ISSUE 01 | AUGUST 2020
Greg Page How a cardiac arrest changed my life and narrowed my focus for the future
WOMEN IN LEADERSHIP Women in ambulance making a change
COVID-19 Working together to fight a pandemic
CAA
Through the years 1962 - 2012
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Dear friends and colleagues,
Welcome to our new CAA magazine, First. We are excited to bring to you a refreshed magazine created to give us the opportunity to share with you the many wonderful and groundbreaking news and programs from across the Australasian ambulance sector. In our first issue we spend time with cardiac arrest survivor, the original Yellow Wiggle, Greg Page, who shares with us the story of his cardiac arrest and how he is travelling now. Greg’s experience shows us just how incredibly important bystander action is when it comes to cardiac arrest. When things go right the outcomes are truly life changing. We share with you the latest happenings from CAA. Our team has been incredibly busy in the last year, launching the inaugural Women in Ambulance campaign, Sustainability strategy and creating our own Hand Hygiene 5 Moments of Care video which showcases how quickly bacteria spreads in ambulance setting when poor hand hygiene practice is present. We cannot put together this issue without looking at the challenges COVID-19 pandemic has presented. Rather than focusing on the bad, we look at how CAA and our members pulled together and through sharing experiences and developments managed to not only survive but come out the other end stronger and ready to tackle the next emergency even better equipped. The magazine is a part of the refreshed CAA communication strategy and together with our presence on social media (Twitter & LinkedIn), a new website, fortnightly newsletters and a new series of webinars, looks to share with you and the wider audience the many beautiful moments, innovative projects and stories from the ambulance world.
Lean back, grab a cuppa and enjoy.
Mojca xx
Contents ISSUE 01 | AUGUST 2020
07 02
Letter from the Editor
06
CAA Milestones
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19
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Focus First: COVID-19 Taking the lead in tackling a challenging pandemic and coming out the other end stronger and more focused.
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Opinion First
Latest news from around the ambulance sector.
Executive Director Ambulance Operations at St John WA, Deon Brink shares his opinion on a topic that is very important to him – occupational violence against paramedics.
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Industry First
CAA First How last year shaped the CAA, working through a restructure, launching new projects and driving the industry forward despite challenging emergencies.
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Women in Leadership How women in ambulance are making a better future for themselves and next generations.
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Sustainability Becoming the eco warriors of the health sector including tips to making sustainability easy and quick to implement at your office, station and at home.
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Service First Showcasing the latest ground-breaking projects from across CAA member services.
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Awards First Featuring Ambulance Victoria’s 2019 CAA STAR Award winner ‘Analytics Uplift Project’.
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Feature First: Greg Page Speaking with Greg Page about his cardiac arrest and the importance of knowing CPR and using an AED that saved his life.
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40
59
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Looking back at CAA 2019 Congress and reflecting on how a year later the world has changed.
Meet the wonderful people that make up the Australasian ambulance services.
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Meet our global partners: AACE, EMS Europe, EMS Chiefs of Canada, Global Resuscitation Alliance & Resuscitation Academy.
Looking after your mental health and general wellbeing with tips and guides from our resident columnist Mitch Mullooly.
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Events First
People First
International First
Wellness First
Research First
The Directory
Sharing the latest innovative research projects from around the ambulance world.
53 Female CEO’s adding value How women in leadership roles add to company value.
THE TEAM
PUBLISHED BY:
Editor: Mojca Bizjak-Mikic Relationship and Content Manager: Stephanie Hartley Graphic Designer: Dylan Read
The Council Of Ambulance Authorities 283 – 287 Sir Donald Bradman Drive Brooklyn Park SA 5032 Australia admin@caa.net.au
Magazine published from paper that is sustainably sourced.
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Data First
CAA Milestones
1962
1977
Introducing CAA
Single 000 Ambulance Number
The inaugural meeting of all state ambulance authorities was held in Canberra from 4-8 December 1962. 19 delegates from New South Wales, Victoria, Queensland, Tasmania, South Australia and Western Australia attended the National Convention which was opened by the Federal Minister of Health, Senator Harry Wade.
In 1977 CAA commenced work on securing that all Australian’s can ring one single number, no matter which state, territory or how remotely they are located, to dial an ambulance service.
1974 New Zealand The New Zealand Ambulance Service sent their delegates to attend the Australian Ambulance Service Authorities Conference as it was now called. In 1981 the Conference was held in Auckland and New Zealand Ambulance Service became a full member, the name was then changed to ‘The Convention of Ambulance Authorities’.
1986 Papua New Guinea Mr Graeme Keake represented Papua New Guinea.
2009 New look CAA Conference
2012 Celebrating 50 Years
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CAA celebrates 50 years since the inaugural meeting in 1962 in Canberra, along the lines celebrating incredible achievements and progress of the Australasian ambulance sector.
The CAA annual Conference received a refresh adding a day-long Conference open to the ambulance sector. Combined with the standing Board meeting, AGM and Rural & Remote/IRCP section, the Conference will, over the next 10 years turn into the industries peak educational and networking event showcasing specialised masterclasses, forums, Awards for Excellence Gala Dinner and Expo space.
caa.net.au
1990s
2002
First Research Units established
First CAA Staff Appointed
The mid 90s saw the setup of the first ambulance service’s research units in Queensland and Western Australia linked with the University of Queensland and Curtin University respectively, providing for important progress in pre-hospital research.
The CAA was incorporated in December 2002 and the Secretariat was set up with an Executive Director appointed earlier in the year, setting up office in Adelaide.
1998 Ambulance Data included in RoGS
Patient Satisfaction Survey
Since 1998 ambulance data has been included as part of the Report on Government Service run by the Australian Government’s Productivity Commission. The CAA work on behalf of services to collate and liaise with the Productivity Commission on behalf of Australian member services.
Since 2002 (Australia) and 2007 (NZ) the CAA has been running the Patient Satisfaction Survey to capture feedback from patients transported by ambulance services.
2007
2004
CAA Awards for Excellence CAA Awards for Excellence were set up in 2007 created to recognise many innovative programs and projects across members enabling services to share their work and learn from each other.
2002
PEPAS
2005 The Council of Ambulance Authorities The final name change was made to the CAA as it is known now.
A program designed to assess and accredit ambulance education programs commenced in 2004 and by 2008 the first trials were done leading to PEPAS accrediting all paramedic courses across Australia and New Zealand between 2008-2018.
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Industry First
Industry News New Zealand’s Most Trusted Charity St John New Zealand has been voted New Zealand’s Most Trusted Charity in the 2020 Reader’s Digest Most Trusted Brands survey for the 7th time. The annual survey is conducted by the magazine throughout the world. In New Zealand, a representative sample of 1,500 Kiwi’s rated brands on a trust scale of 1-10.
New Recruits for NSW Ambulance As part of their plan for a potential second wave of COVID-19, NSW Ambulance recruited 176 new paramedics, their biggest single intake yet, that hit the road in May. Since COVID-19 there has been an overwhelming interest in paramedicine as people struggle to cope with the pandemic and are looking for ways to help fellow community members.
Ambulance Victoria – Sustainability Ambulance Victoria committed to becoming net zero carbon by 2050. Their vision is to source 100% of energy requirements from renewable sources by 2025. This will be a 27% reduction of their overall emissions profile. As an organisation that operates services 24/7 this is a challenging yet exciting project to keep your eye on.
Thank a First Responder Day Amidst the many crisis’ of 2020 the emergency service workers from all organisations across Australia are fighting hard to keep us safe. ‘Thank a First Responder Day’ saw messages of thank you to these incredible workers across social media on June 2. CAA and our members were proud to support this wonderful new initiative.
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Ambulance Service Medal On June 8th, the below staff & volunteers from Australian ambulance services were recognised with the Ambulance Service Medal (ASM) in the Queen’s Birthday 2020 Honours List. NSW: Peter Ian Elliott, Steven Alan Lobley, Alan John Morrison Qld:
Ian Trevor Richter, Lynette Yvonne Richter
SA:
Michael Berden, John Laurence Shute
On January 26th, the below staff & volunteers from Australian ambulance services were recognised with the Ambulance Service Medal (ASM) in the 2020 Australia Day Honours List. Led by Governor-General of the Commonwealth of Australia, the Australia Day Honours List recognises the outstanding service and contributions of Australians across all walks of life and industries. NSW: Ms Clare Louise Beech, Mr Michael John Bray Vic:
Mr William Allan Briggs , Ms Rain Histen, Mr Terrence Patrick Marshall, Mrs Gail Sharp, Mr Lance Francis Simmons, Ms Susan Jane Walsh, Mr Kenneth John Whittle
Qld:
Ms Tracey Anne Eastwick, Mr Wayne William Sachs, Mr Cary Strong
WA:
Mr Christopher Bradley Oakes, Mr David Saunders, Mr Austin Shannon Whiteside
SA:
Mr David Mark Jaensch
Tas:
Mrs Lorraine Joy Gardiner, Mr Han-Wei Lee
Papua New Guinea – UNICEF Partnership UNICEF recently signed a new partnership with St John Ambulance Papua New Guinea to support a package of interventions aimed at enhancing pre-hospital and ambulance care for maternal, new-born and child health. This partnership will ensure St John has resources and expertise to save mothers and infants in hard to reach places in PNG, where no one else can.
Ambulance Tasmania Rescue – What3Words Ambulance Tasmania was able to reach a hard to locate patient on Flinders Island recently, utilising the technology ‘what3words’ saving precious time and resources. The technology assigns 3 words to GPS coordinates making it easier to locate and communicate your position. We heard about this exciting technology from our resident futurist guru David Leggett from SDSI at CAA19 Congress last year.
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CAA First
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As I write down the progress CAA has made in the last year it dawns on me how much has happened in a year and I look forward with excitement to next year when most of our plans will come to fruition and work from our working groups and committees will start leaving lasting changes across our industry.
By Mojca Bizjak-Mikic
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T
he second part of 2019 has seen a restructure of the CAA Secretariat and CAA offices returning to Adelaide, as this is now where the majority of the team is located. The team restructure provided an important opportunity to refresh the branding, structures and systems which have made great improvements in both our external communications, brand recognition as well as the running of CAA workstreams.
From a branding and communications point of view, we are excited to have launched a new website earlier in the year, refreshed our newsletters which now go out fortnightly and CAA has officially joined social media with a new LinkedIn and Twitter profile in addition to our existing Restart a Heart Day Twitter profile. We are thrilled to introduce our new webinar series and with our new magazine ‘First’, the strengthened communications channels will be delivering developments, innovations and progress from our programs and projects as well as member’s stories from the frontlines. As part of the CAA restructure, we focused on reviving our policies and procedures, updated our committee, forum and working groups’ terms of reference as well as created an overarching corporate governance
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framework that details CAA’s structure, operations, procedures and obligations.
generations of women and men progressing through ambulance ranks.
The CAA committees, forums and working groups have had a busy year progressing with their work plans in addition to responding to Australian bushfires, COVID-19 and other urgencies that 2019-20 has presented. And while our 2020 face-to-face meetings have had to be changed to video conferencing, the teams have been able to progress several actions and projects.
Infection Control and Prevention working group has been as expected in light of COVID-19 a big focus and together with the Clinical forum leads the industries response to this global pandemic. Being able to have regular weekly videocall updates, sharing issues and solutions proved how valuable CAA networking and support is in critical times.
Women in Leadership working group has released the CAA Women in Leadership Strategy and launched the inaugural Women in Ambulance campaign designed to recognise and promote women in the ambulance sector. The CAA was extremely proud to announce 58 Honour recipients, women who are incredible role models to the next
A newly established Occupational Violence working group started progressing important work around violence against our members from the public as well as shining light on internal processes and support. The group is looking at incident statistics to be able to progress with solutions to better equip our personnel in dealing with harmful situations.
caa.net.au
Fleet and Equipment working group is looking at a standardised ambulance design as well as working through potential guidelines around bariatric vehicles and taking learnings from Ambulance Victoria’s stroke ambulance. With a strong focus on sustainable future driven by the CAA’s new Sustainability Strategy, the group is considering greener vehicle options as well as recycling and repurposing solutions for old equipment. The CAA Out-of-Hospital Cardiac Arrest Strategy and Mental Health and Wellbeing Strategy were set up three years ago by their respective groups who are committed to tracking services’ progress against the strategies. Our team is preparing internal reports that will capture results from the surveys, gathering progress against the strategy steps and information about programs and initiatives. COVID-19 and Australian bushfire season 2019-20 was a challenging time for our Emergency Management forum, members who most of them spend considerable time in incident management teams responding to these emergencies. They form an important part of CAA’s link with health and emergency departments allowing us
to inform our members by sharing information and experiences. In August 2020 the CAA will be again partnering with Trapeze to capture challenges and solutions our members have experienced during the COVID-19 pandemic. At the 2019 CAA Congress Trapeze prepared an interactive board that captured our participants’ ideas for ‘The Future of Ambulance’ and similarly we will run the 2020 CAA x Trapeze virtual interactive board to capture ideas from the COVID-19 pandemic. Last year the Strategic Business committee was excited to launch the CAA Online Portal which was designed to improve and assist CAA data collections including reporting for the Australian Productivity Commission’s Report on Government Services. Following the success of the CAA Online Portal, the CAA’s Awards for Excellence have also been moved to an online platform making the process of entering submissions and judging easier. Also in 2020, we have added an online survey option to the CAA’s Patient Experience Survey making it easier for patients and their carers to provide their feedback on their ambulance experience.
Australia 3,680,376 incidents
3,163,421 ‘000’ calls
From Australian service users regarding their experience using their local ambulance service
found the call taker HELPFUL AND REASSURING
97%
rated the level of care they received GOOD or VERY GOOD
533,402 patients
OF
OVERALL SATISFACTION
93%
The CAA Mental Health and Wellbeing working group members have had an extremely busy period working on supporting staff during a challenging pandemic that followed one of Australia’s hardest bushfire seasons. We shared several great tips on how to look after your mental health and wellbeing and how to look after your teams, family and kids in our July newsletter. Whilst 2020 is proving to be an incredibly challenging year it has brought us closer together as an industry, helped us grow and set us up to be better prepared for the next emergency. We have an exciting second part of the year planned with the Restart a Heart Day campaign just around the corner, results from the 2020 Patient Experience Survey coming soon and the launch of our new magazine and webinars.
New Zealand
TH
ED
3,505,776 patients
Later this year we will be welcoming the first of our member services to the CAA Mental Health & Wellbeing App. We partnered with an NZ company Chnnl to bring an extra tool to the many wonderful programs and solutions our members utilise to look after their staff’s mental health and wellbeing.
O SE
S U RV
EY
556,429 incidents
506,290 ‘111’ calls
OVERALL SATISFACTION From New Zealand service users regarding their experience using their local ambulance service
94%
found the call taker HELPFUL AND REASSURING
99%
rated the level of care they received GOOD or VERY GOOD
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W
e know about 80% of paramedicine students are female, about 50% of on-road staff are women and yet when we look at the management and executive levels this percentage is not reflected. While the ambulance sector was traditionally a very maledominated sector and the first female paramedics were only employed by Australian/NZ ambulance services 40 years ago in the 1970s, times have changed and it’s time our services start reflecting the new workplace. 1992 marked an important year for women in ambulance with Marita Hargraves appointed as the Director of the Tasmanian Ambulance Service. Mrs Hargraves ran the service from 1992 to 1994. It will take another 9 years for the next female CE to be appointed and to date, only four women have ever been put in charge of running ambulance services in Australia and New Zealand. In 2013 Dame Diana Crossan was the next female CE, Mrs Crossan led the Wellington Free Ambulance until 2017 and sat on the CAA Board making room for other females to follow in her steps. Currently, there are two highly successful women running Australasian ambulance services. Judith Barker has been at the helm of St John Northern Territory since 2017 and Michelle Fyfe APM joined St John Western Australia in 2018 after a long and successful career in policing.
Dame Diana Crossan
In 2018 CAA identified that the issue of women in ambulance and specifically women in leadership roles in ambulance is a topic we need to progress further. During the 2018 Auckland CAA Congress an inaugural Women in Leadership breakfast forum was held which quickly gained momentum and helped formalise the CAA Women in Leadership (WIL) working group whose mandate is to progress this topic, ensuring that women’s voices are equally represented as well as securing that women have a seat at the table. In the short two years of its existence, the working group has set up the Women in Ambulance campaign designed to highlight successful and hardworking women in ambulance services across Australia, New Zealand and Papua New Guinea. The campaign recognised 58 inspirational women who are held as role models with hopes to empower and inspire future generations of women to step into
Judith Barker
ambulance careers and progress into leadership roles and management levels. In July we proudly launched the CAA Women in Leadership strategy that captures the sectors’ commitment and dedication to working on improving gender balance across the Australasian ambulance sector. The strategy seeks to build awareness relating to gender balance through activities and campaigns developed from evidencebased data, it will advocate for a workplace culture and approach that enables career progression for effective female leadership and it will seek opportunities for future leaders dedicated to growing gender balance in our sector. We are excited for the next steps which include a CAA Women in Leadership Scholarship program and building a talent pipeline to encourage female leaders to step up to career growth opportunities.
Michelle Fyfe APM
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CAA First
Sustainability There is no question that running a sustainable, eco-mindful ambulance service is in our future. And there is no doubt our members are keen to pursue this issue. Yet the question on everyone’s mind is how do we go about changing a service whose main purpose is driving big, heavy vehicles to save our patients lives. Where do we start, how do we get our staff onboard and how do you justify any financial implications given services’ funding arrangements. Step in a couple of sustainable believers and the answer is one step at a time and with CAA taking the lead to help support our members on this worthy journey. Last year’s CAA Congress in Perth finished off with an inspirational presentation by a sustainability warrior showing us how other sectors were able to successfully tackle this problem and showed us how in a similar fashion sustainable ambulance is achievable. Prompted and inspired by Paul Frasca’s presentation the CAA team pushed hard to deliver a CAA Sustainability Strategy one of the world’s first ambulance sector-wide commitments to a more sustainable future. June saw the CAA Board endorse the strategy that will pro-actively work to provide and strengthen a positive culture towards a sustainable ambulance sector and reduce environmental impacts from the delivery of our services. The Strategy identified core segments, from reducing carbon emissions by researching options for greener solutions, exploring sustainable water systems which work on collecting and reusing water, providing alternative options for reusable power and working with our members to drive reuse, recycle and repurpose methodology (circular economy).
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CAA is setting up initial data collections to capture current statistics to be able to benchmark and monitor ongoing performance and results against set targets. While these are very early days it’s wonderful seeing services commitment to exploring data and looking to the future with an aim to set some measurable goals that push progress forward. World Environment Day held on 4 June was celebrated with the launch of CAA Sustainability Strategy and marks CAA’s commitment to raising awareness through education, initiatives and events promoting good sustainability practices and sharing innovative solutions in this space. CAA is putting together a suite of fun facts and ideas for quick sustainable initiatives around the office, stations and at home. These have been shared on CAA’s social media and website and more will be shared regularly as part of CAA’s Sustainability Roadmap. The Roadmap will tackle individual strategy segments by deep diving into research, searching for case studies around the world, speaking with vendors and providers of sustainable solutions with the aim to provide our members with easily adopted solutions. The future is looking greener already. Having the commitment from the Australasian ambulance sector to move towards this big change is a step in the right direction and seeing commitments like Ambulance Victoria’s recent power purchase agreement (https://www.ambulance.vic.gov.au/av-movestowards-renewable-energy/) shows we are on our way.
caa.net.au
Waste Fact:
Each year over half of our household garbage waste is made up of food and garden waste.
Tip:
Pizza boxes, coffee grounds, vacuum dust, egg shells and flowers can also be added to your ‘green’ waste bin.
Fact:
Plastic bags can take thousands of years to decompose.
Tip:
Put your reusable bags back in your car after you unpack your shopping so they are ready for next time.
Water Fact:
Energy efficient washing machines can save more water in a year than one person drinks in a lifetime.
Tip:
When buying your next washing machine look for one with at least a 3.5 star energy rating & a 4 star water rating.
Fact:
Bottled water costs about 2,000 times more than tap water.
Tip:
Buy two of your favorite bottles & keep one at home & one in the car or at work.
Reuse & recycle Fact:
By 2050, there will be more plastic in the ocean than fish.
Tip:
Soft plastics e.g plastic bags, can be placed in a collection bin at most local supermarkets.
Fact:
Glass can be recycled an infinite number of times without any loss of quality.
Tip:
Choose products packaged in glass over plastic.
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October 16 2020 restartaheart.net
Focus First
C OV I D As this magazine goes to print Australia stares down a potential spread of the second wave from Victoria across all other states and territories. Numbers over the last few weeks from Victoria alone are toppling all national records from the first wave and one can’t help but wonder how a small bacteria changed our lives in such a short amount of time.
Having the daunting task to meet this pandemic head-on, our paramedics and ambulance services are in the thick of it all. While we knew that this job would take us to the health frontline, nobody could have anticipated the repercussions this global pandemic would have on our services.
CAA’s Operational committee, Infection Control working group, Clinical forum and Aeromedical working group have joined forces to tackle challenges thrown our way. Everything from changing clinical protocols, PPE shortage and use, cleaning of vehicles and aircraft, sorting out staffing resources, looking after our people’s mental health, providing calming and guiding information and a variety of other issues were discussed and reviewed.
As always, our people and their commitment to the public’s health prevails and we can only applaud their response and resilience. Across all services we are working overtime, preparing, planning, responding and adhering to the newly changed rules that this pandemic keeps surprising us with.
The incredible way ambulance services stand together in light of large emergencies shows the character of our people, yet we know we are in this for the long haul and we need to ensure fatigue and complacency don’t set in as much as we need to ensure our peoples’ wellbeing.
CAA was quick to respond to our members' needs and we did what we do best, share knowledge, share experiences, facilitate forums for our members to discuss and find solutions to issues arising from this health crisis.
CAA’s Mental Health and Wellbeing working group were quick to share materials, discuss solutions and tools that had to be erected overnight to deal with heightened concerns and anxiety of our teams, managers and their families.
Since March CAA has facilitated in excess of 80 meetings that brought the sector’s experts together to respond to the pandemic. Being able to hear from services that were caught on the front end, learning from their experiences and adjusting solutions to their own needs, has proven invaluable.
As we look toward the end of 2020 and hope next year brings some relief, we can sleep easier knowing our paramedics and ambulance services will always be here to look after us, come pandemic or shine.
Businesses stopped, schools closed, travelling cut down, families separated, the life we came to love and take for granted feels a world away.
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...the increased anxiety and demands of the job are impacting the familywork-life balance for a lot of us.� Michael Georgiou, Loddon Mallee Regional Director, Ambulance Victoria
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From the frontline: paramedics in the time of COVID-19
L
ike all of our healthcare workers, paramedics have been hugely impacted by COVID-19. We look at the challenges they’re facing at the frontline.
In the COVID-19 world, the terms “essential worker” and “frontline worker’” have become part of our everyday language. Few groups of people are more essential or frontline than paramedics. They might be highly skilled professionals who are trained to assist others, often in emergency situations, but that doesn’t make paramedics immune to the impacts of living and working through a pandemic. “Paramedics have experienced the same pattern of worry and anxiety about coronavirus as the general public,” says Mojca Bizjak-Mikic, General Manager of the Council of Ambulance Authorities (CAA). “At the same time, paramedics not only know they may be more exposed to COVID-19 than others, but that they’ll be the ones people will depend on when the worst happens. It’s quite a complex combination of pressures to cope with.” CAA is a not-for-profit peak body representing the statutory ambulance services of Australia, New Zealand and Papua New Guinea, which employ skilled paramedics within their dedicated teams, delivering unrivalled care and support in the pre-hospital sector.
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CAA’s committees, working groups and forums contribute to evidencebased initiatives and projects designed to keep ambulance services at the forefront of paramedicine.
No such thing as “business as usual” Mojca says the type of call-outs paramedics are attending haven’t necessarily changed, but the logistics look very different. “Each call-out takes significantly more time, and the turnaround of ambulances in between jobs is a lot longer due to cleaning requirements.” Ambulance Victoria’s Loddon Mallee regional director Michael Georgiou adds that changes to procedures have also been a significant source of fatigue and stress. “Clinical practices that we’ve had drilled into us, often for years, and even things like emergency department set-ups have had to change so we can keep everyone safe. That’s been incredibly taxing.”
Taking it home At the start of the pandemic, many paramedics were worried about putting their families at increased risk of COVID-19. But months on, they’re confident that PPE and other on-the-job procedures are working – so far. “That’s given paramedics some peace of mind,” says Mojca. “There’s knowledge that ‘if I follow all the steps, I’ll be okay’.” Michael agrees: “To date, the small number of confirmed COVID cases among paramedics haven’t been contracted in the workplace. So while adapting to new safety procedures has been physically and mentally exhausting, we also know our PPE is protecting us.” That doesn’t mean that family life hasn’t been impacted. “We’re taking other things home,” Michael says, “and the increased anxiety and demands of the job are impacting the family-work-life balance for a lot of us.”
One of the biggest changes is the everyday use of personal protective equipment (PPE).
Mojca explains that it’s not uncommon for both parents in a family to be paramedics.
“Plastic gowns, masks, goggles, gloves – wearing that all the time, on top of the procedure required to remove it safely, impacts the physical health of paramedics,” he says.
“Children may be worried or anxious about mum or dad – and sometimes both – being paramedics because of what they’ve heard about COVID-19 in the media or playground. We’ve worked hard to help paramedics understand how to talk to their children about their jobs and coronavirus, but it is another thing they have to consider.”
Paramedics are also mindful of how PPE affects patients. “Being in a situation that requires an ambulance is scary enough, then to see a paramedic arrive in full PPE is confronting. The thought that we might be increasing a patient’s stress levels adds another layer of concern for us.”
In it for the long haul Healthcare workers, including paramedics, have never viewed the coronavirus pandemic as short term. “We’ve always known this would be a marathon,” Mojca says.
“Like everyone in the broader community, the challenge for paramedics the longer this goes on is avoiding complacency and fatigue around continuing to do what they need to do to stay safe.” Michael adds that the public’s complacency is a source of continuing frustration. “As a healthcare professional, you can’t help but feel frustrated. Doing and seeing what we have to deal with every day as paramedics and then seeing people not doing – or even refusing to do – the right thing is exhausting.”
A boost in support Like other healthcare professionals, Mojca says paramedics aren’t always adept at recognising when they need support – or at reaching out for that support even if they do feel they need it. “Fortunately, a range of strong, effective support services are available to paramedics, from peer support programs to 24-hour counselling services,” she says. And many of them are “reverse engineered”. “Specific call-outs are automatically flagged and support workers immediately dispatched, which means getting support doesn’t always rely on paramedics asking for it.” Additional support resources have been introduced in response to COVID-19, too. “Podcasts, tip sheets and online resources are now available, and we’ve seen a huge uptake in our paramedics accessing these services, which is great,” says Michael. “It’s all part of destigmatising reaching out for mental health support for healthcare workers, including paramedics,” Mojca says.
“On the plus side, that’s meant we’ve had the opportunity to become better prepared for the second wave.
This article was originally published on Beyond Blue’s Coronavirus Mental Wellbeing Support Service. For more information on managing your mental health and wellbeing during the COVID-19 pandemic, visit coronavirus.beyondblue.org.au.
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If you’re finding it hard to cope, share the load with us. The Coronavirus Mental Wellbeing Support Service is free, available 24/7 and, above all, here to help. Chat to one of our expert counsellors by calling 1800 512 348 or visit coronavirus.beyondblue.org.au
THANK YOU Ambulance services in Australia, New Zealand, and PNG for helping to keep communities safe during COVID19.
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Opinion First
O
ne of the more remarkable features of our four-month, COVID-19enforced isolation has been the immediate willingness of Western Australians to accept what, in any other circumstances, would have been considered draconian measures. The community accepted the declaration of a State of Emergency; lined up when required for testing; self-quarantined in their homes; saw the benefits of mandatory hotel quarantine; understood the reasons for intrastate travel restrictions; and applauded closing interstate borders. Turning Rottnest Island into a health fortress was considered an appropriate response. These far-reaching and economically debilitating changes were accepted because, fundamentally, the community understood that it was for the common good; that if we were to “flatten the curve” we all had a part to play – and it worked.
Our paramedics, the same people celebrated for their unflinching professionalism during the pandemic, once again face the prospect of violence while trying to help others. Within two weeks of restrictions being eased, there have been several reports of violence where we had to call in the police to support and protect our crews while attending patients. As part of their training our paramedics are told “it’s OK to walk away” but that is anathema for many people whose first response is to offer aid to those in need. Violence against paramedics is not new. That is why we are covered under State legislation which mandates jail for people who attack emergency service personnel.
Locking down violence against paramedics Proudly, Western Australians proclaimed, we are “all in this together” and the community lauded the sacrifice of the thin green line of health workers — paramedics, nurses, doctors, cleaners — who stood fast in the face of a virus with no vaccine. Our paramedics were, and continue to be, part of that frontline. We ferried the critically sick to hospital and others to their hotel quarantine in convoys flanked by police vehicles, and we dealt with the very real dangers of treating people with the respiratory related virus within the tight confines of an ambulance. Western Australia is now enjoying “Phase Four freedoms” of open nightclubs, dance clubs, bars, restaurants — even the prospect of 60,000 people at Optus Stadium, an outcome considered unlikely only a few weeks ago. And while we rightly celebrate the easing of restrictions, unfortunately some of the old ways have already returned.
Nor is it a local issue. Campaigns are run throughout Australia reminding our personnel and the community that violence against paramedics – and emergency services workers in general – is never OK. We are also targeted by vandals, who attack our ambulances, and thieves who steal lifesaving community defibrillators. If we have learned anything from COVID-19 it is that we will need to work together to make a difference and flatten the curve of violence against paramedics. Much has been made of what society will look like post-COVID. Will it be more tolerant as people reset their priorities, or will we return to old habits?
Deon Brink Executive Director Ambulance Operations, St John WA As the Executive Director Ambulance Operations and registered paramedic, my directorate include Metro and Country Ambulance Operations, the State Operation Centre, the Emergency Helicopter and Emergency Management unit for St John WA. We are contracted to provide the state ambulance service and cover a land mass of approximately 2.5M square kilometres.
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Services First
Two Englishmen and a Canadian walk into a branch... From Ambulance Victoria Community News
David Millican
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Brad Sanders
Nick Thresher caa.net.au
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hings were a bit different in 1990. The clothes were baggier. People wore multi-coloured woollen jumpers unironically and Bob Hawke was PM. House prices were cheap and international phone calls were expensive. But Ambulance Victoria didn’t mind the cost and put out an international call with a difference – asking paramedics around the world to come to Australia and work for what was then known as the Metropolitan Ambulance Service. Three of the men who answered that call are still working at Ambulance Victoria today, and are celebrating the 30th anniversary of taking a chance to serve a whole new community. When David Millican arrived with his wife and two children from England, he knew he wanted to stay, but kept quiet because his wife believed it was only going to be a two-year gig. He needn’t have worried. ‘When two years came around, she wasn’t even interested in going back,’ he says. David is still with AV as a Senior Team Manager. For him, retraining as a Mobile Intensive Care Ambulance paramedic (MICA) and working at AV was just the same as working back home in England.
professionals, [but] you were seen as part of the full health care system in Australia. It was very stimulating and new to me.’
There were also some logistics to get used to. ‘Driving lights and sirens on the ‘wrong’ side of the road was an experience.’
For Canadian Brad Sanders, whose wife is Australian, the differences were more dramatic. ‘Working in Canada as a paramedic I dealt with pretty standard cases, nothing too intense,’ he says, ‘but when I came to Australia I was faced with much more intense work and I had to learn fast. It was definitely an upskill for my skillset coming to Australia.’
Over thirty years, all three men have thrived and put down roots in their communities. David became a MICA paramedic, and Brad is a MICA and also worked with the Air Ambulance. Nick shares his considerable skills as a driving instructor at AV and hasn’t regretted the move: ‘Oz has given my family so much and now I have an Aussie grand-daughter!’, he says.
Despite having to retrain to meet Australian levels of practice, David says, ‘The most challenging thing for me was not so much the work styles. It was getting used to the Aussie climate. I wore shorts all winter!’
Now that call to serve is going the other way, according to Nick. “A lot of newly graduated paramedics are heading to London these days,” he says, “London Ambulance is always looking for new recruits from AV … because AV is such a well-respected ambulance service.”
So too for Nick Thresher and his family, saying ‘I knew from the first day I wanted to be here and for 12 months my wife wanted to go home, then it changed’. As an instructor with London Ambulance Service during industrial action, the lure of Australia was too strong to ignore. Even though ‘the job was the same’, Nick immediately noticed some key differences. AV was ‘far more academic and the UK was far more practical,’ he says. ‘In the UK, paramedics weren’t seen as
Nick Thresher after arriving in Australia
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Albert the python literally bites the hand that feeds him. By QAS Insight magazine
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pswich paramedic Rhys Warwick was left shaking his head after responding to a roommate dispute with a serpentine twist on 3 January, after a pet python struck its owner on the wrist and refused to let go. Matthew Stirling recently met with Rhys, patient Isobelle Slatter and Albert the eight-year-old olive python to uncoil the steps of the case. Problem solving is an ability most paramedics will be familiar with, however, not many can claim to do so while wrangling a nine-foot python stubbornly intent on constricting its owner’s arm. This was the situation presented to Rhys and his partner Bree King when they arrived at a Deebing Heights home to find Albert’s mouth attached to the entire posterior of Isobelle’s wrist, wrapping around to the edge of her anterior wrist. Isobelle, 21, was completing a morning clean of the non-venomous snake’s enclosure when Albert struck. “He latched his jaw down and wrapped himself around his own neck to maintain the grip and then wrapped around and around,” she said.
Realising that Albert wasn’t releasing his grip without some persuading, the crew called a local snake catcher to source a solution. The paramedics were advised to firstly try pouring cold water over the snake, to no avail. Next the crew began rubbing ice cubes along Albert’s jaw, but again he held firm through the discomfort. The suggestion of using alcohol or hand sanitiser was discussed, however, even though she was experiencing immense pain, Isobelle insisted against the idea due to Albert’s poor health. The bizarre reality of the situation was sinking in as the paramedics ran a bath and Isobelle hobbled across the house with the heavy python weighing down her wreathed limb.
“His teeth, which are like 100 plus needles, are inverted so you can’t pull them off and by pushing forward the teeth Albert had only been with were going further in. “After that my hand was not working.” After 25 minutes of futile attempts by Isobelle’s friends to untangle the reptile, concern for her arm set in and the decision was made to call paramedics.
Isobelle a few months since being rescued from an inadequate home. Malnourished and scarred, Isobelle said the python was also recovering from a systemic respiratory infection.
Albert had only been with Isobelle a few months since being rescued from an inadequate home. Malnourished and scarred, Isobelle said the python was also recovering from a systemic respiratory infection. “He went into a feeding response with my arm nearby, reacting to any warmth with a strike and any movement with aggression,” she said. Rhys stated that although he doesn’t mind snakes, he wouldn’t normally touch one. “Usually they just bite and let go. We tried to remove Albert at the start but if we moved him too much he just constricted tighter and bit harder,” he said. “There were concerns the radial artery was involved as we couldn’t see much, and the constriction was cutting off blood flow to the hand. “We had to unwrap Albert a few times because he was getting too tight and Isobelle got briefly cyanosed in her fingers.”
When submerging Albert under water also failed, the team conceded they were running out of options and requested back-up in the form of Critical Care Paramedic Nicholas Abussi and Critical Care Intern Sergio Gomes.
During the paramedics attempts to tip the scales, so to speak, Albert would respond by tightening his constriction, resulting in increased peripheral cyanosis and a cap refill of four seconds. With a vet unable to respond and sedation appearing the only avenue, it was decided that the intertwined duo would be heading into the ambulance. With Albert finally sedated by the veterinary clinic and taken home in a pillow case, the crew were able to inspect Isobelle’s injury. Thankfully, she retained function of her hand with minimal bleeding, and the wounds were cleaned before she was transported to Ipswich Hospital for further assessment. Months later, Isobelle’s small scar serves as a reminder to slip on her motorcycle glove and jacket for protection when around the snake enclosure, with Albert’s strong recovery adding another half a foot to his length. “I struggled to open my hand for a few days afterward,” she said. When queried whether this was Rhys’ strangest case in his four years as a paramedic he replied ‘It’s up there.’
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Awards First
CAA Awards for Excellence 12 years and counting the CAA Awards for Excellence grow in recognition every year. Every year we see a higher standard and tougher competition for the winning spots. 2019 was no exception with 24 entries that showed outstanding innovation and commitment to excellence proving for hard judging.
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ast year the awards received a facelift after a thorough review to bring them in line with the most relevant topics to the current ambulance sector. The revised categories included Excellence in Patient Care, Excellence in Leadership, Excellence in Clinical Practices, Excellence in Staff Development and Excellence in Technology.
The awards program was moved online to provide a better and easier platform for entries and judging. The coveted STAR Award is selected from the category winners and in 2019 Ambulance Victoria took out the gold (or better said the star). AV’s winning Analytics Uplift Project was developed to better support operational managers in driving performance improvements and generate better strategic decision making. The project focused on three main areas – improving technology, up-skilling managers and analysts and delivering complex predictive and prescriptive analytics. The project has resulted in positive outcomes including higher levels of job satisfaction, increased in-house analytics capability and the capacity to tackle rapidly changing business challenges.
continuous improvement, strong leadership, and innovation. Project work, performance improvement, and quality assurance are all incorporated throughout our organisation and our strategic plans, and our drive for significant achievements and progress enables us to evolve and adapt to the changing demand.”
This is not the first time Ambulance Victoria took home the Star Award and we sat down with AV’s CEO Tony Walker to grab a few pointers on the importance of industry awards and how they go about entering the CAA Awards.
When asked about the CAA awards, Tony said “the CAA Awards provide us with an opportunity to showcase and celebrate these achievements. Our staff can be recognised for the important work they do within Ambulance Victoria. As an industry platform, the CAA Awards provide an opportunity for learning, inspiration, and collaboration.”
Tony shared “at Ambulance Victoria (AV) we are committed to
And while the 2020 CAA Awards for Excellence had to be cancelled
2019 Star Award winner, Ambulance Victoria.
due to the ongoing COVID-19 pandemic we are excited to bring you new categories and see the many innovative and brave projects that will result from this health crisis. Entries to the CAA2021 Awards for Excellence will be opened midJanuary 2021, and the CAA Awards Gala Dinner will be held on Friday 16th 2021 in Sydney. Stay tuned for regular updates through CAA channels. We are as always incredibly grateful to our judges who donate their time and expertise in judging the CAA awards. In 2019 Prof Vivienne Tippett, Director of Research for Queensland University of Technology’s School of Clinical Science, Prof Peter Cameron, Academic Director of The Alfred Emergency and Trauma Centre and Professor of Emergency and Divisional Head of Health Services Research at Monash University’s School of Public Health and Preventive Medicine, Tony Blaber, retired St John NZ Regional Chief Executive and Steve Irving, Executive Officer at the Association of Ambulance Chief Executives (AACE) joined our long line of distinguished judges.
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Feature First
Greg Page With 2 months to go until this year’s RAHD we spoke to Greg Page, the original Yellow Wiggle who suffered a cardiac arrest on 17th January this year while performing on stage during a fundraising concert for bushfire relief efforts.
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reg was one of the lucky 10% of people who survive and recover fully after a cardiac arrest event that occurs outside of the hospital. The fact that there was a trained nurse and a doctor in the audience who knew exactly what to do and several other bystanders who helped with CPR, paired with the fact that the RSL had an AED on-site ensured Greg received good quality CPR and a shock delivered by an AED before the ambulance even made it to the scene.
F: How do you recall that day? Do you remember anything One of the paramedics that arrived on scene said: “It’s from the event? only through the efforts of the bystanders before we arrived that Greg is alive today, it was actually an G: “I don’t recall much about the day, or extraordinary story the concert itself. of survival.” Greg’s survival story shows how F: Greg we are all extremely pleased to see you out and about after suffering a cardiac arrest early in 2020. How are you feeling almost 6 months on? G: “I’m feeling very fortunate to be alive! I’m fit and healthy, and aware of the fact that I now have to watch my heart health. Prior to my event, I had no real warning signs or symptoms that I could identify at the time – however, in retrospect, now that I have had a stent put into my main left artery, I can notice a difference when I am exercising.
the public’s awareness of cardiac arrest, knowing CPR and having AEDs located in public areas make a life-changing difference. The fact that Greg uses ‘lucky’ to describe his survival paints a picture that much more work needs to be done to raise awareness and get the public engaged to support ambulance services in the battle of improving survival rates from cardiac arrest. I urge everyone to take a few minutes on Friday 16th October this year to show support for RAHD and help us improve survival rates. David Waters, CEO Council of Ambulance Authorities
The shortness of breath (puffing!) that I was experiencing at the time, I just put down to age, but now, I realise that it may well have been the fact that I had a partly blocked artery that was affecting me. However, with hindsight, we have 20/20 vision –quite appropriate for this year – and fortunately for me, I am alive to recognise it. So, if there is one thing that my survival can achieve, it would be for people to not just think that exercise becoming harder and more unpleasant should be accepted as part of getting older.”
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I have only a few memories of the afternoon, and of the show itself. I don’t really remember doing the show – I can’t recall looking out from the stage and seeing the crowd. I know that we lost power at some stage early in the show, and that there was a song that we forgot to do on the set list. But that’s about it. In terms of my “heart attack”, I don’t recall having any symptoms such as pain or heaviness in the chest. I was short of breath, but obviously, I thought that was because of the show that I was doing. As for the cardiac arrest, I do recall lying on the floor and struggling to breathe – but at the time, I remember thinking that it was just because I had been doing a pretty full-on show – which would be a fairly normal way to feel. But then I just blacked out, and that was my last memory – of lying on the floor looking at the ceiling, trying to get enough oxygen in.”
F: We assume having such a life-changing event it must affect you. Did the cardiac arrest change your outlook on life? G: “Yes, it has had a profound effect on me. It has made me realise that only around 10% of people that have an out of hospital cardiac arrest survive it. That means, I am extremely lucky. That is something that I reflect on every day, and am incredibly grateful for. It has taught me that given the statistics around surviving caa.net.au
a sudden cardiac arrest, I am fortunate to have a second chance with life, and to make sure that I do everything I can to ensure that I live my life to the full now and make every day count. Part of that is to ensure that I help people become aware of heart disease and avoiding heart attack and a potential sudden cardiac arrest. It is also my mission now to generate as much awareness in the community about how we can better-respond to out of hospital sudden cardiac arrests, and try to improve the survival rate, because quite frankly, 10% survival is not good enough. There need to be more people like me who survive and go on to live longer lives.” F: There was a team of bystanders including a nurse and doctor that helped you when you had a cardiac arrest. Have you had a chance to meet them? G: “The universe was looking after me with my cardiac arrest – it happened on that night with all the right elements around me to ensure I survived, and with no damage to my brain or organs. I was incredibly lucky to have had plenty of people around who responded quickly, and with the right actions to not only save my life, but to ensure that my brain was not damaged due to lack of blood flow and oxygen throughout the process of administering CPR for around 25 minutes. I will be forever grateful to the team of people who performed CPR on me for such a long period of time – Kim Antonelli, Steve Pace, Grace Jones and Therese Wales. There is no doubt that their quick-thinking actions saved my life, and preserved my cognitive function – and that is a huge positive for me and my family going forward from this.” F: The AED at the RSL where you had the cardiac arrest was integral to saving your life. Do you think that public places and venues should have a mandatory AED on-site? G: “After surviving this experience, I believe that AED’s play an integral role in the chain of survival, and that the more AED’s there are out in the community, the more lives will potentially be saved.
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After the first three minutes, every minute that a cardiac arrest patient goes without defibrillation, their chance of survival decreases by 10%. Therefore, in the event of someone suffering a sudden cardiac arrest, ideally, we want an AED within 1 minute of every person in the country – that way, if it takes one minute to get to the AED, 1 minute to get back to the patient, and 1 minute to get the patient prepared and the AED in place – then the first shock can be delivered within that 3-minute time frame, ensuring that patient has the best chance of surviving with the best outcome. This is part of my mission – to get more businesses, workplaces, shops, community hubs and organisations to have AED’s on-site.” F: Knowing what you know now about cardiac arrest, is there anything you would do differently? G: “I never thought I would actually have a heart attack at the age of 48, let alone be the victim of a sudden cardiac arrest. I know that I had carried a fair bit of extra weight about 14 years ago, but I lost that. I also had high cholesterol about 10 years ago. However, I changed my diet, and I had been exercising regularly – so I thought I was ok. At the time of my cardiac arrest, upon getting into hospital, my cholesterol reading was 4.8 (total cholesterol) and 3.3 (LDL) – both of which seem to be in the “normal” range f or cholesterol. However, what I didn’t know was what was happening inside my heart. The “unseen” build up of plaque in my arteries was something I was unaware of. So now, knowing about cardiac arrest, I would definitely have taken my heart health more seriously once I reached 40. I should have had much more regular checkups with my doctor, and not just assumed that I was doing enough exercise, and vigorously enough to avoid this happening to me. So, please, if there is one message to take away from my experience, it needs to be for people to understand that exercise and good diet alone may not be enough to avoid this happening to you – it may well be the things you CAN’T see, and the things you CAN’T control that will affect you – so stay on top of your health – make the time to be vigilant of it. Because only 10% of people who have a cardiac arrest will have the chance to try again and get it right.” F: You have been very vocal about your experience and have since your cardiac arrest been pro-active in raising awareness about the importance of knowing CPR and AED use. Tell us about your work in this area.
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G: “Surviving an event like this is definitely life changing. It means that I have the opportunity to ensure that more people have the same opportunity to get a second chance as I got. That means I need to be as vocal as I can about CPR and AED’s in the community. My not for profit initiative, “Heart of the Nation” is aimed at recognising those businesses and organisations that have AED’s and acknowledging them for the investment they have made in these life saving devices. That way, people will know which local businesses have their best interests at heart – literally! This means that when someone comes across a cardiac arrest patient, they will be able to quickly identify the closest location that has an AED to be used to save a life.” F: Is there anything specific you would like to see change in this space? G: “I would like to see it become mandatory that specific places have AED’s – particularly places or locations that people would turn to in the event of a medical episode, as that is where you would naturally want to go if you come across someone experiencing a cardiac arrest. I believe that it should be mandatory for all doctor’s practices to have an AED – this is currently not a mandated thing – which I cannot believe, to be honest. The other locations that should adopt a policy of having an AED on-site would be service stations, and well-known fast food outlets, all of which are open most hours of the day and night. I would also like to see community AED’s in neighbourhoods, allowing residents fast access to AED’s – given that 75% of sudden cardiac arrests happen in the home, it makes sense for communities to get together and raise funds for local AED’s to combat the terribly low survival statistic. If we can create a greater awareness of the importance of AED’s in the chain of survival, no just CPR alone, then I feel very confident that we will increase that survival rate from around 10% to something more like that of Seattle, where they have a survival rate of around 70% - that’s a massive difference, but it shows it CAN be done.”
October 16th marks Global Restart a Heart Day, a day created to raise awareness around out-of-hospital cardiac arrest, the importance of knowing CPR and AED use. CAA has been running the Restart a Heart Day across Australia and New Zealand in collaboration with our member services since 2017.
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OPEN YOUR DOOR and join us for the CAA WEBINAR SERIES! With the postponement of the CAA2020 Congress due to COVID-19. We have designed a series of 1 hour webinars to fill the knowledge gap. This allows all of our members to access an incredible line up of speakers, discussing thought provoking and stimulating topics that directly affect paramedicine of today and tomorrow.
Professional development without leaving the lounge!
For more information go to caa.net.au/webinars
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Events First
CAA2019 Congress
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erth and St John WA hosted the CAA2019 Congress and the week once again proved to be the industry’s top education and networking experience. The week began with the Asia Pacific Ambulance Officers Workshop on Monday, continued with day-long Infection Control and Women in Leadership Forums alongside Global Resuscitation Alliance Masterclasses on Tuesday, which then led into the two-day CAA Congress and Expo. Throw in the CAA Awards for Excellence Gala Dinner and a Welcome function at the WA Governor’s House and the week quickly became the industry event of the year.
GRA Masterclass & Asia Pacific Ambulance Officers Workshop CAA, in its role as the GRA Australasian Secretariat, hosted in partnership with the Resuscitation Council of Asia and sponsored by ZOLL, the Asia Pacific Ambulance Officers Workshop with the main focus on out-of-hospital cardiac arrest. Presenters from Taiwan, Singapore, Thailand, the USA and Australia, addressed regional issues ahead of HighPerformance CPR workshops held by Australasian GRA Resuscitation Academy alumni. The GRA Masterclass on Tuesday showcased the progress Australasian services have demonstrated in measuring and improving cardiac arrest survival against the 10 step CAA Out-of-Hospital Cardiac Arrest Strategy based on Seattle’s ‘10 Steps for Life’ program. The Masterclass program featured presentations from Dr Freddy Lippert, CEO Emergency Medical Services Denmark and Singapore’s Dr Ng Yih Yng, the Lead, Digital and Smart Health Office, Tan Tock Seng Hospital and Central Health Singapore in addition to services’ leaders in the field. Presentations by Singapore’s Dr Ng Yih Yng gave delegates an Asian perspective on the GRA programs and life-saving innovations in use, and on the horizon. Dr Ng also shared Singapore’s development of artificial intelligence programs, which can interpret four languages without the need to be programmed to recognise a person’s voice. Dr Ng said rapid dispatch of ambulances was a critical step in the chain of survival and Singapore had learned that real-time feedback for call takers and quality assurance measures were key factors in improved results.
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Inaugural Infection Control Forum Last year the CAA was excited to hold a masterclass dedicated to infection control and prevention in the ambulance space. An important topic that in hindsight, as we navigate the COVID-19 pandemic, makes the recommendations and work of experts who presented in Perth even more vital. The Manager, Infection Control at NSW Ambulance, Kate Hipsley spoke about the importance of having policies, procedures and guidance and welcomed CAA’s new Infection Control Strategy and hand hygiene messaging. The A/Director Strategy and Innovation at NSW Ambulance, David Morris presented the development of the Make Ready Model NSW Ambulance put in place in 2018. The model involves the environmental cleaning of ambulances and a new methodology for supply chain management of consumable items and operates across 9 sites covering 120 vehicles. David Waters presented on the new CAA Infection Control Strategy saying, “it will provide a guiding framework for ambulance services to see how we can start looking at how we can protect our staff and protect our patients.”
Committing to a more gender-balanced workforce and ambulance leadership “Success means something different for everyone. Success is rarely quick, comfortable, convenient or painless. We have to embark on a journey with eyes wide open. We have to roll up our sleeves with our hearts full of courage and we have to have a vision burned into our minds.” The forum opened with these words from St John WA CEO Michelle Fyfe one of only 4 female CE/CEOs to ever lead an Australian or New Zealand ambulance service. The Forum was a day of inspirational personal stories, messages of empowerment and hands-on workshops designed to provide 150 attendees with tools and support to further grow their careers and encourage women in the ambulance sector to try for leadership roles. Christina Matthews, CEO Western Australian Cricket Association painted a colourful picture of her life in a man’s world and explained that she had to constantly work at proving herself. Her remarkable determination and good humour in the face of sometimes unexpected adversity saw her through a cricketing career spanning 30 years – 12 representing Australia. When Ambulance Tasmania’s Chief Executive Neil Kirby stepped up to the podium he said: “The number one message is Be You. Excel in your qualities. Stand strong in what you can bring to leadership. Mentoring is not how to compete in a man’s world, not moulding into a mould perceived by someone else. Have the confidence to stand tall, to speak up, to be you.”
ten years, reinforcing the need for good mentors and champions. “We have to mentor women, develop them, build their confidence and build to where they feel ready to compete. Provide a framework and plan if you are a mentor”. A video message from NZ Prime Minister Jacinda Ardern and our other incredible presenters that included ambulance service’s Michelle Brett, St John Ambulance New Zealand, Angela Beatson, Queensland Ambulance Service and Michelle Baxter, Assistant Commissioner Queensland Ambulance as well as speakers from other industries Dr Niki Vincent, Commissioner for Equal Opportunity, Jeremy Watkins, The Barefoot Leader and Julie Corvin from Derwent provided for an engaging and informative program.
He said it was likely that the ambulance sector will become a female-dominated profession within the next
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CAA Congress The future was the hot topic of the CAA2019 Congress painting a picture of what the society and ambulance services will look like in the next 20-50 years. A fun topic that saw us reaching for the stars, inspiring for flying ambulances among other ideas. Bernard Salt, the Managing Director of The Demographics Group presented on what Australian and New Zealand societies will
UK emergency medicine and prehospital care consultant Professor Richard Lyon MBE brought the future of ambulance services to life with two presentations sharing developments in technology that can dramatically enhance pre-hospital care which is not only plausible but also on the road to becoming reality. Only weeks after his Congress presentations, Professor Lyons along with development partner Philips, launched a device using remote diagnostic technology, partly funded
Chief Executive of the Stroke Foundation and Skye Coote, Nursing Coordinator Melbourne Mobile Stroke Unit, The Royal Melbourne Hospital. The second day kicked off with an inspirational and technological innovation filled presentation by Bruce McCabe, a futurist that showed us the possibilities that lie ahead of us. Bruce’s presentation showed what is possible, what’s around the corner and stretched our imagination to the possibilities and how technology can assist in the health environment. Concurrent sessions across both days focused on the Future of Stroke Care, Use of Technology and Data to Improve Patient Care, The Paramedics of the Future and Data Convergence. Speakers from Australian, NZ, PNG and Belgium ambulance services, hospitals and associated companies shared their programs and developments providing for truly informational sessions. Closing the Congress was Paul Frasca, eco-warrior and co-founder of Sustainable Salons who laid down the challenge for ambulance services to make their waste history. He asked ambulance leaders to heed the call to adopt sustainability practices: “It’s really simple. Think long term, change mindsets, create transparency, inspire new behaviours, and provide incentives.”
look like in the future. He spoke about challenges and opportunities the future brings and shared his view on what drives prosperity and underpins our way of life. He stressed that Australians and New Zealanders were rich “per capita” and that we have the means to succeed, but added our rates of growth will place pressure on health care systems, including ambulance services.
by the European Space Agency. The portable device used by a Helicopter Emergency Medical Service (HEMS) in south-east England can livestream a patient’s vital diagnostics for more accurate and timely treatment both in the air and on arrival at the hospital. Stroke care formed an important part of the Congress program with presentations from Dr Freddy K. Lippert CEO, Emergency Medical Services Denmark, Sharon McGown,
Paul spoke about how other industries have tackled the challenge and presented some potential solutions for the ambulance world, from rethinking energy use, looking at harvesting rain and re-cycling water, to small changes like dropping plastic water bottles in place of filtered water located at ambulance stations. The CAA2020 Congress was postponed due to COVID-19 restrictions and we are excited to invite you back next year from 15 – 17 July 2021 to the beautiful Sydney. Our topic ‘The New Normal: Adapting to our Reality’ will be more relevant than ever with changes resulting from 2020’s global pandemic.
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International First
International news The Association of Ambulance Chief Executives – United Kingdom The Association of Ambulance Chief Executives (AACE) provides UK ambulance services with a central organisation that supports, coordinates and implements nationally agreed policy. It also provides the general public and other stakeholders with a central resource of information about UK National Health Service (NHS) ambulance services. The Chief Executive Officers of all ten English NHS ambulance trusts are full Members of AACE, with all other UK statutory providers supported as associated members. AACE is a key point of contact with the ambulance service’s main partner agencies at national level – in particular the Department of Health and Social Care, NHS England & NHS Improvement, Public Health England, Health Education England, the NHS Confederation and other emergency services organisations. AACE provides co-ordination for the work programmes of many key national groups including Ambulance Chief Executives, Directors of Clinical Care, Finance, Human Resources, Communications, IM&T, Operations and Quality, Governance and Risk Directors. The work programmes include critical national projects on emergency resilience, clinical practice guidelines, clinical and operational performance and the development of new services. A key aim of AACE is to ensure that ambulance services share their knowledge and skills to better meet the emerging challenges and opportunities facing all ambulance services. Encouraging more efficient use of ambulance service resources through closer working is also a key aim of each work stream, bringing improvements to patient care.
The Ambulance Leadership Forum event (ALF) The annual ALF event (produced by AACE) enables the UK’s ambulance leaders to come together with NHS colleagues, commissioners, other NHS healthcare leaders and overseas colleagues to share current challenges, discuss strategies for the future and learn from experts and leaders in a variety of disciplines – from the UK and abroad. Celebrating success is also a feature with outstanding service from across the UK recognised at the ALF Awards Dinner. Save the date: ALF 2021 16 & 17 March 2021. More information is available from www.aace.org.uk
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The Global Resuscitation Alliance The Global Resuscitation Alliance is an organisation committed to improving cardiac arrest survival rates around the world. The foundation of this effort was laid in 1990 when a group of EMS leaders from around the world gathered in Utstein, Norway to adopt a set of global guidelines for uniform reporting of sudden cardiac arrest. Since then, a vast body of knowledge has been created thanks to the publications of scientific research and guidelines. The next step is to take the knowledge out of academia and apply it to the real world through implementation. In 2015, a meeting was held with leadership from Asia, Australasia, Europe, and North America. A group known as the Resuscitation Academy from Seattle, USA presented their playbook, 10 Steps to Improve Cardiac Arrest Survival. The 10 Steps philosophy was adopted by the GRA and since that time, many have posted significant progress in improving survival rates. A series of case reports showcase that success. They include innovations like a video-enabled helmet for field providers that connects to a centralized medical control at large sporting events, simulation training for 000 dispatchers and call receivers, and programs that pair phone apps with CPR/AED training to activate bystanders to help save more lives. For more information on GRA visit: www.globalresuscitationalliance.org/ten-programs To learn more about the Resuscitation Academy Foundation visit: www.resuscitationacademy.org
The European EMS Leadership Network The European EMS Leadership Network is proud again to host the first European EMS congress following the COVID-19 pandemic. EMS2021 will build on the legacy of previous congresses in Copenhagen and Madrid, with the characteristic blend of high quality scientific and research presentations mixed with an international perspective on current and emerging issues and of course a great sense of networking and fun. EMS 2021 will boast a spectacular programme of speakers and workshops and the opportunity to explore all that EMS has to offer, so you can ensure to have an unforgettable congress while in Scotland. The European EMS Leadership Network strongly values partnership and collaborative working within the EMS community. As such we will have a fantastic scientific and speaker program, a wonderful range of exhibitors and sponsors, hands-on clinical workshops of the highest quality, an EMS championship like no other and a social programme that maximizes all that Glasgow has to offer. All of this in a campus environment in the heart of Glasgow - one of Europe’s premier destinations. We hope you will take part in EMS2021. We will do everything possible to make your visit to the EMS2021 Scotland unforgettable! www.emseurope.org
European EMS
@European_EMS
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Keeping critical services flying during COVID-19 While COVID-19 may have stopped some companies in their tracks, that’s not the case for Babcock Australasia. If anything, it has shown how Babcock’s focussed determination to get the job done continues to provide steadfast support to air ambulance and other critical services. Working in partnership with customers, Babcock Australasia’s aviation team has maintained operations since the start of the pandemic, providing critical services in Victoria, South Australia and Queensland.
and rescue missions despite COVID-19 adding more layers of complexity, maintaining their operations with increased levels of safety and security.
Having adapted their own practices to ensure the health and safety of their own people and the community, they say Babcock’s commitment to service delivery has ensured Babcock has remained fully aligned emergencies are dealt with promptly The professionalism and with their enhanced measures. and safely, with improved current flexibility of the Babcock procedures coupled with the “Babcock has shown enormous staff has been outstanding introduction of new rigorous health flexibility in providing an uninterrupted and hygiene protocols. and they have proven essential service,” said Tracey Tobias, Darren Moncrieff, Babcock’s Managing Director of Aviation and Critical Services, says Babcock’s response has been robust as well as reliable: “Being part of a global organisation, Babcock has been part of the global response to COVID-19 and it’s been amazing to see the innovation that has resulted,” he said.
they have the resilience and resources to meet the challenges of this pandemic and normal operations. Ian Rowan, CEO, CQ Rescue on the Capricorn Coast in Queensland
“We’ve also played an integral role in supporting our customers here in Australia, ensuring they can keep flying and assisting the community safely and efficiently.” “Babcock is responsive and adaptive, rising to the challenge to meet customer needs and community expectations. We’re there when it counts.” Babcock’s customers continue to face the challenges of providing critical services such as air ambulance and search
Director Complex Care at Ambulance Victoria.
“I have been particularly impressed at Babcock’s continued collaboration with Ambulance Victoria, drawing on the experience of each organisation to refine, create and adapt processes to ensure the safety of our personnel and our patients.”
Mark Fewtrell, Executive Director of RACQ Capricorn Helicopter Rescue Service, said that Babcock’s willingness to work with his organisation and Queensland Health on evaluating strategies in the event t hat crews were exposed to the virus was crucial in mitigation planning. “As a client, Babcock’s response provided me with the necessary information and confidence from which to be able to provide assurance to key stakeholders, the community and the board of directors,” he said.
Research First
A quarter of a century of paramedicine higher education – challenges, opportunities, and collaboration.
O Dr Paul Simpson PhD, MScM(ClinEpi), GCClinEd, GCPaeds, BEd, BHSc(PrehospCare), AdvDipParaScience
Dr Paul Simpson is the Director of Paramedicine at Western Sydney University and the inaugural Chair of the Australasian Council of Paramedicine Deans. Paul spends most of his time in academia, but continues to practice when time permits as a registered paramedic in an intensive care role with NSW Ambulance and in the private paramedicine sector.
First published in the Australian Journal of Paramedicine, Vol. 17 (2020)
n 1 June 2020, the Australian Research Council (ARC) released the outcomes of the recent review of the Australian and New Zealand Standard Research Classification (ANZSRC)1. In what constitutes a significant milestone for paramedicine inAustralia and New Zealand, we have been allocated our own paramedicine ‘Field of Research’ (FOR) code for the first time. So, what is a FOR code and why is getting our own of such significance? The ANZSRC allows measurement and analysis of research and experimental development undertaken in Australia and New Zealand2. These data have a wide range of applications in government, industry and tertiary sectors, nationally and internationally. A prominent example is the ARC’s Excellence In Research (ERA) research evaluation framework3. ERA uses the ANZSRC to identify excellence in research by comparing Australia’s university research effort against international benchmarks, identifying emerging research areas and opportunities for further development, and creating incentives to improve Australian research quality. ANZSRCinformed frameworks such as ERA therefore impact on research grant funding availability and prioritisation, which of course is critical to the conduct of quality research capable of achieving meaningful impact. For universities, ANZSRC data allows evaluation of institutional performance in relation to their strategic research priorities, links to external research funding income success, and facilitates prioritisation and allocation of that funding4. The first iteration of the ANZSRC was released in 2008, replacing the Australian Standard Research Classification that had come into effect in 1998. Within the ANZSRC are three classifications: Type of
Activity (TOA), Socio-economic Objective (SEO) and FOR. The FOR classification has a three-tiered hierarchical structure consisting of divisions, groups and fields. Within the 2020 classification are 23 divisions, encompassing 213 groups and 1967 fields1. The hierarchy in which paramedicine sits is as follows: • Division 32 ‘Biomedical and Clinical Sciences’ • Group 3202 ‘Clinical Sciences’ • Field 320219 ‘Paramedicine’. Researchers allocate a FOR code to their work. Attribution may be 100 percent to a particular code but can also be partially attributed across several codes. Until now, there has been no systematic method to reliably identify paramedicinerelated research for the purposes of- evaluation of quantity, focus and quality. Paramedicine research has been anecdotally classified under codes such as ‘Emergency Medicine’ or ‘Clinical Sciences not elsewhere classified’, resigning it to be being diluted in among the diverse areas the research may also have connected with. The creation of the paramedicine code is important for many reasons. First, it constitutes overdue external recognition of paramedicine as a discipline that has and continues to demonstrate strong research growth, in turn indicating our maturation as a profession.
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Second, it will enable robust future evaluation of the ‘epidemiology’ of paramedicine research to identify areas of strength and weakness, attention and neglect, impact and engagement. This could help in the development of a research agenda and strategy for paramedicine, and promote wider collaboration and partnership between paramedic researchers5,6. Third, it will enable paramedic researchers or research centres to quantify their research volume, quality and impact more systematically, resulting in more competitive applications to grant funding bodies and enhanced likelihood of success. This does not however constitute the end of the journey regarding the ANZSRC. There are no sub-levels at the ‘field’ level, so the new FOR will serve as a catchall for all paramedicine research regardless of the specialty area it may focus on. Given the ANZSRC reviews currently happen every 10 years, a decadal goal must be the addition of paramedicine at the ‘group’ level in hierarchy. This would allow multiple paramedicine specialty FOR codes to fall within the group, allowing more precision in allocation and giving recognition to the evolving specialty areas that exist within the profession. It could be argued that we are not quite there yet with regard to having a code at the ‘group’ level, but the current trajectory in paramedicine research suggests it will most likely be demonstrable in a decade. A group-level code
would also give paramedicine an individual presence in ERA reporting, which currently reports down to the group level. Even with our own FOR, our research will be collapsed with other FOR codes and non-specifically reported in ERA under ‘Clinical Sciences’. An early initiative to move us toward a group of our own would be to engage in retrospective re-coding of research since 2016 through to 2020, the period that will be documented in the next ERA report due in 2022. While we won’t appear distinctly in that report, robust data on the 5-year period will help prosecute the case for a grouplevel code in the future. On a related note, the creation of the paramedicine FOR arose following several rounds of public consultation undertaken by the ARC and its ANZSRC partners. The initial discussion document drew 237 submissions in total, and the final consultation draft 238. Of those, only five argued for a paramedicine FOR. Significant developments such as the FOR code creation don’t happen by accident. If we are to continue to grow the discipline, broader engagement in consultative processes such as this will be essential. It is incumbent on us all to advocate for our profession across a diversity of forums, using our collective voice to promote the continuing evolution of paramedicine.
References 1.
Australian Research Council. ANZSRC review outcomes paper. Available at: www.arc.gov.au/file/11423/download?token=n0a9yWch2020
2. Australian Bureau of Statistics. 1297.0 – Australian and New Zealand Standard Research Classification 2020. Available at: www.abs.gov.au/AUSSTATS/abs@.nsf allprimarymainfeatures/5D99AEA1DD8AA8E0CA2574180005421C?opendocument 3. Australian Research Council. Excellence in research for Australia: Australian Federal Government; 2020. Available at: www.arc.gov.au/excellence-research-australia 4. Western Sydney University. Excellence in research 2018. Available at: www.westernsydney.edu.au/research/research/era 5. O’Meara P, Maguire B, Jennings P, Simpson P. Building an Australasian paramedicine research agenda: a narrative review.Health Res Policy Syst 2015;13:79. 6. O’Meara P, Maguire B. Developing a sustainable academic workforce in paramedicine. Australian Universities Review 2018;60:54-6.
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caa.net.au
Comprehensive prehospital clinical assessment of acute stroke patients leads to better outcomes
T Wayne Loudon Critical Care Paramedic
Wayne is passionate about neurocritical care research and has been undertaking the Stroke Prehospital Informed Decision-Making Using EEG Recordings (SPIDER) pilot study to investigate how EEG data may better inform the pre-hospital care of acute stroke patients. The pilot study was co-developed with a multidisciplinary stroke team from the Royal Brisbane and Women’s Hospital and QAS.
horough clinical assessment and history taking is critical to the delivery of acute stroke care reports Critical Care Paramedic Wayne Loudon.
Historically the assessment of acute stroke by prehospital providers has relied on the use of simple assessment tools that identify the most common physical signs of stroke such as limb weakness, speech difficulties and facial palsies. The emphasis was on maintaining a highly sensitive tool to avoid missing any potential stroke sufferers and although this remains very important the evolution of paramedic practice, education and training provides a platform for more nuanced and complex decision making to ensure that every patient, even with atypical symptoms is identified and provided with early definitive care.
What is the benefit of a stroke severity score such as NIHSS-8? Stroke is not a static disease process and it is not unusual to see waxing and waning of stroke symptoms as the complex physiology of the brain attempts to improve perfusion of ischaemic areas by opening of collateral circulation. It is when these physiological responses to insult are overwhelmed that we see symptoms present. The severity of these symptoms can guide the decisions on reperfusion therapies in hospital but what is equally important is the entire clinical picture. There is no aspect of medical practice that relies on a single symptom or sign to make a diagnosis or guide treatment (we don’t assume a patient has a STEMI just because they have chest pain). The NIHSS-8 was developed as a stroke severity tool and as such has the capacity to identify all stroke from milder syndromes which may not be eligible for reperfusion therapies but would benefit from risk factor management (antiplatelet therapy, blood pressure management etc.) to large vessel occlusive strokes that may benefit from endovascular clot retrieval.
Should the NIHSS-8 be used in isolation? The NIHSS-8 is a decision support tool that has been shown to be reliable in identifying those patients harbouring a large vessel occlusion to the middle cerebral artery (Demeestere et al., 2017), however it is not designed to be used in isolation. The assessment of any patient presenting with neurologic symptoms should have a full neurologic assessment whenever possible since neurologic symptoms can be easily missed if the clinician does not perform a thorough assessment. Along with a more thorough neurologic assessment there should be a consideration of risk factors that increase the likelihood of stroke such as the presence of atrial fibrillation, mechanical heart valve, sickle-cell disease, smoking, past stroke etc. Also, most prehospital stroke tools focus on identifying the more common presentations (stroke involving the middle cerebral arteries, lacunar stroke etc.) that would benefit from thrombolysis or endovascular clot retrieval and neglect those to the posterior circulation given their infrequency, vague symptomology and minimal acute treatment options. The NIHSS-8 is a decision support tool and is not there to take away from good clinical assessment, experience and judgement.
What is the role of the NIHSS-8 in areas without endovascular centres? The NIHSS-8 is a reliable tool to indicate the likelihood of a severe stroke syndrome and therefore the presence of a large vessel occlusion or haemorrhage. The tool can then help communicate, using a common language, to receiving facilities or retrieval services that this patient may require early secondary transport to an endovascular centre.
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So how do we identify posterior circulation stroke? Stroke to the posterior circulation is notoriously difficult to diagnose clinically and accounts for 20% of ischaemic stroke. Therefore, a high index of suspicion is required along with a consideration of risk factors and presenting history. In any assessment the clinician should ask “what can’t I afford to miss?”.
Clinical Features
Anterior Circulation
Posterior Circulation
Visual Field defect
+
++
Pupillary changes
+
++ (may be bilateral)
Dysarthria
++
++
-
+++
Bilateral sensory/motor symptoms
-
+++
May or may not be present
+++
++
++
Unusual unless there is raised intracranial pressure or mass effect
Common in thalamic and brain stem stroke
-
++
Double vision Vertigo Dysphasia Altered Level of Consciousness Ataxia (Merwick & Werring, 2014)
What other critical information do receiving hospitals need? • Time of symptom onset or last seen well time – this is critical to guiding thrombolysis treatment which is limited to 4.5 hours after onset (though some patient may still be eligible up to 9 hours) and endovascular clot retrieval which has most benefit within 6 hours (though some patients may be eligible up to 24 hours). • Anticoagulation status – patients that are anticoagulated increase the possibility their syndrome is due to a haemorrhage and they will require reversal of the agent (where available) or this will impact their eligibility for thrombolysis. • Presence of family member or substitute decision makers – if possible, they should accompany the patient as they will be required to consent for any reperfusion therapies the patient may be eligible for. • Prenotification – early notification of acute stroke reduces delays to imaging and treatment.
What groups are at risk of being under triaged? Given the heterogeneity of symptoms in stroke and its effect of patient perception of disability clinicians can become mislead. • Vulnerable groups - mental health conditions, different cultural and language backgrounds and intoxicated/alcohol abuse are at increased risk of miss diagnosis and missed diagnosis. • Stroke to the non-dominant hemisphere (usually right) - may lack the perception of their disability and downplay their symptoms. • Young patients – 30% of stroke presentations are in those under 65 years. (National Stroke Foundation, 2017). The assumption of intoxication, mental health presentation or ‘exaggerating’ symptoms should be a diagnosis of exclusion in the prehospital setting and should not bias clinical assessment.
What if I’m still not sure of my diagnosis? It is always safer to err on the side of over triage than under triage. The impacts of missing a treatable stroke are always far more significant than the embarrassment of over diagnosis.
References Demeestere, J., Garcia-Esperon, C., Lin, L., Bivard, A., Ang, T., Smoll, N. R., . . . Levi, C. (2017). Validation of the National Institutes of Health Stroke Scale-8 to Detect Large Vessel Occlusion in Ischemic Stroke. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. doi:10.1016/j. jstrokecerebrovasdis.2017.03.020 Merwick, Á., & Werring, D. (2014). Posterior circulation ischaemic stroke. 348, g3175. doi:10.1136/bmj.g3175 %J BMJ : British Medical Journal National Stroke Foundation. (2017). No postcode untouched: Stroke in Australia 2017. Retrieved from Melbourne, Australia: http://maps.strokefoundation.com.au/wp-content/themes/dlstroke/downloads/NoPostcodeUntouched_ FullReport_2017.pdf
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JUST LANDED!
q e t
w r y
ACP is pleased to bring you our first fully online and interactive PARAMEDIC CONFERENCE in 2020
2020
ACPIC ONLINEî ž 21-23 October 2020
Your patients. Your profession. Your future.
The ACP International Conference provides an unmatched opportunity for our members to learn from experts and leaders in paramedicine, with research, case studies, panel discussions, presentations and much more over three comprehensive days. For the first time, our conference will be fully ONLINE, available to members anywhere across Australia, New Zealand and the world, streamed live to you.
FOR TICKET AND EVENT INFORMATION VISIT: www.paramedics.org/events
@ACParamedicine #ACPIC20
Utstein recommendation for emergency stroke care Published in the International Journal of Stroke, Vol 15(5) p555 - 564 https://journals.sagepub.com/doi/pdf/10.1177/1747493020915135
Background Stroke is a major cause of death and disability worldwide with an estimated 15.2 million strokes causing 7 million deaths per year globally.1 Over half of stroke survivors will have some degree of disability and for most individuals and their families, it is a life-changing experience. Changes in demography will lead to a predicted 45% increase in stroke incidence in Europe over the next 20 years with similar increases predicted in other parts of the world.2 Rapid recognition of stroke symptoms and delivery of evidence-based acute care, including thrombolytics and endovascular thrombectomy (EVT), blood pressure control for primary intracerebral hemorrhage and stroke unit management have all been shown to significantly improve outcomes.3,4 These treatments are time dependent and require rapid access to definitive care in hospital. Many people consider stroke as an untreatable disease. The public lacks awareness of the signs and symptoms of stroke and the need for urgent medical attention. Less than 50% of individuals with acute stroke recognize the nature of their own symptoms.5 In some countries, individuals with stroke are more likely to call a general practitioner rather than the Emergency Medical Services (EMS) and in many low- and middle-income countries, EMS systems are scarce or nonexistent.6 Compounded by lack of knowledge, inefficient and inadequate acute care pathways and facilities, seen in both high and low resource countries, many people face death and disability after stroke that is potentially preventable.
demonstrating benefit of EVT up to 24 h after symptom onset in selected patients,7 as well as benefit for acute therapy in patients without a witnessed time of onset.8 However, the best outcomes are associated with the shortest treatment times.9,10 Optimizing the organization of stroke systems of care is essential. This article presents a “Chain of Survival� for emergency stroke care and sets out the recommendations for health systems to strive for worldwide. While none of the individual components will be unknown to professionals involved in the area, we believe unifying them into a single program, calling for global action and asking EMS to work in a unified way with hospitals will be of great benefit for health systems trying to improve prehospital and emergency care. Such a system has proved hugely beneficial in cardiac arrest and acute myocardial infarction.11 This study in South Korea shows a doubling of the percentage survival rate and survival with good neurological function after implementation of the Utstein recommendations. While some of the components require well-resourced services, many are applicable to low- and middle-income countries and can be delivered by improving the organization of existing services and close collaboration between stroke specialists in hospitals and the EMS composed in most cases of non-specialists. These interventions in emergency stroke care management will reduce stroke mortality and disability.
Recent advances in acute ischemic stroke care have expanded the pool of patients who may benefit from acute therapy,
Overview Recent advances in treatment for stroke give new possibilities for optimizing outcomes. To deliver these prehospital care needs to become more efficient.
Aim To develop a framework to support improved delivery of prehospital care. The recommendations are aimed at clinicians involved in prehospital and emergency health systems who will often not be stroke specialists but need clear guidance as to how to develop and deliver safe and effective care for acute stroke patients.
Methods Building on the successful implementation program from the Global Resuscitation Alliance and the Resuscitation Academy, the Utstein methodology was used to define a generic chain of survival for Emergency Stroke Care by assembling international expertise in Stroke and
Emergency Medical Services (EMS). Ten programs were identified for Acute Stroke Care to improve survival and outcomes, with recommendations for implementation of best practice.
Conclusions Efficient prehospital systems for acute stroke will be improved through public awareness, optimized prehospital triage and timely diagnostics, and quick and equitable access to acute treatments. Documentation, use of metrics and transparency will help to build a culture of excellence and accountability. Authors
A G Rudd, C Bladin, P Carli, D A De Silva, T S Field, E C Jauch, P Kudenchuk, M W Kurz, T LĂŚrdal, Meh Ong, P Panagos, A Ranta, C Rutan, M R Sayre, L Schonau, S D Shin, D Waters, F Lippert
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World-ďŹ rst research shows female CEOs boost companies by $80m on average By Annabel Crabb
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E
lectrifying new Australian research has established direct proof for the first time that companies do better when they appoint more women to leadership positions.
The study, based on six years of Australian companies’ gender reporting to the federal Workplace Gender Equality Agency, has established that companies who appointed a female CEO increased their market value by 5 per cent — worth nearly $80 million to an tIncreasing the number of women
Ms Lyons said while the headline data concerned gender, the principle demonstrated was about diversity, and leadership in organisations reflecting the community. “If you’re a member of a board or a CEO or executive and you don’t take notice of what this report is telling you, then you are not meeting your
Those four are the New Hope Corporation Ltd, Pro Medicus Limited, Silver Lake Resources Limited and TPG Telecom Limited. The study finds that increasing the number of female board members by 10 per cent or more produces 4.9 per cent boost to a company’s market value.
Key points:
A world-first study shows a link between greater gender diversity and business success
in other key leadership positions by 10 per cent or more, meanwhile, increases a company’s market value by 6.6 per cent or an average $105 million. The study is a world first because of the causal role it identifies between greater gender diversity and business success. While other studies have concluded that such a connection is likely, the data provided by the WGEA allowed real case studies and leadership appointments to be tracked over a number of years to establish direct proof of the link. “The strength of this research, the strength of this information that we launch today, shows that if you improve your diversity you get better results,” said WGEA director Libby Lyons.
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It found a female CEO increased market value by 5 per cent
obligation to your shareholders or your owners.”
It’s irresponsible to ignore a report such as this Of the 11,000 organisations from which the WGEA annually collects gender data, around one third currently have not a single woman on their boards. Of the ASX200 — Australia’s biggest companies — 34 currently have only one female board member, and four have no female board members at all, according to the latest data from the Australian Institute of Company Directors.
A third of the 11,000 companies WGEA collects gender data from have no woman on their boards “If I were a shareholder and there were no women and no diversity, I would be agitating big-time right now,” said Ms Lyons. “Because it’s irresponsible. Really, it’s irresponsible to shareholders to ignore a report such as this.” Ms Lyons said the report also had lessons for other bodies including the Parliament and executive decision-making bodies. Federal Cabinet’s key “razor gang”, for instance, the Expenditure Review Committee, which makes final decisions about Commonwealth expenditure, has since a restructure late last year consisted of five men and no women.
caa.net.au
Companies with more female leaders tend to outperform Share of companies that outperform sector performance benchmarks: by share of female key management personnel
20 20 20 10 10 10 2014 2014
2015
2016
2015
2016
2017
2018
2019
All years
2017
2018
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No women
Up to a quarter women
Up to a third women
More than a third women
No2014 women
Up2015 to a quarter women 2016
Up to a third women 2017
More than a third women 2018 2019
No women
Up to a quarter women
Up to a third women
More than a third women
All years
...and those with fewer women underperform Share of companies that underperform sector performance benchmarks: by share of female key management personnel
20 20 10 20 10 10
2014 2014
2015
2016
2015
2016
2017
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All years
2017
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Up to a third women
No women
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Up to a third women
No women
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2014
2015
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2017
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More than a third women
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Likelihood of sector Percentage outperformance in three Change in market change or more measures value (US$) Likelihood of sector(%) Estimated impact on company performance of increasing or decreasing female leadershipoutperformance in three Percentage Change in market 53.3 change5 or12.9 more measures (%) value (US$) From moving to a female CEO
Women driving success
Frommoving increasing From to afemale femaleboard CEO representation Fromincreasing increasingfemale femaleboard key manager representation From representation
52.6 53.3 Change in market 70.2 value (US$) 52.6
54.9 Percentage 6.6 change4.9
Likelihood of sector 6 12.9 outperformance in three 5.8 or6more measures (%)
Frommoving reducing board representation From tofemale afemale female CEO From increasing key manager representation
29.1 53.3 70.2
-2.7 56.6
12.9 5.8 2.5
Fromincreasing reducingfemale female key manager representation From femaleboard board representation From reducing representation
-30.8 52.6 29.1
-2.9 4.9 -2.7
6
From femalekey keymanager managerrepresentation representation From increasing reducing female
70.2 -30.8
-2.9
From reducing female board representation
29.1
-2.7
2.5
From reducing female key manager representation
-30.8
-2.9
1.7
All graphs sourced from the Bankwest Curtin Economics Centre
6.6
1.7 2.5
5.8 1.7
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The study — led by researchers Rebecca Cassells and Alan Duncan from the Bankwest Curtin Economics Centre at the Curtin Business School — demonstrated that companies who reduced their numbers of women in key leadership roles suffered a loss in value as a result, of around 3 per cent. “What our research shows clearly is that broadening the talent pool drives better company performance and one of the most obvious ways to do this is by having more women at the decision-making table,” said Ms Cassells. “Balance is the key and like good public policy, good business must start with gender equality in the leadership ranks. If women aren’t included, then we’re missing half the population, half the ideas and half the talent.”
Australia’s data is one of a kind The WGEA — created by the Gillard Government in 2012 — collects detailed data every year about gender representation from organisations with more than 100 employees. It’s a mandatory reporting requirement, but WGEA is a “soft touch” regulator so noncompliance does not attract a fine. “There was a lot of pushback to begin with and a lot of people thought it was a lot of work,” Ms Lyons said.
“There’s no other country in the world collecting the same depth and breadth of data.” Former prime minister Julia Gillard welcomed the report, saying that in order to achieve gender equality it was first necessary “to measure progress through a rich evidence base, and get that material into the hands of people who can use it to implement change”. “As Prime Minister, I mandated the collection of gender data from companies in Australia so we could understand the depth of gender inequality in the workforce, and hold ourselves accountable for improving equality through reportable data,” she said in a statement to the ABC. “I know merit is distributed evenly regardless of gender, so diversity in leadership is not just good for business — it is fundamentally fair. While I continue to hope this fairness argument alone is enough to compel business to diversify, I know progress for gender equality
Of the 11,000 organisations from which the WGEA annually collects gender data, about one third currently have not a single woman on their boards. Julian Smith, Australian Associated Press
“But we’re providing the data score card every year, providing tools for people to use; through doing all that, organisations have actually come to the party and realised that this is important information we’re collecting.” Compliance is now at around 98 per cent, and Ms Lyons said the unique trove of information was a credit to
57
Australian companies. “It’s amazing,” she said.
to date has been painfully slow. Hopefully the data collected and research undertaken by agencies such WGEA and BCEC which shows the bottom line benefits of diversity spurs greater speed and action.”
How women differ Ms Cassells said that women tend to have different leadership styles from men. “There is something different about women’s performance and management style. They tend to be more democratic, they tend to be more collaborative and to have a greater sense of corporate social responsibility. They’re also less likely to participate in fraudulent behaviour.” She also said the data captured the experience of companies who replaced mediocre men with women who were merit appointments. Her research partner, Alan Duncan, said such appointments were commercially successful because they weakened the “tyranny of incumbency”. “The history has been that there’s been a repetition of appointments in the same image,” Professor Duncan said. “The consequence is that there can be a laziness or orthodoxy of approach which can produce poor results. When there’s been a struggle to break that barrier, there is an untapped talent pool of women in business.” The researchers used advanced econometric methods to weed out industry-specific and general economic factors when evaluating the success or otherwise of companies which made changes to their gender diversity in leadership. “We’ve actually thrown everything bar the kitchen sink at this research in order to establish whether or not what we were finding was causal and statistically significant,” Professor Duncan. Professor Duncan said while there were available examples of companies who had suffered after the appointment of a female CEO, they did not accord with the broad experience of the thousands of companies studied.
Ms Gillard now chairs the Global Institute for Women’s Leadership.
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CAA WEBINAR SERIES Join our series of 1 hour webinars to fill the knowledge gap. Access an incredible line up of speakers, discussing thought provoking and stimulating topics that directly affect Paramedicine of today and tomorrow.
Professional development without leaving the lounge! August 25
CAA x Trapeze Interactive Ideas Board
Adj. Asst. Prof Ng Yih Yhg, Mick Stephenson, James Wetherall, Raelene Hartman In partnership with Trapeze
September 22
Sustainability & Ambulance Victoria
Sally Mangan
Director Sustainability Ambulance Victoria Supported by Mercedes-Benz
October 27
CAA Mental Health & Wellbeing Staff App
Liz Berryman
CEO, Founder CHNNL
November 24
Women In Leadership
Michelle Fyfe
CEO St John Ambulance WA
December 15
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Adj. Asst. Prof. Ng Yih Yng Consultant, Emergency Physician Lead, Digital and Smart Health Office, TTSH and Central Health
For more information go to caa.net.au/webinars
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QAS Cardiac Arrest #NationalVolunteerWeek20 Survivor:
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60 #bakeoff
CAA Directory
www.amtek.net.au
www.paramedics.org
www.babcock.com.au
www.belgraviahc.com.au
www.ferno.com.au
www.interdev.ca
www.laerdal.com/au
www.paull-warner.com.au
www.philips.com.au
Australian Digital Health Agency
Nautilus Health
Lightfoot Solutions
www.nautilushealth.com.au
www.lightfootsolutions.com
iSimulate
Edith Cowan University
www.isimulate.com
www.ecu.edu.au
www.digitalhealth.gov.au
Device Technologies www.device.com.au
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caa.net.au
*These companies have been included in The Directory as they supported CAA at the CAA2019 Congress or they have advertised in First by CAA. The Directory packages will be available shortly, contact us to express your interest. For more information contact nmurphy@caa.net.au
www.rappaustralia.com.au
www.sdsi.com.au
www.stryker.com/au
www.trapezegroup.com.au
www.volkswagen.com.au
www.zoll.com/au
www.2crisk.com.au
www.3m.com.au
QUT/Palliative Care Education
GAMA Healthcare
Intermed
www.gamahealthcare.com.au
www.intermedmedical.com.au
GoodSAM
Varley Medical Developments
www.qut.edu.au
AMII Medical www.pointingnorth.com.au
www.goodsamapp.org
www.varleygroup.com
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Wellness First
Mitch Mullooly Health and Wellness Strategist Specialising in the wellbeing of first responders, Mitch is the Chair of the Australasian College of Paramedicine, Aotearoa New Zealand; Council member of Te Kaunihera Manapou, New Zealand Paramedic Council; Advisory Committee member for Te Kiwi Maia, The Courageous Kiwi; and proud CAA2020 Women in Ambulance honour recipient.
There is little doubt among researchers that we are made to move as humans. As kids, we naturally run, jump, leap, and play. For kids, playgrounds equate to endless hours of enjoyment. Monkey bars are viewed not as something to cringe at and avoid, but as something to delight in. Moving is so much FUN! Yet for many of us, as we get older, this notion of movement as something to look forward to doesn’t last for too long. Somewhere along the way, movement slowly transforms from something we naturally crave in childhood, to something we’re taught to dread (yet feel some obligation to do) as we reach adulthood. It’s no wonder most people struggle with motivation to get and stay fit. Fortunately, this mindset can be changed. By learning to reframe your idea of what exercise is, you can hack your motivation, break through your plateaus, and make exercise fun again! Let’s dive in.
Mitch is also a published author, speaker and feature columnist for several sector related magazines, blogs, webinars, and podcasts.
Reverse the negative effects of physical and psychological fatigue to make you fit for duty and ultimately fit for life, Claim your free downloadable wellbeing resources, go to www.eattrainbelieve.com
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caa.net.au
Why movement becomes less fun While most of us begin our lives enjoying movement as children, that natural craving often lasts until around the time we hit puberty, when all of a sudden P.E. becomes something to dread and playgrounds become distant memories of the past. While exercise is something most of us know we should do to be a fully functioning human being, we’ve also learned to view it as something that we do because we have to and is usually never any fun.
Most people’s understanding of exercise is completely wrong When people tell me they’re not motivated to exercise, it doesn’t surprise me when they also tell me their typical workout consists of 45 minutes of slogging it out on the cardio equipment at the gym along with a few biceps curls and maybe a squat or two thrown in for good measure. This classic gym goer’s workout isn’t just ineffective and non-goal oriented, meaning you’re not likely to know if you’re ever actually making any progress - it’s also boring as hell. I know this because I’ve been there too. My workouts were not something to look forward to and they definitely weren’t fun. The best way I’ve found to hack motivation is to turn exercise from an obligation to something that’s actually enjoyable, and that requires a mindset shift.
Reframing your idea of exercise If you view exercise as something you know you should be doing but also as something to avoid whenever possible (note the paradox here?!), I have two questions for you: 1. What did you love to do as a kid? 2. What have you always wanted to do or be able to do? Let’s unpack these.
Rekindling childhood play As adults, most of us were taught that we should leave our childhood silliness behind and engage in exercise in a more adult manner. But why does that have to be the case? Without fail, when I ask people what they loved to do as kids, even the most exercise-adverse people immediately tell me how much they loved gymnastics, skateboarding, surfing, playing rugby, or running around on the playground with their friends. “So, why did you stop?” I ask. Usually, I get a blank stare, or maybe a list of reasons (excuses), like they got older, or they got injured, or they needed to demonstrate responsibility. Underlying every response is the same basic reason: most people assume that exercise and movement is something that is enjoyable BUT only for kids. As adults, we need to grow up and do boring, adult-like exercise instead. But who says you have to stop playing as an adult? If your answer is because you think your boring version of adult exercise is more effective than sports or movement centred around actually having fun, you are wrong. Consider this - playing a game of rugby burns significantly more calories than that monotonous slog on the treadmill. And spending a couple of hours at a trampoline park is way more effective than watching the minutes tick by on the stairmaster at the gym.
The key here is to think about what felt more like play than exercise as a kid and go back to doing that. And before you ask - no, you are never too old! Sure, it might look different now you’re in your 30’s, 40’s, 50’s or 60’s, than it did when you were younger, but by allowing yourself to move in a way that is more natural to who you are, you’re going to be more motivated, which will lead to greater consistency, enthusiasm, and ultimately, enjoyment.
Creating performance or adventure related goals Maybe you weren’t super athletic as a kid and don’t really have anything you used to do that brings back fond memories. If that’s the case, it’s time to create some new ones. Start by asking yourself this: What have you always wanted to be able to do? Or thought it was so cool that other people could do?
Then do that! In my experience, when given a few moments to think about it, most people will come up with some pretty cool answers without too much prompting. But if you’re not sure where to start, here are some ideas to get you thinking learn to surf, take up skiing, learn to do a handstand, start rock climbing, train for an obstacle race. Whatever the activity, you should feel a little nervous, but also excited when you think of it. This butterflies-in-your-stomach feeling is the key to creating any big goal.
And don’t expect to be great when you’re just starting out! Take lessons, read books, work with a coach, do whatever you need to do to get past that first awkward learner’s stage, and into the more fun, flow stage of the activity. The added benefit to this approach is that when you find a sport or activity you love, you’re likely to become more motivated to move overall. Your workouts can then naturally support your new lifestyle, leading to greater motivation and joy in movement.
Change your mindset, change your motivation Many people assume they lack the motivation to exercise regularly or to go after bigger, harder, longterm fitness goals. But what if the key to consistent, lifelong exercise isn’t finding more motivation on a day-to-day basis, but merely reframing your idea of what exercise actually is? This simple mindset shift might be all it takes to hack motivation once and for all!
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15-17 July 2021
Sydney International Convention Centre
Australasia’s premier paramedicine event bringing together pre-eminent thought leaders from across the pre-hospital sector. We will explore what the future ‘New Normal’ entails for our ambulance services and what is being done to adapt to these new realities. The four main topic areas are:
CounterTerrorism
Clinical Practice
Demographics of Emergency Management
Cyber Security
Follow CAA social media channels for Congress updates CAA Australasia
@TheCouncilofAm1
Resusci Anne Advanced SkillTrainer Mobile ALS training for advanced healthcare professionals This advanced skill trainer has a realistic anatomy allowing you to train on an extensive range of ALS competencies, including quality CPR, supraglottic airway management and IV insertions. Now available with ShockLink and self-adhesive pads for realistic and safe defibrillation training. Resusci Anne Advanced SkillTrainer comes with foldable legs and click-on arms in a trolley case, making it both lightweight and easy to transport. Key features include: • • • • •
RAAST is designed for task and team training to ILS and ALS curriculums; Airway management with BVM or supraglottic airway devices. Live defibrillation with ShockLink and training pads or paddles (select the right manikin configuration) ECG monitoring 3 leads External Cardiac Pacing
• • • • •
Pulse monitoring IV insertions Quality CPR (QCPR) feedback to measure and improve CPR performance (Guidelines 2015) Debriefing of CPR quality performance and recorded events Create and edit scenarios (SimPad Plus)
Complimentary scenarios to prepare for the COVID-19 The Coronavirus (COVID-19) has created a healthcare crisis that has put a major training burden on hospitals, emergency medical services, and long-term care facilities, among others. To assist you in preparing your staff and teams, Laerdal Medical and partners have created a set of free scenarios to help you prepare. In these scenarios, the participants will encounter a patient with suspected Covid-19 who experiences a cardiac arrest with a shockable rhythm. Learning objectives: • • • • • •
Use donning/doffing procedure Consider a limited use of Aerosol Generating Procedures (AGP’s) Perform airway management for a casualty with suspected Covid-19 Maintain a secure BVM seal Recognize and treat a cardiac arrest with a non-shockable rhythm Identify transport consideration of suspected Covid-19 patient
Use this scenario with: Resusci Anne Simulator, Resusci Anne Advanced SkillTrainer, ALS Simulator and SimMan ALS. For more information, visit www.laerdal.com
www.caa.net.au