Emergency & Health Journal Vol 1

MENTAL ILLNESS AND COVID

THE NEXT PANDEMIC

PPE UNMASKED

WHY HEALTH-CARE WORKERS ARE INADEQUATELY PROTECTED

VOLUME 1 EMERGENCY AND HEALTH JOURNAL

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CONTENTS 05 06 08 10 12 15 16 18 21

WELCOME PPE UNMASKED Why health-care workers In australia are inadequately protected

MENTAL ILLNESS Prevention in a covid-19 world

THE NEXT PANDEMIC Awaiting those on the frontlines

PRECEPTING PARAMEDICS WITH INTENT TIME TO GET STORM READY ARE YOU TIRED ALL THE TIME? ARTIFICIALINTELLIGENCE AND CRIME PREVENTION ADVERTISING DIRECTORY

EMERGENCY AND HEALTH JOURNAL PTY LTD ACN 644115435 admin@emergencyhealthjournal.com.au www.emergencyhealthjournal.com.au Phone: 0756618215 PO Box 8554, Bundall MC, QLD 4217

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WELCOME Welcome to Emergency Health Journal A modern electronic magazine designed to inform and create a dialogue on emergency and health services sector and what it means for you.

The most common ways to get involved in the emergency and health field is communication, education and contributing time, idea’s and skills to enhance skill sets.

Our editorial has been garnered from experts around the world and is designed to help the community understand the resources and opportunities that are made available through various organisations who need your involvement to progress and spread the word.

The Emergency Health Journal is distributed as an EDM (electronic digital magazine). Please support our advertisers as this program can only exist due to their kind support.

Many thanks Paul Crawford

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PPE UNMASKED:

WHY HEALTH-CARE WORKERS IN AUSTRALIA ARE INADEQUATELY PROTECTED In Victoria, more than 1,100 health-care workers have now been infected with SARS-CoV-2, the coronavirus that causes COVID-19. Some 11% of active cases are workers in the health-care sector.

Health-care workers are reported to be among those fighting for life in Victorian intensive care units.

While we don’t know what proportion of the Victorian health-care workers currently infected with COVID-19 acquired it at work rather than in the community, it’s almost certain a portion of these infections were contracted in the workplace.

Early experience from China found the proportion of health-care workers who contract COVID-19 can be up to 29% in settings with inadequate personal protective equipment, or PPE. Lessons from China also show workplace transmission of SARS-CoV-2 can be reduced to negligible numbers with sufficient supply, and correct use of, airborne precaution PPE. Right now, Australia is sitting somewhere in the middle. National guidance needs to be urgently updated to reflect safest practice and acknowledge what we’re learning about the airborne spread of the virus.

What is PPE? PPE is a crucial part of controlling exposure to hazards in all workplaces. It includes items such as masks, respirators, face shields, gowns and gloves.

PPE is categorised into three tiers, corresponding to the type of hazard.

Level 1: standard and contact precaution PPE This PPE limits exposure to standard contact hazards. Examples include face coverings and administrative controls such as hand hygiene, cough etiquette and physical distancing.

Level 2: droplet precaution PPE This PPE prevents exposure to contact and droplet hazards. Examples include surgical masks, eye shields or goggles, long-sleeved gowns, and gloves.

Level 3: airborne precaution PPE 6

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This PPE aims to prevent exposure to contact, droplet and airborne hazards. It includes N95/P2 respirators or powered air-purifying respirators with a P2 filter, eye shields or goggles, fluid-resistant gowns, double gloves, disposable head and neck wear, and protective footwear.

We’ve heard a lot about PPE in the context of coronavirus. But PPE isn’t just for health-care settings. Shutterstock

Current Australian guidelines The national guidance on the use of PPE in hospitals during the COVID-19 outbreak has been written by the Infection Control Expert Group and endorsed by the Australian Health Protection Principal Committee.

The guidance doesn’t recommend universal airborne precaution PPE for health-care workers dealing with patients suspected or confirmed to have COVID-19. It only recommends level 3 protection for highly specialised procedures such as intubating a patient.

A preprint in the Medical Journal of Australia has criticised the current guidance, noting it’s not aligned with increasing scientific evidence regarding airborne transmission of SARS-CoV-2 and is therefore inadequate to protect health-care workers.

Inadequate national guidance has led to an inconsistent and non-standardised approach to airborne precaution PPE across all health-care settings.

In the absence of strong national safety guidance, some hospitals and jurisdictions are making independent improved safety recommendations to their staff.

Why we need level 3 Transmission of SARS-CoV-2 occurs by direct contact with droplets and contaminated surfaces — but emerging datasuggests it can also be spread by the airborne route.

An analysis of health-care worker deaths in the United Kingdom found none among wearers of level 3 PPE, suggesting airborne precaution PPE was protective.

Surgical masks don’t offer as much protection against COVID-19 as respirator masks. Shutterstock Importantly, surgical masks are primarily designed to protect the environment from the wearer. They’re not designed to protect the wearer from respiratory pathogens.

A recent review found N95 respirators offered significantly better protection against viruses including COVID-19 than surgical face masks, while one study found N95 respirators provided 8-12 times more protection than surgical masks against small viral particles.

In Australia, N95 is synonymous with P2 respiratory protection and refers to the filtration efficiency (so N95 means 95% of particles are filtered). But it’s the total inward leakage — what goes through and around the facemask — that’s the critical factor in determining the

level of protection the wearer achieves.

To ensure total inward leakage is minimised, respiratory masks used under level 3 PPE must meet certain standards, including fit testing and the training of wearers in their use.

We need immediate action SARS-CoV-2 is a highly contagious virus with the potential to cause significant ill health and death. In health-care settings, it should be classified as a lethal biohazard and managed accordingly.

The safest approach is to consider all people with confirmed or suspected COVID-19 in hospital, being transported to hospital or being tested for COVID-19 as being able to spread the virus via the airborne route. As such, the use of airborne precaution PPE with a correctly fitted N95/P2 respirator is essential.

There’s also an urgent need for a national registry of health-care worker infections, containing data about the category of health-care worker, where the infection was acquired, severity of disease, hospitalisation, intensive care and death numbers.

This will give us a better understanding of the scope and specifics of the problem, and inform policy and prevention strategies.

Finally, adequate supply of airborne precaution PPE must be available throughout Australia to protect health-care workers from COVID-19.

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WE CAN’T IGNORE MENTAL ILLNESS PREVENTION IN A COVID-19 WORLD

Despite the incremental easing of Victoria’s restrictions, it’s clear the journey towards COVID-normal is far slower than many people had hoped.

for suicide.

Australians – particularly Victorians – have shown remarkable resilience, but many are suffering emotionally.

Last month the federal government released a consultation paper on its proposed National Preventive Health Strategy, setting out what the strategy will aim to achieve and how it might be done.

The mental health impacts of COVID-19 During the early days of the pandemic, surveys showed a sharp increase in symptoms of anxiety and depression across Australia.

These difficulties continued into mid-August. More than 40% of Australians aged 18 years and older feel high levels of anxiety, and around one in six report depressive symptoms.

To target this, federal and state governments have increased telephone, online and face-to-face mental health supports. While this is vital, more needs to be done to prevent people suffering severe mental health problems in the first place.

Prevention is better than cure There’s good evidence we can prevent many cases of depression, anxiety and substance abuse. But Australia doesn’t have a mental health prevention plan or policy, and government funding for prevention is just 1% of the total mental health budget.

The Fifth National Mental Health and Suicide Prevention Plan, the government’s key mental health blueprint, focuses on improving mental health-care services and suicide prevention, but not on preventing the mental health conditions that are a major risk factor 8

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What about illness prevention?

The document’s exciting because it focuses on health promotion and illness prevention, acknowledging we can’t improve the health of the Australian community through health-care measures alone.

But unfortunately, the proposed strategy’s fundamentally focused on physical health issues. In its 20 pages, the consultation paper only mentions mental health three times.

The same principles outlined in the strategy to prevent conditions such as diabetes also apply to preventing mental health conditions such as depression. To prevent either, we need to minimise risk factors and increase protective factors linked to the condition, before it occurs. But some adaptation would be needed for the plan to address both physical and mental health.

Over 40% of Australians aged 18 years and older feel high levels of anxiety, and around 1 in 6 report depressive symptoms.

What prevention measures should be added?

A focus on physical activity, healthy eating, and non-smoking will help to promote good mental health as well as physical health.

To prevent mental health issues we should focus on building

people’s health literacy and self-care skills through public information campaigns and online learning programs. Supportive social environments can be encouraged by parenting programs, and school and workplace mental health promotion initiatives.

Local communities could also be mobilised to take positive action on local issues that contribute to poor health and mental health through place-based strategies. Place-based strategies aim to tackle issues existing at a neighbourhood level, such as social isolation and poor housing.

Services could be reoriented towards prevention. Primary care professionals might provide advice on self-care and use social prescribing to address stress and enhance social supports. Social prescribing involves medical professionals linking patients to non-medical supports. For example, they may provide an “exercise prescription” or “art prescription”.

Finally, appropriate public policy solutions, such as JobSeeker and JobKeeper, that tackle the social and economic determinants of illhealth are needed.

Social factors matter too Research also points to a strong link between mental health conditions and experience of childhood adversity, family

violence, loneliness, racism, homophobia and transphobia. Workplace stressors, financial stress, unemployment and homelessness are also risk factors.

Many of these issues are on the increase because of COVID-19, so to safeguard mental health we need to tackle them and their impact.

This will require the use of evidence-based preventive programs outlined above – many of which already exist but are not being implemented well or to sufficient scale. It will also require public policies to soften the economic blow and ease financial stress.

Targeting these issues will not only help to prevent mental health conditions, but physical health conditions as well.

While better access to mental health-care services is important, it can’t solve all the mental health challenges posed by COVID-19. We also need to strengthen the factors that buffer people against stress, and tackle the underlying factors that contribute to poor mental health.

Whether we create a National Preventive Mental Health Plan, or embed mental health in the current National Preventive Health Strategy, one thing’s for sure: continuing to ignore the prevention of mental health conditions is not an option in a COVID-19 world.

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THE NEXT PANDEMIC

AWAITING THOSE ON THE FRONTLINES With promising signs that the coronavirus curve is starting to flatten in many parts of the world, many of us are becoming hopeful that we can finally start getting “back to normal”.

But for those working on the frontlines of this pandemic, there will be a new pandemic awaiting them.

A new threat of post-traumatic stress disorder (PTSD) will face frontline workers – and this pandemic could rage for years.

I have worked with first responders from the 9/11 terrorist attacks for over 15 years. I have seen this next pandemic unfold. Like the 9/11 responders, those currently working on the frontlines are enduring trauma, worrying that they may become infected – concerned they may infect loved ones.

Some are sleeping in separate rooms – others in separate houses – in a bid to protect their families. On the brink of exhaustion, many have limited access to the protective equipment so desperately needed to protect them. Heroes without facemasks – yet another similarity to the 9/11 responders on the still smoking pile of rubble that was once the World Trade Center.

And look how well that turned out – more 9/11 first responders have now died from illnesses due to their exposure to Ground Zero than died on the day. Thousands are sick and dying and tens of thousands live, even almost two decades on, with PTSD and other lingering mental health impacts.

And like the families of the 9/11 responders, many families of those currently on the frontlines may not lose their loved one to the actual disaster, but what they may not realise – as many 9/11 families didn’t at the time – is that they can lose parts of them to their work.

“Back to normal” We have a tendency to celebrate our heroes, but then quickly expect them to resume their normal lives along with the rest of us after a disaster has passed. But for the frontline workers, that is easier said than done.

As this pandemic ends, those on the frontlines will be expected to resume their usual roles – both at work and in the home. But reentering the site of so much cumulative trauma from these past few months could become increasingly difficult.

The workplace becomes a site that triggers memories of difficult decisions, of patients young and old suffering alone without family members allowed by their side.

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The endless phone calls they made to families on the death of their loved ones will rob them of sleep long after the rest of us “move on”.

The “second pandemic” In the months that follow, we will need to look out for the signs of the “second pandemic”.

Dr. Yuval Neria, the director of trauma and PTSD at New York State Psychiatric Institute, warned of this possible “second pandemic” of PTSD in those on the frontlines.

They have faced life-or-death decisions about patients. They have also faced the life-or-death decision of going to work each day, for fear of exposing themselves – and their loved ones – to this virus.

So will everyone on the frontlines get PTSD? Not necessarily.

Not everyone who experiences trauma, or even the exact same traumatic situation, will respond to it in the same way. Likewise, not everyone on the frontlines who experiences this virus will experience the same post-trauma symptoms or go on to develop PTSD. And it’s also important to note that while a very high percentage of those on the frontlines will go on to experience what are considered

PTSD symptoms immediately after the pandemic, most will go on to recover naturally.

experiencing, thinking, and feeling seems to be a protective factor for not advancing to PTSD.

But some will be left with what is really PTSD.

If you are a family member or friend, keep an eye on your loved one.

Watch out for any changes in their behaviour that might signal that something isn’t right. Reach in and ask RUOK?

What is PTSD? Beyond Blue tell us that post-traumatic stress disorder is a particular set of reactions that can develop in people who have been through a traumatic event that threatened their life or safety, or that of others around them.

This could be a serious accident, physical or sexual assault, or disasters such as bushfires or this pandemic.

As a result, the person experiences feelings of intense fear, helplessness or horror.

Around 12 per cent of Australians will experience PTSD in their lifetime.

However, this figure does not account for the current pandemic situation we are all facing.

What can be done?

If you are on the frontlines, talk about what you are experiencing.

Talk about your thoughts and emotions. Processing what you are

What if that isn’t enough?

It is important to get whatever help is needed.

If a person feels very distressed at any time after a traumatic event, they should talk to a doctor or other health professional. If a person experiences symptoms of PTSD that persist beyond two weeks, a doctor or a mental health professional may recommend starting treatment for PTSD. Utilise available support groups and peer-support. In Australia, first responders with mental health conditions resulting from their service to the community can access online peer support groups like The Code 9 Foundation. Beyond Blue also have their dedicated Coronavirus Mental Wellbeing Support Service.

Don’t underestimate the importance of connecting with others and sharing your experiences. That will go a long way to limiting the impact of the “second pandemic”.

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PRECEPTING PARAMEDICS WITH INTENT One of the things often overlooked in training is the precepting of students and interns. There is no more crucial a time for a new paramedic than their first foray into ambulance life.

Without a specific emphasis on this skill, it can be easy to forget its importance. How we introduce new staff members to the prehospital world can make all the difference. Not only to their experience in the workplace but in their general attitude, clinical practice, should we become their patients in the future.

On the job learning is vital in healthcare settings, particularly in paramedicine with its unique challenges of autonomy and frontline pressure. It enables new staff to enhance academic knowledge through hands-on experience and develop recently acquired skills in the safety of competent clinical supervision.

Overall, they finally get to consolidate training by putting it into practice in real-life situations. With the guidance of an effective preceptor, this venture into each new paramedic’s role can provide the perfect opportunity to increase confidence and job satisfaction.

During such a pivotal period, how a preceptor interacts with the student and guides them into paramedicine may make or break their future career. The aim of instilling excellent clinical practice behaviours and professionalism to last a lifetime is clearly crucial, so what are the challenges in delivering to such a high standard?

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Terminology: Confusion around terminology has been longstanding, with a combination of mentor, preceptor, facilitator, role model, guide, supervisor and assessor referenced over time.

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Approach: Attempts to view every preceptor and every preceptee in the same light have created difficulties in ascertaining a consistently replicable approach.

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Standardisation: Minimal industry standards have existed in terms of what the precepting role entails.

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Tools: Communication skills and feedback were most often based on individual perception, risking confusion, damage to confidence and development of poor habits.

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Workload: Additional workload and increased stress with minimal support or financial remuneration have drained and overwhelmed preceptors in the past.

Lack of clarity in each of these areas causes stress, overwhelm and personal conflict, subsequently reducing willingness to address issues arising in on-road clinical and professional practice. Ultimately, this leads to a more “tick and flick” approach to skills logs. Research and reflection have highlighted areas for improvement and, in more recent years, we see significant headway.

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Terminology: The use of preceptor and, less frequently, mentor are now becoming more familiar as terms that envelop ideal traits and qualities for on-road introduction to the paramedic role.

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Approach: Recognition of different service pathways, tertiary education formats and individual personalities are beginning to enhance understanding around the need for an all-encompassing approach.

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Standardisation: Industry standards are helping to form the basis of performance models, primarily when supported by registration principles.

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Tools: Positive feedback methods have been highlighted as successful and are becoming utilised more frequently within ambulance services and education.

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Workload: Recognition of the additional demand on paramedic preceptors has seen some success through supportive measures such as peer discussion, allocated time for debriefing or documentation, promotional structures and financial compensation.

This gradual development of each facet is slowly increasing collective desire for paramedics to become preceptors, rather than naturally progressing towards the role without a clear purpose. To help to shape a positive future, what are we aiming for?

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Terminology: Clarity and definition around the singular terms “preceptor” and “preceptee” that become globally accepted and recognised throughout prehospital care.

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Approach: Selection and training, specific to evidence-based criteria, so that competent paramedics may be educated in precepting for the future.

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Standardisation: Industry-wide standards formulated to provide clear expectation and guidance for both preceptor and preceptee to work from. The establishment of clear underpinning principles so that paramedics with excellent clinical and professional standards more readily aspire to become excellent preceptors.

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Tools: Development of a range of recognised communication and feedback tools so that both parties have guidance within consistent parameters.

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Workload: Implementation of measures to address, alleviate and compensate for the additional workload and emotional labour involved in precepting.

Strong paths are being forged towards defining the role and industry standards in precepting paramedics for the future. The introduction of students and graduates into prehospital care is now more widely discussed, and previous gaps in research are slowly being filled.

(There are some theses and articles that are well worth reading in the references list below.) Historically, much of the focus has remained on the difficulties faced by graduates entering the workforce, but there are similar facets to consider in supporting both parties if we are to develop effective precepting programs and foster strong working relationships.

It is well recognised that the learning curve is steep for new paramedics, but that learning curve can also be steep in the preceptor position, too. Just as preceptees don’t necessarily know the best ways to approach clinical skills or professional practice, it cannot

be assumed that preceptors always have the best answers either.

Entry into paramedicine is known to be a difficult time with the balance of personal, emotional, academic, financial and professional commitments, but it stands to reason that this can be the case at any time in the preceptor’s life, too.

With so much going on in the background of defining, developing and delivering paramedic preceptorship to a high professional standard, we mustn’t forget those currently active within the role. Unless and until we are provided clear guidelines in each organisation, the following prompts may be useful before and during the time we spend with students and graduates.

Think It Through •

What benefits are you seeking, and what are you offering in becoming a preceptor?

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Are you ready to undertake the additional workload involved right now?

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Do you possess positive professional attributes that may be worth replicating?

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Are you comfortable delivering and receiving honest feedback without feeling stressed?

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Will you be the type of preceptor that you would have benefited from in your early career?

Be Prepared •

Make a list of expectations you have of the role so that you can reassess in the future.

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Note precepting habits you wish to avoid and check in on them annually to stay on track.

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Print out a diagram or chart to follow consistently in working through feedback together.

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Refresh reflective practice techniques and find a set method to become familiar with.

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Seek formal training in precepting, or research and read material to help you form a plan.

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Investigate learning techniques and find out from preceptees which work well for them.

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Know what your registration body expects of all paramedics and use this as a baseline.

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Create (or join if your organisation has one) a confidential peer preceptor support group.

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Find out what additional support exists within your organisation before you get started.

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Make a brief list of things useful for new preceptees to know about working with you.

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Create a list of questions so that you can tailor and optimise each precepting relationship.

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Paramedicine Paramedicine in in the the NT, enjoy enjoy the challenge. challenge.

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1300 ST JOHN 1300 ST JOHN www.stjohnnt.org.au www.stjohnnt.org.au

TIME TO GET STORM READY The NSW State Emergency Service (NSW SES) is urging communities across the state to prepare themselves for the upcoming storm season as wild weather looks to become more frequent in the coming months. This is a timely reminder for all of us across the country to get storm ready as summer approaches.

The NSW SES has already responded to more than 5,600 storm damage jobs in the last three months and over 34,000 storm related jobs in the last year. “While parts of the state have been experiencing incredibly dry conditions and fires have occurred recently, we have also experienced severe storms, including damaging winds, hail, and snow,” said Mr. Elliot.

At the recent launch, the volunteers on hand simulated a rescue from a fallen tree on a crushed car to demonstrate the devastating impact of this strong weather. “NSW SES volunteers and other emergency services are preparing for a busy storm season,” said Mr. Stewart.

time to protect their communities during floods and storms. “I’m confident we have a very well-resourced emergency services fraternity [and] I’m confident they’re well trained,” said Mr. Elliot.

It’s imperative that NSW residents take it upon themselves to be prepared for the upcoming storm season and all that it may have it store. Preparing your residence for the impact of wild weather and staying up to date with weather forecasts should be a top priority.

As Mr. Stewart said at this season’s launch, “Even an average storm season can wreak havoc, like what we saw in the Sydney hailstorms last December.”

For more storm safety tips and how communities can prepare for storm events, visit https://www.ses.nsw.gov.au/disaster-tabsheader/storm/

With the Bureau of Meteorology forecasting a typical severe thunderstorm season, this could likely see the region hit by large hailstorms, heavy rain, flash flooding, and damaging winds. “As the weather heats up over summer, storm frequency increases,” Mr. Elliott added.

Residents are being urged to help prevent storm damage around their properties by trimming back overhanging branches, cleaning gutters and downpipes, and securing or putting away loose items around the yard or on balconies.

It’s also important to avoid parking vehicles under trees and powerlines.

Communities should feel assured knowing that the NSW SES has 9,500 volunteers who selflessly give up their own EMERGENCY AND HEALTH JOURNAL

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ARE YOU TIRED ALL THE TIME? TOP 10 REASONS FOR TIREDNESS & HOW TO OVERCOME IT MANY PEOPLE report feeling constantly tired or fatigued. Are you one of them?

Shift work can certainly mess with your sleep rhythms but we’re talking here about prolonged feelings of exhaustion. If this sounds like you, a trip to the doctor may be in order to rule out medical reasons first. Conditions such as anaemia, chronic fatigue syndrome, glandular fever, diabetes or being coeliac are all linked to tiredness. If you have a clean bill of health then it’s time to look to nutritional or lifestyle factors as potential culprits for your lack of oomph. Here are ten top lifestyle habits that can sap you of energy and what you can do to turn things around.

1. EATING TOO MUCH SUGAR AND PROCESSED CARBS Sugar and processed carbohydrates cause a rapid rise in your blood sugar followed by a sudden drop. All this spiking and crashing can quite frankly, leave your body feeling depleted of energy. Unfortunately it’s a vicious cycle which creates cravings so your best defence is to break the cycle by opting for wholefoods that cause minimal disruption to your blood sugar. Complex carbs, healthy fats and proteins all produce a slow release of energy to prevent the spike and crash pattern.

2. INADEQUATE PROTEIN Did you know that consuming protein boosts your metabolic rate?

Protein can also stabilise blood sugar levels and help you feel fuller for longer. Try to include a good protein source at every meal, such as meat, fish, chicken, tofu, eggs, nuts or cheese. Some high protein vegetables are lima beans, bean sprouts, spinach, green peas, asparagus, sweet corn, Brussels sprouts and mushrooms.

3. NOT EATING ENOUGH VEGETABLES AND FRUIT Malnutrition is another common cause of tiredness. If your body doesn’t receive an adequate base level of nutrition from the foods you eat, then it’s not going to function efficiently. A variety of healthy wholefoods are important, with a focus on fruits and vegetables which pack a punch due to their high vitamin, mineral, phytonutrient and antioxidant content.

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4. LACK OF ACTIVITY Are you too tired to exercise? Unfortunately, that could be part of your problem. Leading a sedentary lifestyle can drain your energy. It may be hard at first but build up over time to replace sedentary behaviours with active ones. Examples are to stand rather than sit, take the stairs instead of the elevator, to walk instead of drive and generally get your body moving more with exercises such as swimming, walking, yoga or Tai chi.

5. POOR SLEEP It’s obvious that you’d be tired if you don’t get enough sleep but it’s a tricky one to solve if you work shifts. The important thing is to try to prioritise your rest periods and establish a routine that works for you.

Tips include, turning off devices an hour before sleeping, not going to bed on a full stomach; getting plenty of sunshine and activity when you are awake during daylight hours.

6. FOOD INTOLERANCE Food sensitivities or intolerances typically cause symptoms like digestive issues, nausea, mouth ulcers, rashes or headaches. But fatigue is another symptom that’s often overlooked. Common food intolerances include gluten, eggs, dairy, soy and corn. A food allergist or dietitian can test for food sensitivities or help you adopt an elimination diet to determine problematic foods.

7. CALORIE RESTRICTION Are you dieting? A severely restricted calorie intake could be the reason you’re feeling tired. When you eat too few calories, your metabolism slows down in order to conserve energy. Most people require a minimum of 1200 calories per day to prevent fatigue from a metabolic slowdown.

8. DEHYDRATION Scientists now know that even mild dehydration can lead to lower energy levels and a decreased ability to concentrate. Water and herbal teas are good options to replenish your fluid loss. Make sure you drink enough so that you don’t feel thirsty and your urine is a pale yellow colour.

9. STRESS Working as a paramedic is one of the most stressful professions around, as it draws upon your mental, physical and emotional reserves which can really deplete your energy. Tips are diet, rest and sharing your concerns with others. Practicing stress-reduction techniques is also a great way to help you manage day to day strain, for example meditation, deep breathing, listening to music, yoga or walking. If your stress is making it hard for you to cope then check in with a professional for some help.

DO’s and DON’Ts for boosting energy boosting energy DO eat a variety of healthy wholefoods which help to heal from the inside and promote wellbeing. The Australian Dietary Guidelines has all the facts on nutritious foods and how much you should be eating.

DO manage your appetite. When working shift work or experiencing tiredness, some people find that they are hungrier, have cravings for the wrong foods, or lose their appetite altogether. Try to eat a moderate amount at regular times to maintain decent nutrition and steady blood sugars.

DO get some sunshine on your skin every day. Just a few minutes a day will help increase your Vitamin D levels, give you more get-upand-go, and help you sleep.

DON’T rely on a quick fix as they don’t exist! No single food alone will boost energy. Superfoods are great but all the superfoods in the world still can’t compensate for unhealthy eating.

10. TOO MUCH COFFEE, ALCOHOL OR ENERGY DRINKS

DON’T skip meals. Breakfast can be especially important if you’re

Drinks that are laden with caffeine, alcohol, sugar, B vitamins, amino acids and other herbs may provide a temporary boost in your alertness levels. But chances are that the high will be followed by a profound dip as the ingredient effects wear off. You’ll be left feeling flatter so avoid these types of drinks if you can.

experiencing tiredness as it can kickstart your energy and healthy eating habits for the day ahead. Opt for slow release carbs, healthy fats and quality protein at each meal.

DON’T eat too many processed foods as they are loaded with additives, preservatives, unhealthy fats, salt and sugar. All these ingredients will mess with your energy and can cause your body and mind to feel lethargic.

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ARTIFICIAL INTELLIGENCE AND CRIME PREVENTION

powerful, number-crunching computers can process the torrents of face recognition and gait analysis data coming from thousands of video cameras, all coordinated by advanced AI that can make sense of it all.

Imagine you live in a smart city that knows your face and follows your every move – the places you go, the people you see, and all of the things you do along the way.

Meanwhile, public safety and counter-terrorism advocates argue that predictive technology has great potential to thwart terrorist attacks and other threats to public safety.

Over time, autonomous artificial intelligence (AI) builds a profile that reports on how likely you are to commit a crime. When that risk is high, the police take pre-emptive action. Welcome to hypersurveillance and the next generation of predictive policing.

Both arguments have force and validity, so the question is where exactly do we draw the line between the public interest and individual freedom?

Both India and China are currently implementing this level of surveillance to bring down crime rates and detect terrorists before they strike. Japan is also looking at predictive systems ahead of the 2020 Tokyo Olympics. London and elsewhere in the United Kingdom have been using similar technology for some time. It might already be happening in the city where you live.

Pervasive, real-time surveillance like this is possible because more 18

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Not too long ago, we relied on eagle-eyed police patrols to ensure public safety. That was when we lived in small enough communities where people knew each other by sight.

But as cities continued to grow, becoming too large for the police officer alone, closed circuit television (CCTV), face recognition and earlier generation predictive systems came into use.

The morality of hyper-surveillance Opinion is divided on the ethics of predictive policing. Privacy advocates and civil libertarians have concerns, if not objections, to this level of surveillance – fearing that it could become an instrument of discrimination.

The answer will differ case by case. Each jurisdiction must negotiate the answer taking account of all stakeholder concerns.

Since terrorists attacked in the United States on September 11, 2001 the degree of surveillance and search in airports has increased dramatically. In time, the travelling public came to accept the situation as being in their own best interests and that of their fellow passengers.

It is generally accepted that you have a right to privacy in your own home. When you close the front door, you can reasonably expect that no-one is looking and listening.

The exception is when you are at home but engaged in criminal activity that threatens the community.

This is where we draw the line in this case between individual rights and the greater good. But when you go outside, anyone can look at you if they wish. They might also overhear the conversation you’re having.

There’s no right to privacy from the public gaze, and never has been.

But looking is different to making predictions – and the uncomfortable truth is that predictive policing technology has the potential to be used as a tool of oppression. Managing this risk in an open, democratic society is certainly a challenge, but not an insurmountable one with checks and balances.

Given the overall experience of predictive policing, it appears there is a strong case for its continued use. In Australia, for example, 15 terror attacks were reportedly thwarted in the past three years through police work supported by computer algorithms.

The question is, how do we minimise the risks to an acceptable level?

The short answer is to establish a legal framework that guarantees ethical transparency in any AI predictive policing methods, including how the algorithms are put together. It would also rigorously ensure the data fed into predictive systems is accurate and unbiased. As with any computer system, the output is only as good as the input – garbage in, garbage out, as the saying goes. This is necessary to address ongoing concerns about inherent bias in predictive systems.

It has been observed that not all police forces are created equal. In the United States there are no less than 12,000 local police forces. There are bound to be differences, reflected in the quality of leadership and the availability of resources.

Human/AI partnership Policing is not perfect and human officers do not get it right all the time.

But when it comes to AI in policing, I believe there should always be a place in law enforcement for the finely honed instincts of an experienced human officer tempered by a system of checks and balances.

The technology should always be subordinate to the human, taking the role of decision support helper.

That way, when the era of hyper-surveillance arrives in your home town, it will be an accountable human, not a machine – however intelligent it may be – who decides whether a person represents a serious risk to public safety.

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