FIRST by CAA | Issue 09 Winter 2022 by The Council of Ambulance Authorities

ISSUE 09 | WINTER 2022

SUSTAINABILITY IN AND AROUND THE PRE-HOSPITAL SECTOR

Dr Jordan Nguyen

A driving force behind positive human and technological evolution into the future

Learn from colleagues and partners worldwide

CAA AWARDS FOR EXCELLENCE 2022 Finalists announced

www.caa.net.au

EMERGENCY SERVICES HEALTH IS FOR YOU AND YOUR FAMILY Emergency Services Health extends beyond the paramedic, nurse and doctor to all employees and volunteers of Australian emergency departments, services, hospitals and their families. This means if you have a brother, sister, parent, grandparent or child, they may be eligible to join Emergency Services Health under your own policy. If you’re unsure about eligibility call it in - 1300 703 703 or email joinus@eshealth.com.au

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Call it in – 1300 703 703 scan the qr code to compare your cover today!

Emergency Services Health brought to you by Police Health Limited ABN 86 135 221 519 A restricted access not-for-profit Private Health Insurer © 09/05/2022 *Customer Satisfaction Survey 2006-2021 Discovery Research. # In a recent Healthcare & Insurance Australia research survey conducted in 2021. IPSOS research conducted every 2 years.

June marks CAA Sustainability month and this issue takes a look at developments across our members and wider into the field to see what is new and exciting when it comes to sustainability measures and changes. We speak to Paul Frasca, the OG eco-warrior who continues to change the world one business at a time. We ask him about new innovations and what quick changes businesses can make to start their path towards a more sustainable environment. We check in with our past sustainability webinar presenter Alexis Percival to hear about new developments in UK, and chat to Catherine O’Shea from Ambulance Victoria ahead of her June CAA webinar on Climate Change and Your Health. Our cover star Jordan Nguyen owns a DeLorean, I’ll leave it there. But seriously Jordan is a biomedical engineer and an inventor that is changing lives through thinking completely outside the box. By applying his innovative ideas to what seem simple daily challenges and with the use of new technology he is making changes to patients we could only imagine in Sci-fi movies. We were thrilled to have a chance to interview Jordan ahead of his appearance at the CAA Congress in August. At the moment, he is busy researching the ambulance world to see what amazing ideas he might come up with to inspire us in Sydney. With less than two months to CAA Congress we hope you have booked your tickets for an unforgettable week of learning, growing, networking, innovation, and technology. And don’t forget the CAA Awards for Excellence Gala Dinner where we get to celebrate fairest and best for 2022. Look through the magazine to find announcement of our 2022 CAA Awards of Excellence Finalists, congratulations to all entries and all the best to our finalists. I hope to see you in Sydney for CAA Congress and to meet in person after long two years of restrictions. See you soon,

Mojca x

Contents ISSUE 09 | WINTER 2022

18 03

Letter from the Editor

Data First Climate Change Snapshot

Opinion First Todd Wehr discusses psychological safety in relation to the ambulance environment

Services First

Showcasing the latest projects and achievements from across CAA member services

Latest news from around the ambulance sector

Industry First

CAA First Discover the excitement of the upcoming CAA Congress

Focus First Learn about sustainability in the pre-hospital sector and beyond

Awards First Join us in congratulating the 2021 Australasian Dispatcher of the Year, and recognising our 2022 CAA Awards for Excellence finalists

Feature First FIRST Interviews Dr Jordan Nguyen, one of Australia’s most innovative engineers

Events First Read about the Australasian Rescue Challenge 2022, European Emergency Medical Services Congress 2022, and the inaugural International Paramedics Day

www.caa.net.au

Need Hi Res Image

86 90

104

118

114

Partners First Hear from our partners The Royal Flying Doctor Service and Australian New Zealand Police Advisory Agency

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

116

The Directory

Research First Volunteer Responder Program & Palliative Care

112

118

Wellness First

Ready for any Emergency

Learn Mitch’s mindset to start treating food as fuel

Discover the Emergency Medical Information Book helping save lives

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

Climate Change The biggest health threat facing humanity

limate change is the single biggest health threat facing humanity, and health professionals worldwide are already responding to the health harms caused by this unfolding crisis.

While no one is safe from these risks, the people whose health is being harmed first and worst by the climate crisis are the people who contribute least to its causes, and who are least able to protect themselves and their families against it - people in low-income and disadvantaged countries and communities. Climate change is already impacting health in a myriad of ways, including by leading to death and illness from increasingly frequent extreme weather events, such as heatwaves, storms and floods, the disruption of food

systems, increases in zoonoses and food, water, and vector-borne diseases, and mental health issues. Furthermore, climate change is undermining many of the social determinants for good health, such as livelihoods, equality and access to health care and social support structures. These climate-sensitive health risks are disproportionately felt by the most vulnerable and disadvantaged, including women, children, ethnic minorities, poor communities, migrants or displaced persons, older populations, and those with underlying health conditions.

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Climate change Vulnerability

Vulnerability Factors • Demographic factors • Geographic factors • Biological factors & health status • Sociopolitical conditions • Socioeconomic factors

Exposure pathways • Extreme weather events • Heat stress • Air quality • Water quality and quantity • Food security and safety • Vector distribution and ecology

Health system capacity & resilience • Leadership & governance • Health workforce • Health information systems • Essential medical products & technologies • Service delivery • Financing

Climate-sensitive health risks Health systems & facilities outcomes

Health outcomes

Injury and mortality from extreme weather events

Heat related illness

Respiratory illness

Zoonoses Water-borne diseases and other water related health impacts

Vectorborne diseases

Malnutrition and foodborne diseases

Mental and Noncommunicable psychosocial health diseases "(NCDs)

Impacts on healthcare facilities

Effects on health systems

Figure: An overview of climate-sensitive health risks, their exposure pathways and vulnerability factors. Climate change impacts health both directly and indirectly, and is strongly mediated by environmental, social and public health determinants.

Industry First

Industry News St John New Zealand: The Order of St John In a very special ceremony, the Governor-General of New Zealand Dame Cindy Kiro has been invested as a Dame of Justice of St John and installed as Prior and Dr Richard Davies invested as an Officer of St John. The Order of St John is an international organisation and this ceremony would usually take place in the United Kingdom, however with Dame Cindy unable to travel overseas last year, this ceremony took place in New Zealand for the first time.

Babcock Australasia's New Director Babcock Australasia is pleased to announce the appointment of Peter Newington as Director, Aviation and Critical Services with effect from 1 August 2022. Peter has a strong track record as a leader in the aviation and critical services sector, currently serving as General Manager – Strategic Projects at CareFlight where he is responsible for the delivery of patient transfer services, aerial firefighting, international jet patient retrieval and rapid response specialist clinical helicopters.

Kete Manaaki St John NZ have been working with iwi hauora teams to support whánau who are isolating with COVID-19, particularly in rural and isolated areas. They have donated a number of Kete Manaaki which are care packs of essential items, created with supplier Amtech to help whánau in need manage their health at home. St John NZ have supported iwi hauora services with funding and ordering processes to supply more for their communities.

Queensland Ambulance Service Distinguished Service Medal QAS Officer Les Steel was presented with the Queensland Ambulance Service Distinguished Service Medal by Commissioner Craig Emery in Townsville. The Distinguished Service Medal, the most significant QAS Honour awarded to operational QAS officers, was awarded to Les in recognition of a long and distinguished career spanning more than 52 years.

St John Ambulance Papua New Guinea receives K250,000 St John Ambulance PNG was presented K250,000 through the Lae City Authority for its continuous provision of world class pre-hospital ambulance service in Lae City and surrounding communities. Member for Lae and Chairman of the LCA board John Rosso made the presentation of K250,000 which is part of LCA's K500,000 annual funding for the St John PNG Ambulance service.

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Australian Stroke Alliance The Australian Stroke Alliance has developed a new approach to Aboriginal and Torres Strait Islander health research, known as Darak. A team of Indigenous leaders within the Stroke Alliance will provide information and support to Council of Ambulance Authorities’ members and other Stroke Alliance researchers, ensuring early engagement with Indigenous people and communities. The aim of Darak is to develop culturally appropriate ways of communicating and working with Aboriginal and Torres Strait Islander peoples to strengthen community engagement in stroke research.

Officer in Charge Awarded Bravery Medal Queensland Ambulance Service Officer in Charge Michael Formica was formally presented with a Bravery Medal from Her Excellency the Honourable Dr Jeannette Young PSM at the Australia Awards investiture ceremony at Government house in Brisbane. Michael received the award for his efforts back in September 2019 when he selflessly ran into a burning home in Harristown to successfully rescue a mother, daughter and two animals from a house fire.

Special Operations Unit Workshop makes Significant Developments in Vertical Rescue A 2-day Special Operations Unit workshop featured Critical Care Paramedics from Aeromedical Operations, NSW Ambulance, Fire and Rescue NSW (FRNSW) and Police Rescue. The SOU brought together the knowledge of all emergency services to develop new and safer ways to extricate patients from complex, high risk situations. The SOU provided an invaluable trade of information for NSW emergency services and significant developments were made in the area of Vertical Rescue.

New Zealand Out-of-Hospital Cardiac Arrest Registry Released The two emergency ambulance services in New Zealand, St John New Zealand and Wellington Free Ambulance, have recently released the latest 2020/2021 Out-ofHospital Cardiac Arrest Registry that records cardiac arrest survival rates and the factors that impact on survival. The latest Out-of-Hospital Cardiac Arrest (OHCA) reports from New Zealand’s ambulance services aim to provide to provide transparency on cardiac arrest deaths in New Zealand to improve future outcomes.

CAA First

It’s not currently possible to spend time in the CAA office without feeling the buzz of the upcoming Congress.

www.caa.net.au

e’ve said it before and we’ll say it again, two years of no events and not getting together to share and learn has taken its toll, but now the time has come, and we can’t hold back our excitement.

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CAA First

The CAA Congress is a 3-day event that’s designed to take you on a journey from start to finish. Meet us at the International Convention Centre, Sydney on 11th August where we’ll begin with a choice of two forums of enthralling topics and speakers.

Women In Leadership Forum Following the success of the 2019 Women in Leadership Forum, we are proud to again put together a program to help empower current female employees, 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. Casey Beros joins CAA Congress as our MC. Casey brings together the inspiring program of speakers including Julie Piantadosi (Total Coaching Academy), Erin Cramlet (Stryker), Judith Barker (St John Ambulance Australia (NT)). For more information on the forum program visit www.caacongress.net.au/program.html

Global Resuscitation Alliance (GRA) Forum This Global Resuscitation Alliance Forum will bring you the latest developments in out-of-hospital cardiac arrest, including experts from around Australia and internationally. The day will offer a High-Performance CPR (Train the Trainer) session to end the day of informative sessions. In 2019 the GRA Masterclass was sold out and we expect the same for this year’s exciting new GRA Forum. Alan Morrison, MC, will introduce you to Ng Yih Yng (Tan Tock Deng Hospital), Hannah Latta (Wellington Free Ambulance), James McManus (Trapeze), Karen Smith (Ambulance Victoria) and masterclasses from Marty Nicholls with the CAA + NSW Ambulance teams. For more information on the GRA Forum program visit www.caacongress.net.au/program.html

After being educated and inspired on your topic of choice, walk out into the bubbling Meet and Mingle event supported by Motorola to enjoy the view of stunning Darling Harbor with beverage in hand and nibble on delectable canapes whilst you get to know others in the emergency services sector. When the night draws to a close head back to your accommodation for some rest because we’re just getting started.

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Join us to be inspired, think outside the box, and work together to elevate the pre-hospital sector.

11-13 August 2022 International Convention Centre, Sydney

CAA First

Friday morning, let us jump start your day with a delicious stand up breakfast whilst we get the very first look at the Expo floor. Expo is a melting pot of innovation and technology with top organisation’s and companies coming together in one space to show you what they have been working on for the past two years plus. The Delegate Networking Breakfast will be a hive of fresh activity and is kindly supported by GoodSAM. Join fellow delegates in the Parkside Ballroom located right next door to the Expo. Keep an eye out for the hugely popular Trapeze Idea’s Board & Poster presentations as you make your way to our Plenary home for the next couple of days where you will be fueled by inspiring teaching, innovation and come away feeling elevated in the pre hospital sector. Casey Beros is our official CAA Congress MC. One of Australia’s most engaging health presenters, brings together the inspiring program including keynote speakers Samantha Crompvoet, Julie Piantadosi (Total Coaching Academy), John Brunning (Australasian College of Paramedicine), Simone Cusack (Ambulance Victoria). Choose from one of our incredible concurrent sessions during the day: Technology, Patient Safety, Stroke or Mental Health & Wellbeing. For more information on the Day 2 program visit www.caacongress.net.au/program.html Friday nights are for celebrating and this year we are hosting the CAA Awards For Excellence which has been running for over 10 years recognizing the hard and innovative work of ambulance services from Australia, New Zealand and Papua New Guinea. A delightful stroll around the water will lead us to Dockside for a divine 3 course dinner, fine wine and views of the sparkling lights of Darling Harbour. We are thrilled to share the announcement of the very first CAA Women In Leadership Scholarship with you on this special night.

To learn about the finalists who will be waiting with baited breath to see if they have won their category, or perhaps even taken it all out with the coveted overall Star Award, see the article in this edition of FIRST. By the third day you will be feeling right at home at the ICC Sydney as we continue to explore CAA Expo 2022 and join in Plenary and concurrent sessions. Casey Beros, CAA Congress MC , brings together the final day’s program including keynote speakers Jordan Nguyen, Damien Eastern (Australian Stroke Alliance), Mardi Steer (Royal Flying Doctors Service), David Waters (CAA CE), AI & Advanced Technology Panel and renowned medical expert, Dr Norman Swan. Take time to join our concurrent sessions during the day: Telehealth, Patient Safety, Aeromedical, Emergency Management. For more information on the Day 3 program visit www.caacongress.net.au/program.html

ICU Later! A Congress like this wouldn’t be complete without a send off, shuffle back across to the Expo floor for the ICU Later (pun intended) farewell event. Take this time to confirm relationships you’ve just made, follow up those who you’ve been meaning to, make plans for the future together and have a moment to reflect on the amazing past few days. We look forward to enjoying this journey with you, see you in August! Tickets for CAA Congress have been released and are available to purchase at caacongress.net.au 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.

www.caa.net.au

Expo Passport To make up for lack of travel these past couple of years, CAA has collaborated with exhibitors to launch our Expo Passport encouraging your journey within the exhibition space! The Passport adds an entirely new experience to Congress and provides a unique and exciting path for delegates to take while exploring the Expo floor. The Passport requires delegates to travel to various booths and areas in The Gallery at breaks and during the congress program to get their passports ‘stamped.’ Once a delegate has received ‘stamps’ from all passport destinations, they can go into the drawer to win a fabulous prize!

Casey Beros, MC

Julie Piantadosi

Erin Cramlet

Judith Barker

Hannah Latta

James McManus

Karen Smith

Samantha Crompvoets

Damien Easton

Mardi Steere

Dr Norman Swan

Mini-Masterclasses Mini-Masterclasses are new to the Expo floor for 2022. CAA has collaborated with top exhibitors, sponsors 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 while engaging delegates to approach sessions with creativity, optimism, and inventiveness. Both entertaining and educational, you will be surprised by how much you can get out of a 20-minute masterclass.

Live Demonstrations As you travel around the Expo floor, you will also find 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 are interested in becoming an exhibitor or discovering our sponsorship packages, please contact events@caa.net.au.

You live it. We built it.

The industry’s first connected ambulance stretcher. Nobody knows what works in the field better than you. That’s why we reimagined our proven design to redefine your partner on scene—focusing on what matters most to help you get the job done.

Power-PRO 2 TM

Lighter. Faster. Stronger.

Stryker or its affiliated entities own, use, or have applied for the following trademarks or service marks: PowerPRO, Stryker, XPS. All other trademarks are trademarks of their respective owners or holders. The absence of a product, feature, or service name, or logo from this list does not constitute a waiver of Stryker’s trademark or other intellectual property rights concerning that name or logo.

Respond confidently • Reach optimal transport height with a single button and increase maneuverability using an extended transport handle • Navigate through tighter quarters with a new retractable foot section (extends and retracts an extra 7.62 cm each)

Respond smartly • See and be seen in low light environments with powerful lights and reflectors • Perform a true, unassisted lift and reach optimal loading height using smarter hydraulic assembly with load-sensing capibilities

Respond ready • Remotely track your fleet with Smart Equipment Management™ (SEM™) and pinpoint your stretcher with its last-known location* • Improve battery life and management with a new lithium-ion battery and charge indicator

Scan me

Focus First

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7 8

2 11 1

Turning the Blue Lights Green By Alexis Percival

he Climate Emergency is a Health Emergency. We in the ambulance service are on the front line of dealing with the climate crisis wherever we are on the planet.

From battling through flood waters and wildfire smoke to dealing with patients who experience extreme heat and violence from civil unrest and war we are also dealing with an increase in the movement of people around the planet due to changing weather to dealing with pandemics and new infectious diseases.

We are dealing with the climate crisis already. The health system also has an impact with over 4% of the world’s carbon emissions being created by the activities and services that we provide to our patients. We have a responsibility to act, especially under our Hippocratic oath ‘to do no harm’.

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12 13 14 15 16 17 18 19 20 26 27

24 28

Ambulance Station of the Future

Compost facilities

Double glazing

Trees for shading and cooling

4 Green space: Wildflower

Recycled/ Eco building materials Roof, wall and floor insulation

10 Trigen or micro CHP

and vegetable growing, green roof, fruit trees, outdoor area for health and wellbeing

11 Battery and/or hydrogen

Solar panels/ solar canopies for generating electricity and hot water

12 Vehicle washing with

Solar panels on the roof of operational vehicles for battery top up and auxiliary power charging for electric/hydrogen vehicles

generation and storage from solar energy and from the grid water recycling system 13 Dual flush toilets using

rainwater and grey water from hand washing 14 LED lighting 15 Low flow taps 16 Motion sensors

17 Voltage optimisation 18 Boiler optimisation 19 Flood protection, if

required: flood barriers, toilet backflow 20 Washing water recycled

for grey water 21 Building orientation to

take advantage of sun 22 Free cooling air

conditioning. Ambient temperature air used for cooling 23 Wind turbine or small

roof top turbines

25 Rainwater collection and

underground storage. Rainwater from roof and porous paving on car parking area used for toilet flushing and vehicle washing 26 Secure bike storage with

e-bike charging 27 Electric vehicle charging

points for staff and operational vehicles 28 Staff electric cars to be

used as a grid balancing through V2V (vehicle to vehicle) or V2I (vehicle to infrastructure) charging

24 Air source/ground source

heat pump

Skylights and sun tubes

Focus First

The NHS in the UK was the first to commit to a Net Zero target of decarbonising everything by 2045, including the ambulance service. COP26 gained 49 new healthcare systems who committed to building climate resilient health systems with 14 laying down decarbonisation targets, some promising to decarbonise as soon as 2030. How can we turn our blue lights green to drive down our emissions? There are key areas that all healthcare systems can identify to reduce and eliminate their emissions as well as adapted to the changing climate. These include estates and facilities, travel and transport, medicines and pharmaceuticals, sustainable models of care, food and nutrition, supply chain and procurement, digital transformation and we need to also include biodiversity and green spaces as well as climate adaptation. By assessing these key areas, we can address the issues that we need to overcome to get to net zero as well as tackle the ecological crisis. An ambulance service in a net zero future will look very different. Our ambulatory vehicles will be powered by renewable energy that should be in the form of wind or solar for electric vehicles and hydrogen. In turn our estate needs to be able to support and store this energy to provide us with resilience. Battery, solar, ground source and air source heat pumps will support this transition. Upgrading our estate to be efficient with low energy requirements will become a necessary part of this transition. We also need to collect and store water from our car parks, install grey water recycling systems (for toilets) and protect our estate from flooding. We also need to reduce air conditioning requirements with insulation, free cooling systems and solar heat storage for heating.

We need to work with our healthcare partners to get in infrastructure to support our fleet and staff as we carry out emergency response – this will also look at how we can improve our communications in the event of extreme events, EV charging infrastructure and change the models of care. Food, nutrition, and biodiversity are a critical part of the system to supporting staff, patients as well as our wider community within the future climate change system. Some of the largest producers of emissions within the ambulance service is the use of Entonox as an analgesic gas (over 10% of Scope 1 and 2 emissions in the UK ambulance service). We need to assess alternatives to this toxic greenhouse gas. Our medical supplies as well as procurement of products contributed around 60-80% of our carbon emissions as many items are shipped around the world, used once and then binned. We need to reduce the amount we use, implement local manufacturing, better packaging, phase out single-use items and implement reusable items and ensure we have a circular economy for all our products. To achieve a Net Zero healthcare system and ambulance service, we need to work together, share our best practice and case studies as well as champion new technologies and solutions to tackle the climate crisis head on. We also need to prepare for it all to go wrong if we can’t work fast enough to keep our emissions below the 1.5 degrees required to stop the climate crisis from detrimentally affecting us all. The Climate Emergency is a Health Emergency, and we need to get our blue lights on to tackle it head on. If you want to find out more about what has been done in the UK, please drop Alexis Percival, Environmental and Sustainability Manager at Yorkshire Ambulance Service NHS Trust a line - alexis.percival@nhs.net

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Climate change

Alexis Percival Alexis Percival is the Environmental and Sustainability Manager for Yorkshire Ambulance Service NHS Trust based in Yorkshire, UK. She started as the first Sustainability Manager for an ambulance service in the country in 2009.

Increased rainfall

Flash floods

Rising sea levels

Surface water floods

Drought

Storms & high winds

Dust

Healthcare impact on climate change

Increased UV Tornadoes & Hurricanes

Contamination of flood waters

Air pollution & particulates

Moorland Fires Forest Fires Poor housing stock

Crop failure

Price rises

Civil unrest

Water restrictions & shortages

Loss of land

Food shortages

Loss of farm land

Violence

Injuries Malnutrition COPD / breathing issues

Loss of housing

Migration / immigration

Heart attacks Heat stress

Cancer

Dehydration Antenatal complications

Ozone Infections

Hypothermia

Water borne diseases

Vector carrying insects

Energy security

Mental health & anxiety

Pressure on health sector

Injuries in flood water

Loss of Life

The effects of climate change on the health system

Heat

Her challenging role involves reducing the carbon footprint of the blue light ambulance service through innovative technologies in the estates, fleet and procurement departments. She is working on the Net Zero programme implementing awareness schemes, rolling out a carbon champion scheme and installing innovative low carbon technologies across the estate. She has worked on the development of low to zero emission ambulances with innovative low carbon fleet technologies as well as facilitating the roll out the EV charging infrastructure for the ambulance service as well as working with civic and other healthcare partners to ensure that additional infrastructure is implemented to support the service. She is also investigating the challenges of decarbonising the ambulance service through renewable technologies, Net Zero ambulance station design, phasing out of entonox and looking at alternative models of care She is also working to prepare the ambulance sevirce for climate adaptation assessing the impact of flooding, heat waves and sea inundation. She set up the GrEAN (Green Environmental Ambulance Network) in 2010, connecting all of the sustainability leads across the ambulance services of the UK to drive forwards the Net Zero agenda. She has over 25 years of experience in the environmental field as an environmental consultant working on large national and international projects in the UK as well as Brazil, Germany, Mozambique and Australia. She took a career break and spent 3 years driving around the world in an ex-military ambulance, travelling overland to Australia and then travelling around South America.

Focus First

Building Net Zero capability in Ambulance Response Branches By Ambulance Victoria

mbulance Victoria maintains approximately 350 locations across Victoria servicing an area of more than 227,000 square kilometres.

Our top priority is the health and care of the more than 5.8 million Victorians who rely on service in times of personal emergency. As a community based institution we are also highly motivated to care for the environment in which we operate, this includes the energy and carbon impacts of our operations. We are committed to achieving ‘net zero carbon’ (NZC) (scope 1 and 2) by 2045. Approximately a third of Ambulance Victoria’s emissions are as the result of electricity used in our ambulance branches. The branches we build today will still be with us in 2045, so a large part of the road map to achieve NZC is improving the performance of the ambulance branches out of which they operate. In 2021 Ambulance Victoria approached AIRAH and i-Hub (the Innovation Hub for Affordable Heating and Cooling) for assistance in studying how this might best be achieved.

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Focus First

With the assistance of Masters level architectural and engineering students from The University of Melbourne, selected consultants from industry, University academics, and Ambulance Victoria staff the challenge of designing net zero emergency response branches was undertaken. Our top priority is the health and care of the more than 5.8 million Victorians who rely on service in times of personal emergency. As a community based institution we are also highly motivated to care for the environment in which we operate, this includes the energy and carbon impacts of our operations. We are committed to achieving ‘net zero carbon’ (NZC) (scope 1 and 2) by 2045. Approximately a third of Ambulance Victoria’s emissions are as the result of electricity used in our ambulance branches. The branches we build today will still be with us in 2045, so a large part of the road map to achieve NZC is improving the performance of the ambulance branches out of which they operate. In 2021 Ambulance Victoria approached AIRAH and i-Hub (the Innovation Hub for Affordable Heating and Cooling) for

assistance in studying how this might best be achieved. With the assistance of Masters level architectural and engineering students from The University of Melbourne, selected consultants from industry, University academics, and Ambulance Victoria staff the challenge of designing net zero emergency response branches was undertaken. The study took place as a part of the integrated design studios (IDS’s) being carried out under the i-Hub. The studios explore how to better marry architecture and engineering to deliver building outcomes that exceed what each discipline would have been able to deliver on their own to provide exceptional technical performance at the same time as superior architectural amenity. The basis of integrated design is to involve all stakeholders in the design from the outset. Designs come from a holistic basis of not only servicing primary response functions, but also of being socially responsible, looking after the wellbeing of the paramedics being sent out onto the road, and serving ancillary functions such as community gardens or providing safe places of refuge for the community in times of need.

“The student design work has been successful in demonstrating that the pathway towards a net zero carbon ambulance branch performance can be achieved using high-performance passive design, energy efficient systems and on-site photovoltaic energy generation. The solutions presented by the student group are all readily available, known technologies that are relatively simple-to-construct which offer enhanced whole life cost performance over the life cycle of the project.” - extract from Atelier 10 feasibility vetting report.

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Readily Achievable Solutions

Enhanced Life-Cycle Benefits

Enhanced Health Outcomes

The body of work produced demonstrated that cumulative energy savings of up to 50% compared to business as usual could be achieved. The study also demonstrated the potential to generate significantly more energy on site than the building uses on an annual basis thus achieving net zero operational carbon impact.

Calculations on the energy and running cost savings showed that all of the technologies identified above yield a net beneficial economic payback over the life of the asset providing a compelling business case for their incorporation into future station designs.

In addition to the financial business case, the measures also offer health and wellness benefits that are a significant value-add to end-users of the ambulance station. Good daylighting in spaces, access to the sun, thermal comfort and welldesigned ventilation systems are key indoor environmental amenity outcomes that benefit through staff well-being and reduced sickness rates. Whilst natural ventilation is applicable for a large part of the year on most sites, the use of heat recovery ventilation in winter is of particular note as a means of achieving healthy internal air quality and minimising energy use.

The technologies and systems proposed were taken from tried and tested solutions in Australia and can be readily adopted for this scale of project. The key systems offering greatest benefit are: •

Optimised Passive Solar principles for winter heating and summer control.

•

High-performance building fabric through enhanced Uvalues of the building fabric.

•

Reduction in thermal bridging and airtightness construction quality assurance.

•

Mechanical ventilation with heat recovery providing energy savings in addition to indoor environmental quality and health benefits.

•

Photovoltaic panels were consistently applied across projects for on-site renewable energy generation.

In a previous comparative study, AV found that if the Branch was constructed today and included the designated design and specification improvements, the additional capital build cost would be +~7%. However, if the existing Branch was modified today to implement the designated design and specification improvements, the additional capital build cost would be +33%. This makes a compelling case for front end investment in environmentally sustainable design (ESD).

As well as learnings on appropriate net zero design technologies, we were able to raise our own internal capability and understanding of what is involved in delivering sustainable buildings. The learnings gained enable us to speak out as an organisation and have more influence in the design of the facilities out of which we operate.

Focus First

NEANN’s actions towards being more sustainable By RAPP Australia Pty Ltd

eing truly sustainable is not an easy route to navigate in an industrial supply environment that has not yet truly embedded the necessary systems to achieve a high standard of sustainability in all aspects of manufacturing and the supply chain. When attempting to have best practice around sustainability, a full “cradle to grave” approach needs to be considered, including the manufacturing of the base raw materials through to the disposal of our products at their end of life. In its 40th year of operation, RAPP Australia Pty Ltd as the manufacturer of NEANN™ products, takes ongoing pride in supplying equipment that is effective, reliable, and safe to use for the individual operator and their organisations. “Meanwhile we are working hard to be more sustainable for ourselves and the organisations we supply to” said Roger Buckle, RAPP Australia Pty Ltd Managing Director.

www.caa.net.au

Focus First

NEANN™ is the medical equipment division of RAPP Australia Pty Ltd, designing, developing, and manufacturing world class products for the professional pre-hospital and in-hospital emergency medical markets within Australia as well as export sales to New Zealand, Europe, and other parts of the world.

Durability

Energy usage

We have determined that one of the biggest impacts to minimise the environmental impact of our products is their durability and service life. Keeping them out of land fill by designing and manufacturing them to have as long a life as possible and providing a repair service is a big part of that impact reduction. Also understanding what they do in the environment at their end of life has been very important. Our premium products supplied to the majority of Ambulance services (and others) are PVC-free and made from a urethane which ultimately breaks down into urea over time. It does not contain any lead or other “toxins” often found in lower cost PVC’s. Our aim is to get PVC’s out of our supply chain altogether, however, we will need our clients to support these initiatives as materials with a lower environmental impact cost more!

Targeting a reduction in our power consumption has led us to installing a “solar farm” of more than 100 panels on the roof of our factories, producing up to 53kWh. This means that our products are now almost completely built using solar power and the balance of power is purchased as renewable power supplies. To further reduce our power consumption we have recently upgraded over 80% of our factory’s electric motors to DC low power usage machines along with a full refit of our lighting, All of these initiatives of course add to the cost of production, however we feel it is a better option in the long run.

Environment In 2008 we participated in an initiative program in regional Victoria run by Village Green Environmental Solutions to change our work practices to achieve a “low impact manufacturing facility”. This, along with being a member of the Barwon Regional Waste Management Programme has assisted us in our drive towards a lower environmental impact. Whilst there is still room for improvement, we are heading in the right direction, especially as a lot of our off-cut material waste is designed to break down without releasing toxins into land fill.

CAA’s goal is to support the ambulance sector to work towards a more sustainable future to achieve #sustainableambulance. As NEANN™ continues to become more sustainable within their organisation, we are proud to have them as a sponsor who supplies to a large portion of our member services.

www.caa.net.au

Medical Packs for All Scenarios • Design Excellence • Custom designed with the First Responder in mind • Trusted by Ambulance Services throughout Australasia • Proudly owned and operated in Australia since 1982

Utilising Environfrei ™ - our revolutionary fabric is: • Antimicrobial, minimising contamination • Cleanable & abrasion resistant • Lightweight but tough • Long term durability

MEDUVENT Standard • Flexible, oxygen-independent mobility due to turbine technology • Diverse ventilation modes for invasive and non-invasive ventilation • The hygiene filter protects patient, staff and the ventilator from contamination • Replaces BVM and triggers mechanical breaths quickly and safely via MEDUtrigger • Built to military standards, easy to operate

www.neann.com.au | +61 3 5284 0925 | sales@rappaustralia.com.au

Focus First

Sustainable Healthcare at John Hunter Hospital

limate change is the greatest global health threat of the 21st century (Costello). It directly increases pressure on existing healthcare systems and undermines public health achievements.

This is evident in the increased cardiovascular and respiratory admissions following catastrophic Australian bushfires (Yu, van Oldenbough, calla wahlquist); and the redistribution and resurgence of infectious diseases like malaria (Wu, Kurane).

during the next decade to lighten and, eventually, eliminate the organisation’s carbon footprint. We will be doing a huge amount of work in the coming years to achieve this green vision and take our place as an industry and community leader in sustainability.

Healthcare itself also fuels climate change (Lenzen) with Australian hospital CO2 emissions comprising 7% of national emissions (McGain). This is largely indirect, via upstream manufacturing and energy supply, although operating theatres additionally contribute solid waste and inhalational anaesthetics (McGain, Muret). This inextricable link between environmental and human health demands urgent change towards sustainability.

As an LHD we have a dedicated Sustainability Project Manager, Elissa Klinkenberg who enhances networkwide sustainability via advocacy for over 200 HNELHD sustainability champions and facilitating communication between clinicians and executives.

As the largest Local Health District within NSW Health, Hunter New England Local Health District (HNELHD) aims to become carbon and waste neutral by 2030. Under the ambitious new initiative, Sustainable Healthcare: Together Towards Zero, we are setting our sights on an environmentally sustainable future. Significant investments will be made in solar power, water sustainability and energy efficient practices

Interdisciplinary collaboration allows a united transition towards sustainable healthcare. At John Hunter Hospital (JHH), collaboration between Anaesthetists and Perioperative staff established reliable recycling streams. For example, perioperative nurse Vicky Sandy contributes via Kimguard recycling setup. PARU nurses Amy Bernotas and Nick McGavin assist in IV bag recycling and auditing soft plastic production. Copper wire recycling established by Anaesthetics SRMO Dr Timothy Wong reduces waste, abates CO2 emissions from new material production and raises funds for future sustainability projects.

www.caa.net.au

We’re already harnessing clean, renewable power at a number of hospitals and work is underway to begin panel installation on more facilities in coming months. We house the largest solar panel installation on any health facility in the world with over 5000 solar panels spread across 11,500 square metres of rooftop at JHH, saving over 1,148,965.63 kg the equivalent of 22,294 trees planted. Generating around 3,238 megawatt hours per annum, the solar panels will help reduce the hospital’s annual energy consumption by 11 per cent. This will result in a 20-year carbon abatement, or reduction in the amount of carbon dioxide produced equivalent to over 52,000 tonnes. Inhalational anaesthetic agents contribute to climate change via atmospheric pollution. Staff Specialist Anaesthetist Dr Gavin Sullivan, for example, has ceased Desflurane use due to its known high global warming potential (McGain/Muret) and runs departmental education on its deleterious effects. Consequently, all JHH Desflurane was relocated to satellite storage, effectively deterring Desflurane use saving both on GHG and expenditure. Given the urgency of climate change and its close relationship with human health and healthcare, we have the responsibility to strive for sustainability, raise awareness and minimise the negative environmental impacts of healthcare.

Costello A, Abbas M, Allen A, et al. Managing the health effects of climate change. Lancet 2009; 373: 1693–733. McGain F, Muret J, Lawson C, Sherman JD. Environmental sustainability in anaesthesia and critical care. Br J Anaesth. 2020;125(5):680-692. doi:10.1016/j.bja.2020.06.055 van Oldenborgh, G. J., Krikken, F., Lewis, S., Leach, N. J., Lehner, F., Saunders, K. R., van Weele, M., Haustein, K., Li, S., Wallom, D., Sparrow, S., Arrighi, J., Singh, R. K., van Aalst, M. K., Philip, S. Y., Vautard, R., and Otto, F. E. L.: Attribution of the Australian bushfire risk to anthropogenic climate change, Nat. Hazards Earth Syst. Sci., 21, 941–960, https://doi.org/10.5194/ nhess-21-941-2021, 2021. Yu P, Xu R, Abramson MJ, Li S, Guo Y. Bushfires in Australia: a serious health emergency under climate change. Lancet Planet Health. 2020 Jan;4(1):e7-e8. doi: 10.1016/S2542-5196(19)302670. Epub 2020 Jan 10. Erratum in: Lancet Planet Health. 2020 Jan 24;: PMID: 31932144. Wu X, Lu Y, Zhou, S, Chen, L, Xu, B. Impact of climate change on human infectious diseases: Empirical evidence and human adaptation. Environment International. 2016. Vol. 86: 14-23. https://www.sciencedirect.com/science/article/pii/ S0160412015300489 Kurane, Ichiro. “The effect of global warming on infectious diseases.” Osong public health and research perspectives vol. 1,1 (2010): 4-9. doi:10.1016/j.phrp.2010.12.004 Lenzen, M, Malik, A, Li, M, Fry, J, Weisz, H, Pichler, P, Chaves, L, Capon, A, Pencheon, D. The Environmental Footprint of Health Care: a Global Assessment. The Lancet Planetary Health. 2020 July 1. Vol 4 (7): e271-279. https://www.thelancet.com/journals/ lanplh/article/PIIS2542-5196(20)30121-2/fulltext

Focus First

Sustainable Salons and Ambulance services A conversation with Paul Frasca facilitated by Jenna Paterson

he 2019 CAA Congress in Perth finished off with an inspirational presentation by sustainability warrior Paul Frasca showing us how other sectors were able to successfully tackle the problem of making sustainability reality and showed us how, in a similar fashion, a sustainable ambulance service is achievable.

Three years on, we caught up with Paul about what is new and exciting in the world of Sustainability. It’s been three years since you developed a Sustainability Report for the Ambulance sector, are we still facing the same challenges? Yes, we are 100% still seeing the same challenges. There are passionate individuals in services who want to see change who are stimulating better practices that I like to call “the gateway to change”. It’s just so important for people to voice the changes they would like to see implemented into their work environment.

How do you bring people along on a sustainability journey? You must first build it into a sustainable business model. When my partner and I first studied the salon industry, we needed to understand the pathway to success, and when I say "success", I mean financially, community and environmentally driven success, and all those aspects need to come together to work out what serious things to focus on first. Our goal is to turn every waste item into a commodity.

www.caa.net.au

There are passionate individuals in services who want to see change who are stimulating better practices that I like to call “the gateway to change”. Paul Fresca, Owner/Director Sustainable Salons Australia

Focus First

What do you see as something for ambulance services to address? The ambulance industry has a fascinating layout. It would be a very ambitious task to undertake, but Ambulance Services hold so many assets around the country which I like to call “free grid space”. We are talking millions of dollars that could be saved in electricity costs by placing solar panels on every ambulance station rooftop. Other than the obvious environmental benefits are you hearing of other benefits to businesses who have sustainability practices in place? Sustainable Salons are working with five of the biggest multinationals and they have stated that having sustainability practices in place is the number one reason they are retaining staff for longer. People want to know they aren’t super wasteful. There is a whole new business model out there that can take care of values. People want to hear that their kids are going to have a great planet to live on when we are gone, and their grandchildren are still going to have resources still left on the earth.

How can Sustainable Salons help? Sustainable Salons can service anyone. We do all the heavy lifting, so all you have to do is sign up. We plug right into your environment and provide you with all the necessary tools, to help you understand how it all works. Your waste is above-ground mining, metals, papers, plastic, chemical waste, razors, sharps are all recyclable. Other than hazardous waste there wouldn’t be anything in Ambulance Service depots that we wouldn’t be able to collect. Not only that, the proceeds from what we recycle can provide one to two meals for someone in need, and provide stable careers for those people with disability. What does it mean to you to have a social enterprise and provide purposeful work for people with a disability? It is my reason to wake up every day. The whole reason why I wanted to build a business that made me want to wake up and feel proud and be on the right side of history.

It's good for business.

www.caa.net.au

Can you tell me about the importance of creating a closed loop circular economy from the items Sustainable Salons recycle? Our aim should always be to keep things in circulation. Finding solutions that give the resources we collect a second life, in the hope that they will benefit our planet or add value to someone’s life is so important.

Finally, as a call to action for our services, what is it you would like them to do? The biggest action I believe staff of ambulance services could make would be to stop using single use water bottles and coffee cups, invest in reusable water bottles and coffee cups.

Has Sustainable Salons developed any new collections in these last three years? We launched our Sharps Collection program which is now available to service beauty and dermal clinics all across Australia and New Zealand and a mission to ensure your sharps are disposed of ethically and responsibly. At the moment sharps are being incinerated, but the hope to create the infrastructure here in Australia to be able to recycle these items locally in the near future. Are there any new innovations you see coming on the horizon? One of the bigger things we are seeing is closed loop manufacturing. What we envision for the Ambulance Sector in the future is seeing the plastic that services recycle being repurposed into the products you continually use in your industry. Your waste is your future.

Opinion First

Psychological Safety in the Ambulance Environment What has changed and where to from here?

ver the years, we have seen a significant change in the medical model and particularly how it integrates within a pre-hospital context.

This has been due to several factors including research, improved disease treatments, disease prevention campaigns and changes to safety requirements such as seat belts, car manufacturing, helmets etc. All of this has led to increased life expectancy; however, this has also led to a more complex patient presentation with co-morbidities and disease that is more difficult to recognise. As a result, the prehospital environment has had to advance to meet this increasing patient complexity and the broader health system has had to consider all of community health interventions. Just like any other health context, mental health has also seen significant advances over the years.

Again, this is attributed to significant research, improved treatment modalities and mental health injury prevention strategies. Organisations and the community have seen greater recognition of psychological wellbeing and a greater need for strategies to prevent psychological injury and prevent psychological illness. This has seen the ambulance staff support systems run parallel to the advances in the pre-hospital clinical environment. Life has become more complex, and work and home demands are greater than ever. Furthermore, we find ourselves in an era experiencing unprecedented ongoing natural disasters. This has led to the need for a holistic approach to mental health involving all of community interventions.

www.caa.net.au

Opinion First

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Just like physical health the work with psychological health is not complete. Nor should it be. Just as we understand more about physical health we will continue to understand more about psychological health. Like physical health, the sole responsibility does not lie solely within the health system but is reliant on a whole of community approach. This includes Individuals with the information and ability to access a range of evidence based/informed services, leaders who are cognisant of maintaining psychologically safe workplaces and a culture that is open and supportive of mental health and mental illness.

Todd Wehr Todd is the Director of the Queensland Ambulance Staff Support Services, known as “Priority One”. As a registered paramedic and a registered psychotherapist, he has spent almost 25 years working within ambulance, on road and in delivering staff support services. During this time, he has also had the privilege to speak and provide training at several Universities, national and international conferences and with other agencies nationally and internationally.

Services First

60 years of world-class care in the air By Ambulance Victoria

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

Air Ambulance Victoria (AAV) recently celebrated 60 years of world-class pre-hospital care. When it began in 1962, AAV consisted of just one rotary wing aircraft and one fixed-wing plane. Twelve patients were transported in the first year, the majority being medical and trauma patients from the Snowy Mountain Hydro Scheme. Sixty years on and AAV’s fleet of four fixed-wing planes and five helicopters (HEMS) provide a vital link between rural communities and metropolitan health services. Fixed-wing aircrafts – typically staffed by Advanced Life Support (ALS) flight paramedics – and HEMS – staffed by Mobile Intensive Care Ambulance (MICA) flight paramedics – reach across Victoria and into parts of southern New South Wales, northern Tasmania and South Australia. The service is made up of just over 37 ALS flight paramedics and almost 50 MICA flight paramedics supported by a dedicated team of flight co-ordinators, pilots, aircrew officers, doctors, engineers, trade assistants, retrieval services and administrators.

‘Our fixed-wing arm is the backbone of AAV and it cares for so many patients per year, really helping to connect regional and rural Victoria with the health services that metropolitan Melbourne has to offer.’ Over the last year, the fixed-wing planes averaged approximately 250 missions each month and clocked up about 430 flying hours (per month), equating to eight to 10 flights per day. ‘Frequent flyer’ 71-year-old Judith Harper said without AAV she wouldn’t be here today. Judith underwent brain surgery in 2018. ‘AAV flies me monthly from Warrnambool to Essendon airport, and then I am transferred by road to hospital for chemotherapy and scans. I always feel so safe and well-looked after, the paramedics are incredibly kind, and their clinical expertise doesn’t go unnoticed,’ she said. The planes also fly patients with acute medical conditions requiring surgery, transfer injured patients from regional hospitals and retrieve critically ill patients from regional hospitals to specialist care, such as cardiac care and intensive care.

In 2020/2021, AAV responded to more than 7,000 incidents – up almost 1,000 on the previous year, with the fixed-wing fleet transporting more than 5,000 patients. AV’s Manager of Air Operations Anthony de Wit said AAV is at the forefront of pre-hospital patient care in Australia and worldwide. ‘While it’s difficult to confirm the number of lives saved since 1962, over the past decade AAV has assisted more than 50,000 people throughout Victoria and our bordering communities,’ he said. edic to Param ho light EMS2). P ictoria F A V MIC ower (H The first lance u D b d m 'A o A R on the fi mbulance Offi sy of e t r rs ce u o c Photo cou t AAV flight Joh r' to work n rtesy of A mbulanceBlosfelds. Victoria

www.caa.net.au

Services First

Photo courtesy of Ambulance Victoria

Services First

On July 19, 1962 MICA paramedic John Blosfelds was the first ‘Ambulance Officer’ to work on the first AAV flight that was transferring a patient with spinal injuries from the Snowy Mountain Hydro Scheme. Latvian-born John had never been on a plane having sailed to Australia as a 17-year-old after fleeing war and living in German war camps for five years. He joined AV just after his 19th birthday. ‘On my first ever flight, I accompanied the Director of the Spinal Unit at the Austin Hospital on the Skyways plane from Essendon airport to Khancoban, to retrieve the young man who had been admitted to Corryong Hospital with a broken spine, and leg and chest injuries after being crushed under falling rock,’ he said. ‘After I did that first flight, I completed a training course that was run by a Royal Australian Air Force (RAAF) surgeon, and I learnt all about air pressure and how patients are affected by altitude - once we passed the course, we had a special badge to wear with the one wing attached to the AV logo.’ A long-serving member of the AAV team, who has been with AV for almost 20 years, is Flight Paramedic Educator Nicole Grant.

‘My most memorable job actually involved no clinical intervention whatsoever; I was transferring an elderly palliative care patient from Melbourne back to country Victoria and she told me she had never been on a plane before.’ Nicole said. ‘It was a beautiful morning for flying and she spent the entire trip with her nose glued to the window. I remember the look of rapture on her face as she said it was the most magical experience she’s had and was so appreciative of being looked after in this way. It reaffirmed why I do the job that I do.’ AAV’s five emergency response helicopters (HEMS) are based at Essendon, the Latrobe Valley, Bendigo and Warrnambool and are called out for life-threatening emergencies, which are mainly trauma and paediatric cases, as well as search and rescue, and transporting remote patients. Anthony said AAV provides a worldclass service using state-of-the-art aircrafts flown by highly trained professional pilots and aircrew. ‘At AAV, the performance and the standard we demand of our staff is of the highest quality, and we continually strive to improve our clinical care and upgrade our facilities – it’s been a privilege to manage Air Ambulance Victoria,’ Anthony said. www.caa.net.au

Photo courtesy of Ambulance Victoria

‘We walk in the shadow of those over the last 60 years and people all over the world use us as a model. That’s something to be celebrated.” Anthony de Wit Manager of Air Operations, Ambulance Victoria

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Services First

Virtual services improve care for SAAS patients From SA Ambulance Service

A Ambulance Service crews are using video consultations to streamline patients’ access to care and help them avoid unnecessary ED presentations.

SAAS has recently integrated two virtual urgent care services into its operations, the Virtual Emergency Service and the Child and Adolescent Virtual Urgent Care Service. Both of these innovative services allow SAAS clinicians and patients to have an assessment and consultation via video-call with senior consultant medical staff, using the HealthDirect platform. About two-thirds of Virtual Emergency Service patients have been able to receive care in place, direct admission or referral to other services. About one-third have required an ED presentation but in most of those cases, the consultation with the VES team has been able to provide planning that expedites their ED arrival.

The Virtual Emergency Service is provided by the new SA Virtual Care Service, while the Child and Adolescent Virtual Urgent Care Service is delivered by the Women’s and Children’s Health Network. Both are staffed by emergency and general physicians, nursing and administration staff. SAAS Health Navigators - who are experienced paramedics – also work closely with the Virtual Emergency Service team, triaging calls from SAAS clinicians to determine whether their patient requires a consultation with the Virtual Emergency Service or brokering referrals to another care pathway.

www.caa.net.au

Albert's Story Albert is a 56-year-old male scuba diver. His friend calls Triple Zero (000) after a brief loss of consciousness after aspirating sea water from his snorkel and having a coughing episode. SAAS contacted the Virtual Emergency Service for advice on whether Albert needed a hospital ED review. SAAS Acting Executive Director Operations (Statewide), Kate Clarke, and Virtual Emergency Service doctor, Dr Tam Le Cong.

“VES and CAVUCS are really making a difference for patients,” said SAAS Acting Executive Director Operations (Statewide), Kate Clarke. “Patients are getting much faster access to an assessment by a doctor, avoiding an ED presentation in most cases and often receiving direct referrals to Local Health Network care pathways which aren’t otherwise available for SAAS referrals.

Albert's Care Outcome A Virtual Emergency Service ED Consultant assessed Albert and viewed his ECG. A plan was agreed with SAAS & Albert for a follow-up with his GP in the coming days. Albert therefore did not require an ED hospital review.

SAAS contacted VES at 16:08hrs & spoke with triage nurse

“For SAAS clinicians, these services have also created opportunities to work more collaboratively with senior medical staff and share their clinical expertise in a more direct way than when we transfer patients to an ED,” said Ms Clarke.

VES ED Consultant reviewed Albert at ~ 16:18hrs

“The medical staff from CAVUCS and VES report that they value the input and expertise of our clinicians, and our crews have been equally positive about the opportunity to work in partnership on patient assessments and care planning. “Of course, the most important feedback comes from the patients and they have been extremely positive about the care they’ve received from these virtual services,” said Ms Clarke..

VES ED Consultant completed assessment & confirmed plan with Albert at ~16:33hrs

Time taken to provide the Virtual Emergency Service care to Albert with SAAS = ~ 25 minutes.

Services First

Papua New Guinea: Australia’s nearest neighbour From St John Papua New Guinea

n insightful look at the incredible work being undertaken by St John Ambulance to improve prehospital care in Papua New Guinea (PNG).

Papua New Guinea is often covered in the news media in Australia, but usually featuring some of the more challenging or negatively viewed aspects. There are so many success stories from PNG, and St John PNG is definitely a good news story. Matt Cannon, who has been working for St John PNG in Port Moresby since 2015, and CEO since 2017, offers his frank and experienced views on the provision of prehospital emergency medical care in Papua New Guinea. Matt is understandably a busy person, running an ambulance service comparable in size to the Northern Territory or the ACT Ambulance Services.

Key facts about St John Papua New Guinea:

Provinces in which St John PNG operates

NCD, Central, Simbu, ENB, Morobe

Population reached by road

4,000,000

Population reached by air

~85%

Fleet

55 vehicles (projected)

Staffing

250

Medical officers

Registered Nurses

HEO

Paramedics

Ambulance Officers and EMTs

100

Kilometres travelled per year

1,300,000km (2020)

www.caa.net.au

Services First

St John Papua New Guinea structure

Papua New Guinea’s health challenges: Measure

Statistic

Population

9,300,000

Life expectancy

64.5 years2

Number of doctors

~ 400 - 1,0003

Maternal Mortality Rate

215/100,0004

Under 5 Mortality Rate

44/1000 live births5

St John PNG is a responsive, dynamic service with a reputation for accountability and transparency, and is regarded as one of PNG’s leading health organisations. St John PNG is an independent statutory body operating under its own Act, established in 1957, and provides PNG’s jurisdictional ambulance service under Agreement with the National Department of Health.

Services Around 80% of PNG's population live in rural areas. Combined with limited rural road infrastructure, delivering ambulance service is uniquely challenging. St John PNG has ambulance stations in Port Moresby, and the provinces of Central, Morobe, East New Britain, and Simbu. The service has around 40 ambulances, around 120 ambulance personnel, 20 nurses, doctors and medical professionals, and 100 associated logistics and support staff. St John PNG is continuing towards a vision to have prehospital care available to the majority of the population through stations in urban centres by 2030.

www.caa.net.au

Utilisation of ambulances

Funding the ambulance service

Interestingly, the highest user of ambulance services are females aged between 14-30 years old. Obstetric issues and trauma are the two most common reasons this group utilises ambulance services. The number of emergencies St John PNG responds to has grown from 3,731 in 2017 to 13,480 in 2021 and is still increasing. First quarter trends suggest that St John will response to 19,000 incidents this year. In 2020 St John ambulances drove more than 1.3 million kilometres bringing people help.

Despite nearly all ambulance patients receiving entirely free services, the average cost to St John PNG of transporting one patient by road ambulance is valued at PGK 800 (A$320). covering the costs of treatment, medicines, wages, fuel, maintenance, equipment, communications, and central control systems. St John PNG receives about 70 per cent of the ambulance service funding from the government, with an even split between provincial governments and the national treasury.

Ambulance training St John PNG does all ambulance training in-house through its Ambulance Service Training Academy (ASTA). All ambulance officers undertake a Certificate III in Prehospital Care at ASTA prior to commencing their on-road internship. St John PNG benefits from close relationships with other CAA ambulance services in developing its clinical training and governance.

CEO Matt Cannon observes that, “the health sector in general in Papua New Guinea is imperfectly resourced. We have strong partnerships with government and private sector which helps to fulfill our role in providing prehospital care and connecting patients with the right health services.” “Given the 30% ambulance service funding shortfall, St John PNG raises funds to bridge this gap (around $1.5 million AUD) through its social enterprises such as on-site medical services, first aid and safety training, and selling of first aid kits and medical equipment.”

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Partnerships strengthen capacity

COVID response

Part of what makes St John PNG unique are the strong relationships we have built with the public and private sector to allow us to provide the most appropriate and timely care across public health and emergency response.

When the Covid-19 pandemic reached Papua New Guinea, St John PNG stepped up to support the governmental and bilateral aid organisation response across PNG. Responding to a significant number of undiagnosed covid cases in the community, St John PNG also set up a large drive-through testing centre and was at the forefront of training in the emergency health response space. As the pandemic situation worsened St John PNG utilised neighbouring sporting facilities to open a 300 bed Covid-19 field hospital in partnership with Port Moresby General Hospital, supported by the Australian Government.

The professional ambulance service greatly benefits from the partnerships with PNG’s large private sector and the international aid sector. These symbiotic relationships ensure St John PNG is well provisioned with medical equipment akin to that which a resourced ambulance service should have anywhere in the world. In return, St John PNG is better positioned to provide large organisations the global standard of 24hr emergency support they require in a health resourced environment. In collaboration with the Sir Brian Bell Foundation, St John PNG teaches first aid to year 9 school students free in Port Moresby, Central, Morobe, East New Britain and Simbu provinces – five of PNG’s largest provinces. Over 5,000 high school aged students have benefited from free first aid training. We continue to work with communities to make first aid and healthy lifestyles a part of everyday society. Being able to harness synergies between clients, community, private, and public sectors are examples where charitable services, like St John PNG, have tremendous advantage in their ability to provide highly responsive and dynamic emergency services.

"I was faced with the situation that either we (St John PNG) take the lead in boosting capacity by building a field hospital, or the ambulance service would face significant ramping and patients (and staff) would suffer. We had to take and lead the initiative", said Cannon. Matt praised his colleagues for their performance during the pandemic, “I was really proud of our St John people – Papua New Guineans and Australians – who’s worth ethic and dedication shone through in helping the country prepare for and deal with the impacts of Covid-19."

Paramedic Spotlight: Health Extension officer Piwen Samol puts her training in rural primary health to the test everyday in her job as a prehospital clinician working with St John PNG. Highly skilled in obstetric and neonatal care. Piwen regularly backs up ambulance crews in attending to obstetric emergencies. With a majority of women in rural areas unable to access comprehensive antenatal care, and St John PNG crews delivering a baby on-road every.

Air Ambulance Alongside the road ambulance network, St John PNG has nationwide coverage via their aeromedical service. With many areas of PNG not accessible by road, air ambulance services provide the only access to a majority of remote locations otherwise cut off from health facilities. In 2021 St John PNG undertook 57 fixedwing and 11 helicopter medical retrievals. As well as providing life-saving access to healthcare for local Papua New Guineans living in rural areas, St John PNG also provides the nation’s leading tertiary level domestic and international medical evacuation services. After nearly two decades of being an observer member of The Council of Ambulance Authorities (CAA), the CAA board voted to formally accept St John PNG as a member of the CAA in October 2019. This symbolised the great strides the service had made in the last decade towards providing a contemporary modern pre-hospital care service. St John PNG staff will be attending and presenting at this year’s CAA conference in Sydney. If you would like to meet with us, know more about our service, or just catch up for a chat, please get in touch, we’d love to meet you!’ CEO Matt Cannon

Paramedic Spotlight: Anthony is a newly graduated trainee ambulance officer (AO). Having completed the 16-week induction program, he now starts his on road internship. Over the next 12 months Anthony will complete remote learning packages and supervised practice towards achieving his Certificate lll in Prehospital Care. “As an AO, we are first responders, the first to arrive on scene to help others. Te expert training St John has provided equips us with the knowledge and skills to provide lifesaving care to patients in a wide variety of situations.”

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St John New Zealand Paramedics Given Best Tool for the Job By St John New Zealand

move to empower St John New Zealand paramedics with the best tools for the job is making a big difference in improving patient care and health outcomes.

St John paramedics are one of the key health professionals providing urgent, unplanned care in the out-of-hospital setting, assessing approximately 1,500 patients per day in the community, nationally but before 2020, they did not have readily available access to their patients’ shared health information. Orla Fowden, St John New Zealand Right Care Advisor and Critical Care Paramedic says this lack of access added a complexity to patient assessment and decision-making regarding treatment and transport. “Working in front line ambulance operations gave me first-hand experience of how frustrating it could be when we had no patient history for the person in front of us,” Orla says. In early 2020 the South Island Alliance (a collaboration between the five South Island District Health Boards) Palliative Care Workstream identified paramedics as a vital part of their patient’s journeys but also recognised that paramedics were ill-equipped to access their patient’s health information. “They agreed this inhibited the paramedic’s ability to provide the best care to their cohort of patients due to limited access to their acute care plan and advance care plans. So, I was thrilled when the Workstream identified St John as a vital partner in their patient’s journey and approached us to form a working group. “The network connected St John with the HealthOne team and the Canterbury Clinical Network, who were all very motivated to make patient’s clinical records available to all registered paramedics in the South Island.” HealthOne is the secure, electronic shared care patient record containing health information, including from General Practice (GP) and hospital records, prescribed medications, and test results in the South Island. Authorised healthcare providers such as GPs, community nurses, pharmacists and hospital clinicians already have access to HealthOne and share vital information to provide informed and therefore, safer care.

Orla says that from early in the discussions, it was clear that greater access to patient information via HealthOne would assist us with assessment and treatment plans when called out to see palliative patients in the community. “Their symptoms were often due to underlying illnesses that could be managed differently, thereby achieving better results for patients and potentially avoiding unnecessary trips to hospital. We were confident this would also help reduce unnecessary transport to ED of some of our low acuity patients.” Orla says now that St John paramedics have access to HealthOne at the scene they can quickly gain a greater understanding of the patient’s medical history and also better help guide treatment decisions. “It truly allows for more robust clinical decision-making on whether the patient should be transported to hospital or can safely be managed in the community.” In February 2021, all registered paramedics in the South Island were eligible to apply for access to HealthOne and now, one year on, St John has more than 300 paramedics who use HealthOne. “St John Extended Care Paramedics are by far the highest users of HealthOne, due to the nature of their role being more focused on low acuity patients and alternative pathways. Orla says the South Island Alliance were vital in instigating the initial working group and have demonstrated immense advocacy for St John in this journey. “A huge thank you to the South Island Alliance, HealthOne, Canterbury Clinical Network and to everyone else that was instrumental in making this possible. It has truly made a difference to how St John cares for patients in the community.”

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SA Ambulance Service’s new volunteer attraction campaign: Answer the Call From SA Ambulance Service

n South Australia, there are over 1,300 ambulance volunteers, who form the backbone of the ambulance services in SA’s country regions.

In around 80 locations across the state, volunteers deliver ambulance services to local communities, providing lifesaving treatment and transfer services to regional towns. Earlier this year, SA Ambulance Service (SAAS) launched its brand-new volunteer attraction campaign titled ‘Answer the call’. The campaign started in March and is due to finish in June 2022. SAAS conducted extensive primary market research to understand what the community thought about ambulance volunteering. This helped develop the new campaign key messages, which are based on myth busting, positive encouragement, and honesty about the role’s expectations. We know emergency volunteering is not easy, but it is very rewarding, and SAAS offers good support to its volunteers. The campaign aims to attract people willing to roll their sleeves up and help out. Our world has never been more different. Through the COVID-19 pandemic we have seen isolation like never before. Ambulance volunteering gives people an opportunity to meet like-minded people, make new friends and, at SAAS, learn essential lifesaving skills. SAAS is a registered training organisation which provides free of charge training up to a Certificate IV in Health Care (HLT411200) to its volunteers. As discovered in market research, it was important that the people portrayed in the campaign be actual SAAS volunteers, who are real and relatable. After an internal call for talent, five volunteers from across the state answered the call: Brad (Clare station), Kristen (Strathalbyn station), Grace (Meadows station), Mike and wife Pam (Burra station). They are now the faces of the campaign, featuring on all campaign items. [see poster] The headline ‘Answer the Call’ was selected following consumer research with volunteers as well as ambulance staff. It taps into the psychological and emotional need by the campaign target audience to be helpful to their community in a volunteer capacity.

Finally, it also refers to the physical action of answering a call to help via radio that becomes a visual cue on campaign items. The new campaign messaging sits around SAAS volunteers’ attributes of trust, loyalty and reliability. Knowing there will be someone who will respond when help is needed.” Rob Tolson, SAAS’s interim Executive Director Operations (Country) said, “we are always looking at ways to attract new volunteers to the service. Unfortunately, COVID-19 affected our ability to actively recruit volunteers for the past two years. Now it’s time to play catch up and increase our volunteer cohort across the state”. SAAS identified over 50 country priority ambulance station teams for the campaign. As the campaign rolls out by the SAAS Communications and Engagement team, each will receive public relations, community engagement support, social media posts, paid digital advertising, and printed collateral, to help encourage people to join. Additionally, many branded word-of-mouth campaign items were developed to support the campaign on the ground, such as editable posters, team posters, postcards, mythbuster flyer, information flyer, business card and email signature tile. Answer the Call talent and Clare volunteer, Brad says, “I wanted to diversify my skill set from my everyday work, which is greatly different to my farming life. As a SAAS volunteer I’ve been able to try something new that is rewarding and has influenced my life for the better. I’ve gained new skills, met new people, and enjoy being part of a team that provides a high level of care to the community. That’s why I am a SAAS volunteer and why I was more than happy to participate in this campaign”. If you live in Country SA and are interested in becoming a SAAS volunteer, check out the SAAS website: www.saasvolunteer.sa.gov.au. For more information email SAASvolunteer@sa.gov.au.

SA Ambulance Service is a Registered Training Organisation RTO code 0264. See what our volunteers get up to: Facebook: @SAAmbulanceService

Instagram: @sa_ambulanceservice.

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95 Years of Wellington Free Ambulance From Wellington Free Ambulance

ellington Free Ambulance was founded on the vision that emergencies needn’t cost lives or money. 95 years on this iconic ambulance service prides itself on upholding the original vision of Sir Charles Norwood who founded Wellington Free in 1927.

Despite an ever-increasing demand for services Wellington Free Ambulance remains the only free emergency ambulance service in New Zealand and the only ambulance service for the people of Greater Wellington and Wairarapa.

As you would expect the organisation has grown and developed considerably since being established 95 years ago this year. Influenced by population growth, technology, advances in medical treatment, the establishment of paramedicine as a registered profession and the healthcare needs of the community.

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The original Wellington Free Ambulance Station, Wellington Waterfront early 1930s

Today the service employs around 400 people both patient facing and support staff. Whilst the emergency ambulance service remains at its core, Wellington Free also provides a regional patient transfer service, a 24/7 on call rescue squad, specially trained tactical emergency medical support team as well as providing the clinical expertise to the regional rescue helicopter. A team of over 80 volunteers work as event medics across the region. The Wellington based 111 clinical communications centre is the hub for all emergency calls, answering over 151,000 calls each year. With seven bases across Wellington, Kapiti and the Hutt, Wellington Free 111 Call takers 1970s Ambulance also has bases in Greytown and Masterton to serve the Wairarapa community. As an essential health service Wellington Free receives the majority of its funding from Government and ACC

but must raise over $7Million from the community each year to ensure services remain free of charge. Claire Carruthers, General Manager of Fundraising and Communications, explained “We are fortunate to have the full support of our community. Each year we are humbled by the generosity of local businesses, grant makers and individuals who donate to keep services free.” Wellington Free Ambulance enjoys a particularly long and successful partnership with cornerstone partner Julie Nevett and the Lloyd Morrison Foundation, who for several years have fully funded the Lloyd Morrison Heartbeat Programme, which sees thousands of people across the region trained in CPR each year. Their commitment also supports the maintenance of the community AEDs across the region and funds a new ambulance on an annual basis.

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“We can’t thank Julie Nevett and the Lloyd Morrison Foundation enough for their ongoing commitment to the Heartbeat programme which equips our community with essential CPR skills to save a life, free of charge.” Claire explains. Wellington Free Ambulance regularly invests in state-of-the-art equipment for the benefit of staff and patients. Being the first ambulance service to introduce electric stretches and most recently rolling out Corpuls defibrillators. This transition has seen the equipment that paramedics carry reduce from circa 16.6 kg’s per patient to 6.5kg. The most recent development in this space is the rollout of personal issue cellular devices to all staff to enhance the connectivity and access to resources and documentation across the team. Looking ahead it is anticipated that demand for Wellington Free Ambulance will continue to grow, meaning the need for a skilled and diverse workforce will continue to be a top priority. “To ensure we can provide top quality care to our community we continually need qualified and experienced staff in a range of roles across the service. We are always looking for paramedicine qualified staff, I encourage anyone with the appropriate qualifications who is wanting to join a progressive and world leading organisation to be get in touch.” Head of Emergency Ambulance Services, Kate Worthington explains. For more information www.wfa.org.nz

The Women's Auxillary Fundraising Committee 1929

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Awards First

Photo courtesy of Richard Bugg

The Tasmanian dispatcher who helped save a life over the phone.

n June 2021, a man in Northern Tasmania called triple zero after sustaining a life-threatening leg injury. He sustained a severe haemorrhage to his right calf in an incident involving a power tool and desperately needed emergency assistance.

Ambulance Tasmania Emergency Medical Dispatcher Lewis Stadler answered and calmly guided him and others on the call to successfully apply a tourniquet which quickly stemmed the loss of blood, ultimately saving the injured man’s life. The patient recovered from his injuries in hospital.

Calm, effective, and successful action over the phone led to Lewis Stadler being named the 2021 Australasian Dispatcher of the Year.

“The paramedic who went out to the job told me the patient had lost a lot of blood and the tourniquet had worked really well and saved the man’s life,” he said.

Mr Stadler said he was humbled by the honour awarded by the International Academies of Emergency Dispatch but considered it more of a team award for the incredible colleagues he works with.

“It’s the unfortunate fact that it’s a job where you don’t get to win every single day and sometimes it feels like the wins are few and far between. To get a win in a situation like that is always great.”

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Photo of Lewis Stadler courtesy of the Tasmanian Department of Health

Ambulance Tasmania Chief Executive Joe Acker said he was “enormously proud” of Mr Stadler’s efforts. “There can be no greater recognition of the contribution of the safety of every Tasmanian who finds themselves facing the worst day of their lives and calling Triple Zero,” Mr Acker said. “Lewis was recognised for his professional judgement and performance providing lifesaving pre-arrival instructions until an Ambulance arrived which is an outstanding achievement.”

Since 1988, the International Academies of Emergency Dispatch has researched, produced, and maintained standards for emergency dispatch and response services worldwide. According to the organisation’s website, the mission is “to advance and support the public-safety emergency telecommunications professional and ensure that citizens in need of emergency, health, and social services are matched safely, quickly, and effectively with the most appropriate resource.”

The IAED Dispatcher of the Year accolade is awarded annually to recognise individuals who make the most significant contributions and further the Academies’ values and mission through their own personal actions. The Australasian victor has been in the role for almost six years and said it’s one of the most rewarding jobs. “You get to help people when they need it the most, and that’s really amazing,” Mr Stadler said.

2022 CAA Awards for Excellence Finalist Announcement

The Awards for Excellence are proudly supported by SDSI

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Excellence in Patient Care Clinical Response to a Global Pandemic

Entry: Virtual Emergency Medicine

NSW Ambulance

St John WA

Martin Nichols

Rudi Brits (Team leader), Prof. Paul Bailey, Dan Rose, Kerryn Welke

The aims of the NSW Ambulance clinical response during the COVID-19 pandemic were: • Maximise safety for clinicians • Provide safe and contemporary care to patients, families and careers • Ensure clinical practice is contemporary, evidence based, high quality, patient-centred and delivers value In early 2020 as Australia was observing the effects that the COVID-19 pandemic was having internationally. Accordingly, NSW Ambulance commenced planning for the pandemic operationally and clinically to ensure an effective response to the pandemic. One key initiative was the establishment of an Incident Management Team (IMT) which has been operational since early 2020. Additionally, NSW Ambulance embarked on a number of clinical initiatives to ensure that the needs of patients and clinicians were met. These initiatives included the establishment of a clinical lead role in the IMT; the establishment of a COVID-19 Clinical Practice Expert Reference Group; development and implementation of specific pandemic protocols; and the introduction of a number of clinical interventions to reduce the risk of aerosol generating procedures. These interventions included mechanical cardio-pulmonary resuscitation devices (mCPR), video-laryngoscopy, syringe drivers, continuous positive airway pressure (CPAP), and enhanced monitoring for Intensive Care Paramedics.

St John WA in collaboration with Fiona Stanley Hospital (FSH) and the South Metro Health Service (SMHS) is revolutionising emergency patient care thanks to its Australia-first, Virtual Emergency Medicine (VEM) service – designed to improve ambulance and emergency department (ED) flow. VEM allows paramedics to initiate a remote consult for non-priority 1 patients aged 16 years and over, with the aim of discharging on scene or diverting them to another suitable inpatient/outpatient service. The initiative is particularly beneficial for geriatric cases. It has successfully operated for about a year at FSH since its launch in February 2021. VEM was designed to improve patient outcomes with the aim of having far reaching impacts by significantly easing pressures on busy EDs and improve overall patient care and flow throughout hospitals and the wider WA health system. It could revolutionise ambulance patients’ Transfer of Care through its game changing emergency medicine model. VEM allows for a rapid pathway (e.g. ambulatory care, chest pain clinic or imaging) at FSH, or direct transport to Fremantle Hospital’s Geriatric Medicine. A concerted push for VEM consults in November resulted in one of FSH’s highest primary ED bed avoidance rates to date (n=105 out of 1235 ED cases or 8.5%) and signaled improved patient turnaround times. With SMHS providing initial and ongoing funding and resources, the WA government committed a further $2.3 million in the 2021 budget for SMHS to expand the service to Rockingham and Peel hospitals. As Omicron spreads in WA, much effort has gone into utilising VEM for COVID-19 cases, with the aim of expanding to Royal Flying Doctor Service admissions, burns patients, and engage with GPs. Eventually other patient cohorts can be identified, such as mental health consumers and direct patient/family contact.

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Excellence in Clinical Practice SAAS Clinical Hub Health Navigation Role Integration into SA Virtual Care Service

St John NT Clinical Practice Manual

SA Ambulance Service

Duncan McConnell, Andrew Thomas (Team Leader), Paul Bellman (dec.),

Kate Clarke SA Ambulance Service is successfully diverting low acuity patients away from hospital EDs, connecting them to appropriately tailored care through: • A comprehensive strategy which has introduced fifteen non-ED pathways to the SAAS service delivery model in the last three years • Health Navigators facilitate patient referrals from crews to alternate pathways • Broad stakeholder collaboration on a statewide level. SAAS consistently diverted between 20% and 30% of patients from EDs since mid-2021. Commencing in 2019, as a unique and innovative role within SAAS Clinical Hub, Health Navigation has played a pivotal role in the development, improvement and utilisation of care pathways and expanded service delivery model. The design of the new SA Virtual Care Service identified the role of Health Navigation within the SAAS Clinical Hub was well aligned with the strategic direction of tailored patient care and utilisation of alternate care pathways, contributing to improved patient flow and health care within South Australia. With models around the world showing higher success with integrated models, SAVCS has become the first fully integrated, multidisciplinary Virtual Care provider in Australia. The role of Health Navigation was a key enabler in providing a SAAS interface and is now integral in development and expansion of SAAS.

St John Ambulance Australia (NT)

The Clinical Practice Manual (CPM) project was developed to support the clinical decision making of St John NT. It includes up to date clinical practice guidelines and drug therapy protocols for all clinical levels from Advanced Responder (volunteer clinical roles) through to Intensive Care Paramedic. The project demonstrates St John NT’s commitment to the best possible pre-hospital care and improved health outcomes for its community. Development of the CPM involved reviewing the clinical practice and management guidelines of many of the services represented by the Council of Ambulance Authorities leveraging off the research and development of these services as well as consulting with Medical Practitioners through the Medical Advisory Panel. The CPM was produced as a printed, online and digital app. Roll out of the new guidelines included both online and face to face training for all clinical staff setting a new standard in the provision of clinical care for St John NT paramedics. The overall project involved significant engagement from across the organisation, supported by external design and digital agencies. This project was developed over 14 months, followed by an intensive four-month training program which was delivered during a COVID-19 response period.

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Spotlight on Aeromedical - Part of an Integrated response to the longest prolonged National emergency in history NSW Ambulance Cameron Edgar Emergency services are responding to an enormous volume of calls with people missing and patients severely injured or ill. Operating conditions are extreme, the smoke from state-wide bushfires that turned day into night is now replaced with low clouds and driving rain from state-wide floods. Communities across the state are isolated with widespread local infrastructure drastically affected. Normal ‘business as usual’ workload continues to rise as does the volume of disaster related emergency calls. Community angst and uncertainty continues as an infectious disease is putting highly trained health professionals and staff into isolation, including their loved ones. Staff, the greater community, government, and media need accurate, timely and constant information. There is no clear end date to this latest state-wide emergency and when the next one may occur. In many cases, the only means of getting essential critical care to these patients is by air. This has been the experience across New South Wales since 2019. The state had just finished burning, a global pandemic is in its third year and the state is now flooding. Direction and reassurance was required, leading to the establishment of the NSW Ambulance Aeromedical Incident Management Team.

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Excellence in Leadership Crisis Leadership – A Leadership Excellence Case Study: The use of intentional leadership and Incident Management Systems to lead an organisation through the COVID-19 pandemic. Queensland Ambulance Service Craig Emery The rapid emergence of the COVID-19 threat posed significant challenges for all organisations, in particular for those responsible for health care delivery. The potential impacts of the COVID-19 pandemic event were both complex and unpredictable, with the constantly evolving environment presenting a substantial challenge for planning and response. The Queensland Ambulance Service (QAS) leveraged well practiced disaster management prevention, preparation, response, and recovery functions, and combined these with Incident Management System frameworks, project management principles and the commitment to future capability and development to lead the organisation through the COVID-19 pandemic. The QAS made a commitment to ensuring a flexible and innovative approach to planning using crossdisciplinary teams, providing a new standard for ambulance operations in Queensland and in particular, for the planning associated with large scale events or disruptions. The true legacy of COVID-19 for the QAS is the development of the QAS leadership capability development framework and the enhanced collaborative capability that can be extended to other aspects of QAS service delivery.

Double Crewing Project Clinical St John New Zealand Susanne Doddrell, Dave Richards In the 2016/17 financial year, only 91.2% of ambulance responses at scene were double crewed, meaning that over 35,000 ambulance responses a year had only one crew member. The Double Crewing Project was established to deliver our new service delivery model, adding approximately 375 new staff and allowing St John to deliver on its vision to end the single crewing of emergency ambulances in New Zealand by 2021. During this project 135 stations underwent some form of assessment or change process and new transport-capable first response units for volunteers were introduced. This project demonstrates a successful approach to large change management for ambulance services. At project completion, 99.8% of ambulances are double crewed, essentially eliminating single crewing. The increase in double-crewed responses has also had a positive influence on out-of-hospital cardiac arrest survival to 30 days, which increased from 11.1% to 16.8%. Inequalities have also been addressed, previously only 90% of Máori patients received a double crewed ambulance compared to 95% for non-Máori; only 92% of patients in high deprivation areas received a double crewed ambulance compared to 97% for low deprivation areas. There is now equality and a better ambulance service.

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National Safety and Quality Health Service (NSQHS) Standards Program SA Ambulance Service Graeme Rayson In December 2021, SAAS was awarded accreditation for the second time, sending a clear and powerful message to the community and ambulance sector that SAAS is committed to safe, quality patient care. In 2013, the National Safety and Quality Health Service (NSQHS) Standards were introduced by the Australian Commission on Safety and Quality in Health Care to assist health service organisations with their delivery of safe and high-quality care. Implementing the NSQHS Standards is mandatory for all hospitals and day procedure services across Australia, but this mandate currently does not apply to ambulance services. SA Ambulance Service (SAAS) was first awarded NSQHS Standards accreditation in January 2018 and, by doing so, became the first Australian ambulance service to achieve this recognition. The latest accreditation was significantly different to the first and a significant undertaking. The main objectives of the NSQHS Standards project were for SAAS to, firstly, implement the NSQHS Standards across the organisation and, secondly, achieve accreditation in the NSQHS Standards. Both objectives have been accomplished, consequently, the project has been an ongoing success. Accreditation in the NSQHS Standards is a milestone event and validates the professional attention to detail which has characterised SAAS’s approach to the accreditation program and, specifically, to the quality of care provided to our patients. With accreditation recently received, we recognise the need to continuously review and improve our systems and processes to ensure patient care in South Australia is optimised. SAAS is using 2022 to transition the program to a sustainable ‘business as usual’ model. Integrating a revised NSQHS Standards committee structure into the organisation’s existing governance framework, a decision approved by the organisation’s executive leadership team (ELT).

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Excellence in Mental Health and Wellbeing 'MyPulse' Health and Wellbeing Program for Tasmanian Emergency Services Workers.

Ambulance Victoria Telemental HEaLth Pilot – TeleHELP

Ambulance Tasmania

Professor Karen Smith, Nicole Magnuson, Lindsay Mackay, Gareth Becker, Mark Wilson, Angela Hodgkinson

Tessa Campin, Matthew Richman Ambulance Tasmania (AT) together with the Department of Police, Fire and Emergency Management (DPFEM) recognised that significant issues existed with the wellbeing of emergency service responders (including career, volunteer and state service personnel). An analysis of the issues identified that there was a need to reimagine our approach to wellbeing, with a particular focus on the proactive dimension. The result – the tremendously innovative MyPulse Health and Wellbeing Program www.mypulse.com.au/.

Ambulance Victoria

Ambulance Victoria’s Centre for Research & Evaluation received funding from the Better Care Victoria Innovation Fund to trial video triaging of mental health patients through an initiative called TeleHELP (Ambulance Victoria (AV) Telemental HEaLth Pilot). TeleHELP allowed mental health nurses within AV’s Triage Services to conduct remote face-to-face assessments with patients who contacted Triple Zero.

The MyPulse program is a collection of health and wellbeing content and services offered to Ambulance, State Emergency Service, Fire, and Police in Tasmania and is tailored specifically to their unique needs and place in the community.

Previously, low acuity mental health patients were transferred to a mental health nurse for triage within AV’s Secondary Triage Service. Through TeleHELP, eligible patients who are transferred to a mental health nurse are now offered the option of video triage as an extension of voice-only triage.

MyPulse provides proactive and preventative pathways designed to empower emergency service responders and their families to enact positive behavioural change. Emergency service responders can do this with the assistance of face-to-face sessions with wellbeing coaches.

Patients who consent to video triage are sent a video link via SMS that enables two-way live video streaming between the mental health nurse and patient. The use of video triage facilitates a more accurate assessment by mental health clinicians who can then refer patients to the most appropriate pathway of care at the time of call.

Whist MyPulse commenced in late 2019, 2021 saw significant changes to the service that amounted to a major re-orientation of the program to ensure it was available to, and appropriate for, volunteers. In addition, as part of a vigorous reshaping of our concept of wellbeing, a comprehensive engagement strategy including the development of Lived Experience videos, was implemented.

The TeleHELP model uses a patient-centred approach and upholds patient safety and quality of care. The model also provides mental health patients with an alternative to receiving an emergency ambulance and/or being transported to a hospital emergency department (ED).

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Medic Fit NSW Ambulance Nam Le NSW Ambulance (NSWA) recognises that supporting our staff's health and wellbeing is vital for gold standard ambulance service delivery. To assist our paramedics with the requirements of their role, in 2019/20 NSWA developed the Medic Fit program. The program provides exercise equipment at over 240 worksites to provide staff with accessible opportunities to undertake low intensity and functional exercises in the workplace. Participation in the MedicFit Program is voluntary and designed to fit around work demands. It focuses on helping reduce the risk of mental illness and physical injuries. What makes the program unique is the internal support available from the NSWA Health and Fitness team -health coaches, injury prevention specialists and psychologists. As part of the program, tailored resources including a MedicFit Program Guide, an online exercise library, and NSW Ambulance injury prevention program have been developed to support staff in safe use of the exercise equipment.

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Excellence in Staff Development Ambulance Victoria's Graduate Ambulance Paramedic Improvement Program Ambulance Victoria Lauren Olney (Team Leader), Peta Reilly, Lisa Bourke, Paul Giagnacovo, Nicole Magnuson The primary goals of the project were to increase the number of students completing the program within 12 months and to improve the graduate paramedic experience. Alongside this were a variety of objectives, including: • Map learning tasks to Paramedic Competencies, enabling consistent and objective assessment. • Implement appropriate systems to ensure program governance, accountability and transparency. • Better support graduates’ psychological health and wellbeing, and physical safety. • Provide opportunities for graduates to participate in structured, off-road training days to support transition to practice and development needs. • Reduce the incidence of performance management initiated by not passing the final program assessment at first presentation. • Provide graduates some scope to self-manage and progress at their own pace, acknowledging that personal circumstances, types of case presentations, area of work, workload and other factors that can delay or enable progress.

• Implement a structured supervision framework in which Team Managers, Clinical Instructors and other support staff would actively monitor graduates, identifying and addressing areas of risk. • Implement a student management system which enables the graduate, program staff and all paramedic support staff to track a graduate’s progress in real time and access the learning history of the graduate if required. Following a review of AV’s Graduate Ambulance Paramedic program, AV’s Commencing Practice Team identified the opportunity to improve the experience of graduates and to increase the number of graduates who successfully completed the course within the scheduled 12-month timeframe. Over the following three years, the CP Team developed a more supportive and robust program, starting with organisation-wide consultation and benchmarking with similar programs in other jurisdictions. The result was a new program in which roles and responsibilities are clearly defined and embedded to support and develop graduates and the learning framework is progressive, objective and standardised, with multiple checkpoints to report, action and support graduates to develop their clinical, operational and safety competencies. The new program was launched in March 2018, with a three-year trial period. Evaluation in March 2021 demonstrated that the new program was highly successful, with over 90 per cent of graduates completing their program within 12 months (compared to 50 per cent under the old program) and the vast majority of graduates who responded to surveys feeling that the new program prepares them well for their AP12 year.

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Ambulance Victoria COVID-19 Surge Workforce

Shocktober

Ambulance Victoria

Joel Marley (Team Leader), Phil Cullen, Andrea Lenaghan, Julian Hanton, Tahryn Mant, Rebecca Danslow, Reyyan Atmaca

Justin Dunlop (Team leader), Michael Stephenson, Matt McCrohan, Kathryn Haden, Brett Drummond, Olivia Howarth, Simon Jensen, Michael Wood, Danielle Saxton To maintain service delivery through the COVID-19 pandemic, Ambulance Victoria (AV) developed a surge workforce of over 1,000 personnel from partner agencies and universities (paramedic students). All relevant partner agencies engaged to provide direct support to AV entered into a memorandum of understanding with AV. Student paramedics were directly employed by AV, leveraging existing education partnerships with universities. Personnel were screened and selected based on a range of key criteria focused on suitability and safety. Individuals received tailored training based on existing skills and experience, with a focus on occupational and patient safety. The training programs used AV’s systems and services, including online learning, information systems, peer support and welfare services as well as a dedicated forum for surge responders. Trained surge responders were rostered with qualified paramedics to support the delivery of exceptional patient care. The surge responders also provided a safe and stable driving platform to carry patients to hospital. The surge workforce provided approximately 120 rostered shifts each day during the peak of the Omicron outbreak. The expanded workforce allowed AV to manage demand as needed. This successful program demonstrated the efficacy of AV’s longstanding contingency to use a temporary surge workforce in response to extreme demand.

Ambulance Victoria

Cardiac arrest survival rates in Victoria plummeted by 50 per cent during the first three months of the 2020 COVID-19 lockdown. As the state’s frontline emergency health provider, Ambulance Victoria needed to mitigate this crisis and equip Victorians with essential, life-saving skills in the event of cardiac arrest. The resulting month-long awareness and education campaign named October as ‘Shocktober’, promoting the need for education in cardiopulmonary resuscitation (CPR) and the three critical steps to save a life: ‘Call, Push, Shock’. The campaign also encouraged Victorians with these life-saving skills to register on the GoodSAM app – a free, global smartphone app alerting registered responders that someone nearby is in cardiac arrest. GoodSAM responders can then support the patient until paramedics arrive. Following the success of the 2020 campaign, Shocktober was held again in 2021, proving to be one of the most successful community engagement campaigns ever undertaken by AV. It resulted in: • 134 online sessions delivered, reaching over 6,900 Victorians. • 1,010 community members registered via the GoodSAM app. • More than 510,000 people reached through Shocktober-related social media posts. Shocktober is now a permanent fixture on AV’s community engagement calendar.

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Excellence in Technology Secondary Triage Work From Home Ambulance Victoria Gareth Becker (Team Leader), Lindsay Mackay, Caley Geary, Angela Iliopoulos, Flynn Snell, Paul Crole, Catherine Spiden, Tom Bawden, Larissa Walsh, Patrice Bottcher, Hayden Peucker, Jenny Davis On 27 January 2020, Ambulance Victoria (AV) identified serious challenges to its operations posed by COVID-19. AV faced the possibility that overwhelming call volumes and staff furloughs would significantly hamper the Secondary Triage Team’s ability to manage Triple Zero calls. A Work from Home (WFH) project was designed and implemented to address this problem. The project provided significant organisational resilience and met the challenge of surge capacity. Prior to the commencement of AV’s WFH project, no ambulance jurisdiction had successfully accessed both Triple Zero callers and the Computer Aided Dispatch applications within an ‘at home’ environment. AV developed vital technical and procedural enhancements to achieve this. Since the successful pilot, the WFH functionality has been refined and has significantly minimised the impact of staff furloughing, as well as delivering greater surge capacity. Within seven minutes of receiving a request for surge capacity support, Triage Practitioners can be online, providing full operational support within the home environment. Home-based Triage Practitioners can now access the full suite of software and tools that allows them to operate as effectively as office-based practitioners.

Proudly supported by

Real-time COVID-19 data linkage to inform the pandemic response Ambulance Victoria Professor Karen Smith (Team Leader), Emily Mahony, Nicole Magnuson, Emily Andrew, Dr Sarah Hopkins, Dr Ziad Nehme In Australia, the collection of COVID-19 surveillance data has been at the centre of the public health response and has supported critical decision-making around testing and hospital capacity. However, comparatively little is known about the way surveillance data is being used to inform the preparedness of emergency medical services for the COVID-19 pandemic. This project, led by Ambulance Victoria’s Centre for Research & Evaluation, established Australia’s first ongoing data linkage initiative between ambulance clinical/operational data and a register of confirmed COVID-19 patients managed by the Victorian Department of Health. The project aimed to: • Provide critical intelligence and real-time reporting of ambulance attendances to COVID-19 patients. • Establish a mechanism to identify vulnerable staff exposure and initiate isolation procedures. • Provide an evidence base for the ambulance response priority to patients with COVID-19. Insights gained from the project have helped drive critical improvements to the pandemic response, including the isolation and quarantining of staff, ambulance resourcing decisions, changes to the ambulance response priority, and enhancements in clinical practice. The initiative now represents an easily transferrable model of surveillance that can be implemented into ambulance services internationally and is likely to support the ongoing emergency response to the pandemic.

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Towards Net Zero Carbon Emissions NSW Ambulance Peter Elliott (Team Leader), Ols Duerr-Reuther NSW Ambulance has started the journey towards net-zero carbon emissions by 2040. As part of the program, NSW Ambulance has designed two innovative systems that have enhanced organisational capability and improved business continuity, while supporting the reduction in our carbon emissions footprint. The first initiative is the installation of solar panels on ambulance stations, with the solar power generation being used to reduce grid power consumption, and stored in batteries for use as an Uninterrupted Power Supply (UPS) for the building’s essential services. The second is the installation of lithium batteries and solar panels on emergency ambulance vehicles to reduce wastage, provide an additional power source for the vehicle’s electrical system and increase the availability of the vehicles. Both initiatives are linked to NSW Ambulance’s corporate objectives to leverage technology and infrastructure through integrative models of care, to better support our paramedics responding to the community.

Join us for the announcement of our Star Award and Category Award winners on day two of CAA Congress at the CAA Awards for Excellence Gala dinner.

Friday, 12 August - Dockside, Cockle Bay Wharf in Darling Harbour, Sydney Purchase tickets at caacongress.net.au/tickets

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J Dr Jordan Nguyen

Dr Jordan Nguyen, is one of Australia’s most innovative engineers, who is committed to improving the lives of as many people as possible, and to help become a driving force behind both human and technological evolution as we move into the future.

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We're living at the fastest rate of change we have ever seen, but it may also be the slowest rate we will ever see again.” 75

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nspired by human endeavour, Jordan has big ambitions to see our world step consciously and creatively into a better future.

An internationally renowned engineer for humanity, Jordan designs life-changing technologies to transform the lives of people with disabilities and the elderly through his role as founder of Psykinetic, a social business committed to bringing positive, sustainable and life-altering change, and shares his adventures through documentaries across the world.

Jordan, can you tell us about some of the key decisions you have made that have directed you to where you are today in your career? I would say that key decisions tend to have come from a level of purpose. A lot of my big ideas and decisions have come from having an understanding of my purpose and that came about from various inspirations. Different people and challenges have inspired me and this is, I believe, a great way to discover purpose. These come in many forms. I’ll start with my parents. My mum is Aussie-Scottish, an artist and a very social, compassionate person, so she very much helped me find my artistic side through most of my life growing up. My father is Vietnamese and a professor in engineering, and has always been able to see the future, with an understanding of where technology was going, the pathways that were going to survive and the tech that wouldn’t.

We had the honour of speaking with Jordan in the lead up to his keynote address at the CAA Congress in August, wanting to get insight into his career and hear his thoughts on technology into the future.

I grew up in Merrylands for the first part of my life. When I was 3 years old my parent’s plan on just one more child was thrown when they had triplets! And I got two brothers and a sister. The boys Alexander and Tristan are both now GPs and have previously worked in emergency, and Zohara is an orofacial myologist. We all moved in the directions that worked for us. At just 5 years old it was awesome to find out that Dad was working on robots. The things that I thought only existed in the movies, in science fiction. I went into work with him to find he was working on an industrial robotic arm and building in Artificial Intelligence (AI), allowing it to learn for itself through trial and error – initially to pick up toys and move them around, and later to play games like naughts and crosses and checkers and chess.

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Towards the end of high school I realised I had interests in robotics and AI from these early experiences. They led me to make the decision to take on electrical engineering at uni, quickly moving into robotics and AI. What I realised whilst there was that I was really interested in people. But I was finding the engineering side really, really difficult and was ready to drop out or change at the end of my second year. After talking to Dad about it I made the decision to continue for another semester to see how things go. It was in this next semester in my third year of uni that I had a dive-gone-wrong incident in a backyard pool where I almost broke my neck. But I got very lucky with only minor injury to my neck, and it led me to learn about the disability sector that I knew almost nothing about. I found in research that 1 in 5 Australians have some form of a disability, and surprisingly 1 in 16 Australians have severe or profound disability. I wanted to know what this actually meant for individuals, such as what kinds of technology assist with independence in the likes of mobility. I didn't know, so I went out and met people and it was these stories that started changing my perspective, starting to pursue the idea that maybe technology could be enabling and help empower new friends of mine to do things that they wanted to do. I met people with very high-level physical disability, including locked-in syndrome, with impaired physical mobility coupled with being non-verbal. Yet I was also realising I was meeting people who were happier, more motivated, and doing more with their life than I was - in some cases running businesses.

One Life. Persist to Improve Many.”

This led me to look into my father's research and what I was learning from him about AI, robotics, brain-computer interfaces, smart wheelchair technology - and I started applying these to the idea of building a wheelchair controlled by the power of the mind so my mates could explore independence in mobility. I did this for my undergraduate thesis and then carried it through to a PhD in biomedical engineering where I continued to work on it for the next four years. During the very first trial, I observed a participant operating my design and it made me realise that my life could maybe matter in the life of someone else, and maybe even potentially more lives. So when I was finishing university at the end of 2012 I had the back of my iPod engraved with the words: One Life. Persist to Improve Many. It was a driving purpose statement to remind myself that I have one life, and I know it’ll take persistence to improve the lives of many. I'm sure this is something that resonates with most of you. Because knowing and acknowledging that your life can make a difference, it's something that we choose to take on, and itself is motivating. This statement helped guide big key decisions I would go on to make. One of those being to turn down a big promotion about a year later at an amazing company that I loved working at, a company that does have huge positive impact. But I knew I was being drawn back to the disability sector so that helped me make the decision to turn down this job promotion and build my social business Psykinetic whilst working for a charity in cerebral palsy. Psykinetic I named from the words Psyche and Kinetic, putting the mind into action. So these were decisions to follow the things that I believe in. As opportunities continued to arise, I felt more and more confident in following my instincts and trying new endeavours I was drawn to, and really many of my big adventures started with following my purpose statement.

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If you had to choose, what would you consider to be a couple of your most celebrated achievements? I don't think of them so much as celebrated achievements. I think of them more as adventures, the adventures that meant the most to me and the people around me, the ones that we think had a great positive impact. Beyond my PhD I’d say the first was setting up Psykinetic, which was huge because it started connecting us with families with communities. And being able to bring to life the ideas that we wanted to build, and forming that direct connection with the people who we build for has always been very important. Further to this I would say my documentary Becoming Superhuman was definitely one of the best adventures of our lives. We wanted to achieve our young friend Riley's dream of driving a car. Now Riley is a super bright young guy who loves technology. He was born with high-level cerebral palsy, affecting his movements and he is non-verbal. He was just 13 years old at the time and has since gone to complete his HSC, has co-founded his own company with his father, building exoskeleton equipment for people with similar conditions to himself. Just a brilliant young guy. We’re still in contact and so lucky to still call him a friend. Now in this documentary, what we want to do is to give him the ability to control household items - the lights, the TV, the speakers. But his big dream was to drive a car!

We built the whole technology on set and worked closely with Riley throughout the whole process to design a technology that could allow him to achieve these controls, harnessing the tiny signals the brain sends to the muscles around the eyes that push and pull them. To pick up on these signals through electrooculography (EOG), we designed a small headband that he could wear. We converted that through a computer running custom AI to detect patterns and differences in the data, similar to my PhD, which utilised EEG to control the wheelchair. In this case real-time EOG classification allowed Riley to control the vehicle with his eye movements. So eventually Riley got into the vehicle and pushed his own limits on camera, to focus, hold himself straight, and with just the movement of his eyes he drove an off-road buggy through an obstacle course. You could see the intense determination in his face after crashing, going back to the start and wanting to make it all the way through the obstacle course in a single run. Eventually he gained perfect control, weaving left and right through the course and all the way through the finish line, it was just incredible. Such an amazing adventure to realise the potential when you set your mind to a big dream and believe in the people around you. We all put trust in each other and Riley and the whole team together achieved something very special. Not only that, but the world wanted this type of content, giving us increased faith in humanity as it spread across the globe. Beyond that, I have presented numerous other documentaries with the likes of Discovery Channel as well, getting to see the major advancements in science and technology across the world and what I wanted to do is to continue sharing them, applying them to various areas that matter and seeing how we can harness these powerful technological tools to bring about positive impact for life on Earth, so I put all these adventures into my book ‘A HUMAN’S GUIDE TO THE FUTURE – How humanity can thrive through our ever-evolving technology’ (available from Dymocks and Amazon), which I’ll say is my third milestone here. I commit all proceeds from the book to new positive impact projects and documentaries. So completing and launching this was also an exciting moment.

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Can you tell me about your social business and the importance in making a social impact? Psykinetic is a social business made to design technology for disability and aged care, and this comes back to our core values of wanting to use tech for good. I think that's an important thing to find ways you can make a difference if that’s what matters to you as an individual or collective. And I know I’m speaking to the right audience here, that’s what your day to day work does, and I thank each and every one of you for your individual sacrifice, contribution, persistence. You make a difference. So from my perspective, obviously coming from that tech background, I chose to move into the space of applying technologies to the areas that we can see that matter. So that's why we build for disability and we started applying the same sort of technologies to aged care – from communication devices to biomedical wheelchair controllers to virtual reality for mental health to preserving memories with avatar technology to futuristic walking canes to AI fall detectors and much more. We see the impacts just trying to support can have, even the small things, in the lives of families. We’ve worked with our own web developer who now codes, Jess Irwin, to achieve her dream of playing music – she has gone on to perform live numerous times using eye-control tech we created together. We’ve worked with families to achieve the ability for children to communicate, control the environment, and play their very first computer games. Sometimes just being there to bounce ideas off works well for families we know. Social impact is mutually beneficial. It connects us on a deeper level, it keeps people in touch with their humanity, and it can create positive impact for all parties involved. So we continue to try and find ways to scale these ideas, to get them out to more people, make them inclusive whilst also sharing these adventures to help others see how they can do the same.

Where is technology leading humanity? I always look towards the intersections between technology and humanity. When new technologies emerge they give us whole new suites of tools. These tools are constantly evolving so we can do so much more with them than in the past, the applications are only increasing. And obviously they're having a larger impact. Not only has our use of technology increased our efficiency across the world, it has also contributed to many negative effects on our environment. This is where being able to share and understand the impact we have is important. Our challenges are getting bigger so with the likes of climate change, we have to be able to harness these powerful tools to better understand and protect this one planet we all call home. So if we look at where it's going, well, powerful technologies like AI, digital twinning tech and cloud computing can allow us to do things like build simulated environments of real world locations that we can then run like a video game – to better model how we should, say, deploy our resources in a crisis, or proactively protect the environment as an ongoing measure, or even better recover from major events. Really where we're going in the future is going to be based on the vision that we collectively set up for the future. Treating dystopic depictions of the future from science fiction as potential warnings, we can consider the things we want to avoid through our advancements, like the potential overtaking of technology disconnecting our humanity. Instead what we need to do is to set out better visions for the future. Where do we want to go? I challenge you to think from time to time about how things done in the likes of ambulance services could incrementally improve, how your work could be made more effective to allow you to do what you do best, and what action can bring about those changes. Continuous improvement steps us towards being the best we can be. I believe we have more ability now than previously to shape change – as an individual or group, an organisation – because of the rapid rate of change that we're living in, perhaps lending it to be collectively steered. We're living at the fastest rate of change we have ever seen, but it may also be the slowest rate we will ever see again. I go way more into all of these ideas in my book.

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What technology innovations are you most excited about? Renewable energy technologies would be one. I also want to see where the power of AI takes us, what opportunities it might open up in truly advancing sustainable technologies in the much needed efforts to clean up our world and improve our environment. One of the better use-cases I’ve seen is AI being used for wildlife conservation, an example being the start of 2020 when I was one the border of Russia and China learning about WWF International and Intel’s efforts to protect Amur (or Siberian) Tigers and Leopards. Thousands of cameras to automatically detect animals in view, record, catalogue, and gain insights into the movements of the protected species and various other animals in their environment. The better researchers understand the data the better they can protect them, including from poachers that get quickly spotted by the cameras. Lots of great potential in creatively harnessing the power of AI.

How do you approach people's fear and how technology is rapidly evolving so that the opportunities can be seen? How I approach fear is I want to get people to look past the initial gut reaction to new technologies we tend to have, which is honestly often quite negative. Much fear likely comes from many of the movies where everything goes wrong. So what I like to do is to make predictions about the future, start building them, and take audiences on that journey through the creation, through the reasoning behind why I build them, and to see how we can potentially create a set of ethics together and have a say in where these technologies go. Really, it's about us collaborating to rewrite that new future, collectively moving towards a better tomorrow. .

I'm excited to see where the endeavours around the Metaverse take us as well. These ideas of digital technologies, virtual and real colliding, but also making sure that we push it into a positive direction and keep on top of the importance of balance. At the same time, very interesting to see other areas as well that are advancing like the many emerging designs for space travel and our understanding of the universe. Love seeing new discoveries about our solar system, our galaxy and beyond. There's just so much to discover. Yes it’s big thinking, but these discoveries can help us here on Earth too. Looking forward to seeing how people bring to life their dreams, and this is of course what I plan to continue pursuing as well – realising the big dreams, and keeping up with technological innovations helps make more of these wild ideas possible. That’s what I’ve come to realise throughout these adventures… Anything is possible!

Our challenges are getting bigger so with the likes of climate change, we have to be able to harness these powerful tools to better understand and protect this one planet we all call home.”

www.caa.net.au

Simon Barton Phone: +61405401494 Email: simon.barton@tracplus.com

Events First

Industry Events What's on in the ambulance world

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Australasian Rescue Challenge 2022

he Australasian Road Rescue Organisation (ARRO) is made up of individuals and emergency service organisations throughout Australasia that attend road crashes every day, such as fire services, state emergency services and ambulance services.

ARRO focuses on furthering the knowledge, skills, and development of road rescue. In making developments in road rescue, members come together annually for the Australasian Rescue Challenge (ARC).

This year’s event (ARC22) is scheduled for the 21st-24th July in Tamworth, New South Wales, after a two-year hiatus due to COVID-19, and just in time for ARRO’s 25th anniversary.

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What is involved in the Australasian Rescue Challenge? The ARC consists of several components, the largest of which are the high fidelity road rescue and trauma scenarios. The simulated road rescue scenarios require full rescue teams of six, including two medics, who must rescue either a single or multiple patients from a road crash scenario within 30 minutes. These scenarios assess three disciplines: •

Time critical – where the patient has one or more time critical injuries which necessitate a specific approach to road rescue, with a focus on extricating the patient as soon as possible.

•

Entrapped- where the patient is significantly entrapped, which requires a very technical approach to road rescue and extrication is usually particularly difficult.

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Controlled – where there are two patients, and one or more require a careful, controlled extrication (for example, they may not have time critical injuries but do have cervical spine injuries requiring spinal immobilisation and a careful, controlled extrication), and the focus is on scene management.

Three key components of the road rescue scenarios are assessed. The ‘Command component focuses on scene management, leadership, communication and ensuring safety. The ‘Technical’ component focuses on the safe use of techniques and tools, for example, cutters and spreaders, to facilitate the road rescue, and the ‘Medical’ component focuses on the medic’s communication, management, and advocacy of the patient(s). Each medic being assessed wears a two-way microphone, which enables the Medical Assessor to hear everything the medic is saying to the patient and their team members. The trauma competitions involve teams of two medics facing a simulation with a patient who has a trauma and/or medical problem. The moulage and props are always a stand-out, with previous teams coming up against patients with large burns, amputations, crush injuries, and even a circular saw in the chest! Each medic has an assessor observing their approach to the scene, communication with, and management of, the patient, and teamwork with the other medic. As well as the high fidelity road rescue and trauma scenarios during these competition days, teams also have the opportunity to face off and see who is best at performing chest compressions using a QCPR manikin, which usually gets very competitive and ends up being an highlight of the challenge. There is also a full day rescue and learning symposium comprising of guest lectures, road rescue case studies, and practical workshops. The busy three-day event culminates with a formal presentation dinner where the top three agencies from each discipline is recognised, and an overall winner is announced.

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Want to get involved? There are two main ways people can get involved in ARC, either as competitors or assessors. If you’re interested in being a competitor, there is still time to get involved for ARC22. You could attend the learning symposium, compete in the trauma competition, or even see if you can bring home a trophy! If this is something you want to know more about, please visit arc2022.com. If you’re interested in becoming an assessor, ARRO will need to learn a bit more about you first. Medical Assessors must be registered paramedics, have the endorsement of their agency, and submit their curriculum vitae for consideration by the Challenge Management Team (CMT). There are limited spaces, but we would love to hear from anyone who meets these requirements and is passionate about road rescue. Those who are selected are usually required to observe and act as a shadow assessor where they are buddied up with an experienced assessor to observe. Once approved by the CMT, individuals are then able to operate as a fully qualified assessor. Please send an email through to enquiries@arc2022.com if this is something you would like to apply for.

For those who want to come along and see the competitors up-close and in action, we welcome you to attend. Please visit arc2022.com for more information about the venue details, and timing of the ARC22 event itself. We encourage everyone to come along and see if this is something that yourself or your agency would like to become involved with in the future. No matter your background or experience, by participating in, or even just observing the ARC event, we’re sure you will learn something that will help in your own individual practice as a paramedic when attending road crash incidents. ARRO is a great organisation, with many people passionate about improving knowledge and skills of road rescue and developing others in the art of road rescue. If you share our passion for road rescue, we’d love to hear from you. We look forward to seeing you at ARC22 for our biggest challenge day yet. Hannah MacLeod Technical Committee – Medical Specialist, ARRO National Ambulance Education Manager, St John New Zealand

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“It takes a system to save a life – People make EMS” And we are the people By Freddy Lippert - on behalf of the European EMS Leadership

he European Emergency Medical Services Congress EMS2022 took place in Scotland in May 2022. This was the 5th European EMS congress following Copenhagen in 2016-2018 and Madrid in 2019.

The Covid-19 pandemic closed the world and the planned EMS2020 was on hold until now. The organisers - the European EMS Leadership - had to consider timing, risks and if people had time, could travel and were allowed to travel. Would it be the right decision to meet face-to-face? It was! It was fantastic again to experience the EMS feeling when being together with more than 1.100 international colleagues and friends from more than 42 countries. It was time to share knowledge and experience from two busy years with COVID, impact of climate crisis, global health issues and the war in Ukraine. It has been two extremely busy and difficult years for EMS, even more work, more tasks, and constantly changing conditions. The impact on staff’s well-being has been obvious, however, the importance of EMS to our communities has been clearer than ever and appreciated by our communities.

This was clearly communicated in the opening session both by Humza Yousaf, The Scottish Cabinet Secretary for Health and Social Care and following keynote speaker Jason Leitch, The National Clinical Director in the Health and Social Care. This was a very good start. Being inspired by our colleagues from Australasia the EMS2022 Congress had two important themes. A theme on Women in EMS Leadership led by Michelle Murphy from Australia. This was a powerful session that strongly advocated for diversity followed by several successful workshops on Women in EMS - Strength based leadership for everyone. Another theme was sustainability. David Waters from CAA gave an inspiring keynote talk on what EMS can do and should do to be part of the solution based upon experiences from Australia and New Zealand. This was an eye-opening moment on the impact EMS has on climate change and what we need to do now.

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The program included more than 100 scientific papers, the usual and very popular EMS “TED” Talks, workshops and traditional sessions. This year we introduced a new concept of a full day of engaging EMS Labs, introduced in a rapid fire, plenary morning session. It was a great pleasure to see, hear and experience the faculty giving their pitch and key messages in a 5 minutes introduction leaving us with: I want more… The EMS2022 award was given to one of the resuscitation giants, the 91-year-old Douglas Chamberlain for his contribution to developing paramedicine and prehospital care and for continuously inspiring us throughout his life. What was not new, was the European EMS Championship, where 16 international teams competed in the preliminary round and ended up with 3 excellent teams in the final. Teams from the Netherlands, Lithuania and Austria made it to the final test, a complex challenge with multiple patients to care for and in front of the all the delegates as “judges”. The winner was the Austrian Red Cross team and the audience prize went to the Dutch Team Ambulance Amsterdam Kennemerland. The session was streamed via Facebook to thousands of followers and can be seen at the Facebook site of the European EMS Congresses.

Finally, we had the social events like morning run, morning yoga, whiskey tasting (not in the morning) and the Scottish dinner with local entertainment. The Scottish know how to have fun. See you at the next European EMS Congress in Berlin, Germany in 2024. In the meantime, you can follow the European EMS congress at our social media. More information: emsleadershipnetwork.org emseurope.org facebook.com/watch/EuropeanEMS (championship final) emseurope.org/impressions-from-ems2022 (movie and pictures from EMS2022)

Photos by Ben Fitzhugh

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Australasian paramedics celebrated in the launch of International Paramedics Day #ServingOurCommunities

riday July 8 marks the first International Paramedics Day celebrating the important work undertaken by paramedics and first responders around the world.

The launch of this campaign sees peak bodies, ambulance services and healthcare partners uniting on a global scale for one purpose: To recognise and celebrate the work being done by paramedics and first responders to ensure their patients receive the best treatment and care possible to improve health outcomes in our region. As experts in providing unscheduled care in unpredictable environments, paramedics play a critical role in our healthcare system and emergency response, from on-road paramedics to those working in the industrial, defence and humanitarian sectors, community paramedics, flight paramedics and everything in between. The Australasian College of Paramedicine (ACP) and the Council of Ambulance Authorities (CAA) have come together for the Australasian launch of International Paramedics Day. Our regional theme is Serving Communities throughout Australasia, and we invite all those working in paramedicine and fellow healthcare professions to join us in this inaugural celebration.

We invite you to advocate for the day and its purpose by sharing content CAA posts on the day, and by posting your own videos and stories using the hashtags: #ServingOurCommunities #IPDAustralasia #InternationalParamedicsDay You can also visit the International Paramedics Day Australasia website for pre-made social media resources and logos. Visit www.ipdaustralasia.org to learn more We look forward to launching this inaugural day with you all on July 8th 2022.

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A glimpse into Royal Flying Doctor Service emergency retrieval

s a health charity with 94 years of serving rural and remote Australia, the Royal Flying Doctor Service (RFDS) is well known for emergency retrievals, even though their service now includes primary health care services, mental health, dental care and much more.

It is stories of emergencies in the bush that most people know the RFDS for. Launched in March 2021, a new podcast series entitled ‘The Flying Doctor’ podcast has been bringing stories of the bush to a much broader audience. These interviews with real patients, RFDS staff and community members, are highlighting surprising, shocking, quirky and interesting stories from across Australia and spanning many decades.

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Partners First

A helicopter crashes in remote Northern Territory…, a young teen is stung by the deadly irukandji jellyfish off the Pilbara Coast in WA…, a young mum has kidney failure on a remote coastline township in South Australia…, a young man has his arm severed in a buggy roll at Packsaddle Roadhouse in remote New South Wales…., a station manager on the second largest cattlestation in the country rolls a ute, end to end, six times. These are just a few of the stories that have been told to date. Lana Mitchell of the Royal Flying Doctor Service hosts the new podcast and uses the podcast to communicate how important first responders are in saving lives, and to educate people on the work of the Royal Flying Doctor Service. “This podcast series brings home how important it is for everyone to know first aid, CPR and what to do in an emergency. This is particularly important for those that live, work and travel in the bush, where emergency access is often difficult”, says Lana.

“These stories are real, gritty and will sometimes make you cringe – however they also detail the learnings, the insight and tenacity of the Aussie spirit in tackling challenging circumstances.” “I work to release a range of stories, from across all states and territories, with a focus on the individuals and the communities – as without the brave and courageous actions of these first responders, the work of the RFDS would be impossible. We rely on volunteers and first responders to keep people alive, clear, administer pain killers, and light and clear runways so we can land and stabilise and then transport the patient. It is very much a cooperative activity. Rural and remote communities rely on the RFDS, and we rely on them to be able to do our work well”, says Lana. The Flying Doctor Podcast won a Bronze award at the Australian Podcast awards in late 2021, and there have already been 120,000 downloads of the 36 episodes released to date.

“I have interviewed a man who was travelling with a friend down the Birdsville Track, and they pulled over for a pit-stop, and his mate stepped out of the car and fell almost immediately into a near-boiling thermal mud pool. With burns to the majority of his friend’s body, he details the actions he took to save his friends life and get him to the closest roadhouse – which was an hour’s drive away, and still a further 8 hours drive from a tertiary hospital.”

www.caa.net.au

Partners First

Insight into the Australian New Zealand Police Advisory Agency

ew Chief Executive Officer of the Australian New Zealand Police Advisory Agency (ANZPAA) Dr Tracey Green is keen to shed a spotlight on the great work undertaken by ANZPAA on behalf of all the Commissioners of Police across Australia and New Zealand.

A former Detective Inspector from the UK Tracey joined ANZPAA in November 2021. She is no new arrival to Australia having first moved to the Goulburn Police Academy, New South Wales on secondment from the Northumbria Police in 1998. “My secondment was one of those out of the blue opportunities which was just too good to pass by. I loved my job in the police and always intended to go back but the lure of Australia soon saw me deciding to stay”.

For those not familiar with ANZPAA, it was established in 2007 through agreement of the Police Commissioners across Australia and New Zealand and the then Australasian Police Ministers’ Council (APMC). The current members are the Police Commissioners from each jurisdiction in Australia and New Zealand, and the Chief Police Officer from the ACT. Amalgamated into ANZPAA are The National Institute of Forensic Science (NIFS) and The Australia New Zealand Council of Police Professionalisation (ANZCoPP).

www.caa.net.au

“The Board of Commissioners set the direction and work of ANZPAA for the benefit of Policing across Australia and New Zealand. It is a great privilege to work closely with the Commissioners and their Leadership groups. They are very generous with their time to talk with me and the team to make sure that the work we do addresses the issues concerning police and the communities they serve.” ANZPAA including National Institute of Forensic Science (NIFS) are a small team (only 30 in total) located in the Victorian Police Headquarters. Our core areas of work include: •

Engagement across policing, industry, and forensic services

•

Environment scanning and foresight

•

Promoting quality and consistent practice

•

Research and Information

•

Co-ordination for policing and forensic services

•

Cross-jurisdictional policy instruments, education, training products and workshops

•

Cross-jurisdictional strategy and capability development

“The work of ANZPAA is relevant to a wide range of police employees and anyone with a police email account can subscribe to our website. For example, we have just commenced a series of interviews with the Commissioners, Police Horizons providing insights on policing and their ideas for the future.

Our Forums also bring together leading experts and police practitioners to discuss key issues, the latest being the Artificial Intelligence Forum held on 28th April 2022, along with our most requested body of work, The Religious and Spiritual Diversity Guide for Operational Police. Whilst ANZPAA is a common police agency there are many challenges and issues which are shared by both police and paramedics. Being the 24hr emergency service responders, both have had a significant role to play throughout the Covid-19 pandemic. There are long term concerns across both areas with staff resilience being tested to the maximum. Many areas of research regarding mental health and long-term impacts of the pandemic will certainly resonate across both organisations. The biggest event in the ANZPAA calendar is the Commissioners Conference #PC22. This year our theme is Navigating Next Generation Policing it will be held in Melbourne on the 8th and 9th November 2022, but the event will also be available as a hybrid, online event for those unable to travel. ANZPAA will be hosting a range of national and international experts as well as sessions with the Commissioners. “I really want to make sure ANZPAA produces relevant and timely work which can assist policing. We work for all the Commissioners across Australia and New Zealand and a lot of the work we do is available on our website” www.anzpaa.org.au

Partners First

Community Paramedicine a must for Australia’s ailing health system By John Bruning, CEO, Australasian College of Paramedicine

he pressures on our national health system continue to escalate as it struggles to cope with the dual challenges of increasing demand and resourcing that, while increasing, has not and is not keeping up.

Our health care workers are buckling under the strain as workforce pressures and limits on hospitals’ capacity take their toll across the sector. As the College has regularly advocated with governments at the Commonwealth and state and territory levels throughout the past two years, we are able to offer a viable, long-term solution - Community Paramedicine - that helps to ease patient demand and reduces the burden on hospitals, lessens ambulance ramping and access block, improves referral pathway utilisation, and boosts the overall quality of patient care. In addition to our advocacy, we are at present working to clearly elaborate the parameters of effective and efficient Community and Extended Care Paramedicine models that are suitable for the Australian context. The College’s Community Paramedicine Working Group is undertaking a Delphi study to formulate a comprehensive definition of Community Paramedicine, and shortly we will commence a research project on Community Paramedic roles, capabilities and structures in Australasia, the UK and Canada to build a comprehensive picture of the role in its various guises. As part of this work, we are engaging with key stakeholders across Australasia to inform and discuss Community Paramedicine, examining how it works for different ambulance services, what challenges exist and what we can learn from each other. We are also engaging with our medical and nursing colleagues on the role Community Paramedics can play in supporting quality patient-centred care.

The College believes that Community Paramedicine has the potential to address both the systemic challenges and the health sector workforce shortages by capitalising on the broader role paramedics can play in community healthcare beyond traditional ambulancebased duties. It will also provide more varied clinical practice opportunities for paramedics that in turn will recognise the clinical decision-making capacity of paramedics and will benefit both emergency response as well as primary care and, ultimately, community health. Recognition of paramedics as highly qualified registered health professionals with capacity to contribute outside of emergency response will pave the way for the broader integration of paramedics within the health system and the adoption of national Community Paramedicine frameworks that delivers better patient care and improved public health outcomes. In Aotearoa New Zealand, our members are already working in integrated health teams with doctors, nurses and other health professionals to boost primary health care services in communities. Similar models can also be seen in Canada and the UK, where Community Paramedics, working outside of jurisdictional ambulance services, are key to providing essential primary care to the community. In Canada, Community Paramedicine has proved to be cost effective, has helped to reduce the number of emergency calls, improved overall quality of life, and lessened the risk of chronic disease.1

www.caa.net.au

With access to health services deteriorating, as evidenced by the 2021 Mirror Mirror report, particularly in rural and regional areas of the country, we are in an ideal position to help to address the challenges currently being faced and the shortage of health professionals in communities that have long struggled to attract a full complement of health care practitioners. It’s time for Australia to follow the lead of our colleagues in Aotearoa New Zealand and other parts of the world. The need is evident. Together with our stakeholders and primary care and allied health professionals, we look forward to the development of the most appropriate models for Community Paramedicine in Australia, and the realisation of the full potential of our paramedics as vital components of a fully functioning health system delivering better services, improved access, and better outcomes for all.

The College believes that Community Paramedicine has the potential to address both the systemic challenges and the health sector workforce shortages" John Bruning

CEO, Australian College of Paramedicine

1. CP@Clinic, Facts and Figures, www.cpatclinic.ca/what-iscpclinic/#facts

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

ACP

Research

SYMPOSIUM

ACP Research Symposium Sunshine Coast QLD 14–15 July 2022

Student Conference Sydney NSW 29 July 2022

2021

ACPIC

ACP International Conference 2022 Brisbane QLD 14–16 September 2022

Find out more paramedics.org/events @ACParamedicine

Paramedicine Australasian College of

Research First

Alerting Volunteer Responders to Out-of-Hospital Cardiac Arrest When Technologies Help Saving Lives

By Mads Christian Tofte Gregers MD, Astrid Rolin Kragh MSc, Carolina Malta Hansen MD PhD, Linn Andelius MD PhD, Freddy Lippert MD, Fredrik Folke MD PhD, University of Copenhagen, and Copenhagen Emergency Medical Services, Denmark

ut-of-hospital cardiac arrest (OHCA) is a significant cause of sudden death worldwide with an estimated incidence of 55 OHCAs per 100,000 person-years and a survival to hospital discharge of only around 8-9%.

Since the implementation of the concept ‘Chain-ofSurvival’, focus on bystander interventions with cardiopulmonary resuscitation (CPR) and use of automated external defibrillators (AEDs) have increased. This is reinforced by the Global Resuscitation Alliance, who recommends early recognition and initiation of telephone-assisted CPR by the medical dispatcher to increase bystander CPR rates. Several countries have established AED registries where private and publicly accessible AEDs voluntarily are made available to the public.

In Denmark, the AED register is a national registry currently with more than 21.000 publicly accessible AEDs (corresponding to 0.5 AED /km2 and 1 AED per 275 citizens). The register is linked to the medical dispatch center, making it possible to instruct bystanders to fetch a nearby accessible AED. To further increase bystander CPR and especially AED usage Volunteer Responder Programs are endorsed by both the Global Resuscitation Alliance and International Liaison Committee on Resuscitation. During the past decade, several Volunteer Responder Programs have been implemented worldwide in both the United States, Canada, Australia, New Zealand, and different European countries.

Research First

The Concept of Volunteer Responder Programs In Denmark, the Volunteer Responder Program was first implemented in the Capital Region in September 2017 with national coverage from May 2020. Since the implementation of the Volunteer Responder Program, the medical dispatcher can activate nearby registered volunteer responders in addition to the ambulance and physician staffed vehicle, which are dispatched in case of suspected OHCA. Volunteers are alerted for cardiac arrest in public places and private homes. However, not for traumatic cardiac arrest. The system is based on smartphone technology (HeartRunner application) and is linked to the Danish AED register making it possible to guide volunteer responders to nearby AEDs. When activated, the system automatically locates the nearest 20 volunteer responders within a 5 km radius of the incident. Volunteer responders are either guided directly to the scene of OHCA to perform CPR or to fetch an AED before arrival. Ninety minutes after an alarm the volunteer responders receive a questionnaire for debriefing and research purposes. Since the implementation, volunteer responders have been dispatched in almost 10,000 cases of suspected OHCA with >120,000 volunteer responders receiving an alarm.

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Profile of a Volunteer Responder On 8 April 2022, a total of 134,297 were registered as a volunteer responder in the Danish Volunteer Responder Program (≈ 2,303 volunteer responders/ 100.000 inhabitants). It is free and voluntary to register in the Program. Only persons above 18 years of age can register. First aid training in CPR and AED usage is not mandatory but highly recommended. However, more than 97% of all registered volunteer responders in Denmark reports having received first aid training prior to registration. Unlike similar programs (GoodSAM and PulsePoint), the majority of volunteer responders in Denmark is not healthcare personnel (70%). The average Danish volunteer responder is either male or female (50:50 distribution) with an age of 35 years.

Volunteer Responders and Bystander Interventions A study describing the first year after implementation of the Volunteer Responder Program in the Capital Region of Denmark found that a total of 6,836 volunteer responders were alerted to a true OHCA. Of these, 1,623 (24%) accepted the alarm (1). When activated, the volunteer responders arrived before the ambulance in 42% of all cases. Arrival of at least one volunteer responder before the ambulance is associated with an almost 4-doubled chance of receiving bystander defibrillation by an AED (Figure 3) (1). Other observational studies (e.g. one using the GoodSAM application in the United Kingdom) have found a potential association with increased survival when volunteer responders are activated (2). To investigate the correlation between survival and volunteer responder activation, a randomized controlled trial is being performed in the Capital Region of Denmark (Clinical Trials: NCT03835403). www.caa.net.au

Daytime Variation in Acceptance Rates Volunteer responders are alerted 24/7/365. In order to understand and potentially optimize the Volunteer Responder Program, we carefully monitor the acceptance rates of volunteer responders when they receive an alarm. A recent study examining 438 OHCAs with 6,836 volunteer responders activated found that volunteer responders are less prone to accept alarms during nights (from 12.00-06.59 am) compared with daytime and evenings (07.00 am to 03.59 pm and 04.00-11.59 pm) and on weekdays compared with weekends (3). This is not surprising as the volunteer responders have to take care of both their own jobs and daily lives. Because of this, it is important to inform both private and public companies about the Volunteer Responder Program to ensure that volunteer responders are allowed to temporarily leave their job to potentially save a life.

Is Volunteer Responders at Physical and Phycological Risk? When authorities dispatch volunteer responders to health-related tasks usually managed by professional Emergency Medical Services (EMS), it is vital to establish that it is safe for the volunteer responders. In the period September 2017 to May 2020 a total of 9,574 volunteer responders where alarmed to 1,665 suspected OHCAs in Denmark (4). Of these, ≈77% (7,334) answered the questionnaire sent after an alarm. Most (99.3%) reported no injuries or risk of injury. Only 24 (0.3%) reported being in risk of an injury (e.g. crossing a red light or similar) and 26 (0.4%) reported an actual injury. Of these, only one reported an injury requiring medical attention (an ancle fracture).

These numbers indicate that volunteer responders are at little risk of injuries when they are encouraged to follow the traffic rules in place. Still, we believe that it is important to continue to monitor adverse effects in volunteer responders after a mission as a safety measure in all Volunteer Responder Programs. In addition, volunteer responders are asked to rate the degree of immediate psychological impact on themselves after attending the alarm. Of 5,395 answered questionnaires the majority reported no psychological impact (≈69%) whereas 25%, 6%, and 1% reported low, moderate, or severe impact, respectively (5). Further, we investigated coping mechanisms, personality traits and symptoms of Post-traumatic Stress Disorder (PTSD) among 102 volunteer responders who had engaged in a resuscitation attempt within the Volunteer Responder Program. The mean overall PTSD score was 0.65 of 12 whereas the mean perceived stress score was 7.61 of 40 (6). Despite overall low numbers, it is important to have a backup system ready for immediate debriefing of volunteer responders. In Denmark, a specially trained nurse is continuously monitoring reports from volunteer responders and everyone reporting severe psychological impact is contacted by phone within 72 hours. Further, volunteer responders are encouraged to contact the EMS if in need of acute defusing following an alarm.

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Volunteer Responders During a Pandemic In the spring of 2020, the world was struck by the COVID-19 pandemic. We considered whether to keep operating the Volunteer Responder Program or to pause activation of volunteer responders for a period. Across Europe, 18 different Volunteer Responder Programs either continued to operate (50%) or were paused for a period of time (50%) (7). The Danish Volunteer Responder Program continued to operate. However, volunteer responders were advised to perform chest-compressiononly CPR and volunteer responders in risk of severe COVID-19 (defined by the Danish Health Authorities) were advised not to accept alarms (8).

During the period of the first national lockdown in Denmark (the spring of 2020), volunteer responders continued to accept alarms without a decline in absolute numbers compared with a period without lockdown. The rates of bystander CPR and defibrillation also remained statistically unchanged. However, volunteer responders reported a shift towards an increased proportion of responders performing chest-compressiononly CPR as advised to during the lockdown period. We saw no increase in the proportion of volunteer responders who reported severe psychological impact during the lockdown period (8). Therefore, we believe that it is feasible to continue to activate volunteer responders even during a pandemic.

Facts about OHCA & Denmark

5,823,000 total population

42,933 km2 total area size

21,600

number of AEDs registered for public access defibrillation

138,737

4,729

total number of OHCA per year

81 / 100,000 628

OHCA incidents

number of survivors* per year

persons per

100,000

population

80%

14%

42%

bystander CPR rates

survival rate* (all OHCA included)

survival* rate for “Utstein population”

number of registered volunteer responders *Survival is defined as 30-days survival

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Mads Christian Tofte Gregers,

Clinical Perspectives Volunteer Responder Programs holds the potential to further improve survival following OHCA especially in areas with long ambulance response time. We need to embrace new healthcare technology in order to both recognize OHCA and to initiate early bystander CPR and defibrillation.

MD PhD-fellow

PhD-fellow in the Danish Volunteer Responder Program at Copenhagen Emergency Medical Services. Focus on optimising our national Volunteer Responder Program with respect to both the number needed to be alarmed and the optimal dispatch radius. Board member of the National Steering Committee of the Volunteer Responder Program.

In Denmark, we are currently working on an AEDdrone-delivery-program where automated drones (supervised by a drone pilot) deliver AEDs in areas with few publicly available AEDs and long ambulance response time. Drone-delivery of AEDs coupled with a Volunteer Responder Program can possibly increase both bystander CPR and defibrillation before ambulance arrival. A recent case-report described a successful resuscitation of an OHCA patient in Sweden where a similar droneprogram delivered an AED to the scene (9). Research is the key to optimization, and it is important to continuously monitor programs and newly implemented technologies to strive for perfection. Without engagement by the community survival after OHCA would be limited. It takes a system to save a live.

References 1. Andelius L, Malta Hansen C, Lippert FK, Karlsson L, Torp-Pedersen C, Kjær Ersbøll A, et al. Smartphone Activation of Citizen Responders to Facilitate Defibrillation in Out-of-Hospital Cardiac Arrest. J Am Coll Cardiol. 2020 Jul 7;76(1):43–53.

7. Andelius L, Oving I, Folke F, de Graaf C, Stieglis R, Kjoelbye JS, et al. Management of first responder programmes for out-of-hospital cardiac arrest during the COVID-19 pandemic in Europe. Resusc Plus. 2021 Mar;5:100075.

2. Smith CM, Lall R, Fothergill RT, Spaight R, Perkins GD. The effect of the GoodSAM volunteer first-responder app on survival to hospital discharge following out-ofhospital cardiac arrest. European Heart Journal Acute Cardiovascular Care. 2022 Jan 12;11(1):20–31.

8. Gregers MCT, Andelius L, Malta Hansen C, Kragh AR, Torp-Pedersen C, Christensen HC, et al. Activation of Citizen Responders to Out-of-Hospital Cardiac Arrest During the COVID-19 Outbreak in Denmark 2020. J Am Heart Assoc. 2022 Mar 15;11(6):e024140.

3. Mottlau KH, Andelius LC, Gregersen R, Malta Hansen C, Folke F. Citizen Responder Activation in Out-ofHospital Cardiac Arrest by Time of Day and Day of Week. J Am Heart Assoc. 2022 Feb;11(3):e023413.

9. Drone helps save cardiac arrest patient in Sweden. BBC News [Internet]. 2022 Jan 6 [cited 2022 Apr 8]; Available from: https://www.bbc.com/news/ technology-59885656

4. Andelius L, Malta Hansen C, Tofte Gregers MC, Kragh AMR, Køber L, Gislason GH, et al. Risk of Physical Injury for Dispatched Citizen Responders to Out-ofHospital Cardiac Arrest. J Am Heart Assoc. 2021 Jul 20;10(14):e021626. 5. Kragh AR, Andelius L, Gregers MT, Kjølbye JS, Jørgensen AJ, Christensen AK, et al. Immediate psychological impact on citizen responders dispatched through a mobile application to out-of-hospital cardiac arrests. Resusc Plus. 2021 Sep;7:100155. 6. Ries ES, Kragh AR, Dammeyer J, Folke F, Andelius L, Malta Hansen C. Association of Psychological Distress, Contextual Factors, and Individual Differences Among Citizen Responders. J Am Heart Assoc. 2021 Jul 6;10(13):e020378.

Acknowledgment The Danish Volunteer Responder program and research project related to the program are supported by unrestricted research grants from the Danish Foundation TrygFonden (www.trygfonden.dk). For more information: hjertestarter.dk/ hjertestarter.dk/english/you-can-save-lives hjertestarter.dk/hjerteloeber/tal-og-fakta-omhjerteloeber

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Research First

Palliative care breaks a narrative for paramedics… that we are lifesavers. Intensive care paramedic participant, qualitative interview study

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www.caa.net.au

lobal demand for palliative care is increasing due to an ageing population and the growing prevalence of chronic non-communicable disease, amongst other factors.

According to the World Health Organization, approximately 40 million people require palliative care each year.1 Within Australia, tertiary health services saw a 18 percent increase in palliative care hospitalisation between 2015/16 and 2019/20.2 However, palliative and end-of-life care provided exclusively by specialists in hospital settings poses unsustainable costs to health services worldwide.3 Furthermore, international literature suggests approximately two thirds of people want to die at home.4

By Madeleine Juhrmann BPSci MPH PhD Candidate Northern Clinical School, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia The Palliative Centre, HammondCare, Greenwich Hospital, New South Wales, Australia Supervisors: Professor Josephine Clayton MBBS PhD FRACP FAChPM and Professor Phyllis Butow BA(Hons) MPH MClinPsych PhD

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Research First

In order to meet the growing need for palliative care, reduce avoidable hospital admissions and better facilitate community preferences, early delivery and a multidisciplinary approach to palliative care service provision is required.1 One interface capable of facilitating more home-based deaths is paramedicine. Paramedics are a unique workforce, attending to patients in the community 24-hours a day seven days a week, in the case of an emergency. However, their scope of practice has traditionally been limited to providing life-sustaining interventions for acute emergencies and conveyance to hospital.5-7 For patients who have a progressive life-limiting condition, an acute hospital admission may not be desired or the best setting in which to deliver appropriate palliative care. Fortunately, global ambulance services are evolving in response to the growing prevalence of palliative care patients, although through different approaches and at varying speeds. Specialised community paramedic roles are emerging in countries following a paramedic-led ambulance approach to facilitate holistic home-based palliative care,6 including Australian and New Zealand services. Ambulance services world-wide are also adopting clinical protocols to guide end-of-life care,8 albeit in a variable manner.

Methodology Our research aims to explore the role of paramedics delivering palliative and end-of-life care in Australian communities, seeking opportunities and solutions to broaden this provision through evidence-based measures, following a four-stage study approach: Study one: We conducted a systematic integrative review to synthesise empirical evidence on the topic and identify further gaps of knowledge for further investigation. Study two: With an international multidisciplinary team, we analysed and appraised the existing palliative and end-of-life care clinical practice guidelines of Australian ambulance services with a selection of comparable Anglo-American ambulance services (New Zealand, the United Kingdom and Canada). Study three: We undertook 50 qualitative interviews with a range of paramedics, palliative care doctors and nurses, general practitioners, residential aged care nurses and bereaved family members and carers. We sought to understand key stakeholders’ experiences and perceptions of the role paramedics play in delivering palliative and end-of-life care, identifying barriers, enablers and opportunities for improving practice.

Ambulance clinicians will often be on the scene at or shortly after the point of death. There may be occasions where the patient is in the final stages of dying. If all reversible causes have been considered, then supportive care for the patient and the relatives/carers may be all that is required.” Exert from the UK’s JRCALC End-of-Life Care General Guidance

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Study four: We will conduct a modified-Delphi with a range of paramedicine, palliative care and health policy experts, as well as consumers, to gain broad consensus on the development of a best practice palliative paramedicine framework suitable for national implementation. Advisory group: Underpinning the PhD, we developed an Australian and New Zealand palliative paramedicine community of practice, with representation across all eight Australian ambulance services, to inform our research from a practical perspective and drive translation of findings into practice in real time. Figure 1. Summary of studies and expected contribution

Summary of PhD Studies 2020

2021

2022

2023

Systematic Integrative Review

CPG Policy Review

Qualitative Study

ModifiedDelphi Study

Palliative Paramedicine Advisory Group

Expected contribution Develop a palliative paramedicine framework suitable for national implementation

Findings Three key themes arose from the systematic integrative review: (1) broadening the traditional role, (2) understanding patient wishes, and (3) supporting families.9 The findings suggest paramedics can play an important role in providing emergency support to patients approaching end-of-life, help facilitate homebased deaths, and reduce avoidable hospital admissions where this is the patient’s preference. The review identified untimely access to documented wishes, family discordance and the medico-legal ambiguity associated with palliative paramedicine as key barriers preventing paramedics from adopting a palliative approach to care. Key enablers highlighted include strengthening communication and support channels with multidisciplinary teams, targeted palliative care training for paramedics, partnering in care with families and palliative care specific clinical practice guidelines to broaden the current scope of practice.

Figure 2. Thematic summary of palliative paramedicine

Palliative paramedicine Broadening the traditional role • Moving beyond hospital-oriented care • Allowing a natural death • Time on-scene • Strengthening communication and support channels with multidisciplinary teams • Professional satisfaction • Training and education Understanding patient wishes

Enhance out-of-hours care

Reduce avoidable hospital admissions

Facilitate more home-based deaths

Improve end-of-life care for people with life-limiting illnesses

Build an Australian and New Zealand Community of Practice

• Documentation • Advocacy • Patients lacking capacity Supporting families • Family discordance • Partnering in care • Family witnessed arrests and bereavement

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Findings from the second study, currently under peerreview, suggest ambulance guidelines are shifting away from protocol driven paramedic practice to broader clinical models, calling on the discretion and decisionmaking skills of paramedics instead of fixed algorithms. The study identified the prevalence of clinical back-up pathways across all the included guidelines, recognising the developing nature of palliative paramedicine and need for multidisciplinary approaches to care. The overall lack of content related to communication skills and care after death underscores a significant gap in current clinical practice. Analysis of the qualitative interviews is currently underway. Preliminary findings suggest the rationale for objection or endorsement of palliative paramedicine determines an individual’s perception of the barriers, enablers and opportunities for improving future practice.

Two broad dichotomies of thought have arisen: (1) Paramedics are ‘life savers’ and their role ought to be rooted in responding to acute emergencies, adhering to the traditional perception of treating to preserve life, compared to (2) paramedics are community responders, and their role is evolving in response to the diverse and changing needs of populations, including increasing demand for community-based palliative and end-of-life care.

Future directions In our final study, due to commence early 2023, we will aim to develop a palliative paramedicine framework suitable for national implementation in Australia, employing a modified-Delphi methodology. Partnering with a multidisciplinary expert panel, we will (1) gain consensus regarding the framework components considered most essential for improving the role of paramedics delivering palliative and end-of-life care in Australian communities, and (2) understand barriers and elicit recommended strategies to underscore the future national implementation of the framework.

Paramedics are a highly regarded profession and have the power to communicate convincingly with families… they help us to take a palliative approach, especially after-hours.” Residential aged care nurse participant, qualitative interview study

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Acknowledgements This PhD has received funding from The HammondCare Foundation and Sydney Vital Translational Cancer Research Group.

References 1. World Health Organization. Palliative Care Key Facts, https://www.who.int/news-room/fact-sheets/detail/ palliative-care (2020). 2. Australian Institute of Health and Welfare. Palliative care services in Australia. 2020. Canberra: AIHW. 3. Sullender RT and Selenich SA. Financial Considerations of Hospital-Based Palliative Care. 2016. Research Triange Park, NC. 4. Gomes B, Higginson IJ, Calanzani N, et al. Preferences for place of death if faced with advanced cancer: a population survey in England, Flanders, Germany, Italy, the Netherlands, Portugal and Spain. Annals of Oncology 2012; 23: 2006-2015. DOI: https://doi. org/10.1093/annonc/mdr602. 5. O'Hara R, Johnson M, Siriwardena A, et al. A qualitative study of systemic influences on paramedic decision making: Care transitions and patient safety. Journal of Health Services Research & Policy 2015; 20: 45-53. DOI: 10.1177/1355819614558472. 6. Long D. Paramedic delivery of community-based palliative care: An overlooked resource? Progress in Palliative Care 2019; 27: 289-290. DOI:

10.1080/09699260.2019.1672414. 7. Oosterwold J, Sagel D, Berben S, et al. Factors influencing the decision to convey or not to convey elderly people to the emergency department after emergency ambulance attendance: A systematic mixed studies review. BMJ Open 2018; 8. DOI: 10.1136/ bmjopen-2018-021732. 8. McCormick G and Thompson S. The Provision of Palliative and End-of- Life Care by Paramedics in New Zealand Communities: A Review of International Practice and the New Zealand Context. 2019: 51-57. 9. Juhrmann ML, Vandersman P, Butow PN, et al. Paramedics delivering palliative and end-of-life care in community-based settings: A systematic integrative review with thematic synthesis. Palliative medicine 2021: 2692163211059342-2692163211059342. DOI: 10.1177/02692163211059342.

Madeleine Juhrmann

BPSci MPH PhD Candidate Northern Clinical School, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia Supervisors: Professor Josephine Clayton MBBS PhD FRACP FAChPM and Professor Phyllis Butow BA(Hons) MPH MClinPsych PhD

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Clinical Management of TBI Patients

raumatic Brain Injury (TBI) remains a significant challenge in EMS and Critical Care. 50% of TBI fatalities happen within hours of injury1 and often result from secondary brain injuries that occur after the initial impact rather than from the primary injury.

As the primary injury cannot be undone, management strategies must focus on preventing secondary injuries.2

Latest evidence – EPIC-TBI study • Statewide (Arizona, US) intention-to-treat using before/after design in patients with moderate to critically severe TBI • Studied the impact of implementation of the pre-hospital TBI guidelines on patient outcomes • Over 130 EMS agencies involved with 21,852 patients enrolled3 These findings support the widespread implementation of the pre-hospital TBI treatment guidelines.

To help prevent secondary brain injury, treatment of TBI patients should avoid:

HYPOXIA - Hypoxia is associated with doubling odds of death4 HYPOTENSION - Single-episode hypotension (SBP<90 mmHg) is associated with doubling of mortality and dramatically increased risk with repeated episodes5

HYPERVENTILATION - Severe hyperventilation is associated with nearly threefold increase in odds of death6

As soon as the situation allows and resources become available, follow ATLS7 principles of managing airway, breathing, and circulation. Focus on: • Stopping uncontrolled bleeding (haemorrhage control) • Maintaining Systolic BP > 90 mmHg The adjusted survival rate doubled among patients with severe TBI and tripled in the severe, intubated cohort. Furthermore, guideline implementation was significantly associated with survival to hospital admission.

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• Maintaining SpO2 > 90% • Maintaining CO2 between 35 – 40 mmHg (do not hyperventilate)

www.caa.net.au

Smart monitoring The X Series® Advanced monitor/defibrillator supports the management and treatment of TBI patients throughout the continuum of care: • View essential vital sign trends • Real-time feedback on manual ventilation X Series Advanced provides clinical decision support for managing TBI patients. The integrated TBI Dashboard™ provides Monitoring and Trending data with a focus on preventing hypoxia, hypotension and hyperventilation.

1. Centers for Disease Control and Prevention (CDC), Traumatic Brain Injury (TBI): Incidence and Distribution, 2004. 2. Vella, M. et al. Acute Management of Traumatic Brain Injury. Surgical Clinics of North America, 2017 Oct; 97(5): 1015-1030 3. Spaite DW et al., Association of Statewide Implementation of the Prehospital Traumatic Brain Injury Treatment Guidelines With Patient Survival Following Traumatic Brain Injury: The Excellence in Prehospital Injury Care (EPIC) Study. JAMA Surgery. 2019 July; 154(7):

The TBI Dashboard enables patient care decisions to be made before a patient becomes critical.

4. McHugh G et al. Prognostic Value of Secondary Insults in Traumatic Brain Injury: Results from The IMPACT Study. Journal of Neurotrauma. 2007 Feb; 24(2)

It provides a comprehensive display of the most relevant physiologic data for monitoring hypotension, hypoxia, and hyperventilation — as recommended by the guidelines and proven by the EPIC study.

5. Manley G et al. Hypotension, hypoxia, and head injury: frequency, duration and consequences. Archives of Surgery. 2001 Oct; 136 (10): 1118-1123

• Continuously updated data provide trending information of all relevant vital signs at a glance. • The breath-by-breath countdown timer helps to maintain proper ventilation rates. • The target values for each parameter remind medics of the targets per protocol.

6. Davis D. et al. 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 and Acute Care Surgery. 2004 April; 56 (4): 808-814 7. American College of Surgeons. ATLS Advanced Trauma Life Support. 10th Edition, 2018 MCN EP 2108 0394-13

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Be ready for any emergency with the Emergency Medical Information Book By Chris Martin

he Rotary Clubs of Tea Tree Gully, Modbury, and Golden Grove, commenced the Emergency Medical Information Book (EMIB) project some 22 years ago.

The idea for the book stemmed from the actions of a mother who was keeping track of questions asked of her by Ambulance Paramedics when they were called to her child (this was happening quite frequently). One of the Paramedics who was a recipient of this information on a number of visits felt that having the history readily available was invaluable. This officer’s idea of developing a system to capture historical and current information eventually arrived at the book attached to the refrigerator that we have today, this was achieved in collaboration with the Rotary clubs who funded and promoted the original project. The Blackwood Lions Club became involved some 8 years later promoting the project through the Lions Club of Australia and effectively making the project a joint Rotary Club x Lions Club Project. The Books and now Pocket Editions are distributed by Rotary and Lions Club nationwide. To date some 1.5 million books have been provided. Clubs have a number of methods by which they get the books out to their communities, some provide countertop boxes complete with stock for folk to access for a gold coin donation.

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These are often located at Pharmacies, Doctors Surgeries, Physios, in fact, just about anywhere that can afford counter space. State Health Departments Local Government, St John WA, Ambulance Victoria, and many other organisations also have involved themselves in the distribution. The Council of Ambulance Authorities have also recently become involved, with the desire to assist with the promotions of the EMIB. Many service clubs have undertaken specific projects ranging from gifts of books to residents in retirement villages, provision of books to real estate agents and car dealerships to be given to new clients. A current South Australian project is to provide St John and State Emergency Services (SES) volunteers along with South Australian Metropolitan Fire Services (MFS) firefighters with a pocket edition card. The information is enclosed in a waterproof envelope so that if the individual needs to be retrieved from an incident they will have the appropriate information with them to ensure the best treatment. The Committee that manages the project consists entirely of volunteer members from Rotary and Lions Club in South Australia. We look forward to being able to continue the project well into the future ensuring that as many people as possible are able to provide the important medical information necessary to assist in receiving the most appropriate treatment.

www.caa.net.au

Join us in celebrating

CAA’s 60th Anniversary Gala 17 November 2022 Follow us on social media for updates

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CQU

Philips

CQUniversity believes higher education should be for everyone. Our accessibility, flexibility, student support, and wide range of courses available online and on campus help our students be what they want to be.

Philips is a health technology company focused on improving people’s lives through meaningful innovation across the health continuum – from healthy living and prevention to diagnosis, treatment, and homecare.

cqu.edu.au

philips.com.au/healthcare

Ferno

Pulsara

The only organisation in Australia specialising in the supply of a complete suite of products to meet the needs of Ambulance, Emergency, Rescue, and Height Safety. Trusted supplier to Emergency Services, Government Hospitals, and general industry for more than 40 years.

Pulsara is a mobile-first telehealth and communication platform that connects teams across organizations. What makes Pulsara unique is its ability to enable dynamic networked communications for any illness or injury. pulsara.com

ferno.com.au

NEANN

Stryker

Through the NEANN brand RAPP Australia Pty Ltd specialises in designing, manufacturing, and distributing a wide variety of products for use in the wider emergency services industry throughout Australia and overseas.

For decades, we’ve been focused on innovations that help improve patient outcomes, help prevent caregiver injuries, and increase operational efficiencies so you can do what you do best: save lives.

neann.com.au

stryker.com/au/en

ORH

Trapeze

Supporting ambulance services in Australia for over 20 years, we have helped solve station location problems, quantify demand and capacity challenges, and set efficiency targets throughout our consultancy-based approach.

Trapeze partners with out-of-hospital care providers, to advance and deliver the technology they need to deliver timely, integrated, patient-centric services to improve healthcare outcomes. trapezegroup.com.au

orhltd.com

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www.caa.net.au

Tactical Medical Degrees Learn to deal with acute trauma situations and be uniquely qualified to respond in resource limited, dynamic and high threat environments with a qualification in Tactical Medicine. These online, highly flexible courses are ideal for paramedics and first-responders. Gain the critical skills needed to assess, plan, prepare and implement strategies for successful operations and patient management within a tactical environment. www.cqu.edu.au

Integrated Patient Care Records The next generation of ePCR, Trapeze MobiMed iPCR is our complete, end-to-end solution for the out-of-hospital care sector - from emergency call to the clinical handover. Trapeze MobiMed iPCR is the only solution of is kind. It's more than a patient record system; the solution is also an intuitive decision support tool capable of handling individual incidents and mass casualty triage. Trapeze MobiMed iPCR has evolved from more than 30 years of development and experience in medical technology. Our iPCR technology is used by over 12,000 paramedics, is installed in 2,700 ambulances, and handles over 200,000 patients every month. trapezegroup.com.au

CAA helps provide an important link between the ambulance sector and businesses that provide goods and services for this industry. It’s instrumental in providing networking and partnering opportunities. Don’t hesitate to reach out to organisations of interest. Interested in becoming a part of The Directory? Contact partnerships@caa.net.au

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Wellness First

and g n i t a e nge i b p o t s How to

g n i t a e r T t r a t S l e u F s a d Foo

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 Board 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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www.caa.net.au

’ve never really talked about it much publicly, but when I was younger, relatively new into my ambulance career, I used to binge eat… a lot.

It would happen mostly when I was tired after a long set of shifts, if I was lonely, or feeling down, or just plain bored out of my brain. Sometimes, it would happen when I was celebrating too, but always when I was alone. I would go to the supermarket, buy way too much junk food, go home, and eat as much of it as I could. I’d eat until I honestly didn’t think I could eat another bite and would feel so sick that I wanted to vomit. Then, I’d wait a while, and when the feelings of nausea started to subside, I’d start eating again until either the food was gone or until I fell into a deep shameful sleep. Without fail, I’d wake up feeling like absolute rubbish the next day. I’d beat myself up about it, forcing myself into an unending spiral of guilt, always wondering why I kept doing this to myself, and often blaming the stress of the job. To make myself feel even worse, I’d look in the mirror and tell myself how terrible I looked and that I would never be good enough until I could stop liking food. That if only I could somehow turn myself into one of those people who just ‘forgets’ to eat, then I’d finally be good enough. But that was the wrong approach. Clearly.

Learning to treat food as fuel Looking back at how I used to treat food and abuse my body, my first reaction is to wonder what the heck was wrong with me back then. After all, the binge eating obviously made me feel so bad, physically, and emotionally, yet I kept on doing it. But when I take the time to look deeper into my past actions, I start to be kinder to myself and feel serious empathy for that past young ambo. It’s obvious now that I’d put myself into an impossible place: if I was good, I wouldn’t eat at all. If I was sad, angry, lonely, or even happy, I would stuff myself with as much unhealthy food as possible. Back then, I didn’t treat food as fuel. I treated it as the total enemy. So, if you deal with binge eating at times, or know someone who does, know that you’re not alone. Know that there is hope. But you must start treating food like you should, as nourishment, not punishment, for your body. Here are the strategies that slowly helped me learn to stop binging on a regular basis and started treating food like as the fuel it is.

Check out the EAT | TRAIN | BELIEVE – 5 Day Sugar Detox Challenge

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Wellness First

Eat enough during the day

Don’t keep trigger foods around

One of the constant mistakes I used to make was to eat as little as possible throughout the day, often limiting my food intake to as little as 1,000-1,200 calories before dinnertime. I thought that I was being ‘good’ and that the least amount of food I could eat without completely crashing, the better. But unsurprisingly, this method of eating would cause several problems:

We all have certain foods that once we start eating them, we just can’t stop. Here are a few of mine:

• It often left me with incredibly low energy, meaning my workouts were often lacklustre (if I worked out at all) • It could cause mental fatigue, meaning I sometimes couldn’t think very clearly as the day went on • It would create feelings of endless hunger at night, even after eating a reasonable dinner. This made me more susceptible to binging on unhealthy foods, especially if I hadn’t eaten enough protein

• Licorice Allsorts • Sweet Chilli Relish Chips • Salted Caramel Dark Chocolate And of course, the list goes on, although these days I could probably control myself well enough that if one of my trigger foods was around, I wouldn’t eat the entire packet, but I still don’t tempt myself. Why? Because it’s just not worth it. It’s fine to have a few indulgences occasionally (and trust me, I certainly can have a hankering) but keep one or more of your trigger foods easily accessible and you will resort to binge eating when your mood or willpower is at a low point, especially when the weather is starting to get a bit cooler.

Have a ‘go to’ strategy Rather than tempting your willpower with known trigger foods, try keeping healthier versions of snack foods around for when you are craving something salty or sweet. My all-time favs include: • Celery. Yes celery, with almond butter and a few raisins for a little sweetness. It’s crunchy, nutty, and yummy. • Dark chocolate (and I mean dark - 85%) and dark chocolate covered almonds. I try to limit myself to just a few of these though since it would be way too easy to eat half the packet. • Watermelon. Yes, it’s fruit and it still has sugar, but you can pretty much eat as much as you want without doing much damage to your diet. • Homemade protein bliss balls. These are super easy to make, transport well and are a great little snack to have in your kit. There are loads of recipes online or reach out to me if you’re looking for inspiration.

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www.caa.net.au

Another trick, before you reach for that bag of chips or open a packet of lollies, is to ask yourself if you’re truly craving snack food or if you’re actually just hungry and need to make something more substantial. This is a fairly common mistake, and something that I’ve had happen to me countless times, especially whilst on shift, around that dreaded 4am! Or maybe I’ve been especially active that day or didn’t eat quite enough for dinner, and by the time 8pm rolls around, I need another small meal, not just a few chocolate covered almonds. If you suspect this happens to you, try making something wholesome and then having a smaller treat afterwards. This strategy works wonders to help stop mindless snacking.

Don’t try to be ‘perfect’ I hate to say it, but nobody is perfect. We will all have days when we eat too much, when we choose the less healthy option, or when we just can’t say no to the bag of chips, homemade chocolate chip cookies, or box of chocolates. That’s why I highly recommend following the 80/20 rule (or 90/10 if you’re really set on being disciplined) because eating perfect and healthy 100% of the time is not only boring and unsatisfying, but also totally unrealistic. That’s where that 10-20% wiggle room comes in, it allows you to cut yourself some slack when you enjoy a delicious dinner out with friends or when you just can’t stop eating all the treats in your house one evening after a long, stressful day at work. Because life happens. And as much as you try to set yourself up for success to eat healthy and work out on a regular basis, there will no doubt be times when you don’t follow the plan and eat too much or go on an all-day (or all weekend) binge. If that happens, the most important thing to do is to forgive yourself. Beating yourself up over it will only lead to you feeling like you failed, which leads to feelings of shame, which ultimately leads to more binge eating.

Develop a healthy relationship with food Whether you find yourself binge eating a couple of times a week or even just once every few months, the way to stop binge eating (or at least greatly reduce it) is to start developing a healthier relationship with food. Because I’ve said it before, and I’ll say it again: food is fuel. What you eat fuels your workouts, gives your brain the nutrients it needs to power through the day, and makes you an absolute rockstar! When you start treating food as fuel rather than the enemy, the need to binge eat slowly starts to fade. When you no longer shame yourself for eating, you start to be more thoughtful about what you put in your body and start to cherish food rather than demonize it. And when a binge does happen, you can simply forgive yourself and move on, knowing the next meal is always a chance for a new beginning.

So be kind to yourself.

You are worth 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.

Keep an eye out for these other upcoming CAA webinars

Aeromedical Supported by

JULY

Mental Health & Wellbeing

Cardiac Arrest

Clinical Practice

AUG

Patient Safety

Technology

Supported by

SEPT

Supported by

OCT

Supported by

NOV Each CAA webinar is worth 1 CPD hour.

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

DEC

Supported by

PROGRAM NOW AVAILABLE

for the rural health sector’s leading event for building knowledge to improve our health system. The conference theme, Bridging social distance: Rural health innovating & collaborating, recognises the complexity of providing rural health care and the positivity and innovation of people working within and for the rural health sector.

Visit

ruralhealth.org.au/16nrhc

Join us to be inspired, think outside the box, and work together to elevate the pre-hospital sector.

11-13 August 2022 International Convention Centre, Sydney