QAS Insight Summer 2021-2022

MAGAZINE SURVEY • REUNITES • EXERCISES • AWARDS

Summer 2021–22

Inside Covid surge planning

Welcome HCC

QAS chaplains a world first

Wayne wins $80k grant

P4

P16

P14

P10

Season YYYY

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CONTENTS • Summer 2021–22

Features

Regulars Minister’s message

2

Commissioner’s message

2

Legacy 42 OpCen Reports

47

HARU Report

50

LARU Report

52

Priority One Report

53

MENTAL HEALTH DURING COVID

JILLY A FRED FINALIST

FIPN Report

54

22

25

FAREWELL HARU DRS

JOB SWAP

28

32

IPP AND CALD UNI GRADS

CELEBRATING TOPIC30TITLE YEARS (PT 3)

38

00 68

ENID CELEBRATES 50 YEARS

KJM AWARDS AND PAPERS

74

83

Awards 56 Happenings 78 Thank yous

80

Movers and shakers

82

QAS INSIGHT is published quarterly by the QAS Media Unit, GPO Box 1425, Brisbane QLD 4001.

Editorial and photographic contributions are welcome and can be submitted to: QASInsight@ambulance.qld.gov.au Want to contribute?

If you know of a QAS ‘quiet achiever’ or an event or program with a story worth sharing with our colleagues, please get in touch with INSIGHT editor Caroline Page by email (above) or phone 3635 3900.

Insight contributors: Caroline Page, Michael Augustus, Andrew Kos, Jo Mitchell, Matt Stirling, Tracey Cater, Melissa Mangan, Madolyn Sushames, Jenifer Kinsella and Emma Woodward.

Designed by: Paper & Desk

Front cover: See page 3 to find out more about our cover photo.

Summer 2021–22

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Minister

Commissioner

Our staff saw yet another busy year facing an immensely heavy workload; our EMDs busy in the Operation Centres taking calls, and our Paramedics and Patient Transport Officers busy treating and transporting Queenslanders.

While the word “unprecedented” has become vernacular over the last two years, now our borders are open, I’m sure it will continue to dominate our state’s updates.

During 2021 our emergency departments experienced unprecedented demand even without the additional challenges COVID-19 will bring in the new year.

In September the Queensland Audit Office released its Measuring emergency department patient wait time which recognised emergency care is growing at a faster rate than population growth and more people are arriving at Emergency Departments with complex issues.

I know this has had a significant knock-on effect to all our Ambulance staff, including our Operation Centre workers, paramedics, and front-line workers out on the roads.

In response we’ve worked with the QAS to deliver some significant workarounds to alleviate this pressure on our Emergency Departments, introducing exceptional and innovative programs with its Clinical Hub, the Mental Health Co-responder Program and LiveMUM rollout – ultimately providing a better service to our patients.

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The Government is delivering an extra $263.7 million to assist with the increased demand in our emergency departments on top of a regular $22.2 million health budget and we are now working to implement all recommendations. Some of these include initiatives to improve handover speed and efficiency at EDs to reduce ramping.

We have also recently announced the hiring of an extra 109 frontline ambulance officers to meet this ever-growing need, on top of the additional 179 officers recruited this financial year.

These new paramedics and emergency medical dispatchers will help to tackle the record demand in our health system and support our COVID-19 response.

QAS professionals lead the nation in the progressive and innovative treatment they provide to critically ill or injured Queenslanders. On behalf of the Premier and the entire government I offer my sincere thanks to you all for your care and dedication to our communities.

Once again, I’d like to thank you all for your outstanding response to getting vaccinated against COVID-19 and your dedication to keeping your colleagues, families and patients, as well as our broader communities safe. This year will be challenging, and many communities will be needing your care in the coming months.

Christmas, the summer holidays and 2022 are hurtling toward us at a tremendous pace and I’d like to wish everyone a safe, relaxing, and joyous festive season. A special thank-you to all staff working over this holiday season too.

Yvette D’Ath Minister for Health and Ambulance Services

Summer 2021–22

Well, what an enormous year we’ve had!

Firstly, I’d like to thank every one of you for your dedication to keeping our communities safe and standing up during another challenging year adapting to our COVID-19 restrictions, natural disasters and everyday callouts.

Despite these challenges, it has been heartening to see our significant QAS innovations developed and rolled out including our Mental Health Response Program, LiveMUM, the Clinical Hub, and QAS’s Aboriginal and Torres Strait Islander Cultural Safety Unit just to name a few.

I’d also like to welcome the Health Contact Centre (HCC) teams who have joined QAS. You can read more about the HCC in this edition of Insight on page 16.

This year we’ve experienced another year of immensely heavy workload during peak periods and increasing pressure on the wider health system, and we know we’ll be faced with more challenges with the arrival of COVID-19 into our communities.

We have been planning for this and I encourage you to read our plans for the COVID-19 surge on page 4.

In November a number of our workforce attended the 13th QAS Workforce Forum. The Forum provided the platform to share insights to help shape the next QAS Strategy with solutionfocused discussions on culture and our workforce agenda, aligning with our focus on respect, fairness and inclusion (see page 54). Work on the development of the Strategy will continue into 2022 and you will hear more about this next year.

On 22 November 2021, the QAS implemented a trial program for Off Load Paramedics (OLP) who are positioned at strategically identified EDs (Logan, Ipswich and Gold Coast University Hospitals), that underpin and complement the existing Transfer Initiative Nurse arrangements. This strategy is aimed at supporting the expediated return of ambulance crews to respond into the community.

I would like to wish everyone a happy and safe Christmas and festive season and to encourage everyone in our QAS family to look after their mental health and wellbeing as I also understand Christmas can also be a difficult time for many people in our community. You’ll see on page 22 Priority One’s Director Todd Wehr has written an article with some mental health strategies for us all to refer to particularly during the expected COVID-19 surge. We have a wonderful support crew available to us and within our ranks, so don’t forget Our Priority One staff are available 24/7 and we also have our Chaplains (see page 14) and our Peer Support Officers.

Finally, to all our staff (and their families) who are working over the festive season, thank you for your dedication and care for our communities. We understand this means you may not have a normal Christmas or New Year celebration, but we do hope you get to enjoy the time you spend outside these traditional celebration days with your loved ones.

Have a happy and safe Christmas all!

Craig Emery ASM QAS Acting Commissioner

Department title / section Survey / topic

How do you want your QAS Insight?

As 2021 comes to a close, the QAS Media team is already focusing on what lies ahead – and in particular, how we can provide you with meaningful information you want, in a way that best suits you.

For most of its history QAS Insight has been a hard copy magazine, but this year Insight became an online-only publication, accessed either through the QAS Staff Portal, or to our non-staff readers through digital flipbook platform ISSUU. And now we’d like your feedback please.

We’re keen to hear what type of news and information you want to receive, how you’d like to receive it – whether you’d like your news in smaller bite-sized pieces as soon as it’s available – for example like a blog, or still in the quarterly deep‑reads.

We also would like to know how you prefer to read it – computer, smart device or phone – or do you miss the hard copy of the mag?

SCAN ME

Please fill in our short survey to give us this feedback: click here, go to https://bit.ly/3EPsCUI or scan the QR code on the right:

About our Front Cover photo

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We thought we’d end the year with one of the QAS’s most heart-warming moments of 2021.

This was a behind-the-scenes photograph taken following a reunite between our crews and people who had attended a birthday party which turned into an horrific emergency.

This reunite received great media coverage for QAS and provided our communities with some timely water safety messages just before the Christmas holidays.

Leenah Ali, 7, was at her best friend Evie’s birthday pool-party in October when she was pulled from the water

by Evie’s father David.

David had been keeping a close eye over the nine children swimming that day, evidence of how a split-second is all it takes for something to go wrong.

Another mum Jaime who is also a teacher, immediately began CPR while Evie’s parents called Triple Zero (000) and followed the lifesaving instructions of our EMDs. Paramedics soon arrived and took over resuscitating Leenah, who’d had no heartbeat for quite some time.

Leenah’s potential outcome was dire, with a near-zero per cent survival rate, but she miraculously survived.

And the families closely involved during that fateful birthday party visited Kedron HQ to meet and thank the QAS officers who helped them that day.

Front cover, from left to right

Celeste Trembath (ACPII), Evie, Leenah and Deb Van Zyl (ACPII).

Summer 2021–22

COVID-19 Demand Surge Planning The QAS’s COVID-19 response has redefined and strengthened our emergency management operability for the next decade.

COVID-19’s rapid emergence has posed significant challenges for all organisations, but particularly those responsible for health care delivery.

The COVID-19 pandemic event’s potential impacts are both complex and unpredictable, with a constantly evolving environment presenting a significant challenge for planning and subsequent response.

The Queensland Ambulance Service (QAS) has dedicated significant resources to understanding, evaluating, and then planning for this threat.

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Inside the State Operation Coor

dination Centre.

As a result, we’re adopting a flexible and innovative approach to our planning, using cross-disciplinary teams, and in the process highlighting a new standard for emergency management operations across the organisation.

So far, the QAS’s COVID legacy has been our enhanced collaborative capability across our service delivery areas.

Queensland has predictable weather and health trends occurring throughout the year, including severe storms, cyclones, heatwaves, fire and winter influenza.

Unpredictable events, such as the COVID-19 pandemic, have paved the way for innovative ways to operate and to challenge our thinking.

Novel service challenges we are experiencing have in turn recognised the need for robust organisational coordination.

The QAS strategic COVID-19 planning team is rising to this challenge, collaborating our planning and response with the QAS Emergency Management Unit (EMU) and the State Operation Coordination Centre (SOCC – previously known as the State Incident Management Room (SIMR)).

During 2021, the ability to rapidly respond to shifting priorities and coordinate deployments to meet new business requirements provided the importance of our key emergency

Summer 2021–22

management principles. This was to both internal and external requests that are now embedded in all aspects of the COVID-19 response.

COVID-19 surge planning

2021 Disasters & Major Events 1 Jan

New Years Eve Events

4–14 Jan

Noosa Testing Clinic

7–22 Jan

Eight Mile Plains Testing Clinic

18–23 Jan

Tropical Cyclone Kimi

30 May

30 May Sunshine Coast SME Expo

26 Jun – 9 Jul

Laura Dance Festival

28 Jun – 14 Jul

Big Red Bash

9 – 20 Aug

Mount Isa Rodeo

3–12 Aug 10–13 Sept 14–17 Sept 30 Sep – 4 Oct

Eight Mile Plains Testing Clinics

Aug – Dec 21

Afghan Flight Reception

Dec 21

Severe weather events Southeast and Southwest Queensland

Snapshot

209

QAS COVID-19 trained testers

60

Additional Staff (employed as COVID-19 response in 2020/2021 FY)

7

COVID-19 fever clinics

58

COVID surge vehicles delivered

518

Staff deployed to testing clinics

114,906

EIDS trigger cases (at 13 Oct 2021)

16,407

COVID tests undertaken by QAS officers (at 13 Oct 2021)

5

7

COVID-19 Timeline

IGEM post event reviews 27 JAN 20 QAS Liaison activation for the State Health Emergency Coordination Centre 1 FEB 20 Strategic Planning Team activated – Concept of Operations

3 30 JAN 20 QAS Stands Up State Incident Management Room (SIMR)

1,209,638

14 MAR 20

24,736

QAS Incident Management Team established

24 NOV 20 QAS Concept of Operations 2

Events across Queensland (since 2013, Emergency Management Unit)

Transported >10,000 patients treated as potential COVID-19 positives with >850 confirmed positive COVID-19 patients (at 13 Oct 2021)

0

10 MAY 21 Transition State Incident Management Room (SIMR) to State Operations Coordination Centre (SOCC)

HCC 13HEALTH COVID-19 distinct calls (period 21 Jan–13 Oct 2021)

975

16 AUG 20 Mid Cycle Review

Event coronial inquests

COVID-19 transmission at 1 Dec 2021

2,996 NOV 21

Average daily call volume (Nov 2021)

QAS Strategic Action Plan

Summer 2021–22

TURN OVER

QAS Incident Management Team 6

The QAS formed a multi-disciplinary team, delivering QAS COVID-19 demand surge response strategies for the Incident Controller, Craig Emery and led by the Deputy Incident controller, Stephen Zsombok.

Left

QAS COVID-19 testing centre.

Top right

QAS COVID-19 planning team representatives at the Queensland 2020 Premier’s Award.

Bottom right

Statewide Infection Prevention program Coordinators Melissa Rogers and Ursula Howarth.

The QAS Incident Management Team (IMT) continues to provide expertise across ambulance operations, clinical services, logistics, service planning, media and communications, education, recruitment, human resources, legal and governance.

This team has developed an innovative and collaborative approach to planning, bringing together disciplinary leads from across QAS’s operational and corporate functions, focused solely on planning the QAS’s COVID-19 response.

Key subject matter experts and work units support not only our ongoing COVID-19 response but also our continued development of new leaders through enhanced capability development programs and succession planning activities.

The IMT’s holistic approach identified key personnel improving organisational resilience and future workforce capability.

Subject matter experts in Infection control, led by Office of the Medical Director’s (OMD)

Summer 2021–22

Statewide Infection Prevention Program Coordinators Melissa Rogers and Ursula Howarth, enabled improved clinical safety and enhanced infection control practices.

QAS Service Planning, led by Director James Robinson continues to drive efficient and effective resources use through enhanced supply chain management and operational planning processes.

As we continue to experience the longest disaster event in our lifetime, the importance of our organisational preparedness and resilience is becoming ever reinforced.

To that end, key QAS emergency management principles have underpinned the QAS COVID-19 response.

Operating under the QAS Incident Controller and Central Office Senior Executives’ (COSE) direction, the EMU ensures prevention, preparedness, response and recovery principles are embedded across the organisation.

COVID-19 surge planning

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In January 2020, the EMU activated the State Incident Management Room (SIMR) in support of the Government’s health response to the COVID-19 pandemic. Covering shifts 24 hours a day, 7 days a week, the EMU and South East Queensland supervisors established QAS incident management systems and built a strong foundation supporting the QAS response through the now permanent SOCC facility at the Emergency Management and Fleet precinct.

The EMU provides support to the SOCC, assisting with developing the emergency management training framework, and bringing enhanced supervisory training to current and emerging supervisors. To date the completion of the capability development activities has identified emerging leaders and pathways for continual learning.

The HCC has played a significant role with immunisation and response to vaccination implementation, and its contact tracing team will play a prominent role responding to communities’ health issues – as will its general information enquiries, Triage and Contact Tracing team, plus its bespoke services established as part of the original response to COVID-19.

Left, top right and bottom right

Standing up at the QAS’s COVID-19 testing centres.

You can find out more about the HCC in QAS welcomes the HCC workforce into its ranks on page 16.

As the QAS COVID-19 Planning Team and EMU prepare for the COVID-19 pandemic surge and 2021-2022 summer season, we recognise one thing is certain, the way we operate will not look the same as it did in 2020 and 2021.

The Health Contact Centre (HCC) which is best known for its two public facing phone numbers – 13 HEALTH (13 43 25) and 13QUIT (13 7848), and more lately 134 COVID, is now a part of QAS.

Summer 2021–22

TURN OVER

QAS Mission to deliver timely, quality and appropriate, patient focused ambulance services to the Queensland community.

Strengthened organisational capability to manage risks from all hazards through enhanced infection control practices.

Enhancement of existing systems and processes to drive informed decision making through real time data and intelligence.

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Embed comprehensive emergency risk management.

Implementation and completion of the QAS Demand Surge Resilience and recovery program to utilise lessons identified during the COVID-19 response.

Interagency engagement across both the organisation and whole or government.

The development of the QAS Demand Surge (COVID-19) Concept of Operations.

Enhance existing disaster management practices to provide holistic oversight of organisational challenges.

Sustainable command and control structure across QAS (human resourcing, fleet, critical inventory items, personal protective equipment (PPE), Central Pharmacy, and infection control consumables).

The QAS continue to rapidly enhance the capacity and capability of the QAS through the implementation of various new and improved business solutions:

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Establishing specialist COVID-19 response teams to provide a rapid and appropriate ambulance response to suspected COVID-19 cases.

4

Rapidly recruiting and onboarding additional paramedics, emergency medical dispatchers, emergency call takers and patient transport officers to ensure QAS readiness for a demand surge.

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10

Implemented the Emerging Infectious Disease Surveillance (EIDS) questions for Triple Zero (000) callers to identify potential COVID-19 cases and enable enhanced interrogation of Triple Zero (000) calls.

2

Enhanced collaboration across Queensland’s system of health through dedicated QAS liaison officers embedded into the State Health Emergency Coordination Centre.

5

New models of staff engagement, including daily email communications, which provided all staff with situational awareness and enabled key messaging particularly around infection control and staff safety.

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Established a 24 hour medical services advice line available to all frontline ambulance staff to provide guidance around key issues such as clinical care and infection control.

Stood up (for the first time) public information, safety and medical services cell within the QAS incident management team structure.

Summer 2021–22

3

Development of “Clinical Hub” which enlivened alternate models of service delivery including clinical review of all potential cases, increased advice to QAS crews attending potential cases and implementation of COVID-19 response vehicles.

6

Utilised the QAS’s existing staff support service, Priority One, and its new Flexible Work and Inclusive Practice Network to offer ongoing support to staff adversely affected by events associated with COVID-19.

9

Creating operational and syndromic intelligence capabilities utilising technology platforms to provide additional assurance of critical workforce and logistical requirements.

Gerard takes on Northern role

Gerard takes on Northern role until it’s permanently filled Long-serving paramedic and QAS executive Gerard Lawler has taken on the position of Deputy Commissioner – North Queensland, Rural and Remote, but only until a permanent appointment is made in 2022.

Gerard has worked in ambulance services for more than 40 years, and with the QAS since early 1992 after moving here from the south and has held many executive roles, working across all areas of service delivery, and on significant projects supporting the QAS. “While I won’t be an applicant for the position, I am delighted and privileged to assist in the establishment and commissioning phase of this enhancement for northern and western Queensland,” Gerard said.

“This is a new and exciting role established as part of the recent QAS Service Review to better focus on service delivery across Queensland, particularly in rural and remote areas.

“My aim is to ensure a legacy of strong foundations and framework for the next Northern Deputy Commissioner to build on.

“In the new model, there are two Deputy Commissioners, one in South Queensland and the other in North Queensland,” he said.

“The southern position is based at Kedron and the new northern position in Townsville, supporting the area from Rockhampton and north to the Torres Strait and west to the Northern Territory and South Australian borders.

“This new position will focus on the unique and challenging dynamics of the service delivery framework in concert with the relevant regional Assistant Commissioners and District Directors.

“In essence, the position will more definitively link the policy, operational and remote and rural health delivery models to the existing Hospital and Health Services and government agencies relating to primary health care matters and emergency management in regional Queensland.

“It will also help our existing service delivery model for remote and rural

patients to improve equity of access to health care.”

Gerard said he has been establishing the Office of the Deputy Commissioner in Townsville while the ongoing position is being prepared for advertising nationally.

“When it’s advertised, this role is expected to create significant interest, given its unique nature and opportunities to build on current foundations and keep pace with demand and improve service delivery models,” he said.

Over the past months, Gerard has travelled to Cairns, Townsville, Thursday Island and Weipa and Rockhampton to meet with the Assistant Commissioners to introduce the role and to forge collaborative working relationships with QAS’s partner agencies and stakeholders across the North and Western Queensland.

Gerard also recently attended a key strategic meeting at Rockhampton focusing on QAS operations in the state’s north.

“This meeting involved the three Assistant Commissioners, senior operational and Operations Centre personnel who reviewed and updated the QAS strategic plan relating to the priorities of North Queensland and the Torres Strait,” Gerard said.

“In addition, a delegation from the state and northern Cultural Safety Unit met to review key aspects of recruitment, education and retention of our valuable Indigenous Paramedic Program members to ensure we promote respect and understanding for country and culture.”

“The highlight of my Weipa visit was attending the Rural and Remote Health Advisory Committee meeting where we discussed the Rural and Remote Health and Wellbeing Strategy 2021-2026 and its deliverables, and other sustainable health-based projects, which have been developed specifically to improve access to health services for all in these rural and remote communities,” Gerard said.

“Having a seat at this table provides the QAS with greater opportunity to align more closely with allied health, Queensland Health, rural doctors, Retrieval Services Queensland as well as our rural and remote communities.

“Our involvement with this working group among others, also provides more opportunity for our rural and remote workforce to get involved in preventative and educational programs in communities.”

Summer 2021–22

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QAS paramedic wins $8Ok EMF research grant Queensland Ambulance Service (QAS) Critical Care Paramedic Wayne Loudon has secured an $86,623 Emergency Medicine Foundation (EMF) Leading Edge grant to investigate how technology can be used by paramedics in the field to improve early identification of severe head injuries, to ultimately reduce resulting disability and improve patient outcomes.

Head injuries are one of the most common causes of ongoing disability and the Australian Institute of Health and Welfare (AIHW) estimates around 107 people in 100,000 will have a traumatic brain injury (TBI) each year, and 20 per cent of these will be considered severe.

In 2008 alone, it was estimated there were 1,500 moderate and 1,000 severe cases of TBI. The long-term cost to the Australian population is approximately $1.2 billion.

QAS paramedics are often the first on the scene to assess those with severe head injuries and play a significant role in preventing a secondary brain injury.

the secondary injury and while there are things we can do, they’re all very much based on temporising actions like using medication to reduce brain swelling,” he said.

Wayne said currently, treatments are administered based on indirect clinical signs, like changes in pupils.

Wayne’s two-year EnTRAIN research project will investigate if EEG could provide ‘real-time’ information on the brain’s response to injury and in the future perhaps aid in the clinical management of this group.

“Current QAS treatment includes our High Acuity Response Unit (HARU) paramedics placing patients into a medically induced coma to reduce

Summer 2021–22

QAS paramedic awarded EMF grant

The study will involve the application of a small number of gel electrodes to the scalp and will not alter the high level of care provided.

and 75+ age groups, with older Australians having a three times greater incidence rate compared to the general population.

health professionals, rural generalists as well as emergency specialists, according to EMF General Manager Beth Chapman.

“For our patients and their families this study will not change the high level of care they receive – all they’ll experience are some little EEG stickers on their heads while they’re in the ambulance and it’s all very noninvasive,” Wayne said.

“The standard accident for an older person is a fall, and for younger people they’re often assaults or road traffic crashes,” he said.

“EMF invests in clinician-led research because those at the frontline of emergency medical care are best placed to develop practical solutions for a resilient and capable healthcare system,” Beth said.

“The project will be performed with the help of the Brisbane HARU team, which will be trained to perform a focused EEG acquisition.

“This research comes off the back of a “SPIDER Project” we did a few years ago with strokes – using an EEG to pick up when brain cells are ischemic (not getting enough blood).

“There is some evidence to show brain swelling and bleeding can be identified on EEG and we may be able to change how we treat people according to those changes, and of course we would be able to identify if patients are suffering any seizure activity after their head injury.”

Wayne said according to research, the risk of TBI is higher in the 15‑19

Wayne said while some EEG work was being done internationally on mild brain injuries, he believes this is the first time this technique is being used on severe TBI in the prehospital setting.

Wayne is in the final stage of a PhD investigating acute stroke care in the prehospital environment, so for him this research into TBIs was a natural progression to looking at other causes requiring neurocritical care.

Wayne and his team of co‑investigators (A/Prof Andrew Wong (RBWH), Dr Stephen Rashford ASM (QAS), Prof Emma Bosley (QAS), Frederik Tremayne (RBWH), Dr Daniel Bodnar (QAS) and Mark Disney (QAS)), is the second paramedic project to receive an EMF grant since the research funding organisation opened its Queensland Research Program to include nurses, paramedics, allied

“This extends beyond the hospital environment - ambulance and retrieval services work hand in hand with hospital-based clinicians, stabilising and transferring patients for urgent treatment.

“In 2019, Hugo Evison received an EMF JumpStart grant, for the project Clinician decision making in peripheral intravenous cannulation in emergency settings.

“JumpStart provides up to $40,000 seed funding for research involving new collaborations and research teams, with potential to lead to further funding from granting bodies.

“We hope this is just the beginning and EMF is very keen to support and encourage the continued growth in paramedicine research,” Beth said.

Thinking about taking on a research project?

EMF runs two grant rounds per year, click here (or type in https://bit.ly/3EbhEYE) to find out more about them.

In addition to Leading Edge and JumpStart, the Project grant provides up to $300,000 funding to larger projects with the aim of generating data to seek further funding from alternative sources.

This year, EMF launched the new Emerge grant for clinicians to develop research skills. Emerge grants provide up to $10,000 for projects that can be achieved within twelve months. The scheme features a streamlined application process and mentorship as key components.

EMF also introduced a Special Research Grants Program with support from the Motor Accident Insurance

Commission to empower frontline clinicians in regional, rural and remote Queensland involved in the management of trauma patients in their navigation of the research path.

The program aims to create an evidence base for the best emergency care of trauma patients, in particular road trauma patients, in regional, rural and remote Queensland, and to identify key barriers to optimal emergency care in these areas.

Summer 2021–22

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SPIDER wins QAS two CAA awards In November, the Council of Ambulance Authorities – Australasia (CAA) held its 2021 Virtual Awards for Excellence and the Queensland Ambulance Service not only won the category for Excellence in Clinical Practice, but also the highly‑coveted overall CAA 2021 Star Award.

Background

CAA’s Stephanie Hartley (L) and Chantelle Kaesler (R) travelled to Brisbane from Adelaide to present Steve and Wayne with the awards.

QAS Critical Care Paramedic Wayne Loudon along with Associate Professor Andrew Wong, Dr. Simon Finnigan, and Professor Vivienne Tippett, had researched new technology to help paramedics identify patients suffering a stroke.

This team’s findings (known as the Stroke Prehospital Informed Decision-Making Using EEG Recordings – or SPIDER) will not only significantly benefit Queenslanders suffering a stroke, but also to our paramedics to help them determine the best transport destination for these patients.

CAA’s awards team made a surprise visit later in the week from South Australia to present Wayne and our Medical Director Dr Steve Rashford with the two awards, both made by a local (South Australian) glass artist.

Summer 2021–22

Dr Rashford said he was proud the team’s excellent research had been recognised by the CAA and a panel of independent industryrespected judges from across the globe.

A huge congratulations to Wayne and the team for this outstanding achievement.

The original article about this research can be found in our Autumn 2020 Insight.

Or to read more about this research from the QAS staff portal click on the QR code.

QBANK Everyday Finalists

Claire and Elliott set a high bar as finalists Two Queensland Ambulance Service paramedics were finalists in the 2021 QBANK Everyday Heroes Awards.

St George Station Advanced Care Paramedic (ACPII) Claire Pass from the South West District and Brisbane Flight Critical Care Paramedic (CCP) Elliott Bates were both nominated for their outstanding service to the community.

QBANK recognises and celebrates the hard work, dedication and exceptional service of Queensland frontline and public service workers each year with its Everyday Heroes Awards.

As last year’s event was cancelled due to COVID-19 restrictions, this year’s event held on 7 October in Townsville welcomed nominations from 2020 and 2021, to ensure peoples’ efforts were captured and properly recognised.

The six award categories included Achievement, Ownership, Dedication, Working Together, Excellence and the Young Everyday Heroes Award.

Five category award winners each received a $1,000 cash deposit and $1,000 donated

to their preferred charity and the young Everyday Heroes award winner would receive a $500 bursary to assist with training and development.

Claire Pass was nominated in the category for Achievement in leadership within the service since moving out to St George and her work in the Fair and Inclusive Practice Network (FIPN) role.

Left

North Queensland Deputy Commissioner Gerard Lawler with Claire Pass.

Right

Elliott Bates.

Elliott Bates was nominated in the category of Dedication for his current role in the QAS, as well as his volunteer work outside of the service with Surf Life Saving Queensland.

Neither Claire nor Elliott walked away with the coveted award but being peer nominated and selected by a panel of judges to enter the finalist stage is entirely rewarding in itself.

A huge congratulations to Claire and Elliott as well as all emergency service and public service winners, nominees, and finalists.

Summer 2021–22

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QAS Chaplaincy Program a national first What started as a labour of love has resulted in a national and international precedent this year, with the QAS recruiting chaplains from within its own ranks to provide spiritual and pastoral care to staff and their families.

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As a result, 13 QAS chaplains can access stations and staff across the state without COVID-19 restrictions or lockdowns affecting face to face chats.

“With around 260 combined years in the service, our chaplains certainly understand the highs and lows of a paramedic’s life because we also live it.”

QAS chaplains are now based in stations across most of the regions to increase accessibility to the service including at South Johnstone, Ingham, Clermont, Burnett Coast, Birtinya, Maroochydore OpCen, Kenmore, Kedron Park, Southport (OpCen), Gold Coast, Toowoomba, Murgon and Miles.

The unique concept of recruiting an internal full-time chaplain, which then grew to a team of internally recruited chaplains, was the shared brainchild of QAS’s s Priority One Director Todd Wehr.

According to QAS’s Clarke Magele, Chaplain Executive Manager, SpiritualPastoral Welfare, the COVID-19 restrictions were keenly felt in various states and territories throughout Australia during the height of lockdowns with contracted chaplains unable to access stations to provide pastoral care to staff.

“Recruiting our own internal chaplains has provided immense benefits to our service,” Clark said.

“Firstly, we weren’t (and won’t be) affected by COVID-19 restrictions and secondly, as all of our chaplains are QAS staff – mostly operational paramedics – they share lived experience with our staff and know exactly what the demands of the job are.

“The idea came about with the retirement of our previous chaplain, Neil Proelecks, one of the Service’s two previous part time chaplains who had both been paramedics,” Todd said.

“We’d worked closely together for years and the idea grew from a discussion we’d shared about future provisions for the chaplaincy service.

“We identified the service really needed a full-time chaplain to match the demand, and that person needed to be someone who had worked within the organisation, who understood both the work and culture,” Todd said.

“We took our suggestions to the then Commissioner Russell Bowles, who was supportive and keen to get this project happening.”

Summer 2021–22

When Todd discussed these plans with QAS Peer Support Officers he discovered Clark, South Townsville’s then Officer in Charge, also held credentials as an Ordained Minister.

“Clark is very good at connecting people, and he embodies the type of person we wanted in this role – he’s highly respected as a paramedic and a highly respectful person to people seeking pastoral care or spiritual guidance,” Todd said.

Clark acted in the role in Townsville before being appointed full-time Chaplain, relocating with his wife to Brisbane in what he described was a big, but exciting change.

Todd said having Clark in this fulltime role was integral to growing the chaplaincy team.

“With Clark as our new ‘face of chaplaincy’ we saw significantly increased demand with people wanting to talk to him about issues they felt were separate to something they’d discuss with a psychologist,” Todd said.

“After looking at chaplaincy models from a statewide perspective we called for EOIs from staff, and we were thrilled with the response – more than 50

Chaplaincy program

people responded and all with valuable qualifications to bring to the roles.”

Clark said each of the 13 chaplains were and are still Peer Support Officers, and more chaplains may be brought on board next year. Chaplaincy, whilst starting to grow within the QAS, has not been without its challenges.

During Priority One courses in the past 1-2 years, some participants have been tentative about sitting in on the Chaplaincy session. Being tentative may be for various reasons - some may have had bad experiences or even sustained harm, and some may be of different or no faith. QAS Chaplains are compassionate, understanding, patient and kind, and some have their own unashamed faith journey. As a result, all Priority One course participants to date walk away surprised, validated and thankful for having sat in on the Chaplaincy session.

“Both the Chaplain Service and Priority One Service work in really well together and we will often refer people to the other if we think their needs might be better met by our colleagues, and this is why it’s handy for our chaplains to also be PSOs

– to provide a support wraparound for our staff,” Clark said.

“People don’t have to have a faith to chat with us, and many don’t.

“We see ourselves as being ‘peoplecentred’ – we are non-denominational, and we’re not gender, sexuality, culture or religion specific.

“People coming to us might want to chat about a job they’ve just been to which has challenged their beliefs, or perhaps they just want to talk about some personal issues, or perhaps they may want to talk about their faith – what’s important to us is being there to offer spiritual support to our people.

“Our Chaplains are a good mix of ages, genders, have diverse life and work experiences and come with various fields of expertise, whether it’s a theology or divinity degrees and even ordained ministers.

Our Chaplains Far North Region South Johnstone Station – Glenn Rigano ACPII Northern Region Ingham Station – Patrick Brown OIC and ACPII Central Region Clermont Station – Damien White OIC ACPII

In our shared QAS and chaplain roles, we do have a sound understanding of what we as first responders face in our everyday work challenge.

But best of all we’re great listeners and always up for a chat.”

For more information about the QAS Chaplaincy service, or how you can access it, click here.

Opposite

QAS Chaplains.

Above

Clark Magele and Todd Wehr.

Metro North Kenmore Station – Jordan Grice A/OIC and ACPII Metro North Kedron Park, Headquarters and Gold Coast – Geoff Hayes – State Communications and Quality Assurance Metro North Priority One, – Clarke Magele, Chaplain Executive Manager, Spiritual-Pastoral Welfare Darling Downs and South West Region Toowoomba Station – Ben Lawson CCP

Central Region Burnett Coast Station – Daniel Ollis ACPII

Darling Downs and South West Region Murgon Station – Clifton Proud ACPII

Sunshine Coast and Wide Bay Region Birtinya Station – David Ellaby CCP/CSO

Darling Downs and South West Region Miles Station – Rebekah Munn ACPII

Sunshine Coast and Wide Bay Region Maroochydore OpCen – Christine Takahashi EMD

Metro South and Gold Coast Region Southport OpCen – Shonara Selwyn EMD

Summer 2021–22

15

QAS welcomes HCC workforce into its ranks The Queensland Ambulance Service (QAS) has welcomed the Health Contact Centre (HCC) into the QAS “family”.

The HCC’s mid-year move from Health Support Queensland to QAS is part of the Department of Health’s Business Case for Significant Change which identified the organisations’ shared synergies and the potential to work more closely together.

The Director-General Dr John Wakefield described how the HCC is well positioned for the broader health system strategic agenda of virtual models of care and the ambulatory care reforms which QAS has a significant role as part of the rationale for the organisational change.

16

The integration process for QAS and HCC has commenced and will take time as enablement functions and governance arrangements are sorted through. The HCC is part of Corporate and Statewide Services and A/Deputy Commissioner, Steven Zsombok has been impressed with the diverse range

of public health, prevention, and primary care focused services the HCC delivers every day to Queenslanders.

Insight recently visited HCC teams at their Upper Mount Gravatt offices to find out more about our new colleagues.

healthcare services in Queensland and delivers more than 4,500 interactions with Queenslanders each day across our 20 statewide services, and that we deliver services via multiple channels not just phone.”

“Our virtual care services provide confidential health assessment and information services to Queenslanders 24/7 using phone – inbound and outbound, online, SMS delivery models,” Victoria said.

The HCC, with Executive Director Victoria Chalmers at the helm, now works closely with QAS’s Deputy Commissioner Corporate and Statewide Services and more broadly within the QAS. “The HCC is probably best known for our two public facing phone numbers – 13 HEALTH (13 43 25) and 13QUIT (13 7848), and more lately 134 COVID which is delivered in strong partnership with Smart Service Queensland, the whole of government contact centre,” Victoria said.

“What is not so well-known is the HCC is one of the largest providers of virtual

With Queensland vaccination rates now beyond the 80 per cent milestone which triggered the reopening of our borders to the rest of the nation, it’s likely three HCC services in particular will play a prominent role responding to communities’ health issues – general information enquiries, Triage and Contact Tracing, as well as all the bespoke services established as part of the response to COVID-19.

HHC’s 19 statewide services • Preventative Health

• General Health Information • Health Alerts • Intentional Contamination of food • COVID-19 response and vaccination implementation

• Quitline • Schedule 8 and Enquiry Service • Way to Wellness

• Communicable Diseases • Immunise Queensland • Contact Tracing • 13 HEALTH Webtest

• Self Management of Chronic Conditions (SMoCC) • Child Health • Child and parent advice • Termination of Pregnancy

• Acute Care • Ryan’s Rule Clinical Review • Missing Person Search • Triage Nursing

• Rapid Response Campaigns • Waitlist Management • Patient Safety and Quality notifications • Health Professional Access to The Viewer Opt Out • yourQH

Allied Health

Other Services in partnership with Smart Service Qld

Summer 2021–22

Nursing Services

Welcome HCC

Triage service The Triage service responds to calls 24/7 and provides an over-the-phone nursing assessment of consumers symptoms or health concerns and then recommends the appropriate course of action - home treatment advice, referral to type of care within a timeframe, information, disease management and crisis intervention.

The team uses a clinical decision support system based on evidencedbased protocols to assist with the nursing assessment and advise of the appropriate care recommendations, rather than diagnosing the cause of the symptoms.

HCC Acute Care Nurse Unit Manager Catherine McIntyre said the team receives around 1,000 calls daily, with RNs taking 25-35 calls each shift. Most calls are received in the afterhours period and close to 77 per cent of consumers are recommended a non-emergency level of care.

“We take calls from people of all ages and areas of Queensland about everything – from a headache to an injury, to high temperatures or chest pain,” Catherine said.

“This service provides all Queenslanders with access to health

advice without them having to leave home, but if they need a doctor’s appointment, we can also direct them to a service in their area which they may not know about like an afterhours GP, or to a doctor providing telehealth appointments,” she said.

Catherine said callers will often say they think they might need an ambulance or should go to a hospital when an in-hours GP consult would ensure they get the care they need.

“On the other hand, we also take calls from people who should have called Triple Zero (000) but hadn’t, perhaps because they were in denial about

their health, didn’t want a fuss made, or didn’t want to worry their family.”

Catherine said Triage nurses assess around 15,000 consumers a year as needing an Ambulance service and warm transfer the caller through to QAS EMDs via Triple Zero (000).

Victoria said ultimately, her aim is for HCC RNs to be able to transfer consumers and their data directly with QAS EMDs to provide a better consumer experience, save duplication of data gathering and reduce the need for consumers to repeat their situation.

17

“Looking ahead we’d like to see an integrated model of care and services which would allow us to forward the patients through directly and seamlessly have all the relevant information automatically populate into ProQA,” she said.

Above

Some of the Triage team getting into the Christmas spirit, including: Clinical Nurse Brett Larsson, Director of Nursing Pam McErlean, HCC Executive Director Victoria Chalmers, Acute Care Nurse Unit Manager, Catherine McIntyre and Registered Nurse Wendy Afflick.

Left

HCC also has First Nations Registered Nurses Tamara Newell and Kisha Spearritt on hand to ensure cultural safety for Aboriginal and Torres Strait Islander consumers.

Summer 2021–22

TURN OVER

Contact Tracing The HCC Contact Tracing capability was formed before COVID-19 to compliment the role of Queensland’s Public Health Units but has greatly expanded to meet the needs throughout the pandemic.

The HCC’s agility to reallocate resources and use existing systems and models of care to rapidly respond to urgent contact tracing needs has proven beneficial over the past two years.

Communicable Diseases Public Health Nurse Alix Jaquest said in addition to COVID-19 tracing, the team traces various communicable disease outbreaks such as measles, varicella and hepatitis C. “The team stood up early on during the pandemic and then was requested to provide extra contact tracers during the Victorian outbreak last year and since then it has provided support to other states and New Zealand,” Alix said.

“Extra support was needed by the community to ensure consumers understood quarantine directions, isolation requirements, when and where to be tested and ensuring people had arrangements for grocery and medication deliveries and other social and emotional supports.”

18

Meanwhile in Queensland, the HCC teams were also being swamped with callers asking about COVID-19 symptoms, border closures and health directions, Quitline support for

Summer 2021–22

people in hotel quarantine, vaccine options, queries about misinformation and vaccination bookings.

Alix said the Contact Tracing team also swung into action during Queensland’s outbreaks.

“The team worked on several high-profile clusters, including the early cruise ship outbreaks, the Hotel Grand Chancellor outbreak, Indooroopilly School and St Thomas Moore College outbreaks and several domestic and international flights with infectious people on them,” she said.

From January 2020 until November 2021, the Contact Tracing team made 10,908 phone calls and sent 10,674 texts or emails to either people infected with COVID-19, or high‑risk contacts.

“Part of our role is to be the response point for the public and to action areas of concern in a clinical environment,” Alix said.

“A great part of our ability is to provide assistance and education and generally promote ways to help people prepare for and reduce their exposure to COVID-19, to give them the best opportunity to keep their families healthy and safe.”

Below

HCC’s Communicable Diseases team who also carry out contact tracing.

Welcome HCC

HCC’s COVID-19 Response stats from January-June 2021

Victoria said overall, the HCC’s COVID-19 response from January 2020 until November 2021 has been part of responding to a total of

TOP FIVE ENQUIRY TOPICS

1.1 MILLION CALLS FIELDED

Queensland travel and entry restrictions

about COVID-19 via the 13 HEALTH, 134 COVID and 13GOV phone lines.

During that time the were about: Entry and quarantine requirements for interstate arrivals Testing and test results Health directives Queensland Border Declaration Passes

The Triage service has responded to just shy of

100,000 CONSUMERS about COVID-19 related health matters and referred over

44,000 PEOPLE to get tested and assessed.

On 23 March 2020, the Triage team received

7,084 CALLS – a record for 13 HEALTH.

From January 2020 until November 2021 Victoria said there has been

MORE THAN 14,000 CALLS FROM COMMUNITY MEMBERS reporting suspected non-compliance with quarantine and health directives, and close to

15,000 CALLS FROM PEOPLE registering for emotional support and practical assistance with grocery and medication deliveries.

“Now the borders are open our teams are getting ready to stand up when COVID-19 clusters appear for contact tracing and to support Queenslanders who are COVID-19 positive with health assessment and advice,” Victoria said.

“On behalf of the HCC I’d like to wish our QAS colleagues a wonderful festive season and we look forward to working alongside you in the coming years.”

Summer 2021–22

19

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Waterfall reunite

Mates keep Craig alive after waterfall accident It was a meeting months in the making and one that will stay with Flight Critical Care Paramedic Lauretta Howarth forever, reports Madolyn Sushames.

In November, Lauretta and the crew from QG Air met Craig Simpson, a patient they cared for in March after he fell down a waterfall and sustained critical injuries.

“We had to be careful with every step we took, it seemed like everything was happening frustratingly slow,” Lauretta said.

“Craig really shouldn’t have lived,” Lauretta said.

If it wasn’t for Craig’s mates, however, the operation would have taken double the amount of time.

“He was critically injured and unconscious on arrival with head and multiple other injuries.”

Lauretta said it was one of the most challenging scenes she had ever worked on.

“There was so much more to it than we realised,” she said.

“It was wet, slippery, steep, uneven, rocky terrain with fast flowing water very close by which was not only hazardous but very noisy.”

When they reached Craig, they saw just how badly injured he was.

“We had to weigh up whether to do a high-risk procedure in a high-risk environment, or just get him out of there,” Lauretta said.

She said they wanted to minimise their time on the ground, but with Craig’s condition rapidly deteriorating, the decision was made for them.

“Extricating Craig via helicopter winch without a secure airway was too great a risk, given he was unconscious and hypoxic with multiple injuries.

“We made the decision to secure his airway via Rapid Sequence Induction and decompressed both sides of his chest,” Lauretta said.

Then the challenge of extricating Craig began.

Lauretta said from the moment Craig fell, his mates kept him alive by pulling him out of the rapids and keeping his airway open until help arrived.

21

“They worked so well together to keep him alive, even the girl who made the Triple Zero (000) call was so calm, there was no panic and she answered every question by passing information up the track.

“They communicated really well to get us the information and to look after him,” she said.

Reflecting on the job, Lauretta said it was amazing no one was injured.

“It wasn’t until we looked back at the photos, we realised how close to another fairly steep drop-off we were,” she said.

“They risked their own lives to help their mates, and that’s pretty incredible.”

Craig has made a full recovery from the terrible fall, apart from one black spot in his left eye and a few scars to tell the tale.

Lauretta has since used this job in her professional development sessions.

“We learned so much from this job and it has really planted some learnings in my mind I know I’ll take to other jobs that may influence my decision making there,” she said.

“That day cemented to us all it was his mates and the people that were there that really saved his life.”

Top

Craig Simpson and his mates who helped save him with the rescue crew from QAS and QG Air. Middle

Craig’s family was told to say goodbye while he was in hospital.

Bottom

Preparing to air-lift Craig.

Summer 2021–22

Priority One Caring for yourself as we move toward COVID recovery

Work

The past 18 months has been a challenging time for many, and COVID-19 could best be described as a natural disaster.

It is in times of disaster Queensland Ambulance Service (QAS) personnel are often at their busiest.

Unlike most disasters, however, that have a finite timeframe where it is very busy for a relatively short period followed by a clear and well-practiced recovery phase, the continuing impacts of COVID-19 have proven to be long lasting with limited opportunity for control.

Fortunately, we are beginning to see some light at the end of the tunnel. States are beginning to open their borders and overseas travel is beginning to look more and more possible. Although we are nearing some form of normality, this may be a time when people are feeling more exhausted and burnt-out.

Fam

22

ily

While there has been significant planning in place with Queensland Health and the QAS to deal with multiple potential scenarios during COVID-19, this is often not seen by frontline personnel and can lead to a greater feeling of uncertainty and anxiety.

Given QAS personnel are used to working in low-control and sometimes highly unpredictable environments, they tend to have a lot of natural and helpful coping strategies.

Some of these strategies have unfortunately been difficult to enact due to COVID-19 restrictions including travel restrictions. As a result, many staff may feel overwhelmed and stressed. It is for this reason, that now may be a helpful time to evaluate what strategies you are currently using.

Wellbeing strategies are a lot like a wagon wheel. If you only have one or two spokes on a wagon wheel, then the wheel is not very resilient and may result in a bumpy ride. If one of those spokes breaks, then the wagon may stop completely.

The more spokes there are, the more resilient the wheel and the smoother the ride. The wheel can afford to lose one or two spokes and still keep going. Likewise, the more wellbeing strategies you have, the more resilient you will be and the more likely you will be able to deal with the bumps of life.

Summer 2021–22

Although Family and work may be very important aspects of your life to you, it would only take one of these areas to be impacted before the wagon wheel may break.

You may already have a lot of strategies but may not be aware of them. An important aspect of having wellbeing strategies is to ensure you enact them in an intentional manner.

In this busy and sometimes complicated world it is easy to lose track and not recognise when we do something that is helpful to us. Your strategies need to be specific to you and it is important you custom make your wagon wheel to ensure it meets your needs and suits your lifestyle.

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Multiple spokes can ensure that if you lose one or two of your strategies, then you still have other ones available to you.

23

Some examples of helpful strategies that I use are:

1

Take some time out

As we get busier it’s easy to get caught in the trap of thinking there is no time to relax. It can be helpful to have intentional and sometimes scheduled time to just rest. This may involve watching a movie, reading a book, playing a game or just relaxing. Even if it is only 15mins, this can be helpful.

2

Nature can nurture

Research has shown spending time in nature can lower our stress levels and release endorphins. This may look like a walk in the wilderness or the beach or even just a walk to the local park or spending time in the garden.

3

Connect with family and friends

4

Explore other interests

In uniformed professions it is easy to overidentify with your work role. But work is something that you do, not who you are. It can help to have hobbies completely unrelated to work. This may be a creative outlet, a hobby, exercise, or sport.

5

Reward yourself

Treat yourself to small rewards in an intentional manner.

This doesn’t have to be something big; just buying a coffee or getting your hair done because you deserve it. Sometimes we do things out of habit and don’t reflect on the significance of what they may mean to us.

Make a note of every time you give yourself or receive a small reward.

Make time to spend with friends and/or family. Humans are hard wired for connection with others. Spending time with friends allows us to support each other, relax and release endorphins and lower our stress levels.

Summer 2021–22

TURN OVER

6

10

Get moving

Exercise has been proven to be good for our physical and mental health. It helps release endorphins and reduce cortisol. This doesn’t mean you have to run a marathon, as a brisk walk can be just as helpful. Some people are motivated to exercise individually, and others seek motivation exercising with others, like yoga, CrossFit, martial arts or playing team sports.

7

Recognise what you can and cannot control. It’s easy to get caught up with things you have absolutely no control over. Because you have no control over the situation, all that happens is you become more stressed and anxious. If you are stressed, angry or anxious about something, reflect on what is it about that situation that you can have control over. Sometimes talking about this to someone else may help. Recognise the control you can have and acknowledge what you cannot.

8

24

Show compassion

Be there for others (when you feel you have the capacity). Research clearly shows a sense of compassion and satisfaction from helping others can be protective for our own wellbeing. Sometimes, however you may feel overwhelmed yourself and may need to care for yourself. Reaching out to others for help can be positive for you and for them.

9

A healthy diet is important for our physical and psychological wellbeing. Research around the Mediterranean diet has demonstrated that it is not only good for your cardiovascular health but can also be good for your psychological health, lowering the risk of depression. Talking to a GP, Nutritionist or Dietician can be helpful.

11

Let go

Self-compassion

Many people in helping professions are great at showing compassion toward others but often struggle to show compassion toward themselves. This can be very difficult to do, but a good start is to recognise how often we say to ourselves that we “I should” or “I have to” or “I must”. These types of statements that we say to ourselves are simply judgements and don’t offer any real solutions. Try recognising when you say these things and replace them with “could”. Instead of saying “I should mow the lawn” try saying “I could mow the lawn”. Now you have options. You can now decide if you want to mow the lawn or perhaps it is better to have a rest.

Eat healthily

Value sleep

Sleep has proven to be essential to wellbeing.

Again, this can have physical and psychological consequences. We know effective sleep can lower the risk of anxiety, depression, and PTSD. The recommended amount of sleep is at least 7.5 hours.

How much sleep do you get?

12

Work helps

Work may at times be stressful, but if balanced with other strategies, can also be highly protective. It helps to provide a sense of satisfaction, routine, connection, mastery and challenge. But, it’s helpful to recognise what you can and cannot control at work. There may be some things that you have a lot of control over and other things you may have no control over or may only be able to influence. When you are feeling stressed, take note of what you can or cannot control and recognise work is only one of the things that you do.

These are strategies I use, but they may not be for everyone.

What are the spokes on your wagon wheel? How many spokes do you have? What would happen if a couple of your spokes break? Do you have other ones to buffer the ride?

Despite having multiple strategies in place there may still be times when you are not okay. It can be helpful to acknowledge that sometimes it’s okay to not be okay.

Sometimes we may need time, support from others, or access to professional support.

Our psychological wellbeing is no different to our physical wellbeing; we can do all the right things but sometimes we may still get sick. Please know the Priority One services are available to you and your immediate dependent family members. You can access Peer Support, Chaplaincy, or internal or external professional confidential counsellors.

To access Priority One counsellors, click here to link to Priority One on the QAS portal, or if you’re using an external search engine, click here or use this link: https://bit.ly/3m8AeKT

Summer 2021–22

Jilly our Fred Awards Finalist

Congratulations to Jilly our Fred Awards Finalist Rockhampton Emergency Medical Dispatcher (EMD) Jilly Alloway received her finalist trophy recently for The Fred Hollows Foundation’s – ‘The Fred Awards 2021'.

The Fred Hollows Foundation is a not-for-profit organisation honouring the late ophthalmologist and humanitarian Fred Hollows, whose mission was to end avoidable blindness.

Fred worked tirelessly restoring sight to people in outback Aboriginal communities but also internationally, treating people in poorer countries, empowering their communities by founding factories to make intraocular lenses needed to restore sight, and trained surgeons to continue his work.

These annual awards search Australia-wide for a Humanitarian of the Year; someone who cares for others in a decent, practical and no-nonsense way – just like Fred did.

Fellow EMD Carrie James nominated Jilly, and shared some of the words from her nomination:

I have never met someone so genuinely kind, thoughtful, caring and with such integrity. Jilly has worked for many years as an Emergency Medical Dispatcher for the QAS, helping people through what are sometimes the worst, most frightening moments of their lives, yet she has never become jaded, but is always compassionate to the core. If anyone in my family was hurt, frightened, dealing with a loved one dying or suicidal, Jilly is who I hope would be on the other end of the phone. And she’s the same with her colleagues and friends. A friend of hers recently had a motorcycle accident and is in an induced coma. Since he has no family or close friends, she has helped organise a group to pay his rent, so he doesn’t lose his house. She takes on extra tasks at work purely out of the goodness of her heart and is always not just ready to lend a helping hand but is attuned to and always willing to comfort colleagues having a tough shift or life. She is truly one in a billion!

Jilly Alloway with her Fred Awar

d Finalist trophy

Jilly’s reaction to her nomination and finalist success is also heart-warming.

“I was (and still am) completely overwhelmed by the love and support that has been sent my way via comments on Facebook as well as via emails from work colleagues,” she said.

“This whole thing has been a really lovely experience for me.”

Jilly joined the QAS in 2007 as a fresh-faced EMD after working in rural Queensland as a governess and station hand after growing up on cattle stations in the state’s far southwest.

This shaped her career choice with the closest medical help via the Royal Flying Doctor Service (RFDS) which would either arrive from Charleville 640kms away, or Broken Hill, 727kms away.

Jilly said she always liked helping others and felt being an EMD was the right role for her.

Summer 2021–22

25

Patients reunite with paramedics on Restart a Heart Day It’s not often paramedics and emergency medical dispatchers (EMDs) get to reunite with cardiac arrest survivors, so officers jumped at the chance to meet their patients on Restart a Heart Day on 16 October, reports Madolyn Sushames.

Restart a Heart Day is a global initiative to raise awareness and educate the community about how to deliver effective cardiopulmonary resuscitation (CPR) and use automated external defibrillators (AEDs) properly.

Top right

Paramedics Nicholas Abrussi and Alysha Borowski (right) with patient Gary Campbell and wife Denise Scott.

Bottom left

26

Paramedics Jack Williams, Allison Boehm and Carley Carney with Vicky Rogers and her dad David and son Ledger.

Effective CPR saved 69-year-old Gary Campbell’s life after he suffered a cardiac arrest while driving near his Blacksoil home with wife Denise in July.

Denise called Triple Zero (000) immediately and EMD Emily Gordon talked Denise and bystanders through CPR until paramedics arrived.

Paramedics Nicholas Abrussi and Alysha Borowski said this immediate action saved Gary’s life.

Nick said each intervention was on key and the crew did a fantastic job being able to get Gary back after he rearrested.

“Just before I went on holidays, I did two or three cardiac arrests in my last week and none of them survived,” he said.

“But that’s the unfortunate reality as only 10 per cent of people survive out-of-hospital cardiac arrests.

“So, it’s really good to be able to meet with Gary and his family and see he’s doing well.”

On that day paramedics delivered 10 shocks and transported Gary to the Princess Alexandra Hospital where he received an implantable defibrillator, and he is now well on the road to recovery.

Across town, more QAS paramedics reunited with a young mum from Elimbah who suffered a cardiac arrest at home in October 2020, just two months after giving birth.

Vicky Rogers and her family celebrated Restart a Heart Day by sharing their story with the officers who helped save her life.

It was just after midday when Vicky collapsed, and her dad noticed her breathing was abnormal, so he called Triple Zero (000).

EMD Kaitlyn Airey helped him stay calm and talked him through CPR until paramedics arrived.

Vicky was technically without a heartbeat for 12 minutes and after four shocks and medication, she finally regained a heartbeat.

These stories serve as a timely reminder for us to keep spreading our message in the community of the three simple steps to saving a life:

1

CALL Triple Zero (000) immediately

Summer 2021–22

2

PUSH hard and fast on the chest with CPR

3

SHOCK the patient with early defibrillation

PTOs’ special delivery

PTOs’ proud moment as Mum-to-be makes an entrance We know our Patient Transport Officers (PTOs) go above and beyond in their jobs, but Cairns PTOs Rachel and Connie took it one step further in November helping to bring new life into the world, reports Madolyn Sushames.

The PTOs were waiting to pick up a patient from the transit lounge at Cairns Hospital when they heard someone yelling, ‘a lady’s in labour, a baby’s coming!’.

The ladies said they sprang into action, grabbing towels, running after the nurse out the door to find a mumto-be had just arrived at the hospital and was standing in the foyer’s doorway in the late stages of labour.

“Just as we stepped around the corner, the Mum, Caroleena had delivered the baby herself and was lifting him up to her chest,” Rachel said.

27

Rachel and Connie went to work, covering Caroleena and bub with the towels, helping her into a wheelchair and taking her upstairs to the maternity ward.

It wasn’t until they were in the lift that they stopped to ask what the baby’s gender was.

“It was a little boy!” Rachel exclaimed.

“Caroleena was very lucky she made it at that time, everything went so quickly, he was her second baby, and her labour progressed a little bit faster than they thought it would.”

Thankfully, our PTOs were in the right place at the right time and were able to put their training into practice.

“We were the first ones to do our certificate IV in Health Care in Brisbane, …that was our first big job,” Rachel laughed.

Cairns Senior Operations Supervisor Leon Oliveri praised the ladies for their quick thinking and high level of patient care.

A memorable moment not only for the family, but for our PTOs as well.

Congratulations to Caroleena and Luke on the safe arrival on baby Mateo!

Above

PTOs Connie and Rachel with baby Mateo and proud parents Luke and Caroleena.

“That’s not normal business for our guys but we do appreciate what they did,” he said.

Summer 2021–22

Farewell

HARU Drs Claire and Ben Tell us about a case which will stay with you… (one of your wins)

Dr Claire Bertenshaw When did you start with QAS? January 2021.

Where were you working beforehand?

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I came from the Emergency and Trauma Centre at the RBWH. Previously I had been working at LifeFlight and Caboolture Hospital ED.

What were you expecting this work to be like?

A brand-new experience that was both clinically challenging and fast paced. I was expecting to feel out of my comfort zone but knew I would be supported.

It has lived up to expectations.

Tell us about some of the differences you’ve noticed the most…

The teamwork that ensures when you come to a scene despite never of meeting the treating paramedics before. Everyone just gets in and does their part to get the job done and do what is best for the patient.

Summer 2021–22

A man with severe anaphylaxis with cardiovascular collapse from a wasp. We treated him as per QAS anaphylaxis protocol and he had a great outcome. It may sound simple but working in a hospital we don’t see such presentations from the outset.

It was a rewarding job as what we did, although basic cares, they were time critical and had a huge impact on his outcome as he was so unwell on our arrival.

What did you enjoy the most about your time with us?

The genuine caring staff who are providing exceptional patient care at the heart of their clinical practice. Also learning how to drive an ambulance!

How will you remember your time with QAS? It has been a fantastic year of new experiences and learning that absolutely flew by.

I have a new understanding of paramedicine and the prehospital field. Additionally, the colleagues I have worked with have become wonderful friends.

Where are you off to next?

I am continuing with QAS half time providing medical consultation and support in the communications centre and clinical hub. I will also work parttime at LifeFlight and in Emergency Medicine.

Farewell HARU Drs Claire and Ben

Dr Ben Aston When did you start with QAS? I started with QAS in early February 2021.

Where were you working beforehand?

I have spent most of my career working in Metro South Health.

I was working at the Princess Alexandra Hospital before coming to QAS.

What were you expecting this work to be like?

I was expecting a lot of time on the road heading to jobs to assist crews in the setting of trauma or sick medical patients. Much of the medical management is similar to that which I have done in hospital, however the move into the prehospital setting including complex or multi-casualty scene management has been the biggest change.

Tell us about some of the differences you’ve noticed the most…

Moving away from the controlled environment of the emergency department – it doesn’t rain, the lights are always on, there aren’t busy lanes of traffic. The prehospital environment is a different entity entirely… not too long ago I was caring for a patient in a car on its side at 2am, on a country road, in the dark, it was raining, and he was down an embankment…

Tell us about a case which will stay with you… (one of your wins) I helped look after a 30-year-old personal trainer who came off his motorbike one rainy night and crashed through some bollards down an embankment.

He had a very badly broken compound femur and ankle fracture. He deteriorated during re-alignment of his limbs and extrication from scene, requiring a blood and plasma transfusion en route to hospital. He was still very unstable in ED and received many more blood products on arrival to hospital and during his operations. Only a week or so later, he left hospital on crutches to start his recovery process.

What did you enjoy the most about your time with us?

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The nature of the people who I had the pleasure to work was one of the most enjoyable aspects. To be surrounded by intelligent, team orientated, flexible, and easy-going staff was an absolute pleasure. It made even the hardest days, and toughest jobs, manageable.

How will you remember your time with QAS? I will remember a band of people who pull together with humour and teamwork to provide excellent care under some of the most challenging situations.

Where are you off to next?

I finish at the end of January and will be moving to Toowoomba to work for LifeFlight.

Summer 2021–22

QAS paramedics head bush for smaller scale exercises Queensland Fire and Emergency Services (QFES) and Queensland Ambulance Service (QAS) piloted a smaller, lighter group course in a bush setting in October as part of their Disaster Assistance Response Team (DART) training.

QAS Geebung-based Emergency Management Unit’s Capability and Engagement Operations Supervisor Steven Robertson said this series of two-day courses called Operation Farmstay were part of 20 held over the two-year DART certification cycle.

Steve said this series of courses was held over two days at Pilton on a privately-owned property where two paramedics joined teams of firies, camping out and retrieving manikins dropped out in the bush.

“The scenario developed for this site was that a parachutist had dropped injured to the ground and needed to be retrieved and to find them, their GPS location would be given to the group just before setting off,” Steve said.

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“The teams then had to get the patient to the extraction point as quickly as possible in the safest way.

“It was a great experience demonstrating the inter-operability between our paramedics and the firies – they’re the experts with the stretchers, and we’re the experts with the patient care.”

Steve said the teams were on site for two days in full deployment conditions from the moment they got on the bus at 7am at QCESA until they returned home at the end of the next day.

“It was a great chance for the teams to get used to their personal equipment, including backpack with first aid for themselves, go bags – a snatch and grab bag including passport and overnight provisions which travels with them – living off ration packs, and learning how to use chain saws – it’s all about being self-sufficient on these deployments,” Steve said.

“The course provided the additional opportunity for our teams to test our equipment’s operational suitability.

“Living in a confined and difficult environment over those two days provided a real-life experience, particularly as heavy rain during the final course left a lot of water and mud around – exactly what it would be like if we were working in a cyclone hit area.”

Summer 2021–22

QAS on Exercise

QAS on exercise: Operation Goldfish A team of paramedics were on hand to try out the new ‘Rail Utility Site’ at the Queensland Combined Emergency Services Academy (QCESA) in October, joining more than 60 participants from allied agencies in a major field exercise.

Donated by Queensland Rail, the retired three-carriage train recently joined the impressive collection of training props collected around QCESA and Operation Goldfish provided the first opportunity for emergency services to get their hands on the new toy.

The scenario, a Queensland Rail train colliding with a Brisbane City Council bus, was played out in realistic conditions, including response times, live power issues and 90 patients requiring triaging.

Four QAS crews as well as multiple commanders and a CCP were active in the exercise with a focus on exploring operational command and control tactics as well as clinical triage skills.

The patients, role players from the Australian Defence Force, kept paramedics on their toes with some emotional acting performances and plenty of bloody moulage.

Speaking to Nine and Seven News as the exercise concluded, Metro South Acting Assistant Commissioner Matt Green said the realistic training was vital for emergency services.

“This gives us an opportunity to practice and the more we practice the better we get at it,” he said.

“These large-scale scenarios provide all emergency services and other stakeholders greater confidence and cohesion when responding to real-life major incidents.”

Prior to the Rail Utility Site at QCESA, Queensland Rail would host similar exercises on the live rail network in the early hours of the morning.

A decommissioned train in the Academy’s backyard means training can now be conducted in a safe and controlled non‑operational environment.

The Electric Multiple Unit (EMU) train was decommissioned this year after more than 12 million kilometres on the Queensland Rail network.

Summer 2021–22

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Job swaps

Could a change be as good as a holiday?

Danielle Nixon How did you make it happen?

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What station are you normally attached to?

Coolangatta, Gold Coast

What made you think about swapping jobs? / Why were you interested?

There were a few different reasons for me. Prior to working for QAS I spent a bit of time in outback Queensland and loved it! I've always been really keen to get back out and experience it as a paramedic, especially at a single officer station as I expected there would be different challenges to those faced when working in metropolitan areas. In addition to that, during COVID it's been difficult to travel and doing a swap seemed like a good way to get to see some of the state... so I thought let’s make it happen!

I was unsure about committing to a term transfer and so I sent an email out to the North West District and asked if anyone would be interested in doing a job and house swap with me for a few months. Lilly from Mount Isa and another paramedic from Karumba were both keen and the process was easy from there. The dates lined up for us all and so we contacted our OICs and HR in both Regions. Everyone was really helpful, and it didn't take long to get approved… we were stoked!

How did you manage the logistics around it – was it a home swap as well? And how did you organise this?

The house swap made things easy and worked out really well! Lilly lives with another paramedic in Mount Isa, Ren (and her dog, Reggie!). Ren’s been a legend since I arrived, super welcoming and made me feel right at home, she also got me involved in some Isa social activities which was great.

Summer 2021–22

How have you found the experience?

Overall I’ve loved it – it’s been a real adventure! As well as being in Mount Isa and Karumba I’ve got to relieve at some single officer stations as I had hoped to. I’ve met some awesome people along the way. The crew out here have been great to work with and always keen for adventures on days off!

What were the similarities / differences?

Workload would be the big difference, as the Gold Coast is pretty flat out every day and we spend a lot of time at hospital. It’s definitely been nice to have a few months working at a slower pace. However, there are different challenges rurally, you have to think about logistics a lot more and where the patient needs to be for definitive care, often we fly people out to tertiary hospitals. It took me a little while to work out who needs to be where and how to go about it! Unlike the Gold Coast, there’s not always a CCP around

Job swaps

Opposite, left and right

At Normanton airport transporting a lady in labour to Townsville.

At her Gold Coast Metro - Blake Murray, Caz Sydenham with Danielle.

Lilly C Moser

Top and bottom

A Mount Isa camel near the station loves a pat and a carrot.

Sunset from Karumba Point beach.

What station are you normally attached to?

Mount Isa Station, North West District

What made you think about swapping jobs? / Why were you interested?

I have been working in rural health for about 3 years and I love it! Buuuutttt…

A season working on the Goldy offered a number of obvious personal and professional benefits. Being originally from the Sunny Coast, of course I miss my family, friends and the beach, and also a few of the creature comforts like Asian fusion, express shipping, barista coffee, recycling, Sunday trading, etc.

Clinically, I wanted to experience the contrast of metropolitan work.

to back you up, but we do have the consult line to use. I’ve found in the smaller communities QAS has a really good relationship with the clinic and hospital nurses who are on call and are happy to help out!

Tell us about one of your stand‑out experiences during the swap…

Working at the Burke and Wills Campdraft and Rodeo was a pretty fun experience! Another paramedic and I drove 300km from Mount Isa (apparently, it’s Queensland’s most remote rodeo) and posted up for the day in the 40-degree heat. We only had a few minor injuries to deal with and so got to watch the various events (the bull ride looked pretty

33

brutal so stoked no one got hurt there!). Not something you’d get to do on the GC!

What are some of the learnings you’ll take home with you from this?

Google maps is not always so reliable - If you want to avoid getting lost and/or bogged (ooops) listen to the locals’ advice!

Where to from then?

When my time in Mount Isa is up, I'm taking some annual leave and hitting the road for five weeks then back to the Gold Coast for me! It’ll be hard to leave but there are aspects of both Regions that I love!

Above

Lilly with local Doomadgee children.

Summer 2021–22

TURN OVER

34

How did you make it happen?

(How did you find each other? And how long did it take to organise – what was your process too?)

“Anyone keen on a few months at Cooly?” Danielle flicked an EOI to the entire North West District, and I was in the perfect position to take her up on the offer. It was actually not a lengthy process. We are both pretty amiable, and this attitude seemed reflected by management/HR. Although I suspect Danielle may have done a lot more than her fair share of the groundwork!

I mostly liaised with my Senior Operations Supervisor who did a lot of the negotiating on my behalf (shout out to Dan!)

How did you manage the logistics around it – was it a home swap as well?

We both drove to/from Mount Isa and have been living in one another’s home, borrowing each other’s camp gear and surf boards.

How have you found the experience?

Tell us about one of your stand‑out experiences during the swap…

The whole experience has been great!

A change is as good as a holiday; seems true. Everyone involved has been super supportive. Of course, it helps that Dani is a bit of a legend.

During my time on the Gold Coast, my partner and I attended a paediatric vs car as the primary crew. Super, super cool to see the definite impact of world class prehospital care on what would have been ultimate morbidity or mortality. Within 30 minutes of the incident, the young chap had HARU transporting Code 1 and was on his way to a capable paediatric facility.

It was a job where against all odds, everything ran smoothly. I was able to follow up in the following days and found that the patient is unlikely to suffer any long-term deficits. Cute kid and grateful parents. I couldn’t help but think ‘anywhere else in the world…’

What were the similarities / differences?

Ultimately, people are human wherever you’re working. They get sick and hurt themselves and appreciate kindness all the same. Yet somehow working in remote health is a truly unique experience and I feel so privileged to have begun my career in this setting. The biggest difference from an ambulance perspective is resourcing.

The sheer volume of people living metropolitan fosters a fairly remarkable level of health resourcing.

There is certainly no HARU in the North West. A single CCP works a rotating roster. ACPIIs often utilise the consult line and air retrieval services for patients of high acuity presentation. There is a real sense of family/community amongst station, including management. You have more down time at station to check on your mates and often share a meal. No meal overtime money though! And a summer day could crack 45 degrees.

Summer 2021–22

What are some of the learnings you’ll take home with you from this?

Don’t forget to push Off Stretcher ;)

Where to from then?

I’m looking forward to Christmas with my family and will be back in Isa early next year.

Above, left and right

Lilly with her North West Executive Manager Brad Hardy.

Lilly with Hilary Wood at the Mount Isa Rodeo.

Clermont exercise

Clermont exercise ensures regional communities practice emergency responses A spectacular car crash exercise staged at Clermont Aerodrome not only provided local emergency services an opportunity to practice tactical responses, but also a valuable learning experience for Clermont State High School seniors.

The exercise called “Hooning”, was organised by Queensland Ambulance Service (QAS) and included Queensland Police Service (QPS), Queensland Fire and Emergency Services (QFES), Clermont Hospital and Isaac Regional Council (IRC) with some help on the side from Bravus and the Country Women’s Association.

According to organiser QAS’s Clermont Officer in Charge (OIC) Damien White, the exercise held on 18 November in the aerodrome’s car park was designed to enhance the response and capabilities of the emergency services individually and cooperatively.

“The crash scenario involved four vehicles,” Damien said.

“Car one with a driver and passenger had been doing ‘donuts’ in the carpark covered by unleaded fuel, loses control and spins sideways into three cars parked around the carpark.

35 “The car hits and crushes a spectator against one car, with a driver and passenger inside, and sends spectators flying onto and under vehicles.

“All up, nine people are involved in the incident with four encapsulated (unable to get out) in their vehicles,” he said.

“It was a very busy scenario with QPS scene controllers managing a crime scene including a death on scene.

“QFES’s role was to ensure scene safety, to extricate patients with potential spinal and head injuries and our role was to triage and treat casualties with limited personnel and resources.

“Years 11 and 12 students from Clermont State High School were also included in the exercise to act as patients and to watch the scenario.”

Damien said this was the second last day of school for the Year 12 students.

“The Clermont emergency services team believes witnessing a realistic major road incident in the local area will provided these students with food for thought for making positive choices around their road safety in the future,” he said.

“For the Clermont Ambulance Station, the exercise enhanced participants’ knowledge in the roles and responsibilities involved in the tactical aspect of a multi casualty incident (MCI) and use of the SMART Triage System.

Summer 2021–22

Exercise Learnings: Challenges

“The exercise provides emergency services team members with experience dealing with an emergency incident with increased workload in these areas with an aim to improving patient outcomes for the community.”

Damien said a large gazebo was provided for the students about 10 meters from the scenario so they could watch the emergency service teams in full action.

Eight students participated in the scenario as casualties and the Clermont Hospital’s Nurse Unit Manager (NUM) moulaged them.

“Clermont Hospital hopes to take a more active role in future exercises and is keen to put its team through their paces when continuing the care of casualties from an incident,” Damien said.

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“Throughout the event the team leaders from each emergency service found time to speak to the students about what they were doing and why.”

Bravus Mining and Resources sponsored the event with lunch catered from our local CWA (Country Women’s Association) at the CWA hall where we also had a debrief with the students.

Special thanks must go to the students who acted as our casualties; Jake Saal, Riley Keene, Makayla Looker, Raleigh Priestley, Georgia Shannon, Kya Shaw and Connor McCabe.

The exercise was well received by all involved, with a lot of great learning achieved. There is great benefit in organising this scale of exercise every second year, but it can only be achieved with the great support of the community.

Summer 2021–22

• We had reduced attendance from Auxiliary QFES members who would have needed to take time off work to attend.

• We (QAS) were still operational throughout exercise as our officers were working eight days on and six off were on fatigue until just before the event. During this time, both oncoming officers were called to a crash about 100 km away two hours before the event which delayed the event.

• Managing the heat in Central Queensland • State Emergency Services (SES) indicated it was disappointed it was unable to be involved due to recent work searching for a missing person in the area.

Positives We had tremendous support from local organisations including: • QPS who provided great assistance with organising logistics • Auxiliary QFES who took time off work and are committed to the exercise goals • G.R Motors donating the vehicles and delivering them to the exercise site at the aerodrome • A local metal scrap yard who donated time to clear the site at no charge • Isaac Regional Council allowed us use of the aerodrome carpark and provided ‘First aiders’ to assist in the exercise • Bravus who provided funding for the lunch and hall hire • The CWA who provided the hall and catered for all involved in the exercise • And finally, Clermont State High school – who during a time when Year 12s are normally focused on their graduation and formal, saw the exercise as a great opportunity for future life learning

Tips for smaller stations wanting to conduct their own exercise • Start planning early (we started just after Easter) to ensure the right people and organisations are involved to be able to set aside time.

• Have a number of people on board to help with planning.

• Use clinical support and operations teams to help create suitable and realistic scenarios – do “call a friend” for advice.

• Talk to schools very early to fit in with their curriculum if you want students involved.

• If taking photos, seek permission from anyone likely to be in the pictures.

Clermont exercise

Hit

P1 – 19 YO GCS 10 (e2 v3 m5), BP 110/60, P 102, R 32 (C-Spine tenderness - large scalp laceration) minor bruising to shoulder

Red

Bystanders Between stationary vehicles

P6 – 20 YO GCS 15, BP 140/90, P 98, R 30 (# Closed Left ankle obvious deformity – poor neuro and circulation – # Right Wrist angulation)

Yellow

Crushed

P2 – 16 YO GCS 3, BP 00/00, P 0, R 0 (boggy mass – occipital - Eye swollen closed – racoon eyes) (Open # Lower limbs)

Black

Bystanders Under Stationary Vehicle

P7 – 19 YO, GCS 14, BP 85/65, P 106, R 22 (Deep Lac to Occipital with Haematoma; R Upper Arm deep Laceration – Lower limbs and Backgeneralised abrasions and bruising)

Yellow

Car 1 – Donut vehicle Passenger

P3 – 20 YO GCS 3, BP 170/100, P 58, R 14 (Closed head injury – large haematoma R Temporal – mastoid bruising – bleeding from R

Red

Bystanders

P8 – Bystander -21 YO, BP 110/83 P 130, R 26 (minor laceration/abrasions to left temporal/Parietal area) (Left forearm and elbow abrasions

Green

Car 1 – Donut vehicle -Driver

P4 – YO GCS 12 (e3 v4 m5) BP 90/, P 114, R 40 (c spine tenderness and rib/ chest pain – increasing chest wall expansion, Bruising to right ribs – reduced R air entry tracheal deviation -Tension Pneumothorax)

Red

Bystanders

P9 – Bystander - 20 YO, GCS 15, BP 135/90, P 92, R 20 (Dislocated Left shoulder, # left clavicle, Laceration to left elbow, minor abrasions to left and right hands)

Green

Car 2 Stationary Vehicle

P5 – 20 YO GCS 15, BP 140/90, P 98, R 20 (#L Lower leg, multiple superficial lacerations,

Yellow

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P6 P7

Spectator Gazebo

P5 P8

P1 P2

P9 P4

P3

Summer 2021–22

First IPP and CALD uni grads In November, Queensland Ambulance Service celebrated its first university graduates from the Indigenous Paramedic Program (IPP) and the Culturally and Linguistically Diverse (CALD) Paramedic Program, which enable students to complete their full Bachelor of Paramedic Science degree.

Both program models support several academic milestones allowing cadets to choose their own path to provide healthcare to community.

QAS Cultural Safety Unit’s Executive Manager Patricia Murray said the IPP began in 2012 to provide education and employment opportunities to Aboriginal and Torres Strait Islander peoples, while building trust and safety with our Aboriginal and Torres Strait Islander communities.

“The CALD Paramedic Program was created in 2016 and shares the same ethos and education framework as the IPP, but focuses on empowering peoples from other culturally diverse communities,” Trish said.

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Both programs were updated in 2018, in partnership with Central Queensland University, to maintain training currency and to include the mandated requirements to complete a Bachelor of Paramedic Science.

“When the IPP began in 2012, six cadets were stationed across three communities in Far North Queensland and Thursday Island,” Trish said.

“Now our program supports 45 cadets across 29 Queensland communities and we’re still growing,” Trish said.

“Before university degrees were mandatory, eight cadets graduated as paramedics through the IPP and all now proudly represent the QAS, some now in leadership roles and supervisory positions, building capacity in their communities and leaving a legacy for the next generation.”

IPP cadet Jessee Day, and CALD cadet Tareta Siakisini (known to his friends and colleagues as T.J) are QAS’s first to graduate with their Bachelor of Paramedic Science qualification.

Deputy Commissioner Dee Taylor-Dutton presented them with their red paramedic epaulettes and caduceus and said this was a proud moment for QAS.

Summer 2021–22

“To see the Indigenous Paramedic Program and the CALD Paramedic Program continue to succeed is tremendous,” Dee said.

“These officers are already fabulous role models in their communities, and they are inspiring future generations from our Aboriginal and Torres Strait Islander communities and Samoan community.

“These two Programs are helping the QAS provide culturally appropriate and responsive services for Aboriginal and Torres Strait Islander people and Samoan people in our communities, which is pivotal towards closing the gap in health outcomes.”

Jessee started with the QAS in 2016 working in patient transport in Rockhampton and was devoted to becoming a paramedic.

He joined the Indigenous Paramedic Program at South Brisbane Station in 2018.

Trish said right from the start, Jessee worked hard to fulfil his dream.

First IPP and CALD uni grads

“His peers tell us what an exceptional clinician he’s become and a valued member of the South Brisbane team,” Trish said.

“T.J also features in our latest series of Ambulance Australia and we are proud to show the nation his exceptional level of clinical care and compassionate nature.”

Jessee has also completed a Certificate III in Non-emergency Patient Transport and a Diploma in Paramedical Science.

T.J has also completed a Certificate IV in Healthcare and a Diploma in Paramedical Science.

T.J started in 2016 with the QAS and was one of our first two cadets to join the CALD Paramedic Program.

At the same ceremony, Dunwich’s Honorary Ambulance Officer Anthony Galea was presented with his Ambulance Technician epaulettes as part of his training in the IPP.

“T.J’s station is in the heart of his own community at Woodridge, and throughout his time in the Program he has been a humble, willing, and keen cadet, always going above and beyond,” Trish said.

“When T.J was asked how he feels to be a part of the Program, he responded ‘I feel blessed – Samoan people often become labourers and factory workers and sometimes it is hard to access education and other opportunities, but this Program has given me an opportunity’.

“T.J is a true leader, supporting and motivating others with their learning journey, telling them to pull their socks up when the need arises and bringing good moral and comradery to the team.

“Anthony started his career with QAS as an Honorary Ambulance Officer in 1996 in his hometown of Dunwich, Minjerribah – Stradbroke Island,” Trish said.

“Since then, he’s worked in several locations across the Metro South district in both the acute and non-emergency side of the organisation.”

Trish said Anthony joined the IPP earlier this year and he is now stationed full time at Dunwich.

“Anthony’s dedication to ambulance services has confronted him with challenging decisions, such as relocating from his home country, family, and community to be able to work full time for the QAS,” she said.

Anthony is also a community Elder and a member of the QAS Aboriginal and Torres Strait Islander Leadership Committee.

Through his lived experiences, he is helping to guide the QAS in pivotal decisions to improve services for Aboriginal and Torres Strait Islander peoples and communities.

Anthony recently obtained his Certificate IV in Healthcare and a Diploma of Paramedical Science.

Opposite

T .J (middle) and Jessee (right) our first CALD and IPP Bachelor of Paramedicine graduates with Ambulance Technician Anthony (left).

Above, top row from left to right

Jessee and his family with Aboriginal Elder Uncle Norm.

Anthony with his partner Narelle and colleague Jess.

T.J and his family with QAS Chaplain Clark Magele.

Above, bottom row from left to right

The trio with Deputy Commissioner Dee Taylor-Dutton ASM with Acting Deputy Commissioner Stephen Zsombok.

The graduation was a full family celebration.

Summer 2021–22

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Time to Get Ready for La Nina The Sunshine State is no stranger to natural disasters, from catastrophic bushfires one month to unprecedented flooding the next, and now the Bureau of Meteorology has declared La Nina is on us, so get set for wet and wild weather.

Get Ready Queensland is a year-round Government‑run program helping our communities prepare for natural disasters.

Your location and where you live can largely determine which natural disaster you’re faced with and when.

There has already been severe storms and flash flooding across many parts of the state throughout spring and summer, which usually brings with it a rise in road traffic crashes and rescues.

As part of this campaign, the Queensland Ambulance Service (QAS) is asking residents to Get Ready now and help emergency services this storm and cyclone season by reducing unnecessary risks.

In October our St George paramedics attended the ‘Get Ready Balonne’ event to educate the community about who to call in an emergency and discussed the dangers of storm damage.

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There has also been plenty of safety messaging go out on social media about the dangers of floodwaters and reiterating ‘If It’s Flooded, Forget It’.

QAS staff will be out caring for the community during natural disasters so we’re calling on all our personnel to be prepared not only at work, but also at home.

Left column, top and middle

Flooding in Stanthorpe, November 2021 Left column, bottom

If It’s Flooded, Forget It Above

QAS Paramedics at Get Ready Balonne event

Summer 2021–22

Get Ready Queensland

Here are some tips to help you Get Ready for storm and cyclone season.

1. Know your risk The first step to getting ready is to understand your risk.

• Do you know which disasters you are most likely to be impacted by?

• When they are most likely to occur?

• What are the likely risks to you, your family, home and other assets?

The more informed you are about the type of risks you could face, the better prepared you can be. The easiest way to find out which natural disasters affect your area is to contact your local council who should be able to tell you if your property is at risk of flood, bushfire, cyclone or storm tide.

Find your local council here.

Questions to ask your insurer

1

What disasters does the policy cover?

2

How do they define each disaster?

3

How much will the policy cover?

4

It’s also a good idea to contact your insurer to make sure you’re covered when disasters do strike.

Don’t forget to take photos – if you don’t have photos of your property – even your car, bike or boat, take some and save them. These can be added to photos after any disaster to be able to provide extra information to your insurer.

5

2. Prepare a Household Emergency Plan Now you know what you’re in for, it’s time to plan. Having an emergency and evacuation plan will ensure everyone in your household knows exactly what to do in an emergency. Sit down with the family and go through each person’s role if a severe storm or natural disaster hits or if you need to evacuate due to potential flash flooding or fires.

Gather all your important documents and keep them in one central place close to hand if you must leave quickly.

Create your Household Emergency Plan here.

It’s 15 minutes now that could save a life later.

3. Pack an Emergency Kit Finally, all that’s left to do is to pack an emergency kit in case you and your family are unable to leave your home for an extended period of due to a storm, flood, or cyclone.

Your emergency kit should contain essential items that will last for at least three days such as water, non-perishable food, important medications, spare batteries, charges and more.

For a comprehensive list of items to include head here.

Follow these three simple steps to Get Ready for storm and cyclone season and ensure you and your family stay safe.

6

7 8 9

Does the policy provide enough insurance to cover the cost of rebuilding your house and any extra costs you might incur?

Is your insurance adequate to cover the replacement of your possessions?

Are your possessions covered for damage caused by potential local hazards such as storm, cyclone, flood and bushfire?

In what circumstances will the insurer reject the claim?

Are you covered for the cost of temporary accommodation if your home is unhabitable?

Does pre-existing damage caused by a previous natural disaster or lack of home maintenance impact eligibility of insurance claim payouts?

Summer 2021–22

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Legacy helps fills Craig’s sails Craig Leto may have learned from an early age he can’t control the wind, but he can certainly adjust his sails and QAS Legacy has been proudly supporting him through this journey.

Craig and his mum Louise recently travelled to Brisbane from their home in Tasmania for Craig to receive his dad Zachary (Zac) Leto’s posthumous National Medal.

Zac, a popular member of the service, had started his career in 1993 as an honorary Ambulance Officer and worked his way to Intensive Care Paramedic, serving the Yeppoon, Rockhampton and Emerald communities. Zac and his three‑year‑old daughter Ashley were both tragically killed in a car accident on 11 May 2005. Louise was pregnant with Craig at the time of Zac’s passing.

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QAS Legacy Scheme has been providing ongoing support to ambulance family members left behind like Craig and Louise.

Now, he’s 15 (going on 30 according to Louise) and Craig said QAS Legacy has helped him pursue this dream.

We last caught up with Craig as an 11-year-old in 2017 and his love for the ocean has continued with the years.

“Because of QAS Legacy I’ve been able to attend a great school, go on school camps, and I’ve also been attending Australian Navy Cadets, which is something I really love,” Craig said.

“QAS Legacy also provided me with pretty important tools like a laptop for school, so I’d really like to thank those who contribute to it, for helping to make my dreams a reality.”

Louise said Craig has a long list of plans for his future.

“Some of his plans include becoming a Marine Technician in the Royal Australian Navy,” Louise said.

“He loves sailing, so he wants to win line honours in the Rolex Sydney to Hobart Yacht Race, and the Rolex Fastnet Race. Sailing is what he lives for.

“The contribution QAS Legacy provides makes the world of difference to me

Summer 2021–22

financially as the money I receive for Craig goes directly to his school fees for the year and I am able to send him to a fantastic school which has helped shape him into an amazing young man.

“It would not have been possible for me to make this choice for him without this support,” Louise said.

QAS Legacy

“QAS Legacy provides much more than money to us though; it provides Craig with a connection to his Dad and the service he loved so much,” Louise said.

“QAS was Zac’s driving force, and Craig has inherited the same drive and tenacity his Dad had.

“Recently we had the opportunity to meet with some of Zac’s former colleagues and they told stories to Craig about his Dad. “Craig was humbled and proud to hear the level of respect people had for Zac, so having QAS Legacy as part of our lives keeps that invisible string connecting us to an organisation that was family to me and for this, I’ll be forever grateful,” Louise said.

“Craig and I have a wonderful life and we are settled and happy. Zac and Ashley are in my heart and my thoughts every day. We were somehow spared in the accident that took Zac and Ash – I don’t know why or how – but one thing I do know is that Craig is going to achieve great things in his life, and Zac and Ash will be sitting on his shoulder going along for the ride.”

“We’d both like to thank everyone who contributes to QAS Legacy, you make a momentous difference to lives.”

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The QAS Legacy Scheme is predominantly funded through fortnightly tax-deductible payroll contributions from current members.

Other funding comes from bequests and tax-free donations, often from retired ambulance officers, Local Ambulance Committees or members of the public expressing their appreciation for work done by ambulance staff in the community.

You can help QAS Legacy Scheme continue to provide its valuable programs by donating. Donations of $2 and over are tax-deductible and will assist with the ongoing support of all ‘QAS Legacy families’.

Opposite, above

QAS Legacy’s President Jamie Rhodes-Bates, Vice President Amy Gomes, Craig Leto and his mum Louise with QAS Legacy Board Member Drew Peters.

Opposite, bottom left

Craig with his own sailboat.

Opposite, bottom right

Craig holds his dad Zac’s medal next to his name at Kedron’s Roll of Honour.

Background

Craig has joined the Navy Cadets.

Summer 2021–22

Schoolies returns to the Goldie With a COVID-related hiatus in 2020, Schoolies 2021 was back on the Gold Coast and did not disappoint!

With 53,000 students completing Year 12, 16,000 young adults congregated to Surfers Paradise to celebrate their completion of high school – 12,550 were registered under the safer‑schoolies initiative.

This year’s cohort was labelled one of the best behaved in Schoolie’s history and Senior Operations Supervisor and Forward Commander of the QAS Schoolies response Justin Payne echoed that sentiment.

“We’re finding this is probably one of the best cohorts that we’ve had to deal with during a Schoolies response,” he said.

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“We had 400 people through the Emergency Treatment Centre (ETC), but even then, the intoxication levels aren’t as high as those in previous years.”

The ETC is an initiative put in place many years ago as part of an Emergency Department avoidance strategy and is a joint response between Queensland Health and the QAS.

It’s a makeshift mobile hospital on the Surfers Paradise Esplanade designed to be able to treat people in the busy Schoolies precinct to reduce the need to call ambulances into the area and transport patients to the busy Gold Coast Hospitals.

The most serious injury treated at the ETC occurred on the first weekend and was a dancefloor injury with a teen breaking a leg. Traumas, minor cuts and grazes and intoxication were the most common presentations.

Out of the 400 people who came through the ETC during the weeklong celebrations, only 23 required transport to hospital and our fantastic First Responder Group provided exceptional support to the teams and patients.

The months of planning from The Safer Schoolies project team as well as Queensland Police Service, Queensland Fire and Emergency Service, Queensland Health, SES, Red Frogs, and other affiliated agencies, ensured the Gold Coast precinct was an incredibly safe space this year for school-leavers to enjoy their special celebrations.

ETC presentations – Schoolie’s Response YEAR

TOTAL

2018

532

2019

463

2021

400

Above

Bicycle Response Team officers on the beat during Schoolies.

Summer 2021–22

Background

Queensland Health and QAS Emergency Treatment Centre staff.

Volunteers return to Imbil

Ambulance First Responder volunteers return to Imbil Imbil’s volunteer Queensland Ambulance Service (QAS) First Responder community group is being reformed after more than six years’ hiatus.

Trained in first aid, First Responder volunteers are dispatched in their own vehicles, with equipment provided by the QAS, to provide initial emergency medical care to patients in their local community while the ambulance is enroute. They might, for example, splint a patient’s leg, or may initiate CPR on a patient who has suffered a cardiac arrest.

Kenilworth Ambulance Station Officer in Charge Wayne Thompson said the previous First Responder group had become inactive from a lack of members, but a new group has been formed and is seeking more volunteers.

“So far three new First Responder volunteers, Kieran Broome, Christopher Daniell and Theodore Pierce are being trained by QAS paramedics to provide emergency first aid and care to people while waiting for an ambulance,” Mr Thompson said.

tree‑changed permanently to the area three years ago after buying land in the region a decade ago.

In his free time, he teaches and trains aerial circus, but has still found time to volunteer for the QAS. “I knew the region fairly well, with my parents owning a property up this way since we were kids,” he said.

“I really enjoy volunteering and think it should be everyone’s responsibility to give back to their community where they can.

“While I volunteer in my professional life, it’s nice to have some balance and do some volunteering to potentially benefit anyone in the community.

“Several more people have recently come forward indicating their interest too.”

“When I weighed up the classic volunteering opportunities with rural firefighters, SES or ambulance, First Responders called out to me the most as I really like thinking and problem‑solving on the spot and enjoy the human interaction.

One of the latest First Responder recruits Kieren Broome is an occupational therapist and company owner who

“Given I’m balancing two careers, parenting, and life, I needed a volunteer opportunity with some flexibility to be on

or off shift which this role also provides,” Mr Broome said.

“Time will tell, but I’m hoping being part of the Imbil First Responder group will give me a chance to feel I did what I could (rather than just hearing after the fact about terrible things that happen) and made my local community a safer and greater place to live.”

Mr Thompson said the first training and meet and greet night was held on Monday 22 November from at the Imbil Fire Station.

“We welcome anyone interested in joining this great team and QAS Sunshine Coast District Director Tony Hucker joined the meeting along with members of our training unit,” he said.

Back row

Julie Foster QAS Clinical education, QAS Sunshine Coast Director Tony Hucker, First Responders Kieran Broome, Rebecca Logan, Theodore Pierce.

Front row

Imbil First Responders Brydie Weston, James McDonald, James McDonald, Chantal Richings, Ellen Richings, with QAS OIC Kenilworth Wayne Thompson.

Summer 2021–22

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Things you need to know: The implications of salary packaging a motor vehicle through a novated leasing arrangement, including tax savings will depend on your individual circumstances. The information in this publication has been prepared by RemServ for general information purposes only, without taking into consideration any individual circumstances. Before acting on any information or entering into a novated leasing arrangement, you should consider your objectives, financial situation and needs, and, take the appropriate legal, financial or other professional advice based upon your own particular circumstances. The Queensland Government strongly recommends that you obtain independent financial advice prior to entering into, or changing the terms of, a salary packaging arrangement.

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Remuneration Summer 2021–22Services (Qld) Pty Ltd | ABN 46 093 173 089 (RemServ)

Reports

OpCen Reports Insight’s OpCen Reports highlight examples of outstanding responses to Triple Zero (000) calls by our dedicated staff at Operations Centres around the state.

Maroochydore

Brisbane

Sean Alexander

Simon McInnes

When Maroochydore student call-taker Sean Alexander picked up a call from the anxious daughter of a man who had fallen and had facial injuries, he could never have predicted the path this call would take.

Brisbane Clinical Deployment Supervisor (CDS) Simon McInnes made a very positive impression on an intellectually impaired patient feeling suicidal and very anxious. Due to high demand, there were no resources available to respond when his call first came in. As a result, the patient was left in the care of his support worker pending the arrival of paramedics.

The caller initially reported her alert and breathing father, had fallen, and had “really bad blood coming from his head”. The caller also reported her father was holding a paint can at the time of the fall and he had paint “all in his eyes”.

Sean immediately provided haemorrhage control instructions and continued through ProQA (the Triple Zero (000) script prompting EMDs use). But the patient’s condition deteriorated very rapidly with the patient going from alert to unresponsive and breathing ineffectively.

Click here to listen to the call excerpt.

With only 15 mentored shifts under his belt, Sean did an excellent job of guiding the panicked callers through CPR. The caller was initially resigned to the fact that nothing could be done for her father. Sean was able to quickly gain control of the call, establish the breathing was ineffective and get “hands on chest” as soon as possible. The HARU on scene reported that “he has done an excellent job!”

Call Lesson This call demonstrates the importance of call control.

On multiple occasions the callers expressed that they “could not do CPR” or that “there was nothing they could do”. Through Sean’s use of repetitive persistence, encouragement, and explanation of his actions he was able to get control of the call and commence CPR. It also reminds us that it is important to give the instructions for CPR and other lifesaving interventions and not to ask for permission from the callers to do so.

Simon made a call back to the patient to determine his current condition. Simon noted the patient was writing his thoughts in his diary, but he still wanted some help. Simon assured him “we would get the paramedics around as soon as possible” at which point the caller sounded quite excited asking “Will that be you?”. Simon advised him it would not be him, but some other paramedics and asked “Is that ok?”. He then closed the call by letting the patient know it was good to talk to him and wishing him all the best.

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Throughout the call the patient was calm, compliant, and very polite. Simon’s choice of words and tone soothed the patient and helped him remain calm until the paramedic arrived on scene. Simon’s call had such a positive effect, that the patient remembered his name and took the time to write Simon a card thanking him for helping him and wishing him a lovely day.

Call Lesson The way you choose to engage with our patients makes a difference. Whether it is delivering a baby, performing CPR, reassuring someone who is scared, or making a call back. What you do every day does make a difference in a patient’s journey. We must be mindful each call is a new call, and each caller deserves our best, regardless of what the previous calls we have had might have presented.

We are pleased to report Sean passed his competency validation on his very next shift.

Summer 2021–22

TURN OVER

Brisbane

Donna Claffey

Vanessa Kew

Southport EMD Shonara Selwyn did an excellent job sorting the chicken from the egg when she received a call for a patient who had fallen on the ground and was not responding.

Mental Health Liaison Clinician (MHLC) Vanessa Kew provides OpCen staff with an insight into how MHLCs manage warm transfers and calls to patients experiencing a Mental Health crisis.

Brisbane EMD Donna Claffey displayed a high degree of compassion and empathy when she received a request for service from an alcoholic who desperately wanted help.

The initial request for service came in from QPS via ICEMS for a first party caller threatening suicide. Vanessa called the patient to establish what’s happening for the patient and how best she can help.

Due to her level of intoxication the caller struggled to provide her exact location details and phone number but continued to beg Donna for help. From the moment Donna answered the call, her compassion for the caller was evident. Donna displayed a consistent approach of care and concern with her, demonstrating excellent communication skills to reassure her. Knowing the caller was in a somewhat desperate and confused state, Donna got the caller to describe what she saw around her and used google maps to help visually confirm the patient’s actual location.

Call Lesson

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Brisbane

Donna demonstrated no judgment or bias towards the patient. Donna further advocated on behalf of the patient by accurately recording her incident comments so as to not create potential unconscious or implicit bias by OpCen Staff and responders reviewing the incident.

Summer 2021–22

Click here to listen to the call excerpt.

Call Lesson Vanessa has extensive Mental Health training and her access to the Consumer Integrated Mental Health and Addiction (CIMHA) application; however, it is the genuine empathy and compassion that she demonstrates that keeps the caller on the line and engaged with Vanessa until help can arrive.

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

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Rural Outback and Remote Paramedic Conference 26 – 27 May 2022

Student Conference July 2022

2021

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Find out more paramedics.org/events @ACParamedicine

Summer 2021–22

HARU Report

Dear Stephen,

My name is Bianca Jones. On 11 April this year you and other Queensland Ambulance Service paramedics came to our home at 71 Eighth Avenue, Kedron after my husband found our son Nik (Nikias) unconscious and not breathing in the gym/shed.

QAS Medical Director Dr Stephen Rashford recently received an unexpected email from the parents of one of our patients.

Bianca Jones and Mathew Umina wrote to Steve after the death of their son Nik, a Year 12 student at Kedron State High School whom they described as a kind, caring and considerate young person who loved soccer, travelling and basketball, and who was always happy, smiling and sharing a joke.

Bianca said he seized every opportunity that came his way and faced challenges with courage to overcome them. Above all he loved life and enjoyed it to its full.

Bianca and Mathew gave Steve their permission for Insight to publish her letter and to discuss Nik’s case.

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Steve said this was an incredibly sad case for everyone involved.

“This is a beautiful, heart-felt letter and it really affected me,” Steve said.

“It really shows how our actions have lasting downstream effects, not only on our patients, but also their families, friends and communities.”

Nik’s family is raising funds to develop a family room in ICU at the Royal Brisbane and Women’s Hospital. Currently there is no room available for parents and or families to use while they have a loved one being treated in ICU. To find out more or donate click here or type in this link: https://bit.ly/33yvkR0

It has taken me some time to write this email, even though I have often thought about what I wanted to say, I was not sure I could articulate it.

On the day Nik collapsed we have since found out he was conscious and jogging at 4.25pm, as he took a photo on his phone.

His father found him within 10 minutes of the photo being taken, an ambulance was called, and his dad commenced CPR. Then QAS arrived within four minutes of our call and were able to resuscitate him after working on him for over 40 minutes.

Nik was stabilised and then taken to Royal Brisbane and Women’s Hospital. Unfortunately, Nik suffered a traumatic brain injury and was declared brain dead on Wednesday 14 April and passed away on Friday the 16th, after we said our final goodbyes to him.

Since Nik has passed, we believe, based on cardiology reports, the ambulance report and his neurologist, that Nik passed due to Sudden Unexplained Death in Epilepsy; that his brain switched off his breathing which then led to him suffering a cardiac arrest.

We don't believe there is anything else any of us could have done to save him.

I am writing to you today to say thank you to the QAS for arriving at our house so quickly.

Nik and Mia.

We would like to thank you for instructing the paramedics to

Summer 2021–22

continue working on Nik, even though we knew his chances of living were minimal.

We would like to thank the paramedics for working on Nik and not giving up.

We would like to thank you for encouraging Bianca to go and be with Nik while the paramedics worked on him.

We would like to thank you all for supporting and helping us during a devastating and traumatic event for everyone there on the day.

We would also like to thank you for resuscitating Nik and giving him a chance at life.

Resuscitating him meant that his family in Victoria and his friends in Brisbane were able to come and spend time with him and say their goodbyes.

Thank you all for the priceless gift you gave us; five more days with our beautiful son, which we will be forever grateful for.

There are no words that will adequately express our gratitude for all that you and the other QAS officers did on that day.

I have attached a photo so you and the others can see what Nik looked like. I've also attached a speech I gave to his Year 12 cohort for you to read (if you want to) so you can see why he was such an amazing young man and why we are so thankful to you all.

Finally, we would appreciate it if you could pass along our message of thanks and gratitude to the paramedics who were at our home on the day.

Kind regards

Bianca Jones and Mathew Umina

Reports

CASE

A 17-year-old male was found in cardiac arrest by his family. He had been exercising on a tread mill, last being seen within 20 minutes of being found.

QAS Medical Director Dr Stephen Rashford The only background history was epilepsy, with the patient being physically fit. The case was attended by Advanced Care and Critical Care Paramedics, the High Acuity Response Unit (HARU) and the Medical Director.

The ACPs found the patient in asystole.

The family had undertaken very effective CPR. Initial treatment consisted of CPR, insertion of OPA that was rapidly upgraded to an LMA, IV access and adrenaline boluses per standard ACLS guidelines. The CCPs, HARU and Medical Director arrived shortly later.

The patient remained in asystole despite aggressive treatment. The initial ultrasound revealed no cardiac activity and no tamponade. Following 3mg of adrenaline, intermittent stuttering circulation was noted but not sustained.

The Corpuls mechanical compression device was applied as transport to hospital was planned, given the patient’s age, circumstances and discussions with the family.

Following another 6 minutes of resuscitation, sustained cardiac output was achieved. The cardiac output was supported by an adrenaline infusion. The LMA was exchanged for an endotracheal tube, following sedation and muscle paralysis. A gastric decompression tube was also inserted. The patient was transported to hospital with his mother present. The adrenaline infusion weaned just prior to arrival.

Case audit: 1. The aetiology of non traumatic cardiac arrest in adolescence is often cardiac in origin, with channelopathies and Hypertrophic Obstructive Cardiomyopathy (HOCM) being prominent. However, a broad differential diagnosis should be entertained.

2. It is critical to involve family in the resuscitation decisions. If possible, dedicate a clinician to explaining what is going and please bring family members into the scene in a

A Mechanical Che st Com

pression Device controlled manner.

(MCCD) being used by Whilst family and QAS staff on a manik in. friends appreciate our professionalism, we are still strangers caring for their loved one.

3. Our actions have a significant impact outside of our initial resuscitation and disposition goals. They are often critical for the closure for family members, and occasionally for families outside of these cases by Unfortunately, due to SUDEP mostly way of transplant programs. occurring during sleep the patient 4. In this case, it is thought the may well be deceased when they are likely cause of death was Sudden eventually found. EMDs and paramedics Unexplained Death in Epilepsy should have a high index of suspicion for (SUDEP). when the partner of an epileptic reports

SUDEP occurs most often at night during sleep when the death is not witnessed.

SUDEP does not include those who die in status epilepticus.

SUDEP occurs in about 1 in 1,000 adults and 1 in 4,500 children with epilepsy a year.1 While SUDEP is rare, epilepsy is not. In Australia, 250,000 people are currently diagnosed with epilepsy.

While the exact cause is unknown, current research is focused on the changes to brain function and the dysfunction of the autonomic nervous system as a result. Characteristic Postictal Electroencephalogram Suppression (PGES) has been shown to be prolonged in those who have died from SUDEP. These findings suggest that respiratory failure and lethal arrythmias may result from PGES. Some of the risk factors that have been include: • Increased frequency of tonic-clonic seizures • Poor compliance with medications • Males between 20-40 years • Early age of seizure onset • Sleeping or living alone • Drinking alcohol

being aware of their partner having a seizure while sleeping.

The best way to lower someone’s risk of SUDEP is to gain the best seizure control for them.

Reference and further resources: 1 Harden, C; Tomson, T; Gloss, D; Buchhalter, J; Cross, JH; Donner, E; French, JA; Gil-Nagel, A; Hesdorffer, DC; Smithson, WH; Spitz, MC; Walczak, TS; Sander, JW; Ryvlin, P (25 April 2017). “Practice guideline summary: Sudden unexpected death in epilepsy incidence rates and risk factors: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Epilepsy Society”.

Neurology. 88 (17): 1674–1680. doi:10.1212/WNL.0000000000003685.

PMID 28438841. https://epilepsyfoundation.org.au/ managing-epilepsy/health-and-wellbeing/ sudep/ https://www.epilepsy.com/learn/earlydeath-and-sudep/sudep

Summer 2021–22

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LARU Report The Queensland Ambulance Service (QAS) began its pilot program for the new LARU graduate certificate last year, starting with a small cohort of officers from around the state, reports Ashleigh Sharp ACP. While the previous LARU model had focused on metropolitan areas, this program also included a strong regional representation.

Many officers around the state applied for the program and I was lucky enough to be offered a position. We are just a little over halfway through the pilot program, and we are already using some of the skills learnt in our day-to-day roles.

52

Top right and bottom left

Ashleigh Sharp examines a “patient” during her training for her LARU graduate certificate

I was interested in the program for several reasons. I think in the current work environment, there is a very real need for the QAS to manage the increasing volume of jobs where patients have multiple clinical and social issues occurring, where hospital may not be the best destination.

The LARU officer role allows for a more holistic approach, greater assessment and in time, more treatment pathways.

The LARU program’s scope has significant potential for growth and future development as current trends indicate increasing numbers of patients with multiple clinical and social issues and these will continue to grow, meaning the skill set to meet this demand will also need to grow.

The course itself has been quite challenging yet rewarding. Each subject has been in-depth and supported by residential workshops run by experienced practitioners.

Assignments, forum posts and reading articles has been a staple of my life since I started.

While initially it was challenging to balance the coursework, full time work and home life, course convenors were able to adjust the program to better tailor it to the needs of adult learning.

Summer 2021–22

With this increased knowledge from our studies, we get to put into action what we’ve learnt on road.

The wound care module encompassed chronic wound management to acute injury care including suturing and has been one of the most enjoyable subjects to complete.

The wounds residential workshop involved stitching up pigs’ feet, skin tear management on chicken Maryland cuts, and removing fishhooks from fake skin. Wound kits were provided by the Region on completion of the module so we could use these skills in the community.

Every day, we see the benefits of what we’ve learnt, regardless of our current role.

We are better at identifying at-risk patients who need a tailored approach to their care.

We can see how patients with multiple, complex comorbid conditions are managed delicately to ensure each condition is not exacerbated by treatment of the others.

We also are improving at finding the subset of patients who would benefit more by avoiding an Emergency Department presentation for their condition.

Reports

Priority One Report: Mental Health Week 2021 Kirstine Britton, Executive Manager – Clinical Psychological Service, Priority One Staff Support

Priority One Regional Staff Counsellors across the state celebrated Mental Health Week (9-17 October) with a range of activities with QAS staff.

This year’s Mental Health Week theme was Take Time for Mental Health, highlighting the importance of taking time to demonstrate good self-care so that we can enhance and maintain our mental health and resilience.

In Metro South, Regional Staff Counsellor Jill Clarke, provided posters and information for staff on signs to look out for when we may be experiencing lower levels of mental health and suggested ways of supporting our mental health such as:

Get healthy

Connect more

Being active and eating well is good for your mind as well as your body

Spending time with other people is important to everyone’s mental wellbeing

Keep learning

Take notice

Learning new things can make you more confident as well as being fun

Paying more attention to the present and the world around you helps relieve stress and enjoy the moment

Show kindness

Embrace nature

Practising small acts of kindness, volunteering time, or simply helping a friend in need can help you feel more satisfied with life

Connecting with the outdoors and taking care of the planet is the best recipe for world wellbeing Source: Qld Mental Health Week

In Central Region, Regional Staff Counsellor Serah Steemson focussed on self-care with the help of Janelle Lawton from Gladstone Station who raised 36 plants from seed to give to her work colleagues to celebrate Mental Health Week.

Left

Gladstone CSO Janelle Lawson with Priority One’s Serah Steemson

Right

Biloela OIC Terry Zillman with Priority One’s Serah Steemson

Staff in Central Region also enjoyed making self-care chatterboxes and receiving kindness handouts, while enjoying some baked treats and a relaxing cuppa!

Priority One is here to help and staff services include: • Regional Staff Counsellors (RSC) • External Counsellors, who can be accessed by QAS staff, their partner/spouse, and dependent children • 24/7 Telephone Counselling Service – 1800 805 980 • LGBTIQ+ Support • Aboriginal & Torres Strait Islander Support • QAS Chaplaincy Service

Summer 2021–22

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Spotlight on the Fair and Inclusive Practice Unit, Office of the Commissioner The last edition of Insight Magazine provided an overview of FIPN. This edition will focus on the head office unit that supports the functioning of FIPN and other employee and culture initiatives.

The Fair and Inclusive Practice Unit (FIPU) is a newly established workgroup, located within the Office of the Commissioner. FIPU directly supports the QAS Commissioner in enacting culture reform and workforce engagement initiatives focused on diversity, fairness, equity, inclusion and respect.

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FIPU originated as an employee-driven approach to assist the executive to better engage, understand, integrate and respond to the views and needs of our diverse workforce. It is now an integral component of the QAS’s approach to modernisation of our workplace to meet the requirements of a professional workforce.

FIPU oversees and coordinates: the Fair and Inclusive Practice

Network (FIPN); QAS RESPECT; Workforce Forum; and Working for Queensland Survey.

Kelly-Anne McGruer

The Unit also collaborates and inputs into strategy, policies, procedures, and workplace practices related to flexible work, and diversity and inclusion more broadly.

This workgroup has organically grown in line with the developing portfolio and now has five dedicated positions, with further support provided by other roles within the Office of the Commissioner: Executive Manager, Fair and

Inclusive Workforce Reform Principal HR Consultant Senior HR Consultant Two Senior Operational Supervisors

(rotating roles filled by operational staff members) IPU takes an evidence-based approach to initiatives and collaborates daily with all levels within the organisation to support workforcedriven reform.

Reform is guided and informed through established consultative avenues including direct feedback

Jamie Rhodes-Bates

Chandni Kantaria

Summer 2021–22

via FIPN, the QAS RESPECT Steering Committee, QAS RESPECT Working Group, Working for Queensland Survey and Workforce Forums, as well as engagement with the Union and other internal and external stakeholders.

FIPU provides a direct link from the workforce to the executive in real time, promoting collaboration and engagement and ensuring the workforce’s innovative ideas and solutions are integrated into workplace practices, which further support the fairness and inclusion agenda.

Enacting initiatives that respond to the diverse values of a rapidly evolving workforce demographic, in a complex emergency health service environment, is undoubtedly challenging. Nevertheless, as part of a public service agency, FIPU’s approach is decided by the Commissioner in alignment with whole of sector and government initiatives, priorities, strategies, policies, procedures and legislation.

Renee Kane

Conor Fardon

Reports

Fair and Inclusive Practice Network (FIPN) Focus Areas

Flexible work

Parental leave, including working whilst pregnant and return to work

Transition to retirement Reminder to reach out for support or advice from a FIPN officer or directly contact FIPU regarding:

Workforce Forum

Working whilst caring

Respect at work Domestic and family violence

The QAS enthusiastically held its 13th Workforce Forum on 23-24 November in Brisbane.

With all the various challenges the COVID-19 pandemic has brought, the QAS has missed the opportunity of bringing our workforce together for quarterly face-to-face Workforce Forums.

More than 100 QAS staff* including union delegates, FIPN Officers, Indigenous Liaison Network Officers and Champions, Priority One councilors, District Managers and Executives shared their

insights to help shape the next QAS Strategy. There were many positive and solution-focused discussions around how we can better support and engage with our workforce to drive forward our culture and workforce agendas.

Key themes that emerged included culture, diversity, leadership, development, flexibility, professionalism, wellness, and safety.

* Selecting Forum Attendees: This was the first forum where many attendees were invited by a random selection process. This change to the way guests are selected is designed to ensure all employees feel empowered to contribute and guarantee a diverse cross section of input.

Professionalisation of paramedicine brought about many changes for individual employees but it also placed a clear onus on the organisation to evolve to provide a workplace befitting a professional workforce.

Q What do you think professionalism means for QAS as a workplace?

Q What else do we need to do to provide a professional workplace?

Q How can the organisation better support you in your role as a professional?

Please click here and share your thoughts.

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A special celebration surprises George When Insight last spoke to George Fennemore, the humble Edmonton paramedic was looking forward to receiving his 30-year Long Service Medal and 25-year National Medal. Cut to 12 November and George never expected the special ceremony that left him stunned and emotional when his colleagues, family and friends rallied to celebrate his milestone, Matthew Stirling reports.

Looking to recognise a quiet man with a big heart, George was kept in the dark by his family and peers as they planned an event fitting for a person who has given so much over three decades.

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George has garnered admiration far and wide during his time working across the Torres Strait, Cairns and Mackay, and this was reflected in a well-attended ceremony at the Edmonton PCYC which included former and current colleagues, past patients, family, and members of the community.

Describing it as one of the proudest honours of her career, QAS Far Northern Region Assistant Commissioner Michelle Baxter opened the addresses and spoke to the pride of the wider QAS Cairns community in seeing their local humble hero being acknowledged for an extraordinary career.

“George is a constant for us. When we see George’s smiling face, we’re all happy” The congratulations kept coming for George long after the final speech was delivered, as a QAS Facebook post saw around 180 supportive comments from QAS staff, family and even former patients recognising George’s distinctive smile.

NITV, 7 News and the Cairns Post all captured the day in moving tributes aired on their respective networks.

Summer 2021–22

George’s special celebration

And what did George think about all the fuss?

“I’m a bit overwhelmed and emotional,” he admitted.

“I didn’t know what to expect on the day but it’s come together really well and I’m emotional and excited.”

When an opportunity came up in his Thursday Island community to join the ambulance, George jumped at the chance to make a difference to his people.

Thirty years later, the simple joy he finds when treating patients remains his daily motivation and the catalyst for why his QAS colleagues admire him.

“I don’t like seeing people in pain, I like helping and making the patient comfortable before getting them to hospital or wherever they need to be,” said George.

As the first Torres Strait Islander man in the QAS, culture is integral to George’s identity and has shaped his career in community care.

Naturally, his medal ceremony featured many touching ties to his community, including singing and dance performances from George’s family and community all the way from the Torres Strait.

A special guest at the ceremony was Aboriginal man Jandamarra O’Shane, one of George’s early patients whose injuries greatly affected him at the time.

Jandamarra was a six-year-old boy when he was horrifically doused in petrol and set alight in a random playground attack in 1996.

George still recalls vivid memories of that day and described it as an eye-opener that shaped his career.

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“I think being there as an Indigenous person with him (Jandamarra), it settled and comforted him in his time of need,” George said.

“It was traumatic to do that first up in my career, but over the years I’ve learnt how to switch on and switch off.”

Cooktown Paramedic Claine Underwood said he has remained friends with George since their first day meeting as Indigenous cadets in the 1990s.

“George is that kind of person you gravitate to. He’s a big man, a big presence even though he’s quiet in nature,” Claine said.

“He’s got a dry sense of humour and he’s such a genuine person too – that’s what I think makes him a great paramedic.”

Opposite, left to right

Edmonton Paramedic George is highly respected amongst his peers.

George watches on as Torres Strait dancers perform a special tribute.

Above, background and inset

George alongside Torres Strait dancers from his community.

George displays his medals alongside his family.

Summer 2021–22

Craig’s family accept their dad’s Posthumous National Medal In November the Queensland Ambulance Service (QAS) paid its respects to one of our late paramedics, Craig McCulloch, by presenting his partner and three children with Craig’s Posthumous National Medal.

The National Medal recognises long and diligent service by members of recognised government and voluntary organisations who risk their lives or safety to protect or help the community either in law enforcement, or during an emergency or natural disaster.

Acting Commissioner Craig Emery said Craig’s name is one of 36 on our Roll of Honour, providing a sobering reminder that when our officers put on their uniform, it’s not without risk.

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“Because of the current COVID-19 climate we were unable to come together to acknowledge this significant occasion with our traditional QAS Remembrance Service on 12 September,” Craig said.

“But we also recognise it’s extremely important to acknowledge and pay our respects to our ambulance officers who have lost their lives in the course of their duty and were able to present Craig’s family with his Posthumous National Medal in a separate ceremony.”

Craig began his career with the QAS in January 2009, working in a number of LASNs as both a Paramedic and Advanced Care Paramedic.

In 2013 Craig travelled to the UK to work as a Paramedic and then in the private sector, before returning to the QAS in June 2018.

“On 28 January 2019 Craig was responding to an emergency when the ambulance he was travelling in was involved in a crash,” Craig (Emery) said.

“Despite bystanders’ and responding emergency services’ best efforts, Craig sadly passed away on scene.

“Craig was well known by the QAS community and respected by his peers.

“He is remembered for being a loyal and caring paramedic who loved helping people and going the ‘extra mile’ for his patients.”

Craig McCulloch’s son Clyde accepted his father’s medal with a bit of support from mum, Heather, older brother Dominic, and his twin sister Ida. Heather and her children live just over the New South Wales border and said they were “very relieved” to be able to travel to Brisbane to receive Craig’s award.

“We all really miss Craig, it’s especially hard on the three children,” Heather said.

“We are all very proud of what Craig achieved and it was very special for his children to be able to accept their dad’s medal.”

We honour Craig for his service and his contribution will never be forgotten – he’s part of the QAS family, always.

Top to bottom

Dominic and his little sister Ida. A/Commissioner Craig Emery presents Clyde Ball with his Dad’s posthumous medal.

Clyde inspects his Dad’s National Medal.

Remembered paramedic Craig McCulloch’s family, Ida, Dominic, Heather and Clyde with Craig Emery.

Summer 2021–22

Awards – Mackay

Mackay’s awards celebrate exceptional community service

Award recipients with Assistant Commissioner Robbie Medlin.

Mackay District held its Service Awards on Thursday 19 November 2021 for some of its long serving officers.

Assistant Commissioner Central Region Robbie Medlin presented officers with their Long Service Medals (LSM) and National Service Medals (NSM).

Recipients included:

Collinsville Paramedic Mark Smith – LSM 3rd clasp 40 years, pictured with Robbie Medlin

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Collinsville Station’s Officer in Charge Michael Robson – NSM 15 years and LSM 10 years, pictured with Robbie Medlin (left)

North Mackay Paramedic Cleveland Marcum – NSM 1st clasp 25 years, pictured with Robbie Medlin

Calen Paramedic Peter Hall – NSM 1st clasp 25 years and LSM 1st clasp 20 years, pictured with Robbie Medlin

Mackay Paramedic Ross Kerswell – NSM 1st clasp 25 years and LSM 2nd clasp 30 years

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Metro North Region Awards Ceremony Metro North Region made the most of a rare face-to-face opportunity in October with staff presented with National and Long Service Medals during its 2021 Metro North Region Awards Ceremony on Tuesday 12 October at Kedron Park.

Metro North Region’s Acting Assistant Commissioner David Hartley presented the medals and posed with recipients for photos.

National Medals presented to five officers: • Iain Hunt, Advanced Care Paramedic – 15‑year National Medal • Katherine Cunningham, Advanced Care Paramedic – 15-year National Medal • William ‘Doug’ Buchanan, Officer-inCharge – 15‑year National Medal • Ronald Cunningham, Officer-inCharge – 15‑year National Medal • Shane O’Donnell, Advanced Care Paramedic – 35‑year National Medal

l recipients; Dave with 15 year National Meda oug Buchanan, ACP Katherine Cunningham, OIC D Hunt.

Iain ACP and m ingha Cunn OIC Ronald

Acting Assistant Commissioner David Hartley with 35-year National Medal recipient ACP Shane O’Donnell

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10 Year Long Service Medals to: • • • • •

Julianne Raven, Roma Street Station Justin Salomon, Narangba Station Jarred Thorne, Bribie Island Station Kellie Mates, Bribie Island Station Angus Jones, Narangba Station

Dave with 10-year Long Service Medal recipients; Jarred Thorn, Angus Jones, Justin Saloman and Julz Raven.

30-year Long Service Medals to: • Leonie VanDer Meer, Northgate Station • David Hogan, Clinical Support Officer 30-year Long Service Medal recip ients CSO David Hogan and Leonie VanDer Meer with Dave (middle).

Summer 2021–22

Awards – Metro North

50-year Long Service Medal – Wayne Jackson, Northgate Station

40-year Long Service Medal and retirement plaque – Tim Anderson, Officer in Charge

Wayne started with QAS as an Honorary Ambulance Officer on 16 October 1970 and became an Ambulance Officer in March 1972 at Sunnybank Ambulance Station. He then moved to Bribie Island Ambulance Station on 29 January 2001. In November 2016, he became a Patient Transport Officer at the Ningi Ambulance Station. Wayne became a casual Patient Transport Officer in July 2017 and is still serving our community.

Tim retired in August 2021 and as a long-standing OIC, received a special mention as he was presented with his 40-year long service medal and a plaque and certificate from the QAS Commissioner. Tim started with QAS on 6 August 1979 as an Ambulance Officer at Sandgate Ambulance Station. During his service with the QAS he worked at various ambulance stations in the Metro North Region including Brendale, Dayboro and Eatons Hill. On 5 April 2004 he was appointed as the Officer-in-Charge at Woodford Ambulance Station, where he served the remainder of his career with the QAS. Thank you, Tim, for more than 42 years of dedicated service to the QAS. Enjoy retirement, you deserve it!

61 ient 50-Year Long Service Medal recip ey Wayne Jackson and Dave Hartl

QAS Long termers - Wayne, David and Tim

David Hartley with Tim Anderson

Metro North medal recipients

Summer 2021–22

Metro South Awards Metro South held two award ceremonies during November, the first at Kedron on 10 November and the second at Beenleigh on 26 November.

National Emergency Medals for the 2019 North Queensland Floods were awarded to uniformed officers who completed at least five days helping with the floods in North Queensland in 2019.

Metro South Assistant Commissioner Matt Green presented Long Service Medals to staff and Local Ambulance Committee members.

At the Kedron ceremony Matt presented the awards:

• Mitch Bloxsom – ACPII at Beenleigh Station • Hannah Gaulke – CCP at Nathan Station • Shane Henderson – OIC Logan West Station

Long Service Medals: • • • •

Peter Hill – ACPII at Beenleigh Station - 10 years Damian Gonzalez – OS at Brisbane – 20 years Steven Barber – ACPII at Beenleigh Station – 30 years Steven Wagner – ACPII at Beenleigh Station – 40 years

National Medal (for 15 years’ service):

National Emergency Medal 2019 North Queensland Floods:

• Christine Archer – ACPII at Beenleigh Station

• Shane Schick – Operations Supervisor

LAC Awards:

Long Service Medals:

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National Emergency Medal North Queensland Floods:

• • • •

Joanne Geritz – ACPII at Mt Gravatt – 10 years Jeremy Lawrence – ACPII at Wynnum – 10 years Benjamin Teague – ACPII at Durack – 10 years Marie Guenette – Casual Advanced Care Paramedic with Metro South – 10 years • Adrian Tong – SOS Metro South Region – 30 years • Sandra Cowley – currently relieving as a CSO – 30 years

LAC Awards: • John Blacow – Secretary and Treasurer, Centenary LAC – 20 years • Colin Myers – Treasurer, Logan and Districts LAC – 20 years • Jeanette Myers – Logan and Districts LAC Member – 20 years • Ray Rickwood – President, Wynnum LAC – 20 years

• Christopher Coonan – President, Macleay Island LAC – 5 years • Diane Coughlan – Mt Gravatt LAC Member – 5 years • Marie Manser – Secretary, Mt Gravatt LAC – 5 years • Carol Knight – President, Redland Bay LAC – 5 years • Doreen Nichols – Redland Bay LAC Member – 5 years • Pamela Caswell – Redland Bay LAC Member – 5 years • Marcia Rowling – Logan & Districts LAC Member – 10 years • Eric Nielsen – CPR trainer, Logan & Districts LAC – 10 years • Annette Doherty – Redland Bay LAC Member – 10 years • Mark Hodgson – President, Beaudesert LAC – 15 years • Barry Ramsay – Logan and Districts LAC Member – 15 years • Alan Burchill – President, Mt Gravatt LAC – 15 years • Janet Sommerville – Secretary, Redland Bay LAC – 25 years • Cheyne Collingwood – Secretary, Macleay Island LAC – 35 years

Matt also presented the Beenleigh ceremony’s awards:

Long Service Badge and Certificate • Shaine McGill –Administration Officer in the Business Support Group at Spring Hill.

Summer 2021–22

Matt also presented epaulettes to paramedics who completed the Graduate Paramedic Program: • • • • •

Angela Trans Bethany Stubbs Denise Seery Megan Gianotti Sarah Vanderlinde

Awards – Metro South

Long serving LAC badge recipients at the Beenleigh ceremony

) recipients Long Service Medal (30 years and Sandra Cowley.

Adrian Tong

Long Service Award and National Service Medal and LAC Long Service recipients at the Kedron ceremony.

LAC 20 year Long Service badg e recipients – John Blacow, Ray Rickwood and Colin and Jeanette Myers.

Graduate paramedics putting on

their new epaulettes.

Long Service Award and National Medal recipients at the Beenleigh ceremony.

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SOCC Awards Nine QAS staff, seven operational and two public servants, were presented with a National Emergency Medal for their contribution to the North Queensland floods disaster response in 2019.

Included in this presentation held at the State Operations Coordination Centre (SOCC) at Geebung was Richard Petersen, who was presented with his Long Service Medal (10 years).

Congratulations to everyone on their achievements.

Above

SOCC Long Service and National Emergency Medal recipients.

Inset, top and bottom

National Emergency Medals – North Queensland Floods 2019 • • • • • • • • •

Damien Dickson Darren Lawrence Brian Lehane Jaime Magnussen John Millwood Emma Sayle (nee McKenzie) Emily Mildred Matthew Stirling Melissa Mangan

Melissa Mangan with Steve Zsombok who presented the staff with their awards.

QAS Long Service Medal (10 years)

QAS Media Unit’s Matt Stirling and Melissa Mangan.

• Richard Petersen

Summer 2021–22

Awards – OMD

OMD Awards

QAS Medical Director Dr Steve Rashford enjoyed a rare quiet moment to present his team with a National Medal and Long Service Badges.

In frames, left to right

The National Medal North Queensland Floods 2019 was awarded to those who served the community for five days or more during the 2019/20 Townsville Floods and was presented to:

Kirsten Wilson and Steve Rashford.

Liz Brooks and Steve Rashford.

Tony Middleton and Steve Rashford.

Background

Tony Middleton, Liz Brooks, Kirsten Wilson and Dr Steve Rashford.

• Liz Brooks

And Long Service badges and certificates (10 years) were presented to: • Kristy Brown – (accepted by Prof.

Emma Bosely on her behalf) • Kathryn Tumini (accepted by Prof.

Emma Bosely on her behalf) • Jamie Quinn (accepted by Prof.

Emma Bosely on her behalf) • Anthony (Tony) Middleton • Kirsten Wilson

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Summer 2021–22

Local Ambulance Committees round-up Congratulations to five Local Ambulance Committees (LACs) for their successful grant applications with the Gambling Community Benefit Fund (GCBF), totalling $105,143.28.

Grant recipients included:

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• Kingaroy LAC (Darling Downs District) $23,916.00 for a Hoverjack and accessories, a Fermo Verice Power Chair and 20 Leatherman Raptor Shears.

• Toogoolawah LAC (West Moreton District) $26,229.35 for a Mega Code Kelly Manikin, an Automatic External Defibrillator, and a Laerdal ALS Baby Trainer 200.

• Ipswich LAC (West Moreton District) $34,660.68 for a Mega Code Kelly Paediatric Full Body Manikin and a Mega Code Kelly Adult Manikin.

• Laidley LAC (West Moreton District) $14,553.39 for a Laerdal ALS Baby Trainer Manikin and a MegaCode child Manikin.

• Nundah/Northgate LAC (North Brisbane District) $5,783.86 for 6 manikins (4 Little Annie adults, 1 child and 1 baby), plants for a serenity garden at Spring Hill and equipment for the serenity garden at Northgate.

In addition, the Toogoolawah LAC was successful with their 2021 Volunteer Grants application to the Community Grants Hub in the amount of $4,700 for outdoor furniture.

The last Queensland Local Ambulance Committee Advisory Council (QLAC) meeting for the 2019-2021 term of office was held on 10 December 2021. The 2019-2021 QLAC term of office was extended by an extra year due to COVID-19 disruptions.

A huge thanks to our out-going QLAC representatives: • Ian Merritt, Central West District – Longreach LAC. Ian has been a QLAC representative since the 2010-11 term of office.

• Peter Doherty, Darling Downs District – Millmerran LAC. Peter was a QLAC representative since the 2012-13 term of office.

• Desley Jozefowski, North Brisbane District and Moreton District – Bribie Island/Ningi LAC. Desley has been a QLAC representative since the 201517 term of office.

And a warm welcome to our new QLAC representatives for the 2022-2024 term of office, which commences on 1 January 2022: • Avril Fazel, Central West District – Blackall LAC • Geoffrey Kapernick, Darling Downs District – Oakey LAC • Rae Guyder, North Brisbane District and Moreton District – Bribie Island/Ningi LAC • Jennifer Floyd, North West District – Kirwan LAC • Neil Musch, CPR Awareness Program Representative, Wide Bay District – Gin Gin LAC • John Stibbs, State Operations Centre Representative, Townsville District – Charters Towers LAC. Top right

Out-going QLAC representatives (back left) Peter Doherty, Ian Merrit and (front) Desley Jozefowski.

Bottom left

QLAC representatives (front l-r) Linley Macleod, Desley Jozefowski, Anne Glasheen, Desley Cunnington, Beryl Wilson, June Nielsen and (back l-r) Gary Langford, Peter Doherty, David Stubbs, Ian Merritt, Trevor Lymbery and Donald Young.

Summer 2021–22

Biloela manikin

Biloela LAC fundraises for new SimMan training manikin Queensland Ambulance Service staff from the Biloela region will be able to ensure their training and qualifications stay up to date thanks to a significant purchase of a $36,000 training manikin.

Biloela Ambulance Station’s Officer in Charge (OIC) Terry Zillmann said Biloela’s Local Ambulance Committee’s successful fundraising efforts saw the purchase of a new Laerdal ALS SimMan training manikin.

“This Advanced Life Support manikin is special as it allows for complex and high acuity simulations to be performed in the training environment to ensure we deliver timely, quality and appropriate, patient focused ambulance services to the community,” Terry said.

“This manikin connects to a computer with software – and can make breathing and other sounds to mimic serious illnesses and trauma conditions.

“With the advances in primary health care, the frequency for our staff to see some serious chronic medical conditions is often diminished, as we don’t see as many acute presentations.”

Biloela is also a training station for QAS’s Graduate Paramedic Program.

“This manikin will allow us to go through all the training requirements the graduates have during their internship for the scenarios and cases they must attend during that time,” Terry said.

“So, if they don’t get the experience on the road, we can simulate the cases in the training environment.

“Our qualified paramedics also have ongoing professional requirements, and this therefore allows us to keep our qualifications current.”

Terry said Biloela Station also provides training for staff from the broader region’s stations including Moura, Theodore and Baralaba.

“With our neighbouring stations accessing this manikin, it ensures the training benefits to be spread much more broadly than just the Biloela community.

“It’s a great asset and a much-needed addition to our station and we’re very grateful to the LAC and the community for its support,” Terry said.

QAS’s Biloela LAC sells first aid kits to the community to raise vital funds for the Station, all money raised stays local and is managed by the LAC. “Our eight LAC members are such a great bunch of people and their decision to sell first aid kits also supports what we’re trying to do – promote community preparedness,” Terry said. “If people have a first aid kit handy, they are potentially able to provide first aid until we arrive.”

From left to right

Terry Zillmann, Vicki Ainsworth, Nikki Zillmann, Damian Mworetti, Angela Moretti, Milton Ainsworth, Gordon Twiner, (Absent – Leanne Moretti, Myf Szepanowski).

Summer 2021–22

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Celebrating 30 years as QAS (Part 3) While QAS’s Local Ambulance Committee (LAC) Conference honouring our 30th Anniversary may have been postponed until mid-2022, QAS Heritage and History Manager Mick Davis’ third instalment celebrating our 30 years as QAS has arrived! It recounts our third decade – A decade of consolidation and evolution – 2011 – 2021.

Click here for the second instalment published in our Winter-Spring 2021 and here for the first instalment in our Autumn edition.

Summer 2021–22

Celebrating 30 years as QAS

The third decade since the transition from QATB to QAS in 1991, was a period of consolidation and evolution; consolidation of a return to Queensland Health as an integrated health service after two decades as part of the emergency services portfolio; and evolution as emergency ambulance responders interacting with health sectors into an accepted and trusted clinical service within the health networks in Queensland.

This decade saw consistent growth in the demand for ambulance services.

In a 12-month period, from 2011-12, QAS responded to 595,444 incidents across Queensland. In comparison, a decade later demand has risen significantly, so even from January to August 2020, we responded to 765,953 and then in 2021, we responded to 810,695 incidents.

In 2011, the QAS lost one of its most dedicated servants with the passing of Gerald Moore OAM on 24 January 2011, aged 81. Gerald had a significant history with the QAS beginning in 1954, including roles on the committee for the QATB and the Queensland Ambulance Services Board Chairman. Later Gerald served on the Redland Bay LAC and the Queensland LAC Advisory Council. In 2001 Gerald was awarded the Medal of the Order of Australia (OAM).

Gerald Moore Chairman QASB

Scenes from Christchurch earthquake.

On 10 March 2011, Queensland’s Premier Anna Bligh officially opened the State Disaster Management Centre (SDMC) in the Queensland Emergency Operations Complex (QEOC). This world-class high-tech facility was announced as a $78 million investment in community safety. In addition to the SDMC, the QEOC would house the 24-hour Emergency Management Queensland (EMQ) watch desk, QAS and QFRS communications facilities, the Queensland Clinical Coordination Centre, and the Department of Community Safety (DCS) Geographic Information Service.

Across the “ditch”, when Christchurch, New Zealand’s second largest city, experienced a severe earthquake on 22 February 2011, Australia responded. QAS officers were part of each deployment to Christchurch, working with either the USAR taskforce or the Tactical Medical Centre.

Confirmation of the Queensland team’s deployment was officially received late on 22 February, and by 10.30am the next day, 70 members of Taskforce 1 (T/F 1) and 14.5 tonnes of their equipment and supplies were en route to Christchurch in a RAAF C-17.

Meanwhile in Queensland, a series of major weather events from November 2010 through to February 2011 resulted in widespread flooding and storm damage across the state, and tragically, 33 deaths. Between November and January, there were six major rain events, dumping more than six times the average December rainfall in areas across the state.

This rain brought extreme flooding affecting 97 communities (around 60 per cent of Queensland), with the worst hit areas including Far North Queensland, Central Western Queensland, Central Queensland’s Rockhampton and Bundaberg, and South East Queensland including Toowoomba, the Lockyer Valley, Ipswich and Brisbane.

During this protracted and widespread weather event, QAS staff were involved in the evacuation of Cairns Base Hospital and surrounding nursing homes in the lead up to Cyclone Yasi’s crossing of the North Queensland coast on 2 February. In what was described as one of the largest peacetime civilian airlifts in Australian history, 3300 seriously ill patients were flown from Cairns to medical facilities in the state’s southeast.

By June 2011, Commissioner Melville had retired and Russell Bowles ASM was appointed as the new QAS Commissioner. Russell’s leadership would make a significant influence on the QAS’s evolution over the next 10 years.

Our Information Technology was evolving with the introduction of Integrated Real-Time Operational Ambulance Management (iROAM) software in 2012. This software provided QAS supervisors and managers with the technology to efficiently monitor and manage demand for service from a smart device like an iPad. The QAS organisational structure was transformed in 2012, when it

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advanced significantly in 2014 through the following series of clinical and operational developments: • The iPad Mobility Project saw the roll-out of iPads to the first 500 QAS paramedics. This project created a new on-line “firsthand” information support for the frontline QAS paramedics and was complete by March 2015.

• In the ambulance clinical operations, pilot clinicalimprovement programs were underway in three regional centres.

• STEMI Reperfusion Strategy continued to be rolled out to all ACPIIs over that coming year.

• The High Acuity Response Unit (HARU) was introduced as a pod into Metro North LASN with 10 Critical Care Paramedics and then the program was next rolled out to the Gold Coast.

Commissioner Russell Bowles

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underwent its most significant structural reform process since 1991 when it transitioned from QATB. There were several important reasons for this reform, including: stronger alignment with our major partner Queensland Health, and the establishment of a direct reporting line for frontline operations to my position as Commissioner.

QAS Clinical governance further evolved with the development and implementation of its new Clinical Practice Manual (CPM) in 2012. It was intended as an engaging vehicle for change to move our paramedic practice and clinical governance closer to our goal of optimal patient care.

The new CPM embodied changes to several practices and procedures, as well as the inclusion of several new drugs. It was truly a digital evolution.

On 1 July 2021, QAS marked 21 years since the 98 committee-administered local Queensland Ambulance Transport Brigades amalgamated to form the statewide Queensland Ambulance Service (QAS), with the service well on its way to becoming “world class”.

A significant part of this change was the evolution to an accepted and trusted clinical service within the Queensland Health network, which

In addition to these developments, Local-area Assessment and Referral Units (LARU) began operating in Townsville, Metro North, Metro South and Gold Coast LASNs, providing an additional 126 shifts per week.

Another significant development was the introduction of a new defibrillator platform, the Corpuls 3 defibrillator/ monitor which was rolled-out over a 20-month period in 2014-15 after extensive user testing and a comprehensive selection process.

QAS’s evolution was broad sweeping, keeping Commissioner Bowles and the QAS Board of Management busy considering the range of improvement proposals and monitoring the many enhancements closely. Other enhancements occurring at this time included: • A Classified Officers Development Program (CODP) • A new and highly technical computerised Telephony system for Communications Centre operations • Priority One review – a 10-year review of our staff support services

Summer 2021–22

• Staffing enhancements – 100 additional ambulance officers were employed across a range of locations • New vehicles – 155 new and replacement vehicles were commissioned across Queensland.

• Introduction of the Emergency Vehicle Priority (EVP) – this system automatically interrupts normal traffic signal operations to provide a green light to emergency vehicles.

The Queensland paramedic “Scope of Clinical Practice” was enhanced through an upgrade for the “Intensive Care Paramedic” (ICP) program to a new and extended Critical Care Paramedic (CCP) program. This new program and title better reflected the knowledge required for this level of pre-hospital care practice in the ambulance environment and first expressions of interest were sought in December 2014.

New QEOC centre Kedron

Our clinical enhancements to the Service kept coming.

The Wide Bay and North West LASNs launched Fibrinolysis Administration pilots, where officers began carrying additional cardiac medications (enoxaparin, clopidogrel and tenecteplase) to offer further advanced lifesaving treatments to heart attack patients.

The Service also saw a High Acuity trial, where CCPs operated under the extended scope of clinical practice (ESoCP). Each case received a high level of scrutiny where interventions such as Rapid Sequence Intubation

Celebrating 30 years as QAS

(RSI) and Focused Assessment with Sonography for Trauma (FAST) were conducted. Audit meetings, with case discussions were held with regular contact between the receiving facilities. The trial attracted a high level of support and QAS’s evolution into an accepted and trusted clinical service within the state’s health network gained strength.

Community trust and acceptance of our QAS clinicians was further strengthened through the new QAS LARUs. Some patients may not require a rapid emergency ambulance response and lower acuity callers have varied characteristics and a wide spectrum of clinical presentations: chronic illness needing medical assessment or minor medical problems such as lacerations, superficial burns, musculoskeletal injury, falls, minor allergic reactions and diarrhoea. Alternatives to ambulance transport or treat and release programs were developed and trialled to better respond to patients’ needs.

While QAS personnel were adapting to these many changes, preparations for the impending Group of Twenty (G20) in Brisbane created a distraction to QAS’s evolutionary journey, with the Service taking part in a Queensland Police Service (QPS) coordinated joint agency exercise on 22 May 2014.

The exercise tested the interoperability and response of agencies involved in G20. The exercise tested responses to specific events and scenarios to ensure interagency effectiveness and the QAS paramedics’ role was to support QPS and Queensland

Trial G-Wagon Ambulance

Fire and Emergency Services (QFES).

The G20, held in Brisbane on 15–16 November 2014 also enabled the QAS to work closely with other state and federal government departments.

The 2015 State Budget increased the QAS budget by an extra $44 million – an all-time record for the organisation.

This included funding for 155 new and replacement ambulance vehicles and $10 million to recruit an extra 75 positions to meet increasing demand for our services. In addition, QAS reintroduced the patient flow directive to free up personnel and vehicles to respond faster to more people who needed them.

On 9 June 2015 in Ravenshoe, QAS responded to the tragic cafe explosion and local Advanced Care Paramedic Darrell Thompson was recognised for his leadership. The QAS response was commended as ‘swift and well resourced’. A few months later on the Gold Coast, Critical Care Paramedic Jaye Newton was also hailed as a hero after helping to save the lives of three children in one day. Both performances demonstrated what dedicated paramedics do every day.

In another great performance during the QAS’s third decade, the Service and its local ambulance committees (LACs) provided the community with the capability and confidence to respond to sudden cardiac arrest through the CPR Awareness Program, which at the time, had trained more than 17,000 people to help save lives.

In May 2015 a campaign kicked off to raise awareness in QAS about sexual harassment and workplace discrimination. The campaign focused on educating and building our staff capability to understand and appropriately deal with these unacceptable issues at work. The objective here was for teams across QAS to come together to define their workplace culture, and the actions and behaviours to support it.

In 2014-15 occupational violence against our staff became a serious issue affecting all first responders, health workers and emergency services personnel, with assaults on QAS paramedics becoming more frequent.

New LARU vehicle

The Government Wireless Network (GWN) was progressively rolled out across almost 30,000 square kilometres in SEQ. The delivery began of digital radio voice and narrow-band data network in collaboration with Queensland Ambulance Service (QAS), Queensland Police Service (QPS) and Queensland Fire and Emergency Services (QFES).

Due to developments in pharmacological interventions being used in 20 per cent of QAS responses, a dominant pharmacology kit emerged from a statewide trial. Soon after, a full-time pharmacist joined the QAS team.

During this final decade QAS joined other government and health agencies to prove social media can be a very useful tool for communicating with a wide audience. The QAS now has more than 175,000 Facebook followers and more than 35,000 Instagram

Summer 2021–22

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diverted its course slightly to give her that special last opportunity and some comfort, which elicited sweet tears and worldwide support when photos were made public on social media.

Because of the scale of the attention this act of kindness received, Danielle and Graeme later met with the Duke and Duchess of Sussex, Prince Harry and Meghan Markle.

me Cooper

ex with Danielle Kellam and Grae

The Duke and Duchess of Suss

followers and nearly 32,000 Twitter followers, ensuring fast and direct communication with our communities.

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A “Zero Tolerance” campaign was initiated in April 2016 after a Paramedic Safety Taskforce report was handed down outlining 15 recommendations to reduce paramedics’ harm risks and to raise awareness to create a safer work environment. Covert duress systems were installed in ambulances and a duress alarm capability introduced to radio systems as part of a move to better protect paramedics from occupational violence.

The QAS’s statewide cardiac reperfusion strategy was introduced, using clot-busting drugs and extensive training and support to paramedics across urban, rural, isolated, and remote locations.

Paramedics were supported by senior CCPs and QAS doctors who provided decision support and assisted ECG interpretation via a consult line when required. Droperidol was introduced for sedation as the last resort for managing agitated patients.

In 2017, QAS celebrated 125 years since ambulance services began in Queensland. This anniversary was placed in the spotlight at station open days across the state and at a large visual display at the Brisbane Ekka, seen by thousands of people.

The QAS took a step closer to national clinical registration of paramedics with the passing of the Health Practitioner Regulation National Law and Other Legislation Amendment Bill in September. Assistant Commissioner Stephen Gough was appointed as the National Board Chair on the inaugural Paramedicine Board of Australia in October 2017.

QAS BRT

In 2017 QAS was also preparing for the Gold Coast 2018 Commonwealth Games (GC2018). Our Bicycle Response Team (BRT) was launched in November, covering an area from Southport to Mermaid Beach, spinning its way through the glitter strip’s high-rises and crowds to assess and treat patients.

The QAS made national and international news when Paramedic Graeme Cooper and PTO Danielle Kellan were transporting a patient to the local hospital’s palliative care unit when she said she wished she could be at the beach again. The team

Summer 2021–22

It was a very proud moment in October 2018 for the QAS when our Staff Support Service, Priority One, was awarded the Open Minds 2018 Queensland Mental Health Week, Large Workplace Award for the second year in a row.

Further clinical advancements occurred in terms of major trauma with chest seals and haemostatic dressings alongside arterial tourniquets introduced for use in uncontrolled extremity haemorrhage. Also, a new clinical practice procedure began to assist specifically trained paramedics perform a digital block prior to the removal of an embedded fishhook or placing sutures.

In April 2018, the QAS undertook its biggest operation ever – supporting the Gold Coast 2018 Commonwealth Games (GC2018). Glowing feedback from across the country celebrated the professionalism displayed by QAS staff throughout the Games.

During this time QAS Emergency Management and Fleet and Equipment Operations Units were co-located at Bilsen Road, Geebung.

The Emergency and Fleet Management precinct played a pivotal role in the preparation, planning, support, and response during GC2018 and housed the QAS GC2018 Support Hub.

GC2018

Celebrating 30 years as QAS

Additionally, a Patient Access Coordination Hub (PACH), designed to improve patient flow coordination to ensure the best possible health care experience for patients, was rolled out in Metro South, Gold Coast and Sunshine Coast Hospital and Health Services (HHS). It follows the patient’s journey from the time they call an ambulance to their hospital treatment and or admission through to discharge.

Natural disasters challenged QAS in the summer of 2018-19. A bushfire crisis ravaged Central Queensland in late 2018. Later, emergency services joined forces again and QAS partnered with the Australian Army where communities were cut off by rising water levels. QAS personnel went above and beyond for the people of North Queensland. Despite being personally affected by the floods, they continued to turn up for work to care for others.

Indigenous paramedic graduates

Bushfires, heatwaves and the global COVID-19 pandemic ensured 2020 was a challenging year. Our early action in planning for the pandemic, which included pre-ordering PPE supplies and standing up the State Incident Management Room (SIMR) ensured we were well prepared to respond. Legacies achieved during this pandemic event included the enhanced management systems around our PPE, establishment of the Clinical Hub and our readiness to stand up a fever clinic.

In September it was announced the QAS would commit up to 50 staff to assist and support Queensland Health and local Hospital and Health Services with COVID-19 testing and as such, an

PPE gear for COVID-19

In the 1970s, Queensland’s first neurosurgeon, Dr Kenneth Jamieson, began a partnership with the QATB to train officers in the treatment of road trauma injuries and establish a valuable research alliance. The legacy of the collaboration he fostered, underpinned by the need to better understand and inform the treatment of traumatic injuries in both the pre-hospital and institutional environments, proudly continued in 2020 through the work of the newly formed Jamieson Trauma Institute.

Expression of Interest was sent to staff. Concern for potential COVID-19 spread in the West Moreton region saw QAS rapidly deployed to its very first COVID-19 fever clinic at Redbank Plains.

week at QAS before his pre retirement break, saying the ambulance service remained a great place to work after 40 years in the organisation.

QAS now enters its next decade awaiting the appointment of a new Commissioner who will inherit a firstclass ambulance service supporting patients and communities that are better serviced because of the consolidation and evolution that occurred over the past 10 years under Commissioner Russell Bowles.

There have been many more enhancements to our service over the past decade, but those mentioned here have been ones that significantly improved our ability and capacity to provide a quality and effective response for our patients in their time of need.

The first part of 2021 proved to be an intense period of pandemic activity for the QAS with rising concern about community transmission of COVID-19 post-Christmas, prompting the deployment of two QAS Fever Clinics, the mass evacuation of a quarantine hotel, and the rollout of the COVID-19 vaccination to frontline staff.

Early in August 2021, Commissioner Russell Bowles enjoyed his final

Granting a last wish

Summer 2021–22

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Volunteer legend honoured for helping Queensland Ambulance Service save lives for 50 years Described by another expert as a ‘fantastic life-saving idea’, the simple procedure could save lives by stopping catastrophic blood loss from shark bites. Original story by Jon Daly from ABC Southern Queensland.

74

Enid Machin, 83, is a giver with few comparisons — volunteering for half a century and raising life-saving funds for the Queensland Ambulance Service (QAS).

he said. "She was always certainly the life of the party at the local ambulance committee meetings."

"We did work, I can tell you," Ms Machin said, grasping her walking frame and looking over the old black-and-white photos from the QAS archives.

Ms Machin estimated her efforts in the committee had raised a total of $100,000 over all those years, which was, at one stage, enough to buy an entire ambulance in the 1970s.

"I feel quite proud, really, that I was able to carry it out. Ms Machin joined the Ipswich Local Ambulance Committee in 1971.

Though her memory is not what it used to be, Ms Machin recalled dear friendships she made through the years of service for QAS.

Family and friends celebrated her 50 years of service with an intimate ceremony where she received a commemorative plaque and badge few others get.

"You don't like to brag about what you do. You just do it," Ms Machin said.

"Back in the day, when Enid started, the ambulance service was run and funded by community donations," QAS West Moreton District chief superintendent Drew Hebbron said.

Her daughter, Jenny Orbell, did not mind bragging about her mother's efforts.

"It would be fair to say her work formed the foundation of the modern ambulance service."

Mr Hebbron recalled meeting Ms Machin in the early days of his career in the QAS. "Enid is a lady who's always got a smile on her face and is a bit cheeky,"

"It's very special to see her win that award," Ms Orbell said. "[Mum] is always volunteering, always helping and always giving.

Top to bottom

Enid Machin has been volunteering for the Queensland Ambulance Service since 1971.

Summer 2021–22

Photo: Supplied by QAS

Enid Machin says she doesn’t like to brag about her life’s work. She’s just proud to have given back.

"She's a true inspiration."

Even in her twilight years, Ms Machin is still volunteering at her local aged care facility.

Photo: ABC Southern Queensland: Jon Daly

Ms Machin (centre) says she has helped raise about $100,000 through her years of service.

Photo: ABC Southern Queensland: Jon Daly

Childers Centenary

Childers celebrates its Centenary It’s not every day you have the inaugural and current Officers in Charge at the same ambulance station, but the Childers Centenary in December certainly delivered, reports Madolyn Sushames.

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Current OIC Michael Formica welcomed members past and present to the celebration, including the Inaugural OIC and last QATB Superintendent Ben Clutterbuck and his family.

“It was wonderful having Ben and his family there, they’ve always been such an integral part of the service here in Childers,” Michael said.

“Everyone knows Ben either from his time on road or in the community and his family has always been very supportive of the local service, so it was an absolute privilege to have them at our Centenary celebrations.”

Childers’ ambulance service opened in November 1920 and has had three Superintendents: Clem Larsen (192152), Roy Smith (1952-72) and Ben Clutterbuck who started in August 1972 before being named the service’s inaugural OIC in 1991.

Michael said it was an honour to be surrounded by so many people who helped build the local service into what is it today.

“It was very reassuring actually to be in such a nice community – they all had nothing but good things to say about the area, so it was good to hear,” he said.

There have been a lot of changes since then, many on display at the Centenary Open Day from the historic vehicles and equipment to photos and newspaper archives.

Childers Ambulance Station also held its annual awards ceremony on the day.

Paramedic Chris Kehoe received his Emergency and National Service Medals and Michael Gray was presented with his 20-year service medal.

“We’re glad we got to do that in front of their colleagues and the officers they work with closely,” Michael said.

“The station is steeped in history and tradition because of members like this who give their all to their community so it’s important we recognise them for all they do.”

It’s now back to business as usual for the busy little ambulance station ahead of the holiday period.

Left

The humble beginnings of the Childers Ambulance Station.

Right

Former OIC and last QATB Superindent Ben Clutterbuck cutting the cake at Childers’ Centenary celebration.

Summer 2021–22

Hughenden celebrates significant milestones Over the past 100 years, Hughenden ambulance officers have seen it all – from floods and drought, heavy vehicle and road crashes, farming injuries and plenty of aeromedical transfers. Last month, the current crop paid tribute as they commemorated the centenary of one of the QAS’s most remote stations, Matthew Stirling reports.

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Clockwise, from top left to bottom right

Current OIC Mario Tinning, former OIC Graham Sealy, and LAC President Alistair Anderson cut the ceremonial cake.

History meets modern at the Hughenden Station centenary.

Running the Hughenden Station is a family affair - OIC Mario and his daughter chat with James Cunington and David Lowe.

Background

The Hughenden community (carefully) flicks through the heritage records and equipment on display.

Opposite, from left column to right column

Samantha Forrest received her 10-year Long Service Medal.

Allan Paine has volunteered 35 years with the Hughenden LAC. LAC President Alistair Anderson is presented a 40-year certificate and badge by A-Assistant Commissioner James Cunington.

Background

A typically sunny day in Hughenden as the community paid tribute to their local ambulance.

Summer 2021–22

Hughenden celebrates milestones

Located along the Flinders Highway in the vast expanse between Townsville and Mount Isa, Hughenden Ambulance Station boasts a lengthy history of providing care in the outback region for travellers and locals alike.

day-to-day efforts will place the Hughenden community in good stead for the next 100 years.

First up was Advanced Care Paramedic Samantha, who was presented her 10year Long Service Medal.

Hughenden’s current paramedics Mario Tinning and Samantha Forrest operate from a modest two-officer station and enjoy the unique challenges and rewards that come with serving a small outback community.

The pair carry on a proud and storied history steeped in a sense of smalltown comradery, born a century ago when a local man, Mr A E Weston, pushed for Hughenden to open its own Queensland Ambulance Transport Brigade (QATB) centre.

and equipment for Hughenden’s ambulance officers.

Fast forward to 4 November 2021 and Hughenden again rallied around its ambulance station to commemorate the blood, sweat, tears and laughter of the past 100 years.

Hughenden Local Ambulance Committee (LAC) members Alistair Anderson and Allan Paine were next recognised for 40 and 35 years of volunteering respectively – an astonishing achievement when considering the portion of the last century that the pair have been contributing to.

Past and present converged when the very first Officer in Charge (OIC) of Hughenden, Graham Sealy, joined current OIC Mario Tinning to cut the ceremonial cake, along with LAC President Alistair.

While a heritage display of vehicles, equipment and records highlighted how quickly Hughenden ambulance has evolved through the decades, it was clear the community support which laid the first foundations - both metaphorically and literally – hadn’t abated.

This vision became a reality within months as an independent QATB was officially opened on 4 November 1921 with Mr Weston as the inaugural superintendent.

In these early years, it was significant fundraising from the local community that provided a building

Among the attendees were former officers and community volunteers who have spent lifetimes working alongside the station, Flinders Shire Council Mayor Jane McNamara and wider QAS Northern Region staff including Acting Assistant Commissioner James Cunington and Executive Manager Operations David Lowe.

A tribute to history provided the perfect occasion to recognise current staff milestones whose accumulated

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Mr Sealy, who can also claim to be the last in an impressive line of superintendents to serve at Hughenden, was re-established from superintendent to OIC in 1991 when the individual QATBs amalgamated into the modern QAS.

Summer 2021–22

Patty bounces in to visit QAS family on Thursday Island Recent Sporting Australia Hall of Fame Don Award winner and Basketball superstar Patty Mills bounced over to Thursday Island not long after his Olympic heroics that saw Australia secure Bronze in Tokyo – our first ever men’s medal in the sport.

A Torres Strait Islander himself, Patty was visiting family who happen to include Field Officer Deidree Whap and Indigenous Cadet Penina Whap.

Patty is currently playing for the Brooklyn Nets in North America’s NBA (National Basketball Association) and continuing the strong form that rocketed him into Australian sporting folklore.

It’s a long throw from Brooklyn, but Deidree and Penina will be among the many cheering Patty on all the way from Thursday Island!

t) ide his partner (lef Patty Mills alongs e) idree Whap (centr and his Auntie De

Patty’s bronze me dal was front and centre as he caught up wit h Deidree and Pen ina.

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Happenings

OCTOBER Paramedics Bel and James participated in a joint emergency services exercise at the Mossman Gorge in the Cairns region.

Dr Emma Bosely, Drew Hebbron, Sandra Garner and Christopher Rendell-Day

OCTOBER A little over two years ago, the QAS Mental Health Response Program was developed to improve the journey of patients through the healthcare system.

Huge congratulations to Sandra Garner and the Mental Health Response Program team who have successfully delivered innovative mental health services which were recognised during Mental Health Week Achievement Awards with the program winning the Workplace Award (Large).

Summer 2021–22

The simulated exercise involved the rescue of two bush walkers who did not return from a hike in the gorge area.

Queensland Ambulance attended to support

Queensland Fire and Emergency Services and State Emergency Services officers in conducting a search of the area.

Both patients were located, one suffering a snake bite to their lower limb and the other suffering a sprained ankle and heat stress.

They were treated and extricated safely from the Mossman gorge to hospital.

HAPPENINGS • Summer 2021–22

OCTOBER: Vale Former QAS officer Malcolm Bruckner QAS would like to extend our condolences to the family of former QATB officer Malcolm Bruckner, who passed away in mid-October.

Daphney, Mal Bruckner with his mother in, and son David, daughter Lachele Meek late wife Beverley.

Mal was well known and respected across the QATB and QAS in Brisbane and had served in the organisation for 46 years.

He started with the QATB in Boonah as an Honorary Officer on 1 February 1964 until his permanent appointment as a Driver Bearer at Toowoomba on 31 January 1966.

Mal with the then QAS Commissioner David Melville APM and the then Minister for Emergency Services the Hon Neil Roberts MP.

He subsequently worked in Brisbane where in his later years he worked as a Patient Transport Officer at Kenmore Station before his final role of Ambulance Transport Officer and Patient Transport at Spring Hill until his separation from the Service on 27 June 2010.

Mal’s sister Marilyn Yarrow has maintained the family ties with the QAS, serving as a Boonah LAC member.

Marilyn said in his early days, Mal would often transport a former Boonah School teacher and during the trip would give her a Fassifern Guardian newspaper to read – a welcomed, and kind thought typical of Mal. Mal was issued with the following awards during his long career with the QAS: • Meritorious Service Award - 2010 • 2002 Australia Day Achievement Medallion • QAS Long Service Medal • QAS Long Service Medal 1st Clasp • QAS Long Service Medal 2nd Clasp • QAS Long Service Medal 3rd Clasp • National Medal • National Medal 1st Clasp • National Medal 2nd Clasp • National Medal 3rd Clasp

NOVEMBER: Women in Leadership Forum Thirteen QAS representatives travelled to Brisbane City to attend the 8th Annual Women in Leadership Summit in Brisbane.

Our staff heard fresh perspectives from a diverse line‑up of key speakers including the former New Zealand Prime Minister the Hon. Helen Clark and Australian Human Rights Commissions’ Sex Discrimination Commissioner Kate Jenkins. Summit sessions over the two days focussed on proactively addressing external and internal roadblocks hindering leadership growth.

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From front left – Rohan Foote , Sandy Brightwell, Riuyi Yin, Mich elle Horch, Carissa Frew, Casey Horn e, Dennielle McCorkelle, and back row – Shinead Williams, Cassie Taylo r, Amelia Dalton, Jodie Murphy, Tessa Williamson and Sandra Garner.

NOVEMBER: Whyte Island 20th Anniversary QAS representatives joined other emergency services staff to celebrate a special milestone at Queensland Combined Emergency Services Academy – its 20th anniversary.

The Queensland Fire and Rescue Academy opened in 2001 and it was soon followed by the Premier’s launch of a Queensland Combined Emergency Services Academy (QCESA) in 2004.

In 2009 the site saw a $20 million redevelopment with a new Operational Training Facility and Streetscape.

Providing the highest quality of professional emergency management training for Queensland’s emergency services workforce and volunteers,

the purpose-built academy provides state of the art resources enabling personnel to train and prepare under realistic and safe conditions.

QCESA comprises the Queensland Fire and Emergency Services (QFES) operational and support staff who make up the School of Fire and Emergency Services Training (SFEST).

SFEST includes the Urban Search and Rescue (USAR) rubble pit, Road Crash Rescue pad, QR Rail prop, Vertical Rescue tower, Streetscape, Breathing Apparatus training, Fire Communications centre and the Live Fire Campus.

QCESA also hosts QAS training for paramedic students, officer development and graduates.

Summer 2021–22

THANK YOU :) Everyone has different levels of success. For me, success Commissioner’s thanks can never be achieved unless you have the desire to Just want to say a big thank you to the ladies Hi from all. Just awesome paramedics and 1 emergency dispatcher initiate it. The amazing and commitment staff a shout out for two The QAS work continues (Corinne Wilkes, Kate Olive and Candice (Brodie and David). Last night my husband became quite unwell and unresponsive, to provide exceptional that continuously results in appreciation letters we receive Boileau) that came to my house this morning pre‑hospital emergency and I was Ambulance. from members of the public, makes me constantly awarein of need of Queensland (July 19) for my little girl and the dispatch guy care and as a result what accomplishments we have made as an organisation.

From the moment I had the dispatcher on the phone she was calm but firm. She was

(Jamaine Prieditis) who helped me stay very between 1 September 2021 reassuring and talked me through what I needed to be doing. She stayed with me on and 30 November 2021, calm. They do an amazing job and I really This month has seen an influx of thank you letters, with the line until paramedics arrived. She kept me calm which was definitely needed in this a total of 200 appreciations appreciated them being so fantastic.

304 letters received this year to date and 609 letters and situation. were received.

emails of thanks sent to staff members.

I have had the pleasure

Kristie, Morningside The paramedics arrived 4 1/2 minutes after they were tasked. I was so thankful they

I cannotofthank you enough for allto your hardresponded work. sending 282 emails quickly. David and Brodie, you guys were wonderful. You were quick and

officers acknowledging

thorough of your assessment of my husband. You reassured me and guided me through what I needed to pack for him. During the ride to hospital again David explained everything he was doing. They explained that they needed to put the siren and lights on I want to send a quick thank you to the and again reassured me all was going to be okay.

Russell Bowles ASM the outstanding QAS Commissioner service provided.

I thoroughly enjoy reading paramedics (Chantal Greaney and Melissa the messages of thanks sent Mark is thankfully going to be okay.

He is still inand the Dajic) who assessed my son tookPA himhospital with ongoing tests. in by the community, and They feel it may well have been a mini stroke.

He is much take great pride in being to hospital on Wednesday night (July 12). It more alert today than when I would like to take the time to express our thanks the boys got to him. abletoto passQAS them onto was the first time I have ever had to call the various officers for the their attendance respective officers.

So, thank you to all involved. I will never forget your kindness but mostly thank you for and assistance at our unplanned home birth

ambulance and I was quite nervous in doing so

instructions in the meantime. Tammy (Olsson)

quickly assessed my son and took us to Lady

arrived on scene approximately 5 minutes

Cilento, all the while distracting my son with

following the birth of our son Woody and I would

Wiggles videos and calming a nervous and

like to commend her professionalism, calm in

panicked mum. Thank you for such excellent

the situation and ability to treat me as a fellow

service and care!!! I don't believe this service

my husband to hospital in time for appropriate treatment.

I am daily of the theTriple Zerogetting – worried I was overreacting and wasting the on reminded 4/9/2017. I commend officer commitment and dedication Desley, Silkstone paramedics time. The two ladies who attended (Julie Ricardo) for her efficiency and ability to in which our officers provide our home were so calm and reassuring. They reassure thatcommunity. help was on the way and clear support tousthe Craig Emery asm QAS Acting Commissioner

Hi, I’d just like to say a huge thank you to the three param edics (Melissa, work ia and Emma) on the 29th gets the recognition it deserves for all theGeorg Septe mber who came to me, as I was screaming in your paramedics do. pain, turns out I was in labour and didn’t know I was Amanda, Wellington Point pregnant.

They were so patient with me and reassured me as I was petrified going to hospital. Thank you!!

Dani, Aitkenvale

being rather than just a patient. She was caring,

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compassionate and efficient. I appreciate Tammy arranging for our transfer through to Hervey Bay Hospital. I believe Arto (Hirsimaki) and another officer (Andrew Rach) assisted with my transfer from Hunters Hut through to Hervey Bay and I found Arto to be very attentive to my needs at this time considering I was having much

Just want to give a shout out to the LARU officer

difficulty. I hope our message can reach the

who attended my home on Monday (August

needed the service on this day! Our little man

Above 21). His name was Steve (Kliese) and we are After reading Dani’s thank you message, we reunited her with Emma in the Ipswich area.

He was prompt, caring, (L) and Melissa (R) who cared for her on her big day. compassionate, empathetic, funny and the list

Woody is doing great settling in at home with his

goes on. He had me reassured within minutes.

older sister Anna, feeding and sleeping well.

If my thanks could be passed to his OIC that

individual officers involved. Thank you to QAS for the important work you do I know we certainly

would be appreciated.

Darren and Kate, Lakeside

36 QAS Insight

SPRING 2017

QAS_Insight_Magazine_SPRING_2017_DRAFT3.indd 36

Yesterday I took my grandson, Braxton, to Bribie Des, Silkstone Island Ambulance Service because he had been bitten by a sea creature and was painful and stinging while in the surf. I just wanted to say that the service was great and they did an excellent job figuring out how to treat him. So a big grateful thank you to the staff (Trent, Paige and Brigette) xx I don’t think his brother and himself will ever forget how they travelled in an ambulance together from Bribie to Caboolture Hospital while Grandma (me) travelled behind in my car. They both fell asleep.

The paramedics were so kind to them.

From Susan, Kedron Above

Braxton receives some medical attention at Bribie Station.

Summer 2021–22

11/10/17 8:43 pm

Thank you

I’d like to thank the ambulance officers (Wayne and Craig ) who came to my house for a miscarriage and the paramedic who was with me, taking care of me was so incredible, kind and caring. I just wanted to tell them our little boy, Cooper, is now 4 months old and is so healthy and beautiful. They don’t know how much they made a difference to a very scared mum and dad. They were incredible. Craig really made the whole experience for one terrified mummy just a bit easier. Wayne was so calming for my husband talking to him and making him laugh and stay calm – we cannot thank them enough. I just want to say thank you so much and I still speak of them to this day From Kylie, Zilmere

Above

Getting in touch Messages collated on these pages are derived from a range of QAS contact points, including: via Facebook facebook.com/qldambulanceservice by email QAS.Media@ambulance.qld.gov.au by post QAS Media Unit, GPO Box 1425 Brisbane QLD 4001

Above

Kylie’s son Cooper.

I called the ambulance because I was having some kind of seizure and I was terrified I would fall unconscious. Lee and a lovely lady (I forgot her name, unfortunately) attended.

The seizure had semi subsided by the time they arrived and I felt so embarrassed, I thought I may be sick with a virus and having some kind of panic attack. Both Lee and his partner were so incredibly kind and suggested I should go to hospital to be checked out. Lee spoke to me the entire journey, he was so calm and reassuring, he made me feel at ease. I am very lucky they talked me into going to hospital as I had a kidney infection that escalated very rapidly. The doctor was clear that I could have gone into kidney failure or even died if not treated at the early stage. Had these paramedics not have performed their duty at such a high standard, the outcome may have been very different. I am grateful for their kindness and utmost professionalism. Ideally, I would love to thank them in person as I may not have been here today without them.

Ann-Louise, Hamilton

Paramedics Emma (L) and Lee (R) with Ann-Louise.

On Wednesday 11 August my Grandma had a severe heart attack and was resuscitated multiple times by paramedics (Declan, Harrison, Rys, Andrew and Ben).

Just wanted to send a message of appreciation and love to those who saved her life.

Everyone we have dealt with has been so wonderful. We as a family would like to acknowledge and thank the fantastic first responders who came to their house and saved her life. The first ambulance team calmly and professionally initially dealt with my Grandmother and then when she suffered the serious event immediately took action and called for assistance.

The next responder took control of the situation organising all of us. At all times they were respectful of my grandmother, each other and the other family members who were present at the scene. There have been a lot of people involved in saving my grandmother’s life, but without this initial team and their comprehensive care there would not have been a life to save. Thank you with all our hearts for returning this beautiful lady back to us and giving her a second chance at life.

Her doctors gave her a 30 per cent chance of surviving surgery, but she made it and day by day is getting her strength back. She is still recovering in hospital, trialling new medications but without the efforts of the Qld Ambulance we would not have her with us today. We are eternally grateful for everything you do.

Victoria, The Grange

Summer 2021–22

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Notes

Reflects activities during the period from 1 September to 1 December 2021.

Farewells

Movers and Shakers

Position Title

Nicola Busch

Executive Manager

11

Office of the Commissioner

Stephen Jenning

Paramedic

25

Central Region

Lisa Cunningham

Emergency Medical Dispatcher

14

Central Region

Margaret Nelson

Emergency Medical Dispatcher

21

Central Region

Charles Brimblecombe

Emergency Driver

15

Central Region

Lorrae Brimblecombe

Emergency Driver

15

Central Region

Bradley Christensen

Honorary Ambulance Officer

11

Darling Downs Region

Donald Kern

Paramedic

19

Darling Downs Region

Eunic Hosea

First Responder

16

Far Northern Region

William Papashalis

Paramedic

13

Far Northern Region

John Ranizowski

First Responder

26

Gold Coast Region

Geoffrey Bennett

LAC Member

19

Metro North Region

Geoffrey Gaerth

Officer-in-Charge

18

Metro North Region

Thomas Sercombe

Paramedic

33

Metro North Region

Peter Nosworthy

Patient Transport Officer

31

Metro North Region

Warren Rose

Patient Transport Officer

21

Metro South Region

Murray Wood

Patient Transport Officer

25

Sunshine Coast Region

Assunta Hamilton

Paramedic

15

Sunshine Coast Region

Andrew Pedrana

Patient Transport Officer

35

Sunshine Coast Region

Bodo Wegener

Resource Readiness Coordinator

18

Sunshine Coast Region

Ross Dixon

Emergency Medical Dispatcher

13

Sunshine Coast Region

Phillip Weinheimer

Paramedic

11

Sunshine Coast Region

Leanne Harvey

Emergency Medical Dispatcher

13

South East Operations Centre

Laurie Annan

Emergency Medical Dispatcher

12

South East Operations Centre

NAME

Position Title

Appointed date

Location

Renee Dore

Executive Officer

17-Sep-21

Metro North Region

Alannah Morrison

Executive Manager Initial Services

20-Sep-21

Clinical Education

Caoidha Coughlan

Mental Health Liaison Clinician

11-Oct-21

Mental Health Response Program

Kathryn Jones

Mental Health Liaison Clinician

11-Oct-21

Mental Health Response Program

Vivienne King

Senior Operations Centre Supervisor

11-Oct-21

Brisbane Operations Centre

Marinda Thomas

Senior Operations Centre Supervisor

11-Oct-21

Brisbane Operations Centre

Kristen Holley

Senior Operations Centre Supervisor

11-Oct-21

Brisbane Operations Centre

Christopher Dor

Senior Operations Centre Supervisor

11-Oct-21

Brisbane Operations Centre

Valerie Morley

Senior Operations Centre Supervisor

11-Oct-21

Brisbane Operations Centre

Maree Williams

Business Systems Consultant

13-Oct-21

Finance Systems

Karen Villalba

Senior Finance Officer

14-Oct-21

Finance Systems

Daniel Briffa

Officer In Charge

25-Oct-21

Torres and Cape District

Matthew Barham

Officer in Charge

01-Nov-21

Cairns District

Chloe Ryan

Executive Support Officer

02-Nov-21

Office of the Deputy Commissioner Corporate & Statewide Services

Richard Jones

Clinical Support Officer

08-Nov-21

Far Northern Region

Caitlin Denning

Officer in Charge

08-Nov-21

Cairns District

Luke Allen

Officer in Charge

08-Nov-21

Mackay District

Jay Nevins

Officer in Charge Support

15-Nov-21

Cairns District

Alicha Edwards

Senior HR Consultant

15-Nov-21

HR Recruitment

Mandy Barr

Officer in Charge

22-Nov-21

Cairns District

Anthony Cunneen

Officer in Charge

22-Nov-21

North West District

Daniel Townson

Senior Operations Supervisor

22-Nov-21

North West District

Tracy Pirie

Officer In Charge Support

29-Nov-21

Central Queensland District

Notes

Appointments made during the period 1 September to 1 December 2021.

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Appointments

Years of Service

NAME

Summer 2021–22

Division / Location

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KJM Patron’s Day Awards and Research Papers

Summer 2021–22

KJM Research and development grants awarded to benefit future patients Two Queensland Ambulance Service (QAS) cardiac arrest research projects are among seven funding grants awarded as part of QAS’s annual KJM Patron’s Day. On Patron’s Day, the KJM McPherson Education and Research Foundation (KJM Foundation) awards annual research and development grants to QAS uniformed operational staff to undertake study or activities to benefit the Service and patients – a vital step to improve patient care across the state.

This year, grants totalling $33,500 were awarded for research or professional development.

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Woodridge Ambulance Station Advanced Care (ACPII) Paramedic Brendan Schultz was awarded the Patron’s Research Grant ($20,000) for his research examining the outcomes of a select group of patients, who during out-of-hospital cardiac arrest, have been administered medication to break down blood clots.

Whitsunday Ambulance Station Advanced Care Paramedic Rhiannon Buckley (ACPII) was awarded the Dr Peter Stephenson Study Grant ($5,500) for her study into increased resuscitation and CPR awareness and training, targeting areas with high cardiac arrest rates but low bystander use.

Tewantin Ambulance Station’s William (Billy) Kneale was awarded the United Workers Union Graduate of the Year Grant ($2,000), which was awarded through supervisor nominations for excellence throughout his study.

Acting Commissioner Craig Emery congratulated all grant recipients.

“It’s great to see our recipients actively driving research to solve issues they see reflected in their day to day operations,” Acting Commissioner Emery said.

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“Queensland Ambulance encourages our staff to think outside the box and to keep challenging ourselves to improve the way we provide prehospital care to the community.”

Named after Kenneth James (Jim) McPherson, a Queensland Ambulance officer who lost his life in an aerial ambulance crash in Bundaberg in 1987, the KJM Foundation is a not-forprofit entity dedicated to improving patient care by providing research and professional development opportunities for uniformed personnel.

The foundation also serves as a memorial to all QAS officers who lost their lives in the line of duty since 1892.

This year, all award-winning posters and papers have also been published.

KJM Awards

KJ McPherson Education and Research Foundation Grant Recipients 2021 Grant

Winners

District

Project/Activity

Amount

Patron’s Research Grant

Brendan Schultz (Advanced Care Paramedic)

Woodridge Ambulance Station, Metro South Region

Thrombolysis administration during outof-hospital cardiac arrest resuscitation: determining survival outcomes and neurological function

$20,000

Dr Peter Stephenson Study Grant

Rhiannon Buckley (Advanced Care Paramedic)

Whitsunday Ambulance Station, Central Region

Hands on Hearts Intervention – developing a targeted and tailored CPR awareness plan for locations with high out-of-hospital cardiac arrest rates but low bystander CPR.

$5,500

Australasian College of Paramedicine Professional Development Grant

Natasha Bennett (Advanced Care Paramedic)

Burleigh Heads Ambulance Station, Gold Coast Region

Travel to ‘2022 Frontline Mental Health’ Conference

$2,000

Brodie Taylor Professional Development Grant

Ronald Cunningham (Advanced Care Paramedic)

Narangba Ambulance Station, Metro North Region

Site visits to New South Wales and Victoria Ambulance re: use of operational body worn cameras in an operational environment

$2,000

United Workers Union Graduate of the Year Grant

William Kneale (Advanced Care Paramedic)

Caloundra Ambulance Station, Sunshine Coast and Wide Bay Region

$2,000

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Australasian College of Paramedicine Student Scientific Grants

Australasian College of Paramedicine Student Scientific Grants – Best papers

Australasian College of Paramedicine Student Scientific Grants – Best posters

1st Jacob Donaldson

Central Queensland University (CQU)

Resuscitative endovascular balloon occlusion of the aorta for patients suffering non-compressible truncal haemorrhage

$600

2nd Felicity Gersbach

CQU

Acute inhalation injuries: Current and future treatment methods

$250

3nd Aimee Berryman

CQU

Treatment of pneumothorax: Current procedures and future advances

$150

1st Alexandra Rengers

Griffith University

Undergraduate paramedic students can effectively deliver CPR and AED community outreach programs

$600

2nd Rowan Cunningham, Ashley Dickson, Julie Doolan & Elizabeth Leyshan

University of the Sunshine Coast

Positive predictive value and negative predictive value: Critiqued within the context of sepsis prehospital screening tool, PRESEP score

$250

3nd Taneisha Beckton & Hannah Dumbleton

Griffith University

Under Pressure: An evaluation of the use of prehospital CPAP

$150

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Brendan’s grant investigates using clot busting medication during cardiac arrests Woodridge Station ACPII Brendan Schultz was awarded the $20,000 Patron’s Research Grant.

With the potential to change practice and ultimately improve paramedics’ care for patients, Brendan hopes his research will determine the long-term survival and quality of life function of patients who have been administered clot busting medication (‘thrombolytics’) during cardiac arrest.

“Cardiac arrests are events where the heart essentially malfunctions and stops beating, resulting in the person becoming unresponsive and requiring immediate cardiopulmonary resuscitation (CPR),” Brendan said.

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“Unfortunately, the vast majority of people do not recover from these events and survival rates are traditionally poor.

“In a very select cohort of patients that are unresponsive to standard chest compressions and defibrillation, we believe the administration of thrombolytics may be beneficial and potentially life-saving.”

“Paramedics in Queensland have been safely administering these medications since 2008 to dissolve clots in coronary arteries, for patients experiencing a heart attack.

“As a proportion of cardiac arrests occur secondary to a heart attack, we believe this therapy may improve the

Q AS Medical Director Dr Stephen Rashford with Brendan Schultz

chances of survival, but more research is needed to explore this.”

Brendan’s research will be completed over the next 18 months and will be put forward for publication in a high impact medical journal.

Rhiannon uses grant for community CPR education Rhiannon’s “Hands on Hearts Intervention” research project was a concept stemming from one of her university assignments which analysed a US CPR training program as part of her Graduate Diploma in Health Promotion at Curtin University.

“This training program had a lot of valuable findings about how social determinants affect how people learn about CPR and it sparked my interest to consider how we could translate this into an Australian context.”

hiannon Buckley R

Whitsunday Station ACP Rhiannon Buckley’s passion is Cardiopulmonary Resuscitation (CPR) education, so she was thrilled to be awarded a $5,000 grant to improve her communities’ awareness and use of this lifesaving tool.

Rhiannon said part of her project’s goal is to identify more clearly what the barriers are to better community CPR awareness and use.

“So far the barriers we’re seeing are largely based on peoples’ concerns about the legal ramifications of providing CPR,” she said.

Summer 2021–22

“We need to solidify in peoples’ minds it’s ok to give it a red-hot go – you’re going to break ribs performing CPR and that’s ok – you won’t get into trouble for trying to save someone’s life.

“Some people think if they start CPR and then stop, they might get in trouble, or they’re concerned about injuries they might cause, and be sued.

“I want people to feel empowered with this knowledge and have the confidence to at least give it a go – backup will be on its way, but the sooner someone can get started, the better chance that person has.”

Rhiannon expects her project to be completed within 18 months and is hoping to discover effective tactics to motivate and mobilise Mackay region’s communities to learn CPR.

KJM Awards

Billy’s award proves it’s never too late to study This $2,000 grant is awarded to a student who has demonstrated exceptional personal and professional leadership qualities and was offered to encourage student paramedics to strive for excellence throughout their course.

Billy’s QAS Education Centre educators, Clinical Support Officers and immediate supervisors nominated him for the award for demonstrating consistent and outstanding performance throughout his study.

Billy Kneale

For someone who left school early, being awarded the United Workers Union’s Graduate of the Year Grant was a proud moment for Tewantin ACP Billy Kneale.

Billy said he was proud to accept the award as it highlights early school leavers can still get degrees.

“I didn’t finish school but realised later I badly wanted be a paramedic, so I had to do a bridging course called a tertiary preparation pathway, which meant a lot more study was needed to get into Paramedicine in 2016.

“I think it shows that all the hard work at uni to not just pass, but to excel, pays off and it’s all worth it in the end.”

Billy grew up on the Sunshine Coast and left high school early, working from offshore fishing boats off the Cairns coast as a commercial fisherman diving for crayfish and lobsters before returning to the Sunshine Coast to become a professional lifeguard, where he still works casually.

KJM recognises long serving members While Patron’s Day is well-known for its annual KJ McPherson Education and Research Foundation Grants presentations, this year’s ceremony also recognised several of the KJM Foundation’s long serving members.

KJM patron Major-General Professor John Pearn and KJM President Gerard Lawler presented certificates to committee members who had provided 10 years of service, including: • Emma Bosley • Brian Daley • Angelique Ettia

• Geoff Jones • Katrina Wright (represented by her sister Karla) And Acting Commissioner Craig Emery presented certificates to the committee members who had provided 15 years of service to the Foundation: • • • •

Terry Beitz Mick Davis Gerard Lawler John Pearn

Special acknowledgements were made in appreciation of the recently

retired Commissioner Russell Bowles’ contribution and support for KJM. MC Kerrianne Watts said in his role as Commissioner, Russell provided significant support and guidance to the foundation, and has always been a practical sounding board for the development and implementation of the Foundation’s objectives.

Another special acknowledgement was made to Althea Cleland for her long commitment (19 years) and dedication to her role going above and beyond to provide administrative and other support to the foundation.

Above, from left to right

G erard Lawler and John Pearn with 10 years of service recipients Emma Boseley with Katrina Wright’s sister Karla representing her 2 5 years of Service presentations

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Gerard Lawler, Althea Cleland, John Pearn

Summer 2021–22

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The development of a pneumothorax is typically associated with traumatic cardiac arrest with chest involvement and can pose a life-threatening risk if not treated. In an already procedure rich scenario, quick and effective identification and treatment of this condition is essential for positive patient outcomes. The traditional method of needle decompression has proved to be ineffective for a multitude of reasons, not limited to the inconsideration of patient size, the incorrect diagnosis, and the incorrect placement. Throughout this paper, modifications to chest decompression were explored; touching on ways to better the traditional needle decompression, integrating the use of ultrasound, and introducing finger thoracostomy at an Advanced Care level. The aim of all paramedic care is to provide the best treatment to all patients, however, in this scenario, patients with thinner chest wall or a thicker chest wall do not benefit from the needle method. Throughout the research process, it was determined that the use of finger thoracostomy in conjunction with the use of ultrasound was problematic in a logistical sense as the cost is too great. Therefore, it was suggested that finger thoracostomy is used in the scenario of needles failing as well as for overweight patients. By implementing these alternative methods, iatrogenic injuries, misdiagnosis, and ineffective decompression can be avoided.

Introduction Prehospital traumatic cardiac arrest typically results due to a small group of factors; respiratory arrest, airway obstruction, tracheobronchial injury, thoracoabdominal injury, and pneumothorax (Teeter & Haase 2020). Typically, a pneumothorax occurs when the lung collapses as a result of air entering between the parietal and visceral pleurae (Jalota & Sayad 2020). The air that is present external to the lung increases the pressure placed on it, resulting in a collapse of the said lung and a consequential shift of associated structures (Jalota & Sayad 2020). Additionally, the pneumothorax, whether it is caused via penetrating/blunt trauma or rib fracture, can lead to a tension pneumothorax.

A tension pneumothorax is when the air is able to enter into the pleural space but is then not able to exit, resulting in an increasing intrapleural pressure that causes an ipsilateral lung collapse (Jalota & Sayad 2020). If left untreated,

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the pressure can be placed on the heart, resulting in hypoxaemia due to reduced cardiac filling, decreased venous return, the triggering of pulmonary vasoconstriction, and the increase of pulmonary vascular resistance, summarised as hemodynamic instability (Jalota & Sayad 2020). Thus, hypoxaemia acidosis leads to cardiac arrest.

As traumatic cardiac arrest is typically a polytrauma event, early identification of a pneumothorax can prevent further damage to vital organs and tissues (Teeter & Haase 2020).

Treatment for prehospital trauma is an ever-changing field, with new reviews for best practices consistently being researched and released. The identification and treatment of a pneumothorax is an essential aspect of trauma resuscitation due to its ability to diminish cardiac output and result in pulseless arrest. Therefore, new interventions and changes in practice should be assessed, like the introduction of finger thoracostomy and ultrasound, as well as consistent revision of current practices, such as needle decompression. By assessing recent advances such as these can increase out-of-hospital survival rates and overall patient recovery.

Recent developments in the management of pneumothorax Finger thoracostomy as a possible future The standard practice in the management of a pneumothorax is typically needle decompression but has of late been linked with unsuccessful treatments, whether it be the catheter entering the pleural cavity or the cannula becoming kinked (Hannon et al. 2020). With a success rate varying from 18% to 62%, alternative methods have been researched with one such being finger thoracostomy (Hannon et al. 2020). Due to finger thoracostomy being extensively researched, it was determined that, although effective, the procedure required further training, held a risk of pre-hospital surgical procedure complications, and iatrogenic injuries caused by sharps (Hannon et al. 2020).

Additionally, due to the procedure being relatively new in the pre-hospital environment, its long-term effects remain to be discerned.

The procedure occurs by having the patient in a supine position with the arm of the affected side placed behind the head by being abducted and externally rotated (Hannon et al. 2020). Once the fifth intercostal space is located, the

KJM Awards

paramedic is to put on sterile gloves, sterilise the area using alcoholic preparation solution, and isolate using an open window drape (Hannon et al. 2020). The area is opened with a scalpel to 20mm over the rib, forceps are inserted through the tissues into pleural space, where they are then opened, allowing for expulsion of air/blood (Hannon et al. 2020). This is followed up by a finger sweep to ensure decompression before a stoma bag covers the wound. Rapid transport and management of other symptoms are essential for best patient survival.

In a review pool of 103 patients, three cases were identified that involved potential complications related to finger thoracostomy, eight major complications, and nine deaths (Hannon et al. 2020). Of the three cases that were potential complications, one was an infective issue and the other two were related to the incorrect positioning of either the incision or the dissection (Hannon et al. 2020). There were, however, no noted cases where a patient presented with a major bleed, lung laceration, or pleural infection. In one case there was empyema, however, it was resolved with a course of antibiotics and had a positive patient outcome (Hannon et al. 2020). As previously mentioned, the process of a finger thoracostomy does have a risk of infection.

Prehospital trauma is always a septic environment and there are few aseptic techniques, increasing the risk of empyema or cellulitis (Hannon et al. 2020). Unlike needle decompression, this process has shown to be reliable in both smaller and larger builds, as the needle has the proclivity to either go in too deep or not far enough, however, more trials should be performed.

Prehospital ultrasound as an identification method Ultrasound (US) is a skill that is commonly utilised in the in-hospital environment as a tool to identify injuries not visualised externally. It improves diagnostic accuracy, forms a direct link to rapid transport times - the main predictor in a patient’s mortality - and has been linked to higher costs and more complex care (El Zahran & El Sayed 2018).

A rapid diagnosis of life can lead to faster judgements for treatment choices, receiving facility, i.e., general hospital, neurosurgery, etc., and triage management, which shows a 39%-47% increase in preventable fatalities (El Zahran & El Sayed 2018). Additionally, ultrasound technology is available as a portable hand-held device that is shown to be user-friendly and effective in prehospital trauma.

In America, the use of US has been categorised as focused abdominal sonography for trauma (FAST), an assessment, now made a primary survey, in occult haemorrhage (El Zahran & El Sayed 2018). With this implemented, an improvement was noted in those patients with blunt or penetrating trauma due to its innovations in the diagnostic improvement and rapid identification of changing patient disposition (El Zahran & EL Sayed 2018). Of the 202

patients included in the study, the use of thoracic US took approximately 2.4 minutes on average and an accuracy of 99%; this led to a change in management of 30% of the patients (El Zahran & EL Sayed 2018). In a review of another article, Zahran and Sayed discussed that the use of prehospital US during air transport had no effect on the transport time of the patients and had an accuracy of diagnostic imaging at 95.3% and a 2–3-minute completion of the examinations (2018). Additionally, it can be used to avoid iatrogenic injuries, such as tube misplacement, arterial injuries, and incorrect insertion positioning (Menegozzo et al. 2019). Saving time in these scenarios can make the difference in multicausality events by assisting in prioritising patients based on injuries and how rapidly they need to be transported (El Zahran & El Sayed 2018).

Ultrasound can identify and diagnose the pneumothorax before it develops into a tension pneumothorax and surrounding structures start to become damaged.

There are a variety of hand-held designs utilised around the world, with varying weights, designs, capabilities, and costs.

In a study performed by Kirkpatrick et al., a 2.4-kilogram hand-held device was used in 313 blunt trauma cases where it had a reported 99% specificity and was determined to be an accurate tool that identifies intraperitoneal fluid, such as blood, but would be complimented best if it was followed up by a CT scan once in hospital (2005). This is due to previous inconsistencies associated with chest decompression, where 26% of patients were treated with a needle thoracostomy when they did not need it. This was confirmed on arrival to the hospital with a CT scan, a case that could have been avoided if US was utilised and the paramedics were able to change their therapeutic treatment.

More recent advances in technology allow for ultrasound devices to be no heavier than a handheld phone.

Needle decompression as the current best practice Needle decompression is performed by inserting a 5-7cm needle into the second intercostal space at the midclavicular line and has had reports of varying success.

An observational study found needle decompression to be successful when using >7cm needle, approaching from either a lateral or anterior approach (Robitaille-Fortin et al.

2021). Needle decompression is shown to have a success rate varying anywhere from 18%-62% due to a variety of complications, such as kinking/blockage of the catheter, and the needle failing to reach the pleural cavity (Hannon et al. 2020). Furthermore, iatrogenic injuries were more likely to occur when approaching laterally due to the proximity to the heart (Robitaille-Fortin et al. 2021). Decompression using the needle also does not take into account different builds of patients, with 24.2% of paediatric patients, 37% in medium build adult patients, and 29% in overweight patients having insufficient decompression (Terboven et al. 2019).

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Paediatrics and geriatrics have an associated reduced chest wall thickness, smaller intercostal space, and increased risk of injury as the size of the needle is typically one size (Robitaille-Fortin et al. 2021). This also affects patients on the opposite weight end, as overweight patients have an increased chest wall thickness that the typical needle may not reach to successfully treat the pneumothorax, resulting in patient deterioration (Robitaille-Fortin et al.

2021). Although the standard is 5cm for the needle, this does not account for people who have a BMI<18.5kg/m^2 as they are at high risk of injury due to decreased chest wall thickness (Sirikun et al. 2017). On the opposite end, people with a BMI>30kg/m^2 had a rate of 54.5% in which the 5cm needle was unable to successfully penetrate the pleural cavity; these patients had a higher success of having the decompression performed anterolateral approach (Sirikun et al. 2017). This does increase the risk of cardiac, mediastinal, and diaphragmatic injuries due to a patient’s respiration causing movement, which can be corrected if a medial angulation of 20 degrees is applied (Sirikun et al. 2017).

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The positive sides to this process are that it is a simple and relatively quick procedure and tool that is already used in other areas of emergency care. As this is consistently used, training is kept up to date, both on the skill and the physiology (Sirikun et al. 2017). Overall, needle decompression has been the best method of treatment for pneumothorax in previous years with numerous studies made on the advances and withdrawals, as well as it being a fast and easy skill to utilise.

Future best practice recommendation Based on the current reviews for the best practice of chest decompression in the scenario of a pneumothorax, it would be a vast improvement to generalise the use of ultrasound machinery as well as the use of finger thoracostomy.

Upon reviewing recent articles and studies performed prehospital, it has shown that the current practice of needle decompression leaves room for error, iatrogenic injury, and complications differing in severity (Hannon et al. 2020).

Although finger thoracostomy is a more invasive procedure, it has a reduced likelihood of infection and paramedic caused injury. Finger thoracostomy does have the chance of causing damage to related structures such as lung lacerations, major bleeds, and pleural infections, however, with training and revision of anatomy, the procedure has proved to be successful and increase patient survival to and out of the hospital. As it is a skill already utilised in the Queensland Ambulance at a Critical Care level, it would be recommended that this is introduced at an Advanced Care level as a trial, and then perhaps additional modifications could be made when further studies are performed, such as cost, yearly assessment of new data, and the training required. Additionally, another skill already used that would increase survival is the use of ultrasound.

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By incorporating ultrasound on road, and not just for use of flight paramedics and in-hospital use, the benefits of reducing classic complications would increase patient survival. Accurate visualisation of the diaphragm and surrounding structures has been shown to decrease complications from 25% to 3.2% (Menegozzo et al. 2019).

There have been very few reports released analysing the use of ultrasounds in chest decompression, therefore, only having a small pool of results. This should not overshadow the fact that the times it has been utilised, successful decompression, and reduced complications are highly associated with it (El Zahran & El Sayed 2018). Therefore, further research should be performed to determine the full scope of the technology and should be trialled with the current use of needle decompression before finger thoracostomy.

Needle decompression is still a viable option for the treatment of pneumothoraxes but it would have a higher success rate if it were used with an ultrasound machine.

Based on the current research it would be best if the needle decompression was phased out and instead replaced with finger thoracostomy as the go-to practice. This would, ideally, decrease complications associated with polytrauma accidents and increase the correct diagnosis and treatment of a pneumothorax while ruling out one reversible cause of cardiac arrest.

Conclusion Upon reviewing the current advances in prehospital trauma resuscitation of a pneumothorax, it would be best practice if on-road paramedics were provided the training necessary to perform finger thoracostomy in the scenario where needles fail and where obese patients do not receive adequate depth from the needle. This would provide essential skills without the burden of maintenance and procedures that increase the survival rate of patients as well as decrease associated complications related to needle decompression. The correct identification of internal structures by utilising ultrasound paired with the visualisation of the pneumothorax would show an improvement in paramedic confidence and allow focus on the other aspects involved in polytrauma cases, where the use of ultrasound could be further utilised.

References El Sayed, M, & El Zahran, T 2018, ‘Prehospital Ultrasound in Trauma: A Review of Current and Potential Future Clinical Applications’, Journal of Emergencies, Trauma, and Shock, vol.

11, no. 1, pp.4.

Hannon, L, St Clair, T, Smith, K, Fitzgerald, M, Mitra, B, Olaussen, A, Moloney, J, Braitberg, G, Judson, R, Teague, W, Quinn, N, Kim, Y, & Bernard, S 2020, ‘Finger thoracostomy in patients with chest trauma performed by paramedics on a

KJM Awards

helicopter emergency medical service’, Emergency Medicine Australasia, vol. 32, no. 4, pp.650-656.

Jalota, R, & Sayad, E 2021, Tension Pneumothorax, viewed 10 September 2021, https://bit.ly/3kthi8W Kirkpatrick, AW, Sirois, M, Laupland, KB, Goldstein, L, Brown, DR, Simons, RK, Dulchavsky, S, & Boulanger, BR 2021, Prospective evaluation of hand-held focused abdominal sonography for trauma (FAST) in blunt abdominal trauma, viewed 10 September 2021, https://bit.ly/3D7FvZJ Menegozzo, C, Artifon, E, Meyer-Pflug, A, Rocha, M, & Utiyama, E 2019, ‘Can ultrasound be used as an adjunct for tube thoracostomy? A systematic review of potential application to reduce procedure-related complications’, International Journal of Surgery, vol. 68, no. 1, pp.85-90.

Robitaille-Fortin, M, Norman, S, Archer, T, & Mercier, E 2021, ‘Prehospital Decompression of Pneumothorax: A Systematic Review of Recent Evidence’, Prehospital and Disaster Medicine, pp.1-10.

Sirikun, J, Praditsuktavorn, B, & Wasinrat, J 2021, The Accuracy of Chest Wall Thickness: To Improve Success Rate of Emergency Needle Thoracostomy, viewed 10 September 2021, https://bit.ly/3ofTzu0 Teeter, W, & Haase, D 2020, ‘Updates in Traumatic Cardiac Arrest’, Emergency Medicine Clinics of North America, vol. 38, no. 4, pp.891-901.

Terboven, T, Leonhard, G, Wessel, L, Viergutz, T, Rudolph, M, Schöler, M, Weis, M, & Haubenreisser, H 2019, ‘Chest wall thickness and depth to vital structures in paediatric patients – implications for prehospital needle decompression of tension pneumothorax’, Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, vol. 27 no. 1.

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van der Weide, L, Popal, Z, Terra, M, Schwarte, L, Ket, J, Kooij, F, Exadaktylos, A, Zuidema, W, & Giannakopoulos, G 2019, ‘Prehospital ultrasound in the management of trauma patients: Systematic review of the literature’, Injury, vol. 50, no.12, pp.2167-2175.

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Inhalation injury, following exposure to extreme heat, smoke and/ or toxic chemicals, is a serious condition which usually requires medical intervention. Depending on the severity and primary cause of the injury, patients will develop different clinical manifestations and will respond differently to treatment. If extensive airway injury occurs, fibrin casts may develop within the structures of the lower airways.

The presence of fibrin casts in the lower airway will cause occlusion, discomfort, and respiratory distress. Currently, there are no pre- hospital management methods that aim to prevent cast formation.

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The following research article will investigate pathophysiology, clinical features and current treatment methods used by the Queensland Ambulance Service (QAS). The main focus of the report will revolve around the formation and negative effects of fibrin casts. More thoroughly investigating the potential for futuristic prehospital treatment methods, such as the administration of anticoagulants with a goal to prevent the formation of fibrin casts.

Introduction Foster & Holmes (2017) defines inhalation injury as exposure to extreme heat, smoke and/ or toxic chemicals, resulting in damage to the upper and lower airways.

Affected structures may include the nasal passage, mouth, nasopharynx, oropharynx, larynx, trachea, bronchi, and alveoli (Shubert & Sharama 2021). Jones et al. (2017) estimate that inhalation injury can be identified in up to one- third of all burn victims, and accounts for approximately 90% of all burn- related deaths. Depending on the mechanism of injury, damage to the upper and lower airways can either be seen in conjunction with a cutaneous injury or in isolation. Regardless of the associated injuries, the presence of inhalation injury following thermal exposure is critical and will result in an increased risk of mortality (Curtis & Ramsden 2016).

The extent of injury is classified as either upper airway injury (above the larynx), lower airway injury (below the larynx), chemical injury or systemic toxicity. The risk of mortality and permanent damage to the airways can be reduced by early diagnosis and effective treatment (Curtis & Ramsden 2016).

For the purpose of this report, smoke inhalation and heat exposure will be the main focus. The report investigating pathophysiology, clinical features, current treatment

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methods, recommended pharmacology, and current/ future Queensland Ambulance Service (QAS) protocols.

Main Body Following extreme heat exposure, the inhalation of smoke leads to several pathophysiological processes that occur within the body, many of which result in acute lung conditions and acute respiratory distress syndrome (Jones et al. 2017).

Enkhbaatar et al. (2016) stated that the extent of airway injury primarily depends on the duration of exposure and the composition of the smoke inhaled; however, the upper airway may sustain injury via direct and localised thermals burns from flames/dry heated air. An investigation report

by Toon et al. (2010) found that direct thermal burns of the upper airway can result in tissue oedema and airway obstruction.

Direct Thermal Injuries The upper airway has a tremendous ability to effectively disperse heated dry air; hence, direct thermal injury to the lower airways is relatively rare. It is only after extreme heat exposure that the lower airways may develop thermal injuries (Curtis & Ramsden 2016), with the exception of water vapour (steam) inhalation (Fidkowski et al. 2008). A research report by Yan-hua et al. (2010) explained heat dispersion as the airways ability to cool dry heated air through the effects of turbulence, convection, and evaporation. Evaporation occurs at the mucous membranes, which allows for rapid heat absorption. The pathophysiological mechanism of evaporation plays a crucial role in lowering the temperature of dry heat in the airway (Yan-hua et al. 2010).

Unlike the inhalation of heated dry air, the inhalation of water vapour is more likely to cause direct thermal damage to not only the upper airway, but also the lower airways.

Mlcak, Suman and Herndon (2007) stated that water vapour has a much higher heat capacity, compared to heated dry air alone. The higher heat capacity of water vapor overwhelms the upper airways heat dispersion ability. Therefore, in instance where water vapour has been inhaled, direct thermal burns may be identified in both the upper and lower airways (Mlcak, Suman & Herndon 2007).

Yartsev (2017) states that the clinical manifestations, and key identifying factors, associated with direct thermal burns include obvious burns to the face, singed nasal

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hairs, soot in the airway, inflammation of airway structures, stridor, hoarseness, cough, dyspnoea, altered level of consciousness and mucosal ulcerations. Regardless of the presence of these key identifying factors, airway involvement should be considered for all patients who have been exposed to extreme heat, smoke, or other toxic chemicals (Yartsev 2017).

Chemical Injury Unlike direct thermal injury to the upper airway, lower airway injury is more likely to result from chemical injury caused by smoke inhalation. Chemical injury following smoke inhalation occurs because several components found in smoke are toxic to the human body. These components include heat, particulates, system toxins and respiratory irritants (Toon et al. 2010). The composition of the smoke differs from fire to fire, depending on the materials being burnt, the amount of oxygen available and the nature of the fire (Shubert & Sharama 2021).

The by-products of fires, found in smoke, include carbon monoxide (CO), carbon dioxide (CO2), cyanide, esters and complex organic compounds, ammonia, phosgene, and hydrogen chloride (HCI) (Curtis & Ramsden, 2016). Shubert & Sharama (2021) found that the more highly water-soluble compounds will be dissolved more quickly at the mucus membranes, whereas the less water-soluble compounds will move to the lung parenchyma (sites of gas exchange).

Fidkowski (2008) adds that the inhalation of particular toxins, such as CO and cyanide, are likely to result in systemic toxicity.

The presence of inhaled toxic compounds within the airways results in a cascade of pathophysiological events. These events potentially result in pulmonary oedema, ventilation/ perfusion mismatch (V/ Q mismatch), cellular dysfunction and cast formation, all of which cause pulmonary dysfunction (Toon et al. 2010). The irritants stimulate sensory nerve endings found with in the airways, while also activating inflammatory mediators. The stimulation of the nerve endings leads to bronchoconstriction/ bronchospasm and the synthesis of nitric oxide (NO). The increasing levels of NO play a significant role in several pathophysiologic events, subsequently numerous negative responses arise (Gupta et al. 2018).

According to Dries & Endorf (2013) the clinical manifestations associated with chemical injury will either be delayed or will present immediately following exposure to the irritant. The manifestations related to chemical injury include pulmonary oedema, bronchitis, bronchial swelling, bronchospasm. These characteristics often present as a respiratory wheeze.

Between 12- and 48-hours following exposure, respiratory failure may occur. Respiratory failure may present as decreased lung compliance, increased V/Q mismatch, and an increase in dead space ventilation. In addition to respiratory failure, the patients’ condition may develop

to mucosal sloughing and intrapulmonary haemorrhage.

Unfortunately, resulting in obstruction and alveoli flooding (Dries & Endorf 2013).

Nitric Oxide Production NO is a powerful vasodilator, which causes an increase in bronchial blood flow and a decrease of hypoxic pulmonary vasoconstriction in poorly ventilated areas of lung, resulting in V/Q mismatch and decreased gas exchange (Murakami & Traber 2003). An article by Fidkowski et al. (2008) discussed how the increased levels of NO, following inhalation injury, play a role in pulmonary microvascular endothelial damage, which consequently results in pulmonary oedema (Fidkowski et al. 2008). In addition to V/ Q mismatch and pulmonary oedema, Toon et al. (2010) found that high levels of NO results in deoxyribonucleic acid (DNA) damage and cellular dysfunction.

DNA damage occurs when NO combines with superoxide (O2-), to form peroxynitrite (ONOO-). The presence of this highly reactive agent leads to DNA damage and the activation of poly (ADP- ribose) polymerase, an enzyme associated with DNA repair. This response requires large amounts of chemical energy (ATP and NAD). The requirement for large amounts of chemical energy results in depletion of ATP and NAD, leading to necrotic cell death of deprived energy-dependent tissues (Toon et al. 2010).

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Fibrin Cast Formation In addition to NO production, the effects of inhalation injury result in the formation of fibrin casts within the airways. The casts may cause barotrauma, total or partial occlusion, a reduction of available surfactant, increased airway resistance, decreased pulmonary compliance and/ or hypoxia (Enkhbaatar et al. 2016; Jones et al. 2017).

Research by Murakami & Traber (2003) proposes that the cast-like structures are made from infiltrated neutrophils, shedding bronchial epithelial cells, mucus, and fibrin. Gupta et al. (2018) suggests that the removal of these casts is an important component of patient treatment and should occur as soon as possible, with a goal to improve oxygenation levels. Unfortunately, due to the thick, sticky consistency of the casts they are very difficult to remove (Gupta et al. 2018).

Systemic Toxicity The final effect of smoke inhalation is systemic toxicity, such as CO poisoning (Curtis & Ramsden 2016). CO is a common compound produced by the burning of certain materials.

CO is a gas that can be absorbed into the blood stream via gas exchange in the lungs. Similar to oxygen, CO forms a bond with haemoglobin, a protein found in the blood (Raub et al. 2000). However, the bond formed between CO and haemoglobin has approximately 200 times the affinity, compared to the bond between oxygen and haemoglobin (Fidkowski et al. 2008). The presence of increase CO within

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in the blood significantly decreases the oxygen carrying capacity of haemoglobin. The decreased availability of oxygen to tissue soon results in hypoxia. This phenomenon being referred to as carbon monoxide poisoning (Raub et al.

2000).

Gupta et al. (2018) found that the severity of the manifestations caused by CO poisoning vary, depending on the amount of CO present in the blood stream. Common symptoms that may be identified include headaches, dyspnoea, impaired concentration/ thought process, lethargy, syncope, respiratory failure, seizures, coma, decreased cardiac function or even death.

Best Practice Treatment In a pre- hospital setting, inhalation injury is diagnosed through the existence of clinical manifestations and risk factors. These factors include, but are not limited to, recent history of exposure, facial burns, soot in the airway, and symptoms of decreased oxygen exchange (low saturation levels, increased respiratory rate and respiratory wheezes) (Shubert & Sharama 2021).

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As written by Shubert & Sharama (2021), maintaining a secure airway is the main goal when providing treatment to patients with potential inhalation injuries. As discussed previously, the inhalation of extreme heat and/ or smoke can result in inflammation of the airways. Without a sufficient airway device, partial or complete occlusion may develop. Depending on the severity of the injuries, either an oropharyngeal (OPA), nasopharyngeal (NPO), or laryngeal mask airway/supraglottic airway (LMA) may be considered to maintain patency (Miller & Chang 2003; Shubert & Sharama 2021). In cases where complete loss of airway patency occurs intubation is necessary, and QAS Critical Care Paramedic (CCP) back up is required (QAS Clinical Quality and Patient Safety Unit 2021b).

Airway obstruction is also caused by the formation of fibrin casts, as reviewed earlier. Studies investigated by Gupta et al. (2018) found that the prevention of fibrin cast formation can positively impact a patient’s recovery.

Evidence supported by Glas et al. (2020) back the idea that the administration of nebulised anticoagulants, such as heparin, can assist in the prevention of fibrin casts formation; as a result, airway obstruction is minimised, and oxygenation is improved (Enkhbaatar et al. 2007).

Studies conducted at the University of Texas Medical Branch reinforce the idea that the administration of nebulised heparin will limit the formation of fibrin casts within the airways, while improving recovery rates. The study was conducted on sheep that had been exposed to heat and smoke inhalation, some received anticoagulants whereas others did not. It was discovered that the sheep who received aerosolized anticoagulants developed less casts compared to the sheep who did not receive the anticoagulants (Enkhbaatar et al. 2007). Other studies

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found that for maximum effect both heparin (anticoagulant) and antithrombins can be administered concomitantly (Phelps et al. 2020). Heparin works by increasing antithrombin III activity, which prevents factor X from converting prothrombin to thrombin and fibrinogen to fibrin.

This mechanism inhibiting the formation of obstructive fibrin casts (Phelps et al. 2020). Unfortunately, nebulised heparin can cause negative side effects, the most significant being haemorrhage. However, an investigation report by Phelps et al. (2020) discussed the incidences of major and minor haemorrhage following nebulised heparin. The study found that only a small percentage of patients, who were receiving nebulised anticoagulants, develop haemorrhages.

These results were gathered from patients who do not have a medical history comprised of hypersensitivity to heparin, concomitant anticoagulant therapy, bleed, or clotting disorders (Phelps et al. 2020).

Additionally, CO poisoning treatment should be considered.

Huzar, George & Cross (2013) recommended that CO poisoning should first be managed by removing the patient from the site of exposure, ensuring it is safe for the resecure to do so. Once the patient is no longer exposed to higher levels of CO, high flow oxygen must immediately be administered. High flow oxygen is administered with a goal to competitively displace the CO from haemoglobin. This process can occur while breathing only room air, however, supplementary oxygen speeds up the process significantly (Stevens & El-Shammaa 2015).

Queensland Ambulance Service – Current and Future Treatment Options Currently there are no pharmacological treatment avenues available to QAS Paramedics for the purpose of treating inhalation injuries; rather, the service focusses on symptomatic treatment and effective airway management (QAS Clinical Safety and Patient Safety Unit 2020).

As discussed earlier, clinical trials are currently being conducted to investigate the reliability and effectiveness of nebulised anticoagulants. Assuming that further research is conducted, and additional clinical trials are completed, the use of nebulised anticoagulants in a pre- hospital setting could be beneficial in providing adequate treatment to patients with inhalation injuries.

The administration of anticoagulants may not immediately show positive effects in a pre- hospital setting, however, the patients progressing condition and recovery period may be significantly decreased. Improvements of the patient’s prognosis (following anticoagulant nebulisation) stem from the prevention of fibrin cast formation, which eliminates an aspect of airway obstruction and allows for more efficient oxygen exchange within the lungs (Phelps et al. 2020).

In regard to managing CO poisoning, QAS currently follow the recommended treatment methods discussed above.

These treatment methods include the administration of high

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flow oxygen, with the consideration of intravenous access.

The Clinical Practice Guidelines (CPG) also specify that patients with suspected CO poisoning should continue to receive high flow oxygen until they have been examined by the receiving facility (QAS Clinical Quality and Patient Safety Unit 2021a).

The QAS CPG also recommends fluid resuscitation for all burns patients, including those with inhalation injuries.

The purpose being to manage hypovolemia, and to reduce the risks of shock and multi- organ failure (Williams 2008).

Although, the CPG states that in the presence of inhalation injuries that patient’s airway takes priority and should be secured prior to fluid resuscitation (QAS Clinical Quality and Patient Safety Unit 2021a).

Conclusion To summarise, inhalation injury is a common, yet fatal, condition associated with burns patients. The development of inhalation injury significantly increases the risk of mortality and is the cause of most burn related deaths.

Inhalation injury can present as direct thermal burns, chemical injury, and/ or systemic toxicity. Treatment methods for the condition are still developing and the investigation of nebulised anticoagulants is promising.

Anticoagulant nebulisation is not currently a part of prehospital treatment; however, evidence suggest that the administration of these mediations helps to avoid cast formation/ airway occlusions. Providing further testing is conducted, anticoagulant nebulisation could be recommended as QAS prehospital treatment. Currently the QAS CPGs state that airway management techniques, oxygen therapy and fluid resuscitation all be utilised when treating a patient with suspected inhalation injury and burns. The research discussed in this report supports all current QAS treatment options, with the potential addition of nebulised anticoagulants in the future.

References Curtis, K & Ramsden, C 2016, Emergency and trauma care: For nurses and paramedics, Elsevier Dries, D & Endorf, F 2013, ‘Inhalation injury: epidemiology, pathology, treatment strategies’, Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, vol. 21, no. 1, pp. 3-7, viewed 30 July 2021, https://bit.ly/3F6plAc Enkhbaatar, P & Traber, D 2004, ‘Pathophysiology of acute lung injury in combined burn and smoke inhalation injury’, Clinical Science, vol. 107, no. 2, pp. 137-143. https://bit.ly/31ESjsv Fidkowski, C, Fuzaylov, G, Sheridan, R & Coté, C 2009, ‘Inhalation burn injury in children’, Pediatric Anesthesia, vol. 19, no. 3, pp. 147-154. https://bit.ly/3qsr5jm Foster, K & Holmes, J 2017, ‘Inhalation Injury’, Journal of Burn Care & Research, vol. 38, no. 3, pp. 137-141, viewed 3 September 2021, https://bit.ly/3ofCJeM Glas, G, Horn, J, Binnekade, J, Hollmann, M, Muller, J, Cleffken, B, Colpaert, K, Dixon, B, Juffermans, N, Knape, P, Levi, M,

Loef, B, Mackie, D, Malbrain, M, Preckel, B, Reidinga, A, van der Sluijs, K & Schultz, M 2020, ‘Nebulized Heparin in Burn Patients with Inhalation Trauma—Safety and Feasibility’, Journal of Clinical Medicine, vol. 9, no. 4, pp. 1- 8, viewed 5 September 2021, https://bit.ly/3F4ql8a Gupta, K, Mehrotra, M, Kumar, P, Gogia, A, Prasad, A & Fisher, J 2018, ‘Smoke Inhalation Injury: Etiopathogenesis, Diagnosis, and Management’, Indian Journal of Critical Care Medicine, vol.

22, no. 3, pp. 180-188, viewed 6 September 2021, https://bit. ly/31KevkZ Huzar, T, George, T & Cross, J 2013, ‘Carbon monoxide and cyanide toxicity: etiology, pathophysiology and treatment in inhalation injury’, Expert Review of Respiratory Medicine, vol.

7, no. 2, pp. 159-170, viewed 3 September 2021, https://bit. ly/3qrnJNB Jones, S, Williams, F, Cairns, B & Cartotto, R 2017, ‘Inhalation Injury’, Clinics in Plastic Surgery, vol. 44, no. 3, pp. 505-511, viewed 31 July 2021, https://bit.ly/3wElCa3 Miller, K & Chang, A 2003, ‘Acute inhalation injury’, Emergency Medical Clinics of North America, vol. 21 pp. 533- 557, viewed 5 September 2021, https://bit.ly/3BZA5i5 Mlcak, R, Suman, O & Herndon, D 2007, ‘Respiratory management of inhalation injury’, Burns, vol. 33, no. 1, pp. 2-13, viewed 7 September 2021, https://bit.ly/3Daht03 Phelps, M, Olson, L, Patel, M, Thompson, M & Murphy, C 2020, ‘Nebulized heparin for adult patients with smoke inhalation injury: A review of the literature’, Journal of Pharmacy Technology, vol.

36, no. 4, pp. 130-140, viewed 8 September 2021, https://bit. ly/3kr3bRc QAS Clinical Quality and Patient Safety Unit 2021, Clinical Practice Guidelines: Trauma/ burns, viewed 8 September 2021, https://bit.ly/3H5diFj QAS Clinical Quality and Patient Safety Unit 2021, Clinical Practice Guidelines: Toxicology and Toxinology/ Carbon Monoxide, viewed 8 September 2021, https://bit.ly/3c0MibD QAS Clinical Quality and Patient Safety Unit 2021b. Clinical Practice Procedures: Airway management: Oral endotracheal tube insertion, viewed 8 September 2021, https://bit.ly/3qraBI1 Rong, Y, Liu, W, Wang, C, Ning, F & Zhang, G 2011, ‘Temperature distribution in the upper airway after inhalation injury’, Burns, vol. 37, no. 7, pp. 1187-1191, viewed 31 July 2021, https://bit.ly/3F6l4gd Shubet, J, & Sharma, S 2021, Inhalation Injury, Statpearls Publishing, Treasure Island.

Stevens, J, & El-Shammaa, E 2015, Carbon monoxide and cyanide poisoning in smoke inhalation victimsm, viewed 8 September 2021, https://bit.ly/3EZLmAA Toon, M H, Maybauer, M O, Greenwood, J E, Maybauer, D M 7 Fraser, J F 2010, ‘Management of Acute Smoke Inhalation Injury’, Critical Care and Resuscitation, vol. 12, no. 1, pp. 53–61, viewed 11 September 2021, https://bit.ly/2YBaPAV Williams, C 2008, ‘Parkland formula – fluid resuscitation in burns patients 1: Using formulas’, Nursing Times, vol. 104, no. 14, pp.

1, viewed 12 September 2021, https://bit.ly/30eQOAN Yartsev, A 2017, Airway burns and smoke inhalation injuries, viewed 3 September 2021, https://bit.ly/3n4Lhpb

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Currently, resuscitative clamshell thoracotomy (RCT) with aortic cross-clamping is being used in the pre-hospital treatment of patients suffering non-compressible truncal haemorrhage (NCTH). RCT is an invasive procedure with low survival rates; REBOA has shown great potential as a viable, less invasive option than RCT in patients suffering NCTH through multicentre trauma centre studies. The centres that utilised REBOA saw a decline in the use of RCT and increase in the use of REBOA due to the increased survival rates amongst patients who underwent REBOA. This procedure has proven effective in the pre-hospital environment and is possible without the use of fluoroscopy.

REBOA works by inserting a catheter through the femoral artery with balloon inflation occurring at alternate zones throughout the aorta according to the suspected level of haemorrhage. This occludes the artery, halting any distal haemorrhage, increasing cerebral and coronary perfusion and concurrently increasing the afterload on the heart. This new technology has the potential to improve the return of spontaneous circulation along with neurologically viable survival rates. The purpose of this report is to review current best practices against traditionally used treatments and development in the gold standard management of NCTH and make recommendations against current statutory guidelines within Australia.

Introduction Exsanguination from trauma is one of the greatest causes of mortality worldwide. The fatality rate of traumatic cardiac arrest (TCA) is exceedingly high, particularly in patients with blunt force trauma (Hilbert-Carius et al. 2020).

After a traumatic injury, cardiopulmonary resuscitation (CPR) is thought to be ineffective; although when an unconscious patient’s carotid pulse cannot be palpated, CPR is commenced (Hilbert-Carius et al. 2020). However,

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Jacob Donaldson, Central Queensland University Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a technique that dates back to the Korean War when it was first documented to treat two soldiers suffering traumatic injury. Exsanguination from haemorrhage after a traumatic injury remains the leading cause of death globally, with dysregulation of the haemostatic system leading to traumatic cardiac arrest and eventually death.

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this does not rule out the possibility of true cardiac arrest, as it could indicate a state of insufficient perfusion with approaching cardiac arrest (Hilbert-Carius et al. 2020).

Ineffective coagulation in a quarter of trauma victims is caused by a dysregulation of the haemostatic system, also known as trauma-induced coagulopathy (TIC) (Giordano et al. 2017). The endogenous factors involved in TIC are fibrinogen depletion, endogenous anticoagulation, platelet dysfunction, hyperfibrinolysis, fibrinolytic shutdown, and endotheliopathy (Giordano et al. 2017).

When combined with endogenous factors, the secondary exogenously induced factors that affect clot formation and platelet function are metabolic acidosis, hypothermia, haemodilution, anaemia, and exogenous anticoagulation (Giordano et al. 2017). The end effect of this cascade of events is systemic bleeding with significant transfusion rates and death, with a quarter of all trauma patients developing TIC (Giordano et al. 2017).

Resuscitative clamshell thoracotomy (RCT) with aortic cross-clamping is the conventional treatment for individuals experiencing a non-compressible truncal haemorrhage (NCTH) (Heindl et al. 2020). Aside from this being quite invasive, the procedure’s survival rates are extremely low (Heindl et al. 2020). Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a less intrusive, promising technique for preventing patients from exsanguination in NCTH; however, it is not yet addressed in the current CPR or any Australian State ambulance service’s guidelines (Hilbert-Carius et al. 2020). This report will review contemporary literature around the existing treatments for patients suffering NCTH, comparing recent developments and procedures for best practice management.

Recommendations will then be made in accordance with current state ambulance service guidelines in Australia, noting any adjustments to existing treatments.

Current Treatments Patients suffering circulatory collapse following NCTH have traditionally had RCT with thoracic aortic cross-clamping (Moore et al. 2016). There are numerous benefits of aortic cross-clamping; it increases afterload causing enhanced cerebral and cardiac perfusion, along with momentary inflow regulation to reduce bleeding developing beneath

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the level of the diaphragm (Moore et al. 2016). RCT is usually a reactive operation intended for individuals who have lost all vital signs (Moore et al. 2016). RCT remains currently indicated for trauma patients receiving CPR for less than fifteen minutes and suffering acute refractory shock (McGreevy et al. 2019). RCT exists to treat intra-thoracic trauma, administer open CPR, constrict the thoracic aorta, and resuscitate patients using warmed blood products (McGreevy et al. 2019). Currently, state-based ambulance services in Australia, such as the Queensland Ambulance Service (QAS), document absolute indications for the use of RCT. These include patients who have suffered penetrating thoracic injuries with a sharp implement or acute thoracic trauma from a blunt object, and have lost signs of life in less than 10 minutes (Queensland Ambulance Service 2021).

This also includes those who have pericardial tamponade and cardiac activity observed on a Focused Assessment with Sonography for Trauma (FAST) scan (Queensland Ambulance Service 2021).

Relative indications are described for patients with a thoracic gunshot wound with pericardial tamponade or cardiac activity who lose all indicators of living in less than 10 minutes (Queensland Ambulance Service 2021).

Patients with neck or extremity haemorrhage with a loss of indicators of life in less than five minutes also meet relative indications for RCT (Queensland Ambulance Service 2021). While RCT can sometimes be successful, it is quite intrusive, and it has the potential to exacerbate blood loss, hypothermia, and coagulopathy by exposing a previously undamaged body cavity (Moore et al. 2016). Considering the physiological benefits of aortic cross-clamping, RCT causes a considerable physiological shock to the patient, as well as a poor prognosis (Moore et al. 2016).

Recent Developments in Treatments The idea of REBOA as a haemorrhage control strategy is not novel, with Colonel Carl Hughes first documenting this treatment during the Korean War, treating two seriously injured soldiers (Bekdache et al. 2019). Although the initial patients died from their wounds, the technique’s potential to be used as a resuscitative procedure was established, and it showed potential in improving survival by temporarily occluding the aorta and restoring circulation to the brain and heart (Bekdache et al. 2019). REBOA has recently become more prevalent, being used as a temporary stabiliser in haemodynamically unstable patients with NCTH (Özkurtul et al. 2019). It is thus widely studied in severely injured patients as a viable alternative to emergency RCT with aortic cross-clamping (Özkurtul et al. 2019). In a recent multicentre study incorporating the findings of the R Adams Cowley Shock Trauma Centre in Baltimore and Texas Trauma Institute in Houston, patients experiencing NCTH originating below the diaphragm who underwent REBOA were evaluated against those who underwent RCT (Moore et al. 2016). Both

institutions saw a decline in RCT use and an increase in REBOA use over 18 months (Moore et al. 2016). Furthermore, compared to the RCT cohort, REBOA had a greater overall survival rate (Moore et al. 2016).

Procedure The procedure of inserting the REBOA entails immediately inserting a flexible 7-French catheter through the common femoral artery (CFA), guiding this into the aorta without the use of fluoroscopy, then expanding the balloon at the catheter’s tip (De Schoutheete et al. 2018). This reduces blood flow beyond the balloon, reducing arterial haemorrhage distally while simultaneously increasing afterload, increasing coronary and cerebral perfusion until definitive surgical care can be provided (De Schoutheete et al. 2018). The balloon can be positioned and inflated in different zones throughout the aorta; zone I is located at the beginning of the left subclavian artery until the celiac artery (De Schoutheete et al. 2018). In the event of intraabdominal bleeding, such as from a liver or splenic rupture, the balloon is inflated in this zone (De Schoutheete et al. 2018). Zone II is located along the celiac artery through to the lowest renal artery (De Schoutheete et al. 2018). Due to the possibility for occlusion to the celiac trunk and superior mesenteric artery with subsequent mesenteric ischemia, placement in zone II is contraindicated (Knapp et al. 2018). Finally, Zone III is found at the lowest renal artery to the aortic bifurcation; proximal management of bleeding, secondary to a fracture of the pelvis, can be established by expanding the balloon in this zone (De Schoutheete et al. 2018).

A FAST scan must be performed to verify the presence of pericardial fluid and intraperitoneal haemorrhage (Moore et al. 2016). Zone I balloon inflation is sought if the patient displays a positive abdominal FAST scan (Moore et al.

2016). A measurement taken from the inguinal region of the right leg to the middle of the sternal body can be used to determine the device length for Zone I inflation (Teeratakulpisarn et al. 2021). If absent pulses are palpated in the lower limbs, and the blood pressure in the upper limbs is elevated, the physiological reaction of the patient’s vital signs can confirm the presence of an aortic balloon in the correct location (Teeratakulpisarn et al. 2021). The approach of visualising landmarks on the patient appears to be an effective and straightforward procedure that does not necessitate the use of any additional equipment or experience (Nakajima et al. 2019). There is a chance it may be used in emergency outpatient or pre-hospital settings where fluoroscopy or X-ray is not possible (Nakajima et al.

2019). If a FAST scan comes back negative, but the patient is suffering a pelvic fracture, a pelvic binder must be used along with Zone III balloon inflation (Moore et al. 2016).

The administration of REBOA elevated central systolic blood pressure (SBP) by over 80 mmHg in polytrauma patients suffering haemorrhagic shock, demonstrating the

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procedure’s efficacy (Wortmann et al. 2020). Occlusion times have been reported to vary significantly, with some reporting occlusion times between 20-90 minutes (Bekdache et al. 2019). Avoiding thromboembolic problems and reperfusion events, several trauma centres strive to prevent occluding the vessel for more than 60 minutes (Bekdache et al. 2019).

the last decade, there has been accumulating evidence that using ECMO in conjunction with advanced care life support (ACLS) improves results (Daley et al. 2017). In the pre-hospital environment, REBOA could be used as a bridge to ECMO; specialised pre-hospital ICU teams could implant REBOA in the pre-hospital environment and then take the patient to the trauma centre (Daley et al. 2017).

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Complete REBOA (c-REBOA) involves complete occlusion of the aorta and is potentially an adequate solution to RCT amongst practitioners, although it is associated with various risks (Heindl et al. 2020). Another critical problem in c-REBOA is the duration of the blockage (Heindl et al. 2020).

Total occlusion of 30-60 minutes has been demonstrated to cause a variety of metabolic disturbances (Heindl et al.

2020). Apart from an increase in the pancreas, skeletal muscle, liver, and kidney enzymes, as well as an increase in lactate caused by prolonged ischemia (Heindl et al. 2020).

An increase in pro-inflammatory markers interleukin-6 (IL-6), tumour necrosis factor-alpha (TNF-α) and Interleukin-1β (IL1β), and anti-inflammatory markers such as interleukin 10 (IL-10), is commonly reported following reperfusion (Heindl et al. 2020).

RCT has been utilised as a last resort in the resuscitation of patients. REBOA is believed to be similar to RCT, although it is a less invasive intervention (Nunez et al.

2017). However, there is an absence of clear indications for REBOA in patients suffering traumatic injuries, highlighted by the reality of RCT being carried out in patients suffering more significant physiological fatigue as well as a poorer prognosis (Nunez et al. 2017). Furthermore, it raises the question of whether REBOA is an analogous procedure to RCT or if it is a hemodynamic collapse prevention strategy in non-agonal unstable patients (Nunez et al. 2017).

A major complication associated with c-REBOA is the danger from significant distal ischemia within the lower limbs and spine, resulting in amputation or paraplegia (Heindl et al. 2020). While c-REBOA has numerous advantages, it also has many drawbacks, which can be reduced by using partial occlusion with partial REBOA (p-REBOA) (Heindl et al. 2020). Due to its efficacy and lower mortality among exsanguinating patients, p-REBOA is progressively gaining traction (Heindl et al. 2020). To promote distal perfusion, the device must be expanded in conjunction with titrating the proximal blood pressure to around 80-90 mmHg whilst assessing distal blood pressure (Heindl et al. 2020). This change enables sufficient occlusion to enhance blood supply proximally to a more physiological level and promotes perfusion to the distal limbs, minimising the impacts from weakened extremities and reperfusion damage (Heindl et al. 2020). The overall metabolic derangements greatly decrease with this constant perfusion, improving the patient’s prognosis (Heindl et al. 2020). Additionally, whilst proximal SBP is useful for monitoring occlusion, end-tidal carbon dioxide (EtCO2) is a simple but efficient marker for monitoring reperfusion after deflation of the balloon (De Schoutheete et al. 2018).

It appears that this exciting new technology has the potential to enhance the return of spontaneous circulation (ROSC) and neurologically viable survival rates; REBOA could also aid as a short-term gateway to additional interventions like Extracorporeal Membrane Oxygenation (ECMO) or cardiac catheterisation (Daley et al. 2017). Over

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This report found multiple sources where REBOA has been successfully applied in the pre-hospital setting as a successful adjunct whilst transporting patients to definitive care at a trauma centre. De Schoutheete et al.

(2018) described indications for using REBOA following the algorithm based on the acronym MIST: • Mechanism of trauma – High energy trauma, potentially causing penetration.

• Injury – haemorrhage below the diaphragm as diagnosed by a FAST scan.

• Signs of shock –SBP below 90mmHg. • Treatment – p-REBOA in Zone I. Furthermore, insertion in zone III should be considered in patients suffering pelvic fractures with signs of impending cardiovascular collapse (Bekdache et al. 2019).

Contraindications recommended for this procedure have been described by Bekdache et al. (2019), which have been modified to contraindications possible in the pre-hospital setting: • • • •

Suspected blunt/penetrating cardiac injury.

Suspected thoracic exsanguination.

Patients younger than 18 years old.

Patients in pulseless electrical activity (PEA) > 10 minutes for blunt trauma.

• Patients in PEA > 15 minutes for penetrating trauma.

De Schoutheete et al. (2018) concluded that p-REBOA is appropriate for use in the pre-hospital setting by trained practitioners. Therefore, this report suggests that it would be reasonable to recommend that p-REBOA be used for patients suffering sub-diaphragmatic haemorrhages.

Patients must meet the indications mentioned above

KJM Awards

with appropriate contraindications ruled out and RTC be continued in the treatment of thoracic haemorrhages where p-REBOA is not appropriate. This report further recommends that for such services as QAS, the scope of p-REBOA should be used exclusively by extended scope critical care paramedics in the High Acuity Response Unit (HARU) or similar scope level by other state ambulance services within Australia.

Conclusion Traditionally, RCT with aortic cross-clamping has been used in the pre-hospital setting to treat patients suffering NCTH. The use of REBOA dates back to the Korean War, but this device has recently shown great promise in being a less invasive alternative to RCT. A multicentre study into two level one trauma centres showed an increase in the use of the REBOA with greater survival rates compared to RCT. Many pre-hospital studies have supported the use of p-REBOA over c-REBOA in patients with NCTH due to its high efficacy, with lower mortality rates and decreased chance of reperfusion injury among patients. P-REBOA has been shown to be a relatively safe and effective procedure to be used by practitioners in the prehospital environment alongside, rather than as a replacement to, RCT in patients suffering sub-diaphragmatic NCTH.

A, Caragounis, E C, Falkenberg, M, Handolin, L, Chang, S W, Kessel, B, Hebron, D, Shaked, G, Bala, M, Coccolini, F, Ansaloni, L, Larzon, T & Nilsson, K F 2020, Prehospital CPR and early REBOA in trauma patients-results from the ABOTrauma Registry, World Journal of Emergency Surgery, 15, 23-23.

Knapp, J, Bernhard, M, Haltmeier, T, Bieler, D, Hossfeld, B & Kulla, M 2018, Resuscitative endovascular balloon occlusion of the aorta; Option for incompressible trunk bleeding? Der Anaesthesist, 67, 280.

Mcgreevy, D, Abu-Zidan, F, Sadeghi, M, Pirouzram, A, Toivola, A, Skoog, P, Idoguchi, K, Kon, Y, Ishida, T, Matsumura, Y, Matsumoto, J, Reva, V, Maszkowski, M, Bersztel, A, Caragounis, E, Falkenberg, M, Handolin, L, Oosthuizen, G, Szarka, E, Manchev, V, Wannatoop, T, Chang, S, Kessel, B, Hebron, D, Shaked, G, Bala, M, Coccolini, F, Ansaloni, L, Dogan, E, Manning, J, Hibert-Carius, P, Larzon, T, Nilsson, K & Hörer, T 2019, Feasibility and Clinical Outcome Of REBOA in Patients With Impending Traumatic Cardiac Arrest, European Journal of Vascular and Endovascular Surgery, 58, e831-e832.

Moore, L J, Martin, C D, Harvin, J A, Wade, C E & Holcomb, J B 2016, Resuscitative endovascular balloon occlusion of the aorta for control of non-compressible truncal hemorrhage in the abdomen and pelvis, American Journal of Surgery, 212, 12221230.

References

Nakajima, K, Taniguchi, H, Abe, T, Yamaguchi, K, Doi, T, Takeuchi, I & Morimura, N 2019, Does the conventional landmark help to place the tip of REBOA catheter in the optimal position? A non-controlled comparison study, World Journal of Emergency Surgery, 14, 35-35.

Bekdache, O, Paradis, T, Shen, Y B H, Elbahrawy, A, Grushka, J, Deckelbaum, D, Khwaja, K, Fata, P, Razek, T & Beckett, A 2019, Resuscitative endovascular balloon occlusion of the aorta (REBOA): indications: advantages and challenges of implementation in traumatic non-compressible torso hemorrhage, Trauma Surgery Acute Care Open, 4, e000262-e000262.

Nunez, R M, Naranjo, M P, Foianini, E, Ferrada, P, Rincon, E, García-Perdomo, H A, Burbano, P, Herrera, J P, García, A F & Ordoñez, C A 2017, A meta-analysis of resuscitative endovascular balloon occlusion of the aorta (REBOA) or open aortic cross-clamping by resuscitative thoracotomy in noncompressible torso hemorrhage patients, World Journal of Emergency Surgery, 12, 30-30.

Daley, J, Morrison, J J, Sather, J & Hile, L 2017, The role of resuscitative endovascular balloon occlusion of the aorta (REBOA) as an adjunct to ACLS in nontraumatic cardiac arrest, American Journal of Emergency Medicine, 35, 731-736.

Özkurtul, O, Staab, H, Osterhoff, G, Ondruschka, B, Höch, A, Josten, C & Fakler, J K M 2019, Technical limitations of REBOA in a patient with exsanguinating pelvic crush trauma: a case report, Patient safety in surgery, 13, 1-7.

De Schoutheete, J C, Fourneau, I, Waroquier, F, De Cupere, L, O’connor, M, Van Cleynenbreugel, K, Ceccaldi, J C & Nijs, S 2018, Three cases of resuscitative endovascular balloon occlusion of the aorta (REBOA) in austere pre-hospital environment-technical and methodological aspects, World Journal of Emergency Surgery, 13, 54-54.

Queensland Ambulance Service 2021, Clinical Practice Procedures: Trauma/Resuscitative clamshell thoracotomy, viewed 07 July 2021 from https://bit.ly/3HbNwit

Giordano, S, Spiezia, L, Campello, E & Simioni, P 2017, The current understanding of trauma-induced coagulopathy (TIC): a focused review on pathophysiology, Internal and Emergency Medicine, 12, 981-991.

Heindl, S E, Wiltshire, D A, Vahora, I S, Tsouklidis, N & Khan, S 2020, Partial versus complete resuscitative endovascular balloon occlusion of the aorta in exsanguinating trauma patients with non-compressible torso hemorrhage, Cureus, 12, e8999-e8999.

Teeratakulpisarn, P, Angkasith, P, Tanmit, P, Thanapaisal, C, Prasertcharoensuk, S. & Wongkonkitsin, N 2021, A lifesaving emergency department resuscitative endovascular balloon occlusion of the aorta (Reboa) with open groin technique, Open access emergency medicine, 13, 183-188.

Wortmann, M, Engelhart, M, Elias, K, Popp, E, Zerwes, S & Hyhlik-Dürr, A 2020, Resuscitative endovascular balloon occlusion of the aorta (REBOA) : Current aspects of material, indications and limits: an overview, Chirurg, 91, 934-942.

Hilbert-Carius, P, Mcgreevy, D T, Abu-Zidan, F M, Hörer, T M, Mcgreevy, D T, Abu-Zidan, F M, Hörer, T M, Sadeghi, M, Pirouzram, A, Toivola, A, Skoog, P, Idoguchi, K, Kon, Y, Ishida, T, Matsumura, Y, Matsumoto, J, Maszkowski, M, Bersztel,

Summer 2021–22

99

Discussion

The available literature s CPAP therapy as a part exacerbations of COPD CPAP as a treatment conditions has evidently i and decreased the requi minimal evidence of adve justifies its safety within th its effects on reducing h remains uncertain (3).

Several studies conclude for AECOPD when use standard drug therapies these patients should be has been associated with using a low fraction of enhance patient outcome

Despite a number of stu may be beneficial in respiratory infections, suc evidence to support its ind

Introduction Discussion

la

s

Given that the presentation of acute respiratory distress or failure may be due to a number of aetiologies, paramedics must be able to identify the appropriate treatment modality for each individual patient. The objective of the literature review was to identify the respiratory conditions that may benefit from prehospital CPAP therapy.

Paramedicine students, Griffith University School of Medicine and Dentistry, Paramedicine Program Gold Coast, Queensland, Australia.

Acute respiratory distress (ARD) is a common and potentially life-threatening medical emergency that may lead to acute respiratory failure (ARF)(1). The presence of underlying conditions such as pneumonia, chronic obstructive pulmonary disease (COPD), asthma, acute respiratory infection, and acute pulmonary oedema (APO) may lead to a failure to maintain adequate blood oxygen levels and/or increased carbon dioxide, potentially leading to ARF(2).

The available literature suggests that the use of prehospital CPAP therapy as a part of the management of APO, acute exacerbations of COPD (AECOPD) and asthma is justified.

CPAP as a treatment modality for the aforementioned conditions has evidently improved patients’ physiological signs and decreased the requirement for intubation (2, 3, 5, 6, 7). The minimal evidence of adverse events for these patients further justifies its safety within the prehospital setting (2, 3, 5). However, its effects on reducing hospital length of stay and mortality remains uncertain (3).

ce

|

| Be

Continuous positive airway pressure (CPAP) has been used in the in-hospital environment for APO, acute exacerbations of COPD and asthma (3). Currently, the Queensland Ambulance Service (QAS) utilises CPAP for APO and severe or lifethreatening exacerbations of asthma (4).

Methodology The review may be limited by the lack of high-quality and externally validated prehospital studies, evidenced by the fact that many had small sample sizes and/or did not include a comparison group. This ultimately made it difficult to draw sound conclusions from the findings. The results from the trials were also unsuccessful in specifying the exact outcomes associated with particular conditions.

Limitations

Despite a number of studies suggesting that CPAP therapy may be beneficial in the prehospital management of respiratory infections, such as pneumonia, there is insufficient evidence to support its indication (2, 3).

Several studies concluded that CPAP may be most beneficial for AECOPD when used in conjunction with or following standard drug therapies (5, 7). However, oxygen therapy for these patients should be given cautiously; high flow oxygen has been associated with increased mortality and thus, CPAP using a low fraction of inspired oxygen and pressure may enhance patient outcomes (5).

Acute respiratory distress (ARD) is a common and potentially life-threatening medical emergency that may lead to acute respiratory failure (ARF)(1). The presence of underlying conditions such as pneumonia, chronic obstructive pulmonary disease (COPD), asthma, acute respiratory infection, and acute pulmonary oedema (APO) may lead to a failure to maintain adequate blood oxygen levels and/or increased carbon dioxide, potentially leading to ARF(2).

Continuous positive airway pressure (CPAP) has been used in the in-hospital environment for APO, acute exacerbations of COPD and asthma (3). Currently, the Queensland Ambulance Service (QAS) utilises CPAP for APO and severe or lifethreatening exacerbations of asthma (4).

Introduction

Given that the presentation of acute respiratory distress or failure may be due to a number of aetiologies, paramedics must be able to identify the appropriate treatment modality for each individual patient. The objective of the literature review was to identify the respiratory conditions that may benefit from prehospital CPAP therapy.

Methodology

o s t e r: 3

Conclusion

The review may be limi externally validated preho that many had small sa comparison group. This sound conclusions from th were also unsuccessful associated with particular

The evidence in this review suggested that the use of CPAP therapy in the prehospital setting may be beneficial for the treatment of asthma, AECOPD and APO. This therapy has been proven to reduce intubation and mortality rates and improve patient vital signs. However, a larger prehospital randomised controlled trial is required to determine the validity of prehospital CPAP administration in patients suffering from these conditions.

Limitations INDICATIONS

• Acute Pulmonary Oedema • Asthma (with evidence of severe ARD, unresponsive to 3 x salbutamol NEB) • Acute exacerbations of COPD (with evidence of severe ARD, unresponsive to initial drug therapy)

Proposed CPG

CONTRAINDICATIONS

1.

Fuller G, Keating S, Goodacre S, Herbert E, Perkins G, Rosser A, et al. Is a definitive trial of prehospital continuous positive airway pressure versus standard oxygen therapy for acute respiratory failure indicated? The ACUTE pilot randomised controlled trial. BMJ Open. 2020;10(7):e035915.

Dunand A, Beysard N, Maudet L, Carron P N, Dami F, Piquilloud L, et al. Management of respiratory distress following prehospital implementation of noninvasive ventilation in a physician-staffed emergency medical service: a single-center retrospective study. Scand J Trauma Resusc Emerg Med. 2021;29(1):85.

Patients < 16 years GCS < 8 Inadequate ventilatory drive Diminished airway reflexes Pneumothorax Hypotension (SBP < 90mmHg) Epistaxis Vomiting Facial/neck trauma Penetrating chest trauma Facial or respiratory tract burns

• • • • • • • • • • •

2.

References

3.

6.

5.

4.

Finn JC, Brink D, McKenzie N, Garcia A, Tohira H, Perkins GD, et al. Prehospital continuous positive airway pressure (CPAP) for acute respiratory distress: A randomised controlled trial. Emerg Med J. 2021.

Queensland Ambulance Service (QAS). Clinical Practice Procedures: Respiratory/Non-invasive Ventilation – CPAP [Internet].

QAS Website: QAS; 2017[2017 October; 2021 August]. https://www.ambulance.qld.gov.au/docs/clinical/cpp/CPP_Non%20invasive%20ventilation_CPAP.pdf Nielsen VM, Madsen J, Aasen A, Toft -Petersen AP, Lubcke K, Rasmussen BS, et al. Prehospital treatment with continuous positive airway pressure in patients with acute respiratory failure: a regional observational study. Scand J Trauma Resusc Emerg Med. 2016;24(1):121.

Pinczon J, Terzi N, Usseglio-Polatera P, Gheno G, Savary D, Debaty G, et al. Outcomes of Patients Treated with Prehospital Noninvasive Ventilation: Observational Ret rospective Multicenter Study in the Northern French Alps. J Clin Med. 2021;10(7).

Luiz T, Kumpch M, Gruttner J, Madler C, Viergutz T. Prehospital CPAP Therapy by Emergency Physicia ns in Patients with Acute Respiratory Failure due to Acute Cardiogenic Pulmo nary Edema or Acutely Exacerbated COPD. In Vivo.

2016;30(2):133-9.

7.

Summer 2021–22

Under Pressure

Paramedicine students, Griffith University School of Medicine and Dentistry, Paramedicine Program Gold Coast, Queensland, Australia.

A review of literature utilising medical databases including Ovid Medline, Embase, CINAHL Complete, ProQuest Central, and PubMed Central was conducted. To encapsulate the most current literature, the review encompassed articles from the last five years. Numerous relevant concepts and Medical Subject Headings (MeSH) to ensure all potential articles were accessible. Articles involving all study types were included if they contained information on CPAP therapy for patients experiencing a respiratory complaint prehospitally. Articles s were excluded anift they were not primary studies, did not relate Gr treatment, or contained information on BIPAP, to prehospital the use of CPAP in paediatric patients, or those with COVID19. p

rd

tp Stud

ACP

A review of literature utilising medical databases including Ovid Medline, Embase, CINAHL Complete, ProQuest Central, and PubMed Central was conducted. To encapsulate the most current literature, the review encompassed articles from the last five years. Numerous relevant concepts and Medical Subject Headings (MeSH) to ensure all potential articles were accessible. Articles involving all study types were included if they contained information on CPAP therapy for patients experiencing a respiratory complaint prehospitally. Articles were excluded if they were not primary studies, did not relate to prehospital treatment, or contained information on BIPAP, the use of CPAP in paediatric patients, or those with COVID19.

An evaluation of the use of prehospital CPAP

Taneisha Beckton taneisha.beckton@griffithuni.edu.au | Hannah Dumbleton hannah

Taneisha Beckton taneisha.beckton@griffithuni.edu.au | Hannah Dumbleton hannah.dumbleton@griffithuni.edu.au

An evaluation of the use of prehospital CPAP

Under Pressure

Scientifi c e

nt

KJM Awards

PRESEP Score

Robson tool

Cunningham R, Dickson A, Doolan J, Leyshan E.

Positive Predictive Value and Negative Predictive Value: critiqued within the context of the sepsis prehospital screening tool, PRESEP Score Fig. 4

Fig. 5

Positive Predictive Value

Of every 10 people screening positive with the PRESEP Score, 6.6 will have sepsis compared to Robson’s 3.3 in every 10. PPV is 0.66 and 0.32 respectively.1 The Robson PPV 0.32 is relatively low.1

The clinical concern is the False Positive cohort receiving antibiotic administration and triage escalation.8

PREP Score:

Global incidence of sepsis in 2017 was 688.5 per 100 000 or 48.9 million (95% CI 38.9-62.9).9

Fig. 6

Below is what would happen if we shifted the cut off mark for a positive test further to the right. We can increase the percentage of true positives achieving a higher PPV.

As a consequence, we see more true positives fall through our screening ‘net’ becoming false negatives. With a critical condition such as sepsis, a screening tool’s NPV is most important.8

PPV and NVP: relationship with condition prevalence

A further limitation of the statistic is its direct relationship with condition prevalence.3,4,11 This has proven to be a poorly recognised concept among medical practitioners.4 The formula below illustrates this relationship; however, it is dependent on the knowledge of the prevalence within a population. This may be applicable for a researcher retrospectively analysing data; it is unlikely a paramedic can apply this in the field.

50% prevalence of sepsis = PPV of 95%

Fig. 7 A visual depiction of the PPV/Prevalence relationship

1% prevalence of sepsis = PPV of 15%3

References

Understanding the applications and limitations of PPV and NPV arms paramedics with appropriate confidence and caution, interpreting screening tool results as part of a risk analysis bundle. Critically evaluating gathered information, paramedics can confidentially advocate for the urgent treatment of patients who may otherwise full through the net.

Conclusion

Rather than disregarding patients testing negative, paramedics can sort through with their knowledge of epidemiology, aetiology, pathophysiology and patient history.

Practitioners must acknowledge these limitations with screening tools and understand that there is “no one clinical feature and pathological test that reliably identifies sepsis.”10

Finn JC, Brink D, McKenzie N, Garcia A, Tohira H, Perkins GD, et al. Prehospital continuous positive airway pressure (CPAP) for acute respiratory distress: A randomised controlled trial. Emerg Med J. 2021.

Queensland Ambulance Service (QAS). Clinical Practice Procedures: Respiratory/Non-invasive Ventilation – CPAP [Internet].

QAS Website: QAS; 2017[2017 October; 2021 August]. https://www.ambulance.qld.gov.au/docs/clinical/cpp/CPP_Non%20invasive%20ventilation_CPAP.pdf Nielsen VM, Madsen J, Aasen A, Toft -Petersen AP, Lubcke K, Rasmussen BS, et al. Prehospital treatment with continuous positive airway pressure in patients with acute respiratory failure: a regional observational study. Scand J Trauma Resusc Emerg Med. 2016;24(1):121.

Pinczon J, Terzi N, Usseglio-Polatera P, Gheno G, Savary D, Debaty G, et al. Outcomes of Patients Treated with Prehospital Noninvasive Ventilation: Observational Ret rospective Multicenter Study in the Northern French Alps. J Clin Med. 2021;10(7).

Luiz T, Kumpch M, Gruttner J, Madler C, Viergutz T. Prehospital CPAP Therapy by Emergency Physicia ns in Patients with Acute Respiratory Failure due to Acute Cardiogenic Pulmo nary Edema or Acutely Exacerbated COPD. In Vivo.

2016;30(2):133-9.

1.Bayer O, Schwarzkopf D, Stumme C, et al. An Early Warning Scoring System to Identify Septic Patients in the Prehospital Setting: The PRESEP Score. Acad Emerg Med. 2015;22(7):868-71. doi: 10.1111/acem.12707 2.Smyth MA, Brace-McDonnell SJ, Perkins GD. Identification of adults with sepsis in the prehospital environment: a systematic review. BMJ Open. 2016;6(e011218). doi:10.1136/bmjopen-2016-011218 3.Parikh R, Mathai A, Parikh S, Chandra Sekhar G, Thomas R. Understanding and using sensitivity, specificity and predictive values. Indian J Ophthalmol. 2008;56(1):45-50. doi:10.4103/0301-4738.37595 4.Manrai AK, Bhatia G, Strymish J, Kohane IS, Jain SH. Medicine’s Uncomfortable Relationship With Math: Calculating Positive Predictive Value. JAMA Intern Med. 2014;174(6):991–993. doi:10.1001/jamainternmed.2014.1059 5.Paramedicine Board of Australia - Professional capabilities for registered paramedics. Paramedicineboard.gov.au. 2021. Accessed one 16 August 2021. https://www.paramedicineboard.gov.au/professional-standards/professional-capabilities-for-registered-paramedics.aspx 6.Wilson A, Howitt S, Holloway A, Williams AM, Higgins D. Factors affecting paramedicine students’ learning about evidence‐based practice: a phenomenographic study. BMC Med Educ. 2021; 21(45). doi.org/10.1186/s12909-021-02490-5 7.The Australasian College of Paramedicine. Talking Research: research 101. Paramedics.org. 2021. Accessed August 16,2021. https://paramedics.org/courses/Research101 8.Dykes LA, Heintz SJ, Heintz BH, Livorsi DJ, Egge JA, Lund BC. Contrasting qSOFA and SIRS Criteria for Early Sepsis Identification in a Veteran Population. Fed Pract. 2019;36(Suppl 2):S21-S24. Accessed August 16, 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6453603/ 9.Rudd KE, Johnson SC, Agesa KM, et al. Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study. The Lancet. 2020;395(10219):200-211. Doi:https://doi.org/10.1016/S0140-6736(19)32989-7 10.Queensland Ambulance Service. Clinical Practice Guidelines: Medical/Sepsis. Ambulance.qld.gov.au. 2021. Accessed August, 16 2021. https://www.ambulance.qld.gov.au/docs/clinical/cpg/CPG_Sepsis.pdf 11.Altman D G, Bland J M. Statistics Notes: Diagnostic tests 2: predictive values. BMJ. 1994;309(102) doi:10.1136/bmj.309.6947.102

Summer 2021–22

Background

The PRESEP Score sepsis screening tool can be used to facilitate timely diagnosis.1,2 However, to critically appraise the results of the tool, a practitioner must know how to interpret its associated health statistics.3,4 A health professional will “critically evaluate the information collected to make clinical judgments”.5 Fig. 1

TN = True Negative FN = False Negative FP = False Positive TP = True Positive

Looking to the right of the cut off value

Figure 1 represents the diagnostic accuracy of a screening tool. The dissecting line shows the tool’s cut off value: scores to the right have screened positive for the condition; scores to the left have screened negative.

Looking to the left of the cut off value Fig. 3

Issues: ▪ Over triaging ▪ Inappropriate treatment with antibiotics

•

Mortality Rates for Sepsis:

•

Robson ‘net’

Missing 1 in 20 is an issue

3.

7.

Sepsis accounted for 19.7% (95% CI 18.2-21.4) of global mortality that same year, equating to approximately 11 million deaths (95% CI 10.1-12.0) or rates globally of 148.1 (95% CI 136.4-161.0) per 100 000. 9 The criticality of sepsis calls for a low treatment threshold and should be considered for any deteriorating patient,10 therefore the test’s PPV is not as concerning as its NPV.8 PRESEP Score ‘net’

In recognition of this relationship, the PRESEP Score researchers acknowledge the lack of universality of the findings due to the high prevalence of sepsis in their study sample.1 With this understanding, a paramedic adds further caution in using a screening tool exclusively to make a provisional diagnosis for sepsis; in particular, adding caution in ruling sepsis out.

•

“High sensitivity in a sepsis screening tool is paramount.”10

Exclusively using the PRESEP Score: 1 in 20 negatively screened patients will have sepsis (NPV 95%)

References

Fig. 2

Total 118 257 375

Negative Predictive Value

Fuller G, Keating S, Goodacre S, Herbert E, Perkins G, Rosser A, et al. Is a definitive trial of prehospital continuous positive airway pressure versus standard oxygen therapy for acute respiratory failure indicated? The ACUTE pilot randomised controlled trial. BMJ Open. 2020;10(7):e035915.

6.

Patients < 16 years GCS < 8 Inadequate ventilatory drive Diminished airway reflexes Pneumothorax Hypotension (SBP < 90mmHg) Epistaxis Vomiting Facial/neck trauma Penetrating chest trauma Facial or respiratory tract burns CONTRAINDICATIONS

How does a paramedic accommodate for the 1 in 20 falling through the net?

2.

5.

Figure 3 represents a ‘test positive’ cohort from the PRESEP Score tool1. The Positive predictive value (PPV) indicates the percentage of positive results that will be true positives (66%).3 The remaining 34% are false positives. These people will not have sepsis but may be treated for it.

Disease Absent 39 243 282

INDICATIONS

The screening tools offer comparable NPVs (PRESEP Score 0.95; Robson 0.97);1 very few sepsis positive patients fall through these nets. Of every 20 patients screening negative, approximately 1 person will be a false negative (they will have sepsis and possibly go untreated).

Dunand A, Beysard N, Maudet L, Carron P N, Dami F, Piquilloud L, et al. Management of respiratory distress following prehospital implementation of noninvasive ventilation in a physician-staffed emergency medical service: a single-center retrospective study. Scand J Trauma Resusc Emerg Med. 2021;29(1):85.

4.

The PPV and NPV are functional health statistics.6 They allow the practitioner to understand the strengths and limitation of the results of a screening tool such as the PRESEP Score.3,4,7

Disease Present 79 14 93

Results Table 1. Contingency table adapted using data from Bayer O, Schwarzkopf D, Stumme C, et al. 2015 Test Positive Test Negative Total

Discussion

Proposed CPG

• • • • • • • • • • •

udies suggesting that CPAP therapy the prehospital management of ch as pneumonia, there is insufficient dication (2, 3).

Figure 2 represents the ‘test negative’ cohort from the PRESEP Score tool. The negative predictive value (NPV) indicates the percentage of negative results that will be true negatives (95%).3 The remaining 5% are false negatives. These people will have sepsis and may not be treated for it.

The evidence in this review suggested that the use of CPAP therapy in the prehospital setting may be beneficial for the treatment of asthma, AECOPD and APO. This therapy has been proven to reduce intubation and mortality rates and improve patient vital signs. However, a larger prehospital randomised controlled trial is required to determine the validity of prehospital CPAP administration in patients suffering from these conditions. suggests that the use of prehospital t of the management of APO, acute (AECOPD) and asthma is justified. modality for the aforementioned improved patients’ physiological signs irement for intubation (2, 3, 5, 6, 7). The erse events for these patients further he prehospital setting (2, 3, 5). However, hospital length of stay and mortality

1.

ited by the lack of high-quality and ospital studies, evidenced by the fact ample sizes and/or did not include a ultimately made it difficult to draw he findings. The results from the trials l in specifying the exact outcomes r conditions.

• Acute Pulmonary Oedema • Asthma (with evidence of severe ARD, unresponsive to 3 x salbutamol NEB) • Acute exacerbations of COPD (with evidence of severe ARD, unresponsive to initial drug therapy) ed that CPAP may be most beneficial ed in conjunction with or following s (5, 7). However, oxygen therapy for e given cautiously; high flow oxygen h increased mortality and thus, CPAP inspired oxygen and pressure may es (5).

Conclusion

The following will aim to further illustrate the functionality of PPV and NPV by comparing the PRESEP Score with the Robson (sepsis) screening tool.

h.dumbleton@griffithuni.edu.au

In 2018 the Queensland Ambulance Service attempted resuscitation of 2,152/ 5,364 out of hospital cardiac arrests (OHCA) across Queensland. 76% of these patients receiving resuscitation attempts had received bystander CPR. Patients who received bystander CPR were almost twice as likely to be discharged alive and to reach 30-day survival than those who did not. From these figures bystander early intervention is critical to patient survival.

A 2017 study of the public CPR training rates in Victoria sited having never thought about it, lack of time, not knowing where to learn, and cost as reasons for non-certification. Untrained bystanders face barriers including difficulty in identifying the signs and symptoms of a heart attack, inability to deliver effective chest compressions, and lack of confidence in employing the use of an AED where possible.

CPR and AED community outreach programs targeting these key skills are essential to increase OHCA bystander delivered CPR and patient survival rates.

There was significant improvement in participant confidence across all key skills post-session (Figure One). Most notably, confidence associated with AED application increased from 2.67 ±1.3 to 4.33 ± .73 (p<0.01, ES 1.57).

A 41% increase in self perceived CPR ability was reported, with the greatest improvement in ability to correctly perform CPR (p<0.01 ES 1.95).

The ES for all pre and post questions was greater than .8, demonstrating a large increase in perceived ability across all key skills (Figure Two).

Mean participant score for the comprehensiveness and educational quality of the event was 4.8/ 5, indicating the effectiveness of the undergraduate paramedic student lead CPR and AED community outreach program.

8

7

6

5

4

2 3

Overall the event was comprehensive and educational

Following the event I feel confident I can apply and operate an AED

Following the event I feel confident I can correctly perform CPR

Following the event I feel confident I can identify someone in cardiac arrest Following the event I feel confident I can perform CPR if required

Prior to the event I felt confident I could apply and operate an AED

Prior to the event I felt confident I could identify someone in cardiac arrest Prior to the event I felt confident I could perform CPR if required Prior to the event I could correctly perform CPR

Table One: Pre and post questions

9

Any further comments?

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10

1

Q

2

Q u e s tio n

Q

3

Q

4

P o s t E d u c a t io n

P r e E d u c a t io n

Figure One: Pre and post participant self reported improvement

T a b le 1 P a ir e d t-te s t o f S u r v e y D a ta

6

4

2

0

Q

References

Bray, J. E., Smith, K., Case, R., Cartledge, S., Straney, L., & Finn, J. (2017). Public cardiopulmonary resuscitation training rates and awareness of hands-only cardiopulmonary resuscitation: A crosssectional survey of Victorians. Emergency Medicine Australasia 29(2), 158-164. https://doi.org/10.1111/1742-6723.12720 Kavelak, H.L., Hollands, J.M., & Bingham, A. L. (2019). Student-led cardiopulmonary resuscitation education to lay providers results in successful knowledge acquisition and skill performance. Journal of Allied Health, 48(1),18-21. https://www.ingentaconnect.com/content/asahp/jah/2019/00000048/00000001/art00005 Mirjalili, N., Bonabi, T. N., Sharifabad, M. B., & Jaberi, A. A. (2017). Improving nursing students perceived self-efficacy in CPR, through peer-leg educational method. Creative Education, 13, 86-91. http://eprints.covenantuniversity.edu.ng/8697/1/OMOJOLA%20MALAYSIA%20CONFERENCE%20PAPER.pdf#page=101 Paramedicine Board Ahpra. (2021). Professional capabilities for registered paramedics. https://www.paramedicineboard.gov.au/professional-standards/professional-capabilities-for-registeredparamedics.aspx Queensland Ambulance Service. (2020). Out of hospital cardiac arrest in Queensland 2018 annual report. https://www.ambulance.qld.gov.au/docs/QAS%20OHCA%20Annual%20Report%202018.pdf

P o s t E d u c a tio n T o t a l

P r e E d u c a t io n T o t a l

Figure Figure Two:Three: Overall Overall pre and prepost andparticipant post CPR and self reported AED t a l P r e participant v eimprovement r s u s P o self s t reported improvement awarenessT osession 20 18 16 14 12 10 8

P re v e rs u s P o s t

To perform competent and ethical practice registered paramedics are required to participate in guiding the learning of others and contribute to orientation and ongoing education programs.

Community engagement of this nature aligns students with the mentor, teaching and development aspects of their future roles as outlined in AHPRA’s Paramedic Professional Capabilities for Registered Paramedics.

Research into the value of undergraduate paramedic student lead community outreach programs would help determine as to what level these sessions can prepare students for their future practitioner roles.

Overall, undergraduate paramedic student lead community outreach programs allow students to practice classroom skills while engaging with community members and further develop these future paramedic practitioners.

Further undergraduate paramedic student lead community outreach programs of this nature are required to determine their effectiveness and impact on OHCA bystander delivered CPR and patient survival rates.

While this study impresses that undergraduate student paramedics can effectively deliver CPR and AED community outreach programs, the small sample size inhibits a decisive conclusion.

All participants reported significant improvement in all key skills postsession participation, regardless of pre-session self perceived ability. Most participants assessed the community outreach program delivered by the undergraduate paramedic students to be comprehensive and educational.

S c o re

Undergraduate paramedic student lead community outreach programs will assist in fostering the educational facet of a paramedic’s role to enhance the quality of paramedic practitioners within the community setting.

Acknowledgements: Sandy MacQuarrie, Steve Whitfield & Griffith Paramedic Society

Ali.Rengers@griffithuni.edu.au

Summer 2021–22

Limited research has been reported regarding the engagement of undergraduate paramedic students for the delivery of CPR and AED awareness sessions. The delivery of community training by these students is not well understood, prompting this research.

Several studies have demonstrated the effectiveness of medical student lead CPR and AED education on the knowledge and correct implementation of key skills of students and the general public.

This study aimed to examine if undergraduate paramedic students could successfully and effectively deliver a CPR and AED awareness session to a community group in the context of a community outreach program.

A Queensland community group consisting of 21 female members between the ages of 30 and 70 years, with novice to experienced CPR knowledge, attended a free undergraduate paramedic student lead CPR and AED community outreach program.

Study participants were asked to complete a paper-based survey instrument with 10 questions. Nine of these questions employed Likert scoring (1 – strongly disagree to 5 – strongly disagree) and one was an open-ended qualitative question (Table One).

•

Likert scoring consisting of five numbers allowed for a neutral opinion, which may have impacted results.

Participants completed questions one to four prior to the session and questions five to 10 post participation. The collected data was deidentified, collated, cleaned, a paired t-test model was fitted, and effect sizes (ES) calculated.

• All questions were designed to be answered after the awareness session. The decision to have questions answered pre- and postsession was made to encourage accurate reporting.

S c o re

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