FIRST by CAA | Issue 12 2023

Lindsay Mackay

Over the holiday period (that seems so long ago!), and after an activity-packed year, I found myself thinking about ‘resilience’. It’s a popular buzzword on LinkedIn at the moment, in coaching & mentoring training and in just about everything you see or hear about managing mental health.

But what does ‘resilience’ actually mean?

The Collins Dictionary defines it as, “People and things that are able to recover easily and quickly from unpleasant or damaging events.” To me, this doesn’t feel quite right given the complexity of us as people and our relationships at work, at home and in the community.

After some consideration of what Collins has to say, I’ve decided that ‘being resilient’ is not ‘recovery’ but a way of managing your wellbeing on a continual basis. Resilience is easier if you can try and keep perspective, not letting things that worry you to stay bottled up, and basically taking care of yourself.

To me, resilience is also about helping your colleagues and friends when you can see they need a hand. You know what they say; a problem shared is a problem halved.

And for many of us that work in the pre-hospital sector, resilience is all-important in making sure we are at our best to do our best, for our colleagues, for our patients and for our friends and families when we get home.

March 8th was International Women’s Day, and in this edition of FIRST we talk with Lindsay Mackay to explore some of the challenges she faced in her career and ways she has found to overcome obstacles and build resilience. We also meet last year's 2022 CAA women in Ambulance Honour Recipients to learn what they're up to now, and how becoming an Honour Recipient has shaped the way they pursue their careers.

We also take a look at 2023 CAA Congress, due to be held on 2 and 3 August in Brisbane, Australia, introduce you to CAA’s new 5 Year Strategy and share with you our 2023 Women in Ambulance Honour Recipients.

I hope you enjoy Issue 12 of FIRST, and as ever warmly invite any suggestions you may have for articles in future editions by contacting us at admin@caa.net.au.

Mojca

Ambulance Snapshot

The CAA continued to collate data throughout 2022 from the Australian and New Zealand statutory ambulance services.

The data collected is used for comparison benchmarking and is published across CAA platforms. The Australian data collated by the CAA is provided to the Australian Government’s Productivity Commission Report on Government Services.

The full report is available to read at caa.net.au/report-on-government-services

Across New Zealand and Australia in 2021-22 financial year:

1,801

Salaried ambulance staff

7,376 Air ambulance aircraft

112

23,336 Volunteers & first responders

11,939

Across New Zealand and Australia in 2021-22 financial year:

Incidents reported to ambulance service organisations

4.7 million

Responses where an ambulance was sent to an incident

6.0 million

Calls made to 000 or 111

4.2 million

Industry News

Ambulance Victoria announces a new Chief Executive

Jane Miller has joined Ambulance Victoria as its new Chief Executive. With more than 30 years’ experience in healthcare and medical industry experience in executive senior management and clinical roles, Ambulance Victoria is delighted to have Jane’s extensive experience and wisdom leading them into a new chapter.

New scholarship for volunteer paramedics

Six Western Australian country volunteers have the opportunity to study emergency pre-hospital health care thanks to a new scholarship from the Australian Paramedical College. This is a joint initiative been St John and the Australian Paramedical college that will provide the scholarship recipients with a pathway to paid work within the pre-hospital sector.

Westpac Rescue Helicopter Service awarded Pandemic Service medals

The NSW Ambulance crews at Westpac Rescue Helicopter Service were awarded a Pandemic Service Medal for going above and beyond these past few years. The medals were presented by Assistant Commissioner, Tony Gately.

New ambulance station for Wellington Free Ambulance

The new $7 million, state-of-the-art ambulance station will be built in the Wairarapa and will be the only one in the region. Centrally located in Masterton, this will become the permanent base for the 30+ emergency response crew, patient transfer officers, and rescue squad members who serve the Wairarapa community.

St John NT welcomes new CEO

Andrew Tombs has stepped into the role of CEO at St John NT. Andrew is from Alpine Energy Limited, where he was Group Chief Executive Officer for 13 years. Andrew has significant governance experience as director having served on boards, including holding the role of chair. He was also vice president of his local Chamber of Commerce.

Are they triple ok?

PODCAST NOW STREAMING

Mental health and wellbeing organisation R U OK? has launched a new podcast series which aims to encourage life changing conversations, early intervention and supportive behaviour amongst first responders, their peers, and loved ones.

Visit the R U OK? website to learn more.

Australia Day Honour Recipients

The Ambulance Service Medal (ASM) recognises distinguished service as a member of an Australian ambulance service.

The CAA congratulates the following recipients who were recognised in the 2023 Australia Day Honours List.

New South Wales

Dr Gary Tall

Victoria

Mr Brett Drummond (MACPara)

Mr Lewis Gerald McDonald

Dr Benjamin MEadley (FACPara)

Ms Julie Faye Miller

Ms Carmel Louise Rogers

Queensland

Ms Nadine Cherise Bond (MACPara)

Mr Kerry Matthew Dillon

Mr Mark Thomas Nugent (MACPara)

Western Australia

Dr Joseph Cuthbertson (FACPara)

Mr Danny Louis Rose

South Australia

Mr Paul Graham Stratman (MACPara)

Mr Robert George Tolson

Mr David Christopher Walker

Northern Territory

Mr Stuart James Allison (MACPara)

Ms Judith Barker

The Council of Ambulance Authorities (CAA) have hit the ground running for 2023 and are thrilled to provide you with an incredible year ahead full of activities to get involved in, to learn from, and enjoy.

CAA Strategy 2023-28

This year the CAA takes on the first year of implementation of the 5-year CAA Strategy (2023-28).

The strategy has enabled us to determine why we do what we do, encouraged us to idenify the needs and challenges of our member services and the wider ambulance sector, and allows us to take steps to action changes and programs where necessary.

The three core pillars that have been established through the strategy are: advocacy, knowledge & information, and learning & development. All important areas with their individual challenges and opportunities, we look forward to putting our best foot forwards to do and be better for the Australasian ambulance sector.

CAA Congress 2023

Planning for the 2023 CAA Congress is in full swing. The program is growing together day by day, venue secured, sponsors and partners are coming on board. All that’s missing now is for you and your colleagues to secure your ticket.

This year we are co-hosting with Queensland Ambulance Service at the Brisbane Convention and Exhibition Centre on August 2 & 3.

Once again, we’ll be providing highly regarded speakers, an exciting Expo, and not-to-be-missed networking events for all to enjoy.

Both inspiring and educational speakers are coming from around the world to discuss areas of demand management, workforce development, sustainability, and more.

Early bird registrations are open (closing 1 June) and there are still sponsorship opportunities available.

Visit caacongress.net.au to learn more.

Women in Leadership Forum

2023 CAA Women in Ambulance Awards

A key component of our previous CAA Congress, this year the Women in Leadership Forum makes its debut as a standalone event in 2023.

To be held at Citadines on Burke, in Melbourne Australia, on Thursday 26 October 2023. Save the date now with updates available at caa.net.au/wilforum

Previously celebrated for its ability to help empower current female employees, and foster thriving new careers for emerging woman within the pre-hospital sector, the program can be expected to contain impactful, dynamic, and uplifting presentations from inspiring speakers, with insights, tools, and stories to make use of both personally and professionally.

It’s that time of year again where we recognise the hardworking women that help make up our ambulance services, shining a light on the role models they are to help inspire leaders of the future.

The following pages detail our 2023 CAA Women in Ambulance Honour Recpients. You can learn more about each one of them by visiting caa.net.au/wia.

Stay in the know about what CAA is up to by following us on Facebook, Twitter, or Linked In, or by subscribing to the CAA newsletter by visiting caa.net.au

2023 CAA Women in Ambulance Awards

In 2018 the CAA established the CAA Women in Leadership working group, a group that provides a forum for the women leaders in the ambulance sector, allowing them the opportunity to exchange knowledge and effect positive changes in the sector.

From this working group the Women in Ambulance Awards were created. In it’s fourth year now, the CAA Women in Ambulance Awards is designed to highlight the successful and hardworking women in ambulance services throughout Australasia.

This year the CAA Women in Ambulance Awards recognises 54 women for their work and career progression, these individuals are women who are being championed as role models to the rest of the workforce.

To learn more about each of the 2023 CAA Women in Ambulance Honour Recipients, visit caa.net.au/wia.

St John Ambulance Australia (NT) Inc.

Women in Leadership Forum

OCT 2023 26

CITADINES ON BOURKE

Melbourne, Australia

On average, men apply for a job when they meet only 60% of the qualifications, but women apply only if they meet 100% of them.

We believe that the ambulance sector has a large pool of hidden talent - women currently in leadership roles or who aspire to be leaders but are unsure about how to take that next step in their careers.

The Women in Leadership Forum will provide attendees with practical skills, tools, perspectives and takeaway tips to help these women take the next step.

We invite you to meet and network with some of the Australasian ambulance sector’s most talented women in person at the 2023 CAA Women in Leadership Forum.

Tickets now available. Scan this QR code to book yours today.

2022 CAA Women in Ambulance

Honour Recipients

Join us as we take a step back to learn what our 2022 Honour Recipients have been up to and seek inspiration from their journey.

So tell us, since becoming an honour recipient in 2022, what have been some of yourprofessional highlights?

The biggest highlight for me professionally is non-clinical. In July I was given the opportunity to relieve as Senior Team Manager for the Mildura local government area. The key duties of this role is to be a direct manager for the Mildura Intensive Care Paramedics as well as the Mildura Advanced Life Support Paramedics. Additional to this I was working collaboratively with key stake holders in my LGA such as other emergency services and the Mildura Base Public Hospital to provide best care to all of our patients. I relieved in this role for 6 months and found it to be incredibly challenging almost to the point of regretting my decision to give it a go but also incredibly rewarding and the amount of personal growth I can see within myself is enormous.

In a clinical context, being lead clinician at a truck rollover with an extrication time of over 5 hours with great outcomes for both occupants was definitely a highlight.

What are some of the ways you have been, or do you intend to be proactive about growing both personally and professionally?

When I started in the role as Senior Team Manager I thought I had quite a good level of experience as a manager, however I was amazed to realise just how much there was and still is for me to learn. I couldn’t plan for some of the challenges I faced but could work out an action plan to overcome these, by proactively seeking help from my mentors and colleagues that I regularly network with, but also by doing my own research. I dedicated time to researching and then comprehending policies, procedures, legislation and other material relevant to my role and could then make sound decisions that I perhaps would not have once been able to do or wouldn’t have been as credible in doing.

In regard to personal development I have learnt to say no and to take time off or change something when I feel the signs of burn out creeping in. These are big steps for me as I am very much a ‘yes’ person and can easily take on too much, because my passion for what I love and care about can often get in the way of making a sensible decision.

Looking at the next generation of women within the ambulance sector, how do you believe services can help develop their talent and skills?

I have been really focused in the last twelve months on goal setting and accountability for such goals from an individual perspective but also group/team based. I think it would be great to see services further promote and maintain this type of personal and team development. I would also like to see that women can discuss their gender-based strengths, because they do exist, and be well supported by managers in doing so. Recognising the need for greater flexibility for continuing education for mums would be wonderful to see as I reflect back on the hardship I faced when applying and completing my intensive care training. There have been some significant changes in this space but we need to see more so that programs such as the MICA course in AV is appealing to mums not off putting. Often the people on maternity leave are some of our best and most experienced in the business in multiple facets of the role such as clinical instruction, manual handling and management and we need to nurture them so they return to the workforce and continue to better themselves professionally.

Ambulance Victoria, 2022 CAA Women in Ambulance Honour Recipient

Finally, do you have any advice for recent paramedic graduates starting out in the workforce?

Never be afraid to ask a question. It is most likely a really great question that others have been wanting to ask too.

Respect authority and experience but advocate for patient safety always.

Be proud of your achievements and take the time to recognise how hard our job is. Often we have to make some hard decisions. Reflect on these decisions with others and build resilience by doing so.

Show humility. To me being a paramedic is a privilege even though it was my choice to become one. Keep in mind when your pager goes off next that although it is our ‘job’ and we put our heads down and get on with it, it could actually be the worst day of someone’s life and the positive impact we can have should never be underestimated.

Bronwyn Lambert

Focus First

So tell us, since becoming an honour recipient in 2022, what have been some of yourprofessional highlights?

I value the small victories and good patient outcomes as professional highlights. Working in the country where everyone knows everyone, I value that the community sees me as a trusted practitioner and have faith that I will do my best for them. I am lucky that I work with a diversity of people, ambulance volunteers, paramedic teams and other health practitioners. Recently a combined effort of remote area nurse, myself, a community member and RFDS joined forces to treat a trauma patient. The silos of health care just can’t exist in these small communities and the ability to work with others and develop a camaraderie to benefit the patient is so positive.

I recently joined SA Health Palliative Care Workforce Working Group whose membership includes a variety of health professions that look at management of palliative patients through available networks and identifying the professional areas needing development.

Listening to other professions and the issues they have, has been enlightening. It is also good to be able to provide a perspective from ambulance.

SA Ambulance Service, 2022 CAA Women in Ambulance Honour Recipient

I think it is important to raise the profile of the ambulance service with other health services. Identifying with them the various clinical levels working in ambulances and variance in clinical delivery. A shared education experience is always good.

What are some of the ways you have been, or do you intend to be proactive about growing both personally and professionally?

I guess I am at an age where it seems I get asked often about retiring. I have always admired those paramedics who were my mentors and aimed to keep clinically current and enthusiastic about the job right up to retiring. I never found learning easy, but have always found information relevant to practice very interesting and always evolving. You never stop learning. It is a strong motivator to keep developing clinical knowledge of practice.

Participating in workshops, helping present at conferences and maintaining clinical competency is an active way for me to do this. I love the availability of online learning, (a real bonus for remote workers) and being able to share and access so much more information. Thinking about how I am going to deliver training to my ambulance volunteers also keeps me reflecting on the audience learning needs and my own knowledge base.

Janet Brewer

I want to avoid compassion fatigue, so it is important to “fill the bucket”. I have probably learnt to balance life work ratios a bit better than I used to. I like having other interests like training my border collie puppy and networking with likeminded dog owners. I also am a plant addict and care for about 400 African violet plants, again networking with other growers across Australia.

At the end of the day work finishes, the stress of the day is left behind. I do not let others determine how I feel about the job and do not buy into negativity. It takes too big a toll. I choose my own path and find contentment in what I do.

Looking at the next generation of women within the ambulance sector, how do you believe services can help develop their talent and skills?

I think services have spent a lot of time and focus on teaching some amazing clinical skills and intervention. Having seen a more even percentage of women and men in the ambulance workforce, has changed the culture of the service I entered into many years ago.

I think women can be hesitant to put their hand up to try roles especially executive and high levels of management. Women in these roles have support from their families and co-workers. I believe woman tend to be reluctant to push themselves into roles they may not be totally comfortable in and yet when they have, have thrived and excelled in those roles. Our own service has some amazing women in a diversity of roles. They should be mentors and supporters for the future clinical and administrative leadership. Diversity in leadership is important in creating dynamic perspective for the service.

Services need to look at their leadership philosophy and educate leaders in their understanding of what barriers services may create in encouraging the female workforce to develop. I have had colleagues who find shift hours don’t work with childcare so have left the profession. New female workers statistically are in the larger percentage for workplace injury. In a worse case scenario experience harassment.

What helped me develop in my career, in a time when ambulance was dominated by men was my manager who was keen to support me in a team leader role. He was always interested in my welfare and how I was functioning at work. He managed people not just workers and provided support that at the time was just so valuable.

I think service leaders need to identify what they can do, to encourage confidence for women and all staff really to thrive in an ambulance career. Current service leaders should engage with staff and actively recognise, support and encourage those who demonstrate potential and be proactive in influencing them to further develop professionally. Services need to have the tools, resources and support to do this, like mentoring, leadership training and education, performance reviews, career counselling and encouragement to reflect on potential they may be demonstrating.

Finally, do you have any advice for recent paramedic graduates starting out in the workforce?

Value and care about people. This job should not be about how many skills you have performed on a patient but on holistic outcomes for people. It may sound obvious that people are patients, but I sometimes think there is so much focus on treating the condition, treating the person doesn’t get done particularly well. Never expect a patient thankyou as setting high expectations will lead to disappointment. Thank yous are always a bonus.

Valuing and caring about people also includes looking after yourself. Treat others with respect. Ego has no place in clinical care. Spend time getting to know your other colleagues by talking to them and not just checking social media platforms.

Life work balance is important. Don’t take shortcuts with work health and safety. Plan risk adverse care and ask yourself if this was a loved family member would I be taking the same risk? If there are opportunities to work in various environments such as country, take the opportunity to broaden your perspective.

The skill of dialogue, respect and empathy should be as much part of patient assessment as the physical exam. I also think the reflection of how cases impact on practitioners is emotionally and educationally important.

Mindfulness and retrospection are important in evolving as a competent, resilient and caring practitioner.

So tell us, since becoming an honour recipient in 2022, what have been some of yourprofessional highlights?

Since attending the 2022 CAA Congress in Sydney as an award recipient, I have had the opportunity to upward relieve as the Acting Assistant Commissioner of both the Far Northern Region and Southeast Operations Centre, and the Director of Brisbane Operations Centre within Queensland Ambulance Service. I was exceptionally grateful to CAA and QAS for the privilege of this nomination and the opportunity to network, view the latest in emerging Ambulance technologies, listen to other agency stories of lessons learnt, and see the opportunity for growth and innovations in our challenging and complex industry.

Brina Keating

What are some of the ways you have been, or do you intend to be proactive about growing both personally and professionally?

The role of Assistant Commissioner, Southeast Operations Centre was an opportunity and experience that I honestly felt would come later in my professional life. Working in Far North Queensland for most of my career I recognised the need to step out of my comfort zone and applied for a Director level position to backfill in Brisbane.

I was rewarded with the acting position, a huge professional step forward for me. It was during my time as Acting Director that other leaders (who I have not worked closely with) were able to see my potential for further growth and provided me with honest and meaningful feedback and advice. This mentoring was vital for my increasing confidence and abilities in the role.

Queensland Ambulance Service, 2022 CAA Women in Ambulance Honour Recipient

From my comfort of my substantive position and support networks, I did feel somewhat of an imposter. I was the first female and first Acting Assistant Commissioner for Southeast Queensland Operations Centres who had worked her way up from an Emergency Medical Dispatcher, Operations Centre Supervisor and to a management role. Whilst I say I felt like an imposter this isn’t a negative as I have often felt this way, I have learnt to embrace that feeling in the moment to see the upward relief opportunities as personal growth that comes with being vulnerable. Whilst I had much to learn, I found I bought my own skills and experience others could also learn from.

I look forward to future opportunities this year but it’s my intention to continue to coach, mentor and sponsor other staff for their own personal growth. In the last 12 months I have reflected on my own leadership style, how others see me, and I have become so much more comfortable in just being me. I have learned to play to my strengths and seek advice/guidance from others. Most importantly I am not afraid to pick up the phone and ask for help.

Looking at the next generation of women within the ambulance sector, how do you believe services can help develop their talent and skills?

Sharing your challenges and experiences as a female leader is vital to break down the very real barriers. We need to create networks that you can call upon at any time for support and guidance. This support is not only around leadership, but I’m also forever grateful for those who have supported me and propped me up when I was trying to juggle family, work, and the chaos of life. Sometimes it isn’t the formal conversations that have got me through the challenging times, it’s been other women who have checked in to ask “how are you travelling?” Often, we need to share our stories to feel somewhat normal as life can be complex, unrelenting, and joyous all at once!

Over the span of my career, it was mainly male mentors and sponsors who have seen my potential and abilities, often as they held the positions in upper leadership positions. Whilst I’m grateful for all these opportunities, this has certainly changed over the past few years in the Queensland Ambulance Service. Happily, the number of women in leadership is beginning to represent the changing demographic of our workforce.

One piece of important advice I was given was ‘never say no to an opportunity’. Even if you don’t think you can tick every box or think it’s something you would be very interested in, do it! Also, you need balance of the people you seek mentorship and guidance from. The saying “you cannot be what you cannot see” has really resonated with me other the years. Every organisation needs diversity, including representation of female leaders across all levels of leadership. For me, investing time, training and meaningful conversations is key.

Finally, do you have any advice for an Emergency Medical Dispatcher starting out in the workforce?

Be kind to yourself - it isn’t an easy job. It will be stressful and demanding but is also a very rewarding role. If you enjoy working in a tight knit team, in a fast-paced environment and serving the community then this is the job for you. No two shifts will ever be the same, that is certain.

Receiving constructive and positive feedback over your training and mentoring phase can be difficult at times. You need to remember that nothing can truly prepare you for this role, but you will grow exponentially in it. Whilst we recruit staff with exceptional customer service backgrounds, great multi-skills and excellent listening skills, taking emergency calls is challenging. You need to be the calm, reassuring, and controlled voice in another human's life-threatening emergency.

Since becoming an honour recipient in 2022, what have been some of your professional highlights?

When I was the only ambulance officer at the scene to revive a senior state lawyer, who had collapsed in the court room. I was able to improve his condition with the AED machine, and get the casualty to ROSC.

Deployed to the highlands of Papua New Guinea as a special operations medical team, to assist the Royal Papua New Guineas Constabulary (RPNGC), the PNG defence force, and other security task forces during the 2022 National Elections.

Being involved with the Covid-19 programs, and being trained in various areas which included swabbing, and vaccinating individuals. This also involved developing community awareness on Covid-19, and becoming a team leader at the Morata Haus Covid-19 Call Centre.

Actively taking part in APEC 2018 as a medic on standby, and attending to several obstetric complicated cases. This included cases with breech births, retained placenta, and PPH.

In what ways have you been, or do you intend to be proactive about growing both personally and professionally?

Being a female officer and a mother working outside can become risky, dangerous and unsafe. However I love my job, saving lives is my passion and at the end of the day it feels satisfying to have completed my route jobs.

Even though this career path can appear to be more male dominated, despite being a women, I love my job. I love being able to respond to different cases in a range of areas (urban, settlements, and rural), by going anywhere and everywhere via land, air or sea to save the lives of those needing assistance.

I like sharing my knowledge and skills by training and mentoring new/junior clinicians, and ambulance officers. I am able to teach them how to provide support to people, by being able to provide high quality pre-hospital health care to those who are medically ill and suffering from all types of trauma.

I find it important to actively take part in fitness training, to be able to physically help others. Completing case briefs to understand what actions were good, and what areas needed improvement.

Rachel Pyokol

St John Ambulance Service Papua New Guinea, 2022 CAA Women in Ambulance Honour Recipient

How do you believe services can help develop the talent and skills of the next generation of women within the ambulance sector?

I believe that the next generation of women in the ambulance sector will be able to develop their skills by looking at some of the current female officers already within the field. Every day these women are taking risks and facing challenges that work towards a common goal, being able to care for everyone.

It is important to ensure that all staff are updated with any new pre-hospital knowledge that becomes available. This includes supporting, training, and mentoring all employees within the pre-hospital sector.

What is some advice that you have for recent paramedic graduates starting out in the workforce?

Working in the pre-hospital sector is tough, risky, and challenging. As a senior officer my encouragement and advice is to "love your job" and to do the following.

1. Have a willingness to learn, by doing research after attending a new case. Reading on a certain topic, will help you to understand what has occurred and how to attend to it.

2. Always accept corrections! If you do something wrong, and you are being corrected by a senior colleague, accept their advice kindly.

3. Always complete a debrief in regard to the partner that you have worked alongside (attendant, driver etc.). Evaluate areas that can be improved.

4. Do all that is possible to be the best paramedic that you can be. Create working experiences, by always showing a willingness to learn.

So tell us, since becoming an honour recipient in 2022, what have been some of yourprofessional highlights?

My nomination has filled me with a strong sense of pride and I would like to thank my team and ESA for this honour. I would say that this is one of my proudest achievements within my time with ESA.

I work in a small high paced team within the Workforce Planning team of The ACT Ambulance Service. And whilst I am not a paramedic, we strive to support all the Staff in a highly professional manner at all times; whilst being extremely approachable, even when they start talking medical ‘lingo’ to us, which I have no idea about.

Whilst it has been a very tough couple of years our team has always managed to work through these challenging times with a smile on our faces and had a bit of a laugh on the way. I see this as a major highlight. It may not seem like a professional highlight to everyone else, but you have to love where you work, and without my team it just would not be the same.

What are some of the ways you have been, or do you intend to be proactive about growing both personally and professionally?

Being part of a hard-working, small team. We all have to do our part, and just ‘get the job done' to meet deadlines. I do this using some of the tools below.

I always:

• Plan ahead.

• Set goals.

• Prioritise.

• Learn to problem-solve.

• Take action.

• Take responsibility for my actions. and

• Don't dwell on the mistakes from the past, but learn from them.

• Read all new procedures/ guidelines

• Always stay as up to date as you can

ACT Ambulance Service, 2022 CAA Women in Ambulance Honour Recipient

Looking at the next generation of women within the ambulance sector, how do you believe services can help develop their talent and skills?

Women are as ambitious as anyone and bring to the table different sets of life and work experiences. This can only be a good thing.

It’s becoming increasingly important to women that they work for organisations that prioritise flexibility, employee well-being, and diversity, equity, and inclusivity.

The next generation of Women in the Ambulance sector will still face battles ahead to be recognised and rewarded for what they do, to be inclusive in what was generally considered a boys club. I’m proud to say that I have seen a major cultural shift in our organisation in the last ten years. And continue to see that strong women are being included, accepted and rewarded.

Finally, do you have any advice for recent paramedic graduates starting out in the workforce?

Again, whilst I am not a paramedic, some general advice that I would give any new starter in any profession would be to:

• Learn and listen to the people you are now working with. Take it all in, they are extremely knowledgeable in their field and if you are willing to learn, they will happily share their life skills with you. It may be one little bit of information that you hear along the way that may make a difference in a case that you are working on and might just change the outcome entirely, and in that one minute may also change a whole family’s worst day into a day that they can look back on with extreme gratitude to you;

• You will need to do the paperwork, its just a part of life; and

• And one last little nugget ‘try to maintain a healthy work/life balance’.

Barbara Stephens

So tell us, since becoming an honour recipient in 2022, what have been some of yourprofessional highlights?

Since becoming an honour recipient, I have been re-elected to the board of the Australasian College of Paramedicine and elected assistant secretary of the Australasian Council of Ambulance Unions. Within Ambulance Tasmania I have been appointed acting Coordinator of Clinical Practice which has been a fantastic opportunity to develop clinical practice guidelines and work on the Ambulance Tasmania Cardiac Arrest Registry which I find very interesting,

What are some of the ways you have been, or do you intend to be proactive about growing both personally and professionally?

Last year I participated in the inaugural leadership program with ACP, which afforded me an opportunity to work with peers across Australia and Aotearoa to develop skills in leadership and communication. I am also enrolled in the University of Tasmania graduate diploma of leadership and currently undertaking a project management course through UTas also.

Further to this I ran for council in the recent Tasmanian Local Government elections and was successfully elected to the Kentish Council. I look forward to learning from the community leaders and professional development opportunities that arise through this role. Many of the skills are parallel to those required in ambulance and I look forward to applying them to my daily work.

Ambulance Tasmania, 2022 CAA Women in Ambulance Honour Recipient

Looking at the next generation of women within the ambulance sector, how do you believe services can help develop their talent and skills?

You can’t be what you can’t see. Services need to foster and encourage women to put themselves forward for higher duty positions. The research shows that women are less likely to apply if they don’t address all the selection criteria whereas men take that risk. Applying and having the opportunity to work in such positions will teach the skills. The expectation to be already good at a job that you have never done is a difficult mindset to change.

Services should also be focusing on mentoring and coaching women to help them gain the confidence and skills to apply for different roles. Consultation with women in the workforce is vital to understanding their concerns and aspirations. Services need good leaders, not just managers, to move forward.

Finally, do you have any advice for recent paramedic graduates starting out in the workforce?

Don’t be too hard on yourself. Being a paramedic is tough at times. As amazing and rewarding as this profession is, it is hard at times. You need to take time for yourself and your well-being, both mental and physical. You can learn something from every case you attend and every mentor/ preceptor/ coach you have. Don’t be afraid to ask for help if you need it; not asking early makes it harder on yourself in the long run.

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New AED technologies: It’s about time!

By Benjamin S. Abella, MD MPhil Director, Center for Resuscitation Science, University of Pennsylvania

Disclosure: the author has no financial relationships with the companies described in the article.

Automated external defibrillators (AEDs) have been a crucial tool to improve survival from out-of-hospital cardiac arrest (OHCA) for over two decades.

One pivotal study from 2002 demonstrated a high survival rate from OHCA taking place in airports with the rapid deployment of AEDs,1 and a major randomized trial in 2003 demonstrated improved OHCA survival in residential buildings and schools that were outfitted with AEDs for public use.2

For OHCA victims with shockable arrest rhythms, prompt AED use can be life-saving. However, despite the broad deployment of AEDs globally and in Australia, survival from OHCA has only modestly improved in most developed countries. Why have AEDs not lived up to their promise?

One key failing of current AEDs resides in the lack of “smart” technology inherent in most AED models and systems of care. AEDs in current use are much like home fire extinguishers: both work perfectly well when used, but both represent devices with passive technology.

They do not communicate with emergency dispatch, they cannot help connect potential users via geolocation technology in an emergency, nor can they alert users or systems of care remotely if they are malfunctioning (e.g. low pressure for fire extinguishers, or low battery power for AEDs). Another problem with current AED technology is the large size of the devices, limiting their ability to be carried easily by non-professional rescuers – they are too small for a car glovebox or shoulder bag for example. Finally, AEDs are mostly deployed in static installations, much like fire extinguishers – they require a person to physically deliver the AED to the victim’s side. In rural or suburban areas, this distance represents a real problem when each minute counts; time to defibrillation is a key determinant of survival (see Figure 1).

The good news is that recent innovations may finally upend the current paradigm of AED deployment and use, which has not changed much in the past 20 years. These include AEDs with GPS and wifi capabilities, allowing remote monitoring of device health (battery power, pad function) and easy geolocation by dispatchers when OHCAs occur. An AED with these capabilities has just received FDA approval in the United States (www.avive.life).

Another new direction for AEDs involves miniaturization, allowing these devices to be much more portable. For example, a significantly smaller AED could be easily transported in a sports team equipment bag, or a shoulder bag of a person with heart disease as they go about their daily travels. Such a device is now approved in Australia and being evaluated in implementation trials with Ambulance Victoria (www.cellaed.io/row). Finally, teams around the world are studying drone delivery of AEDs, in an effort to solve the problem of static AED installations and make delivery over great distances possible at rapid speed. For a dramatic video demonstration of what this might look like, see tinyurl.com/s7xfv5x5.

AEDs are crucial components in the OHCA chain of survival, and prompt AED use can improve survival before the arrival of emergency medical services personnel. The next few years will be an exciting time for innovation in AED design and our opportunity to rethink our approach to saving lives from cardiac arrest.

Benjamin S. Abella

MD MPhil Director, Center for Resuscitation Science, University of Pennsylvania

Benjamin S. Abella, MD

MPhil is the William G. Baxt Professor of Emergency Medicine and Director of the Center for Resuscitation Science at the University of Pennsylvania (Philadelphia, USA). He has led cardiac arrest research for the past 20 years, and has published over 200 works on CPR and post-arrest care topics.

References

1. Caffrey SL, Willoughby PJ, Pepe PE, Becker LB. Public use of automated external defibrillators. New Engl J Med 2002; 347:1242-7.

2. Hallstrom AP, Ornato JP, Weisfeldt M, Travers A, Christenson J, McBurnie MA, Zalenski R, Becker LB, Schron EB, Proschan M; Public Access Defibrillation Trial Investigators. Public-access defibrillation and survival after out-of-hospital cardiac arrest. N Engl J Med 2004;351:637-46.

3. Chan PS, Krumholz HM, Nichol G, Nallamothu BK; American Heart Association National Registry of Cardiopulmonary Resuscitation Investigators. Delayed time to defibrillation after in-hospital cardiac arrest. N Engl J Med. 2008;358:9-17.

Figure 1 - Survival depends crucially on the time to defibrillation. Adapted from Chan et al.3

Recycling of old St John NT uniforms helps fight against textile waste

From St John NT

The implementation of new uniforms for paramedic staff in July 2022 brought many obstacles to navigate, including the question of what to do with the old uniforms?

St John NT made the commitment to being environmentally friendly with the uniform changeover and researched several options for recycling or disposal of the old uniforms. It was determined that the best option was to engage with textile recycling company UPPAREL.

UPPAREL is Australia and New Zealand’s only direct-toconsumer and commercial textile recovery and recycler and in 2020 was awarded the National Sustainability Champion award by the Australian Retail Association.

Collection containers were made available on station across all locations for crews to return old uniforms. In total an impressive 900kg of uniforms were sent to the UPPAREL recycling facility to minimise the environmental impact of disposal.

The partnership with UPPAREL resulted in the achievement of 971kg of textile material being diverted from landfill.

The decision to dispose of the uniforms in an environmentally conscious way also resulted 3398.5kg in greenhouse gasses being prevented.

Each and every item that comes to UPPAREL avoids landfills, helping decrease greenhouse gases and overall waste.

St John NT is proud to participate in the overarching mission to eradicate textile waste from landfills and play a part in achieving the greatest possible positive impact for the environment. For more information on the textile recycling process visit www.upparel.com.au

GoodSAM app launched in South Australia

From SA Ambulance Service

SA Ambulance Service (SAAS) has launched GoodSAM in South Australia to improve cardiac arrest survival rates.

GoodSAM is an alert system that uses a phone app to notify registered responders – like off-duty health professionals and first-aiders – if a cardiac arrest occurs near them. These responders can provide CPR while an ambulance is on the way.

In the first phase of SA’s GoodSAM activation, SAAS staff and volunteers were able to register as GoodSAM responders. SAAS is now moving to sign up other registered health professionals, followed by others with first aid and clinical training.

“We’re enthusiastic about opening up registration to non-SAAS health professionals and others with first aid training because that will dramatically increase the chances of a GoodSAM responder being nearby and able to help in a cardiac arrest,” said Kate Clarke, SAAS Executive Director of Statewide Operational Services.

“There are many thousands of South Australians with clinical or first aid training and SA is fortunate to have this incredible community resource of people with the Good Samaritan instinct and the skills to save a life,” said Ms Clarke.

In the Adelaide CBD, the GoodSAM app can alert responders within 400 metres of a cardiac arrest, while in the suburbs of Adelaide and regional cities, it will alert responders within 600 metres.

In regional areas, the response radius is 5 km in regional towns and up to 15 km in more remote locations.

GoodSAM was launched in December by the SA Minister for Health and Wellbeing, the Honourable Chris Picton. “Recruiting the help of people nearby is an

important start in the chain of survival before an ambulance arrives and this will save lives,” said Mr Picton.

Also speaking at the launch were SAAS Intensive Care Paramedic Pip Raimondo and cardiac arrest survivor Rex Leverington, who was aided by a passing stranger when he collapsed on a city street.

In a similar story, Intensive Care Paramedic, Pip Raimondo, was off duty and shopping for groceries in the Adelaide Hills when a friend alerted her to a cardiac arrest outside the store.

“That man was lucky because a bystander saw him collapse, called an ambulance immediately and started CPR while someone else had run over to the library for the AED and I was nearby,” said Ms Raimondo.

“But it doesn’t always happen like that and that’s what GoodSAM is all about; linking all those elements together to give someone the best chance of survival,” said Ms Raimondo.

Across SA, SAAS expects that around 1500 cardiac arrest cases would be suitable for a GoodSAM alert each year.

The GoodSAM service has been operating in Victoria and New Zealand since 2018. “We’ve received a great deal of help and support from Ambulance Victoria and Hato Hone St John in New Zealand, and of course, the GoodSAM team. They have all been very generous in sharing their experience and knowledge,” said Ms Clarke.

SAAS Executive Director Kate Clarke, SA Minister for Health and Wellbeing, Chris Picton, cardiac arrest survivor, Rex Leverington and Intensive Care Paramedic, Pip Raimondo.

Meet Claire –Australasia NAVIGATOR Dispatcher of the Year, 2022

From Wellington Free Ambulance

Claire has been working in our Clinical Communications Centre since 2008. She works with a team who answer emergency 111 calls as well as non-urgent calls from medical centres and hospitals.

“Before I joined Wellington Free, I ran a sign-writing business with a partner. I had no medical background at all,” says Claire.

“But I grew up in a family who all worked in emergency services. My grandfather, uncle, dad and brother have all been fire fighters.”

One day, Claire saw an advert in the Hutt News for Emergency Medical Dispatchers, and says it just caught her attention. “I applied, had a phone interview and went to an open day. I’ve never looked back!”

Claire still remembers her first day at Wellington Free Ambulance. “I’d had no sleep the night before. I was so nervous and my stomach was doing loops. But once I arrived, been introduced to everybody and started my training, I relaxed.”

“It can be quite daunting when you first get in that seat and start taking calls. There’s a lot of responsibility on your shoulders, and it’s difficult to come to terms with the fact that you have peoples’ lives in your hands. We have to get so many things right. I felt a lot of pressure.”

Claire settled in quickly. “I really enjoyed the interaction, helping people,” she says. After a while she found herself naturally helping other, newer members of the team. “I thought to myself, I have a lot of knowledge to pass on and two years ago, when the role of Call Taking Supervisor came up, it made sense for me to apply.”

While Claire still takes calls herself, her primary role now is to support other call takers on her team. She is also one of WFA’s peer supporters, which involves reaching out to other staff members after traumatic calls or experiences and offering support.

Claire has seen a lot of change over the last 14 years. One of the most significant is that call taking is now handled nationally.

“When I first started, all calls from the Lower North Island would come to us, and if all the Emergency Medical Call Takers were busy, callers would sit in the queue until someone was free.

“It’s changed now. New Zealand now has three emergency communications centres – north, central, and south. It doesn’t matter where the call taker is located - if you are free you get the next call, no matter where in New Zealand it is coming from. This was a massive change, and it’s really helped as it means people don’t need to wait as long for help.”

Since Claire first joined, there have also been some significant technology changes. Now, if someone is calling for help, and they don’t know exactly where they are or can’t describe where they are, we have sophisticated technology which can help locate them.

Claire recalls a recent call where a man had come off his motorbike. He was with a group of people, but none of the group knew exactly where they were. “All they knew about the area they were in was that they had just had a coffee and were taking some back roads. Thanks to the call being made from a mobile phone, we could pinpoint precisely where they were. He was critically injured and without that technology we would not have been able to find them.”

Each year, all the emergency communications centres throughout Australia and New Zealand have the opportunity to nominate their Emergency Medical Dispatchers for a range of awards which recognise consistent excellent performance and remarkable skill, empathy and professionalism. In November 2022, Claire received the prestigious Australasia NAVIGATOR Dispatcher of the Year award.

“When I found out I’d won the Dispatcher of the Year award, I was just gob smacked!” says Claire. “I knew some of the other people who were nominated and they are all amazing at what they do. We all do the same thing, so it feels a bit odd being the one who was selected. This is my job, I don’t do it for accolades or awards, I do it because I love it.”

Claire’s Shift Manager, Simon, was one of the people who nominated Claire for the award. In his nomination, he noted that Claire handles her calls “with compassion and empathy, even when helping people through complex situations.”

What the judges found really remarkable, was the description of one particular call that Claire took during 2022.

“It was a fentanyl overdose,” says Claire. “I remember it happened in the afternoon. The patient’s partner rang, told me he had taken fentanyl and was not awake. After some questions we established that he wasn’t breathing.”

“I needed the caller to get her partner onto the floor and start giving CPR. However, their children were watching and trying to climb on their dad’s chest. I needed to distract the children, so I told the older childto go and

help with the baby. You can quickly and easily die from a fentanyl overdose. I needed to make sure the CPR was being performed correctly.”

“The patient was in a very remote spot, nearly an hour by road. We needed to send our paramedics in a helicopter as it would have taken too long to get there by ambulance. I talked the caller through giving CPR and stayed on the phone giving instructions for about 25 minutes,” recalls Claire.

“When our paramedics arrived, they administered a Fentanyl antidote - and he sat up and started talking immediately.”

In Simon’s nomination letter, he noted that “the patient would not have survived had it not been for Claire’s expert navigation… as well as her calm yet assertive delivery.”

“I am really proud to have won the award, but I’m still just doing my job!” says Claire. “The fact that my peers took the time to nominate me – that means more to me than anything.”

Kate Jennings, Head of Clinical Communications for Wellington Free Ambulance, remarked how proud she was of Claire and how well deserved the win was.

“Claire is a remarkable member of staff, she is cool and calm under pressure, but still shows huge amount of empathy and compassion for callers, patients, and fellow staff members alike. To still be passionate about the role after 14 years, shows an incredible amount of resilience and humility."

Kate added that whilst Claire's award is a massive achievement for her and Wellington Free Ambulance's Clinical Communication Centre, Claire joins some other awesome staff members who have been previous award winners.

Wellington Free Ambulance has now won the award 4 times in the last 8 years. “For a small centre like ours (relative to some of the bigger Australian services) to consistently produce such high-quality call takers is simply astounding," says Kate.

Kate advised that the WFA Clinical Communications Centre is also an Accredited Centre of Excellence, which is an international standard that only the top 4% of all ambulance centers across the world achieve.

“When I reflect on what my staff do, day in, day out – saving lives, under constant pressure, working long hours – and they do it with professionalism, compassion, and excellence. They work together as a team, supporting each other and consistently striving to improve our service. I am truly humbled. They really are the unsung heroes that you will never see!”

St John WA receive funding for domestic violence training

From St John WA

St John WA has welcomed more than $2 million in State Government funding to expand sector-recognised Family and Domestic Violence (FDV) training to Western Australia’s Triple Zero (000) ambulance workforce.

The funding will build the capacity of about 5,500 St John personnel including call-takers, on-road staff and volunteers to respond to family and domestic violence calls.

It will enable Triple Zero (000) responders to recognise and respond to the needs of patients who may be experiencing family, domestic and sexual violence with the aim of increasing the safety of patients, including children.

St John records instances of FDV by injury – more broadly trauma, or psychosocial disturbance –which won’t specify individual circumstances.

In the past year St John responded to more than 6000 cases involving psychosocial social problems, trauma in a domestic setting, assaults, sexual assaults, and stabbings for women aged up to 70.

About 5,500 St John personnel –including call-takers, on-road staff and volunteers – across the state will benefit.

St John will partner with a FDV specialist to build on the capacity for identification and response to family and domestic violence within a health context and the training will be delivered in metro and regional areas.

St John Executive Director People and Culture

Tamsyn Howard said the funding built on St John’s existing programs which deliver best practice mental health and wellbeing support and training to its people.

“We know it is not unusual for emergency medical personnel to encounter incidents of family and

domestic violence in the course of their work, either in person or as a call taker,” Ms Howard said.

“This can take a real toll as patients may refuse transport or be in an ongoing vulnerable situation.

“We look forward to collaborating with sector leaders to develop a program which will suit the whole workforce, particularly those in the regions who may know the families involved.”

The training is expected to be rolled out in the middle of next year.

This builds on existing programs which support the workforce in mental health and wellbeing, and de-escalation skills.

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Virtual Emergency Medicine (VEM)

The 2022 CAA Excellence in Patient Care winning project

A collaboration between St John WA and South Metropolitan Health Service

Could you please provide us with a quick recap of the project. What was the initial aim and end goal?

In December 2020, with increasing Emergency Department (ED) overcrowding and ambulance ramping across metropolitan Perth and impending impacts of COVID-19 entering Western Australia, an expansion of the Fiona Stanley Hospital (FSH) ED consulting capabilities was initiated by FSH ED clinical staff with support from the South Metropolitan Health Service (SMHS) Kaartdijin Innovation team.

A close collaboration between SMHS, St John WA’s Ambulance Service and other healthcare providers ensued to successfully design and implement a Virtual Emergency Medicine (VEM) proof of concept, including the establishment of a Command Centre at FSH and workflow for the tele-triage of ambulance patients across SMHS.

A daily VEM service from 10am - 6.30pm has successfully operated at FSH’s command centre since its launch in February 2021. The service teleconferences, or conducts video calls when possible, with paramedics to assess and triage patients at the scene or enroute to FSH.

VEM has streamlined and improved access to the right care, in the right place, at the right time for patients in the community, based on their individual needs. Patient feedback throughout the proof-of-concept emphasised VEM provided feelings of ‘safeness’, ‘reduced bottleneck’, ‘of being looked after’ and ‘a cut above service’. FSH clinical staff communicated VEM’s great service to the community had improved patient experience and staff satisfaction.

Image: St John WA paramedics celebrated 10,000 VEM cases in 2022, alongside (clockwise from rear left) Alexandra Ayton (SMHS), Dr Ian Dey (FSFHG), Dr Andrew Waring (FSH), Dr Vanessa Clayden (FSH), Christine Bishop (FSFHG) , Leanne Morrall (FSFHG), April Kruining (FSFHG), Martin Depiazzi (FSH) and Hazel Hudson (SMHS).

Dan Rose

St John WA

State Operations Manager, Clinical Hub

Since its inception, VEM has helped to reduce ramping, manage ambulance demand at FSH and started to make some improvements to SJWA Transfer of Care (ToC) times. The initiative is particularly beneficial for the frail elderly who are given a rapid pathway (e.g. ambulatory care, chest pain clinic or imaging) at FSH, directly diverted to Fremantle Hospital’s Rapid Assessment Treatment Unit (RATU) with specialist aged care services or can receive other in-home-care services without the need for transfer to hospital.

So, what is the history of the health stakeholders and how did they come to play a central role in the integration of the Virtual Care Service?

Led by the SMHS Innovation Team in collaboration with SJWA, and input from FSH clinical leaders and consumers, the VEM concept of tele-triaging inbound ambulance patients was developed using MS Teams, SJWA iPad, phones and cardiac monitoring. A video-call to the FSH command centre allows ED clinicians to support paramedics to assess and triage patients and determine what is the best care option, whether that is connecting in with a local community health service or to streamline access into the hospital, if required.

Implemented in a methodical, phased approach, the program now interacts with ambulances either on scene or en-route to hospitals in SMHS’ catchment.

Dan Rose joined St John Ambulance WA as a Paramedic in 2012, progressing through various clinical roles.

Dan started his prehospital career in in Zimbabwe, before relocating to the United Kingdom in 2000 to undertake undergraduate studies in Paramedicine and postgraduate studies in Prehospital Critical and Advanced Care Practice at the University of Warwick (Medical School UK).

He has experience as a frontline Paramedic, Critical Care Paramedic (Helicopter Emergency Medical Service) and an Advanced Care Practitioner within an Urgent Care setting.

In his role at St John WA (SJWA), Dan focuses on collaboratively developing paramedical clinical excellence strategies and promoting patient safety. In 2021, among his other SJWA responsibilities, Dan assumed the clinical lead for South Metropolitan Health Service’s ground-breaking Virtual Emergency Medicine program, which was collaborated on and piloted by Fiona Stanley Hospital and SJWA. Dan has been instrumental in shaping the VEM processes SJWA clinicians use in day-to-day patient care, while also collaborating with key stakeholders over VEM’s strategic direction as it continues to evolve.

Image: Members of St John WA proudly receiving the trophy for Excellence in Patient Care.

VEM was specifically designed with the following build themes:

• Partnership between SJWA and SMHS;

• Patient centric models of care, improving early access to the right care;

• Leveraging from and enabling existing community service providers;

• Consumer groups, GP and Residential Aged Care (RAC) sector engagement.

Through these partnerships VEM has been able to triage and connect patients with these specialist services right from the beginning of their journey, ensuring more rapid access to exactly the right care, and a better patient and family experience. The model has fundamentally changed the patient journey for many – especially the frail elderly.

Without first coming to potentially overcrowded EDs, patients can receive assessment and care at home (including RAC facilities) or directly access specialist care at Fremantle Hospital. In circumstances where patients and/or families have already expressed wishes about end-of-life care, this can also be facilitated by an Emergency Physician tele-medicine assessment without the need to transport to the ED.

Now that the project has been established I'd like to take a look at the future. What is the next step for this project?

The next phase of the VEM service will focus on:

• Improving connectivity to patients in the community e.g. trial of a telehealth platform with enhanced connectivity for ease of paramedic and VEM clinician use.

• Improving current pathways for care of frail and elderly patients in the community to ensure best model of care, which is timely and completed in the right place for their needs.

• Continued collaborations with the Department of Health (DoH) in preparation for VEM’s scale up across Perth’s metropolitan area.

• Expansion of the SJWA’s Secondary Triage Team (STT) as a VEM ‘partner’ and enhancing the technological infrastructure to support connectivity and data sharing between services.

St John WA (SJWA) paramedic Giovanni Pampano using the Virtual Emergency Medicine (VEM) service at Fiona Stanley Hospital (FSH) to assess a Perth patient. Credit: South Metropolitan Health Service (SMHS).

In relation to the project, what are some of the goals for Health stakeholders?

Current focus for SJWA and SMHS is to continue to enhance optimum pathways for the community, leveraging existing communication links between SJWA and FSH staff through the trial of a new telehealth platform. There are also ongoing discussions with DoH and other healthcare providers about the scale up of VEM across the whole of Perth.

Finally, what are the collateral benefits of a project like this?

The methodical, phased implementation of the VEM program delivers patient-centric care, reducing ambulance ramping through effective hospital diversion. This technology-enabled, innovative, paramedic-driven and clinician-led reform allows ED teams to better understand and manage incoming caseload, resulting in reduced patient wait times and improved ambulance and ED flow for hospital and SJWA staff.

VEM has vastly improved the partnership between SJWA, SMHS, external providers, patients and the wider community. The benefits include:

• Evolving models of ambulance and community care, which are increasingly designed to provide care in situ rather than transport to hospital as the default.

• The expansion of ambulatory models of outpatient care by expertly triaging patients which minimises risk and avoidable ED presentations.

• Access to ED Physician decisions wellbeyond the confines of the ED, improving options for patients and their families in the community to have care delivered as per their advanced wishes and preferences.

• Increased support for community service providers.

• Employee satisfaction with smooth clinical workload.

FSH

Head of Emergency Department, Dr Vanessa Clayden, assessing a patient using VEM in collaboration with St John WA ambulance. Credit: SMHS

Graduate Ambulance Paramedic Improvement Program

The 2022 CAA Excellence in Staff Development winning project

A program by Ambulance Victoria

Can you please provide a quick recap of the project. What was the initial aim and end goal?

The aim was to review the graduate program, consult with the wider Ambulance Victoria (AV) workforce and other support divisions, benchmark a new program against other graduate programs (both paramedicine and other health professions), embed contemporary education principles and practices, communicate, transition, and implement the new program across AV.

Please share with us, how did the project come to be?

Following a review of AV’s Graduate Ambulance Paramedic (GAP) program, AV’s Commencing Practice (CP) team identified the opportunity to improve the experience of graduates and increase the number of graduates who successfully completed the course within the scheduled 12-month time frame.

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. 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 (the 12 months following graduation as an Ambulance Paramedic). Completion rates at 12 months continue to be at 90% or above (January 2023).

Now that the project has been established I'd like to take a look into the future, what is the next step for this project?

There will be continued auditing and monitoring of this program, with a six-monthly audit and risk KPI of 90% or more graduates completing their program within the first 12 months. While there is new and updated clinical, operational and organisational content regularly, the program itself has not required change. We are looking at more flexible delivery options, for example, offering the program as a part time employment model. We have also modified it to offer a highly successful partnership program for Interprofessional Graduates – where dual registered Nursing/Paramedicine graduates complete both programs over 18 months by rotating between AV and two rural hospitals –and recently a new graduate employment model where the graduate commences in a medium acuity response service (six months) and moves into high acuity response (nine months).

Continuing on from there, what are some of the future goals for the program?

That we continue to deliver a program which is a supportive progressive learning and positive experience, which is well understood by those managing and mentoring the graduates on road and meets the goals of confident independent practitioners, and successful and timely completion.

Finally, what are the collateral benefits of a project like this?

• Less delays to graduates completing, which reduces the pressure on our support staff and on rostering and is a better outcome for the graduate (confidence and mental wellbeing).

• Better prepared and competent graduates, to meet the expectations of the AV Best Care Framework: We are responsive to and respectful of patient needs and circumstances, our patients and staff are safe and experience no harm, we provide the right care, in the right way, with the best possible outcomes, and we connect patients to the care they need.

• Reduction in budget required as a result of delays (extra supervision costs, less independently practising staff available)

• Using this program as a template to develop other similar programs.

The Inter-professional Nurse Paramedic Graduate Program | health.vic.gov.au

Interprofessional Graduates (AV and Grampians Health)

Executive Director of Operations with Ambulance Victoria, and Chair – Women in Paramedicine with the Australasian College of Paramedicine.

Lindsay Mackay

Always stay focused on what you want, know that you can achieve it, and reach out to others, to seek guidance on how to get there.”

Lindsay Mackay

In this interview, FIRST speaks with Lindsay Mackay, Executive Director of Operations with Ambulance Victoria, and Chair – Women in Paramedicine with the Australasian College of Paramedicine.

Born in Scotland, over the course of a distinguished and growing career, Lindsay has had a variety of roles in retail and academia, as well as her paramedicine career. A known advocate for propelling talented people into leadership positions, she champions gender equity as the norm for future generations of health professionals.

Lindsay, as many of our readers may know, you have had an extensive and varied career – not all of it in Australia, and not all in the ambulance sector. If you had to choose, what would you consider to be some real career highlights?

My first career highlight was at 17 years old, and I credit this one decision as the catalyst for every decision I have made in my career. When I left high school, I chose not to go to university and instead started on a leadership development program with a retail store.

I thrived in that environment, and truly believe my early learning and training in leadership created an amazing foundation, and the inspiration to propel me into the career I have today.

And it is hard to call out one or two key career highlights, because I have had so many, from creating national and international firsts in the development of health pathways to providing improved patient care outcomes, to working with amazing teams to win awards for innovative processes and implementing new ways of working which have been shared with ambulance services around the world.

I have experienced many firsts as a woman in paramedicine but I was only ever able to achieve my goals because I either created the opportunity for myself, found the right person to support me or when I was offered an opportunity – as my grandpa always told me, “always say yes to an opportunity, as you never know where it would lead to” – so I have always said yes when I can.

If I had to pick one thing that stands out for me as my biggest highlight, it would be the change in myself and the confidence in my own leadership style. As I’ve grown more comfortable and confident in myself, I focus on inspiring change and engaging my people to achieve shared outcomes.

I always want those around me, in my teams or the organisation, to know I am there to support them. I am driven to create opportunities for talented people and watch them flourish and I know many I support will advance well beyond me, and that’s exciting to see and be a part of.

We all know that a successful career is not just a straight line up the organisation chart or a series of happy accidents and coincidences. Looking back on your career to date, what do you think were some of the key events or decisions you made that helped to push forward and succeed?

The biggest driver of my success is influenced from my childhood. I didn’t come from a wealthy family, and things weren’t always easy, but I was always supported and told I could do anything, even if it was difficult to achieve or there were many times that I wasn’t successful, but that never stopped me from trying again.

I remember being 11 years old and my brother and the boys from our village all started learning karate, so of course I wanted to start karate. I didn’t want to be left out because I was the only girl.

I was told it wasn’t for girls and that I would get hurt, and that I wouldn’t stick with it! This made me all the more convinced I was absolutely going to take up karate, and I would not quit! But I mainly wanted to prove everyone wrong and demonstrate that girls can do anything the boys do (and better). I wanted to take on the challenge and see what I could achieve.

So, one year in and I was the last person still attending Monday night sessions thanks to an amazing, supportive and inspirational sensei. I was not quitting. Five years later and I completed my final assessment to become a Black Belt first dan! I felt I had accomplished what I set out to achieve, so the following week, I took a break… and that break continues today.

But experiences like this, so young, taught me so much. When you start karate on day one you are taught the same skills and techniques you use in your final assessment. The difference is, over the years, through repetition, you develop control of your mind, which allowed me to develop social, intellectual and technical skills, while maintaining calm rational thought. This ultimately taught me to be controlled in my movements and actions, something I think connects directly with my drive to succeed and how I approach my career. It has supported me in making decisions while facing challenges as a woman in ambulance services.

I think going on that journey so young, with an incredibly supportive sensei, taught me so much.

And I truly believe self-awareness is the key to unlocking human potential. Moving through leadership within ambulance services hasn’t always been easy but it has helped me to know myself and find the courage to be vulnerable, noting vulnerability is certainly not a weakness; it takes courage, and it comes from the strength to know one-self.

We know from last year’s presentation at our Women in Leadership Forum that you faced some significant challenges, and experiences that left a lasting impact on you. Could you explain an experience in your career to date that really taught you the skill of resilience and the courage to keep going in your career?

Last year, at the Women in Leadership Forum, was the first time in my life I have openly shared my experiences and, to be honest, it was daunting. My heart was racing throughout, and I genuinely wasn’t sure if my style of story sharing would connect with the others in the room. But what I can say is I am so thankful to CAA for that opportunity, because not only did I learn something about myself, it reaffirmed in my mind why I do what I do, because the response following that forum was humbling.

At that forum I shared a story about a time that taught me resilience, courage, and made me even more determined to make sustainable cultural change in whichever sector I work in, following an experience between myself and two senior male managers.

I attended a meeting with two men, with more than a combined age of 100, sitting opposite me as a 20 something female.

I don’t know if they had the self-awareness or emotional intelligence to know how I perceived their approach to me, but I remember clear as day feeling the power imbalance.

The reason I was asked to meet was to offer me an “opportunity”.

The flattery came out about how I had done so well in my current role and then they told me, this new opportunity was one that I wouldn’t be able to turn down because they were doing me a favour by offering it to me.

The one-sided dialogue went on for some time, as I was emphatically told this would be a good move for my career. I thanked them for considering me for this opportunity and said I would be happy to support the organisation further, however I would not be able to move to where they wanted me to go, because it wouldn’t work for my family.

I thought me saying no politely, and even providing a little explanation, would have been enough, but I realised quite quickly these two people didn’t expect me to turn them down or hadn’t had someone turn them down before.

It was like I had insulted them, and one of them responded: “Well let’s not pretend, you wouldn’t want to damage your career based on not moving because of your partner”, and then outrightly told me that my partner would probably cheat on me, so I shouldn’t let that be a factor in my decision making.

I was absolutely dumbfounded, furious, disgusted and almost speechless… almost!

At that moment I made a quick decision that I would not sit there and let anyone speak about me or my partner in that manner, and not speak up for myself.

So, I thanked them again and said I appreciated the offer, but I would not be accepting this opportunity, but hoped it wouldn’t stop me from progressing in the future.

As they got up from the table, I knew that the interaction was going to impact my career. I felt flat and defeated for a few weeks, but I knew I did the right thing.

Three weeks later I applied for a higher position, I turned up to the interview and one of the men was on the panel. I left the interview feeling confident in my answers, my experience, my demonstrated academic record to support the role. But I knew I wouldn’t get it, and I was right.

Recruitment feedback stated I had the same score as one other individual, but they thought he was a better fit. Well, what a kick in the guts, because when this person was announced, they were male, 20 years older, less educated, and had less leadership experience but they certainly did “fit”!

Following that interaction, I knew I wouldn’t let that stop me progressing in my career, but it made me more driven to do everything I could within my control to ensure no person would ever have to experience what I experienced.

I didn’t let it hold me back or stop me but knew I couldn’t stay at that organisation. So, with the support of my amazing partner, I made the leap and left. The key moment for me was following the meeting and my reflection that my purpose as a leader is to speak up when others can’t or don’t feel safe to, and that I want to stand up, for and beside others to show that they are not alone. I want to ensure I show courage in times when others need to see it, in the hope that by showing others you can be what you see and more.

FIRST is read by a very wide audience, not just in Australasia but globally. To the readers, and the women in particular, what advice would you give them to grow their careers in the way they want to?

The first thing I would say is that every woman should play the ‘infinite game’. There is no winning or losing, and rules can always be changed. Your objective is to keep playing, keep perpetuating what you want to see and know you have permission to be a positive disrupter. Change the dialogue within your organisation and have those conversations that may not necessarily be comfortable but will support you in ultimately achieving your career goals.

Always stay focused on what you want, know that you can achieve it, and reach out to others, to seek guidance on how to get there.

My final thought would be ‘know yourself’ and what your purpose is in life. As I have moved through my leadership journey, I have been mindful that I need to prioritise what is important to me, know and accept that I can’t do everything and be everywhere but by knowing myself and trusting in my decision making, I know I will make the right decision and will achieve my goals.

Many of us have been fortunate enough to have mentors and sponsors, sometimes in the workplace but sometimes outside of where you work. Do you have any thoughts or experience with mentors?

When I think of mentors, I always want people to know you choose your mentor, and they don’t choose you.

I think the value of mentorship comes from the connection you make with someone who has been through what you are going through and have managed to navigate potentially similar or replicable situations to overcome challenges throughout their journey.

I often get asked about my thoughts on mentorship and the one point I always stand by is, don’t look at an organisational chart and pick the most senior person you can find that you ‘think’ will help your career. I have never seen that create sustainable leadership progression.

I have seen it open doors for short periods, doors you may not have opened previously, but I would always advise choosing a mentor you feel inspired by, trust and know would be there to support you even if you flourish and advance beyond them.

I will be honest in sharing that throughout my career I have never participated in a formal mentor program. I know it may work for some, but I have always felt mentors are a personal choice, and a formal placement with a person that I didn’t choose has never made me feel comfortable.

I have had mentors at different times in my career and dependent on where I was at that point, it has always varied in levels of engagement. I would always advise any person who has goals and aspirations to reach out to someone you think you would connect with and could support you. But I would also say, be mindful that mentoring is a two-way process. Throughout my career, I have constantly mentored different people from all genders and background and what I have learnt from them is, I hope, was as invaluable as they learnt from me.

We know from many studies and reports that important, fundamental rights-based issues such as gender pay equity, diversity in the workplace and accessibility for people with disability is a big issue in many countries, industries, and organisations. Do you see many changes for the better happening? Do you have any thoughts of how you believe these questions of equality could be better managed?

It may be where I am sat currently in my career, but I do feel confident that change is happening and that gives me hope.

As a senior female leader in ambulance, I believe it is my responsibility to have those courageous conversations at a senior level and to set an example.

What I mean when I say that is, I am very comfortable with challenging issues relating to basic human rights, and doing that respectfully in forums, within the organisations I work for, or with external stakeholders.

I do refuse to be silenced and have become more confident in speaking up for those who don’t have a voice, or don’t feel they can speak up. And I think that’s because of my own lived experiences.

Many times in my career when I would ask questions which challenged the hierarchy, I was told to be ‘thankful for the opportunity’ or be ‘grateful for what I’ve got, as other women weren’t where I was’. I was often made to feel I hadn’t earnt the right to challenge or speak up about my situation, and I should be ‘grateful’.

But I think, overall, the world is changing, and it will never be the same again. Everything always changes and I am driven to ensure I will change with it, so I can be part of this transformation that will shape the way we are for the next generation.

This edition of FIRST celebrates Women in Ambulance and coincides with International Women’s Day. Focusing on gender diversity, what do you think could be done to develop the talent and skills of the next generation of women leaders, either in the pre-hospital sector or organisations in general?

I definitely want to start by saying, women are already equal, it’s just unfortunate some don’t realise that enough.

Across the world, not just limited to ambulance, the debilitating power of antiquated customs and gender stereotypes continue to stand in the way of women being able to achieve their potential.

I have said this many times, but I feel it needs to continue to be said, that women supporting women in life is not just compelling and powerful, it’s also a responsibility. Women supporting women within paramedicine is crucial to the positive progression of women working within the industry.

Organisations in general need to understand the systemic challenges women experience within leadership and understand that women do not need to change but it is certainly clear that organisations need to change their systems to support women in achieving success.

One of the most powerful generational changes that can occur, in my opinion, is for women to feel confident in portraying a mindset of equality and work with organisations brave enough to stand shoulder to shoulder with us, demonstrating that from the top.

Some simple fundamental changes I think could occur across all organisations is the consideration of leadership development programs which are primarily created by women and led by women.

So often I attend leadership training, and I am confronted with a panel of persons that look nothing like me – I can’t identify with them, and they haven’t had the same lived experience as me.

Creating development programs for women, led by women of all backgrounds, I think is one step organisations can take to develop their talent. This will allow women wanting to move into leadership to find a safe space to start. But I certainly would say I don’t think single gender leadership programs create well rounded leaders overall, and as women feel more confident, mixed gender settings are highly beneficial to long-term sustainable leadership practices across an organisation.

If I could say one final thing on this topic, I want to urge women to never see themselves as the underdog striving for air but know your value and the reason you are there doing what you are doing.

Thanks very much for your time and insight, Lindsay. One last question before you go; If you could give 15-year-old Lindsay some career advice before she starts out on her journey, what would it be?

Never give up, and always feel confident in yourself.

When I left high school, as I said previously, I didn’t go straight to university and instead allowed myself to try new things.

There definitely felt like societal pressures about the path I was expected to take and the one I chose. I didn’t know it at the time, but I was internally confident in my decision making and if I could tell myself anything it would be, to trust in myself and be confident that with all that life will throw at me, I will be okay.

Industry Events

What's on in the ambulance world

Celebrating and Educating the First, First Responders

IAED conference is a place for emergency dispatchers to relax and recharge.

By Becca Barrus, writer for the Journal of Emergency Dispatch

The International Academies of Emergency Dispatch (IAED™) has been the definitive standard-setting organization for emergency dispatch and response services worldwide for 40 years and is the leading body of emergency dispatch experts.

In conjunction with Priority Dispatch Corp (PDC™), the IAED provides medical, fire, police, and emergency nurse triage protocols to ensure that every single emergency call receives the right response in the right place at the right time. Emergency dispatchers provide callers with a Zero-Minute Response Time by providing relevant Post-Dispatch Instructions and Pre-Arrival Instructions before responders arrive on scene.

As part of our mission to maintain high standards of compliance and celebrate the work emergency dispatchers do every single day, the IAED holds seven NAVIGATOR conferences yearly in the United States, the U.K. and Ireland, the Middle East, Asia, China, Europe, and Australasia. Emergency dispatchers use that time to attend sessions to sharpen their skills, network with professionals from other agencies and ask questions that ultimately improve the protocols, the profession, and the community at large.

The 2022 Australasia NAVIGATOR conference was held in November in Melbourne, Australia and got off to a jubilant start in the opening session where the Dispatcher of the Year and the region’s Accredited Centres of Excellence (ACEs) were announced.

The Dispatcher of the Year was Claire Gilroy, an emergency medical dispatcher (EMD) with Wellington Free Ambulance (WFA). Gilroy is one of WFA’s peer supporters, which involves reaching out to other staff members after traumatic calls or experiences and offering support. Over her impressive career, she’s helped deliver more than 50 babies over the phone using the IAED’s childbirth protocol instructions. Mel Johnson, EMD Instructor and PDC/IAED contractor in Australia, said Gilroy is “one of the most beautiful, passionate people I know.”

Other nominees for this honor were Emma Gibbons, Joy Leach, Toni Sinai, Grace Roffe and Lea Costley with Wellington Free Ambulance; Kerrie-Ann White, Ann Collie, Christine McCutcheon, Joanne Young and Alexandra Pickwell with NSW Ambulance; Amelia Mahon and Karina Pell with Emergency Services Telecommunications Authority; and Sasha Dobbs with Queensland Ambulance Service.

ACE agencies are ones that consistently perform at high compliance standards and go all-in to cultivate centre pride, teamwork and innovation by putting their communities first. Agencies with this distinction have completed the IAED’s “20 Points of Accreditation,” a rigorous and measurable set of globally recognized best practices.

SA Ambulance Service, Wellington Free Ambulance, and Hato Hone St John were all lauded for having maintained their accreditation status by re-accrediting, which can be as difficult as achieving ACE in the first place.

As far as the conference’s educational opportunities went, Renee Kaye, attendee and Shift Development Officer with St John WA, summarized what she learned from three of her favourite sessions: which EMDs make the best mentors, the benefits of implementing quality performance review (QPR) in your centre and how to train the model EMD.

In his session, IAED Mentor Instructor Jonny McMullan with the Northern Ireland Ambulance Service described the ideal mentor as someone who is enthusiastic about the job and has a high level of interest and commitment to the mentoring process. “The best EMD may not always be the best mentor,” McMullan said.

He also discussed the risks and benefits of a mentor program in the emergency response agency as it relates to service delivery. An effective mentor program must have a culture of positivity and learning environment in order for it to thrive. It’s a hugely beneficial tool that coincides with recognition for good work. On the opposite side, there can be a risk of demotivating emergency dispatchers who are not chosen for the program. When the emergency dispatchers are happy, there is less burnout and a higher threshold of patient satisfaction.

Grant Perry with Ambulance Tasmania gave a presentation about how PDC’s quality performance review (QPR) program has improved compliance with the protocol and motivated the staff to perform better. He spoke about recognizing that the agency’s culture had to change, establishing trust with the team and using the challenging areas picked up by the reviewer to conduct bespoke training. Their journey with QPR is assisting Ambulance Tasmania in achieving ACE.

The final session highlighted the importance of providing new emergency dispatchers with structured, consistent information from experienced trainers. Training on the IAED protocols, CAD and other systems, centre policy and procedure, legal risks and first aid are essential in creating the model EMD. This “gold standard” is key in professional longevity.

The IAED was honoured to convene this conference for the region’s first, first responders and looks forward to seeing them all again in 2023 in Brisbane!

Connecting with partners at the ANZPAA Police Conference 2022

Having attended the Australia New Zealand Policing Advisory Agency’s (ANZPAA) first in-person conference in three years, police from across Australia and New Zealand left inspired by new ideas and innovations.

The two-day event on the 8-9 November 2022 brought together more than 500 delegates from eighteen countries across the sectors of policing, government, academia and industry. For the first time, delegates were also able to join the ANZPAA Police Conference (PC22) online, allowing inclusive access to the program for those who were unable to travel.

The thought-provoking sessions were focused on the theme ‘navigating the next generation of policing’ and speakers included global experts on recruitment, future technologies, organised crime, police health and wellbeing, resilience and policing in the Indo-Pacific.

Threaded throughout almost every session was the importance of collaboration and partnerships, with workshops, showcase rooms and case studies providing welcome opportunity for delegates to learn from each other.

The value of the relationship between emergency service agencies, police and the public was explored during the Police Commissioners’ panels. These panels are always a highlight of ANZPAA Police

Conferences because they provide a rare opportunity for Commissioners’ to provide their collective insights on topical policing issues.

Speaking at the panel on trust in policing, the Commissioners’ discussed the varying degree of impact COVID-19 had on police and emergency services and the shifting role policing had in mandating health directives.

Commissioner Donna Adams APM, Tasmania Police, Emergency Services provided a unique perspective as head of an organisation that provides three services; firefighting, state emergency service and the police service. As firefighting and emergency services are primarily volunteer services, she noted that they benefit from a higher level of trust than police typically has, and generally handle a lower level of public scrutiny than may be directed to other government organisations.

The conference also focused on partnerships between law enforcement, industry, and how successful partnerships can ensure cost savings, time efficiencies, agile workforces, enhanced community relationships and improved public safety.

Keynote speaker, futurist Michael McQueen

A highlight of the conference was the keynote address from Jürgen Stock, Secretary General of INTERPOL on the power of a global platform and the value in sharing intelligence across regions to boost police capacity and technical capabilities.

Speaking at PC22, Secretary General Stock shared some of the initiatives INTERPOL have deployed in Australia and New Zealand, noting that the “advantage of these operations is the permanent benefit they build among police officers.”

Speakers from academia, industry, policing and ANZPAA grappled with such themes as future workforces, digitisation of policing, the metaverse, and artificial intelligence.

Futurist Michael McQueen spoke about the speed at which technology is accelerating and how to lean into the change without being overwhelmed.

“My focus was not just on what’s coming in terms of the metaverse, generational change, AI and predictive analytics but how do we make sure we are ready for it. Focusing on the strategies to drive innovation and make sure as teams, as well as organisations, we are open to adapting as the world changes” said Mr McQueen.

ANZPAA Chief Executive Officer, Dr Tracey Green said she was very pleased with event feedback. “The ANZPAA Police Conference couldn’t happen without the support and co-operation of the Commissioners and their jurisdictions across Australia and New Zealand, who are committed to focusing on working together to navigate emerging challenges. The event has been a great success, in terms of support from delegates and sponsors.”

“In addition to being adaptable and resilient, the police of the future need to focus on partnerships with industry, academia, emergency services, and other police jurisdictions to navigate new and emerging types of crime and support the community in times of need,” said Dr Tracey Green.

Using future scenarios to improve decision making: a Pacific focused activity. Facilitated by Dr Ryan Young, Director and Owen Cooper, Senior Advisor at National Security College Futures Hub, The Australian National University.

The Australia New Zealand Policing Advisory Agency is the policy and research agency for policing, providing strategic foresight, research and policy advice directly to Police Commissioners across Australia and New Zealand.

If you would like information on next year’s Police Conference, please express your interest to events@anzpaa.org.au.

You can find out more about ANZPAA’s resources and events at www.anzpaa.org.au

Two best friends. One incredible mission.

The story of Blue Light Card.

Now that Blue Light Card has welcomed Australia into its global community, co-founders Tom Dalby and Steve Denny reflect on what the business has achieved over the past 14 years – and what it means to them and millions of frontline workers to be here.

Blue Light Card, the discount service exclusively for frontline workers and emergency services volunteers, launched in the UK in 2008. But its origins started much earlier, when two eight-year-old boys became best mates.

The physical Blue Light Card launches providing members with in-store discounts

From Left to Right: Tracey Duff (General Manager Blue Light Card), Steve Denny (Co-founder Blue Light Card), Mojca Bizjak-Mikic (General Manager CAA) and Tom Dalby (Co-founder Blue Light Card)

The seed of an idea

Steve Denny and Tom Dalby met at primary school, and quickly bonded “We delivered newspapers and did other odd jobs. Even at that age we knew we wanted to work together,” remembers Steve.

After high school the boys went in different directions – Tom to university and then work, Steve into the police force – but they stayed close. It was in a session at the gym that the seed for Blue Light Card was planted.

As a police officer Steve had seen a gap between members of the public wanting to show their gratitude to frontline workers, and how workers could accept discounts or savings ethically. “Officers were discouraged from accepting small discounts because it was seen by the force as bribery but the community and local businesses really wanted to say thank you” he explains.

Tom understood the public’s need to show support for the officers and others in the community who often put themselves in harm’s way for people they don’t know. “I was at Steve’s swearing-in ceremony when he became an officer, and there was a lot of talk about the community being there to support these incredible people who do this really hard job.”

And it isn’t just police officers who do a tough job. Tom and Steve were inspired by what Blue Light Card could mean to more people, and they were motivated by their own personal experiences to include the wider frontline and first responder services.

“When we had complications with our first child the hospital staff were absolutely incredible” recalls Steve. “I don’t even know how they did it, but it was amazing to watch. And everyone will need that kind of help sometimes – hopefully not often, but sometimes. So, we knew first-hand why people wanted to give back and say thank you. But there was no way to do that. Blue Light Card was the answer.”

Making a difference every day

Tom and Steve launched Blue Light Card in the UK from Steve’s spare room in 2008. Their childhood dream of running a business together became a reality.

Fast forward to 2023, the UK business has 3.2 million members, partners with some of the biggest global brands and saved frontline members over £250 million last year. In the UK and Australia, members can access exclusive, best-in-market discounts and offers from top brands and local businesses.

Blue Light Card launch partnership with Starbucks

2016 2018

Blue Light reaches 10 members of staff.

While the organisation has changed and grown, the mission stays the same: a commitment to do more for the frontline workers Blue Light Card is here to support, by helping them save money.

Blue Light Card in Australia

When it came to expanding Blue Light Card, Tom and Steve say Australia was the obvious choice.

“There’s a clear allegiance between the UK and Australia – apart from when it comes to cricket,” smiles Tom. “In all seriousness though, impacts of the bushfires, floods and the pandemic have called all Australian frontline workers and volunteers to action in recent years. The community wants to give back and show gratitude for what the SES volunteers, nurses, firefighters, paramedics and others have done, and are still doing. Blue Light Card makes that possible.”

It’s why General Manager, Tracey Duff, is so proud to lead Blue Light Card in Australia: “To know that each day I come to work, I get to help thousands of frontline workers and their families just as they have helped us so many times is the most amazing feeling. I am so grateful to be a part of a company with such an important purpose.”

“Blue Light Card isn’t just a job to us, and the people who work with us would all say the same,” Tom continues. “We wouldn’t have gotten to where we are today, including launching in Australia, without our incredible team. They share our vision and believe in what we’re doing for members.”

“Blue Light Card is a community, and we’re on a mission to help as many people as we can.”

Blue Light Card launches in Australia

2019 2022 2023

1 million frontline members

Donate over £100k to national emergency services charities

£250 million saved by members

3.2 million members

17,500 brand partners

165 members of staff

The College’s new Paramedicine journal another milestone for the profession

By John Bruning, CEO, Australasian College of Paramedicine

Last month marked the launch of the College’s new Paramedicine journal to advance and transform the discipline of paramedicine through high-quality, evidence-based research, and to inspire robust discussion, encourage innovative thinking, and inform the profession’s leadership. It aims to create a connected discourse that spans paradigms, methodologies and methods for the advancement of the profession, the public it serves, the systems it connects to, and the people tasked with enacting that service.

Formally the Australasian Journal of Paramedicine (AJP), the new publication will both define and support the future of paramedic practice in Australasia and internationally. In our role as the peak professional organisation supporting and representing all paramedics and student paramedics throughout Australia and Aoteroa New Zealand, the journal marks another step forward in our continued commitment to leading and shaping the ongoing development of paramedicine.

And as a paramedic-led publication that spans all dimensions of our professional practice and is comprised of some of the world’s leading paramedicine academics and researchers, we are taking ownership of our research space, empowering our profession, and ensuring greater research exposure and visibility.

The bi-monthly, open-access, peer-reviewed Paramedicine journal will publish research from any country engaged in any area of paramedicine, including but not limited to clinical care, models of practice, operations, patient safety and clinical quality, leadership, education, aeromedical and retrieval practice, tactical paramedicine, and community paramedicine.

Importantly, it is published online in partnership with the renowned Sage Publishing, which disseminates high-quality research and engaged scholarship globally. Sage’s international journal publishing experience and infrastructure will enable Paramedicine to grow and prosper, while providing authors with a professional publishing experience.

Paramedicine is indexed in several top databases, including the Cumulative Index of Nursing and Allied Health Literature (CINAHL), Elsevier Scopus, EMBASE, and Google Scholar, and has a Q1 “Best Quartile” in the Scimago Journal and Country Ranking (SJR). Publishing in Paramedicine will therefore increase the visibility and accessibility of researchers’ work and promote greater translation and subsequent impact.

Associate Professor Paul Simpson is the Editor-inChief alongside an international team of Deputy Editors comprised of Professor Julia Williams (UK), Associate Professor Walter Taveres (Canada), Dr Alan Batt (Canada) and Dr Kathryn Eastwood (Australia). Supporting the editorial leadership team is a diverse Associate Editorial Panel consisting of 28 researchers, academics and paramedics from nine countries.

The transition to the new journal began two years ago, with a review of the AJP in achieving the College’s objective of leading the paramedicine research space internationally. In its time, the AJP played a vital role in the dissemination of research and bringing us to where we are today, but to take the next step we needed to reimagine what the journal could be and what it could deliver for paramedicine.

The subsequent efforts to establish a fully international paramedicine journal, with an eminent international editorial team and partnering with Sage Publications, will progress and deliver on the research promise of paramedicine. Paramedicine accepts primary quantitative and qualitative research, mixed-methods research, structured reviews including systematic and scoping designs, research methods summaries, perspectives, commentaries, and case reports.

With submissions now open, we encourage paramedics to join us in publishing what we aim to be the world’s preeminent paramedicine research journal. There is no fee to publish, and we have revised our submission process to ensure a faster and more streamlined experience for our contributors.

If you’re interested in submitting your research, head to: tinyurl.com/wukkatb5

We look forward to working with you and to continuing to showcase the highest quality work in the paramedicine research space.

We are taking ownership of our research space, empowering our profession, and ensuring greater research exposure and visibility”

Prehospital Interventions to Improve Outcomes from Paediatric Traumatic Brain Injury

By Ben Bobrow, MD FACEP, Professor and Chair, McGovern Medical School at UT Health Houston Department of Emergency Medicine

Worldwide, traumatic brain injury (TBI) is a leading cause of injury-related death and disability, with a devastating impact on patients and their families.

Severe TBI can result in mortality rates as high as 30 to 40%.1 In developed countries, children under four years of age have the highest rate of emergency department visits from TBI and that number continues to increase.1 In the U.S. alone, paediatric patients make up 37,000 of 2.5 million people suffering brain injuries annually, and sadly, approximately 2,500 of those paediatric patients don’t survive.2

Falls are the number-one cause of paediatric brain injury and subsequent TBI. Motor vehicle crashes are another major cause, followed by an assortment of causes that don’t fall into a singular category:2 penetrating trauma, gunshot wounds, and other injuries.

EMS providers are familiar with TBI and the primary brain injury that causes TBI. Providers may be less familiar with secondary brain injury and the mechanics of secondary brain insults, as well as ways to optimise prehospital management of paediatric TBI patients in order to maximize patient outcomes.

• Consider the real-life case of a three-year-old boy who was restrained in the back seat of a passenger vehicle when it was struck by a tractor trailer, traveling at high speed. The crash required a prolonged extrication of all victims. The paediatric patient had a heart rate of 143, blood pressure of 68/36, respiratory rate of 42, and an oxygen saturation of 92% on room air. The patient’s Paediatric Glasgow Coma Scale (pGCS) score was E-2 V-3 M-4 = 9.

After stabilising the paediatric patient and completing the primary assessment, what are the next treatment priorities? How can we optimise the care of paediatric brain injury patients?

Case Presentation

• 3-year-old male

• Prolonged extraction

• HR 143; BP 68/36; RR 42; Sat 92%

• pGCS E-2 V-3 M-4: 9

The Mechanics of Brain Injury

Primary brain injury occurs when there is a sudden force against the head that causes an acceleration and then rapid deceleration of the brain. The brain sits slightly suspended in fluid within the rigid bone of the skull. The movement that occurs when the head suddenly accelerates causes a primary injury— the contrecoup—in the front of the brain. As deceleration occurs, a secondary impact occurs to the posterior part of the brain.

The four main mechanisms of TBI are direct impact acceleration, deceleration, rapid acceleration, and deceleration. These impacts cause bleeding and bruising to the brain tissue as well as damage to the blood vessels—both arteries and veins—that support the brain, causing it to compress. The brain is extraordinarily sensitive to blood flow and pressure and can only compensate for a modest change in either one.

The Circle of Badness (Secondary Brain Injury)

While primary brain injury occurs immediately, secondary brain injury occurs over minutes, hours, and days following the primary injury. A lack of blood flow, oxygen, and nutrients to brain cells leads to a cascade of inflammation and ischemia that are often referred to as the “Circle of Badness.”

Hypoxia (low blood oxygen), hypotension (low blood pressure), and hyperventilation (excessive ventilation rate and tidal volume)— sometimes referred to as the “three H-bombs”—are the three key systemic insults providers must try to prevent and limit when treating TBI patients.3

Inflammation starts very quickly following the primary brain injury. Damaged cells die and release inflammatory mediators—a whole host of different types of chemicals— that then harm other cells. This quickly leads to swelling, resulting in increased intracranial pressure and decreased brain perfusion pressure. As the pressure in the skull increases, the perfusion pressure to the brain lowers, meaning the brain receives less blood. That in turn leads to a decrease in oxygen to the brain, further brain injury, and without rapid intervention, possible death.

Responding to TBI

It’s important to understand the mechanisms of brain injury, predict what might happen, and try to limit it. Currently only a few effective medical interventions exist; for example, measuring intracranial pressure will occur once a patient has been transported to the hospital. In the field, however, there are three critical steps that can dramatically help prevent secondary brain injury:

• Increase perfusion pressure by increasing blood pressure (via administering intravenous crystalloid fluids)

• Improve oxygenation to prevent low blood oxygen (via administering upplemental oxygen)

• Strictly avoiding iatrogenic hyperventilation by providers (close monitoring of ETC02)

Prehospital providers can help mitigate secondary brain injury and insult in TBI patients, by avoiding and rapidly treating hypoxia, hypotension, and hyperventilation.

The current most common paradigm for prehospital care of paediatric TBI patients involves rapid stabilisation and transport (“scoop and run”) to the closest facility that can care for them. Unfortunately, only focusing on that goal leaves missed opportunities to help patients in those first critical minutes after their injury.

Consider the paradigm used for cardiac resuscitation: There’s a very short window during cardiac arrest to change the trajectory of patient outcome. Cardiac arrest patients need immediate highquality CPR to perfuse the brain and heart until they can be treated with a defibrillator. Many EMS systems now focus on continuous monitoring of CPR quality to achieve that goal. It’s clear that both highquality CPR and defibrillation improve cardiac arrest outcomes and early administration of medications such as adrenaline may be beneficial as well.

Now imagine a similar paradigm of monitoring for high-quality cardiac resuscitation to paediatric (and adult) brain resuscitation to prevent and treat secondary brain insults.

Hypoxia

Intubation can control oxygenation and ventilation and protect a patient’s airway in the prehospital setting but can also cause harm if patients become hypoxic before, during, or after the procedure, as is common in approximately half of severe TBI patients.4 One single episode of hypoxia, defined as a non-spurious pulse oximetry less than 90%, is associated with at least a doubling of mortality.4

Hypoxia

Pre-hospital hypoxia is very common

Occurs in ~50% of patients with severe TBI5

Occurs in >50% of patients with TBI before or during intubation4

O2 sat of <90% is independently associated with at least a 2X mortality4

Hypotension

A documented systolic blood pressure of less than 90 is independently associated with at least a doubling of mortality.6 It’s common for patients to become hypotensive with endotracheal intubation or simply due to shock. When treating paediatric braininjured patients, it’s important to anticipate, prevent, and rapidly correct hypotension.

Data suggests that the depth and duration of hypotension may contribute to patient outcome.7 Low blood flow for a prolonged period of time will likely have a more significant impact than slightly lowered blood pressure for a very brief period of time.

Hyperventilation

Hyperventilation is another common insult to the injured brain. In a study of rapid sequence intubation among severely head-injured adult patients, Davis found that hyperventilation harms TBI patients. His data showed one-third of all TBI cases suffered extreme hyperventilation, while two-thirds fell into the category of moderate hyperventilation with an end-tidal CO2 of less than 30.8 Other trials have demonstrated a doubling to a six-fold increase in the risk of death if patients are hyperventilated.9

Additionally, hyperventilation constricts cerebral blood vessels and decreases critical cerebral blood flow, leading to decreased cerebral blood volume and intracranial pressure.

Previously it was thought that decreased blood flow was helpful for patients with swelling in the brain. However, over the last decade or so, data shows that decreased blood flow is actually harmful for the brain and should only be undertaken for a very brief period as a lastditch lifesaving effort when TBI patients are rapidly deteriorating despite all efforts to optimize their oxygenation, ventilation, and blood pressure. Decreased intracranial pressure leads to worsening brain injury, increased cellular metabolism, and neuronal cell death, which then leads to poor oxygenation—continuing the vicious “Cycle of Badness.” Be aware that hyperventilation worsens all of this.

Combined effects of hypotension and hypoxia

Recent data also demonstrates that hypotension and hypoxia together have a far greater effect than either one by itself. In one study, patients with hypotension had a mortality rate of 20.7% and those with hypoxia had a mortality rate of 28%, while patients who suffered both had a 44% mortality rate.7

It appears that there may be something synergistic about the combination of hypotension and hypoxia. Nevertheless, hypoxia, hypotension, and hyperventilation are very harmful to the injured brain.

Does prehospital TBI care even matter?

While prehospital TBI guidelines exist, there are very few high-quality studies that show their impact. One is left to wonder if EMS even helps TBI patients and even whether we even need EMS? While we don’t believe this to be the case (and would not be in our line of work if we did believe this!), some uninformed lay person could reasonably ask this question.

The Excellence in Prehospital Injury Care (EPIC) Traumatic Brain Injury Project, a seven-year statewide trial conducted in Arizona, tried to determine whether implementing the national EMS TBI guidelines could increase the number of severe TBI victims who survive with good neurological outcomes. (Visit https://epic.arizona.edu/ for more information. The main study results were also published in Jama Surgery.10)

To prepare for the trial, more than 600 master trainers instructed 11,000 EMS rescuers to implement the TBI guidelines, focusing on the three H-bombs (hypoxemia, hypotension, hyperventilation).

Those EMS rescuers cared for patients in over 90% of the state, meaning more than 90% of all TBI patients were cared for by an EPIC-certified provider.

The EPIC trial was designed in three phases: EMS rescuer training, data collection, and post-intervention analysis. It included approximately 22,000 moderately and severely injured adult TBI patients and approximately 3,500 paediatric TBI patients.

The EPIC team also trained EMS agencies to implement in the EPIC4Kids Algorithm11 and then measured the benefits of utilising this algorithm. EPIC4Kids involved training responders to rapidly recognize, anticipate, and correct hypoxia, hypotension, and hyperventilation while utilising the guidelines for pediatric ventilation rate and depth, oxygenation, and blood pressure.

EPIC collected over 36,000 patient care reports from pre-hospital EMS agencies and linked them to the Arizona State Trauma Registry.

Approximately 99% of all linked cases were captured in the study data, including nearly 3,500 paediatric patients, with more than 2,000 in the pre-intervention phase and 760 in the post-intervention phase. This remains the largest linked EMS-hospital TBI database in the publication.

The main outcome of the EPIC trial was an overall significant improvement in the process of care, including:

• a lower rate of intubation

• a greater reversal of hypoxia by arrival at a trauma center

• an increased likelihood of IV fluid bolus for hypotension and lower blood pressure

• a lower rate of hyperventilation in intubated patients

The EPIC trial also showed more patients closer to targets. Those who were hypotensive received a higher volume of fluids and those who were intubated had a lower rate of hyperventilation or hypocapnia. Although the study was not designed to change providers’ selection of airway technique or question the benefits of pre-hospital intubation, data showed that awareness of the risks led to fewer intubations.

Intervention against H-bombs

Implementation was associated with:

• Lower rate of intubation, despite greater injury severity

• Greater reversal of hypoxia by arrival at trauma center

• Greater likelihood of hypotensive and near-hypotensive patients receiving a fluid bolus

• Greater volume of fluid boluses for hypotensive and nearhypotensive patients

• Lower rate of hypocapnia in intubated patients

The paediatric arm of the trial did not show a higher survival to hospital discharge,10 which was not statistically significant due in part to the number of patients in the trial. There was a statistically significant increase in survival to hospital admission.

Source: https://epic.arizona.edu/

Because EPIC was focused on the prehospital phase of care and not on improving in-hospital care, this was not surprising.

The adult arm of the trial demonstrated a doubling of survival to hospital discharge for severe TBI patients, while the number of intubated adult severe TBI patients who survived to hospital discharge tripled.10

The number of patients enrolled in the adult arm of the trial means that the improvements for both severe TBI and intubated severe TBI patients were statistically significant. The objectives were the same for adult and paediatric patients—to rapidly identify and treat hypoxia, hypotension, and hyperventilation— and the results were very similar for both groups.

”If you can't measure it, you can't improve it”

This famous adage has been attributed to various people, including the Scottish engineer, mathematician, and physician Lord Kelvin.

To help EMS rescuers accurately monitor potential insults to TBI patients, EMS agencies helped develop and then utilised technology called the TBI Dashboard™ from ZOLL®. The TBI Dashboard can be configured based on a patient’s age and displays trends in respiratory rate, systolic blood pressure, endtidal CO2, and SpO2. Utilising this dashboard during EPIC helped rescuers keep track of these measurements. EPIC helped inform the development of this technology and the technology helped improve the EPIC trial, creating hand-in-hand advancement.

Returning to our earlier question: Does prehospital TBI care even matter?

The outcome of the EPIC Trial proves that EMS care does matter. In fact, it may matter most when caring for patients suffering from TBI. As we learned from our experiences with cardiac resuscitation, inhospital care matters very little if return of spontaneous circulation doesn’t happen prior to a patient’s arrival at the hospital. It may be that in severe TBI cases, when the brain is injured but not yet irreversibly traumatised, what EMS providers do in the prehospital setting may have the most impact. Finding an intervention as we did in the EPIC trial that doubles the survival rate of a major public health problem such as TBI is a huge advancement. Our biggest opportunity may not be finding the next TBI drug or TBI treatment but may instead be better utilising the tools at our disposal.

Perhaps meticulously and continuously measuring, managing, and improving ventilation, blood pressure, and oxygenation in a more holistic and systemic fashion that doesn’t allow for missed opportunities and prevents patients from becoming hypoxic, hypotensive, or hyperventilated is the way to improve care for TBI patients.

Returning to the real-life case mentioned at the beginning of this article: The youngster in the horrific car crash was quite sick after the accident and spent several days in the ICU. Thanks in part to the application of the TBI guidelines, six years later he has grown up absolutely healthy and is doing all the things any other 9-year-old is able to do. He is a perfect illustration of the potential we have to help people recover from severe TBI.

References

1 CENTER-TBI website, https://www. center-tbi.eu/files/news/21571f8120b8-4860-a3dd-1f6e27d02b3d.pdf

Accessed 1 February 2023.

2 Centers for Disease Control and Prevention Website: https://www. cdc.gov/traumaticbraininjury/ pdf/TBI-surveillancereport-2016-2017-508.pdf Accessed 1 February 2023.

3 Van Wyck D, et al. Traumatic brain injury management in prolonged field care. Joint Trauma System Clinical Practice Guideline. 2017;17(3):130–140.

4 Davis D, Hoyt D B, Ochs M, Fortlage D, Holbrook T, Marshall L K, Rosen P. The effect of paramedic rapid sequence intubation on outcome in patients with severe traumatic brain injury. J Trauma. 2003;54(3):444–53.

5 Stocchetti N, Furlan A, Volta F. Hypoxemia, and arterial hypotension at the accident scene in head injury. J Trauma. 1996;40(5):764–7.

6 Chesnut RM, Marshall LF, Klauber MR, Blunt BA, Baldwin N, Eisenberg HM, Jane JA, Marmarou A, Foulkes MA. The role of secondary brain injury in determining outcome from severe head injury. J Trauma. 1993;34(2):216–22.

7 Spaite DW, et al. The effect of combined out-of-hospital hypotension and hypoxia on mortality in major traumatic brain injury. Annals of Emergency Medicine. 2017;69(1):62–72

8 Davis DP, Dunford JV, Poste JC, Ochs M, Holbrook T, Fortlage D, Size MJ, Kennedy F, Hoyt DB. The impact of hypoxia and hyperventilation on outcome after paramedic rapid sequence intubation of severely head-injured patients. J Trauma. 2004;57(1):1–8.

9 Denninghoff KR, Griffin MJ, Bartolucci AA, Lobello SG, Fine PR. Emergent endotracheal intubation and mortality in traumatic brain injury. West J Emerg Med. Nov 2008;9(4):184-189.

10 Spaite DW, et al. Impact of statewide implementation of the prehospital traumatic brain injury treatment guidelines: The excellence in prehospital injury care (EPIC) study. JAMA Surgery. 2019;154(7):e191152.

11 https://epic.arizona.edu/system/files/ files/EPIC4KidsAlgorithmFINAL.pdf

5

simple changes to help you live greener

Many of us want to be more sustainable. In fact nearly 9 in 10 (88%) of Australians want to reduce their environmental impact in some way, but sometimes it can be challenging to know how.Here are five simple changes you can apply into your everyday life to help you live more sustainably.

1

Carry your own reusable water bottle

80% of the plastic water bottles we buy end up in landfills. By using a reusable water bottle you are reducing the number of plastic bottles in landfill significantly.

2

Eat local

Eating more local food reduces CO2 emissions by reducing food miles. Food miles is the distance food is transported from the time of its making until it reaches the consumer. Not only is it better for the environment to eat local foods but it is also better for you. Locally grown fruit and vegetables are often more nutrient dense and contain less pesticides than imported produce.

3

Swap to a reusable coffee cup

Having a reusable coffee cup in your car, bag or at the office gives quick access to an environmentally friendly alternative to the single use cup when getting take away coffee. Less than 1 in 400 disposable coffee cups are recycled due to the plastic lining inside. Other environmentally friendly ideas to minimalize waste when eating out include using your own re-useable straw, cutlery, and using your own re-useable container for leftovers.

4

Use the correct bin

Disposing of waste correctly minimalizes the amount going into landfill. When organic matter is disposed of incorrectly into landfilled it decomposes and produces methane gas which is up to 34 times more powerful than CO2 over a century.

5

Practice eco-friendly driving

Eco-friendly driving saves fuel and reduces excess emissions. Here are some examples of how to practise eco-friendly driving:

• Accelerate smoothly and brake gradually;

• Change gear as early as possible at a modest engine speed; and

• Use cruise control where possible on open roads!

#bakeoff

#StJohnDay

#NationalVolunteerWeek20

#WomenInAmbulance

#restartaheart

Our community

#ThankAFirstResponder

#lovefromWA

Paramedics visit home schooled children

#ThankAFirstResponder

#WorldEnvironmentDay

#MeFirst People First Queensland Ambulance Service Peer Support Officers lend their ears

#MeFirst

#ThankAFirstResponder

#HandHygiene #HandHygiene

#HandHygiene

Ambulance Tasmania Paramedics Ellen and Katrina took a trip to meet some children who are home schooled to give them insight into the world of ambulance. They explored the inside of the ambulance and shown various pieces of medical equipment and information. The experience allows the children to feel more confident and relaxed about being inside an ambulance.

#stayathome

#PeopleFIRST

#dogsofambulance

#HandHygiene

#PeopleFIRST

#PeopleFIRST

#HandHygiene #HandHygiene

#dogsofambulance

#PeopleFIRST

#lovefromWA

#ThankAFirstResponder

#inthistogether

#NationalVolunteerWeek20

Peer Support Officers (PSO’s) visited the Bundaberg Hospital with ice blocks to lend an ear to their paramedics. PSO’s are trained in taking an interest in the wellbeing of their colleagues and to be there to listen for those who may be going through a tough time.

#SustainableAmbulance

#MeFirst

#WomenInAmbulance

#charitygolf

#dogsofambulance

#stayathome

#StJohnDay

#PeopleFIRST

#restartaheart

#ThankAFirstResponder

#charitygolf

#restartaheart

#restartaheart

#WorldEnvironmentDay

#MeFirst

#ThankAFirstResponder

#charitygolf

Knitted teddies donated to comfort

#inthistogether

#HandHygiene

#SustainableAmbulance

#bakeoff

#MeFirst

#WorldEnvironmentDay #stayathome #StJohnDay

#WorldEnvironmentDay

#lovefromWA #lovefromWA

younger patients

#StJohnDay

#WomenInAmbulance

Donated by the Pukekohe Spinners and Wool Crafters, these awesome knitted teddies have been provided to the team at Hato Hone St John in Pukekohe, Waiuku, and Papakura to help comfort the younger patients.

#charitygolf

#PeopleFIRST

#inthistogether

Paramedics participate in the Starlight Foundation Super Swim

#WomenInAmbulance

#WorldEnvironmentDay

#WomenInAmbulance #dogsofambulance

Two of St John NT’s Katherine crew paramedics participated in the Starlight Foundation Super Swim which involved swimming 42km throughout February whilst raising money for sick kids.

#PeopleFIRST #PeopleFIRST

#WorldEnvironmentDay

#NationalVolunteerWeek20

#WomenInAmbulance

#ThankAFirstResponder

#ThankAFirstResponder

#charitygolf

#NationalVolunteerWeek20

#NationalVolunteerWeek20

#restartaheart

#restartaheart

#ThankAFirstResponder

#stayathome

#NationalVolunteerWeek20

#lovefromWA

National Cadet of the Year announced for 2023

#StJohnDay

Nate Whitfield is the Hato Hone St John

National Cadet of the Year 2023. Nate is the ambassador for St John Youth in Aotearoa New Zealand, and he is enjoying representing young people whilst growing the mentoring and learning opportunities for young people in the organisation. You can see Nate's work on Instagram @ncoty.nz.

#SustainableAmbulance #ThankAFirstResponder

#inthistogether

#restartaheart

#restartaheart

#MeFirst

#dogsofambulance

#restartaheart

#SustainableAmbulance

#ThankAFirstResponder

#ThankAFirstResponder

#WomenInAmbulance

#ThankAFirstResponder

#restartaheart

#WorldEnvironmentDay

New ambulance design for Hato Hone St John

Hato Hone St John has rolled out a new ambulance design. It is believed that this ambulance is the first in the world to visually incorporate emergency vehicle safety standards while embracing cultural designs. The design features on all new emergency ambulances along with our Command Units, Major Incident Support vehicles, Patient Transfer Ambulances and Complex Patient Vehicles.

#MeFirst

Pedalling paramedics at the Santos Tour Down Under Paramedics Jazz and Chris jumped on their bikes as the SAAS Bicycle Response Unit where they attended to spectator injuries and medical needs, with other SAAS crews following the racers, ready to respond to on-track emergencies.

Ambulance Victoria paramedic

Brian Moffatt named Citizen of the Year

Brian, a paramedic and GoodSAM responder, was awarded Mitchell Shire Council’s Citizen of the Year from a local after he responded to a GoodSAM app alert and helped revived his neighbour with lifesaving CPR.

#ThankAFirstResponder #ThankAFirstResponder #NationalVolunteerWeek20

St John WA and St John Ambulance Papua New Guinea paramedics reunite

#MeFirst

A heart-warming reunion, St John WA paramedics Lekkisha Duncan and Kirsty Fraser have surprised Papua New Guinea colleagues Ruth and Kathleen after four years apart.

40+ years of service for Ambulance Tasmania paramedics

Two of Ambulance Tasmania’s well loved paramedics have recently retired. Neale Smith after 41 years and Simon Butterley after 48, we congratulate these two on this tremendous achievement. Neale’s roles have included: Clinical Support Supervisor, Intensive Care Paramedic, Flight Paramedic, Wilderness Paramedic, and Educator. Simon’s roles have included: Intensive Care Paramedic, Wilderness Paramedic and Flight Paramedic.

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#MeFirst

#MeFirst

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#MeFirst

Photo courtesy of Richard Bugg

Recognising the difference between a Patient Zone (red), a Clean Healthcare Worker Zone (green) and a Healthcare Worker Zone (yellow) is essential for determining when hand hygiene is required. Hand hygiene between these areas will minimise the level of microbial burden on patient care equipment, vehicles and frequently touched areas. Follow these simple steps to prevent cross infection between patients and improve overall staff safety.

CLEAN HEALTHCARE WORKER ZONE

Conduct hand hygiene before entering a Clean Healthcare Worker Zone.

HEALTHCARE WORKER ZONE

Conduct hand hygiene before accessing clean equipment e.g. in overhead lockers and medication draws.

PATIENT ZONE

Conduct hand hygiene before and immediately after leaving the Patient Zone.

Take your career to the next level

Master of Paramedicine (with specialisations)

Open new doors in your career as a critical care or extended care paramedic with Australia’s most experienced provider of paramedicine education.

Choose your path

Specialise in critical care or extended care.

Study online, be flexible

Choose study that fits in with your life. We’re Australia’s most experienced online uni and know what it takes to manage study, work and family.

Learn with experts

Our academics come from industry, work with industry and provide research to drive industry. With international and local expertise, they make your study relevant, engaging and challenging.

Build your qualification

Enrol directly into the online Master of Paramedicine or start with a graduate certificate and build to your ideal qualification.

• Graduate Certificate – 0.5 years of full-time study (or 1 year part time)

• Graduate Diploma – 1 year of full-time study (or 2 years part time)

• Master’s – 1.5 years of full-time study (or 3 years part time)

Save on study in 2023

If you’re thinking of starting with a graduate certificate and building to a master’s, we’ve got great news – study is now even more affordable. Apply now to study and save on your fees for a Graduate Certificate of Paramedicine with a Commonwealth supported place (CSP) in 2023 and save over $8,700. Plus, with a CSP you’ll be able to apply for a HECS-HELP loan and defer payment to a later date.

Get started

To be eligible to study the master’s, you must have completed an undergraduate degree in paramedicine. Or, for graduate certificate entry, you must be practicing as an intensive care paramedic with extensive industry experience. Apply now to begin your study in March or July.

“Working full-time meant online study was the best option for me. Initially, I was quite hesitant about undertaking online education. But my experience with Charles Sturt was very positive. The faculty are incredibly experienced and knowledgeable healthcare professionals and tertiary educators.”

Callum Shepherd

Master of Paramedicine

Paramedic – Hazardous Area Response Team

London Ambulance Service

Boost your employability

In some states, you need a postgraduate qualification (at a minimum of a graduate diploma level) to apply for intensive care, critical care and extended care roles. So you know that with us, you’ll achieve the qualification level that’s right for you.

CQU

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.

cqu.edu.au

Ferno

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.

ferno.com.au

NEANN

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.

neann.com.au

ORH

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.

orhltd.com

Philips

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.

philips.com.au/healthcare

Pulsara

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

Stryker

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.

stryker.com/au/en

Corvanta

Corvanta partners with out-of-hospital care providers, to advance and deliver the technology they need to deliver timely, integrated, patientcentric services to improve healthcare outcomes.

corvanta.com

ZOLL

ZOLL® Medical Corporation, an Asahi Kasei company, develops and markets medical devices and software solutions that help advance emergency care and save lives, while increasing clinical and operational efficiencies. With products for defibrillation and cardiac monitoring, circulation enhancement and CPR feedback, supersaturated oxygen therapy, data management, ventilation,

and therapeutic temperature management, ZOLL provides a comprehensive set of technologies that help clinicians, EMS and fire professionals, as well as lay rescuers, improve patient outcomes in critical cardiopulmonary conditions.

www.zoll.com/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, the Corvanta iPCR is our complete, end-to-end solution for the out-ofhospital care sector – from the emergency call to the clinical handover. It’s the only solution of its kind. The Corvanta iPCR is more than a patient record system; the solution is also an intuitive decision support tool capable of improving patient safety and decision support, increasing operational resource availability, streaming of diagnostic quality vital signs, a seamless transfer of records, and more! Our iPCR technology is used by over 12,000 paramedics, is installed in 2,700 ambulances, and handles over 200,000 patients every month. corvanta.com

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

Why We Lose Motivation and How to Get It Back!

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.

I realised a wee while ago that I was shattered, as I think all of us on the frontline over the past few years have become. Often it isn’t until we slow down or stop do we actually feel the effects of what we have been doing and I think in the profession we are in, we often just keep on going, despite what adversities come our way, it’s in our makeup.

The thing is though, even if we give ourselves a bit of a break, we can find it really challenging to get going again, often putting up barriers, perceived or real, to hinder us fully getting back into the swing of things. Resonate? Okay, maybe it is just me then… but if this is you too, read on, because if you’ve lost motivation I’m going to give you some really valuable tips on how to get that sucker back!

We all know that exercise is good for us so why aren’t we all super-fit already? Because no one can sustain their enthusiasm for exercise forever. No one. Even the best of us who manage to go through life and remain relatively fit have our low points, breaking points and the points when we feel like the whole world can burn for all we care.

We all have these days.

And this is where it happens - we lose our motivation. One low day/ week is perfectly normal and arguably, even healthy. The problem with our low days is that, as we hide under our mental (or actual) blanket, we feel good. In contrast to the everyday struggle it feels ultimately better to simply do nothing. So getting back to what we often remember as the discomfort and pain of training is hardly a cheerful prospect. It’s incredibly difficult to go back to feeling tired and sore all the time in the name of the greater good aka our health and fitness because all we have are the memories of feeling tired and sore.

Memories and associations are the key component here. That’s how our brain works - based on past experience we form associations and we feel either positive or negative about a particular event or activity.

If we went out with friends and we had a bad experience we will be reluctant to go out with them or go to the same place again. And if the experience continues to be negative, well, we might just stop going out altogether and stick to Netflix.

Our brains are reward driven. We eat a slice of cake and we feel good. There is an instant reward right there, consequences be damned. When it comes to exercise, though there is just pain and soreness, and then the memories of the pain and the soreness. There is but a promise of reward at a later date as it takes time to get fit, and then even more work to stay that way. There are no guarantees just the possibility of getting fit and healthy if we work hard somewhere down the road, perhaps. That’s why cake wins over a workout every time.

We can push, shame, and force ourselves on a regular basis but no one can withstand continued misery forever. Everyone breaks eventually and then the cycle begins again. We force, we break, we start again - if we can bear it psychologically.

One of the reasons we need a new nutrition plan or a new training programme every single time (and every year there is one or even ten new ones to choose from), is because we haven’t formed those negative associations with this new shiny object yet, so that we feel we can give it a shot hoping that this time it will be different. And every time it fails us because we continue to suffer, and that suffering creates negative neural pathways in our brains making us more and more reluctant to repeat the experience.

So, what can we do? We must form positive associations with exercise instead by using any and all tools at our disposal. If we feel good before, during and after exercise the reluctance to do it again becomes less and less over time. Eventually, we are able to sustain our fitness and that is the end goal.

Reduce The Amount of Pain

When we feel our motivation is slipping and we are losing any desire to exercise, we should reduce the amount of pain inflicted - even remove it completely. The moment we accumulate enough negative associations with exercise our self-preservation kicks in and our brain tries to keep us away from any further discomfort. It’s only natural to shy away from pain especially when it can be easily avoided. The way our brain sees it, no more exercise means no more pain.

Remove the pain from the equation and the reluctance will lessen.

Tip #1: Continue to exercise regularly but significantly reduce the amount and/or the intensity of exercise until you no longer feel apprehensive about training.

Combine Exercise with Things You Enjoy

That’s why so many of us listen to music when we exercise. We feel good when we listen to music we like, and it helps us get through harder patches during our training session. It can sometimes help take our mind off the pain completely.

Training with others, people whose company we enjoy, has a similar effect. We can partner up with friends, fellow colleagues, or a group of people with similar interests and exercise together. That way we focus on the social aspect of training and not on the struggle and we have something more than just discomfort to look forward to.

We don’t always need a distraction but it helps every now and then to create better memories and associations.

Tip #2: Aim to make every training session an enjoyable experience.

Use An Instant Reward System

It takes time to see results in the mirror. Health benefits of exercise go fairly unnoticed throughout life - we tend to notice when things go wrong with our body, but we rarely pay attention to it when we feel fine. So, there is no instant reward for exercise unless we add some artificially.

We can create badges or award ourselves stickers for completing workouts. Crossing out days in a calendar can also be incredibly satisfying as we get to measure our progress. We can get a jar and add a marble to it for each workout completed with a goal to fill it up by the end of the year. We have to create a reward system that works for us, that’s instant, something we get on completion of our workouts to compensate for the discomfort.

Food can be a powerful motivator, too. We don’t have to reward ourselves with cake, which would be counterproductive, but we can schedule our training so our breakfast, lunch or dinner comes directly post-workout serving as a reward for our struggle. Eventually our brain connects the two and we form positive associations with the physical activity.

Tip #3: Follow up exercise with an instant reward every single time to create positive associations.

Inoculate Yourself to Exercise

Most of us already have negative associations with exercise. We wouldn’t need motivational articles if we didn’t! So the moment we even start thinking of training all the negative emotions begin to come to the surface, all the bad memories of soreness come flashing back and in the end, we skip a workout because we just can’t do it today, or ever again.

When the negative associations are already formed it becomes really difficult to see exercise as anything but a painful barely tolerable experience. Over time we amplify it in our head beginning to remember it being worse than it actually was. Our memory is imperfect that way, sometimes all we remember is how we felt and if all we felt is discomfort we tend to find reasons to avoid repeating the experience even though logically we know it’s wrong.

Not all is lost however. Just because we already see exercise as an evil painful thing - it doesn’t mean we can’t change it. We can in fact rewire our brains - it just takes a little bit of effort and just like with anything worthwhile, consistency.

The pain you feel today will be the strength you feel tomorrow.”

Arnold Schwarzenegger

All we need is five minutes a day. We don’t even need to exercise all five minutes, we just need the commitment and a bit of exercise so we can slowly inoculate ourselves to it and teach our brain that it’s not always painful or difficult. All we have to do is show up, do somethinganything, and do it every single day. This unassuming routine will make a huge impact on our psyche overtime and eventually it will become a gateway to longer and more demanding sessions.

Tip #4: Do light training for five minutes, whatever happens, every day at the same time to teach your brain that it’s not always hard or uncomfortable to exercise.

Tipping the Scales

It really doesn’t matter how hard we train if we seldomly do it. Consistency is the only way to get lasting, permanent results in how we look, feel, and move. Unfortunately, finding the emotional strength to come back to exercise on a regular basis is often a lot harder than the exercise itself.

It’s literally all in our head. It’s how we see training, our associations and connections in our brain. If all we expect is pain and suffering, we are unlikely to do it again and certainly we are unlikely to stick to it long term which is ultimately the goal with fitness, and of course your overall health and wellbeing.

In order to continue to stay motivated and be able to schedule and show up for our workouts we must tip the scales in favour of exercise so we can turn it into a desirable activity, something we look forward to rather than recoil from. In order to change our relationship with exercise we must create good memories of the experience using every tool at our disposal whether it’s instant rewards or gamification of the process, good music or good company or simply reduced physical stress and a better environment.

If all else fails, a routine that requires us to put in five minutes of exercise a day (that can be extended each time if desired) must be established. Everyone has five minutes to exercisethat five minutes may not sound like much but most of the time, it’ll be the gateway to longer and more demanding workouts in the future. And each time it will provide us with the opportunity to change how we feel about exercise, create positive associations - which will go a long way in changing our entire outlook and our willingness to do it again.

Staying motivated comes down to how we see exercise and what we remember about our last training session. Was it fun? Was the discomfort tolerable? Was there an instant gratification after? Did we enjoy at least some part of it? If the answer to all these questions is “Yes” more often than “No”, having the motivation to exercise regularly will never again be a problem!

Go on - you know you’re worth it!

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