QAS Insight Magazine - Summer 2016-17 edition

QAS Summer 2016-17

Year in Review | Duress Systems | Fibrinolysis Administration

FROM THE COMMISSIONER

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NEW DURESS SYSTEMS

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WHITE RIBBON

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YEAR IN REVIEW

CHRISTMAS NOT STRESS-MAS

WORLD-CLASS CARDIAC CARE

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OPERATIONS CENTRES WRAP-UP

SCHOOLIES

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Go west and prosper

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Celebrating 125 years

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Cairns welcomes new ACP2 kits

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Live streaming coming to a crash site near you

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Situation critical: when it’s more than business as usual 20 HARU Report

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Case study: Decision Supported Fibrinolysis Administration 26 SIT N YARN

KJM

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QAS Insight is published quarterly by the QAS Media Unit, GPO Box 1425, Brisbane 4001. Editorial and photographic contributions are welcome and can be submitted to: QAS.Media@ambulance. qld.gov.au or +61 7 3635 3900.

Summer 2016-17 editorial contributors: Edda Mwangi, Michael Franks, Michael Augustus, Joanne Mitchell, John Murray, Brett Rogers, Gary Berkowitz, Dr Stephen Rashford, Eileen Stead, Lara King and Teresa Jurgensen.

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QAS Insight | Summer 2016-17

From serving a sleepy town to a booming metropolis 32 It’s all about our people

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Building our cultural capability 42

Cover photo: The team from Sarina Ambulance Station gets into the Christmas spirit in a big way. A special thanks goes to Sarina locals Lyn Birch and Bec Bannan for their help with the photo.

Minister’s Message This has been a big year and your hard work has not gone unnoticed.

Whether working physically on-road or providing day-today operational support behind the scenes, all QAS staff deserve our utmost respect and gratitude.

I would particularly like to make a special mention of the paramedics and emergency medical dispatchers who worked together responding to the recent tragic events at Dreamworld on the Gold Coast, Kowanyama in Cape York and the bus fire in Moorooka.

No paramedic wants to attend a job where they cannot make a difference.

In each of these cases and more throughout the year, you demonstrated your professionalism and provided comfort to families, bystanders and all Queenslanders.

On behalf of all Queenslanders, I would like to thank all of you for your courage and dedication to duty.

I’d also like to congratulate all QAS staff involved in the Ravenshoe café explosion and recovery for their joint win with other agencies at the 2016 Premier’s Awards for Excellence in the Performance category. The multiagency response was unprecedented and is a testament to your professionalism.

November to announce the installation of new covert duress systems in ambulance vehicles and a duress alarm capability for radio systems.

The new Duress Monitoring System for ambulance vehicles means a treating paramedic will be able to discreetly notify the paramedic in the front of the vehicle that a potential situation is developing.

Paramedics will also be able to quickly alert the respective Operations Centre to an emergency situation with the enhancement of existing analogue radios to include a duress alarm capability.

This rollout will commence in the Cairns Local Ambulance Service Network (LASN) from mid-December 2016 and is expected to be completed statewide by June 30, 2017.

Finally, I’d like to especially acknowledge and thank all QAS staff who will be working throughout the festive season. Our thanks is also extended to your families who will undoubtedly miss you during the holidays.

To those among you who will be taking a break these holidays, I wish you a safe and Merry Christmas and a Happy New Year.

In the same way that you put patients first, we are also putting you first.

As a direct response to the 15 recommendations of the Paramedic Safety Taskforce Final Report handed down in April this year, I was pleased to travel to Cairns in

Hon. Cameron Dick MP Minister for Health Minister for Ambulance Services

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From the Commissioner As the end of the year draws near, I’d like to take stock of what has been yet another busy year and acknowledge the dedication that all QAS staff have shown throughout 2016.

A major focus this year has been on improving our work culture and making the workplace safer for you, our staff.

There would be no ambulance service without each and every one of you and if we are to continue achieving our objective of excellence in ambulance services, we all have an equally important part to play, including you and I. To that end, a number of initiatives were launched this year aimed at improving our conditions. First up was the Paramedic Safety Taskforce report that was handed down in April. The report outlined 15 recommendations for reducing the risk of harm to paramedics and raising ongoing awareness for the creation of a safer working environment.

All 15 recommendations are on track to be completed by the end of this year and include the Droperidol rollout for all Advanced Care Paramedics, revised SAFE2 training, a public awareness campaign and ongoing work to identify technology options that can assist paramedics in the context of interventions.

I was pleased to see the QAS Workplace Health and Safety Performance Report 2015-16 which showed a reduction in the incidence of workplace injuries among QAS employees and a reduction in absence from the workplace due to injury/illness. The health and safety of all QAS employees is a key priority and the report was encouraging, however I would encourage all QAS staff to remain vigilant in relation to your safety at work and your co-workers and to continue building on these achievements.

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QAS Insight | Summer 2016-17

In June, I received the results of the Working for Queensland Employee Opinion Survey. The results showed that from a state perspective, the workplace climate has improved on the 2015 survey results with eight out of 10 of the strategic priority categories showing an improvement or maintaining the positive results from last year.

The areas with the most improvement when measured against 2015 survey results were the complaints management process, job security, organisational leadership, job empowerment and anti-discrimination.

Early next year, I intend to meet with a large cross section of staff to talk about the future for QAS, our employee opinion results and workplace culture.

On behalf of the executives within the QAS, I would like to take this opportunity to commend you all for your hard work and dedication to the organisation. Whatever you are doing over the holiday period, I hope you have a safe and happy Christmas and enjoy the time off with your families.

To all of you who are working through the holiday period, I thank you for your commitment and dedication. Please stay safe and look after each other.

Russell Bowles QAS Commissioner

Minister Cameron Dick during the new duress systems announcement

Duress systems to protect paramedics Covert duress systems will be installed in ambulances and a duress alarm capability introduced to radio systems as part of a move to better protect paramedics from occupational violence.

These initiatives are in response to the Paramedic Safety Taskforce Final Report recommendation to investigate the potential for new technology to help reduce the risk of violence against frontline staff.

The installation of the Duress Monitoring System (DMS) in ambulances will enable the treating paramedic to discreetly notify the paramedic in the front of the vehicle that a potential situation is developing by streaming a live video feed to the rear view display screen.

The new systems will be fitted to all new ambulances during production and a retrofit program will be rolled out to 862 existing ambulances across Queensland.

Existing analogue radios being used around the state will be enhanced with a duress capability which will allow officers to quickly alert the respective Operations Centre to an emergency situation.

The rollout in vehicles begins in the Cairns LASN from December 2016 and is expected to be completed statewide

by June 30, 2017.

The rollout of the duress capability on analogue radios will begin in the Cairns LASN from March 2017.

Remuneration Inquiry begins Work on the joint QAS and United Voice Queensland (UVQ) Remuneration Inquiry began in late October and is expected to be completed by May next year.

The independent review will be looking into the pay and conditions for ambulance officers.

The current determination expired on October 2, 2016 and the review gives stakeholders a chance to engage in a meaningful and constructive way.

An interim pay increase of 2.5 per cent was granted to eligible officers on August 1.

The review is being undertaken by Mercer Consulting (Australia) who were successful in an invitationto-offer process for the contract to undertake the Remuneration Inquiry.

extensive public sector experience, including with health and ambulance services.

Work on the review will include: ▸▸ Aligning and analysing key occupational groups within the QAS to other ambulance services across Australia.

This analysis will include reviewing remuneration and conditions as well as a broader analysis of the work, skill and responsibility of the roles. ▸▸ Aligning and evaluating key benchmark occupations within the Queensland Government, such as nursing and firefighting roles. ▸▸ An analysis of the key changes to the evolution of work of key QAS occupational groups.

For more information, contact your LASN Manager.

Within Australia, Mercer has been providing remuneration and job evaluation services for more than 35 years, with

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Go west and prosper Between them they’re responsible for delivering ambulance services to a vast geographical area covering 53 per cent of the state, including iconic Queensland towns like Longreach, Birdsville, Cunnamulla, Mount Isa, Roma and Julia Creek.

They’re the modern face of ambulance service delivery in rural and remote Queensland, with 40 years of combined experience in providing health care in some of our most challenging and isolated locations.

Meet Jessika Brind, Gavin Farry and Loretta Johnson.

The trio have recently taken up roles as Local Ambulance Service Network managers and all bring a unique understanding of, and deep affinity with, the people of our remote and rural communities.

For Jessika Brind and her paramedic husband Sam, a twoyear stint of country service has turned into an incredibly rewarding six-year adventure that’s taken them from Townsville to Julia Creek and Mount Isa.

Jessika is the Superintendent in charge of the North West LASN, which covers an area of 253,000 square kilometres and is home to more than 30,000 people.

It’s about as far away from her childhood home of the Sunshine Coast as you can get, but Jessika and Sam have well and truly embraced life in the outback.

“When you’re working in a small community, you’re more than just a paramedic. You wear many different hats and the people in these small towns really like it when you get involved in community activities,” Jessika said.

“That’s great but there are also some challenges that go with it, especially when it comes to treating people you know and have become close to.

“It can be very hard to treat people you know well and there’s been times where I’ve had to say to myself ‘right for the next 60 minutes I don’t know this person’, so that I can focus on providing the best clinical care for that patient and not be thinking about the repercussions of the incident or injury for that person and their family.

“That said, I have had many good outcomes and many occasions when people have come up to me to say thank you for helping them.”

jillaroos from a property to help you carry equipment and move the patient.

“As a child I didn’t see myself living in a remote area, but as I progressed through my career I could see a lot of opportunities for professional development were in rural and remote areas.

“I’d like to focus on encouraging all of our staff in the North West to consider their own professional development – whatever their own path may be. Be it in clinical roles or aspiring to Officer-in-Charge roles, I’d certainly like to give people the opportunity to grow and develop their careers.”

Gavin, the Superintendent in charge of the Central West LASN based in Longreach, is honoured to be serving in the community where he was born.

Jessika Brind

Jessika started her career in 2006 as an Emergency Medical Dispatcher in Brisbane before transferring to Townsville the following year. She soon made the transition to an on-road role working out of Kirwan Station as a student paramedic.

In 2010 she not only qualified as an Advanced Care Paramedic, but was the dux of her student group. In early 2011 Jessika and Sam headed off to the North West LASN for a relieving stint and six months later Jessika was appointed Officer-in-Charge at Julia Creek. Sam took up the position of paramedic at the station and they settled into the country life, soon welcoming their children Evangeline (2) and William (1) into the world.

Now leading a team that operates from seven ambulance stations and three hospital-based stations in locations as diverse as Cloncurry, Dajarra, Camooweal, Karumba and Mornington Island, Jessika believes her rural and remote service has been incredibly important to her career development.

“Working on my own in a small town as a single officer is something that I’ve really enjoyed. Sometimes due to the distances and small populations it’s not always easy to get back-up and there are times when you are faced with clinically challenging cases,” Jessika said.

“It meant I really had to think for myself and learn how to harness the resources available to me to effectively treat patients and work through how to move them from a remote location to a place where they can receive definitive care.

“But while you’re often the only paramedic there, you’re not the only person there. In small communities there are always bystanders who are more than happy to help you out, so it’s not hard to quickly recruit four or five ringers or

“It genuinely is a privilege to serve these people. The people here value and actively support the Queensland Ambulance Service’s contribution in their community,” Gavin said.

“Through my experience I’ve developed a great respect for country people and admire their resilience and strength but also their generosity and sense of fun. Country people draw together in times of need and do what has to be done.

“To be in a position to support rural and remote communities with a first-class ambulance service is living the dream for me.”

Gavin’s ‘patch’ in the Central West covers 418,500 square kilometres and is home to more than 12,000 people, stretching from Alpha and Winton in Central Queensland to the South Australian and Northern Territory borders.

With five permanent ambulance stations and a combined 10 Primary Health Care Clinics and hospital-based ambulance services, Gavin believes the Central West is an ideal place for young paramedics to develop their skills, knowledge and experience.

“Professionally, there’s a chance to become a more rounded paramedic through exposure to situations where you’re treating patients for extended periods without immediate access to major facilities,” he said.

“Working in this environment provides a level of complexity that doesn’t confront paramedics in Brisbane.

It helps you to develop ‘out of the box’ thinking when you’re assessing how to access, treat and transport patients from difficult-to-reach locations.

“Another benefit to consider is the opportunity to relieve in Officer-in-Charge, Operations Supervisor, Senior Operations Supervisor and other roles. The Central West LASN supports a large number of volunteers and remote area nurses who provide clinic- and hospital-based

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Gavin Farry and his family — Kym, Charlie and Madelyn

ambulance responses. These unique opportunities are something that’s not as readily available to early career paramedics in the metropolitan areas.”

and a strong sense of community make rural and remote service a perfect option for officers with young families in Gavin’s eyes.

But Gavin’s career has not been exclusively long and dusty dirt roads and searing outback heat.

Many paramedics also take the opportunity to study, with the Central West LASN enabling and supporting academic development opportunities and James Cook University maintaining a satellite campus in the LASN.

He started his career on the Gold Coast in 1996 as a Qualified Ambulance Officer and taught patient extrication skills at the Ambulance Officer Training Centre before moving to Cape York with his young family in 2001.

After a stint as Officer-in-Charge at Bamaga, the Farry family enjoyed an idyllic sabbatical – sailing a small yacht from Brisbane to the Kimberley region in Western Australia and working for St John Ambulance in the Northern Territory during the wet season.

In 2006 Gavin headed for Cairns where he qualified as a Critical Care Paramedic and started working as a Flight Paramedic in Cairns and later in Mackay.

He’s also worked as a Health Risk Advisor for a number of multi-national mineral companies and as part of a James Cook University research team that collected health data in Cape York Indigenous communities.

A move into the Clinical Quality and Safety Team at State Headquarters in 2014 as a Clinical Policy Development Officer gave him exposure to managerial roles and in October 2016 he made the move to Longreach with wife Kym – who is also a paramedic – and daughters Madelyn (17) and Charlie (4).

Opportunities for professional development, recreation

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QAS Insight | Summer 2016-17

“It’s a great place and a safe place for young families.

They can enjoy some of the freedoms not available in the cities. People here keep an eye out for everyone’s safety and children walk and ride their bikes to school and enjoy the outdoors and the freedom to explore. There are good schools here that are really well resourced and have great teachers,” Gavin said.

“The recreational opportunities are also brilliant. It’s pristine wilderness all around you and you’re free to move around the countryside.

“Being an ambo can open a lot of doors for you here and there’s plenty of station owners who’ll give you the opportunity to use their property to go camping, fishing, four-wheel driving, motorcycling or recreational shooting on your days off.”

Like Gavin, Superintendent Loretta Johnson’s appointment as head of the South West LASN this year was something of a homecoming.

“I am a born-and-bred Injune local, which is about 100 kilometres north of our LASN office in Roma,” Loretta told

QAS Insight. “I was raised in the Carnarvon Gorge ranges and have grown up surrounded by horses and cattle.”

The South West LASN, home to 30,000 people and covering almost 320,000 square kilometres, has eight permanent ambulance stations and five hospital-based services, stretching from Surat to Thargomindah.

Loretta says while working in remote and isolated areas can be tough, she is passionate about delivering a high standard of care for her community.

“I have a passion for the bush and I have a passion for ambulance, so put the two together and you get a passionate young lady ready to lead the way in rural and remote ambulance services,” she said.

“It’s a very different type of ambulance service than paramedics experience in the city. You are very connected into the community and networking is a big part of it.

You’ll be invited to join a number of committees and organisations and will very much be a part of the broader support network in these areas.

“When I was in Longreach we suffered through one of the worst droughts in many years and that really affected the mental health of many of the farmers out there. I had to make sure they all knew that I was there for them and that they could always call me.

“You also need to be prepared for the long distances you’ll be driving. I remember a case when I was at Aramac where I transported a patient to Barcaldine Hospital. It was a 430-kilometre round trip and took more than seven hours.

“In that situation you really need to be thinking about safety. You need to remember to have your sat phone ready and you need to make sure you have enough fuel and water for the journey.

“Local knowledge is also important. You really need to know the area – where all the local air strips are and which ones can land a Royal Flying Doctor Service plane.”

Loretta started her career in Rockhampton in 2007 as a student paramedic and developed her skills and experience under the guidance of Officers-in-Charge Bradley Miers and Gordon Acutt. After completing her Diploma of Paramedical Science, she spent time working in a number of Central Queensland communities, including Mount Morgan, Wowan, Baralaba and Marlborough.

In 2012 she headed to Barcaldine for 12 months before being appointed Officer-in-Charge at Longreach. In 2015 she moved to Emerald Station, but was soon back in Longreach as acting LASN Manager following the departure of Robbie Medlin to Townsville. That managerial experience served her well and she was permanently appointed to the South West LASN role earlier this year.

Reflecting on her own experience and knowledge, Loretta

Loretta Johnson

offered some wise words for any paramedics considering making the move to the country.

“People who succeed in rural areas are the ones who want to be heavily involved in the community. We do a lot of community engagement work with the local schools, LACs and community groups,” she said.

“You really need to get to know people and who they are, because they are the ones who will help you when you’re working as a single officer.”

“They’re the ones who will give you a hand when you’re treating a patient and who’ll drive the ambulance to hospital for you.

“I encourage anyone that wants to really make a difference at a local level to consider doing a couple of years in a remote community. You will be very well received, made very welcome and you’ll be a highly respected member of the community.”

It’s a sentiment strongly echoed by Gavin Farry.

“You can expect to get invited to every social event and to be embraced with open arms so contrary to what people might think your social life will actually be quite active in smaller communities,” he said.

“If you integrate and engage and participate in your local community you will reap the benefits. This is a place to give and the people that live here will be really appreciative of that.”

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Celebrating 125 years 2017 will mark 125 years since ambulance services began in Queensland.

For those unaware of the origins of our service, it all started at the Brisbane Showgrounds in August 1892 when a rider fell from his horse and suffered a leg fracture after his horse rolled on him.

Some well-meaning but untrained bystanders unceremoniously loaded the poor fellow into a horsedrawn cab and carted him off to hospital – and in the process turned the injury into a compound fracture.

Watching on in horror from the ringside were Brisbane General Hospital Superintendent Dr Sandford Jackson and Seymour Warrian from the Queensland Defence Force Ambulance Corps.

The pair convened a meeting at Warrian’s residence at Annerley on September 12, 1892 and the City Ambulance Transport Brigade (CATB) was formed soon after.

The CATB established its first headquarters at the Brisbane Newspaper Company where the ‘bearers’ slept on rolls of newspaper.

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QAS Insight | Summer 2016-17

The brigade transported its first official patient from Taringa to a private hospital in New Farm in November 1892 and soon became a regular fixture at local race meetings, before gaining greater prominence during the 1893 flood.

125 years later, we are now a professional ambulance service that answers 737,000 Triple Zero (000) calls and responds to 986,000 incidents every year.

As part of the celebrations, a 125th anniversary commemorative pin will be struck and presented to all QAS staff and volunteers.

We’ll also be adding 125th anniversary decals to all of our vehicles during 2017.

A key focus for the year will be on community engagement, which will include a schedule of station open days and a strong presence at the Brisbane Ekka and a number of regional shows.

History and heritage will also be the central theme to Ambulance Week celebrations, which are set for September 11 to 15, 2017.

New uniforms set for rollout in February Development of the new QAS uniform has continued in recent months and pilot feedback from staff has resulted in some minor design and aesthetic changes being made to the pilot pieces.

Some of these changes related to feedback shared by the pilot wearers on fit and functionality as well as aesthetic changes driven by wider staff opinion and feedback.

Operations Centre personnel were asked to express a preference on maintaining epaulettes and the QAS roundel on their upper garments.

85 per cent of 228 EMDs voted to retain epaulettes and 76 per cent voted to retain the sleeve roundel.

The finalised uniform items are now in production and are on track to start rolling out in February 2017.

Fit kits for the new pieces have been created and these will travel the state for all individuals to try on and select their appropriate size.

The uniform items have been produced in sizes that align more closely with garments to be found in ‘high street’ outlets and differ slightly from the cut of the previous uniform.

It is very important for each officer to take the time to have a fitting due to this change and the potential for incorrect size selection when initially ordering the new pieces.

Ordering will take place via an online system so individuals will be able to choose what uniform they would like to order and when, commensurate with their annual allowance.

New and current uniform items may be mixed and matched until such time as the new uniform replaces all current garments at the end of their useful life.

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Cairns welcomes new ACP2 kits The much anticipated new Advanced Care Paramedic (ACP2) Primary Response Kits (PRK) have been welcomed in the Cairns and Hinterland Local Ambulance Service Network.

The supply of a practical, efficient and user-friendly carriage system has evolved to match both the pharmacological and procedural progression of the QAS. The new red kits weigh 5.85 kilograms when fully stocked compared to the previous blue response kits that weighed 10.24 kilograms.

To reduce the weight being carried repeatedly by paramedics, statistics were reviewed that revealed paramedics give drugs more than any other single intervention but officers were still carrying a full range of patient care supplies into every job. The drug kit therefore became the primary driver in the new kit design.

The weight reduction was achieved by considerably de-engineering and designing the bag to carry essential patient care supplies, with the PRK utilised in conjunction with Minor (green) and Major (red) trauma modules.

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Other features include an interior that is now wipe clean and grey in colour as opposed to the previous porous black fabric which absorbed and did not reveal potential contamination or dirt.

Each section of the interior of the kit is also removable and replaceable should it become contaminated and unable to be cleaned.

To further provide cleaner surface areas and a more pleasant tactile experience, the use of velcro has been minimised with the use of magnetic attachments and closures.

Quick release catches have been used on the neoprene sprung shoulder strap which makes for more comfortable carriage of the kit over the user's shoulder.

Clear plastic drug ampoule cases have also been incorporated into the design which may be easily removed and stored in station safes without having to manually handle glass drug ampoules and risk breakage. A new cannulation pack has also been incorporated to make it easier to replenish the kit.

All kit contents are labelled by location to ensure layout consistency across the QAS fleet so no matter what part of the state you find yourself working in you will be immediately familiar with the PRK.

QAS takes White Ribbon pledge November 25 was White Ribbon Day – a day when we recognise the need to stand up, speak out and act to prevent men’s violence against women.

In a very moving and impressive show of support, the QAS executive and staff across the state took the White Ribbon Oath to ‘stand up, speak out and act to prevent men’s violence against women’ at various White Ribbon Day events.

The day kicked off with the Queensland Government’s 2016 White Ribbon Day Breakfast at the Brisbane Convention and Exhibition Centre.

Members of the QAS executive and staff joined other public sector agencies and private sector organisations from across Brisbane. The breakfast focused on the importance of leading change every day to maintain momentum towards a community free from all forms of violence – something the QAS is aiming to achieve by taking part in the White Ribbon Workplace Accreditation Program.

White Ribbon Day lunch at Kedron

the statewide telephone service offering anyone affected by domestic or family violence a free ‘crisis hotline’, 24-hours-a-day, seven-days-a-week.

Staff across the state also organised morning teas, lunches and other events at stations and LASN offices.

Accreditation The results of the White Ribbon Accreditation Survey are currently being analysed. The survey was the first step towards White Ribbon Australia Workplace Accreditation, which is aimed at further supporting staff affected by domestic and family violence.

The survey results provide a baseline measure of our awareness and perceptions in relation to violence against women.

A 34 per cent response rate was achieved and once analysed, results will be used to determine areas of focus for the QAS during the accreditation period in addressing violence against women, domestic and family violence and cultural change more broadly.

A new Queensland Government domestic and family violence prevention video that QAS took part in was launched at the breakfast. The video had personal accounts on how domestic violence affects victims and emergency services personnel who attend such incidents. The QAS is very proud to be involved in this important campaign.

Yet another highlight was a lunch held at Kedron where Commissioner Russell Bowles invited staff to sign the White Ribbon Oath and money was raised for DV Connect,

Rockhampton Operations Centre Emergency Medical Dispatchers Michael Thurman, Marg Nelson, Narelle Smith and Vicki Ceola

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2016 in review The year 2016 has certainly been an eventful one for QAS. Apart from continuing to deliver a high level of patient care throughout yet another busy year, we made great strides working to improve our work culture and protecting frontline staff from occupational violence. We look back at some of the initiatives that were aimed at putting all QAS staff first so they could get on with the job of putting patients first.

Zero tolerance campaign recognised A combined QAS and Queensland Health $1.3 million campaign has been recognised this month (December) at the 2016 Department of Health Awards for Excellence.

The campaign was just one of the 15 recommendations in the Paramedic Safety Taskforce Final Report handed down in April.

Numerous recommendations have already been implemented with the rest to be completed by the end of the year. They include the introduction of the sedative

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QAS Insight | Summer 2016-17

A television commercial to increase the public’s awareness of the issue of assaults on health workers was filmed in March at Beenleigh

medication Droperidol into clinical practice for all Advanced Care Paramedics (ACP2s) in October. SAFE2 training has also been revised with more than 3,600 paramedics completing the training aimed at ensuring paramedics can more easily identify, de-escalate and withdraw safely from potentially dangerous situations.

Independent remuneration review An independent remuneration review jointly co-funded by QAS and United Voice Queensland was announced in July to look into the pay and conditions of ambulance officers.

An interim pay increase of 2.5 per cent was granted to eligible officers on August 1. The previous enterprise bargaining agreement expired in October this year and the remuneration review currently being undertaken will provide insight into the nature of ambulance officer roles as they are performed today.

Premier’s award for Ravenshoe response and recovery The multi-agency response to the explosion at the ‘Serves You Right Café’ in Ravenshoe on June 9, 2015 – which injured 21 people, two of whom subsequently passed away

At the scene of the response to the Ravenshoe tragedy

in hospital – won in the Performance Category of the 2016 Premier’s Awards for Excellence.

for ‘Excellence in Ambulance Services’ was launched to provide a road map for the QAS.

QAS worked with various emergency services, state and local government agencies, community organisations and volunteers on the day. The Ravenshoe community also provided what has been termed as unprecedented assistance by helping with cooling and wrapping burns, providing emotional support, and manually handling patients and equipment. These actions enabled paramedics to provide advanced life support measures and transport the injured to receiving hospitals at the earliest opportunity.

This was closely followed by the Queensland Ambulance Service Aboriginal and Torres Strait Islander Cultural Capability Action Plan 2015-18 aimed at creating a greater organisation-wide awareness and respect of cultural differences. Also in September, QAS began working towards White Ribbon Workplace Accreditation to further support our people affected by domestic and family violence.

A review of the response headed up by former QAS Commissioner David Melville, found the ambulance service’s response was ‘swift and well resourced’.

July marked the beginning of celebrations commemorating the 25th anniversary of Local Ambulance Committees (LACs) and the QAS. The anniversary commemorated the July 1, 1991 amalgamation of 96 individual Queensland Ambulance Transport Brigades into one statewide ambulance service, and the introduction of LACs to maintain the ambulance service’s close connection to the community. Celebrations hosted by LACs and Local Ambulance Service Networks have been running throughout the second half of 2016.

Improving our work culture A number of initiatives were launched this year to address how we interact with the community we serve and improve our work culture. In September the Queensland Ambulance Service Strategy 2016-2021 detailing our vision

Celebrating 25 years of QAS and LACs

Display of ambulance equipment through the years at the Wynnum Ambulance Museum

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Live streaming coming to a crash site near you Avid Facebook users will no doubt have noticed the new ‘Facebook Live’ feature that was rolled out recently.

For the uninitiated, the feature allows users to stream live video using the Facebook app on their phone or tablet.

The video appears in the news feeds of their friends or followers and people can interact in real time by asking questions or posting comments that appear next to the video feed.

Interestingly, Facebook has even created a map of the world which shows all of the live videos being streamed at any point. Users can hover over the various blue dots and see what is being streamed and then click into the one they want to watch.

These videos are automatically saved to each person’s account and can be re-watched and shared, just like any other regular Facebook post.

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It’s a feature that could have significant implications for emergency services and law enforcement agencies.

Whereas previously a camera crew and an outside broadcast truck were needed to be able to broadcast live from an incident scene, the Facebook Live feature means a single reporter with a smartphone can now broadcast instantly from the side of the road.

And it may not necessarily even be a journalist live streaming from the car crash on the highway or the residential house fire – it could be anyone with a smartphone and the Facebook app.

We’ve already seen numerous instances of regional and metro news outlets streaming live video to their Facebook pages from incident scenes in Queensland. On several occasions emergency services officers have even been approached for interviews.

Paramedics and First Responders need to be mindful of this new technology. Anytime there is a phone pointed in

your direction, there’s a good chance the video or photos being captured will end up on social media or an online news website.

Cairns Senior Operations Supervisor Neil Noble recently noted an increasing tendency for local news outlets to post videos filmed on phones to their websites – often without being edited.

“With the advent of social media live streaming apps like Periscope and now Facebook Live we’re encountering more and more reporters who are filming us on their phones and uploading the videos to their websites and social media feeds,” Neil said.

“There is a huge amount of pressure from their editors to be first, so waiting until that night’s TV bulletin or tomorrow’s newspaper is no longer an option. It has to be up straight away on Facebook and Twitter and often that means the videos are posted online completely unedited.

“In days gone by they’d go through and edit the footage and pick out the best parts, but that’s no longer happening, so we need to be really well prepared and treat every interaction with a journalist as though it’s a live interview.

“That means always being aware of your surroundings and being mindful of your words and actions on scene.”

So what’s the best way to approach this situation?

Simply, do your job. Act in a professional manner and stay focused on getting the best-possible outcome for your patient.

If someone is affecting your ability to treat a patient, ask them politely (remember, you’re being filmed), but firmly, to give you some space.

If you’re concerned for the patient’s privacy, ask them to stop filming or potentially seek assistance from other emergency services personnel or bystanders to hold up towels or sheets as a privacy screen.

If approached for an interview on scene, ask the reporter for a couple of minutes to get your facts together and have a quick chat to them offline about what sorts of questions they plan to ask you.

This gives you the chance to set the ground rules and negotiate what you can and can’t talk about before you give the interview.

And remember, regardless of whether someone is pointing a professional-grade video camera or an iPhone at you, always assume that whatever you say or do could end up on television or the internet.

Christmas or Stress-mas: How to best enjoy the festive season

By John Murray, Priority One Staff Counsellor

“Oh my God, is Christmas that close?” represents the anxiety that many have as the precious resource of time, so needed to meet the expectation of the season, is gradually eroded away.

While meaningful to most, Christmas is also characteristically stressful as the nature and number of expectations placed upon us is increased.

We may carry within us our own internal expectations of what others expect, of what I ‘should’ do and of what Christmas ‘should’ be like.

All these expectations mean we sometimes run ourselves tired and often broke trying to meet these expectations, paradoxically depleting our ability to actually enjoy the season.

Christmas can also be tinged with sadness, regrets, or anxiety especially for those living in separated or blended

family circumstances. And having to work across the Christmas period, away from children and loved ones, brings its own difficulties.

So how do we take control of the Christmas season and ensure we enjoy it more? For starters it is usually helpful to stop ‘shoulding’ and start ‘coulding’.

Christmas is unfortunately laden with ‘should’ expectations. When we work out of a ‘should’ mentality we are constantly trying to meet externally imposed expectations.

And on the matter of gifting, realise that a ‘gift is a gift’ and thus does not have any expectations attached. If the receiver is not happy with it, then that is their right, but the giver does not own the responsibility for the receiver’s pleasure.

The internal dialogue is something like “As a giver of a gift I hope you like my gift but if you don’t then that is okay, I won’t be offended.”

The nature of a gift is not to receive any kudos or praise for the giving. Gift giving is an altruistic practice.

Even when we have precepts about what Christmas ‘should’ be like we are working from an internal script that has been imparted via the expectations of others.

Also, take pride in on-gifting. It is a sensible practice that saves on waste, including monetary waste. It is especially useful for books and items that can have many lives.

‘Should’ only has one option – to meet the ‘should’ expectations.

Being open and transparent about this frees up lots of items that can be second-hand gifted and still be just as much enjoyed over and over again.

To change the word ‘should’ to ‘could’ within our internal dialogue, subtly but potently alters the internal paradigm from one of no control to one of personal choice, personal control and personal responsibility.

When we run an internal ‘could’ dialogue we can be more intentional about our decisions, instead of having to meet the explicit and implicit ‘should’ expectations of others.

So how might this play out at Christmas?

Thirdly, plan your shopping. Don’t expect to be able to go the shops on Christmas Eve and be inspired or serendipitously find that special gift. It rarely happens.

“ When we try to please or impress everyone, then stress and anxiety are almost inevitable.”

It is common that we overload ourselves with inherited traditions from ages past, yet these practices don’t always fit our changing lifestyles or circumstances.

Working from a ‘could’ paradigm, consider how you could create your own Christmas traditions, more in keeping with your personal situation expectations and resources.

Consider what matters most to you and prioritise those matters. “It is easier to say ‘no’ if you know what you are saying ‘yes’ to” (Breitman, P.) Don’t get caught up in what is not really important.

Secondly, be planned around your spending. Decide upon a budget that is affordable to you and stick to it, regardless of others’ expectations.

To spend beyond your means just to please others, or meet your own internal ‘should’ script often brings resentment.

Proactively consider a family approach to gift giving. This might involve a ‘Secret Santa’ where every adult draws a name to purchase a gift for just that person and agree on a price limit on such gifting. Alternatively, just agree within your extended family that gifting is only to be towards the children.

Notably the word ‘happen’ along with ‘happy, hapless and mishap’, come from a 14th Century word ‘hap’ which simply means by chance.

So don’t leave it up to chance.

Instead, lists are good. List exactly, who you are going to buy for and decide before departing exactly what you are going to purchase for each person. This might take some work but the time investment always pays off.

The internet is full of ideas, price indicators and the like so refine your tasks before leaving the house. By doing this you will keep within budget and avoid the aimless and unproductive wanderings of shopping malls that often end up in impulsive and somewhat thoughtless last-minute purchases.

The same approach applies to the Christmas grocery shopping. Decide who is bringing what for Christmas meals and then just shop for that, not to excess.

Finally, don’t expect miracles at Christmas. Sure they sometimes happen but family and other relationship dynamics are usually reflective of the past and will continue through the festive season.

Moderation in expectations, spending, diet and drinking are all important to making the Christmas season less stressful and as happy and joyful as possible.

Happy Christmas from the Priority One team.

When we try to please or impress everyone, then stress and anxiety are almost inevitable.

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Emergency Management Training in Roma

Situation critical: when it’s more than business as usual The summer of 2010-11, when Queensland experienced two of the most significant natural disasters in recent history – Tropical Cyclone Yasi and the Queensland Floods, brought the importance of emergency management into sharp focus.

The death of more than 30 people in floodwaters sparked a Commission of Inquiry that resulted in 175 recommendations for how government agencies could improve their collective preparation and response.

QAS is an integral part of our state’s emergency management arrangements, working closely with the Queensland Police Service, Queensland Fire and Emergency Services, local governments and a range of other agencies to respond to anything that nature, or indeed humans, throw at us.

And whether we’re facing a Category 5 cyclone or a multicasualty incident like the Ravenshoe Café explosion, the planning, preparation and management of QAS resources needs to be guided by a systematic approach to risk and disaster management.

Our Director of Operations Emergency Management, Danny Murphy, said it was critical for the organisation to continue building its capacity in this area.

“Significant events can often occur with little or no warning, so we need to make sure that we have the

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essential command, control and coordination structures in place to be able to respond to all hazards,” he said.

“That means building the capacity of our staff and making sure they understand the principles of emergency management and have practical knowledge and training in our Incident Management System (IMS).”

One of the ways in which the service is building that capacity is through the Emergency Management Course that forms part of the Classified Officers Development Program (CODP).

More than 430 staff from around the state have now participated in the week-long course that gives them an opportunity to review QAS incident management and disaster processes and apply them during exercise and scenario activities.

Course participants complete Australasian Inter-Service Incident Management System (AIIMS) introductory training delivered by Queensland Fire and Emergency Services as well undertaking an introduction to the State Disaster Coordination Centre.

According to Danny, the course also focuses on real-life case studies and includes complex scenarios that allow officers to put theory and experience into practice.

“The scenarios are tailored around QAS-specific incidents which give our staff a chance to practise standing up a Local Ambulance Coordination Centre and a Forward Command Post,” he said.

Resources and development opportunities In addition to the CODP Emergency Management course, there are a range of other opportunities for staff to gain experience in emergency management, as well as resources to utilise in the field.

On deployment during Tropical Cyclone Ita

“Officers are tested on their ability to think critically, work as a team and to clearly define the Situation, Mission, Execution, Administration, Command and Communication required for a successful resolution to the incident.

“They also gain an understanding of all of the key IMS roles involved in the effective operation of a Local Ambulance Coordination Centre and Forward Command Post.”

Another component of the scenario training involves media interviews conducted by the QAS Media Unit.

“Public information is an incredibly important function of an effective emergency response,” Danny said.

“Not only can it help to safeguard life and property and help expedite post-event recovery operations, but if done poorly it can result in negative impacts on the community and the reputations of emergency services agencies.

“By putting our people in front of the camera to experience that interview pressure in a realistic manner, we are giving them some exposure to the types of situations they’ll find themselves in when major incidents happen.

“QAS Media plays the interviews back to the group and provides instruction on how to effectively deal with reporters at incident scenes.”

Danny encouraged staff interested in undertaking the course to approach their manager.

“It’s important to note that this isn’t just a course for onroad staff. When a major disaster hits, it affects our entire organisation, so we strongly encourage Operations Centre staff and administration officers to get involved and gain a better understanding of our IMS,” he said.

For information on upcoming courses, contact the Classified Officers Development Program team on QAS.CODP@ambulance.qld.gov.au

The Emergency Management section on the QAS Portal is a permanent online resource for all staff (https://qas.psba.qld.gov.au/operations/ em/Pages/default.aspx). All of our polices, guidelines and templates are available, as well as sections for multi-casualty, major events, exercise planning, event planning, heatwave, pandemic, counter-terrorism, risk management and emergency management assets.

Local Ambulance Service Networks and stations regularly run training exercises for staff development and to work with other local agencies to test and validate QAS systems. At a minimum these exercises are run annually within LASNs, allowing staff to explore emergency management systems and how to integrate them into daily operations.

The Australia-New Zealand Counter-Terrorism Committee (ANZCTC) Writing Course is available to a limited number of staff (selected by LASN managers), and provides specific training and experience in writing LASN exercise plans to help prepare staff for potential major incidents specific to their location.

Emergency Support Units (ESU) are available to provide logistical and tactical back up for major incidents. These vehicles have enough stock and equipment to re-stock QAS vehicles or manage multi-casualty incidents and are available to each LASN. Multi-casualty Incident Kits that include Incident Forward Command Kits, Commander Kits and Multi-casualty Management Kits are also available. These kits contain everything needed for rapid, effective triage of multiple patients and to set up an incident command post.

Other assets such as Operational and Tactical Support Units from State LASN Operations can also be deployed on request to support LASNs during major events.

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QAS making strides in contemporary cardiac care

By Brett Rogers, Statewide Reperfusion Coordinator

Coronary heart disease affects approximately 1.2 million Australians and is the single leading cause of death in Australia, killing one Australian every 26Â minutes.

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Every year QAS paramedics provide treatment to thousands of patients suffering Acute Coronary Syndromes (ACS) using QAS guidelines and procedures developed in line with national and international evidenced-based recommendations.

The National Heart Foundation of Australia, in conjunction with the Cardiac Society of Australia and New Zealand, has recently published updated guidelines for the management of ACS. QAS has been actively involved in formulating these latest guidelines, with Executive Manager Clinical Policy Development Lachlan Parker acknowledged as having contributed to their development.

The Clinical Quality and Patient Safety team together with the Medical Director and Queensland Ambulance Service Education Centre, ensure that the QAS ACS guidelines remain at the forefront of contemporary, evidence-based cardiac care.

Since Commissioner Russell Bowles approved the expansion of cardiac reperfusion strategies to Advanced Care Paramedics (ACPs), Statewide Reperfusion Coordinator Brett Rogers has conducted in excess of 100 face-to-face education workshops for ACPs, and train-the-trainer sessions in more than 40 locations across Queensland.

Workshop participants participated in ‘real-time’ simulations in order to confidently demonstrate their ability to identify patients with STEMI suitable for reperfusion therapies and safely undertake the life-saving interventions of either Decision Supported Fibrinolysis and/or Decision Supported pPCI referral.

QAS paramedics, pPCI facilities, emergency departments and aeromedical services now work together to provide an integrated approach to appropriate timely reperfusion therapy for Queenslanders and our visitors no matter where they are located within the state.

Australian Clinical Guidelines for the Management of Acute Coronary Syndromes 2016 provide a summary of key, evidence-based recommendations, many of which have direct relevance to paramedic practice, and are embodied in the QAS Clinical Practice Procedure: Acute Coronary Syndromes and the QAS Clinical Practice Reperfusion Procedures.

The National Heart Foundation of Australia has made several “strong” recommendations which are also incorporated in relevant QAS guidelines and procedures, including the following: ▸▸ Patients with acute chest pain or other symptoms suggestive of an ACS should receive a 12-lead ECG within 10 minutes. (Included in the CPG: Acute Coronary Syndrome) ▸▸ Patients presenting with acute chest pain or other symptoms suggestive of ACS should receive care guided by an evidence-based protocol. (Refer to the CPG: Acute Coronary Syndrome) ▸▸ Patients with STEMI (in the absence of advanced

age, comorbidities etc.), should be considered for emergency reperfusion therapy. (Refer to the QAS Reperfusion CPPs) ▸▸ Primary PCI is the preferred reperfusion therapy for patients with STEMI if it can be performed within 90 minutes of first medical contact (hence QAS currently has PCI referral as a treatment option for patients located within 60 minutes transport from pPCI facility from the time of first 12-Lead ECG diagnostic of STEMI). ▸▸ Aspirin 300mg orally is strongly recommended for all patients with ACS in the absence of contraindications.

(Refer to the DTP: Aspirin).

Furthermore, the National Heart Foundation of Australia also provides the following practice advice: ▸▸ The routine use of oxygen therapy for ACS patients with oxygen saturations >93% is not recommended.

(Refer to DTP: Oxygen) ▸▸ An electronic algorithm for 12-Lead ECG interpretation (coupled with remote review by an expert) can assist in STEMI diagnosis. (Refer to QAS Decision Supported Fibrinolysis Administration) ▸▸ For patients receiving fibrinolysis therapy for STEMI, enoxaparin 30mg IV bolus followed by 1mg/kg SUBCUT (15mins) is the recommended anticoagulant.

(Refer to DTP: Enoxaparin) ▸▸ A fibrinolytic agent that can be given as a bolus dose such as tenecteplase is advisable for ease of administration, especially in the pre-hospital setting.

(Refer DTP: Tenecteplase) ▸▸ For fibrinolytic-treated patients, clopidogrel (300mg loading dose) is recommended at the time of fibrinolytic therapy. Currently the safety and efficacy of ticagrelor has not been studied in conjunction with fibrinolysis. (Refer to DTP: Clopidogrel) ▸▸ The use of opioid analgesia may be considered for patients with ongoing chest pain. (Refer to DTP: Fentanyl) ▸▸ Nitrates are effective in controlling the symptoms of ischemia by providing vasodilation and lowering blood pressure. (Refer to DTP: Glyceryl trinitrate).

The QAS has recognised the importance of an evidencebased approach to cardiac care and has included cardiac care as a strategic outcome in the recently released QAS Strategy 2016-2021. QAS cardiac strategies have already benefited many Queenslanders.

Rapid recognition of STEMI with prompt restoration of coronary artery perfusion is the key to myocardial salvage and decreasing mortality. Paramedic-initiated care based on sound evidence and drawing on expert opinion is saving lives.

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HARU REPORT

By Gary Berkowitz, Critical Care Paramedic, Gold Coast HARU and Dr Stephen Rashford, Medical Director

A 25-year-old male riding a superbike travelling at approximately 60km/hr collided with a motor vehicle at an intersection. His face struck the vehicle as he was wearing an open-face helmet. An Advanced Care Paramedic (ACP2) crew arrived finding the patient in the right lateral position on the road, with an altered level of consciousness.

A Critical Care Paramedic (CCP) arrived a few minutes after the ACPs, with the High Acuity Response Unit (HARU) shortly thereafter.

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The initial exam was as follows: Airway: Threatened due to blood and facial fractures Breathing: Chest symmetrical, no evidence of surgical emphysema or palpable rib fractures. 20 breaths/min, Sp02 95% on room air Circulation: 200ml blood on road from helmet, strong radial pulses. HR 80, BP 121/65 Disability: GCS 12 E3 V3 M6. Only the right pupil was visible and it was 3mm and reactive, the patient was moving all his limbs. Mild agitation was present.

Exposure: ▸▸ Blood from right ear ▸▸ Left peri-orbital haematoma ▸▸ Epistaxis ▸▸ Dental trauma with missing teeth ▸▸ Fractured mandible ▸▸ Deep abrasion (non-communicating) Zone 2 of right hand side of neck ▸▸ Non-pulsatile haematoma Zone 2 left hand side of neck ▸▸ Small abrasion mid sternum The ACPs and CCP provided the following treatment: ▸▸ Helmet removal, airway support and suctioning ▸▸ Placed on high flow supplemental oxygen ▸▸ Clothing removed and a soft collar applied with whole body spinal care ▸▸ Intravenous access gained and TKVO fluids started The HARU paramedic arrived on scene and administered 2 x 20mg of Ketamine IV to provide analgesia and sedation while maintaining airway patency. ▸▸ A pelvic binder and warming blanket was placed, with the patient extricated to the ambulance in a semi upright position. ▸▸ A FAST ultrasound scan was performed, which did not reveal any intraperitoneal or pericardial blood. ▸▸ The patient underwent a rapid sequence intubation (RSI) – 100 microg Fentanyl, 100mg Ketamine & 100mg Rocuronium. The intubation was successful on the first attempt, with no significant hypoxia nor hypotension. ▸▸ Immediately post intubation the patient's face was packed to prevent further blood loss: 1. An orogastric tube was placed 2. Bite blocks (tightly rolled and taped bandages) were placed between molars and canines to reduce and splint the maxilla 3. The oropharynx was packed with a large saline soaked roller bandage 4. A rigid cervical collar was applied 5. Rapid Rhino® nasal pacs inserted ▸▸ The patient was transported in a head up position to the pre-notified Gold Coast University Hospital.

A further 20mg of Ketamine and 40 microg of Fentanyl was administered on route. ▸▸ The patient was assessed in a resuscitation bay and quickly transferred to the waiting CT scanner, which revealed complex facial fractures (Le Fort III), spinal fractures as well as a small sub arachnoid haemorrhage. The patient was taken to theatre shortly thereafter for surgical intervention to his facial injuries.

Dr Rashford – learnings from the HARU audit: The face and head are extremely vascular.

Haemorrhage control is a priority in these patients. Patients bleed to death from these injuries. Generally awake patients find a position of comfort to allow the airway to be patent and postural drainage to occur.

Do not be afraid to position the unconscious patient so that postural drainage occurs. Whilst trauma patients should lay flat, in this case a gentle head up position is acceptable. It is important to risk assess the scenario and just be gentle with all movements.

The out-of-hospital RSI should be considered a high-risk procedure. It is even more so in this circumstance, but justified for those clinicians with appropriate training and quality assurance activities. The RSI in this case achieved a number of main objectives: 1

ecuring an airway that was prone to S obstruction

2

I t facilitated haemorrhage control by allowing reduction of mid face fractures and tamponading of bleeding sources.

3

europrotection of an agitated head injured N patient exhibiting potential signs of raised intracranial pressure.

4

Optimisation of oxygenation and ventilation

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T here are a variety of ways to initiate the anaesthetic. It is important to consider natural postural drainage options.

6

T his was a high-risk intubation, requiring effective teamwork across the ACP and CCPs present working in parallel to decrease scene time and provide high performance care.

7

xpect patterns of injury to occur – head E injury, facial injury and cervical injuries.

8

arly pre-notification of the trauma centre E allowed for the CT scanner to be cleared and specialists requested to decrease time to definitive care.

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Case study: Decision Supported Fibrinolysis Administration

By Brett Rogers, Statewide Reperfusion Coordinator

A 68-year-old male developed central chest pain while at rest as he was cutting some fruit for lunch. He lives in a small rural location about 20 minutes from a regional hospital, and his wife calls Triple Zero (000).

Paramedic assessment A local Advanced Care Paramedic crew is dispatched code 1 and arrives on scene to find the patient has 8/10 central chest pain, radiating to both arms, appears pale and looks clammy.

The crew gathers history and vital signs, and records a pulse of 65 regular, NIBP 156/89 and oxygen saturations of 97% on room air. Within five minutes of first patient contact a 12-lead ECG is also acquired. They administer

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aspirin (300mg), GTN and gain IV access, followed by 25mcg of fentanyl for the pain, and 4mg ondansetron.

During this time the treating paramedic quickly completes the Decision Supported Fibrinolysis Administration (DSFA) Checklist (available at http://ow.ly/G0lF306PZqV). The contraindications on the DSFA checklist are designed to ensure that a thrombolysed patient is ‘low risk’ for a serious cerebral bleed or uncontrollable bleed elsewhere.

The crew move quickly through some questions, using the DSFA Checklist Contraindications as a guide.

The ECG device indicates possible acute inferior myocardial infarction and another 12-lead ECG shows even more reciprocal ST depression in lead aVL, making the diagnosis of STEMI more likely. If the patient can receive early fibrinolysis it is hoped that it can quickly ‘bust the blood clot’ in his coronary artery and pain should reduce and his symptoms may subside.

The patient is located some hours away from the nearest pPCI facility, he is able to provide a clear history, the onset of pain was just over an hour before the first 12-lead was taken, so the blood clot is likely to still be fresh and soft. It is clear that the patient is suffering an inferior STEMI with typical reciprocal ST depression.

The treating paramedic takes an image of the 12-lead ECG, and being sure to get all the ECG information in the image (including the date and time, vital signs, all ECG lead views, and the ECG analysis at the end of the printout), emails the ECG image to the “QASStemigroup" email address.

Decision support The treating paramedic has decided the patient meets all the criteria for fibrinolysis and has no contraindications and now seeks ‘decision support’ from the Senior Critical Care Paramedic on the QAS Clinical Consultation and Advice Line.

Following a quick discussion and review of the case and the 12-lead ECG, a joint decision is made to consent the patient for treatment, and administer prehospital fibrinolysis. Advice is provided to administer a 30mg dose of enoxaparin IV, followed by a flush, then the weight adjusted dose of tenecteplase, followed by another good saline flush.

The ACP is advised to head to hospital once tenecteplase is administered. They are also told to check his BP manually by auscultation and if appropriate consider further GTN and also give 4 tablets (300mcg) of clopidogrel enroute to hospital and 15 minutes after the IV enoxaparin dose, give the SUBCUT dose of enoxaparin.

The ACP agrees to call back if there are any complications and to debrief the case as soon as the patient is handed over.

The Senior CCP rostered on the QAS Clinical Consultation and Advice Line then contacts the Clinical Coordinator at Retrieval Services Queensland (RSQ) to let them know a patient is being thrombolysed, which hospital the patient is being transported to and the expected arrival time.

This allows RSQ to begin initial planning in the event they need to retrieve a patient back to a facility with a cath lab.

Patients that receive thrombolysis are triaged according to how they respond to the treatment and the urgency of their subsequent retrieval is based on risk criteria.

the hospital, with significant reduction in ST segment elevation, and the patient says he feels well enough to go home. The hospital arranges for aeromedical retrieval and the patient is transferred to a cardiac facility in a stable, pain-free condition. Early thrombolysis has dissolved the blood clot and the patient’s heart attack has been treated, but expert care in a cardiac cath lab is still indicated as his coronary arteries may require further surgical intervention.

Learnings During the subsequent debrief the treating paramedic is reminded about the importance of getting a good baseline manual BP by auscultation for the first BP at least, or where a BP is borderline or if there is any doubt about the accuracy of a BP value. Hypertension is a significant risk factor for patients who receive thrombolysis, as they are at an increased risk of a serious or even fatal haemorrhage.

Numerous aspects of this case reflect contemporary ‘best practice’ cardiac care – an early Triple Zero (000) call, early dispatch, a quick 12-lead ECG (well within 10 minutes of arrival), appropriate pain relief, careful use of GTN, early aspirin, early fibrinolysis according to an agreed protocol, and retrieval to a pPCI facility within transfer guidelines.

Outcome The patient arrives at the cardiac pPCI facility and is pain free, with stable vital signs. He is scheduled for routine follow-up angiography the following day, with the specialist interventional cardiologist planning to do an urgent pPCI procedure should ischemic pain symptoms return during the night.

A routine angiogram is performed mid-morning the following day which shows mid-right coronary artery plaque, which was the site of an acute blood clot that was dissolved by the tenecteplase. A coronary stent is placed to fully open the artery and the patient is discharged that afternoon.

Rapid recognition of STEMI, with prompt restoration of coronary artery blood flow is the key to saving hearts and saving the lives of patients suffering severe heart attacks. Decision Supported Fibrinolysis Administration has been demonstrated to be safe and effective and can reduce the time to treatment for many patients. This process is a key component of the QAS integrated cardiac reperfusion strategy.

Hospital arrival On arrival at the regional hospital the thrombolysis has started to work, with the patient experiencing complete resolution of the chest pain. The ACP crew report that the patient’s ECG still shows an inferior STEMI pattern. The ECG changes subside quickly before the crew departs

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ECG masterclass

By Eileen Stead, A/Senior Clinical Educator

Whether you need to revise your knowledge or start from scratch, this masterclass will assist officers of all clinical levels with improving their ECG interpretations skills.

Following on from the autumn edition’s masterclass on Left Bundle Branch Blocks (LBBBs), this masterclass will focus on partial blockage of impulses through the left bundle branch. As explained previously, the aim of this masterclass is to teach you pattern identification first, then when you are confident that you can recognise and identify the type of ECG abnormality, we will move onto the pathological process that is occurring ‘behind’ the ECG aberration.

Just to briefly revise on our cardiac anatomy, the left

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bundle branch is made up of two main branches; the thinner, anterior fascicle and the thicker, posterior fascicle. These sub-branches bifurcate distal from where the left and right bundle branches form. These specialised branches are responsible for carrying impulses through to the myocardium of the left ventricle (including the left wall of the inter-ventricular septum) ¹. This masterclass will focus on electrical conduction disturbances to the left anterior fascicle of the left bundle branch.

Sometimes certain conditions can cause disruption to the transfer of electrical impulses along the left anterior fascicle. Typically, this is reflected in the ECG trace and evident in leads II and V6.

To be able to identify what is abnormal in an ECG, you must first know what is normal in each lead.

I cannot stress enough, the importance of knowing what each waveform (i.e. P wave, QRS, T wave) should look like in each lead, whether the waveforms are positive in amplitude, negative, or equiphasic. In a normal ECG, the QRS complex in Lead II there should have a positive, large ‘R’ wave and little-to-no ’s’ wave, and in Lead V6 there should also be a positive, large ‘R’ wave and little-to-no ’s’

wave. Knowing this will enable you to spot an abnormality when assessing those ECGs that have a left anterior fascicular block (commonly referred to as a left anterior ‘hemi’ block).

Look at the diagram of the ECG below and note the highlighted abnormal waveforms in leads II and V6:

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The following five ECGs all feature left anterior fascicular blocks. There will be other ECG abnormalities within the examples, however for the benefit of this lesson, focus will only be given to the LAFB patterns within the traces. As with the previous masterclass, I will initially highlight the LAFB pattern (in blue) and then leave the remaining ECGs without the highlight.

A

B

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C

D

E

Frequently, a left anterior fascicular block is seen with other ECG abnormalities such as a right bundle branch block (RBBB), and atrioventricular (AV) blocks. When seen with a RBBB, the grouping is referred to as a ‘bifascicular block’ because it involves the right bundle branch and the left anterior fascicle of the left bundle branch - two separate fascicles.

The abnormality in the two branches gives rise to the term ‘bifascicular’. You may also hear people refer to the grouping of a fascicular block (left anterior or posterior), with a right bundle branch block and an atrioventricular block as a ‘trifascicular block’, however this term is not entirely accurate, as the atrioventricular node is not technically a ‘fascicle’.

Either way, it’s a good idea to make yourself familiar with these terms.

References: 1. Cardiac Conduction Overview - Heart Failure - GUWS Medical. (2016). Guwsmedical.info. Retrieved 20 November 2016, from http://www.guwsmedical. info/heart-failure/cardiac-conduction-overview.html#download 2 Burns, E. (2016). Left Anterior Fascicular Block - LITFL ECG Library. LITFL: Life in the Fast Lane Medical Blog. Retrieved 20 November 2016, from http:// lifeinthefastlane.com/ecg-library/basics/left-anterior-fascicular-block/

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From serving a sleepy town to a booming metropolis Townsville’s Operations Centre has come a long way from its inception as a district communications centre in the early 1990s.

“Prior to setting up the Townsville district communications centre in the early 90s, stations would take their own calls and communicate with their vehicles over their own local radio channel,” he said.

The centre originally started out at the former Townsville station’s superintendent’s residence at the back of the ambulance station before moving to its current location at level 1 of the station in 1999.

“Each station – Townsville, Ayr, Bowen, Charters Towers and Ingham – had its own radio call sign. The smaller stations had no dedicated telephone or radio operators, so the superintendent or an on-duty officer would answer the phones and radio.”

The centre began taking Triple Zero (000) and non-urgent calls and dispatching ambulances for district stations including Ayr, Home Hill, Giru, Collinsville, Charters Towers and Ingham as well as Townsville.

Les Steel who joined the Queensland Ambulance Transport Brigade in Townsville as a permanent staff member in 1973 fondly remembers the early days. He still works for QAS in Townsville on the Government Wireless Network (GWN) and Public Safety Regional Radio Communications projects team.

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“If both those officers were out on calls, the superintendent’s wife would answer any incoming telephone or radio calls.”

Les recalls that in Townsville, station officers staffed its control room on day and afternoon shifts only.

On night shifts, telephones were answered by one of the two officers, called ambulance bearers in those days, while the other would respond to patients.

If both were called out, the Townsville Superintendent would come over from his residence to staff the control room until one of the officers returned back to base.

Once the communication centre moved to its current location on level 1, this location came online with new radio and telephone technologies, redundant power capabilities along with state introduced regional CAD functionality. Prior to this, Townsville centre still operated with manual cards.

The Townsville centre commenced with five CAD workstations. A further upgrade took place in 2004-05 prior to upgrading the CAD platform to VisiCAD. This upgrade increased the centre’s capability to 12 calltaking and dispatch workstations with redundant power, telephony, voice logging and corporate IT. Today the Operations Centre dispatches across three Local Ambulance Service Networks – Townsville, North West and part of Central West – with 48 staff made up of a Manager, Professional Development Officer, Operation Centre Supervisors, ICT Customer Service Officer and 45 Emergency Medical Dispatchers.

Acting Manager Brad Gillam says the growth is proof of just how fast the population is growing with the Townsville LASN made up of 255,000 people and North West LASN having 30,000 people.

“The diverse geographical spread means the Operations Centre manages a constant mix of calls from urban, rural and remote communities which can cover anything from cyclone season and flood management to day-to-day medical incidents and road traffic crashes,” Brad said.

“They handle approximately 150 Triple Zero (000) calls per day, with 95 per cent of Triple Zero (000) calls answered in 10 seconds.”

Brad credits the staff’s caring attitude for this accomplishment.

“They constantly strive to make their Operations Centre the best it can be to support the operational LASNs and the communities it serves,” he said.

With the growth the town has seen and with Townsville’s place as one Queensland’s biggest centres, the team at the Townsville Operations Centre team is certainly one to watch.

33

QAS Operations Centres wrap up busy year From January 1,

2016 to October 30,

2016 QAS received

632,446

Triple Zero (000) calls statewide, which is an increase of 52,179 on the

same period last year

Every 43 seconds

a call is received by our Emergency

Medical Dispatchers

Each Operations Centre is a point of entry to QAS. As we get busier as an organisation because of the impacts of a growing population and changing demographics, our Emergency Medical Dispatchers are at the front line of patient care.

34

QAS Insight | Summer 2016-17

In excess of

3,000 cases handled each day by ambulance crews and

Operations Centres

509 Operations Centre staff

across 8 locations

There has been a nine per cent increase in calls on last year, however we still continue to improve our call answer times across the state.

A number of education packages and mentoring workshops have also been introduced to better equip our Operations Centre staff, making 2016 a big year for staff training and development.

Our top 5 caller wants

Medical Priority Dispatch System (MPDS) Masterclasses commenced in August and will continue through into 2017.

The workshop has built on Operations Centre knowledge around the Performance Standards. Specifically how they are applied through the Operations Centre Call Taking, Quality Improvement and feedback processes and their linkage to the Caller Engagement Initiative to ensure the caller’s needs are met.

To help improve the performance culture within the Operations Centre environment, Performance Improvement Training was also introduced in the first quarter and has continued throughout the year. A key goal was to ensure Supervisors have an intricate knowledge of the revised QAS Performance Management Framework to support EMDs.

1

I want to talk to a real person

2

I want that person to be able to action my request

3

I want to tell them what has happened

4

I want to know I've been heard

5

I want to know that help is on the way

To facilitate improvements as identified in the Working for Queensland Staff Opinion survey, there will be a workshop at each Operations Centre run on the Management of Difficult Situations and Callers in 2017.

A significant body of work has been undertaken in relation to improving console ergonomics in the Operations Centres. Within the Brisbane Operations Centre, all consoles have been refurbished with modern monitor arms and a change to the configuration of the equipment to meet contemporary ergonomic standards.

For all other Operations Centres, work is well underway on the installation of a purpose-built height adjustable workstation to existing consoles. This work has been integral to the continued modernisation of our work environment.

New PTS bus for Townsville Patient Transport Services in Townsville received a boost recently with the launch of a new Bonito Multi-purpose PTS bus. The bus can be modified to transport a mixture of up to 11 seated patients or five patients in wheelchairs.

Townsville Assistant Commissioner Robbie Medlin said QAS currently transported around 140 to 150 PTS patients each week.

“The bus will improve pre-booked medically authorised non-urgent transport service delivery to the community and free up ambulances to respond to emergencies,” he said.

35

It’s all about our people We’ve all had some interaction with the friendly folks at Human Resources (HR).

Whether it was sorting out your appointment when you first joined QAS to managing workplace health and safety, we’ve all come across them at some point.

From L to R: Conor Fardon, Principal HR Consultant Workplace Reform, Ben Jorgensen, Senior HR Advisor Metrics and Reporting and Acting HR Director Wendy Lowes

To get a better understanding of what they all do, QAS Insight spoke to Acting HR Director Wendy Lowes. As experience goes, you can’t get much better than Wendy.

She’s worked in the public service for 26 years in various HR and recruitment roles, with the bulk of that time spent in QAS. Wendy has five extremely busy teams that fall under her portfolio, namely HR Recruitment and Administration,

Workforce Reform, HR Metrics and Reporting, Employee Relations, and Workplace Health and Safety.

The first stop for any new starters at QAS is the HR Recruitment and Administration team. They’re the people who provide advice and support to all staff with recruitment and generalist human resource matters.

Wendy explained that the team manages all aspects of operational recruitment including coordinating bulk recruitment campaigns for Graduate Paramedics, Emergency Medical Dispatchers, Critical Care Paramedics and Supervisory Recruitment.

“This has included implementing new and innovative ways for candidates to apply for positions and be individually assessed against position criteria,” Wendy said.

“In short, they are the people behind the scenes who make sure our work culture is one that supports you and makes you happy to come to work.”

The Employee Relations team deal with all things related to employee and industrial relations and partner with Local Ambulance Service Networks to assist in the management of employee complaints, performance matters, discipline issues, and interpretations of employee entitlements contained within legislation, awards and agreements.

They are also the team responsible for assisting and facilitating negotiations with unions for enterprise bargaining processes.

The number crunchers are the HR Metrics and Reporting team.

“The exceptional work undertaken by the team in recruitment has contributed to improved recruitment outcomes and subsequent reductions in attrition rates across the operational roles.”

“They work closely with a range of internal and external stakeholders to prepare and deliver workforce data, metrics and key workforce performance analytics to drive effective decision-making,” Wendy said.

In addition to assisting business areas with recruitment, the team also facilitates staff and position movements and liaises with Shared Services to resolve payrollrelated issues.

“The team assists LASNs in managing workforce matters through the provision of detailed employee and establishment metrics, which enables informed decisions, enhancing employee support and improving recruitment practices.

If you’ve seen all the White Ribbon posters and activities, participated in the Employee Opinion Survey, or seen the harassment prevention and positive culture messaging across the state, you’ve seen just some of the handiwork of the Workforce Reform team.

“On top of looking after the development and implementation of the QAS HR Policy, they are responsible for the implementation of strategic workforce management initiatives and change projects to support the ongoing improvement in HR practices and organisational outcomes,” Wendy said.

“And when it comes to advice and support services related to workplace health and safety, injury management and workers’ compensation matters, the QAS Workplace Health and Safety team always does a great job.”

“They work collaboratively with LASN Health and Safety Advisors to achieve successful, local health and safety solutions, ensuring our people are kept safe.”

And that’s HR – five dedicated professional teams that look after your employment within the QAS.

New eARF moving forward The construction of the new electronic Ambulance Report Form (eARF) is nearing completion, with User Acceptance Testing starting in November 2016 and pilot targeting expected to start in December in two stages.

The first stage will be undertaken by the Low Acuity Response Units operating within the Metro South and Metro North LASNs, before progressing to Central Queensland LASN for the second stage.

Online as well as face-to-face training is being designed and scheduled for each LASN to complement the rollout of the new eARF. New features include crewing information auto-populated from CAD based on MDT or radio log in; incidents will only be assigned when a user advises they are ‘on scene’; other crews arriving on scene can access an eARF already created, but only the original creator has the ability to amend it; and less mandatory fields.

37

Gold Coast schoolies heed safety message As more than 9,000 school leavers descended on the Gold Coast to celebrate the end of Year 12, QAS was there reminding the revellers to be safe, look out for their mates and call Triple Zero (000) in an emergency.

Close to 20 agencies and support services provided a coordinated response to schoolies this year.

Senior Operations Supervisor and Event Coordinator Warren Painting said coordinating multiple agencies and support services was an extensive effort which began early in the year, with more than 16 planning meetings held in the lead up.

Acting Senior Operations Supervisor, Events Coordination Gold Coast, Justin Payne, said this year’s event was very similar to last year.

“Schoolies this year were very pleasant, they interacted well with QAS and were very thankful for our presence at the event.”

In addition to the usual preventative tips, the main message to schoolies this year was to, ‘Play it safe, look after your mates and call for help by phoning Triple Zero (000) in an emergency.’

Gold Coast crew at schoolies

38

QAS Insight | Summer 2016-17

Justin said the majority of incidents were still related to intoxication, but not the very heavy intoxication seen previously.

“I think that the change in levels of intoxication are related to the education packages in schools, and the safety messaging put forward by QAS,” he said.

Presentations to the QAS Ambulance Triage Centre throughout the week involved trauma ranging from significant lacerations to minor first aid.

This year the Ambulance Triage Centre had the added capability of Queensland Health mental health nurses who worked with schoolies who presented with social issues or mental health complaints.

Mental health is considered a significant issue when all the stressors of schoolies are added up, which often include lack of sleep, being away from home, intoxication and intensive social situations.

QAS also gave free CPR Awareness training for school leavers while they checked in, and each evening at 5pm.

Over the week close to 1,000 people took part in the training and learnt a skill that could save a mate’s life in an emergency. The training was well received by schoolies and the broader community with two school leavers learning CPR for each person treated by the ambulance triage team.

Schoolies taking part in the CPR awareness program

CPR Aware Schoolies with their CPR awareness certificates

Gold Coast Schoolies 2016 Summary Patient Assessment Count

Transported to Hospital Count

2015

2016

2015

2016

Daily Average

73

79

Daily Average

8

4

Day 1 Saturday

48

41

Day 1 Saturday

8

2

Day 2 Sunday

68

93

Day 2 Sunday

9

4

Day 3 Monday

83

98

Day 3 Monday

5

2

Day 4 Tuesday

83

55

Day 4 Tuesday

8

2

Day 5 Wednesday

96

81

Day 5 Wednesday

9

6

Day 6 Thursday

70

78

Day 6 Thursday

11

6

Day 7 Friday

66

104

Day 7 Friday

5

8

Total

514

550

Total

55

30

QAS helps out Airlie Beach schoolies Airlie Beach, a popular spot for school leavers, was not to be outdone by the Gold Coast. Around 2,000 schoolies spent the week celebrating there in November.

A team of paramedics from Townsville organised Airlie’s very own Ambulance Triage Centre, managed by Critical Care Paramedic Chris O’Connor. The triage centre had anywhere between two and eight crews working each day, with around 60 schoolies seen during the week.

Whitsunday OIC Steve Thurtell said: “We had a relative mix of presentations over the seven days, but no serious concerns and the majority of the alcohol presentations were related to rapid consumption rather than quantity.

We had a few drug presentations, but also blisters, rolled ankles and general medical complaints.”

The triage centre provided a great relief to the local hospital that would otherwise have been inundated over the week of celebrations, and during the week transported only 14 patients to hospital.

39

South West team hits the road In October, the South West Local Ambulance Service Network and the South West Hospital and Health Service partnered in a joint training exercise in the remote areas of Bollon, Thargomindah, Quilpie, Augathella and Morven.

South West LASN Acting Senior Clinical Support Officer, Steven Darnell said the localities all had hospital-based ambulance facilities where nurses responded to incidents rather than paramedics.

40

QAS Insight | Summer 2016-17

“Bollon, Thargomindah and Morven have remote clinics while Quilpie and Augathella have remote hospitals,” Steven said.

“We ran an exercise scenario of a single-vehicle crash with a female driver sustaining injuries to her right femur and pelvis and a child with no injuries.

“We had two nurse educators and myself facilitating and our involvement was to run the scenario and to help guide learning throughout to assist health staff that have limited exposure to these types of incidents.

“The scenario was chosen as it was simple and a real possibility in these locations. It’s a large geographical area with a significant farming community and you’ll often find a parent travelling the roads with a child in the car.”

The goal of the scenario was to see how the health facility would respond, assess and treat the casualties with consideration for extrication and communication with relevant services.

The scenario also encompassed the transportation and handover at the health facility to give an insight into how clinical information is provided and identify what critical information is required by the receiving health facility.

drivers involved were very engaged and multiple learning points were discussed during the debriefs that we held after each scenario,” Steven said.

“Key lessons reiterated the importance of early notification to the ambulance to help the early deployment of additional resources. Staff also learned alternate extraction methods such as the use of an extrication board with a sitting patient.

“It also improved teamwork and provided valuable practice with the equipment such as the femoral traction splint, SAM splint, extrication boards and the stretcher.

A simulated crashed vehicle and an off-line ambulance were used to ensure operational capability was continued.

“We had some very positive feedback from all staff who took part who said they found it a valuable learning experience.”

A number of the challenges of managing incidents in remote areas were addressed, including distance to the patients, a lack of additional resources and the length of time taken for retrieval.

Steven said future exercises would also include Retrieval Services Queensland, to focus on the provision of continued care in a realistic timeframe as well as the use of tele-link video conferencing.

“Each scenario was performed well with excellent involvement from all. The health staff and emergency

The training scenario in Quilpie, staff load the patient for transport

41

Building our cultural capability Queensland is home to the second-largest Aboriginal and Torres Strait Islander population in the country and to people who come from more than 200 countries and hold more than 100 different religious beliefs.

For QAS, recognising and respecting the diversity of the people we provide services for and work with is fundamental to achieving our objective of providing timely and quality ambulance services which meet the needs of our community.

Building our ‘cultural capability’ – the skills, knowledge, behaviours and systems needed to plan and deliver services in a culturally respectful and appropriate manner – is therefore crucial.

The Queensland Ambulance Service Aboriginal and Torres Strait Islander Cultural Capability Action Plan 2015-18 outlines how we will deliver on our commitment to build cultural diversity and capability of our workforce, and to improving health outcomes for Indigenous Australians and people from different cultural backgrounds and their communities. It is underpinned by five key principles:

A/Director Leesa Mills from Service Planning and Performance said: “It’s about understanding the issues affecting Indigenous Australians as well as people from different cultural backgrounds, so we can work with them to improve the quality of our services. It’s everything from helping to recruit and mentor staff, to improving our cultural practice, and strengthening community partnerships.”

Cultural capability tools ▸▸ Queensland Ambulance Service Aboriginal and

1. Valuing culture 2. Leadership and accountability 3. Building cultural capability to improve economic participation 4. Aboriginal and Torres Strait Islander engagement and stronger partnerships 5. Culturally responsive systems and services The QAS will also be responsible for key actions under a new whole-of-government multicultural action plan

that’s currently being developed. The action plan will help promote a united, harmonious and inclusive community, and foster an environment of opportunity for people from culturally and linguistically diverse backgrounds.

Torres Strait Islander Cultural Capability Action Plan 2015-18 ▸▸ Protocols, fact sheets and guidelines available on the QAS portal at ow.ly/gJDa306oPJr ▸▸ Two-hour Introductory Aboriginal and Torres Strait Islander Cultural Practice Online Program from Queensland Health coming soon via LMS

The award-winning Indigenous Paramedic Program has given us a new Advanced Care Paramedic (ACP) in the Woorabinda community. Josh Weazel from Woorabinda Ambulance Station was recently presented with his epaulettes by Commissioner Russell Bowles to recognise his ACP qualification in November and is fortunate to be working in the community where he grew up.

The QAS Indigenous Paramedic Program was formally recognised with two awards at the 2016 Council of Ambulance Authorities conference, held in Brisbane in October. The program took out the ‘Management Practice and Operational Performance’ and the overall ‘Star’ awards demonstrating the importance of the program and the positive changes it has already made. It also underscores its potential to further help close the gap on Indigenous disadvantage.

42

QAS Insight | Summer 2016-17

Mellissa Keune

Sit ‘n’ Yarn for No Harm in Cape York The Sit ‘n’ Yarn for No Harm program, designed for Cape York and recently released in Kowanyama, is a great example of how QAS staff are strengthening partnerships in Indigenous communities.

The brainchild of Kowanyama Field Officer-in-Charge Mellissa Keune, the program provides a 30- to 60-minute first aid/CPR workshop designed for Indigenous Australians.

“Our participants select the subject they would like to learn about, then we can go and discuss the topic in a location of their choice, such as Homelands, inside homes or outside in their country or waterways, so I can contextualise the learning to suit their needs,” Mellissasaid.

of the Kowanyama community, as most had no prior knowledge of first aid and would only access it if it was a work requirement,” Mellissa said.

“As we are extremely remote and isolated for many months of the year due to the wet season, it became apparent that many people needed to develop a base knowledge of what to do in an emergency.”

“The distance to any major town is more 600 kilometres via a dirt road of 400 kilometres. There’s also extreme weather conditions all year round and they are often cut off by flooded waterways.

“A collective decision was therefore made to educate as people many as possible in caring for themselves and others in an emergency if needed, as medical aid can be many hours away and some people have minimal to no phone coverage.”

“It’s all in the name with this program so Sit ‘n’ Yarn for No Harm aims to provide this information in a relaxed and less rigid environment.”

Mellissa has delivered the workshops to several groups and individuals so far and has received resounding positive feedback.

“The program is open to all ages and participants like to chill on the ‘yarning mat’, kindly donated by local Police Officer Renee.”

“I try to remove the fear of first aid as much as possible and replace it with confidence and fun. At the end of a session people are happy to join in and participate with bandaging, CPR and scenarios,” she said.

The program is constantly undergoing fine-tuning to the community’s requirements and Mellissa even has her mind set on developing an Indigenous-based first aid/CPR video, which will enable more practical hands-on learning and less PowerPoint instruction.

“I found a greater need for reaching the larger population

The concept of these workshops allows it to be a progressive view on all first aid and emergency topics for those that would not normally have an opportunity to complete a full first aid/CPR course, while also allowing those that would like to be accredited in the future to have a better understanding on the day.

43

LAC 2016 wrap-up

By Teresa Jurgensen, Executive Manager LAC Volunteer Support

2016 has been a very busy and eventful year for Local Ambulance Committees.

Over the past year, LAC volunteers partnered closely with local QAS staff in their communities to deliver a range of highly valued community engagement activities. These activities have been as varied as the communities LACs and QAS serves, demonstrating and exemplifying the close relationship that exists between the Queensland community and its ambulance service.

From May 9 to 15, QAS and our volunteers celebrated National Volunteer Week with a range of activities including thank you barbecues, Station Open Days, and CPR Awareness sessions.

Importantly, during the second half of 2016, LACs and QAS have celebrated the 25th anniversary of LACs and QAS. The Ambulance Service Act 1991 came into force from July 1 1991, creating the single statewide ambulance service and establishing Local Ambulance Committees in communities across Queensland. Again, LACs and QAS staff have been celebrating this significant milestone by throwing open the doors to ambulance stations across the state, inviting the

44

QAS Insight | Summer 2016-17

CPR training in Hervey Bay

community to come along to open days to meet their local paramedics, enjoy sausage sizzles and learn CPR. Celebrations continued with Ambulance Week 2016, with award presentation events held in locations across Queensland, with many LAC members receiving service badges recognising their long service to their LAC, QAS and the community.

During Ambulance Week at the Commissioner’s Achievement Awards presentation held in Brisbane on Friday, September 16, Cathy Ihm, Volunteer First Responder and Dayboro LAC Secretary, was a joint winner of the Excellence in Leadership award – empowering people through excellence in leadership, collaboration and team development. A special congratulations to Cathy!

Community support for LACs LACs continue to flourish with many welcoming new members over the past year. Following hard on the heels of Normanton LAC’s reactivation last year, in 2016 we welcomed the newly re-formed Gladstone LAC. Congratulations and a big thank you to both the Normanton and Gladstone communities for their support in re-forming LACs in these locations.

The Cairns Local Ambulance Committee

CPR Awareness During the course of 2016, the CPR Awareness Program continued to go from strength to strength. Since mid2014, LAC volunteer trainers and QAS frontline staff have provided CPR Awareness sessions to more than 49,000 participants. This is a significant achievement and each and every volunteer and staff trainer is to be congratulated on their efforts.

In addition to the numbers trained, the CPR Awareness Program has been a successful tool for LACs and QAS staff to engage with their community when delivering an important safety and resilience message. LACs have also used the CPR Awareness Program to encourage new members to join as volunteer trainers, offering flexible volunteering options for people in their community. Well done to all involved.

QLAC We are into the second year of the 2015-17 Queensland Local Ambulance Committee Advisory Council (QLCAC) term of office, and in 2016 the group has met four times with QAS senior executives and senior managers

at Kedron. As the peak volunteer and community advisory group for QAS, QLAC members are an important local contact for LACs. QLAC members are experienced LAC members ready to help and support your LAC. If your LAC has not already had contact with your QLAC member, please don’t hesitate to get in contact. All QLAC member contact details are published in the monthly LAC Network Contact List.

The year ahead LACs and QAS are looking forward to a wonderful 2017.

Continuing with the delivery of the CPR Awareness Program and providing opportunities for the community to visit their ambulance station, LACs have a valuable role to play in engaging the community with their local ambulance service.

We are all also all looking forward to the 2017 LAC State Conference to be hosted by Hervey Bay LAC from August 25 to 27, 2017. See you there!

45

2016 KJM grant recepients at the Brisbance ceremony in November

KJM continues to enhance patient care Grants totalling $29,500 were awarded to QAS personnel and paramedic students in November to help them undertake research and development projects that will enhance patient care across Queensland.

Named after Kenneth James (Jim) McPherson, a Queensland Ambulance officer who lost his life in an aerial ambulance crash in Bundaberg in 1987, the KJ McPherson Education and Research Foundation (KJM Foundation) is a not-for-profit entity dedicated to improving patient

care by providing research and professional development opportunities for uniformed personnel.

The annual 2016 KJM Foundation Patron’s Day Symposium was held at Brisbane City Hall on November 8 with the theme of Integrated Healthcare: Opportunities and Innovation, was attended by more than 200 QAS staff and volunteers. Grant recipients announced at the presentation ceremony were:

KJ McPherson Education and Research Foundation Grant Recipients 2016

46

Grant

Recipient

Patron's Overseas Short Study Grant sponsored by Physio Control ($5000 each)

Cameron Anderson - Clinical Support Officer, Wide Bay LASN Clinical Education Unit Darren Lawrence - Acting Senior Clinical Educator, Metro North LASN Clinical Education Unit Scott Nash - Acting Senior Clinical Educator, Metro South LASN Clinical Education Unit

Dr Peter Stephenson Overseas Study Grant sponsored by Dr Peter Stephenson, Montserrat Day Hospitals ($5500)

Mindy Thomas - Operation Centre Manager Rockhampton Operation Centre State Operations Centre LASN

QAS Research and Development Grant sponsored by Spectrum Data Systems International ($3000)

David Lowe - Executive Manager Operations Townsville LASN Office

Paramedics Australasia Professional Development Grant sponsored by Paramedics Australasia ($2000)

Scott Jones - Officer-in-Charge Julia Creek Ambulance Station, North West LASN

QAS Professional Development Grant sponsored by Laerdal ($1000)

Gavin Nichols - Advanced Care Paramedic (ACP2), Coomera Ambulance Station, Gold Coast LASN

United Voice Graduate of the Year Grant sponsored by United Voice ($1000)

Amy Cooper – ACP2, Charters Towers Ambulance Station, Townsville LASN

Paramedics Australasia Scientific Student Grants sponsored by Paramedics Australasia

Best Paper ($600) - Emma Dale, Central Queensland University, “AMETHOCAINE (Aka Tetracaine)” Runner-up Best Paper ($400) - Kiarne Dippel, Central Queensland University, “Sumatriptan Use in a Pre-Hospital Environment – An Analysis and Review” Best Poster ($1000) - Therese Walsh and Elise Riley, Queensland University of Technology, “Crush Injuries: An Educational Overview”

QAS Insight | Summer 2016-17

New LARU vehicles coming soon Keep an eye out – two sleek new Low Acuity Response Unit (LARU) vehicles will be hitting the streets soon. They are part of eight newly designed vehicles currently being built and fitted out.

The new vehicle model type is the Hyundai i-Load Crew, which boasts a larger space in the rear to hold equipment.

It was chosen after a consultation process that found the existing vehicle, the Hyundai Santa Fe, did not meet the growing requirements for a LARU response vehicle.

Additional features also include a sliding door on the side of the vehicle to provide greater access for patients, particularly the elderly. It also has grab handles to assist entry into the vehicle and a drop-down side step.

The vehicles have a portable temperature controlled fridge and a LARU-specific kit for wound management.

New LARU Doc on the block Meet Dr Kim Lai, an experienced General Practitioner with emergency medicine experience. Kim will be assisting the Medical Director with clinical support and oversight of our extended care paramedics within the LARU program. Kim has been involved with all of the new LARU courses in 2016 and will continue to play a pivotal role in this expanding area of QAS operations. Say hello to Kim when you see her out and about.

47

Roadshow sessions focus on Strategy QAS executives have been traversing the state on a roadshow aimed at discussing the Queensland Ambulance Service Strategy 2016-2021. The roadshow sessions started in September and are running through to the end of the year.

They have been developed to enable a conversation on the QAS Strategy that was developed to ensure the organisation moves forward as changes in Queensland’s population and community profile impact demand.

The Strategy ensures we remain capable of providing the services that our patients and community need, when they are needed.

The roadshow sessions have been well-received with staff taking the opportunity to explore what the Strategy means to them, and how we can all achieve Excellence in Ambulance Services.

Topics covered have included why we need a strategy, what is in it, how we can all play our part and some of the initiatives QAS is working on to help improve the way we work.

This is just the start of the conversation – watch this space for more in the New Year.

QAS Strategy 2016-2021 roadshows Number of roadshows per LASN

By the end of 2016: QAS executives will have

travelled more than

9,200 kilometres

1

to 18

1

1

different locations

1

1 1

2

1 1

48

QAS Insight | Summer 2016-17

2 2 2 1 2

and spoken to more than

380 managers, supervisors and staff

Bob with Commissioner Russell Bowles and son Robbie Medlin after he was presented with his certificate of appreciation and long service medal

Appointments and farewells QAS said thank you and farewell in November to Bob Medlin after an impressive 47 years of service in Central Queensland.

Bob was honoured at a ceremony on November 14 and presented with a plaque and certificate of appreciation by Commissioner Russell Bowles. His son Robbie, the Assistant Commissioner of the Townsville LASN, was also there to say thanks.

Bob has been a mentor to many and was one of QAS’s pioneers in Central Queensland. His career started in 1968 as an Honorary Ambulance Officer at Emerald, before being appointed as Officer-in-Charge at Marlborough in 1981.

Since then he has undertaken many roles within the QAS, including Superintendent, District Operations Coordinator, District Superintendent, Manager Communications, Manager Property and Assets, Manager Operational Support and most recently Manager Business Support.

Best wishes to the following people who are leaving us after making their valued contributions to QAS.* Name

Position Title

Years of service

Division/Location

Laurence Green

Patient Transport Officer

38

Logan West Ambulance Station

Howard Porter

Patient Transport Officer

34

Metro North LASN

Brett Harrod

Senior Advisor

32

Service Planning and Performance

Harold Toon

Patient Transport Officer

25

Mackay LASN

Jason Danbury**

Paramedic

17

Metro South LASN

Graeme Coulson

Patient Transport Officer

17

Metro North LASN

Paul Shore

Paramedic

17

Sunshine Coast LASN

Rosemary Gore

Executive Manager

13

Executive Manager

Michele Dalton

Paramedic

11

Northgate Ambulance Station

Malcolm Moss

Advanced Care Paramedic

10

Mt Tamborine Ambulance Station

Luanne Chapman

Administration Officer

10

Wide Bay LASN

Movers and shakers Congratulations are also in order to those who’ve either joined the QAS family or moved on to a new position or area.* Name

Appointment Date

Position Title

Division/Unit

Teresa Jurgensen

26/09/2016

Executive Manager LAC Volunteer Support

Officer of the Commissioner

Nicola Busch

26/09/2016

Executive Manager

Officer of the Commissioner

Peta Robertson

4/10/2016

Director Operational Business Intelligence and Planning

Operational Business Intelligence Planning, Service Planning and Performance

Paul Griffiths

4/10/2016

Manager Business Support

Mackay LASN

Jennifer Gribaudo

10/10/2016

Manager Employee Relations

Human Resources, Corporate Services

*Staff appointments and retirements are provided for the period of September 1, 2016 to October 30, 2016. The appointments list is of classification levels AO7 and above and includes those who have been made permanent after acting in a position. ** Staff departure in May 2016.

49

Thank you QAS I once read – ‘There’s a difference between interest and commitment. When you’re interested in doing something, you do it only when circumstances permit. When you’re committed to something, you accept no excuses, only results’.

Just wanted to thank John (Green) and Shaun (Webber) of QAS, for attending to my daughter this afternoon (November 6) in Nundah, Brisbane. The ambulance arrived so quickly and put us all at ease. Many, many thanks for doing an awesome job.

Despite the challenges that frontline officers face in their line of work, I am pleased to say that this has not stopped staff in their commitment to the Queensland Ambulance Service and work ethic. So far, a total of 401 letters of appreciation have been received this year from members of the public, with 847 letters and emails sent out to staff in recognition of their efforts.

Jackie - Nundah

From Commissioner Russell Bowles

I would like to say a massive THANK YOU to Lucy (Blackler) and Ben (Baxter) who were called out to attend to me early Tuesday morning (October 4). They both showed such care, professionalism and empathy. They truly are a credit to your service.

Tammy - Wynnum West

My husband (Stan) required medical help whilst out on a bush walk with my sister (on November 18). They were a fair distance away from help. Triple Zero responded quickly with 'Jason Duxbury' attending. As they were not accessible by normal vehicle, Jason spoke with my sister (who is a police officer) which put her at ease and trekked half way up the bush terrain with all his gear to help my husband who had passed out, hit his head, had been unconscious and was suffering from some heart issues. I can't say enough how impressed by Jason and his crew we were and feel blessed to have been able to call upon the support of Queensland Ambulance Service.

Nicole – Magnetic Island

I would just like to say a very big thank you to QAS. On Saturday November 5 I had to use your service and I found the staff, Ryan (Forbes) and Caitlyn (Lewis), to be very professional but they also made me feel at ease. I am now recovering from a major operation but just wanted to give thanks where it is deserved. All you guys do a wonderful job. Many thanks.

Nell - Kallangur

A big bouquet to Ambos Rob (Andrews) and Sam (Zonca) from Nathan who picked up my elderly mother Desley Clarke at 4.45 yesterday afternoon (October 2) at Robertson and took her to Mater Emergency. Your kindness and professionalism was extraordinary, making us feel so much better as soon as you arrived. We are very fortunate to have such lovely young men looking after us, thank you.

Jayne - Nathan

I'd just like to say a huge thank you to you all and for the work you all do. Today (October 27) two of your finest (Stephen Henderson and Jon Buteux) came to the corner of the Bruce Hwy just south of Childers and helped my dad out. I can't thank you enough.

Broddie – South Isis

I would like to thank the two female ambulance paramedics (Alexandra Doolaard and Janet Lilley) that attended to Graham Fels on Saturday (October 29) at Jollys Lookout. Your care and attention was greatly appreciated.

Jenny – Jollys Lookout

Just wanted to express my thanks to Elliot (Shirane) who picked me up with an injured leg at the University of Qld last night (November 11). Whilst being injured and in an ambulance isn't the most pleasant of experiences, Elliot was fantastic and I am really grateful to him for helping me to stay calm!

Jess – St Lucia

Thanks Danny (George) and Lachlan (Matthew) from Nanango Station for your superb service last Wednesday (September 28) when I had my heart attack. You both displayed excellence in your treatment and transport of me from home to Nanango.

George – Blackbutt

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QAS Insight | Summer 2016-17

ABC Radio’s Rebecca Levingston chats to Emergency Medical Dispatcher Adrian Falconer and Paramedic Daniel Townson at the Get Ready Queensland Community Fun Day at Greenslopes

In the media QAS has received a significant amount of media coverage throughout the course of 2016, with more than 10,000 news items generated from January 1 through to the end of November.

The highest volume of coverage occurred on January 25 around the issue of assaults against paramedics. After two assaults the previous night, QAS coordinated a combined media response that included United Voice representatives and reaction from Minister for Ambulance Services Cameron Dick.

During late November and early December, QAS launched a campaign to raise awareness about the dangers of heatrelated illnesses as Queensland braced for a heat wave.

Minister Cameron Dick and QAS Director of Clinical Quality and Patient Safety Tony Hucker spoke at a media event at QUT in Brisbane and QAS Media coordinated a number of interviews in LASNs across the state.

The tail end of the year had media coverage focussed on significant multi-casualty incidents, particularly in October. The day with the highest volume of media coverage was October 17, after 16 people suffered adverse reactions to illicit drugs on the Gold Coast over the weekend of October 15-16. Senior Operations Supervisor Stephen Burns conducted multiple interviews in relation to the QAS response.

There was also significant media coverage on October 25 following the tragic events at the Dreamworld theme park on the Gold Coast where four people died.

Peter Batt on scene at a poisoning incident at Deception Bay State School

QAS Media Coverage Month

Jan 2016

Feb 2016

March 2016

April 2016

May 2016

June 2016

July 2016

August 2016

Sept 2016

Oct 2016

Nov 2016

News items

1,309

1,016

768

817

914

1,309

704

725

1,022

1,359

1,059

51