FIRST by CAA | Issue 08 Autumn 2022 by The Council of Ambulance Authorities

ISSUE 08 | AUTUMN 2022

Michelle Fyfe

The first female CEO of St John WA shares her story

DEMAND MANAGEMENT: A UNIVERSAL CHALLENGE A collection of responses from the Australasian Ambulance services

CAA WOMEN IN AMBULANCE AWARDS 2022 Honour Recipients

www.caa.net.au

Be inspired, think outside the box, and work together to elevate the pre-hospital sector. CAA Congress: 11-13 August, 2022 International Convention Centre, Sydney

Tickets available now at caacongress.net.au Follow CAA social media channels for Congress updates

Change. One thing that is constant, everything changes. The last two years have seen some seismic changes in everything we do, our family lives, work, technology, schooling, and while our lives have been flipped upside down, as is usually the case, changes tend to bring with them opportunities for growth. We have been seeing some innovative programs set up due to the pandemic, virtual consultation rooms and even virtual emergency departments are something that will be a long-lasting legacy of the COVID-19 pandemic. Businesses pivoting their services and adapting to new demand, workplaces embracing flexible work arrangements, families re-prioritising their lives and everyone using QR codes, go figure. This issue we are honoured to feature an incredible woman who has seen many changes in her career, including her last one that took her from police ranks to head St John WA. Michelle Fyfe, first female CEO of St John WA, a leader and truly inspirational woman shares with us what it took to build a career that inspires next generations of females to follow in her footsteps. We look to our services in how they are tackling the current demand growth and ramping issues, both that have seen unprecedented growth over the last year. Innovation and collaboration are bringing forth great new programs to tackle these challenges. Changes are coming to the CAA Congress. Finally, after almost three years of planning we get to come together to innovate, inspire and elevate our industry and leaders. Our team is organising a wonderful program filled with top end speakers, Expo that will bring together the latest in technology, products and services, and many networking events to reconnect the sector after missing out on two years of in-person meetings. We are excited to announce our 2022 CAA Women in Ambulance honour recipients, women who were selected for their commitment and talent, women who are role models to the workforce and will themselves head the next generation of leaders in our sector. A big issue filled with wonderful examples of how change can push us to be better, grow, reinvent and rethink the current status. In December 2022 the CAA will celebrate 60 years since we first got together to talk changes, and safe to say these six decades have seen some incredible shifts in the ambulance sector, all which we will look to share with you at our 60th Gala Dinner celebrating CAA and everyone that contributed to our success. Sit back, enjoy the last beautiful summer evenings, and pick up our latest issue of FIRST.

Mojca xx

Contents ISSUE 08 | AUTUMN 2022

24 03

Letter from the Editor

Data First 2021 Ambulance Snapshot

Opinion First Dr Benjamin Abella and Dr Michael Saulle discuss their views on the promise and pitfalls of Mechanical CPR

Services First

Showcasing the latest projects and achievements from across CAA member services

Latest news from around the ambulance sector

Industry First

CAA First Find out what’s on CAA’s radar for 2022 & celebrate our 2022 Women in Ambulance Honour Recipients

Focus First

Awards First Hear from the 2021 CAA Awards for Excellence Star Award winning project about the future of S.P.I.D.E.R.

Feature First FIRST Interviews CEO of St John WA Michelle Fyfe on her exciting career background

Hear from our CAA member services about the universal challenge of demand management

www.caa.net.au

67 67

Events First Take a look into the 2022 CAA Congress

Sustainability eWaste: What is it and what can we do with it

100

Partners First Hear from our partners about EMS Congress & AFAC22

People First Meet the wonderful people that make up the Australasian Ambulance services

102

Research First Sharing the latest innovative research projects from around the ambulance world

The Directory

104

Artificial nature & Mental Health

Wellness First

If time in nature is good for your mental health, what about artificial nature?

Learn Mitch’s approved method for overcoming life’s obstacles

THE TEAM

PUBLISHED BY:

Editor: Mojca Bizjak-Mikic Relationship and Content Manager: Stephanie Hartley Editorial Team: Chantelle Kaesler & Savanah Stouraitis Graphic Design: Alpha State

The Council Of Ambulance Authorities 2/141 Sir Donald Bradman Drive Hilton SA 5033 Australia admin@caa.net.au

Magazine published from paper that is sustainably sourced.

For article submissions or to advertise in FIRST by CAA magazine please contact admin@caa.net.au

Data First

Ambulance Snapshot

n 2021 the CAA has continued to collate data from across our member services that provide a snapshot into the workings of our world leading ambulance services.

The data is published across CAA platforms, provided on behalf of the Australian ambulance services to the Australian Government’s Productivity Commission Report on Government Services, and used for comparison and benchmarking globally.

Demand growth continued during 202021 across the Australian, New Zealand and Papua New Guinean ambulance services. The COVID-19 pandemic pushed the ambulance services to the limits in providing quality response and care to the community.

Across New Zealand and Australia in 2020-21 financial year: Ambulance stations & locations

Ambulances and other vehicles

Air ambulance aircraft

1,801

7,376

112

Salaried ambulance staff

23,544 6

Volunteers & first responders

18,670 www.caa.net.au

Incidents reported to ambulance service organisations

4.7 million Responses where an ambulance was sent to an incident

6.0 million Patients assessed, treated or transported by ambulance service organisations

4.6 million Calls made to 000 or 111

4.3 million Across Papua New Guinea 2021 calendar year: Total Patients

Incidents

12,888

13,840 7

Industry First

Industry News PACER Delivers Results Less Than Two Weeks After Launch A multi-disciplinary mental health team that can rapidly deploy in response to mental-health-specific triple-0 calls has started operation in Southern Tasmania. The dedicated new team, The Police, Ambulance and Clinician Early Response (PACER) formed to support those experiencing mental health distress in the community and is already achieving positive results less than two weeks after being launched.

Queensland Ambulance Service Appoints New Commissioner Queensland Ambulance Service are pleased to announce the appointment of Mr. Craig Emery ASM as their new Commissioner. Craig has been Acting Commissioner of the QAS since 7 August 2021 and has now been selected to lead QAS into the future.

New Era For NSW Ambulance Takes Flight Five state-of-the-art NSW Ambulance aircraft are set to take to the skies across the state, providing even better care for rural and regional areas. The brand-new fleet of Beechcraft King Air 350C planes will be operated and maintained by Pel-Air under a 10-year contract. NSW Ambulance Commissioner Dr Dominic Morgan said the medical fit-out on-board was tailored to the clinician’s needs and could pick up more than 6,000 patients every year.

Statewide Care Service Gives SA Health System A Boost A new statewide virtual care service has been established to improve access to healthcare across South Australia. The new $10 million service at the Tonsley Innovation District provides clinicians with visibility of capacity across the whole health network and includes a Virtual Emergency Service (VES) which gives ambulance crews access to emergency consultations and other clinical support while they are on-scene with a patient.

www.caa.net.au

Australia Day Honour Recipients The Ambulance Service Medal (ASM) recognises distinguished service as a member of an Australian ambulance service. CAA warmly congratulates the following recipients recognised in the 2022 Australia Day Honours List.

Paramedic Wins $80k EMF Research Grant Queensland Ambulance Service (QAS) Critical Care Paramedic Wayne Loudon has secured an $86,623 Emergency Medicine Foundation (EMF) Leading Edge Grant to investigate how technology can be used by paramedics in the field to improve early identification of severe head injuries, to ultimately reduce resulting disability and improve patient outcomes.

New South Wales

Tasmania

Western Australia

Mr Gary William HENDRY

Ms Samantha Louise ALLENDER (MACPara)

Mr Sarel DE KOKER (MACPara)

Ms Kirsten Michelle LINKLATER (MACPara)

Mrs Vicki Anne KNOWLES

Mr Clifford Leonard FISHLOCK

Dr Peter Frederick MULHOLLAND (MACPara)

Ms Jacqueline Louise MACKAY

Mr Wayne John McKENNA (MACPara) Mr Brett Kristian STANDALOFT (MACPara)

South Australia Victoria Ms Josephine Mary BROOKES (MACPara)

Queensland Ms Rita Joy KELLY Mr Crad Richard SMITH (MACPara)

Northern Territory Dr Felix Ho Lam HO (MACPara)

Mrs Nichole BASTIAN Mr Lawrence Sylvester TOMNEY

Mr Ian James DUNELL Mr Bernard Dominic GOSS (MACPara) Mr Gavan John KEANE Dr Ziad NEHME (FACPara) Ms Frances Lorraine SCOTT Ms Glenice Ann WINTER

SAAS Announces New CEO SA Ambulance Service (SAAS) has announced Rob Elliott as the new Chief Executive Officer. Rob has made a positive impact on SAAS staff and its operations over his 32 years of service, and as he takes up the mantle of the permanent CEO, we can be confident that this trend is set to continue.

CAA First

www.caa.net.au

CAA First

ith the first campaign of 2022 already in full swing, we are getting more and more excited about sharing with our colleagues the flurry of CAA events and initiatives that are soon to launch throughout the year.

Whilst we facilitate events and campaigns, our plans for the year ahead could not have been made possible without the dedicated support we receive from our member services, who continue to share our optimism and enthusiasm in bringing exciting initiatives before the pre-hospital sector for another year.

Our year ahead is filled with events and campaigns to inspire collaboration amongst the sector, and continue to support and highlight ground-breaking news, milestone achievements and innovative programs. With everything from webinars to campaigns, to gala dinners, 2022 is shaping up to be our most spectacular year yet. We hope you share in our excitement as we dive head-on into a year filled with some of the biggest and most impactful events in the Australasian pre-hospital sector.

Webinars caa.net.au/webinars We started off the year by relaunching the CAA Webinar Series. The CAA Webinar Series is designed to inspire and educate with a range of speakers discussing topical issues from around the ambulance world. These 1-hour long webinars are held once a month, are free to attend and are advertised on CAA’s website and through our fortnightly newsletters and social media channels. For a complete list of webinars and to access past recordings visit www.caa.net.au/webinars

Women in Ambulance Awards 8 March 2022 caa.net.au/women-in-ambulance-subpage The CAA Women in Ambulance Campaign kicked off the year with a bang. This year, the CAA 2022 Women in Ambulance Awards recognises 50 incredible women in the sector for their work and career progression. The women that were nominated were recognised as Women in Ambulance Honour Recipients with lapel pins, certificates, and invitations to the CAA Congress 2022 Women in Leadership Forum. The Awards look to empower and inspire future generations of women to step into ambulance careers and progress into leadership roles and management levels.

www.caa.net.au

2022

Event Calendar JAN 21

JUL WOMEN IN AMBULANCE Nominations close

FEB 22

WEBINAR Clinical Practice

FIRST MAGAZINE Autumn

WOMEN IN AMBULANCE Honour Recipients Announced

11-13

CAA CONGRESS Sydney

CAA AWARDS FOR EXCELLENCE Gala Dinner - Winners Announced

WEBINAR Patient Safety

SEPT

WEBINAR Women in Leadership

FIRST MAGAZINE Spring 28

APR 14 28

WEBINAR Aeromedical

AUG

MAR

CAA AWARDS FOR EXCELLENCE Entries Close WEBINAR 2021 CAA Awards for Excellence Star Award Winner

MAY 5

TAKE 5 FOR HAND HYGIENE World Hygiene Day

WEBINAR Infection Prevention & Control

JUN FIRST MAGAZINE Winter

WEBINAR Mental Health & Wellbeing

OCT 10

ME FIRST World Mental Health Day

WORLD RESTART A HEART DAY

WEBINAR Cardiac Arrest

NOV 28

WEBINAR Technology

DEC FIRST MAGAZINE Summer

SUSTAINABLE AMBULANCE World Environment Day

CAA'S 60TH ANNIVERSARY Gala (Canberra)

CAA AWARDS FOR EXCELLENCE Finalists Announced

WEBINAR Clinical Practice

WEBINAR Sustainability in the Ambulance Sector

CAA First

Take 5 for Hand Hygiene 5 May 2022

Sustainable Ambulance 5 June 2022

caa.net.au/hand-hygiene-subpage

caa.net.au/sustainable-ambulance-subpage

Take Five for Hand Hygiene is an annual campaign created by The Council of Ambulance Authorities to highlight the importance of hand hygiene during paramedic's time with patients. The campaign is designed to highlight 5 key moments when dealing with patients and importantly speaks about good hand hygiene and the over-reliance on wearing gloves, that, when inappropriately used, can assist in spreading contaminants.

June brings a month-long focus on sustainability with the Sustainable Ambulance campaign. CAA is committed to supporting the ambulance sector to work towards a more sustainable future. Throughout the month, CAA will be continuing to share posts that reflect the best sustainability practices from around the globe, vendors and suppliers of sustainable products and solutions, and ideas on how to start making long-lasting changes for a better environment. Whilst this campaign is highlighted throughout June, information is continually circulated year-round to assist with ongoing growth in this area in the ambulance sector.

Previous years of the campaign have seen the production of videos by member services demonstrating what good and bad practice hand hygiene might look like. Be sure to keep an eye out for the Take 5 campaign which will be returning in May with brand new content.

Last year CAA created the successful ‘CEOs Planting Trees’ initiative which helped to raise awareness for them of 2021 World Environment Day. Keep an eye out for another fun, hands-on initiative launching in June this year.

www.caa.net.au

CAA Congress 11-13 August 2022 caacongress.net.au In August we look forward to the CAA Congress which is Australasia’s premier event for the pre-hospital sector and brings together top clinical and educational leaders and senior management teams from ambulance, health, and emergency management services. The Congress features several days of speakers and forums, social and networking events, and a bustling Expo.

CAA Expo 12-13 August 2022 Running concurrently with the 2-day Congress, the CAA Expo is a premium and dynamic space that will provide our partners and exhibitors with the chance to liaise with our delegates and share their latest updates and innovations. Recently we have explored how we can engage our attendees even further in the Expo space and it will now also feature an engaging program with Mini Masterclasses and Demos to ensure this space will be an innovative hub throughout Congress.

In addition to our member services and their team, CAA Congress is also open to a wider audience, including Police, Firefighters, SES, Lifesavers, Universities and many more. It is a great opportunity to meet key decision-makers and influencers from the ambulance, pre-hospital, and emergency management sectors. Flip to page 66 for a full look at 2022 CAA Congress.

CAA First

Awards for Excellence 12 August 2022

ME First 10 October 2022

caa.net.au/awards-for-excellence

caa.net.au/world-mental-health-day-subpage

The CAA Awards for Excellence have been run for over 10 years to recognise the hard and innovative work of member services from Australia, New Zealand and Papua New Guinea. The awards are designed to encourage innovation and to enable services to share their work and learn from each other. The awards are independently judged by a panel of industry respected judges from across the globe, with the winners announced at a prestigious gala dinner event held in Sydney during the Congress week.

The ME First campaign is created to celebrate World Mental Health Day in October and while the CAA and members generally prepare internal facing tools, for the last two years, the work in this space was ongoing due to the COVID-19 pandemic. The biggest challenge in 2020-21, which continues to be the case going forward, is the longevity of the pandemic and the impacts this is having on ambulance staff. As much as our teams are resilient by their nature, having no break from the relentless two years of the pandemic is taking a toll on all levels of ambulance teams and flowing into their private lives. CAA members have always been wonderful in sharing their experiences, exchanging plans and new programs, developments and generally supporting each-other throughout these difficult times. ME First will bring a month-long focus on delivering resources for looking after mental health and wellbeing of ambulance staff and their families.

www.caa.net.au

Restart a Heart Day 16 October 2022 restartaheart.net

60th Gala Dinner 8 December 2022

CALL. PUSH. SHOCK. is the message shared on October 16 around the world on Restart a Heart Day. In 2022, The Council of Ambulance Authorities together with their ambulance service members and all other Australian emergency responder departments, will again join forces to raise awareness on out-of-hospital cardiac arrest.

Last but certainly not least, our 60th Gala dinner will be taking place in December. For the past 60 years, CAA has been facilitating fundamental collaboration in and beyond the Australasian pre-hospital sector. 60 years has taken us on a journey like no other. Through ground-breaking news, milestone achievements and innovative programs, CAA and member services have played a significant role in paving the refined and bright path to the prehospital sector as it is today

CAA has been running the RAHD campaign since 2017 and together with our ambulance member services, we managed to reach over 175,000 members of the community. With a new CAA team member dedicated solely to the Restart a Heart campaign throughout the year, we are expecting 2022 to be the Restart a Heart campaigns biggest year yet.

To celebrate this milestone, we are hosting a 60th Anniversary Gala. The Gala offers an opportunity for CAA to recognise all within the industry who have worked tirelessly to drive change and progression within the sector. With notable interest already being expressed for this significant event, sponsorship opportunities are now open and are available in various formats.

CAA First

CAA2022 Wo m e n i n Ambulance Awa r d s F

ollowing the success of the 2021 Women in Ambulance campaign, we are proud to again put together a campaign to help empower existing female managers and foster thriving new careers for emerging female leaders across the pre-hospital sector. The awards are designed to highlight the successful and hardworking women in ambulance services across Australasia.

This year, the CAA2022 Women in Ambulance Awards recognises 56 women within the sector who are championed as role models to the rest of the workforce.

The awards recognise these honour recipients for their work, career progression, and tireless dedication to the prehospital sector.

Join us as we celebrate the incredible, dedicated, and hardworking women who work to elevate the emergency services sector.

NSW Ambulance

Haley Mestroni

Katherine Andrews

Kay Armstrong

Melissa Willis

Raelene Hartman

Acting Program Office Manager

Project Manager CREWs/ VERITAS

Duty Operations Manager

Business Engagement Lead

Chief Psychologist

14 years service

13 years service

27 years service

22 years service

4 years service

Vicki Castle Station Manager, Helicopter Deployment Officer 16 years service

www.caa.net.au

Ambulance Victoria

Anna Devereux

Bronwyn Lambert

Debbie Ray

Eileen Craven

Lindsay Mackay

Senior People Partner

MICA Paramedic Educator

Area Manager

Project Manager

5 years service

15 years service

22 years service

20 years service

A/Executive Director Operational Communications 15 years service

Queensland Ambulance Service

Brina Keating

Crystal Nelson

Lisa Courtney

Melissa Rogers

Sandra Garner

Ursula Howarth

Executive Manager

Acting Executive Manager

Acting Nurse Unit Manager

17 years service

10 years service

30 years service

State Infection Prevention Program Coordinator

Director- Mental Health Response Program

State Infection Prevention Program Coordinator

5 years service

3 years service

14 years service

CAA First

St John WA

Brooke Cook Area Manager Southeast District 11 years service

Linda Randall Staff Deployment Resourcing & Scheduling Team Leader

Naomi Powell

Nicola Peacock

Rondel Dancer

Shelley Johnstone

Manager of Metropolitan Operations

Recruitment Consultant

Industrial Trainer

Paramedic

6 years service

12 years service

14 years service

18 years service

13 years service

SA Ambulance Service

Emma Perry

Janet Brewer

Madeleine Preece

Megan Walkley

Nicole Bradtke

Therese Hornby

Acting Operations Manager

Regional Team Leader

Clinical Support Officer

Operations Team Leader

Communications Coordinator

35 years service

9 years service

19 years service

Manager Volunteer Support Unit

19 years service

31 years service

11 years service

Ambulance Tasmania

Deborah Quilliam Volunteer Ambulance Officer 6 years service

Ellie Grace

Leah Geard

Simone Haigh

Tessa Campin

Duty Manager

Clinical Support Manager

Intensive Care Paramedic

Staff Officer

18 years service

20 years service

3 years service

12 years service

www.caa.net.au

In 2019, CAA brought together women in various roles from ambulance services across Australasia to form the Women in Leadership working group. In 2020, the working group released CAA’s Women in Leadership strategy that provided a path to start bridging the gender gap and looking at ways to support women in growing successful careers in the pre-hospital sector. Now, in 2022, we celebrate the CAA Women in Ambulance Honour Recipients. We recognise the inspirational, talented, and hardworking women who work to elevate the emergency services sector, and who will no doubt inspire many others to reach out for that next step in their career and venture into leadership roles.” Tony Walker ASM, CAA Chair, CEO Ambulance Victoria

ACT Ambulance

Barbara-Ann Stephens

Nicole Day

Nicole Price

Workforce Planning Officer

Patient Transport Officer

Intensive Care Paramedic

12 years service

3 years service

22 years service

St John Ambulance Australia (NT)

Andrea Canning

Billie Turner

Jeannette Button

Kate Owen

Monique Fynn

Communication Supervisor

Emergency Medical Dispatcher

Marketing and Communications Manager

Ambulance Services Coordinator

Clinical Support Officer

5 years service

3 years service

14 years service

2 years service

Naomi Alcover Paramedic 2 years service

7 years service

CAA First

St John New Zealand

Anne-Maree Harris

Bridget Dicker

Jo Stuart

Territory Manager

Head of Clinical Audit and Research

Emergency Medical Technician

20 years service

7 years service

25 years service

Monique Le Roux

Nicola Cunneen

Norrie Meauli

Paramedic

12 years service

25 years service

Duty Centre Manager 7 years service

Wellington Free Ambulance

Abby Perry Extended Care Paramedic 6 years service

Heidi Little Clinical Educator, Extended Care Paramedic, Clinical Paramedic Advisor

Kimberley Beban

Lucy Lloyd-Bain

Melanie Cotterill

Intensive Care Paramedic

Facilities Manager

Systems Accountant

12 years service

3 years service

15 years service

9 years service

St John Ambulance Papua New Guinea

Rachael Pyokol

Zoe Saulep

Health Extension Officer/ Trainee Paramedic

FAIS Program Lead Coordinator 3 years service

3 years service

www.caa.net.au

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Focus First

Demand Management: A Universal Challenge By Professor Tony Walker, ASM

n the face of it, ambulance is a simple proposition – someone has a health emergency, we get a call for help, and we help them. If only it were that easy.

Every ambulance service contends with an assembly of moving parts and navigates a range of dynamic factors to ensure patients receive the right care at the right time. While no two ambulance services are alike, we have much in common including the universal problem of managing demand. Add in the pressures of meeting community expectations and the effects of a global pandemic – on ambulance services, hospitals, our people and our communities – and the demand management puzzle becomes even harder to solve. So what interventions are required and, more importantly, at what point of the patient journey? Is it public messaging to reinforce the appropriate use of ambulance before people call for help? Is it during the emergency call itself, where the needs of the callers can be best assessed and assisted to alternative services or self-care options? Is it in the hands of paramedics and practitioners who assess patients in the field and, where appropriate, direct them to healthcare options that better suit their needs than a hospital ED?

Or is it at the emergency department itself where a seamless transfer of a patient to hospital care can make all the difference to ambulance availability for the next patient who needs us? There is, of course, no clear answer nor one-size-fits-all approach. In Victoria, the effects of COVID-19 forced us to reimagine how we can best serve our community, and we have taken unprecedented steps to managing both our workforce and response. Our paramedics, first responders, communications, and corporate staff have been working extremely hard to manage increasing demand while prioritising care to our sickest patients. As you’ll read on these pages, ambulance services across Australia, New Zealand and Papua New Guinea are taking many different and novel approaches to tackling demand. Importantly, and despite our shared challenges, our ambulance services continue to deliver remarkable patient outcomes each and every day.

www.caa.net.au

Focus First

Ambulance Victoria’s experience

mbulance Victoria responded to the highest level of patient demand in 15 years as the global COVID-19 pandemic had an unprecedented impact on the health system across Australia and internationally.

Decreased hospital transfer performance, calls to more than 300 COVID-positive patients a day, and up to 500 Ambulance Victoria employees at time furloughed meant that traditional methods of demand management weren’t enough. From March 2020, Ambulance Victoria prepared for and gradually implemented a multi-faceted plan to meet and record demand. We implemented various strategies to relieve pressure in the system including the expansion of our Secondary Triage Service, implementing Ambulance Patient Offload Teams, rolling out our Medium Acuity Transport Service, reviewing our dispatch grid and employing a surge responder workforce. In 2021, Ambulance Victoria recruited a record 700 paramedics and effectively doubled our Secondary Triage Service for less-urgent Triple Zero calls with more than 150 additional paramedics and nurses.

www.caa.net.au

Focus First

Our Secondary Triage Service manages more than 1000 cases a day – freeing up ambulances for the sickest patients by connecting Triple Zero (000) callers to better assess patients’ needs and pathway them to the right care for their particular condition, which won’t always be an emergency ambulance. Our Secondary Triage Service is consistently and safely linking more than 20 per cent of emergency 000 calls every day to alternative care. We also reviewed our dispatch grid, carefully moving an extra 275 emergency cases a day to our Secondary Triage team for further assessment. From April 2021 Ambulance Victoria Introduced Ambulance Patient Offload Teams (APOTs) to assist with the timely release of ambulance crews by monitoring suitable patients awaiting admission to hospital EDs. APOTs were introduced to directly impact ambulance availability and improve staff welfare by leading to better end-of-shift and meal-break management. Our new Medium Acuity Transport Service (MATS), supported by 22 vehicles and 165 staff, provides care for lower-acuity patients. MATS crews are dedicated to less-urgent calls to free up ambulances to respond to the most critical cases.

Our MATS teams are making a real difference ensuring less-urgent calls get high expertise and care while having a positive impact on workload pressures being experienced by paramedics.

While qualified paramedics are always responsible for a patient’s care, these other agencies have been supporting and working along qualified paramedics at emergencies and hospitals.

Ambulance Victoria also engaged our own first responder workforce and a range of partner agencies to increase the availability of suitable first responders to perform operational duties. This cohort – known collectively as the COVID-19 Surge Workforce – has been trained to provide support to operational paramedics and includes:

During the peak of the pandemic, patients with COVID-19 or suspected COVID-19 were transferred to hospital care almost immediately as they arrived. This helped limit the time our paramedics shared a confined space with patients and increased availability of ambulances for emergencies in the community.

• AV Ambulance Community Officers (ACOs) • AV Community Emergency Response Team volunteers (CERTs) • St John Ambulance Australia (Victoria) – first aid volunteers • State Emergency Service (SES) volunteers • Life Saving Victoria volunteers • Chevra Hatzolah CERT responders • Australian Red Cross volunteers • Undergraduate Paramedicine students • Returned retired paramedics

Finally, we acknowledge that the community can also play a part. More than one-in-five calls to 000 do not require an emergency ambulance – and that’s why we continue to promote our evidence based “Save Lives, Save 000 for Emergencies” campaign. A peerreviewed and published evaluation of the effectiveness of this public communication approach revealed that it was successful in reducing daily inappropriate calls requesting an emergency ambulance and increasing intentions to use alternative services. See Ambulances are for emergencies: shifting behaviour through a research-informed behaviour change campaign

• Australian Defence Force personnel.

APOT case study In April 2021, an Ambulance Victoria night shift crew transported to hospital an elderly patient who had experienced a non-traumatic fall. The patient was triaged by the Health Service ED as Category 3, 4 or 5, meaning that an APOT staff member was able to offload them within 30 mins of arrival. The incoming crew was able to return to the community and was then dispatched to a patient suffering an Acute Myocardial Infarction (AMI), and requested a HEMS dispatch while enroute. Today, the AMI patient is alive.

www.caa.net.au

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Focus First

NSW Ambulance’s centre of attention By NSW Ambulance

hile COVID-19 has placed unprecedented demand on NSW Ambulance, it’s also paved the way for groundbreaking initiatives to improve service delivery and safe patient care, including the implementation of a Virtual Clinical Care Centre. After being fast-tracked to support pressures on the health system caused by the COVID-19 pandemic, NSW Ambulance’s Virtual Clinical Care Centre (VCCC) commenced operations just over five months ago. It has since rapidly expanded to help better meet the needs of patients who call Triple Zero (000). Dr Dominic Morgan, NSW Ambulance Chief Executive, is optimistic about the positive impact the VCCC is having on patients across NSW. “NSW Ambulance continues to deliver excellence in care during an unprecedented period,” he said.

Clare Beech, NSW Ambulance Executive Director, Clinical Systems, said the VCCC assists with service demand by ensuring patients who call Triple Zero (000) receive the most appropriate care for their condition, at the right time and by the right health care provider. “The VCCC connects patients with the care they need, bringing about a greater level of sophistication and clinical decision-making at the time of call. It’s a positive step for bridging gaps for patients and the care they are seeking,” she said. “The VCCC provides secondary triage and in collaboration with NSW Health and all the Local Health Districts, connects patients with the most appropriate care pathway for them.

“From mid-December 2021 to mid-January The dedicated team working in the VCCC 2022, with the Omicron variant spreading rapidly across NSW, our organisation experienced an “Once fully established, I am certain this will be a game unparalleled increase in Triple Zero (000) demand. A changer for patients, frontline paramedics and the entire record 5,120 unique calls were received on the first of health system.” January. “I’m incredibly proud of what our clinicians, emergency medical call takers and dispatchers have done to serve the community in what has been the busiest period in our history. What they have achieved and continue to do so is nothing short of remarkable.”

The evolution of the VCCC is considered fundamental to NSW Ambulance’s 2021-2026 Vision and Strategic Plan, “Redefining Our Future”, which was launched last year. The VCCC also aligns with other NSW Government priorities, including the Future Health and Virtual Care Strategies.

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Clare Beech, NSW Ambulance Executive Director Clinical Systems, with the team on the launch day of the VCCC

The VCCC is staffed by Paramedic Specialists (Extended Care Paramedics) who are well placed to virtualise clinical practice and deliver secondary triage and referral. Feedback from patients so far is exceptionally positive, with close to 100 per cent of patients reporting high levels of satisfaction with the care provided to them. From January this year, 40 Clinical Support Assistants have come onboard to provide call-backs to patients during times of high demand, which in turn has given much-needed relief to call-takers and dispatchers to focus their attention.

“It has already rapidly expanded both in terms of size and hours of operation. Since December, we have doubled the amount of VCCC specialist clinicians,” he said. Mr Nichols said the main role of the VCCC is to provide a secondary triage to patients who call Triple Zero (000). This is subsequent to the primary triage that occurs at the time of the call.

Jannice Yusi, one of NSW Ambulance’s Extended Care Paramedics working in the VCCC. The team had a special visitor from Ollie, a NSW Ambulance Therapy Dog

The VCCC is also actively recruiting multidisciplinary clinicians to broaden the type of cases the VCCC can triage and refer.

Martin Nichols, NSW Ambulance Associate Director Clinical Practice, helps manage the VCCC and is among those clinicians recently recruited to the team.

“We know that not everyone who calls Triple Zero (000) needs to go to an Emergency Department. Through a secondary triage consult with a VCCC clinician we can identify if a patient’s healthcare needs can be met without an ambulance resource attending,” he said.

Along with secondary triage, the provision of remote clinical support is another key aspect of the VCCC, which is poised to have greater growth and impact in the future.

Focus First

QAS Clinical Hub “In the midst of every crisis lies great opportunity.” By Queensland Ambulance Service

he COVID-19 pandemic has provided the opportunity for the Queensland Ambulance Service (QAS) to unify and enhance a number of secondary triage and alternative models of care services into one package, namely the QAS Clinical Hub.

The Clinical Hub Provides:

Mental Health Care

• Secondary Triage and Advice to patients

Across Australia there has been sustained growth in calls to Triple Zero (000) from patients experiencing a mental health crisis. The assessment and care of people experiencing a mental health crisis can prove to be a challenge for Emergency medical Dispatchers (EMDs) and paramedics.

• Mental health advice, triage and dispatch of Co-Responder units • Co-ordination of Hotel Quarantine Transfers • Telehealth, including video conferencing, outreach for patients • Medical oversight of the QAS response

These often-complex presentations require an understanding of the collateral history, precipitating factors and risk features which may not be immediately available in an acute emergency assessment. To support QAS paramedics and EMDs, the Mental Health Liaison Service (MHLS) is embedded into the Brisbane operations centre 24 hours a day. This service provides information, advice and assistance across the whole of Queensland, to EMDs, paramedics and managers regarding people who call Triple Zero (000) in a mental health emergency.

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The experienced mental health clinicians can provide clinical information to support decision making. The mental health clinicians may also provide a brief intervention to people in crisis to re-direct to appropriate care without the use of an ambulance resource. In addition, the QAS Mental Health Co-responders (MH CORE) are co-ordinated and dispatched via the mental health clinicians in the Clinical Hub. The MH CORE, pairing a senior paramedic and a senior mental health clinician from a local health service operates in areas of high demand in multiple locations across the state, providing a face to face assessment and treatment, in response to Triple Zero (000) calls, in people’s own homes using their own resources; more often than not providing a comprehensive intervention which does not require transport to hospital.

Secondary Triage and Telehealth For over a decade, the QAS has incorporated senior clinicians, specialist paramedics and doctors within Triple Zero (000) operations centres to provide clinical leadership and oversite of incidents and jobs, which has produced positive results for patients and EMDs alike. The Covid-19 Pandemic saw an increase in call rates and volume and the QAS has enhanced this 'oversight' with the launch of the QAS Clinical Hub. The centre is staffed by senior paramedics 24/7, with on site emergency physicians for 12 hours per day during peak presentation periods.

The QAS Clinical Hub performs a secondary triage and health navigation role for callers to Triple Zero (000). The purpose of this triage is to identify risk factors, ensure appropriate priority coding, provide risk mitigation to pending cases and identifies patients that are suitable for appropriate alternative care pathways. The deployment of a telehealth solution within the hub has seen a significant change in the way in which cases are assessed and managed. By enabling the ability of clinicians to remotely view patients, another layer of safety and advice has been achieved. Enabling telehealth has allowed incidents involving minor to moderate injuries and other cases where a visual review of the patient is of benefit. Both clinicians and patients have expressed satisfaction with this new service. Significant improvements in access to alternate pathways have also been realised. The QAS Clinical Hub, incorporating Mental Health Care and Secondary Triage have had a significant impact on assisting the QAS in managing the increasing demand for ambulance services. The expansion of the number and scope of clinicians within the operations centre has provided significant value add to each interaction they complete. This produces higher quality and timely services for patients, appropriate use of resources across the QAS and the broader health network, as well as increased satisfaction and professional fulfillment for clinicians.

Focus First

Save 000 for when it matters By SA Ambulance Service

hristmas Day 2021 was one of the busiest days on record for SA Ambulance Service (SAAS), and the catalyst that set the service on a mission – to drastically reduce the amount of unnecessary Triple Zero (000) calls coming in, with a new public campaign called ‘Save 000 for when it matters’.

Reducing demand has been a priority for SAAS over many years, starting with the introduction of Extended Care Paramedics over 10 years ago. The impact has been steady and strong, but there’s nothing like a global pandemic and an enormous rise in Triple Zero (000) calls, to push SAAS even harder. SAAS has seen a steady rise in calls over the years, but when you hit close to 800 calls a day, it’s time to act. Within weeks, the ‘Save 000 for when it matters’ campaign was up and running on television, radio and social. Its main aim was to outline what an emergency really is. The by-line ‘Is it trivial? Or is it 000?’ invites the reader to stop and think, and to make an informed decision about whether calling Triple Zero (000) is the right thing to do. Manager for Communications and Strategic Engagement at SAAS, Natalie Gibson said, “this campaign was crucial to help the community identify what an emergency is, and when to call SAAS. It wasn’t about getting people to risk their health but to ensure they get the right care for their needs”.

Everyday SAAS Emergency Medical Dispatch Officers take Triple Zero (000) calls from people who are unsure what health services are available to them. “Health Direct is an amazing resource that the community can tap into when they are unsure. GPs and pharmacists are also go-to people. Call SAAS when it’s an emergency and when there is a life on the line. “I’m pleased to say that all three iterations of ‘Save 000 for when it matters’ have made a difference. South Australians did their part and saved 000 for when it matters. Coupled with other demand measures and the national 000 Recorded Voice Announcement, calls have dropped, and it can only get better. We will continue to spruik this important message, as we face ongoing COVID-19 pressures and influenza season,” said Natalie. The campaign is estimated to have reached almost all South Australians over aged 18 in one form or another with 75,000 views online alone.

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SAAS has implemented a range of programs to ensure high demand is kept at bay: • Fast tracked recruitment of Triple Zero (000) call takers, with an additional 24 staff members recently coming on board.

• SAAS fast tracked the onboarding of qualified paramedics into SAAS, with 26 deployed in February.

• The Clinical Telephone Assessment provides patients with genuine alternatives to the emergency department. Patients directly speak to a clinician, which often results in no ambulance dispatch.

• SAAS doubled its paramedic intern intake to 96.

• The use of Alternate Pathways such as the Virtual Emergency Service, CAVUCS and COVIDKids has been phenomenal. SAAS works closely with providers to develop scope and increase opening hours. • Due to an increase in positive COVID-19 cases, SAAS introduced and quickly doubled the Ambulance Transport Assist. Staffed by second year paramedicine students, the team transport positive patients not requiring clinical intervention to health services or quarantine, reducing the emergency and nonemergency load.

• Some ambulance officers, who traditionally transfer low acuity patients, were temporarily moved into the emergency stream to work with paramedics as drivers and support officers. This allowed an increase in paramedic single responders. • 40 third year paramedic students, who already completed driver training, joined to support non-emergency crewing. • SAAS continues to work with accredited private providers, such as St John, to offer additional support.

Focus First

St John NZ is prepared for Omicron By St John New Zealand

he COVID-19 pandemic has dominated the world over the past couple of years and amid all its challenges, St John New Zealand’s emergency ambulance service continues to step forward to help those in need.

With the Omicron variant now in the community, all the preparations to protect Aotearoa’s team of five million and the health system is now being put to the test. St John plays a critical role in responding to and supporting the Omicron response. However, St John New Zealand is very aware Omicron comes at a time when the emergency ambulance service is already facing unprecedented demand. St John’s ambulance data for 2021 reported nearly a 10 percent increase on the number of 111 calls and a five percent increase in the number of incidents attended, compared to the previous year. St John New Zealand has been working on its own plans to protect the ambulance service from becoming overwhelmed, to ensure it can continue to support its people, patients, and communities. Additional Government support this year is enabling St John to launch several key initiatives in its COVID-19 resurgence plans, to bolster the ambulance service and ensure the resilience of 111 communications centre staff and frontline crews through utilising the skills and experience of its existing workforce. To date, St John has deployed up to 14 additional frontline ambulances. Eight of these in Auckland and six around the country where needed. St John is working on filling the extra ambulance shifts with qualified ambulance officers currently working in other roles, including volunteers, for a fixed period.

To date, St John has deployed up to 14 additional frontline ambulances. Eight of these in Auckland and six around the country where needed. 37

Focus First

St John New Zealand is working closely with the organisation’s customer service team to provide staff who can respond to non-urgent calls received via 111 to its ambulance communications centres, to enable emergency call handlers to focus on urgent calls for help. St John is also delivering additional ambulance training programmes to increase the number of new recruits to be qualified to work on the frontline. As Omicron spreads, St John New Zealand anticipates an influx of 111 calls from what it calls ‘the worried well’. Their COVID-19 symptoms are likely to make them feel miserable and anxious. Generally, these people can be safely managed at home, and St John has developed clinical practice guidelines to support its paramedics to manage patients at home, where possible. St John has also developed a public facing campaign encouraging people to seek health advice from their usual health provider in the first instance, and also consider alternative methods of transport to medical facilities for non-urgent conditions.

If St John does experience extreme demand in the cases needing to go to hospital, it may bring on ambulance assistants who have been trained to drive an ambulance, safely lift patients, and perform effective CPR. These people would be partnered with a qualified ambulance officer to provide additional support in lower workload areas. This would enable St John to rapidly increase the number of ambulance crews, while maintaining a trained clinician on each ambulance. St John has already completed the first of these training courses and has put a call out to onboard more assistants over the coming weeks. St John New Zealand is working alongside other ambulance providers, and the wider health sector to ensure a joined-up approach to manage the demand that will face all of us. Key to this has been ensuring good ambulance representation within Government and Ministry of Health decision making groups. As the health sector learns more about how Omicron is behaving in Aotearoa New Zealand, St John is able to adjust these initiatives to ensure it is able to better meet the needs of the COVID-19 response in consultation with the Ministry of Health.

St John has also developed a public facing campaign encouraging people to seek health advice from their usual health provider in the first instance, and also consider alternative methods of transport to medical facilities for non-urgent conditions.

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Experience the unforgettable as a paramedic in the NT

Now recruiting

www.stjohnnt.org.au/careers Image courtesy of Australian Catholic University

Focus First

Preparations included recruitment of more than 230 additional frontline personnel.

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St John WA geared up for safe transition by St John WA

A’s frontline emergency ambulance service is prepared for borders to open as part of Western Australia’s Safe Transition Plan. Preparations included growing the Specialised Isolation Ambulance vehicle fleet, recruitment of more than 230 additional frontline personnel and flexible deployment of personnel in metropolitan and regional WA. Preparations were informed by the experience of ambulance services around Australia and overseas and include: • Recruiting an additional 233 frontline positions during 2022, including 155 registered paramedics. • Modifying seven vehicles to be Specialised Isolation Ambulances (SIA) for transfer of COVID-19 patients. This increased the total SIA fleet to 17. • Developing a pathway to introduce mixed crews in the event of pressure on the ambulance front line due to the spread of COVID-19 resulting in increased demand, a reduced workforce and/or increased ambulance ramping. • Bolstering deployment options for paramedics to regional WA. • New guidelines to increase and monitor Personal Protective Equipment (PPE) and critical equipment, including securing supply chains.

Focus First

The measures are supported by a big investment in the ambulance frontline during 2021, including: • Adding 60 staff to the State Operations Centre and doubling recruitment through Direct Entry, resulting in more than 260 additional frontline personnel recruited since mid-2020. • Funding 18,000 additional shift hours through overtime and recruitment. • Appointing Hospital Liaison Mangers to fast-track patient handover in EDs and support frontline staff. • Continuing a Secondary Triage Team to deliver suitable patients to alternative care pathway. • Facilitating triage en-route for ED bypass through a Virtual Emergency Medicine program.

Combined, these activities returned about 12,000 hours of emergency ambulance care to community last year by reducing ambulance ramping and bolstering frontline capacity. St John WA Chief Executive Michelle Fyfe said St John had worked with union representatives to plan for mixed crews to support the front line and maintain services in the event demand for Triple Zero (000) responses increased following borders opening. “We are fortunate to learn from our counterparts interstate and overseas to inform our plan to respond to a rise in demand. Just as important as our ability to scale up to respond to demand is the trigger points which allow us to rapidly return to normal operations,” Ms Fyfe said.

• Introducing a Patient Transport Paramedic trial for Priority 4 inter-hospital transfers.

We are fortunate to learn from our counterparts interstate and overseas to inform our plan to respond to a rise in demand. Just as important as our ability to scale up to respond to demand is the trigger points which allow us to rapidly return to normal operations.” Michelle Fyfe

St John WA Chief Executive

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s e c n e r e f n o c e g e l l o C 2022

Trauma on the Border 18 March 2022 – Face-to-face & online Twin Towns Services Club, Tweed Heads, NSW Find out more paramedics.org/events/TotB2022

ROAR RURAL, OUTBACK & REMOTE

PARAMEDIC CONFERENCE

Rural Outback and Remote Paramedic Conference 26 – 27 May 2022

Student Conference July 2022

2021

ACPIC

Find out more paramedics.org/events @ACParamedicine

ACP International Conference 2022 14 – 16 September 2022

Focus First Opinion First

The Promise & Pitfalls of Mechanical CPR

he notion of automated CPR delivery has been around in various forms for decades. It sounds both logical and very appealing to prehospital providers: a machine that performs uniform chest compressions with the push of a button.

This technology has evolved into several widely marketed mechanical CPR (mCPR) devices that hold much promise to improve care, but also have a number of potential weaknesses that are important to recognize. The literature on this topic is far from conclusive; both observational studies and randomized trials over the past decade have not been able to demonstrate consistent improvements in survival or neurologic recovery (see selected readings at end of this article). Deploying mCPR may have the potential to aid resuscitation care delivery in the most difficult circumstances, but like many technologic solutions, the challenge is not the devices themselves, but the training and implementation of these tools. In short, execution is key. Poorly planned implementation of this technology within emergency care systems is fraught with hazards. Prolonged out-of-hospital cardiac arrests and CPR during transport represent two scenarios where these devices could be especially helpful. EMS providers widely understand that it is difficult to perform high-quality manual chest compressions in the back of a moving ambulance.

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Like many technologic solutions, the challenge is not the devices themselves, but the training and implementation of these tools 45

Opinion First

MS team staffing is often lean, and the ability to offload the physical burden of chest compressions represents an important benefit for these providers.

EMS agencies around the world are strapped for staffing and resources; using mCPR could potentially limit the number of people sent out on each EMS call, and thus could address these challenges. Prolonged arrest is another scenario where this technology may be useful. You’ve been working the patient for an hour, and they keep arresting again and again. Less fatigue, fewer CPR rescuers, and less clutter might improve the ability to think carefully and plot the next maneuvers, such as ECMO if warranted. Offloading the mental burden of coordinating effective compressions and allowing for improved focus for the nuances of these resuscitations might be an important benefit. But these potential benefits do come with pitfalls. Evidence has accumulated that mCPR depends on rapid deployment to minimize compression pauses, and on correct placement to avoid abdominal injuries. Careful staff training programs and refreshers are required.

Device malfunctions can occur, so regular maintenance and system checks are a necessity. Cardiac arrests are infrequent events and therefore mCPR devices often sit unused for weeks at a time. It is easy to overlook training and maintenance amidst the already too-long to-do lists of busy EMS and emergency department directors. Key insights into CPR pauses and mCPR training have recently been published by Levy et al in Alaska (see selected readings, below). mCPR devices have the potential to improve outcomes. The devil is in the details – choosing the right patients, training staff in proper device use, and maintaining the machines correctly. mCPR is not the answer for all cardiac arrests – but it may be the answer for some.

Michael Saulle MD

Benjamin S. Abella MD MPhil

Dr. Saulle is a resident physician in emergency medicine at the Hospital of the University of Pennsylvania in Philadelphia, USA. His academic interests include acute resuscitation and CPR quality improvement.

Dr. Abella is Professor and Vice Chair for Research in emergency medicine at the Hospital of the University of Pennsylvania in Philadelphia, USA. He has authored over 200 published works on topics pertaining to CPR and post-arrest care.v

Selected readings: Wik L, Olsen JA, Persse D, Sterz F, Lozano M Jr, Brouwer MA, Westfall

Gao Y, Sun T, Yuan D, Liang H, Wan Y, Yuan B, Zhu C, Li Y, Yu Y. Safety

M, Souders CM, Malzer R, van Grunsven PM, Travis DT, Whitehead A,

of mechanical and manual chest compressions in cardiac arrest patients: A

Herken UR, Lerner EB. Manual vs. integrated automatic load-distributing

systematic review and meta-analysis. Resuscitation. 2021 Dec;169:124-135.

band CPR with equal survival after out of hospital cardiac arrest. The randomized CIRC trial. Resuscitation. 2014 Jun;85(6):741-8.

Levy M, Kern KB, Yost D, Chapman FW, Hardig BM. Metrics of mechanical chest compression device use in out-of-hospital cardiac arrest. J

Buckler DG, Burke RV, Naim MY, MacPherson A, Bradley RN, Abella

Am Coll Emerg Physicians Open. 2020 Jul 4;1(6):1214-1221.

BS, Rossano JW; CARES Surveillance Group. Association of Mechanical Cardiopulmonary Resuscitation Device Use With Cardiac Arrest Outcomes: A Population-Based Study Using the CARES Registry (Cardiac Arrest Registry to Enhance Survival). Circulation. 2016 Dec 20;134(25):2131-2133.

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Services First

NT Presents Exciting New Opportunities From St John Ambulance Australia (NT)

ver the last few years, ambulance services across the country have been stretched beyond imagination.

With the biggest recruitment drive in St John NT history underway, the organisation is ready for some much-needed relief.

“You see cases up here that you won’t experience anywhere else – from flood water rescues to crocodile attacks and jellyfish stings”, said Mr Thomas.

St John NT CEO Judith Barker acknowledged the commitment all frontline services have made during the pandemic.

“Working in the Northern Territory presents once-ina-lifetime opportunities for paramedics to expand their scope of practice and have a diverse and challenging professional experience that will open doors for them wherever they go.”

“The past 20 months has presented challenges for all of us. Throughout this period, staff from across our service have remained focused and committed to protecting and providing a service to the community,” St John NT CEO Judith Barker said. “The commitment all frontline services have made during the pandemic has been outstanding, and we have worked with the Department of Health to identify how we can best serve our community and ensure the safety and wellbeing of our staff.” “As a result, we have secured additional funding to recruit 45 new staff to support our response to the COVID-19 pandemic.” This will equate to the biggest recruitment drive in St John NT history – an increase in operational staff by 10%. Director of Ambulance Services Andrew Thomas acknowledged what a huge undertaking this would be. “We usually run two intakes over the course of the whole year. This drive means we will be recruiting throughout the year and running consecutive induction programs with only a two-week break between each round. “Our Clinical Services and Human Resources team will be screening potentially hundreds of applicants and running induction programs almost non-stop. While we understand this will be a challenging exercise, we cannot wait to see the fresh faces up in the Territory.” While St John NT may be one of the country’s smallest ambulance services, they deal with some of the most extreme medical cases.

2021 Paramedic of the Year for the Southern Region, Rachael Welsh, reflects on her time in the Territory. "My four years in the Territory have been filled with great memories, good laughs and I've found lifelong friends. It's a place where you control your experience, all about that work-life balance and how social you want to be. I love the community feel. “Because we provide an emergency response to everywhere within 150km of Alice Springs, we have a great opportunity to work in some remote locations. Although it can be challenging, it’s something you don’t experience in big towns or capital cities. It’s really helped me to critically think and be adaptable in regards to patient management." Rachael cites that Mparntwe (Alice Springs) is still getting used to 'the new normal' with community events kicking back off but loves to explore camping spots, national parks and gorges in her free time. "All in all, if there’s something that you like to do, you will be able to do it in Alice! Unless of course it involves a beach!" St John NT is encouraging graduate and qualified paramedics across the country to experience the rich opportunities the Territory has to offer. Applications are now open at: https://stjohnnt. connxcareers.com/

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Services First

Women on the frontline in Hopetoun From St John WA

hey may be the only St John WA sub centre entirely crewed by women, but volunteers at a regional outpost known for its rugged beauty and harsh coastline don’t think that makes them any different to any other branch.

“A lot of the men down here are on the mines and are away from town a lot,” Hopetoun’s Karina Bray said. “I mean, the women work, too, but we’re mostly closer to home.” “It’s just turned out that we are all women.”

While the odd male volunteer has come and gone from the Hopetoun sub centre, the community’s emergency medical and transport needs have largely been met by this dedicated team of women, who are not only trained to deal with people experiencing the worst day of their lives, but who have also forged tight-knit friendships among themselves.

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They get together regularly for sub centre meetings, or just to catch up with each other, and when they do, there is plenty of chat and laughter. It’s the easy camaraderie that often goes hand-in-hand with life in a small town. They babysit each other’s children, they nurse each other’s loved ones. Some of the older members have even taught the younger ones in their school days. “We all get along,” Emergency Medical Assistant Ekua Abaka said. “I joined up when I moved here, hoping to meet new people in a new town and to give back to the community. “I find it very rewarding.”

The St John WA model of engaging career paramedics and volunteers allows the organisation to deliver the highest quality of pre-hospital care across even the most remote parts of Western Australia. Hopetoun is one of more than 140 locations are supported entirely by volunteers with support of a Community Paramedic. The model means WA has more emergency ambulance locations per head capita than anywhere on mainland Australia. At a tick over six hours away from Perth, there’s no question Hopetoun is remote, but the dedication of the town’s St John volunteers shows service to humanity knows no bounds, and the service these women provide to their community through their expertise and team spirit is invaluable. They may not think they’re doing anything special as a group of women, but the Hopetoun team continue to inspire the wider community, not just on International Women’s Day, but every day.

Services First

New South Wales Ambulance Celebrating 60 Years of Ambulance Rescue. From NSW Ambulance

s the new year takes off, the Special Operations Unit (SOU) is reflecting on the importance of last year on its rescue capability.

Along with significant capability development and increased rescue officer staffing, NSW Ambulance Rescue celebrated its 60th birthday.

This resulted in Australia’s first dedicated purpose-built rescue vehicle, the ‘Q-Van’, commissioned into service in a ceremony on 6 October 1961.

NSW Ambulance Rescue units are staffed by Rescue Operator-qualified Paramedics who provide technical rescue services in their respective areas of responsibility around the State.

Station Officer Jim Smith was the first rescue-trained officer and went on to operate the vehicle and train other officers for the next 17 years. During this time, he moved his family into Rockdale station and was involved in all but three rescue calls in all those years.

These skills include road crash rescue, vertical rescue, land search and rescue, tactical medicine, swiftwater operations and large animal rescue. In 1961 a public fundraising campaign was initiated by Supt. Sandy Purdie and his son, Officer George Purdie of St George District Ambulance Service, with the support of radio announcer Gary O’Callaghan.

Superintendent Keith Williams, Manager SOU, remembers the impact of SO Jim Smith when he started on the Caringbah rescue truck in 1987. “He was a legend of the rescue community and a lot of our gear and procedures were pioneered by him when I joined,” Keith said.

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“His dedication to Ambulance Rescue is something we remember to this day.” This tradition of service continues with the six Ambulance Rescue stations - located at Rutherford, Singleton, Tamworth, Cowra, Bomaderry and Wagga Wagga. “As we’ve expanded our capabilities, including tactical medical response and large animal rescue, we’re seeing an increase in both rescue calls from the community and requests for inter-agency support,” Keith said. “Our team are performing incredibly well with great feedback coming back to us.” Recently, a combined team from Singleton Ambulance Rescue, Rutherford Ambulance Rescue and Port Stephens SES won seven of the nine categories of the NSW State Road Crash Rescue Challenge Competition. This challenging event consisted of rescue teams from NSW rescue agencies and tested their ability to coordinate and conduct difficult road crash rescue scenarios. The team also represented Australia in the World Rescue Challenge, taking gold and silver in two events. Overseeing the training and development of the capability is Rescue Coordinator, Inspector Dane Goodwin. Dane and the Rescue Training Team conduct over 80 regional training days per year across the six regional stations in addition to the Ambulance Rescue Courses. A/Training Officer Tim Nulty said he enjoys interacting with each of the rescue units.

“It’s a unique role we have being able to get out there and spend time with the rescue officers at each station. They’re always really motivated on training days which makes for a great day of learning and problem solving.” Rescue Paramedic Jess Evans graduated from the demanding two-month NSW Ambulance Rescue course in Oct 2020 and is one of the newer officers in the Wagga rescue team. In the past 12 months she’s conducted vertical rescues, freed entrapped patients in motor vehicles, responded to tactical incidents and a structural collapse that required roof shoring. “So far my most memorable experience has been the camaraderie among the rescue team and knowing that on-scene we can work as a team to tackle any incident,” she said. With a project underway to deliver new, state-of-the art rescue trucks, 2022 looks set to be another busy year for Rescue and the Special Operations Unit. “Our rescue officers are some of the best in the State and this investment in rescue trucks will allow us to stay at the forefront of technical rescue services in Australia,” CTEM Associate Director Richard Cohen said. As always, Rescue Paramedics will continue to provide a unique technical rescue service to their communities and uphold SOU’s motto ‘Per Effectus’ (by performance).

Services First

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St John WA Marine Trauma Response From St John WA

t John WA activates new Marine Trauma Response Resource to assist emergencies along the Esperance coastline this summer

• St John WA’s Esperance Sub Centre has launched a Marine Trauma Response Resource to support major trauma incidents along the coastline, • The 10 Marine Trauma Response Resources are freeto-use community resources located across popular Esperance beach locations, • Esperance Community Fundraising Group donated $4000 to fund the new Marine Trauma Response Resources and the installation of a new Automated External Defibrillator at Kelp Beds. St John WA’s Esperance Sub Centre has launched a new Marine Trauma Response Resource (MTRR) to support beachgoers in the event of an emergency. Ten community MTRRs have been activated across Esperance’s popular beach locations including Kelp Beds, Duke of Orleans Bay, Lucky Bay and West Beach. Each MTRR includes a Combat Application Tourniquet and a variety of dressings and gloves, which are housed in a black Pelican waterproof, dustproof, drop proof case. The MTRRs are kept within St John WA’s Automated External Defibrillator (AED) units, which are located within close reach of the Beach Emergency Number (BEN) signs that aim to improve emergency response times by providing accurate location information. The MTRRs are free to use and will help support patients in the vital minutes between the incident occurring and first responders arriving on scene. The MTRR project was made possible by the Esperance Community Fundraising Group, which secured $4000 to fund the 10 new MTRRs and a new AED. The new AED has been installed at Kelp Beds, a popular beach for surfers where two residents have tragically lost their lives in the past three years due to shark attacks.

Esperance Community Fundraising Group Secretary, Sue Elliot said the donation to develop the MTRRs has had a profound impact on maintaining the safety of beachgoers in the coastal town. “Esperance is known for having some of the most picturesque beaches in the country. Our town lives and breathes by the beach, which is why we funded the MTRRs. This new resource plays a vital role in helping keep our community and visitors safe,” Ms Elliot said. St John WA Esperance Community Paramedic, Paul Gaughan said the MTRRs support the broader community with common trauma incidents that may not always involve marine life. “St John WA’s MTRR project was developed by our local team here in Esperance in response to the three shark attacks that took place across our coastline in the last three years. Being the first responders to such emergencies, we decided to develop a resource that houses tools to support major trauma in the vital time between an ambulance being called and when we arrive on scene. Through our experience, it’s these tools that often save a life,” Mr Gaughan said. “Shark attacks are one of many emergency incidents that can occur at the beach. MTRRs also help support patients with common incidents such as deep cuts or grazes and add to St John WA’s existing footprint of AEDs available by the coastline. We’re extremely grateful to the Esperance Community Fundraising Group in helping fund the initial ten MTRRs. We’re hoping to scale this cost-effective resource broader in the coming years,” he said. MTRRs are accessible to the community through the St John WA Community First Responder network and the state emergency operations centre, which provide a safety code to unlock the contents of the unit.

Awards First

The Future of the Award Winning QAS S.P.I.D.E.R Project

ueensland Ambulance Service’s Excellence in Clinical Practice and Star Award winning entry, ‘Stroke Prehospital Informed DecisionMaking using EEG Recordings’ (S.P.I.D.E.R), was an outstanding project recognised for its importance and innovation to the ambulance sector.

We spoke to project member Wayne Loudon to get an insight on where the project has gone since their CAA 2021 Awards for Excellence win, and where this project will head in the future.

Dr Steve Rashford (left) and Wayne Loudon (Right)

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The project really highlighted the importance of interprofessional collaboration in research since every member of the research team brought valuable experience in their field. 57

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S TA R AWARD WI NNE R

Provide a quick recap of the project. What was the initial aim and end goal? The S.P.I.D.E.R study aimed to investigate the feasibility and utility of EEG to assist prehospital clinicians in identifying acute stroke. It is hoped that quantitative measures derived from EEG (qEEG) data can provide clinicians with a simple yet reliable tool that, along with good clinical assessment, could confirm the presence of stroke. The secondary aim was to determine whether the qEEG measure could confirm or rule out the presence of a large vessel occlusion. The project recruited patients who were suspected to be suffering an acute stroke. The participants received standard stroke care from responding paramedics but were also further assessed by a critical care paramedic to determine if they could be included in the study. Six self-adhesive gel electrodes were then placed on their scalp and EEG activity was recorded until arrival at hospital. The study did not delay or alter any acute care provided to these patients and retrospectively the data gathered was linked with the clinical findings and imaging to determine stroke presence and subtype. Before the project commenced significant work was done to communicate the intent of the research to everyone involved in the prehospital stroke care continuum from emergency medical dispatchers and operations centre supervisors through to responding paramedics. This improved our early identification of potential candidates while preventing any delays or misunderstandings.

How did the project come to be? The project was born out of coincidental associations. Associate Professor Andrew Wong had been involved in a study investigating inhospital quantitative EEG and recognised that such a technology may be useful in the prehospital environment. Along with Dr. Simon Finnigan they approached me with his idea and we were able to translate the idea into a research protocol. This led to development of the S.P.I.D.E.R project, which earned its name since the device we initially planned to use resembled a large spider placed over someone’s head. Unfortunately, this device was ultimately not fit for purpose however the name stuck. The project really highlighted the importance of interprofessional collaboration in research since every member of the research team brought valuable experience in their field. Support from the Queensland Ambulance Service was also integral. I was lucky enough to be placed in a project role for the recruitment period and provided with dedicated response unit that allowed me to identify and respond to all potential stroke cases within the response area. Since being awarded the Excellence in Clinical Practice and Star Award winner in November 2021, has there been any further advancements to the project? S.P.I.D.E.R has demonstrated that EEG data can feasibly be collected by Paramedics in the prehospital setting. We also know that this EEG adds diagnostic value to the clinical assessment. We are collaborating with others to explore the use of prehospital EEG in other emergency settings. While we await publication of our findings, we have been lucky enough to be awarded an Emergency Medicine Foundation (EMF) grant to deliver the EEG in traumatic brain injury (EnTRAIN) study that will hopefully commence recruitment this year. www.caa.net.au

Looking towards the future and investment in the Stroke space, what is the ‘next step’ for the S.P.I.D.E.R project? Although we now know that prehospital EEG can be collected feasibly, we have not yet explored how this data can be analysed in real time, nor whether this data can be used to improve the management of patients. Initially the sole goal was to further develop an EEG-based stroke diagnostic tool, but the study highlighted the potential for qEEG to contribute to other areas of neurocritical care. Currently the team is interested in exploring the use of prehospital EEG in other emergency settings as well as the stroke space. It is also important to highlight the great work being done by the Australian Stroke Alliance in partnership with CAA. The partnerships involved in this alliance will see the development of novel mobile imaging technologies aside from our EEG work that will revolutionise prehospital management of stroke.

What is the ultimate goal for the project? The results from the S.P.I.D.E.R project are the first step towards a technological solution to monitoring pathophysiologic changes that occur after brain injury. EEG can potentially provide real-time and continuous information to clinicians that may be able to guide treatment plans and contribute to improvements in neurologic outcomes. What are the collateral benefits of projects like this? We recognised the opportunity this project had for stroke education both within the organisation as well as the community. We therefore delivered focussed stroke education during the study period through flyers, CPD events and in field coaching. Paramedics showed great engagement and desire to improve stroke care. We also hope that visible projects like this will stimulate interest from paramedics to get involved in clinical research and build up prehospital research capabilities across the country.

Feature First

M Michelle Fyfe

Looking at Michelle Fyfe’s long and distinguished career, the many achievements she has to her name, you can’t help but be in awe of this incredible leader, a woman that has not only climbed through the ranks of WA Police Force but headed some of its most prestigious and demanding roles.

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My advice for women wanting to grow their careers is to look for opportunities. Lazy people wait for them to arrive, dreamers hope they will appear, but smart people look for them and even smarter people create them." 61

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ichelle continues to break the norm becoming the first female CEO of St John WA in its centenary year of Ambulance. Not only that, she is one of only four women to have ever sat on the Board of CAA in our long 60-year history.

What is great about all these achievements, they show others that things can get done, an inspiring career can be held, even if you are the first one to do it. As we sat down with Michelle for this interview, I can’t help but be continually inspired by her path and her thinking of what the future holds. I hold on to something Michelle said in her first CAA Webinar in November 2020 when speaking about being a parent and having a busy career: ‘You can have it all, just sometimes not everything at the same time’. For me it was almost a permission to slow down a little bit and enjoy having kids and not stress that I will miss

Michelle, you have had a prestigious career and have risen to the top of the police industry; if you had to choose, what would you consider to be a couple of your most celebrated achievements? While I’ve successfully navigated an exciting and challenging career, my journey to get this point was a little out of the ordinary. I come from a broken home and watched my mother work every day to feed, clothe and care for two daughters on her own while her husband – my father – was in and out of trouble with the police. My childhood shaped my career. I knew I couldn’t change my beginning to life, but I had control over where it went. I forged my career based on ambition and confidence in my decisions. That confidence has wavered occasionally, even now, but in the words of Venus Williams - Believe in yourself. Even if you don’t, pretend that you do, and at some point, you will.

out on something big and immediate, that I can pick up and go hard when the time is right for me and my family. And isn’t that what we need, leaders that we can be inspired by, leaders that show us and help us to break the mould, to achieve the impossible and all along stand right there beside us cheering us on. With March, a month when we celebrate Women in Ambulance, what great timing to have Michelle featured on our cover and share with us a bit of her story and advice in how we can grow our careers and achieve new heights.

Looking back at your career, what were some of the key decisions you made that helped push you forward and succeed in your field? At one point in my late thirties I made the decision to apply for the Major Incident Group at the Police Force. I was the first woman to have done so and that decision changed the course of my career. It was a difficult, scary decision at the time and I felt out of my depth, however it accelerated my career forward and bought me to where I am now. Before then, I was an average Police Officer, not bad at my job but not outstanding. By applying for that role and taking the opportunity I gave myself a profile. People suddenly took notice of me. My husband was a very high-profile police officer and suddenly I was being looked at for my skills and abilities rather than just as Mark Fyfe’s wife. I was promoted very quickly through the ranks after that. I took a chance of myself, and it paid off.

Professionally and personally, one of my triumphs is that I broke the stereotype. I didn’t follow the path laid out for me, I followed my dreams and worked to make them come true. My most celebrated achievements in my career have all revolved around community service whether that be in the Police Force and eventually holding one of the highest positions, or now having the privilege of being the first female CEO in St John WA’s 100+ year history. However, my greatest achievement of all is my family, my children and grandchildren. Families are the compass that guide us, they are the inspiration to reach great heights and our comfort when we falter.

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Were there any barriers to your rise in leadership? As a woman in policing I faced many barriers. When I started out, I was one of 12 women in a class of 84. Unlike paramedicine, policing still struggles with attracting women to the workforce, so in 1984 women were an absolute novelty. On day one at the Police Force, I was given high heels and handbag while my male counterparts received batons and other equipment – there were barriers I needed to overcome from the very beginning. Further along in my career, after I became a mother and had ‘other’ responsibilities, I faced a different string of challenges. It still amazes me how many people seem to think that after childbirth you lose your brain with the placenta. While many doubted me and my ability, I refused to listen to the doubters, I worked hard and continued to prove myself in each and every role I attained over the course of my career. For our women reading today, what advice would you give to grow their careers? Women, regardless of our profession, have to reinforce the fact that you don’t lose skills if and when you take a break to have a child or any career break for that matter. They may need a bit of polishing here and there but you don’t lose them. It is equally honourable to stay home as a full-time mother as it is to return to work and juggle both aspects of life. When my children were young, I took a nonoperational role where I had stable hours and set work patterns. It worked for us as a family and I learnt a lot, but secretly I missed the excitement and wanted to get ‘back in the game’. I am an ambitious woman and I made moves to progress my career and have a family. Ambition is not a dirty word, and no-one should ever make you feel guilty for harbouring it.

We hear a lot about the importance of having mentors and sponsors. What are your thoughts and experience? In the beginning of my leadership journey, I was told something that has stayed with me over the years – A leader’s job is to identify, train and nurture the person or people who may one day take their role. When you leave your role there should be at least six people who can take over from you. I try to live by that every day. Good leaders take the opportunity to identify talent at every turn and then nurture, support and mentor that talent. As the first female CEO in St John WA’s history, I feel privileged to hold this role and have influence over others. As a leader, I value ideas, innovation, creativity, discussion, I want people to argue with me, I enjoy and encourage divergence and robust discussion. I believe leadership is not about a position or a title, it has very little to do with an organisational structure – leadership is about action and example – it is about one life influencing another, it’s about building the capability and capacity of others and the organisation. As part of my leadership at St John WA, I have implemented Mentorloop. Mentorloop is an online matching platform which enables mentors and mentees to form a ‘loop’, engaging directly online and arranging their preferred frequency and mode of interaction to achieve their agreed goals. St John WA participants register into the program by responding to a series of questions designed to establish their areas of expertise or areas for which mentoring is sought. I champion having a mentor because it expands your network and allows you to learn from others you might not interact with in your regular circles. Through Mentorloop I encourage our staff and volunteers to use their mentors and mentees as a resource, a wealth of knowledge and an extra person to lean on.

As a leader, I value ideas, innovation, creativity, discussion, I want people to argue with me, I enjoy and encourage divergence and robust discussion." 63

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What are some of the changes you would like to see in the future for more balanced workplaces, not only for gender but for other marginalised groups? G.D Anderson is an Australian writer and founder of the Cova Project which aims to solve the problem of access to menstrual items for women in Africa. She said, “Feminism isn’t about making women stronger, women are already strong, it’s about changing the way the world perceives that strength”. We know gender equality has come a long way, but it still has a long way to go and the same goes for other marginalised groups. In the future, I would like to see more marginalised groups feel comfortable to speak out and voice their thoughts, opinions and concerns. From my own personal experience, I know speaking the truth to people in power can be fraught with danger. I’ve always encouraged those around me to share their diverse experiences, beliefs, thoughts and attitudes and to challenge me when I am wrong. I want to see confidence in marginalised groups, confidence to strive for what they deserve. At St John WA, we recently held a survey to help us improve diversity and inclusion and create a workplace where all employees can contribute and succeed as part of our Diversity and Inclusion Strategy. For us to better understand the diversity of our people across St John WA, we asked all staff and active volunteers across the organisation to share their experiences. If we can better understand groups within our organisation, we can work towards creating more balanced workplaces. I believe this is something all workplaces should be doing to strive for a shared goal.

What do you think is key to developing the next generation of female leaders in any organisation? I have run the Police Academy, Human Resources and Professional Development Department, Traffic Operations, Specialist Services (Police Air Wing, Water Police, K9 and Mounted Unit) and worked as the Assistant Commissioner of State Crime – Homicide, Child Abuse, Sexual Assault, Forensic, Gang Crime, Organised Crime and now the emergency ambulance service for the largest ambulance jurisdiction in the world geographically to name a few. Not bad for a girl who left school at 15 to sell shoes. I think the key to developing the next generation is to instil in them a sense of confidence and to ensure they know their worth. I have made some tough choices particularly where family and career aspiration converge, however I always had confidence in my decisions. It has taken me nearly 40 years to finally learn that the fact that many people rolled into one - a woman, a wife and a mother and grandmother, with different perspectives, different priorities, different life experiences which - while threatening to some in the workplace - is a strength. I just wish I knew this at the beginning of my career, so hopefully those women reading this can embrace that knowledge. Can you comment on potential challenges that the generations of women coming behind you may face? Looking to the future, the fight for gender equality is not over. However, I take solace in the fact that women like myself may have helped to pave the way for future generations. Female Police Officers are no longer handed a pair of high heels when they join the force instead of a baton, women proudly follow a career in paramedicine and pursue leadership roles… we’re making progress. While there is undoubtably an increased awareness of women’s rights, future generations are still bound to face challenges and hardships. Women are still underrepresented in C-suite jobs and with COVID-19 monopolising the media, gender equity has taken a backseat.

Women need to continue to be confident, ambitious, challenge those around us. 64

A lot of the issues that existed 40 years ago when I started my first day on the Force still exist now. Women need to continue to be confident, ambitious, challenge those around us, decide what’s important, never compromise on your values and never underestimate your skills. We only get one life and time is the one resource they’re never making more of, so make the most of it.

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Free professional development without leaving your seat! Designed to inspire and educate, these hour-long webinars feature a range of speakers discussing topical issues from around the ambulance world.

22 March 2022 JULIE PIANTADOSI Women in Leadership: Real women fix each other’s crowns

28 April 2022 WAYNE LOUDON Stroke Prehospital Informed Decision-making using EEG Recordings

Keep an eye out for these other upcoming CAA webinars 31 May

Infection Prevention & Control - Supported by RAPP

28 June

Sustainability in the Ambulance Sector

26 July

Aeromedical – Supported by ZOLL

30 August

Patient Safety

27 September

Mental Health & Wellbeing

25 October

Cardiac Arrest – Supported by Philips

22 November

Technology – Supported by Trapeze

13 December

Clinical Practice – Supported by ZOLL

For more information and to register visit caa.net.au/webinars

Earn one CPD point for each webinar you attend.

Events First

Events First 66

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Inspire. Innovate. Elevate.

e look forward to welcoming you to CAA Congress 2022. Keep an eye out on our socials and other communications for more information on Congress that will be released shortly Over 2020 and 2021, we saw the entire world of face-toface events come to a screeching halt as we navigated a global pandemic. Everything from sporting events and festivals to conferences and meetings came to an eerie stand-still as in-person events seemingly became a thing of the past. CAA Congress was just one of the many events that was put on hold. Whilst we can all agree that the last 2 years have been exceptionally difficult, there has been a silver lining. Despite the devastating impacts of COVID on the events industry, it seemed we all found a greater appreciation for the inspiration and connection that face-to-face events bring. As appreciation rises, in person events have once again become a beacon for leaders, thinkers, and innovators alike. After a while of riding a wave of postponement, cancellations, and uncertainty, it is with great enthusiasm that we invite you to CAA Congress 2022 to do all the things we haven’t been able to. Join us to be inspired, think outside the box, and work together to elevate the pre-hospital sector. Complete with heavily anticipated specialised forums, a jam-packed Expo, captivating welcome function, and the glamorous Awards for Excellence Gala Dinner, CAA Congress 2022 is truly expected to be Australasia’s premiere event for the pre-hospital sector.

Events First

Congress: a place to be inspired On August 11-13th 2022, we welcome you to ICC, Sydney’s world-class International Convention Centre on the picturesque Darling Harbour- a place to be inspired. Situated at the intersection of Sydney’s academic, cultural and technology precincts, International Convention Centre Sydney (ICC) affords delegates convenient access to Australia’s most cosmopolitan city. Congress will feature a range of engaging speakers presenting on a broad range of topics within the pre-hospital sector. Expect for the message to not just be heard, but understood, absorbed and acted upon.

Keynote Speakers Spotlight: Dr Norman Swan Dr Norman Swan hosts The Health Report on the ABC's Radio National, which is the world's longest running health programme in the English speaking world. Norman has won many awards for his work including Australia's top prize for journalism, the Gold Walkley. He was the third person to be awarded the prestigious medal of the Australian Academy of Science and was given an honorary MD by the University of Sydney on its 150th Anniversary. Dr Swan will paint the picture of what health systems will look like in the next 5-10 years. He will review what the last two years of pandemic, demand management growth and health surge has done to the sector and how the systems need to adapt to be better for our patients, teams, and the public.

Spotlight: Professor Tony Walker ASM Over recent years, Ambulance Victoria has undergone significant transformation focused on improving the health and wellbeing of their workforce and the response they provide to the community. Despite these reforms, a recent review by the Victorian Equal Opportunity and Human Rights Commission, identified deeply engrained cultura issues which need to be addressed. Tony Walker ASM, CEO of Ambulance Victoria, will be presenting as a keynote speaker at CAA Congress 2022 and will explore the cultural drivers identified by the Commission and the pathway to change being adopted by Ambulance Victoria to addresses the Commission’s recommendations and ensure AV is a safe and inclusive organisation for all its people.

Spotlight: Julie Piantadosi

Julie Piantadosi, one of Australia’s most sought after coaches and trainers, will be presenting at CAA Congress in August. She helps leaders make the shift from ordinary to extraordinary through simple and effective tools. Julie will inspire, elevate and transform you, and get you ready to take action. As an NLP Master and cognitive behavioural coach, Julie has trained companies such as Qantas, BMW, Porsche and Kenneth Cole, just to name a few. As a 9/11 survivor, Julie encourages us to dig deeper, carefully consider our daily choices, reconstruct our attitudes, and increase our self-awareness to unlock our full potential. www.caa.net.au

Forums Women in Leadership Forum Kicking off Congress is the return of our much-anticipated Women in leadership and Infection Control. Following the success of the 2019 Women in Leadership Forum, we are proud to again put together a program to help empower current females, and foster thriving new careers for emerging females across the pre-hospital sector. Expect an impactful, dynamic, and uplifting presentation full of insights, tips, and development training to take back to, not only your place of work, but everyday life. Part inspiration, part education, part interactivity, you will leave with a set of tools, stories, and perspectives to flourish in any leadership role.

Infection Control Forum Infection control has never been more prevalent than it has in the last few years. As we left 2020, one of the most bizarre and challenging years for many to date, we entered 2021 with direction and precedent on how to navigate a global pandemic. At this point, we’re sure you’ve heard more than a few discussions on infection control. Join us for a completely refreshed Infection Control Forum where we focus on new and emerging technologies and divisions within the area. Expect a forum where we dive deeper into the topic of infection control and take a closer look at areas and implementation strategies that are, even after navigating a global pandemic, often overlooked.

Global Resuscitation Alliance Forum This Global Resuscitation Alliance Forum will bring you the latest developments in out-of-hospital cardiac arrest, including experts from around Australia and globally. The day will offer a HighPerformance CPR (Train the Trainer) session. In 2019 the GRA Masterclass was sold out and we expect the same for this new Forum.

Events First

Expo Running concurrently alongside Congress is the CAA Expo, a focal point of Congress. A hub of interaction, the CAA Expo floor is a bustling and dynamic environment where ideas come to life. Make your way through a specially designed, premium and dynamic space featuring state-of-the-art exhibition booths, designed to flaunt our exhibitors' latest innovations.

Expo Passport

Mini-Masterclasses

Live Demonstrations

If you’re feeling adventurous, for the first time ever, CAA has collaborated with exhibitors to launch our Expo Passport. The Passport adds an entirely new experience to Congress and provides a unique and exciting path for delegates to take when exploring the Expo floor. The Passport requires delegates to travel to various booths and areas on the expo floor in exchange to get their passports ‘stamped.’ Once a delegate has received ‘stamps’ from all passport destinations, they can go into the drawer to win one of many prizes.

Mini-Masterclasses are new to the Expo floor for 2022. CAA has collaborated with top exhibitors and renowned topic experts to bring you these sessions, which have been carefully crafted to teach you a new skill in just 20 minutes. These Mini-Masterclasses are not only designed to teach new skills, but are constructed to deliver a wholistic experience to also practically engage delegates to approach the sessions with creativity, optimism, and inventiveness. Both entertaining and educational, you’ll be surprised by how much you can get out of a 20-minute masterclass.

As you travel around the Expo floor, you’ll also see a number of live demonstrations from a variety of our exhibitors. See the latest industry products, strategies, and emerging ideas come to life in hands-on demonstrations designed to intrigue and light up the space. If you’re interested in becoming an exhibitor or discovering our sponsorship packages, please contact events@caa.net.au.

Events Intertwined into 2022 Congress is a number of social, networking and celebratory events.

CAA Congress Welcome Function Finish off the first busy day of Congress by joining the CAA team, colleagues and partners on the ICC balcony overlooking Darling Harbour to mingle over welcome drinks and nibbles.

Delegate Networking Breakfast Held in our Exhibition Space, the ICC’s Gallery, this networking event will kick off the Expo and provide delegates with an opportunity to meet and mingle with exhibitors before the two-day plenary kicks off. Be the first to see our bustling Expo space with a chance to meet and network with our delegates, partners, exhibitors, and speakers.

Awards for Excellence The CAA Awards for Excellence have been run for over 10 years to recognise the hard and innovative work of member ambulance services from Australia, New Zealand and Papua New Guinea. The awards are independently judged by a panel of industryrespected judges from across the globe, with winners announced at our prestigious Gala Dinner event at the beautiful Dockside restaurant overlooking Darling Harbour.

Tickets for CAA Congress have been released and are available to purchase through the CAA Congress website. We will be thrilled to welcome you to you to ICC, Sydney in August 2022. To stay updated with all things Congress, keep an eye out on our socials. We look forward to seeing you, your organisation, and your colleagues then.

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Tickets available now at caacongress.net.au

11-13 August 2022 International Convention Centre, Sydney

Partners First

Mark your calendar: AFAC22 returns to Adelaide

he date has been set for 2326 August 2022 when the emergency management sector will connect again, ready to be inspired by the latest in research and practice.

‘Connecting communities. Creating resilience.’ will be the conference theme for AFAC22 powered by INTERSCHUTZ, which will be held at the Adelaide Convention Centre. The AFAC22 team invites you to share your knowledge, research and projects that speak to the unique position the emergency management industry is in to connect diverse communities. Through collaboration, engagement and partnerships, links are formed which bind us together. These links are enabled by technology and infrastructure that facilitate networks that are not limited by space, distance or time. AFAC22 will explore how an inclusive approach across emergency management agencies, is integral to reducing risk and fostering resilience now and into the future. The AFAC22 Program Committee is currently looking for examples of solutions to emerging risks, impacts and recovery through the presentation of case studies, research utilisation and storytelling.

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Partners First

Connect and network with peers on site and in person

What can you expect at AFAC22?

Back in-person better than ever, AFAC22 will build on the success of the past two phenomenally successful events. A testament to the resilience of the industry, AFAC21 was the first virtual event in the conference and exhibition’s 26-year history. The virtual event attracted more than 2,500 attendees, featured 120 sessions across seven streams, nine keynote presentations, and 37 virtual exhibitors.

AFAC22 powered by INTERSCHUTZ is Australasia’s largest and most comprehensive emergency management conference and exhibition and will be hosted by the fire, emergency service and land management agencies in South Australia.

The last in-person, pre-pandemic event, AFAC19 in Melbourne saw a record number of over 4,000 practitioners, researchers, critical thinkers, and international guests in attendance. At 12,000sqm, delegates were able to witness the latest technology and operations equipment first-hand with a live demonstrations area, further presentations and 194 exhibitors, including 47 international exhibitors from 17 countries.

AFAC22 will offer you an unrivalled opportunity to learn from international and local thought leaders across the multi-streamed AFAC conference, featuring the Institution of Fire Engineers (Australia) National Conference and the Australian Disaster Resilience Conference. AFAC22 will also feature its renowned world-class exhibition. Every year, the exhibition attracts a comprehensive range of exhibitors covering all facets of emergency management equipment, technology and services. All attendees have access to the very popular live demonstration zone and practical expo stage presentations. For more information, go to afacconference.com.au

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European EMS Congress in Scotland

he European EMS Congress is back and will take place in Scotland in May. The theme is It Takes a System to Save a Life and this year we added People Make EMS.

We are proud to invite you to our usual concept of interactivity, engagement, high scientific standard, and the well-known Championship with 16 international teams competing daily and in the finals. In addition, we are now introducing a day three with a new concept: EMS Rapid Fire session followed by 8 EMS Labs. Our popular and inspiring “EMS-TED” talks are of course still part of the program. Women in EMS and Sustainability in EMS are new important themes and are inspired by our friends at the Council of Ambulance Authorities in Australia and New Zealand. This international congress is organized by the European EMS Leadership and is a truly international congress with participants from more than 50 countries. As COVID restrictions are ceased we now expect more than 1.000 participants, and we have the ambition to make this the best European EMS congress ever.

Scotland welcomes you at the famous convention centre Scottish Event Campus (SEC) in Glasgow, known for its accreditation as a healthy venue and for its sustainability. The social program is all organized by our Scottish Colleges from Scottish Ambulance Service. Don’t miss this opportunity for networking, Scottish hospitality and surprises. Ahead also awaits the amazing Scottish landscapes and nature for you to explore. As EMS we are serving our communities and we have so much in common and so much to share. We learned a lot being in the frontline in the fight against COVID-19. Now is the right time to get together – in May in Scotland.

As international experts are gathering in Scotland, it has been decided to host a Global Resuscitation Alliance meeting - the first since 2019. More information to follow.

For more information visit www.emseurope.org

Partners First

ACP workforce survey will shape new career pathways for paramedics By John Bruning, CEO, Australasian College of Paramedicine

he past two years of the COVID-19 pandemic have placed an enormous strain on frontline health workers across all jurisdictions, stretched the capacity of paramedics, and laid bare the staffing, resourcing and systemic gaps within the health system that have come to the fore during this public health crisis.

The Australasian College of Paramedicine believes paramedics, with their unique skillsets and range of capabilities, are well placed to help address these challenges through deployment in different capacities in the community, which will alleviate pressure on the health system, reduce health care costs, and improve overall public health outcomes.

We believe this will mark the beginning of a new era for paramedicine; one that will reflect the current diversity of professional practice, realise the potential for better utilisation of a highly educated and skilled health workforce, and support the continued evolution of the profession as it expands beyond traditional emergency ambulance response into innovative new models of care.

However, the current data on paramedicine is disjointed and unsuited to highlighting the important role paramedics can and do play in the health system, hindering the potential for the expansion of the paramedicine profession and its ability to address the challenges currently being faced.

Since the introduction of paramedic registration in Australia in 2018 and last year in Aotearoa New Zealand, paramedics are increasingly working across a variety of healthcare settings, not just jurisdictional ambulance services, taking on a range of duties across multiple settings in primary, community and extended healthcare.

In order to overcome the data deficit, the College will this year launch a major workforce survey that covers all facets of paramedicine, all work and employment areas (including jurisdictional services, private, industrial, maritime, mining, and events, among others), academia, management, students, graduates, and volunteers. Our goal is to create a complete picture of paramedicine and provide usable and publishable data to show what is happening with paramedics and students and the work they are doing. The data that is gathered will help the College create a Paramedicine Career Framework in collaboration with stakeholders that will define pathways and opportunities for paramedics and students across all areas of paramedicine in 2023.

As degree-qualified registered health professionals, with largely independent scopes of practice supported by practitioner clinical reasoning and evidence-based guidelines, paramedics are being employed in private and event medical support organisations, heavy industry and large institutions, in aged and disability care providers, in primary health care settings, and in Aboriginal and community health services. Paramedics’ education, knowledge, skills, and experience provide a comprehensive base upon which to deliver high-quality, holistic and responsive health services spanning all facets of community and out-of-hospital care in a variety of formal and informal environments. They have been at the forefront of developing and supporting new community-based models of care, and throughout the pandemic have assisted with contact tracing, quarantine health, testing, vaccination, respiratory clinics and targeted mobile responses to isolated and remote communities.

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The College will this year launch a major workforce survey that covers all facets of paramedicine, all work and employment areas” John Bruning

CEO, Australian College of Paramedicine

Our workforce survey is the first step in gathering and consolidating industry-wide data on the breadth of paramedicine professional practice that will enable us to develop a multifaceted, industry-first framework for paramedics at all stages of their careers, and will pave the way for different work options for paramedics that will ultimately result in improved health services, strengthened primary care provision, and the ability of the profession to address the existing workforce shortages and gaps in health services; roles that will benefit the health sector and ultimately, all communities. We encourage all paramedics, employers and stakeholders to embrace and participate in this important survey, in so doing helping the profession to realise the full potential of paramedic practice, knowledge and skills within health services, and the integration of the profession across the health system.

Research First

The STAY Trial Safe Treatment of Atrial fibrillation in the communitY By Ambulance Victoria

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ntroducing a new model of care in Victoria to treat patients with atrial fibrillation safely and efficiently at home.

STAY is the first of its kind and may serve as a paradigm to treat other low-risk patient cohorts not necessarily requiring emergency ambulance transportation and immediate hospitalisation.

Research First

Background

Aim

Roughly 10,000 patients present to Victorian emergency departments (EDs) each year with atrial fibrillation (AF). Approximately two thirds of these patients are currently assessed by paramedics in their homes and transported to hospital EDs for further care. Patients referred to specialist clinics via ED generally face a 4–6-week delay for an appointment. Ambulance Victoria was approached by the Victorian Department of Health and Safer Care Victoria (SCV) to develop an alternative pathway for low-risk AF patients to reduce the burden on ED.

Overall, the study aims to understand whether community-based care for AF patients at low shortterm risk of clinical complications can be provided demonstrating feasibility, safety, and patient acceptability.

Safe Treatment of Atrial fibrillation in the communitY (STAY) is a feasibility study that is being pioneered in Melbourne by Ambulance Victoria in partnership with university teaching hospitals with established specialist atrial fibrillation outpatient clinics. STAY involves the establishment of a telehealth cardiology consult service to be utilised by paramedics during ambulance attendances of low-risk patients with acute AF presentations. Under the direction of the cardiologist, paramedics may administer a single dose of a beta blocker and anticoagulant. Rather than being transported to ED as per standard care, patients will remain at home to be contacted by the outpatient AF clinic to secure a rapid access appointment within 48 hours.

• Feasibility will be defined by the proportion of lowrisk patients managed safely in the community and subsequently attending the AF clinic. • Safety will be assessed by clinical risk stratification tools, and any serious or major bleeding events, or other adverse events after medication administration. • Patient acceptability will be assessed by Net Promotor Score (NPS), a 10-point scale satisfaction tool, administered at the outpatient clinic.

Rationale There is currently no Australian paradigm for this model of AF care and there is a scarcity in the literature regarding alternative care pathways for pre-hospital AF management. Hospital trends in Australia demonstrate that AF is the most common cause of cardiovascular hospitalisations in Australia1. As hospitalisations account for over 50% of associated costs for AF, this growing epidemic represents a major public health challenge2. As the number of individuals in Australia with AF is expected to double by 20343, AF places a significant resource and financial burden on health services. There are several potential advantages if this model-of-care is validated; not only can patients avoid the stress, inconvenience and costs associated with ambulance transport and hospital admission, patients will be able to prevent unnecessary contact with hospitals while the COVID-19 threat persists.

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Procedure

Early experience

The pilot study, led by Professor Karen Smith, Ambulance Victoria, and Dr Mark Horrigan, Austin Health, involves a smaller patient catchment surrounding Austin Health in Melbourne. The in-field procedure is as follows:

Since the pilot’s commencement in December 2021, paramedics have successfully enrolled and treated four patients at home under the direction of Austin Health Cardiology. The AV and Austin research teams continually work together to improve the service and infield procedure, utilising feedback from both paramedics and patients. The in-field procedure to connect paramedics with the cardiology service is imperative to the study’s initial success and long-term sustainability if integrated into an evolving ambulance service. To date, the study has received positive feedback from all enrolled participants, who favoured the timely followup by the outpatient clinic, and the opportunity to avoid hospital ED and consequently a possible exposure to COVID-19. The pilot will conclude in December 2022 before the study expands to other participating hospital sites.

• All adult patients with AF attended by Ambulance Victoria paramedics can be considered for the alternative care pathway. Patients who live alone are not considered for enrolment. • After confirming an AF diagnosis via electrocardiogram (ECG), a risk assessment is performed by paramedics to identify patients with compromised circulation, heart failure, bleeding or other problems that mandate transport for hospital assessment and care. Patients exhibiting these symptoms are transported to hospital as per standard care. • Paramedics transmit the ECG output to Austin cardiology and telephone the on-call cardiologist to discuss the patient’s presentation. • Under the direction of the cardiologist, eligible patients may receive a single dose of metoprolol and rivaroxaban where appropriate. • Paramedics advise the patient of next steps regarding being left at home, and hand over written documentation with further instructions and contact details if they experience a deterioration. • Austin Health cardiology contact the patient within a 48-hour time period to arrange either a telehealth or in-person outpatient clinic appointment. The clinic will also organise ongoing prescriptions in the interim if necessary. • The clinic collects comprehensive clinical information including ECG, biometrics. (CHA2DS2-VASc score, to assess patient’s thromboembolic risk, and HAS-BLED score to assess the patient’s risk of bleeding. The clinic will also administer the NPS, which asks the patient to rate the following question on a scale of 1 to 10, “How likely would you recommend the service to a friend or family member?”

Given the increasing demand on hospitals, further exacerbated by the COVID-19 pandemic, it is possible that this clinical pathway or similar has the potential to be implemented for other low-risk patient cohorts not requiring immediate ambulance transport to an emergency department. Ultimately, the development of novel models-of-care enable Ambulance Victoria to provide the right care in the right place and at the right time.

References 1. Gallagher C, Hendriks J, Giles L, Elliott A, Middeldorp M, Mahajan R, et al. Twenty-Year National Trends in Hospitalisations Due to Atrial Fibrillation in Australia: A Relentless Rise. Heart, Lung and Circulation. 2017;26(S2):S175-S. 2. Briffa T, Hung J, Knuiman M, McQuillan B, Chew DP, Eikelboom J, et al. Trends in incidence and prevalence of hospitalization for atrial fibrillation and associated mortality in Western Australia, 1995&#x2013;2010. International Journal of Cardiology. 2016;208:19-25. 3. Ball J, Thompson DR, Ski CF, Carrington MJ, Gerber T, Stewart S. Estimating the current and future prevalence of atrial fibrillation in the Australian adult population. 2015;202(1):32-5.

CRITICAL CARE IN THE AIR CRITICAL CARE ANYWHERE

Call for abstracts EXTENDED to IT'S NOT TOO LATE TO SUBMIT AN ABSTRACT FOR THE

2022 ASA+FNA CONFERENCE VISIT WWW.AEROMEDCONFERENCE.COM

Video Streaming in Emergency Medical Dispatch By Gitte Linderoth, Christian Meyhoff, Doris Østergaard, Helle Christensen, Fredrik Folke and Freddy Lippert, University of Copenhagen and Copenhagen EMS.

Technology can unblind the dispatcher Most communities have an emergency number for critical injuries and medical conditions. An accurate assessment of medical needs and priorities is essential for any Emergency Medical Service (EMS) System, for best patient care and for best use of resources. The process has been based upon a traditional telephone call with an interview with questions and answers. Then a decision usually is made about the severity and the right medical response should be taken within few minutes. We have been using only verbal communication for decades. Now is the time to ‘unblind’ the telecommunicator/dispatcher, to reveal more exact information from the emergency scene and be less reliable on the difficult verbal communication.

“New technology” has been here for years, video streaming is used by most of us daily to facilitate communication, feelings and see the real world. EMS agencies can now move forward and introduce new technology like video streaming to their dispatch system. The traditional barriers are well known and often an excuse for not taking advantages of what seems to be obvious: faster and better assessment of a medical incident and thereby better patient care and better use of our limited resources.

Research First

From verbal communication to verbal and visual communication In this article we want to share our experiences from Copenhagen, Denmark with use of video streaming for emergency calls. This includes, why we initiated this and our journey from Analysing closed-circut television (CCTV) from the emergency scene to now fully implementation of video streaming in our dispatch and control center. During this period, we collected data and carefully analyzed our results and published scientific documentation ending up with a PhD degree obtained by MD Gitte Linderoth in February 2022 at the University of Copenhagen. Results from these studies will briefly be presented for inspiration (ref 1).

Starting with cardiac arrest It has become evident that the first link in the chain of survival is crucial to final outcome, especially in case of time critical incidents like cardiac arrest. For years we have used the traditional phone call to establish contact to the control room of the ambulance services. This has been the only communication tool to receive information, ask questions and get medical and health care information from lay persons in order to respond appropriately and to guide the caller, for instance, to start bystander cardiopulmonary resuscitation (CPR).

What is going on before arrival of the ambulance service We wondered how we could get more information about what happened on scene before the arrival of the ambulance services. For this purpose, we started collecting information from CCTV located near the scene of a cardiac arrest.

Snapshot from CCTV surveillance at train station (blurred and with permission)

We analyzed these footages and combined the visual recording with the corresponding voice recording from the emergency call to the dispatch center. It became evident that there were a lot of communication mistakes. These included, lack of situation awareness and scene overview leading to suboptimal guidance, and not using available resources at scene. It became evident how important specific feedback and follow up on instructions are. The important role of the dispatcher as team leader cannot be emphasized enough. (ref 2)

The setting - Copenhagen Emergency Medical Services Copenhagen EMS is a public health organization within the Capital Region of Denmark. Copenhagen EMS is serving a population of 1.8 million people. The dispatch center answers 110,000 emergency calls per year (European emergency number 1-1-2). Copenhagen EMS dispatches 200,000 emergency ambulance responses in total. The medical dispatchers are specially trained, registered nurses or paramedics and their decisionmaking process is supported by a nationwide criteriabased Emergency Medical Dispatch protocol (Danish Index). Medical call-takers are paramedics and nurses with a medical doctor on duty in the dispatch center for supervision of dispatchers and ambulances. The Computer Assisted Dispatch system is provided by Logis Solutions (https://logissolutions.net). The Video Streaming solution used for these studies was provided in collaboration with GoodSAM (https://www.goodsamapp.org).

Figure 1 - An illustration of communication pathways

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The dispatcher’s perception

The practical and technical solution

The footage and the voice logs were used to get information about the dispatcher’s perception and value of adding video to a call. The dispatcher listened to their own calls and then to the call including the footage. The reflections from the dispatchers were that video gave added value to situation awareness, the scene, the patient’s condition, and more relevant information about the caller’s response to guidance. (ref 3)

When the dispatcher receives a call, they automatically get the phone number of the phone being used and a GPS position of the phone. The dispatcher asks for confirmation of the number and location and use a criterion based electronic protocol (Danish Index for Emergency Care) for further assessment. When video streaming is used, the dispatcher informs the caller that the dispatcher would like to add video streaming and that the dispatcher has sent a link to their smartphone asking for permission to open the camera. If the caller accepts this request the camera on their phone opens immediately and the dispatcher will receive encrypted video streaming to one of their screens. It is a one-way streaming, so the caller is not able to see the dispatcher. The footages are stored at the Copenhagen EMS server and linked to the actual call-ID

Figure 2 - Simulated live Video Streaming. Illustration provided by GoodSAM, UK.

From case analysis to live streaming during emergency calls These two studies revealed the need for adding visual information for the dispatcher during the emergency call. To test practical issues and feasibility it was necessary to introduce video streaming during emergency calls to our dispatchers, educate and train the dispatchers and test and adapt our technical solution during non-emergency calls. We collaborated with GoodSAM using their video streaming solution. After an initial training and having the option of adding video streaming to the conversation, we decided to analyze the added value of video streaming. This was done in two different studies. One study analyzed the impact to the dispatcher’s decision; would adding video streaming change the initial assessment and ambulance response or not. The second study analyzed whether video streaming could improve bystander CPR performance and quality.

Decision making with or without video streaming This study investigated whether video streaming would give further relevant information and thereby change the priority and the assessment of the situation. The dispatcher would make their initial assessment and decision about priority and response type bases upon the traditional verbal communication. After this was done the dispatcher could add video streaming and reassess the situation. In total, 828 emergency calls with added video streaming were obtained. In the half of the cases using video streaming, there was a change in the assessment, and often an upgrade or downgrade of response. The dispatchers were also interviewed whether they considered video useful. In 88% of cases the dispatcher considered video very or extremely useful. (ref 4)

Figure 3 - Illustration – with or without video streaming

Research First

Impact of video streaming on bystander CPR quality In this study 52 cardiac arrest cases were analyzed with 90 bystanders providing CPR. After cardiac arrest was confirmed, traditional dispatcher assisted CPR (DA-CPR) was initiated using verbal communication. When DA-CPR was on-going and the ambulance had been dispatched then video streaming was added to the ongoing verbal telephone communication. This was only done if more than two bystanders were available at scene. With video streaming the dispatcher had more information on the ongoing CPR and could thereafter guide according to the additional information. The footages were later analyzed by the research team to evaluate the usual quality standards for bystander CPR: correct hand position, compression rate and depth, stretching arms, recoil, hands-off time and ventilations. Though it was not possible to make a reasonable assessment of ventilation by using the recordings, all preselected quality indicators were improved after adding video streaming and additional guidance, except for recoil quality being unchanged. (ref 5)

Clinical perspectives for the future These studies examining video streaming in emergency calls revealed a potential for adding visual information to the dispatcher’s traditional verbal communication with the caller. It also demonstrated that live video streaming of emergency calls to a dispatcher is technically and practically feasible. Without delay in call handling, video streaming can be added, and the dispatchers expressed high satisfaction with the option to obtain more and better information. With live video streaming it was also shown that this led to changes in the assessment of the patient in half of the cases and often a change in the emergency response. For a specific study on bystander CPR quality, it was shown that using video streaming had a positive impact on quality of bystander CPR as the dispatcher could improve their guidance and feedback based upon visual information. These studies were not designed to address survival as final outcome. However, it seems obvious that live video streaming offers a potential for better emergency assessment and bystander guidance during emergency calls. The technology is here, it can be implemented in everyday practice - so the question is: why don’t we unblind our dispatchers now? Video streaming has now been fully implemented in Copenhagen EMS not only for emergency calls but also for calls at our medical helpline being used for out-ofhour services and referral of patients to emergency departments.

Figure 4 - Change in CPR quality before and after video streaming

Barriers such as traditional thinking and ethical concerns must be recognized and addressed. We emphasized an open dialogue and broad implementation to facilitate quick adoption of experience with the new technology. Training in establishing video streaming is essential and most importantly, we need to re-consider and change our protocols for dispatchers accordingly. We have trained our dispatcher for years using verbal communication to make critical decisions for decades. Now we should retrain our dispatchers also to watch and to analyze visual information and combine this into new dispatch protocols.

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References

Acknowledgments

1. Video from the emergency scene before ambulance arrival - Introducing, analyzing, and understanding video to the medical dispatcher with focus on cardiac arrest Linderoth, G., PhD thesis obtained February 2022. University of Copenhagen, Denmark.

Studies received unrestricted grants from the Danish Foundation TrygFonden, The Danish Heart Foundation and Laerdal Foundation.

2. Linderoth, G., Hallas, P., Lippert, F. et al. Challenges in out-of-hospital cardiac arrest-a study combining closed-circuit television (CCTV) and medical emergency calls, Resuscitation, 96 (2015), pp.317-322. https://doi. org/10.1016/j.resuscitation.2015.06.003

GoodSAM solution was used for video streaming. GoodSAM UK offered technical support and collaboration and had no influence on data collection, interpretation and reporting.

3. Linderoth, G., Møller, T.P., Folke, F. et al. Medical dispatchers’ perception of visual information in real out-of-hospital cardiac arrest: a qualitative interview study. Scand J Trauma Resusc Emerg Med 27, 8 (2019). https://doi.org/10.1186/s13049-018-0584-0 4. Linderoth, G., Lippert, F., Østergaard, D. et al. Live video from bystanders’ smartphones to medical dispatchers in real emergencies. BMC Emerg Med 21, 101 (2021). https://doi.org/10.1186/s12873-021-00493-5 5. Linderoth, G., Rosenkrantz, O., Lippert, F et al. Live video from bystanders' smartphones to improve cardiopulmonary resuscitation. Resuscitation, 168 (2021) pp 35-43. https://doi.org/10.1016/j. resuscitation.2021.08.048

Freddy Lippert

Gitte Linderoth

MD, Copenhagen EMS, associate professor University of Copenhagen, Denmark. Founding member of The European EMS Leadership, the European EMS Congress and founding member of The Global Resuscitation Alliance. After more than 25 years in emergency care, as a clinician, as manager, medical director, and as chief executive I am convinced that 'It takes a system to save a life'.

Specialist in anesthesiology and prehospital emergency care. Physician on the mobile critical care unit at Copenhagen EMS. PhD within the prehospital care investigating the use of the live video streaming from a bystander's smartphone to the medical dispatcher. Works in-hospital at Copenhagen University Hospital-Bispebjerg and Frederiksberg, Denmark.

MD, PhD

Research First

Prehospital Interventions to Improve Outcomes from Traumatic Brain Injury Ben Bobrow, MD, Professor and Chair, Department of Emergency Medicine, McGovern Medical School at UTHealth Houston

What is Traumatic Brain Injury (TBI)

Excellence in Prehospital Injury Care (EPIC)

TBI occurs when external mechanical forces impact the head and cause either an acceleration or deceleration of the brain within the cranial vault. TBI is a leading cause of death and disability and approximately 5.3 million affected Americans require long-term assistance with their daily activities1. TBI occurs as a primary brain injury at the time of injury and can also have a secondary brain injury component occurring in the minutes and hours following the primary injury2. Early goals to resuscitating the injured brain include:

The EPIC project was a statewide collaboration with more than 130 Emergency Medical Services (EMS) throughout Arizona, United States of America. The project collected and linked prehospital and hospital outcome data on approximately 22,000 major TBI cases and conducted studies that measured the incidence of TBI and process of care to determine the impact of the prehospital TBI guidelines.7 The EPIC project resulted in approximately 93% of TBIs state-wide receiving care by EMS agencies that were trained and certified in the EPIC protocol7. The project had 600 master trainers statewide with over 11,000 trained prehospital providers that were trained in aggressively preventing and treating hypoxia, hypotension, and hyperventilation7. Project requirements included TBI guideline training for trainers, implementing guideline-based treatment approaches, and providing prehospital data7.

1. Avoiding and rapidly correcting hypoxia: Over 55% of patients with TBI suffer from prehospital hypoxia while more than 50% of patients suffer from hypoxia before or during intubation3,4. Hypoxia can be critical as multiple studies have shown that a single non-spurious oxygen saturation of less than 90% is independently associated with doubling of mortality4 2. Avoiding and rapidly treating hypotension: Data from multiple studies have shown that a single episode of systolic blood pressure (SBP) decreasing to less than 90 is independently associated with at least a doubling of mortality5 3. Avoiding or rapidly correcting hyperventilation: Hypocapnia with end tidal carbon dioxide (ETCO2) less than 30 millimetre of mercury (mmHg) occurs in two thirds of cases while ETCO2 less than 25mmHg occurs in remaining cases6.

EPIC Project Design The study had three phases, phase 1(P1) preimplementation, phase 2 (P2) training (initiation to completion), and phase 3 (P3) postimplementation. Using data from the Arizona State Trauma Registry with data on patients treated at level 1 trauma centres (TCs), electronic and paper-based records from included patients between January 1, 2007 to June 30, 2015 were collected5. Patients were included in the study based on the following criteria7: 1. Transported directly to or transferred to a TC 2. Diagnosis consistent with TBI 3. Met at least 1 of the definitions of United States Centres for Disease Control and Prevention Barell Matrix-Type 18,9 4. Abbreviated Injury Scale Score (ISS)-Head of at least 3

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EPIC Project Treatment Protocol

EPIC Project Results

The EPIC project treatment protocol included the following steps7:

The study cohort had 21,852 patients who met the inclusion criteria for the project with 15,228 patients cared for by agencies in P1 and 6,624 cared for by agencies in P37. Patients included in the study were 70% with severe TBI ISS 3-4, 20% critical TBI ISS 5-6, and 10% moderate TBI ISS 1-27.

1. Treatment of hypoxia by administering high flow oxygen early (at 15 litres/min through non-rebreather masks). Hypoxic patients with oxygen saturation of less than 90mmHg received assisted bag-valve-mask (BVM) ventilation at 10 beats per minute (bpm), and intubation was only done if BVM was inadequate, high risk of respiration, or if the patient was on air transport to far from a TC. 2. Prevention of hyperventilation through rapid identification and aggressive treatment. While the guidelines indicate SBP less than 90mHg, in the EPIC project, intravenous crystalloids were administered if SBP approached 90mmHG or was trending downward. This treatment would be continued until SBP increased over 90mmHg. To avoid hyperventilation, a ventilation-emergency medical technician was assigned to monitor ventilation rates. Target ventilation rates were: a. Adults over 15 years of age - 10 bpm

The primary analysis showed an adjusted odds ratio (aOR) of 1.70 (95% confidence interval (CI), 1.38-2.09; P < .001) for survival to admission and an aOR of 1.06 (95% CI, 0.93-1.21) for survival to discharge which was nonsignificant (p=.40)7. Meanwhile, the secondary analysis showed the effects of intervention on survival in different injury categories such as moderate, severe, and critical TBI. It was found that in patients with severe TBI, the odds of survival to hospital discharge doubled (Figure 1a)7. Patients with severe TBI that required positive ventilation had 3.5 times higher odds of survival to hospital discharge as seen in Figure 1b7. This showed that implementing the prehospital TBI treatment guidelines was beneficial and results in the tripling of survivors for the severely injured TBI cohort7.

b. Children between 2 - 14 years of age - 20bpm c. Infants - 25 bpm 3. Avoidance and treatment of hypotension by infusing isotonic fluids10

Research First

Figure 1a and 1b showing secondary analysis results of EPIC study. (Image on left) patients with severe TBI had twice the odds of survival to hospital discharge and (image on right) patients with severe TBI that required positive pressure ventilation had 3.5 times the odds of survival to hospital discharge7. Implementation of the EPIC project was also associated with the following: 1. Lower rate of intubation 2. Greater hypoxia reversal 3. Greater likelihood of receiving a fluid bolus patients that were hypotensive and near-hypotensive 4. Lower rate of hypocapnia Figure 1a

Figure 1b

Conclusion of EPIC Project EPIC found that when prehospital providers implemented the TBI guidelines, it was not associated with improved overall survival rates for moderate, severe, and critical TBI7. However, in patients with severe TBI, survival rates doubled while in those with severe TBI who received positive pressure ventilation or intubation, survival rates tripled7. This prehospital intervention holds tremendous promise to improve TBI patient outcomes. www.epic.arizona.edu ZOLL’s TBI Dashboard on the X Series® Advanced monitor/defibrillators, as seen in Figure 2, is able to support effective management and quick treatment of TBI patients11. ZOLL’s TBI Dashboard allows medics to have access to real-time display of comprehensive data on hypoxia, hypotension, and hyperventilation which enables them to make appropriate medical decisions to treat each patient7,12. The TBI Dashboard also triggers an alarm as threshold levels for hypoxia, hypotension, and hypotension are reached and again if they are crossed to help medics provide timely care to patients11. In addition, ZOLL’s Real BVM Help can also assist medics to provide real-time audio and visual feedback on BVM parameters to ensure that patients are not over-ventilated as ventilation is a component of TBI management13. Subsequently, the feedback obtained can be used in postevent briefings to improve the quality of care provided to TBI patients.

Figure 2 illustrating ZOLL’s TBI Dashboard, which available on ZOLL’s Propaq MD and X Series Advanced professional monitor/defibrillators11.

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References: 1. Cdc.gov. 2022. [online] Available at: <https://www. cdc.gov/traumaticbraininjury/pdf/TBI_in_the_ US.pdf> [Accessed 21 January 2022]. 2. van Wyck, D., Loos, P., Friedline, N., Stephens, D., Smedick, B., McCafferty, R., Rush, S., Keenan, S., Powell, D. and Shackelford, S., 2017. Traumatic Brain Injury Management in Prolonged Field Care. J Spec Oper Med, [online] Fall 2017(17(3), pp.130140. Available at: <https://pubmed.ncbi.nlm.nih. gov/28910483/> [Accessed 21 January 2022]. 3. Stocchetti, N., Furlan, A. and Volta, F., 1996. Hypoxemia and Arterial Hypotension at the Accident Scene in Head Injury. The Journal of Trauma: Injury, Infection, and Critical Care, 40(5), pp.764-767. 4. Davis, D., Hoyt, D., Ochs, M., Fortlage, D., Holbrook, T., Marshall, L. and Rosen, P., 2003. The Effect of Paramedic Rapid Sequence Intubation on Outcome in Patients with Severe Traumatic Brain Injury. The Journal of Trauma: Injury, Infection, and Critical Care, 54(3), pp.444-453.

7. Spaite, D., Bobrow, B., Keim, S., Barnhart, B., Chikani, V., Gaither, J., Sherrill, D., Denninghoff, K., Mullins, T., Adelson, P., Rice, A., Viscusi, C. and Hu, C., 2019. Association of Statewide Implementation of the Prehospital Traumatic Brain Injury Treatment Guidelines With Patient Survival Following Traumatic Brain Injury. JAMA Surgery, 154(7), p.e191152. 8. Barell, V., 2002. An introduction to the Barell body region by nature of injury diagnosis matrix. Injury Prevention, 8(2), pp.91-96. 9. Clark, D., 2006. Estimating injury severity using the Barell matrix. Injury Prevention, 12(2), pp.111-116. 10. Spaite, D., Bobrow, B., Stolz, U., Sherrill, D., Chikani, V., Barnhart, B., Sotelo, M., Gaither, J., Viscusi, C., Adelson, P. and Denninghoff, K., 2014. Evaluation of the Impact of Implementing the Emergency Medical Services Traumatic Brain Injury Guidelines in Arizona: The Excellence in Prehospital Injury Care (EPIC) Study Methodology. Academic Emergency Medicine, 21(7), pp.818-830.

5. Chesnut, R., Marshall, L., Klauber, M., Blunt, B., Baldwin, N., Eisenberg, H., Jane, J., Marmarou, A. and Foulkes, M., 1993. THE ROLE OF SECONDARY BRAIN INJURY IN DETERMINING OUTCOME FROM SEVERE HEAD INJURY. The Journal of Trauma: Injury, Infection, and Critical Care, 34(2), pp.216-222.

11. TBI dashboard: The information you need ... - info. zoll.com. Available at: https://info.zoll.com/hubfs/ Markets/EMS/Documents/XSeriesAdvanced_TBI_ Dashboard_EP0260_A4_05.pdf?hsLang=en-gb [Accessed February 3, 2022].

6. Davis, D., Dunford, J., Ochs, M., Park, K. and Hoyt, D., 2004. The Use of Quantitative EndTidal Capnometry to Avoid Inadvertent Severe Hyperventilation in Patients With Head Injury After Paramedic Rapid Sequence Intubation. The Journal of Trauma: Injury, Infection, and Critical Care, 56(4), pp.808-814.

13. Corporation, Z.O.L.L.M., Learn more about the X series advanced. ZOLL. Available at: https://info.zoll. com/learn-more-about-the-x-series-advanced-zoll [Accessed February 3, 2022].

12. Joint Trauma System/Committee on Tactical Combat Casualty Care, TCC Guidelines 1 Aug 2019.

Partners First

Time in nature is good for our mental health… but what about artificial nature? By Navjot Bhullar BA (Hons), MA, MPhil, PhD, MAPS, Professor of Psychology at Edith Cowan University

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ake a moment and imagine yourself in nature — whether it's walking in a rainforest, bushwalking, swimming in the ocean, or a moment of wonder at the animals and plants around us. So, time in nature does us good. But how?

Do you feel it? You might feel relaxed and less stressed by experiencing yourself being in contact with nature. Nature offers us a respite from the daily grind of routines and demands. This innate desire to connect with our natural environments is labelled "biophilia hypothesis" — a term put forward by sociobiologist Edward Wilson in 1984. Research has found that spending time in natural settings is linked to:

How do we derive such positive experiences from being in nature? Now, many cultures have their own complex connections to nature, but

We found that a virtual experience of wild nature (natural settings, such as wilderness with little human interference) improved positive mood.

•

Reductions in stress, feelings of anger, and fatigue

•

Increases in happiness (otherwise known as "positive mood")

•

Fewer symptoms of depression in adulthood and reductions in symptoms of attention deficit and hyperactivity disorder in children

from the Western scientific school of thought at least, two major theories help us understand this connection. First, Attention Restoration Theory is the idea that natural settings restore our attention. We can only focus our attention for a certain period of time before feeling mentally fatigued.

Natural environments tend to provide greater recovery from attention fatigue, and they restore cognitive resources depleted by everyday routine activities more than other types of non-green and/ or built environments. This sense of "restorativeness" improves our sense of wellbeing, and breaks the routine of our everyday life, and helps explain some of the relationship between eco-connectedness and better psychological wellbeing. Second, Stress Reduction Theory explains this positive link via promoting recovery from stress (which is different from attention fatigue). This is important for our survival and helps us better adapt to our surroundings. Stress Reduction Theory specifically focuses on how natural settings can reduce physiological stress and aversive emotion. In other words, natural environments, due to their calm and pleasant aesthetic quality, provide a stress-reducing response that helps with releasing tension.

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Does virtual nature have the same effect?

Benefits seem to depend on the type of nature experience.

We've evolved to respond positively to non-threatening, natural settings.

Research from my lab has looked at the interactive virtual reality (VR) experience.

For our ancestors, these environments would have increased the chances of survival because they provided opportunities for reproduction, food and shelter. Our emotional responses to stimuli we find aesthetically pleasing, like green spaces, tend to decrease arousal responses (such as decrease in blood pressure, normal breathing pattern). This makes us feel relaxed and reduces stress levels.

We allocated people into two different groups: natural environment versus urban environment. They got VR headsets that provided full 360-degree immersion, along with corresponding directed sound. What we found was that a virtual experience of a natural environment resulted in higher levels of positive

By contrast, a virtual experience of urban nature (such as parks in urbanised areas) The answer is that reduced negative mood. So, the next step in understanding this link is — does virtual contact with nature mimic this positive effect?

experiences of nature don't have to take place inperson. A study that brought together data from 32 previous studies reported that while people got the most psychological benefit from physical exposure to nature, exposure to simulated natural environments — such as film or virtual reality — had a comparable effect.

The wild nature video featured rainforest and dry sclerophyll forest scenes filmed in Mt Glorious, Brisbane. The urban nature video showed public parks and gardens in Brisbane suburban areas; and our non-nature control condition video showed urban built environments (in two suburban areas in Brisbane).

What do we mean by improving mood? There are two ways to measure improvements in "mood": by increases in positive mood or by reductions in negative mood. We found that the effect of nature exposure on our wellbeing varied depending on the type of nature (wild versus urban) and was not the same for positive mood and negative mood. We found that a virtual experience of wild nature (natural settings, such as wilderness with little human interference) improved positive mood.

mood and greater attention restoration compared to a virtual reality experience of an urban environment.

By contrast, a virtual experience of urban nature (such as parks in urbanised areas) reduced negative mood.

In another study from my research lab, we tested whether virtual contact with wild nature versus urban nature improved mood differently.

Both are good outcomes, but we can all agree that the first is better to have a net gain in positivity.

People saw different videos on a screen, depending on the group they were in.

Increasing our daily contact with nature Like with so many things we know are good for us, it's not always possible to spend time in nature every day. Promoting exposure to virtual natural environments seems like an effective way to improve psychological wellbeing. For many, actual contact with nature may be inconvenient, or not readily available. Maybe you're a resident in an aged care facility, or you live in an urban area. For these people, simulations can help improve urban and indoor environments where access to nature is limited, such as hospitals, urban offices, apartments, and inner-city schools. This might mean displaying photographs and videos of natural colours and patterns, installing living green walls, or placing potted plants in areas people move through every day.

Just another reason to care for our environment We need to recognise the role of biodiversity and ecosystems in maintaining our quality of life beyond just what we can physically harvest from them. Understanding nature's contributions helps inform naturebased health interventions that provide accessible, cost-effective ways of improving psychological wellbeing. This recognition that nature can provide benefits represents a major shift in public health thinking for both the prevention and the treatment of health issues. In a meta-analysis conducted in 2019, researchers found that naturebased mindfulness intervention resulted in positive outcomes, with moderate associations with positive psychological wellbeing outcomes. This study also suggested that natural environments — "wild" nature — such as forests, resulted in significantly larger effects than human-made natural environments like gardens or urban parks.

Knowledge of the benefits of nature also provides an avenue for communicating the detrimental impacts of climate change on our natural environments, and on our mental health. Many people are now reporting having climate anxiety or ecoanxiety; and my hypothesis is that it is due to the realisation that climate change is disrupting our connection with nature. But maybe there's an opportunity here. If we can understand our deep connection with nature and various psychological benefits we get by connecting with it, it becomes personally relevant to look after our environment. It motivates people, who may otherwise be disengaged or dismissive of negative impacts of climate change, to protect and conserve natural habitats and threatened ecosystems. To improve our psychological wellbeing, we need to help protect and improve our natural environments — an outcome where we all win. n.bhullar@ecu.edu.au @DrNavjotBhullar Originally published in ABC Health & Wellbeing.

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AustRALAsIA’s LARgEst AND mOst COmPREhENsIVE EmERgENCy mANAgEmENt CONfERENCE AND ExhIbItION

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e waste Australia is one of the world’s top ten consumers of electronic goods, buying more than 4 million computers and 3 million televisions every year1. Australians produce over 140,000 tonnes of e-waste annually, 98% of this waste can be fully recycled2. Our reliance on electronic devices is rapidly increasing, making e-waste one of the fastest growing contributors to our waste stream1.

What is e-waste? E-waste, also referred to as electronic waste is made up of discarded electronics and electrical components such as computers, televisions, and cameras2. If these items are disposed of into landfill it can be extremely environmentally harmful as these items contain toxic and hazardous materials such as cadmium, lead, and mercury3. If these items are disposed of correctly, the recyclable components can be recovered and reused, and the hazardous materials can be treated appropriately2.

Facts • E-waste is being sent to landfill at three times the rate of general waste3. • Less than 10% of computers are recycled4. • Televisions and computers also contain valuable non-renewable resources including gold, steel, copper, zinc, aluminium, and brass4.

• If 75% of the 1.5 million televisions disposed into e-waste annually were recycled there would be savings of 23,000 tonnes of CO2 emissions, 520 mega litres of water, 400,000 gigajoules of energy and 160,000 cubic metres of landfill space4.

• The amount of gold recovered from one tonne of computers is more than what is recovered from 17 tonnes of gold ore4. • 40% of e-waste comes from households, majority of e-waste comes from industrial companies4.

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How to dispose of e-waste? E-waste is collected from businesses and public drop off centres where it is then sent to a recycling facility2. The e-waste is then manually sorted, dismantled, and separated into categories of specific recycling/ recovery processes2.

Accepted in the e-waste bins

Not accepted in the e-waste bins

• • • • • • • • • • • • •

• • • • • • • • • • •

All televisions Remote controls Computer monitors Laptops and tablets Speakers Cameras Headphones Cables IT accessories Keyboards and computer mice Printers and scanners Motherboards Batteries

Mobile phones DVD players Game consoles Radios Power tools Digital set top boxes Kitchen appliances Plastic, metal, or glassware Liquid Chemicals Organic matter

Note: e-waste disposal may vary in states across Australia and in other locations2.

References: 1. PGM Refiners 2. Suez 3. Greenpeace 4. Australian Bureau of Statistics

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Wellness First

or f d o h t e M d e v o r p p h’ A c t i M ‘ s i Try th

g n i m o c r Ove s e l c a t s b O s ’ Life

Mitch Mullooly Health and Wellness Strategist Specialising in the wellbeing of first responders, Mitch is 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. Mitch is also a published author, speaker and feature columnist for several sector related magazines, blogs, webinars, and podcasts.

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ow often have you started working toward a new goal, full of determination and drive, only to give up when you encounter an obstacle or challenging circumstance? This happened to me over and over when I was first starting my personal health and fitness journey. I’d commit to working out four times a week and vow to swap out not-so-nutritious food for healthier options. As long as everything went exactly as expected, I’d be fairly successful at sticking to my plan. But, of course, life never goes as planned. Inevitably, something would happen to throw me off course long hours, tough jobs, night shift. Sooner or later, I’d give up on my goal altogether, lose my motivation and my progress, then have to start all over again at a later date. The more I went through this demoralising cycle, the more I became convinced that I could never become fit or healthy. But it’s not that I was doing anything wrong or that I wasn’t capable of change in the first place: I just didn’t have any alternative arrangements to fall back on when I encountered challenging circumstances.

Whenever we are striving for a goal, whether fitness or health-related or otherwise, we will inevitably encounter obstacles. Rather than being surprised by the hurdle’s life throws at us, we can learn to plan for them.

The ‘Mitch’ approved ifthen planning method One simple yet effective way to avoid this self-sabotaging cycle is with a tactic high level athletes often use called if-then planning.

First developed by German psychologist Peter Gollwitzer in the 1990s, if-then planning is a tool for overcoming challenges by creating a plan for the obstacles that may arise with the following formula:

“If situation X arises, then I will perform response Y.” For example, a marathon runner might consider everything that could go wrong in a race, from inclement weather to their shoe becoming untied in that last kilometre, to encountering an overwhelming feeling of wanting to quit throughout the race. They can then think through their response to each of these hurdles, and when a difficulty does arise in the moment, they’ll have a plan of action already in place.

If-then planning works for overcoming any obstacle You can use if-then planning in any domain, whether your initial goal is health and fitness-related or is tied to work, relationship, or life goals. For example, if you’re trying to develop a morning meditation habit, you might come up with two or three other times in the day you can easily fit in meditation in case you don’t fit it in during your planned morning slot. Similarly, if you’re trying to be less emotionally reactive but tend to lash out at those around you when you’re “hangry,” your if-then plan might be to start carrying healthy snacks with you at all times. This strategy will keep you from getting overly hungry and thus better manage your reactions..

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The key to if-then planning is to understand that any situation can be linked with a response that’s consistent with the goal you’re trying to achieve. Try using this simple template to create an if-then plan: 1. Identify your overall objective. 2. Plan your action steps: where, when, and how you will act. 3. Identify the obstacles that have the potential to derail your goal-striving attempts. Then consider what effective action(s) you could take to overcome your obstacle. 4. Complete this statement: “If [obstacle], then [effective action].” Ideally, you’ll write these out in your journal or discuss them with someone you trust so that you have a concrete plan to tackle any obstacles.

Example if-then plan Objective: Get a new fitnessrelated personal record (PR). Action: Create your training plan to include where, when, and how often you’ll train to achieve your goal, as well as what you’ll be doing (your specific training plan). Potential obstacles: • If-then: If you’re tempted to skip your workout because you’re tired at the end of a long day, commit to getting yourself to the gym anyway, even if you don’t do your full planned workout. That way, you keep up your momentum and keep your commitment to yourself. • If-then: If you feel stuck and have reached a plateau in your training, find a coach to create a new training plan for you and give you some accountability. • If-then: If you miss a workout due to sickness, injury, or life, remind yourself that one missed workout isn’t going to matter much in the long run, and double down on your commitment to tomorrow’s workout.

Obstacles don’t have to stop you. If you run into a wall, don’t turn around and give up. Figure out how to climb it, go through it, or work around it.”

Plan for the predictable and the unpredictable When creating if-then plans, don’t just plan for predictable situations. When high level athletes do this type of planning, they think of everything that could go wrong then visualise their response to each. Your plans should include both external obstacles (encountering traffic or a meeting running over time) as well as internal obstacles (combating feelings of wanting to let up on your efforts or quit altogether). Often, our mental snags hinder our goal-striving process even more than external ones. You can use if-then planning in any of your goal-striving attempts, from fitness and sports to career, relationship, and lifestyle goals. Try making a list of your top goals then coming up with as many if-then strategies as possible. As you get better at if-then planning, you’ll begin to teach yourself that you can overcome life’s toughest obstacles. As a result, you’ll develop the confidence to attempt even higher, harder goals.

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