel underprepared and have difficulty in treating these people. The patients' behaviour can often be reflected in the conduct of paramedics. The impact of burnout due to high exposure to people with mental illness, especially in metropolitan areas, may lead to decreased levels of empathy and compassion.

Clinical presentations, physician consultations and patient transport options for Australian remote and industrial paramedics

Tania Johnston — 2022-07-27

Introduction

The aim of this study was to provide a snapshot of Australian remote and industrial paramedics’ patient clinical presentations, experience with physician consultations and options for patient transport to tertiary care.

Methods

This exploratory, cross-sectional descriptive study employed a purpose-built online survey. Participants were 78 paramedics working in Australian rural and remote industrial settings recruited in 2015 using web-based, respondent-driven sampling. In addition to a series of closed ended questions, respondents were asked to recall the number of times they encountered specific clinical presentations during the past year. Data were analysed using descriptive statistics and modes were calculated for ordinal data associated with clinical presentations.

Results

The traumatic presentations that participants recalled encountering at least 10 times the preceding year included back pain (39.7%), minor lacerations (38.5%), joint (36.4%) and hand (30.8%) injuries. Respondents selected headache (64.1%), nausea, vomiting or diarrhoea (52.6%), respiratory infections (50%), ear, nose or throat problems (43.6%) and localised infections or rash (39.7%) as the most common medical presentations. Of the respondents, 38.4% managed patients with mental health presentations a minimum of six times in the preceding year, and 45.3% treated at least one patient in cardiac arrest. While 94.8% of participants said topside support was available, over half described consulting physicians infrequently and if they did, it was typically by telephone. Most respondents (61%) indicated that their worksite was located over 100 km from a hospital.

Conclusion

Survey findings indicate that paramedic participants recall encountering a wide range of clinical presentations and managing low acuity illnesses more commonly than traumatic injuries. Most respondents were located at least 100 km from the nearest hospital and although almost all had access to topside support, over half stated they consulted physicians infrequently.

Contrapower harassment in paramedicine: Experiences of academic staff in Australian universities

Brett Williams — 2022-08-10

Background

Although bullying and harassment among academic staff has been well researched, research on students bullying and harassing academic teaching staff (ie, contrapower harassment) is less common. Contrapower harassment has been on the rise in academia over the last decade, partly attributable to changes in the student–faculty staff relationship. This study aimed to understand better the extent and impact of students’ contrapower harassment on paramedic academic teaching staff within Australian universities, as well as actions and interventions to address it.

Methods

This study used a two-phase mixed methods design. In phase 1, a convenience sample of paramedic teaching academics from 12 universities in Australia participated in an online questionnaire. In phase 2, an in-depth interview was conducted with nine participants from phase 1.

Results

Seventy-six academic teaching staff participated in the study. Survey results showed that most academics surveyed had experienced harassment from paramedic students, with the highest incidence of harassment occurring during student assessment periods. Alarmingly, over 30% of the academics surveyed had been ‘stalked’ by a student and over 50% had felt powerless and helpless when students had attacked them on social media. Problematic students were identified as those who presented with an over-inflated sense of entitlement or with psychological states and traits that find it challenging to accept feedback and failure, and look to externalise their failures. Reasons for increases in contrapower harassment included a complex mix of consumer and demand-driven education, on-demand (and demanding) instant gratification and degree self-entitlement, and an increase in social media and online learning (particularly during the COVID-19 pandemic of 2020).

Conclusion

Although most of the academics in this study experienced contrapower harassment by students, they also report that most students are level-headed and supportive, and do not carry out this type of harassment. Promoting student professionalism and reassessing student evaluations are starting points for addressing this type of harassment. Further research on the broader systemic issues that influence the contributors to contrapower harassment is needed.

Australasian College of Paramedicine Student Conference (StuCon 2021) Abstracts - Oral and Poster Presentations

Liam Bruton — 2021-08-19

These are the conference abstracts for oral and poster presentations at the Australasian College of Paramedicine Student Conference (StuCon 2021) Abstracts, Virtual online, Australia, 30th July 2021

Comparison of two pre-hospital stroke scales to detect large vessel occlusion strokes in Australia: A prospective observational study

Cecilia Ostman — 2022-03-22

Aims: The Hunter-8 and the ACT-FAST are stroke scales used in Australia for the pre-hospital identification of large vessel occlusion (LVO) stroke but have not previously been compared. Moreover, their use in identifying distal arterial occlusions has not previously been assessed. We therefore aimed to describe the area under the receiver operating curve (AUC) of the Hunter-8 versus the ACT-FAST for the detection of classic LVO.

Methods: Both scales were performed on consecutive patients presenting with stroke-like symptoms within 24 hours of symptom onset presenting to the emergency department at a tertiary referral hospital between June 2018 and January 2019. The AUC of the Hunter-8 and the ACT-FAST was calculated for the detection of LVO using different definitions [classic LVO (proximal segment of the middle cerebral artery (MCA-M1), terminal internal carotid artery (T-ICA), or tandem occlusions) and extended LVO (classic LVO plus proximal MCA-M2 and basilar occlusions)].

Results: Of 126 suspected stroke patients, there were 24 classic LVO and 34 extended LVO. For detection of classic LVO, the Hunter-8 had an AUC of 0.79 and the ACT-FAST had an AUC of 0.77. For extended LVO, the AUC was 0.71 and 0.70 respectively.

Conclusion: Both scales represent a significant opportunity to identify patients with proven potential benefit from thrombectomy (classic LVO), however M2 and basilar occlusions may be more challenging to identify with these scales.

Comparing the number of Emergency Medical Dispatchers (EMDs) scheduled based on the judgment of the managers with predictions of the Erlang C formula: a brief report

Peyman Saberian — 2022-12-18

Introduction: Currently, at Tehran Emergency Medical Service (EMS) centre, Emergency Medical Dispatchers (EMDs) are scheduled based on the managers’ experimental estimates. In this study, we planned to evaluate the conformity of managers’ predictions with the Erlang C formula estimates in scheduling EMDs.

Methods: First, the Emergency Medical Communication Centre (EMCC) performance was evaluated over one week. Afterwards, the number of required EMDs was calculated using the Erlang C formula. Finally, the predictions of the Erlang C formula were compared with those of managers’ judgments.

Results: During the study period, 79,583 calls were received by the Tehran EMCC. The average number of EMDs per hour ranged between 9.5 and 22.7. The actual number of EMDs was more than Erlang C formula predictions during the 24 hours in all but three time points, i.e. 14:00–14:59, 15:00–15:59 and 18:00–18:59. In all hours, 90% of calls were answered in less than 10 seconds, and the average waiting time for a total of one week was 7.3 seconds. Also, only 2.1% of all calls were answered after 10 seconds.

Conclusion: In the current study, we found that the number of EMDs scheduled based on the managers’ experimental estimates was higher than that of the Erlang C formula calculations. Also, it was found that the waiting time for emergency calls was lower than the defined standards. Although the primary results of the current study indicated that, at least on paper, the Erlang C formula has the potential to be used as a predicting model in the Tehran EMCC, further research is required to evaluate its effect on the actual performance of the EMCCs.

The Impact of the UK National Lockdown on Trauma Patterns and the Prehospital Advanced Trauma Team Response within Metropolitan London

Andrew Milne — 2022-03-22

Introduction

The societal changes triggered by the COVID-19 pandemic and resultant lockdowns have the potential to alter the incidence and nature of injuries within affected populations. We aimed to investigate these changes within Metropolitan London and the impact lockdown had on London’s Air Ambulance’s (LAA) response to incidents.

Methods

This retrospective cohort study compared data from all LAA missions in the two-month period following instigation of the 1st UK national lockdown in 2020 to the equivalent period in 2019. Patient demographics, nature and severity of injuries, incident details and LAA mission parameters were assessed.

Results

LAA saw a significant reduction in the mean (standard deviation) of activations per week under lockdown (32.75 [4.95] versus 54.25 [4.53], p<0.001). The distribution of patients across different trauma aetiologies differed significantly under lockdown, with proportionately more injuries resulting from domestic violence (0.7% versus 3.8%) and deliberate self-harm (DSH [16.5% versus 12.4%]), although the absolute number of DSH fell. Significantly fewer incidents occurred in central areas of London, but injury severity was unaffected by lockdown. After adjustment for confounders, lockdown was associated with shorter drive times, but not overall response times. There was no association between lockdown and aetiology or severity of injuries.

Conclusion

The COVID-19 pandemic and ensuing UK national lockdown had a substantial impact on major trauma patterns within London and the subsequent LAA response. The feared rise in suicide was not observed, but there was a notable increase in domestic violence frequency.