Saascene December 2016 Edition

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e n e c S SAA

DECEMBER 2016

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SAAScene

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CONTENTS 21

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32

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56

Features

Commendations

SAAS REMOTE

4 2016 Graduation and Presentation Ceremony

11 Thanks to our staff

20 Kangaroo Island volunteers get trained up

10 The Storm

Clinical Journey 16 Bariatric issues in prehospital care

Gang Green

18 Heat related illness

30 Meet some stellar SAAS people

SAAScene is the official internal magazine of SA Ambulance Service. The publication is produced bi-monthly by the Corporate Communications team. Find the latest edition of SAAScene, as well as all back issues, on SAASnet. Contributions, including articles and photographs, are welcome from all SAAS staff. Please ensure you have received approval from your line manager before submitting. Front cover: Tony Meli and Kate Firmager at the White Ribbon Ball held on 19 August 2016.

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Editor Alexi Tuckey Graphic Design Jamshop Writers Fiona Crowe Gabrielle Lott Simon Nankivell Jenny Rea Rachel Stelmach Carissa Tucker Alexi Tuckey

GPO Box 3, Adelaide SA 5001 Telephone 8274 0413 Facsimile 8272 9232 healthsaasnews@sa.gov.au Š SA Ambulance Service 2016 Material from this publication may be reproduced with the approval of the Editor providing appropriate acknowledgment for all photographs and articles. SAAScene and Pulse are printed on 100% carbon neutral paper.


FROM THE CEO As the year draws to a close this is a good time to reflect on not only where we’ve been but, more importantly, where we’re going. The new strategic plan is getting into its final stages before implementation commences from early next year. As we set out our strategic direction for the next three years on a path of reform and improvement we will begin consultation on some of the more complex parts of the change and improvement, agenda as final details are set. From January I will chair a monthly Transformation Program Board which will oversee a myriad of projects by local teams across our organisation supported by the new Office of Transformation and Strategy. More colleagues and resources are on the way from Transforming Health investment with two new stations opened and two more to follow. We’ve just launched a media campaign for the Destination Triage Tool, to educate the public that they’ll always be taken to the most appropriate hospital for their needs – not necessarily the nearest one. The ‘With You All The Way’ campaign consists of posters, online ads, social media and a TV commercial starting in 2017. Thanks to everyone at SAAS who made it happen. Speaking of social media, we launched SAAS on Facebook and Twitter at the end of March. Both have been travelling extremely well as new avenues to communicate with the public and showcase the outstanding work that’s been happening at SAAS. There’s more to do here next year as we develop our presence on these communication channels and use them to best effect.

We saw the most ever CEO Commendations at our Graduation and Presentation Ceremony and many other colleagues recognised for their fantastic achievements with a collective total of over 3000 years of service recognised at just one event. We had a different venue this year seeing the introduction of a live band to the reception after the awards ceremony at which I was delighted to welcome the Honourable Hieu Van Le, Governor of South Australia, as our principle guest. 2016 has been my first full year as your CEO and I’ve reflected on what I’ve heard, seen and found in the last 12 months. Overwhelmingly our organisation is full of hard working dedicated people, wanting to do the right thing to provide great quality care to our patients. Our people work tirelessly in doing this and together we have responded to more critically ill and injured patients faster than ever before this year. We’ve opened new stations, grown our workforce, developed a plan for the next five years, deployed social media channels, got closer to a new intranet site, got closer to an electronic case card, all but completed White Ribbon accreditation, seen more people recognised for the great work they’ve done than ever before, agreed changes to our uniform, implemented a new simplified and streamlined governance process supporting stronger management of our corporate risks, introduced new drugs and clinical equipment, and most importantly engaged with nearly 800 colleagues face to face during two rounds of state-wide roadshows. There of course is a lot more that’s been done locally that I couldn’t even begin to list here.

So what does that mean for 2017? Completion of the trio of reviews we have underway, and plans for a revised service delivery model, will see reform flow from the reports’ recommendations. We will see more recruitment, enhancement to our clinical scope of practice, our accreditation assessment for the National Safety and Quality Health Service Standards (the first ambulance service in the country to do so), the opening of the new Rescue, Retrieval and Aviation Services base, the launch of a new intranet site, the deployment of new stretchers across the fleet and much more. With much more planned for 2017 you’ll need to stay tuned to our internal communication channels regularly to keep up with what’s happening. As we approach the Christmas and New Year break I want to say a special thankyou to everyone who is working over this festive season – particularly colleagues who are foregoing their own celebrations to serve the community, and in doing so I also recognise the support of your families and friends, not only now but throughout the past 12 months. Merry Christmas, have a great New Year and I’ll see you all in 2017 as we lead the way to better care through our strategy for the next three years, and make SAAS the ambulance service in Australia everyone wants to be part of. Cheers, Jason Jason Killens Chief Executive

SA AScene DECEMBER 2016

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GRADUATION 2016

SAAS CELEBRATES T

HE SKY MAY HAVE BEEN GREY but the SAAS stars were bright at the 2016 Graduation and Presentation Ceremony, held on 30 October at the Hilton Hotel. It was an affair to remember, starting with a standing Vice Regal salute for the entrance of His Excellency, the Honourable Hieu Van Le, Governor of South Australia. His opening speech talked about how much he revered our service and commended the recipients for their commitment to the community.

CHIEF EXECUTIVE OFFICER COMMENDATION

Wendy Crossman, Jarred Gilbert, Ian Jansse, Josie Lord, Neil McKenzie, Yvonne Roberts and Naomi Stidiford These ambulance officers from Salt Creek, Tintinara and Meningie were despatched to two backpackers who had been seriously assaulted. Each person took on their role with calm, and demonstrated a high level of compassion and support for the patients. The professionalism and leadership of each team member helped them manage an extremely stressful situation.

Adelaide personality, Graeme Goodings, hosted the day and steered the audience through a record breaking 18 CEO commendations, multiple clinical awards, professional certificates and significant service awards. Glen Woods from the Retired Officers Association presented their inaugural Community Engagement Award, Chris Howie spoke about the incredible success of the ‘Hands Master of Ceremonies off our Ambos’ campaign, and Graeme Goodings a new SAAS video showcasing our outstanding staff was premiered – complete with drone footage. Vickie Kaminski, Chief Executive SA Health and Nat Cook MP were also on hand to present awards. After the ceremony, recipients and guests kicked on for celebratory refreshments, all to the smooth sounds of the 10th/27th Army Battalion Band – they looked pretty slick in their white uniforms too! To those who received an award on the day, and to those who could not make the ceremony as they were on shift, a special congratulations to you all!

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Detective Brevet Sergeant Suzanne Holmes, Constable Tim McGurgan and Senior Constable Andrea Wilson These SA Police Officers responded to an assault in Port Pirie. While the suspect was restrained, they identified the victim was in cardiac arrest. Not only did they initiate very effective CPR, they also assisted the SAAS clinicians with clinical care and extrication of the patient.


GRADUATION 2016

Lauren Grigg

Colin Willoughby

Clarke Timmins

Volunteer ambulance officer, Lauren was tasked to a trauma case at Strathalbyn Abattoir for a patient who had been critically injured by a buffalo. Remaining calm and composed, Lauren provided strong leadership to the bystanders on scene, and was able to remove the patient from danger and provide clinical care. Her courage and leadership goes beyond the call of duty.

Colin is an Emergency Services Officer for the Woomera Township. On a visit to Adelaide, he assisted an elderly gentleman who had collapsed. As he went into cardiac arrest, Colin commenced CPR, which resulted in a successful return of spontaneous circulation. Colin’s quick response was instrumental in the return of the patient’s pulse.

Clarke has been a paramedic for 33 years and for 17 continuous years has been a Health and Safety Representative. Clarke has positively influenced the outcomes of many state-wide issues resulting in improved safety for paramedics and patients. He is trusted and respected by staff and management.

Heinz Schroeder and Clarke Timmins During the Pinery fires Clarke and Heinz were dispatched to a significantly burnt patient. Even though the EOC suggested they terminate their tasking as the fires were too close, they continued onto the patient, despite the obvious risk. They were able to provide much needed pain relief and treatment, and proceed to hospital driving through smoke and rain. The patient was seriously burnt, and required many months of treatment. Had it not been for their exceptional courage, the patient would not have survived. Marcus Syvertsen

John Mattinson and Colin McIntyre

Marcus was at Noarlunga Hospital when he was approached by a distraught mother holding her child in cardiac arrest. He took the child to the resus room to start CPR, and managed to achieve return of circulation for the child. Sadly, the child died some days later. His scene management is of an exceptionally high standard, and is a true example of what an ambulance clinician should be.

John and Colin attended an elderly patient in Millicent who had fallen, and broken his glasses. While his injuries were relatively minor, he was transported to hospital for treatment. His major concern was his glasses, as without them he would be blind. John and Colin arranged for an optometrist in Mount Gambier to fix them, and then personally delivered them to the grateful owner.

CONTINUED >

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GRADUATION 2016 Clinical Excellence in Professional Development

Clinical Excellence In Practice

Angela Martin

Grant Copley

Angela’s true passion is community paramedicine. She began her journey when she attended a conference in 2012, enrolled in a research degree, won the 2013 Paramedic Australasian Rod Kershaw Scholarship, and visited Canada and the US where she researched the impact of community paramedicine on patients, organisations and clinicians. When SAAS received funding for a trial, Angela was heavily involved in developing the program.

As a rescue retrieval paramedic, Grant is committed to professional development, ongoing training and study to achieve clinical excellence for his patients. This was truly evident when he was tasked to a job where the patient had a critical airway obstruction, and required invasive action by way of a cricothyroidtomy – saving the patient’s life.

SAAS Safe Champions Award

Retired Officers Association Community Engagement Award

Shaun Rieck Shaun has been the driving force behind the design and fitout of the Volkswagen Amarok Pod that has become the mainstay vehicle for use by regional team leaders, country operations managers and community paramedics. To accompany the vehicle Shaun also developed a user manual. The manual ensures users know the safest and most efficient way to use the vehicle.

Stephen Simmons Paramedic Steve sought and gained a Natural Disaster Resilience Program Grant from SAFECOM to place three AEDs in Edithburgh, after he identified the need for the community. He then personally trained community members to use the defibrillator using the 30 minute CPR program. The implementation of the AEDs ensures patients have access to life saving equipment, while an ambulance is on the way.

NATIONAL MEDAL – 15 YEARS Joanne Blieschke, Christopher Bonnici, Amanda Bridge, Pauline Britza, Margaret Brotherston, David Cadd, Matthew Callaway, Michael Cummings, Melissa Fennell, Cherie Fergusson, Kirsty Finlayson, Julie Forbes, Nicola Franklin, David Galvin, Kristian Glover, Sandra Gutsche, Scott Guy, Stephen Haldun, Joanne Hansen, Andrew Hillier, Paul Jaensch, Lisa Kammermann, Lisa Kotz, Shane Kuhlmann, Tricia Larcombe, Matthew Lever, Toni Lindner, Jonathan McGillivray, Carol Miller, Andrea Papini, Nathan Parks, Thomas Reynolds, Eva Rhodes, Tracey Richards, Timothy Scott, Peter Sheridan, Andrew Shouksmith, Shane Smart, Darryl Sparrow, Cyle Sprick, Wayne Stoddard, Mary Threlfo, Melissa Turner, Stephanie Whitehair, Shane Williams, Benjamin Winter

THIRD CLASP TO THE NATIONAL MEDAL 45 YEARS

FIRST CLASP TO THE NATIONAL MEDAL – 25 YEARS Grant Averis, Anne Baillie, Stephen Bradley, Karen Braunack, Alison Buck, Michael Cawthorne, Gerard Clingly, Neil Clune, Brian Davis, David Glasspool, Brett Greenslade, Stephen Hambling, Christine Hartmann, Kym Hobbs, Therese Hornby, Karl Kreuzer, Richard Larsen, Phillip Leane, Trevor Matthews, Stephen McGregor, Janet Neumann, Shaun O'Sullivan, Ian Pay, Robert Pearce, Michael Perry, Stephen Pettman, Alexander Popovich, Lars Richter, Dario Rossi, Merryn Sadler, Tammi Schubert, Andrew Sharpe, Stephen Simmons, Scott Souter, Lynnette Summerton, James Tscharke, David Turpin, Aaron Vidorin, Paul Vinar, Robert Willoughby, Garry Wood, Peter Yankoff

SECOND CLASP TO THE NATIONAL MEDAL – 35 YEARS Lynette Andrews, John Cahill, Paul Clark, Leon Cutting, Richard Doyle, David Glasspool, David Jaensch, Noel Johncock, Diane Johnson, Phillip Knight, Kym MacDonald, Peter McEntee, Michael Meaney, Viktor Schwarze, Brett Scott, Paul Stratman, Keith Summers, Sue-Ellen Thomas, Peter Turtur, Mark Virgin, Dean Vivian, Gregory Ware, Steven Wright

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His Excellency and Kingsley Folland


GRADUATION 2016 Volunteer Certificate of Merit

Volunteer Distinguished Service Award

Eric Parsons

Kerry McCarthy & Michelle Everett

Humanitarian Overseas Service Medal

2015 SA Emergency Services Medal

Raymond Cossey & Philip Dalton

Madeline Paech & Maxine Starks

Ambulance Service Medal Steve Cameron, Leon Cutting, Philip Knight & Richard Larsen

2015 Ministerial Commendation Mathew Nicholls & Ty Whitmore-Prowse

25 YEAR SERVICE AWARD Gerard Clingly, Trevor Daley, Brian Davis, Ian Davis, Brett Greenslade, David Hansen, Therese Hornby, Phillip Knight, Richard Larsen, Phillip Leane, Bronte Parbs, Michael Perry, Stephen Pettman, Maxwell Pitkin, Lars Richter, Dario Rossi, Merryn Sadler, James Tscharke, David Turpin, Paul Vinar, Peter Yankoff,

CERTIFICATE IV IN HEALTH CARE (AMBULANCE) Kym Bagley, April Bainton, Drew Baker, Navjot Bambra, Penelope Barnard, Patrick Barry, Erica Batten, Clive Bennett, Jessica Bernhardt, Petta Burnett, Annette Busbridge, Nichole Carlaw, Otto Chabayanzara, Matthew Cheminant, Bernadette Cheriton, Julia Collis, Wendy Crossman, Sandra Daldry, Jennifer Darlington, Amy Defluiter, Fiona Dignan, Sharon Duncan, Thamsin Dunn, Tania Franklin, Karl Fredrickson, Shanaka Galbokka Hewage, Andrew Gigney, Deanne Gill, Jack Gloyn, Kali Graham, Nicholas Graham, Lauren Grigg, Chelsea Guinane, Ilse Gulpers, Sam Gum, Ishara Gunasekara, Catherine Haarsma, Peter Hammond, Jessica Hann, Alicia Hole, Joshua Holland, Bruce Hosking, Kathleen Hunt, Shona Hyde, Alexander Jenner, Catherine Kite, Brett Kornelissen, Denise Kreuch, Rosemarie Lappin, Joshua Larby, Erica Larwood, Chi Wai Lee, Chad Liebelt, Susan Loechel, Tyson Lye, Tina Lynch, Estee Macleod, Aileen Magnay, Nicholas Manion, Hayley Mannix, David Mansueto, Andrew McDougall, Jodi Mickan, Megan Miller, Sarah Mitchell, David Mooney, Tania Morris, Tania Morris, Melissa Murphy, Valerie Nesbitt, Daniel Norris, Jillian Pethick, Benjamin Poppy, David Portolesi, Narelle Preiss-Yeates, Elizabeth Rawolle, Olivia Ritchie, Sharon Ritchie, Melissa Round, Luke Sanders, Nirbeejanand Saraswati, Merrilyn Sattler, Margaret Schiller, Verity Schmelzkopf, Lesley Smith, Graham Stangewitz, Thalia Staude, Joshua Stearnes, Karen Stephenson, Anita Stewart, Geoffery Stone, Christian Taormina, Rhonda Teague, Naomi Thompson, Fiona Verma, Kathy Watkins, Carol Weepers, Nicole Weidenhofer, Michael Wells, Shane Whitbread, Natalia Wilkin, Jessica Williams, William Wood, Stafford Wulff, Dannielle Yukich,

INTENSIVE CARE PARAMEDIC PROGRAM Mark Burdett, Beau Griffiths, Stephen Haldun, Patrick Johns, James Kosmala, Paul Liersch, Anthony Mason, Dylan Milde, Carly Ogle, Chantelle Puliatti, Nick Worthley,

GRADUATE PARAMEDIC PROGRAM Laura Bainger, Harrison Barolo, Rachel Borresen, Rebecca Brumby, Rachael Byrne, Christina Calvert, Hannah Caon, Grace Crawford, Ilgizar Gabitov, Thomas Gleeson-Hammerton, Emma Hayes, Ebony Hewett, Alicia Howie, Jessica Hutchings, Kelsey Jaensch, Sophie King, Ruby Laing, Tyson le Clercq, Sebastian Lesnicki, Christian Marx, Winnie Peck, Amanda Pelly, Stephanie Penrose, Kristian Rudevics, Jordan Smith, Benjamin Staude, Jennifer Stevens, Shay Tippins, William Toms, Jake Wilson

CERTIFICATE III IN AMBULANCE COMMUNICATIONS (CALL TAKING)

CERTIFICATE IV IN AMBULANCE COMMUNICATIONS (DISPATCH)

Rachel Bagshaw, Henry Brooks, Rick Candy, Heidi Dent, Jolyon Dunn, Adam Hausler, Stephen Huston, Derek Irvine, Kerri Law, Liam Lee, Robert Manfrin, Benjamin Poppy, Bradley Taylor, Natasha Williams

Alison Christie, Kerry-Jane Gogler, Owen Ridgwell

DIPLOMA OF PROJECT MANAGEMENT Jake Dedert, Lisa Horsell, Chris Howie, Lachlan Ophof, Tina Tutic

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POWER AND PERFORMANCE Following a successful procurement phase, the Stretcher Project is now entering the rollout phase and bringing the new powered stretchers to an ambulance near you. On 21 November 2016, Cabinet approved for SAAS to enter into contract with Stryker Australia Pty Limited for the Power PRO (stretcher) and Power LOAD (vehicle loading equipment) with the first delivery scheduled for March 2017. The Stryker Power PRO is an innovative battery-powered hydraulic powered stretcher which reduces the need for lifting and the associated risk of staff injury. The Stryker Power LOAD fastening system improves operator and patient safety by supporting the stretcher throughout the loading and unloading process. The Power PRO weighs the same as SAAS current manual Ferno stretcher however is a fraction longer and is the same width. The Power PRO has four wheeled operation to increase manoeuvrability as well as an innovative battery-powered hydraulic system to raise and lower patients with the touch of a button. The new powered stretcher provides superior performance and outstanding ergonomics plus has an easy to use manual back-up system in the event of power loss. Both the Power PRO and Power LOAD have the maximum weight capacity to hydraulically lift patients weighing up to 318 kg.

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Photos taken a during demonstration in July 2016.

With the length of the powered stretcher being longer than the manual stretcher minor modifications will be made to the airway seat and personal storage locker behind the driver’s seat during the retrofitting and installation process. The project team is now planning the training stage of the rollout including consultation with metropolitan and country operational stakeholders to ensure all of our career and volunteer ambulance clinicians receive training in the use of the Stryker powered stretcher. While the training program is still being confirmed, the training schedule is as follows:

The installation and rollout of the new powered stretcher and vehicle loading equipment into the ambulances is scheduled to occur within two weeks of ambulance clinician’s practical training session. Sessions will ensure participants are competent in: •

Loading and unloading powered stretcher

Safely manoeuvring the stretcher

Safely adjusting the patients positions

Manual operation of the stretcher and/or loading system

PTS and ESS – March 2017

Metro – April to June 2017

Country career – May to September 2017

Safely setting up a foot end bridge

Country volunteer – July to October 2017

Troubleshooting stretcher or loading system failures

Removing and replacing straps

Replacing batteries

• •

Remaining areas – September to November 2017

— If you have any questions regarding the project please contact Meredith Knowler at meredith.knowler@sa.gov.au or any operational questions can be directed to Terry Whales at terry.whales@sa.gov.au.

And it will include an online component with video.

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FROM

FIRESTO FLOODS

It has been a tumultuous 12 months in South Australia with on the frontline. From the Pinery fire last November, to the flooding in September this year, volunteer and career staff alike were working side-by-side with our emergency service colleagues, ready to respond to emergencies. Throughout these events SAAS had an Incident Management Team operating and liaisons in emergency management teams around the state. Colleagues were called upon to work additional shifts and SAAS collectively stepped up to the plate. Battling flooding, power outages and even tornadoes, SAAS staff persevered and continued to attend the community’s emergencies, plus additional workload, in sometimes harrowing, isolated environments. During the state-wide blackout tripe zero (000) calls increased by 491 per cent compared to the same day a week earlier. As a result, patients that weren’t triaged as a priority one or two were either upgraded by an Emergency Operations Centre clinician or advised they would not be receiving an ambulance to ensure crews were available for seriously ill or injured patients. No matter what role you played, thank you to everyone who helped out during the recent storms.

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COMMENDATIONS METRO Sincere gratitude for your professionalism and kindness while assisting her mother who is a palliative care patient. Your kindness and support was greatly appreciated. Neisha Kelvin, Jim Howie (East C) Please pass on sincere thanks for your professionalism, calm and kind manner mixed with a touch of humour. It really helped her through a difficult situation. Andrew O’Connor (South B) Grateful thanks to you for your professionalism and your lovely manner. Scott Wheaton (Casual PTS), Laura Egarr (Edwardstown PTS) Sincere thanks for your professionalism, calm manner and reassurance. Young son had a choking episode, you turned what was a frightening experience into a positive one and she remains impressed and grateful for the wonderful care he received. Alex McKenzie, Aaron Widger (East D) Pass on sincere and grateful thanks for your professionalism and genuine compassion following her collapse. You are a great credit to SAAS. Daniel Harnas (SPRINT), James Greenhalgh, Madeline Peters (North A) Sincere thanks for your professionalism, care and kindness. Your quick assessment and pain relief was much appreciated. He was diagnosed with Osteomyelitis and a Staph sepsis. They are both very appreciative of the care he received from both the paramedics. Carolyn Kinnane, Prudence Cowell (South C) Sincere appreciation for your professionalism and for the care and kindness shown to his son. He commented that you are all legends and is very thankful for the service. Daniel Grey (SPRINT), Michael Payne, Eli Southern (West D)

Sincere thanks to you for your professionalism. Your kindness and support was greatly appreciated. Lynsey Irwin, Ed Etherington (South D) Grateful thanks for your professionalism, excellent care and amazing skills. You made him feel like he was your only patient and what you do each day is truly extraordinary. Krystal Edge, Anastasia Bougesis (North C) Please pass on sincere and grateful thanks for your prompt response, professionalism and genuine compassion following your colleague’s collapse at home. You provided his wife with much needed reassurance and calm, she stated it was much appreciated and that you are a great credit to SAAS. Daniel Kretschmer, Jack Berry (North D) Sincere appreciation for the professional and thoughtful care of the patient who dislocated his knee. Thank you for your kind and diligent service, it has made his recovery that much faster. Alice Hastie, Simon Walter (East A) Congratulations on exceptionally professional and calm approach to the situation during transport, it was handled very well. Together you did an excellent job and sought support when needed. As the attending ICP I congratulate you, well done. Joe Taylor, (Fulham PTS), Nattalie Trinichini (ESS A) Sincere thanks for your professionalism, care and treatment of my husband following a cardiac arrest in the ambulance, it was greatly appreciated. Ivana Kanyitur (West C), Clinton Daniels (SOT), Anastasia Bougesis (North B) Please pass on sincere appreciation for the professionalism, prompt attendance and reassurance during a frightening experience. Very impressed and remain grateful for the treatment and care patient received, the good news is she is recovering well. Elizabeth Grosvenor, Elena Caon (North B), Jay Mancuso, Shanra Kessell (East B), Timothy Sara (South B)

Sincere thanks for your professional care and great understanding. Patient was fearful and your reassurance made a difficult and frightening situation for her much easier. They appreciated your follow up visit in hospital, it was clear you enjoy your job and you are wonderful at it. Tess Chaplin (East D), Toby Dodd (Ashford PIDT) Please pass on my apologies for my behaviour and also my most sincere thanks for the care and treatment provided to my daughter. Jennifer Edwards (Woodside), Shana Leonard (North B) Thank you for the amazing work you do and for the kind and understanding assistance you provided to my elderly father. Your kindness and support was greatly appreciated. Alice Hastie (East D), Carolyn Kinnane (NW 8hr Team), Joseph Schar (West A), Prudence Cowell (South B) Sincere thanks for your professionalism and understanding. You managed and assisted the patient’s son with the utmost respect and kindness during a stressful experience following the death of his father. Scott Bemmer (Stirling), Colin Cronk, Jennifer Edwards (Woodside) Please pass on my sincere thanks to the team that attended our site for their exceptional professionalism and respectful care of our resident. They were kind, friendly, efficient and showed great compassion throughout the process. Belle Kerr, Manager Residential Services – Resthaven Paradise Jacqueline Stephensonm, Josephine Swinton (ESS C), Jay Elliott, Martine Fairley (Gepps Cross PTS) Grateful thanks for your professionalism and prompt attendance. They were very impressed and remain grateful for the care, concern and reassurance during a frightening experience. Kathryn Reeks (E-Shift), Stephen Brown, Aaron Turner (North B)

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COMMENDATIONS A huge thank you to the three absolutely wonderful paramedics who looked after me after a car crash. They took the extra time and care to make sure I was okay and transported me to the RAH safely. Thank you again, it was definitely a once in a lifetime experience that I never want to repeat but I’m glad I had such nice people looking after me. Tim Wakeling (East A), Luke O’Callaghan (SOT), David Portakiewicz (North D)

Sincere thanks for assisting his wife and keeping her informed. You did a great a job. Tina Bolto (SPRINT), Callum Eime (South C), Bianca Lang (Noarlunga PIDT)

Please pass on sincere thanks to paramedics that treated his mother for the professional, friendly and wonderful care provided. Daniel Osborne, Simmone Joyce (SE 8hr Team)

Grateful thanks for your professional care and support. She mentioned she has never received such kindness and service. You are a credit to SAAS. Sandra Thompson, Bryan Harris (Casual PTS)

Sincere thanks for your professionalism, care and kindness, it was a comfortable trip given the circumstances and to all involved, I thank you very much. Theresa Say, Kristian Glover, Philip Gloede (Whyalla), Jessica Hutchings (North A)

Sincere thanks for your professional attitude and for the wonderful care given. Simmone Joyce, Daniel Osborne (South D)

Sincere thanks for your professionalism and understanding. You managed and assisted her with the utmost respect, kindness and reassurance during a frightening experience. Martin Chessell, Sanda Thompson (Casual PTS), Merrilyn Sattler, Shane Bonnici and Jay Elliott (Gepps Cross PTS) They kept it light, very friendly and ensured I was comfortable. They helped me feel at ease and made the treatment feel personal which made the whole process easy and not stressful. The paramedics waited with me to be admitted, made sure I felt I was in safe hands, thank you so very much. Kelly Darran (West C), Barry Manning (West B) We are both very pleased with professionalism, efficient and caring treatment received. Their effort made the situation that little bit easier. Chloe Fogg, Alison Gosling (East C) Sincere thanks to you for your professionalism, friendly manner and reassurance. Your kindness and support was greatly appreciated. Paul Jaensch (SPRINT)

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Sincere thanks for your professionalism, calm reassurance and care. The family has nothing but high praise for the high level of skill and compassion afforded to their father. Jennifer O’Hehir, Jim Howie (East C)

Thanks for your professional, friendly manner and great care. Your support and ability to make him comfortable in the difficult circumstances was absolutely brilliant. Kristi Lane (West C), Christine Cotton (West B) I would appreciate that my thanks and gratitude are passed on to all who attended, the personal concern shown for my welfare prior to and after the incident, going above and beyond, following up to inquire on my wellbeing afterwards, demonstrated a concern and caring that is indicative of SA Ambulance Officers and deserves the highest recognition and applause. Abbie Milne (E Shift), Heidi Bradtke (North A), Chloe Fogg (East C), Erin Weldon (East D), Brian Davis (East A) Grateful thanks for the care and professional assistance provided to my husband. He sadly did pass away but I wanted to ensure you knew how much your kindness, respect and support was appreciated. David Funnell (North D), Paul Liersch (North C), Coral Mansfield, Maria Lavender (Kapunda) Sincere and grateful thanks to the paramedics who saved my son’s life, if it were not for the great work of your staff I dread to think what may have been.

Melinda Cross (North D), Garth Gill, Yvonne Mullins, Kathy Friend (East B), Krystal Edge (SE 8 hr team) A huge thank you to paramedics that supported and treated my family member. We are extremely appreciative of all your help and efforts. James Kosmala (North D), Jacqueline McBride (East A) You were brilliant with my distressed and unwell child, your compassion, friendliness and professionalism was exceptional. Thank you so very much. Amanda Vella (North D), Georgia Morris (Whyalla) Just wanted to pass on what a fantastic job you all did. It was a complex case and made more difficult by being in an upstairs unit. You all performed amazingly and should be proud of how the case was managed and the subsequent outcome. The patient has since made a full recovery and returned home to her family. The medical and nursing staff involved with the case at the QEH have also praised the crews. The positive outcome is a direct result of the initial lifesaving interventions undertaken at scene and en-route to hospital. Job well done. James Murchland, Nicola Thoo, Kathryn Bray (West A) Please pass on our heartfelt thanks to those that treated the patient. You were calm, positive and professional at all times. Your keen sense of humour also helped you assessed the wound and administered pain relief. We are grateful and feel you are very special people to work as paramedics! We ask that you please pass on our warmest thanks to all three men for their professionalism, dedication and care. Kevin Franklin, Shay Tippins (NW 8hr team), Clinton Daniels (SOT ) Sincere thanks to those that attended, they were patient, non-judgemental, understanding and professional in their manner. They were impressed and grateful for your concern, reassurances and how you managed the


patient preventing stress for those in attendance. Julie Power, Sam Keough, Brett Heywood (West D), Isabella Coldwell (Fulham PIDT) Please pass on my sincere thanks to staff that assisted my mother on several occasions this year. She has now passed away but we wanted thank those involved in her care. The care and professionalism they displayed during these times gave us as a family confidence that our mother was in safe hands. Ashley Hanlon-Evans, Tanya Crompton, David Hansen (Victor Harbor), Karyn Steer, Simon Polling (Mt Barker), James Tscharke (Fleurieu RMTS), Lucy Cooper (Western KI) Sincere thanks for getting me going again. My wife and I would like to thank the crew for saving my life. This was the first time we needed your help, and you saved my life – a big thanks. Matthew Read (South B), Jeanette Holmes (South C) Grateful thanks for the prompt, efficient and caring service. Thank you for the work you do, I very much appreciated your service. Grace Crawford (North D), Dylan Milde (North B) In the midst of our busy lives, we are constantly troubleshooting issues, but far too frequently don’t take the time to say thank you and commend people when they do a fantastic job. Recently my wife and I were driving a close friend home when the friend received a call from her mother that her father had collapsed, SAAS had been called and were on scene doing CPR. We immediately drove to her parent’s house, where there were two ambulances and a response vehicle on scene.

a high functioning team was there in abundance. We were also really struck by the compassionate manner in which all the crew members dealt with the family during this difficult time, both during and after resuscitation was ceased. My wife who is non-medical made the same comments about “what brilliant paramedics, amazing caring and compassion”. I wish I had taken note of all the names of the crews. One was a tall ambo called Shane whom I had not met before. They were all outstanding and I wonder whether there is any means to feed back to them sincere thanks from the family and from my wife and I. Dr Andrew Blyth, Network Clinical Director – Emergency Services SALHN Alice Hastie (East D), Timothy Sara (South B), Shane Kuhlmann (SPRINT), Tyson Rohrlach (South D), Chanel Kind (Noarlunga PIDT) Please pass on my congratulations for a job well done. I would not have done anything different, delayed cutting of the cord, baby was nice, pink and healthy on arrival which is no small part due to the crews’ actions. Well done. Lisa Gurney (East C), Wade Emmerton (East PT) Tom and Iggy have been working together on the SA73/131 vehicle since it became a 12/12 car. The team and I really have enjoyed having them line up with B shift. They are courteous

and professional and their infectious enthusiasm has been good for morale. On a number of occasions when operational workload has been high or we have dropped some northern vehicles they have stayed back a number of hours past their 0100hrs knock off. Even as I write this to you, they offered to attend a case on my behalf, so I wouldn’t have to single respond to a dodgy part of Pooraka, they won’t finish up till after 0300hrs. They often offer to do extra cases to protect others’ knock offs and cribs. They arrange BBQs for some of their afternoon shifts and are always inclusive and welcoming of others. When North B had an IC intern, they were always keen to assist with scenario practice and white-board explanations. Even though their cribs seem to occur so late, they are not often napping in the recliner, instead helping with station duties such as dishes. With only a limited time of the SA73/131 car being 4on/4off they will certainly be missed by myself and the team. Olivia Delli Quadri, Relieving Area Clinical Team Leader North B Thomas GleesonHammerton, Ilgizar Gabitov (NW 8 hr team)

Sadly, despite a prolonged resuscitation, the patient passed away, though I don’t think any medical intervention could have altered this. Given his underlying diagnosis and recent deterioration, everyone involved was at peace with the outcome. I was really struck by the incredible teamwork of your crews. Every attribute you would like to see from

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COMMENDATIONS A ‘little birdy’ sent me a picture of you helping yesterday with a Scout group. Seems like they were extremely appreciative of your involvement. I just wanted to pass on my personal thanks for your commitment to helping out with this community outreach. Well done on representing SAAS so well. Hollie McClure (SE 8 hr team)

ECP Grateful thanks for your professionalism, lovely manner and treatment. She heeded your advice and visited her GP to investigate a sore on her leg, it was malignant and has since been treated. She is so thankful for your thorough care and advice. John Noble (ECP AD) Thank you for the professional and extremely thorough assessment, skills and knowledge. It made all the difference to our resident. Phil Kesby (ECP BC) Thank you for the kind and considerate treatment and pain relief. Paul Ekkelboom (ECP AD)

COUNTRY Sincere thanks for your professionalism and understanding. You managed and assisted with the utmost respect, kindness and reassurance during a frightening experience. Laura Schwerdt, Serena Linton (Mt Pleasant) Please pass on grateful and sincere thanks for professional and fantastic service. They thankfully only suffered minor injuries and wanted you to know you did a great job. Allan Chivell, Olivia Ritchie (Balaklava), Roger Morgan, Roy Darling, Sophie Baker (Maitland), Judith Millar (Port Wakefield) Grateful thanks for your professionalism, friendly manner and reassurance. Your kindness and support to get her admitted to Ashford was greatly

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appreciated. Max Pitkin, Clive Vernis (Victor Harbor)

Whitmore-Prowse, Chris Meaney, Craig Hunter (Port Augusta)

Sincere thanks for your kindness, she had suffered a cardiac arrest and was truly overwhelmed by the treatment and care she received. Jennifer Edwards, Paul Cottier (Woodside)

Thanks for your kindness, your help was amazing. Bruce Wilhelm (Port Augusta), Seb Lesnicki (SE 8 hr team)

Please pass on sincere thanks for your professionalism and the brilliant care you provided. It was greatly appreciated. Stuart Banks, Rob Willoughby (Stirling) Thank you for the services which were provided and for the professional and kind performance of both teams .They were absolutely top class and it would be appreciated if our thanks could be extended to them and additionally for their senior managers to be made aware of the quality service which they provide. A difficult day was made considerably easier through their efforts. Sarah Hamilton, Tyson Lye (Mallala), Susan Felby, Sharon Ritchie (Balaklava) Sincere thanks for your professionalism and care, he felt reassured from the outset due to your competence and skills. Scott Baulderstone, Amy Rutten (Stirling) I would like to express our deepest thanks for the care and professionalism you took to help remove a patient from ‘The Slot’. The story was well covered and had a good ending. It will be one of those events that will be recounted in years to come. A special thanks to Annika who went down the cave and spent quite a long time there. Annika Pearce, Alan Hall (Naracoorte), Clinton Daniels (SOT) Please pass on our sincere thanks to the crew that attended the accident in quorum pass yesterday, by all accounts they did a fantastic job. Chris Meaney, Emma Haynes, Harry Barolo (Port Augusta), Shannen Ellis (Quorn) Absolute rave to all ambulance officers, but particularly the four that attended to me on Sunday. You all made me less frightened and I felt very well looked after. Thank you for your care. Tyron

This special note holds more appreciation than any words can say, for you’re among the nicest people I have ever known and you’ll never be forgotten for the thoughtfulness you’ve shown. Keep the blood sugar pumping – we’d never cope without you. Carly Evans, Dave Hanke, Maxine Starks, Chris Meaney (Port Augusta) Sincere thanks for your professional, kind and caring manner. Your approach and management made her feel safe and reassured during a time of uncertainty. Angela Moritz (Whyalla), Lars Richter (ECP AD) Thank you for your care and professionalism. You made the transfer extremely comfortable. I’m on the mend and getting back into action. Nick Williams, Carly Evans (Port Augusta) Thank you to all the paramedics that assisted me. Your reassurance and kindness, along with your knowledge of spinal injuries was wonderful. You are all a marvellous bunch of people. Chris Meaney, Harry Barolo, Nick Williams, Duncan Johnstone, Craig Hunter (Port Augusta) Thank you for everything you did for us when you were called to our home recently. Cheryle Tomalin, Nick Williams (Port Augusta) Grateful thanks to you for your professional and incredible service. It was greatly appreciated. Rosemary Coldwell, Chris Taliangis (Stirling) Sincere thanks for the care you provided to wife and deceased husband. Your kindness, respect and support were greatly appreciated. Chris Robson, Jenny Whittenbury, Julia Schneider, Maxine Byles (Barossa)


An enormous thank you for your kindness, support and help. It was such a relief to have you arrive, and your calm and helpful manner will always be remembered. We are eternally grateful, a hero in our eyes. Chris Taliangis (Stirling)

EOC Please pass on sincere thanks for the professional, kind and reassuring assistance you provided. Kerry Jones (EMDSO Team D) Sincere and grateful thanks for your professionalism and genuine compassion during her triple zero (000) call following colleague’s collapse at home. You provided his wife with much needed reassurance and calm, she stated it was much appreciated and that you are a great credit to SAAS. Henry Brooks (EMDSO Team A) Sincere thanks for your professionalism, support and clear and calm instructions that enabled him to perform CPR on his friend before crews arrived. Your ability and encouragement was wonderful and was greatly appreciated. John Davies (EMDSO Team A) Grateful thanks for your professionalism, friendly manner and reassurance. Your ability to bring calm and advise what needed to occur while waiting for the ambulance arrival was greatly appreciated. Andjelka Stojsavljevic (EMDSO Team B) Sincere thanks for your professionalism and for keeping her informed on how she could support the patient while waiting for ambulance crews to arrive. You did a great a job. April Bainton (Team B)

CUSTOMER SERVICE CENTRE Sincere thanks for your professionalism and kindness. I appreciated your understanding, taking the time to explain items slowly, you made my day and you’re an asset to SAAS. Giovanna Lionello (Customer Service Representative) Sincere appreciation for the wonderful assistance, problem was easily rectified. Appreciated the help and wished to pass on thanks. Pam White (Customer Service Representative) Thank you for finding a solution to query so promptly, your kindness and manner with regard to issue was appreciated. You are an asset to SAAS. Diane Rowlands (Customer Service Representative) Thank you for outstanding service, your message was polite, clear and in a manner that her mother was able to relay, well done. Laura Thomson (Customer Service Representative)

CALL DIRECT Sincere thanks for your help and kindness during this stressful time, it was greatly appreciated. Tracey McCreight (Customer Service Representative)

MEDSTAR Sincere thanks for your dedication and expertise in handling these precious little babies and safely taking them to FMC for respiratory care. Your compassion, concern and care shown to the babies and their mum was wonderful. Twins went home after a 65 day stay, they are beautiful, healthy boys and we are so grateful to all who looked after them during this time. Family made donation to MedSTAR Kids in the hope it can go towards a project to help the amazing service they provide. Jared Jeffrey RN, Dr Rebecca Nelson Such a pleasure to undertake retrieval with these two, both were amazing and a true credit to the service. It was a most stressful and unpleasant experience for all. Despite the outcome, the staff and family at Mt Gambier were full of praise for the ‘team in red’. Please pass on my thanks and let them know how fabulous they are. Dr Ray Farley Dr Martie Botha, Geoff Lyon RN We wish we could express in words just how grateful we are to you for taking such wonderful care of our son. We are so thankful for your leadership, knowledge and calming presence on what was the worst day of our lives. Thank you for saving our son. Jared Jeffrey (RN)

Thank you for taking the time to speak with me, you were very pleasant and a great help. Andrew Keynes (Call Direct Technician)

Do you have a commendation? Simply email it to healthsaasthankyous@sa.gov.au

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CLINICAL JOURNEY

BARIATRIC ISSUES IN PREHOSPITAL CARE Management of the obese patient presents significant challenges in both the prehospital and hospital environments. These challenges include the logistic issues of actually moving the patient as well as disease burdens caused by obesity and challenges in the performing of procedures. This article discusses the epidemiology of obesity, the conditions from which an obese patient might suffer, some of the physiological problems caused by obesity and some possible approaches to procedures.

EPIDEMIOLOGY

1. Berrington de Gonzalez A, Hartge P et al (2010). "Body-mass index and mortality among 1.46 million white adults". The New England Journal of Medicine. 363 (23): 2211– 2. Poirier P, et al. AHA summary statement, obesity and cardiovascular disease. Arteriosclerosis, Thrombosis and Vascular Biology 26:968–976, 2006. 3. https://airwayjedi.com/2016/04/01/positioningthe-head-for-intubation/linen-ramp/

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The World Health Organisation (WHO) classifies weight according to Body Mass Index (BMI). BMI is calculated from a person’s weight and height (weight divided by height, squared). WHO categorises patients using the BMI ranges shown in table 1, but there are other definitions used for patients with very high BMIs shown in table 2 (note there is no universal consensus about these terms). There is a clear association1 between BMI and mortality, with the risk of death rising as BMI increases. Obesity is an increasing problem in developed countries. In 2011-12 62.8% of Australians aged 18 years and over were overweight (35.3%) or obese (27.5%). The number of overweight or obese Australians has increased from 56.3% in 1995 and 61.2% in 2007-8.

PHYSIOLOGICAL EFFECTS OF OBESITY Obesity affects both pulmonary and cardiovascular physiology. Deposits of fat in the abdominal cavity and the chest wall decrease compliance and diaphragmatic movements with the result that the respiratory muscles have to work harder to move air in and out of the lungs. In other words, obesity increases work of breathing and the worse the obesity, the worse the effect on work of breathing. Lung volumes are also reduced, with obesity decreasing both residual volume and total lung capacity. Obesity also increases oxygen demand. Adipose tissue both directly metabolises oxygen, and increases the energy required to perform any task. So obesity both increases the body’s demand for oxygen and reduces the ability of the pulmonary system to supply it. Unsurprisingly, then, it has been shown that obese patients desaturate twice as quickly as patients of normal weight when undergoing rapid sequence induction of anaesthesia. For every 10kg increase in weight, systolic blood pressure rises by three (3) mmHg and diastolic pressure by 2.3 millimetres of mercury (mmHg2). Hypertension increases the risk of coronary artery disease, and direct deposition of fat in the myocardium can cause an obesity related cardiomyopathy. So patients with obesity often have congestive cardiac failure which increases their weight due to fluid retention.


Relative risk of mortality by BMI in White US men 3.0

2.4

2.4

Relative risk

Relative risk

Relative risk of mortality by BMI in White US women 3.0

1.8

1.2

1.8

1.2

0.6

0.6 15.0 to 18.4

18.5 to 19.9

20.0 to 22.4

22.5 to 24.9

25.0 to 27.4

27.5 to 29.9

30.0 to 34.9

35.0 to 39.9

40.0 to 49.9

15.0 to 18.4

18.5 to 19.9

20.0 to 22.4

22.5 to 24.9

BMI

CHALLENGES OF MANAGING PATIENTS WITH OBESITY Assessment of obese patients As always, most diagnostic information comes from the patient’s history but accurate examination of obese patients can be very difficult. It is very important to use the correct sized blood pressure cuff; a cuff that is too small may give a falsely high value. Heart and lung sounds may not be well transmitted through adipose tissue so auscultation might not be very helpful. Palpation of the abdomen is much more difficult than in a non-obese patient. Management of an obese patient’s airway The airway contains adipose tissue and so obese patients are more prone to obstruction. The issues of increased pulmonary compliance and restricted expansion apply to assisted ventilation as well as spontaneous breathing, and the pressures needed for lung inflation will be substantially higher than in patients not suffering obesity.

27.5 to 29.9

30.0 to 34.9

35.0 to 39.9

40.0 to 49.9

BMI

Proper positioning of obese patients is vital for airway management. An obese patient lying supine will often have their head and neck flexed rather than extended, making airway obstruction more likely. A ‘ramped’ position has been suggested, with sheets or towels placed underneath the patient’s shoulders and head to bring the head and neck into a less obstructing position. The aim is to bring the patients ear to the level of their sternum (see Fig 1). Venous access for obese patients This often very difficult and early consideration of alternatives such as the intraosseous route is appropriate. Immobilisation challenges The use of standard devices for immobilisation is often impossible for patients with severe obesity. Cervical collars, femoral traction devices, pelvic binders and vacuum mattresses are manufactured to fit patients of a certain size, and will not fit much larger people. Alternative techniques such as support with blankets and pillows may be needed.

This makes bag and mask ventilation more difficult as well as increasing the chance of a leak with supraglottic airways like laryngeal masks. A number of people have suggested a two-person technique for bag/mask ventilation. Studies have shown that intubation of obese patients is not predictably more difficult, although they will deoxygenate much more quickly.

Maintaining professionalism

Obesity is a risk factor for many diseases, including:

• Cancer (endometrial, breast, colon) • Hypertension • Stroke • Liver and gallbladder disease • Sleep apnoea

• Coronary artery disease • Type 2 diabetes

25.0 to 27.4

There are many management challenges in caring for obese patients and it is very important to maintain professionalism at all times. A thoughtless remark prompted by frustration can do great harm to the clinician/patient relationship. Remember that all patients deserve our respect and compassion.

Table 1: World Health Organisation weight categories BMI (kg/m2)

Classification

<18.5

Underweight

18.5-25

Normal weight

25-30

Overweight

30-35

Class 1 obesity

35-40

Class 2 obesity

>40

Class 3 obesity

Table 2: Other obesity definitions BMI (kg/m2)

Classification

35-40

Severe obesity

40-45

Morbid obesity

>45

Super morbid obesity

Fig 1. Ramping an obese patient for optimal airway positioning3.

• Osteoarthritis • Gynecological problems • Kidney disease • Psychological issues

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CLINICAL JOURNEY

HOW HEAT IS PRODUCED Basal metabolism: A 10% elevation in basal metabolic rate per 0.6 °C Exercise: Heat production is 15-20 times greater during exercise

HEAT-RELATED ILLNESS

External heat sources: May include weather, fire.

HOW DOES THE BODY MANAGE HEAT NORMALLY? Heatwaves have killed more Australians than any other natural hazard and since 1890, have caused more deaths than bushfires, cyclones, earthquakes, floods and severe storms combined. Heat is also one of the most common causes of preventable death in sport. Heat related illness is for obvious reasons a common presentation in (South) Australia. Rapid recognition, resuscitation and early cooling in the prehospital arena are crucial interventions, decreasing morbidity and mortality. More severe cases, particularly when heat stroke is suspected, require rapid transport to hospital due to potentially complex critical care needs in the setting of multi-organ failure.

THE HUMAN PHYSIOLOGY Humans belong to a group that includes mammals and birds, encompassing ‘warm-blooded’ homeothermic animals. Homeothermy is thermoregulation that maintains a stable internal body temperature in humans of 36.5-37.2 degrees Celsius (°C) regardless of external influence. Human metabolism including enzymes work best in this temperature range, which is tightly controlled and regulated by the hypothalamus. The body initiates responses by muscles, organs, glands, and the nervous system if the body’s core temperature is becoming too low or too high.

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Let’s look at an example to explain this. During summer, lying down in the sun can result in a heat gain of up to 150 kilocalories per hour (kcal/h), or ten times more during exercise. Evaporation does not occur when the ambient humidity exceeds 75%. Not acclimatised, the body can only produce one litre of sweat per hour which dispels 580 kcal/h, whereas acclimatised individuals can produce two to three litres of sweat per hour and can dissipate as much as 1740 kcal/h through evaporation. This means physical activity in heat and humidity can progressively overwhelm compensatory mechanisms and lead to heat related illness.

HOW DOES HEAT-RELATED ILLNESS PRESENT AND HOW CAN WE TREAT IT? Heat cramps are mostly caused by dehydration and salt depletion causing sustained muscle contractions during exercise. They respond well to rest and oral rehydration. Heat (Pre) Syncope occurs due to venous pooling and is treated with rest, elevation of legs and oral rehydration in most cases. All types of heat-related illness can present with nausea for which ondansetron can help. The most serious types of heat-related illness are heat exhaustion and heat stroke. Heat exhaustion most commonly happens due to exercise in warm, humid conditions and can result from volume/ sodium depletion. The elderly are also vulnerable when decreased fluid intake and heat exposure are factors.

Hot

Cold

Vasodilation Arterioles dilate (enlarge) so more blood enters skin capillaries and heat is lost.

Vasoconstriction Arterioles get smaller to reduce blood going to skin: keeping core warm

Sweating Sudorific glands secrete sweat which removes heat when water changes state. Pilorelaxation This means the hair flattens. Stretching Out By opening up, the body was a larger surface. Table © scienceaid.co.uk/biology

Shivering Repaid contraction and relaxing of skeletal muscles. Heat produced by respiration. Piloerection Hair on skin stand up. Curling Up Making yourself smaller so smaller surface area.

Symptoms include an elevated body temperature, tachypnoea and tachycardia, headache, weakness, thirst, nausea/vomiting and a slight mental status alteration like mild confusion. Heat exhaustion if not managed appropriately can lead to heat stroke. Apart from passive cooling, rest and usually intravenous rehydration, hospital admission is often required. Heat Stroke is a true emergency and life threatening. Diagnostic


PREDISPOSED ENDOGENOUS FACTORS AND CIRCUMSTANCES CONTRIBUTING TO HEATRELATED ILLNESS Radiation: 30-65% transfer by infrared waves

Convection: 1-4% depending on wind velocity, heat to air/ water vapour circulating around the body

• Acute illness • Chronic illness (diabetes mellitus) • Sleep deprivations • Obesity • Poor acclimatisation • Inexperience, overexertion • Dehydration • History of heat illness • Extremes of age

Conduction: 2% via direct contact

Evaporation: 10-80% liquid sweat to vapour

criteria include exposure to heat stress, elevated body temperature (usually higher than 40°C) and major central nervous system dysfunction including bizarre behaviour, seizures, coma, etc. Patients are tachypnoic, tachycardic and hypotensive, and often cannot sweat (anhidrosis). The excessive heat denatures proteins, destabilises phospholipids and lipoproteins, liquefies membrane lipids and ultimately leads to cardiovascular collapse, multi-organ failure, and death. Classic heat stroke affects those who lack the capacity to modulate the environment like infants, the elderly and the chronically ill. Elderly people and those with poor cardiovascular health have diminished physiological reserves to cope with heat stress. During extreme heat many of these high-risk groups become very vulnerable. The mortality rate is 70% untreated, and 10 to 20% when treated. Exertional heat stroke is seen in younger, active people pushed to their physical limits, when heat generation is faster than dissipation. They may still be sweating but already suffer from rhabdomyolysis and organ failure with a mortality rate of 30% untreated, but less than 10% treated.

Other conditions like infections, seizures and trauma can cause elevated body temperature and are part of the differential diagnoses while factors like alcohol, stimulants, medications and environmental conditions may also contribute.

Paediatric considerations Children have a higher basal metabolic rate and are less able to dissipate heat making them more susceptible to heatrelated illness. All basic principles for treatment still apply - early cooling, correction of hypoglycaemia, seizure management and correction of hypovolaemic shock. For children with classic heat stroke, 10-20ml/kg of isotonic fluid resuscitation may be sufficient. Teenagers with exertional heatstroke may need more than 40ml/kg in total.

KEY TREATMENT FOR HEATRELATED ILLNESS In the first instance, it is extremely important to remove patients (and ourselves) from the contributing heat source and remove any hot clothing or shoes. Resuscitation should then be undertaken concurrently with cooling. Rapidly lowering the patient’s core temperature to about 39°C (to avoid overshooting and rebound hyperthermia) remains the primary goal. Regardless of the underlying cause, the extent of morbidity and mortality is directly related to both the degree and duration of severe hyperthermia. Once in a cool environment, active cooling is achieved by cool packs, fans, tepid water spray and a moist flannel/sheet. Paracetamol is useless.

Hypotension results from peripheral vasodilation, cardiac dysfunction and volume depletion. Cooling alone may improve tachyarrhythmias and hypotension, allowing blood to redistribute centrally. Intravenous fluid therapy consists of judicious boluses of isotonic normal saline in 250 to 500 mL aliquots however in young people with exertional heat stroke larger volumes are usually required. Given the risk of pulmonary oedema, excessive fluid administration should be avoided. Alpha-adrenergic agonists cause vasoconstriction and may impair cooling. Hypoglycaemia is common in patients with exertional heatstroke and can be a sign of liver failure. Correction with 10% dextrose is the best option in this setting. Patients can also develop coagulopathy and disseminated intravascular coagulation (DIC). Seizures are treated as per usual with midazolam but as with all other resuscitation, cooling plays a major therapeutic role. Rapid transport to hospital is important, as muscle necrosis may develop so rapidly that electrolyte disturbances can cause cardiac arrhythmias which need immediate therapy. Sedation and mechanical ventilation, dialysis (rhabdomyolysis and acute kidney injury), transfusion of blood components (DIC) and ECMO may be required.

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ON THE JOB

VOLUNTEERS TO THE RESCUE: SAAS REMOTE TRAINING ON KANGAROO ISLAND SAAS REMOTE recently arrived on Kangaroo Island, with eight local volunteers participating in a two-day vertical access course facilitated by SOT and the Kingscote SES. SAAS REMOTE training is focused on providing safe options for extricating patients from high angle and/or vertical areas. SOT paramedics shared useful tips to ensure safe and successful outcomes for both the responders and community who may find themselves in rescue environments. Along with the SES, SOT paramedics passed on techniques and standards to ensure a seamless approach to the vertical rescue environment. Kangaroo Island attracts up to 200,000 tourists each year, many of whom visit remote coastal walking trails and viewing points. While popular with locals and tourists, these areas can be difficult to access in case of emergency. Local volunteer Bernard May loved the opportunity to be part of this training.

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“It was full on all weekend. We weren’t sitting around watching a lot of presentations – the training was really hands on and we have plenty of chances to practice. We all slept well on Sunday night!” “My favourite part was at the end when we scaled down the cliff. We had spent the whole weekend learning, so it was great to finally have a go. None of us had ever done anything like that before so it was a real experience for everyone.” For Bernard, it was the opportunity to learn from our Rescue and Retrieval experts that made the experience special. “The coaches were excellent. They are the guys who are regularly doing the stuff they trained us to do, and they coached us well.” SAAS volunteers have a close relationship with other emergency services like SES and commitment to join training like this will only help to improve patient outcomes on Kangaroo Island.

“It was really great to work with the SES guys, and learn about each other’s skills,” said Bernard. SOT Team Leader Simon Craddock travelled to Kangaroo Island to deliver the training and was impressed by the dedication and professionalism of the volunteers. “SAAS volunteers are proud of their community and want to provide a high quality service to their patients. It was impressive to see the large amount of pre-learning work they put in before the training.” “SAAS REMOTE is an integral part of our organisation’s ability to deliver emergency care in difficult and inaccessible locations. This group should be proud of themselves, proud of their commitment to SAAS, and proud of their new ability to deliver patient-centred rescue abilities on Kangaroo Island.” Photo: (L-R) Dale Arnott, Heiri Klein, Bernie May, Mick Berden, Toni Kempster, Trish Leeuwenburg, Rick Southgate and Wendy Penhall


BABY ALANNA’S BIG TRIP Sonia Lawrie was 29 weeks pregnant when she and husband Haydn went to Ashford Hospital after experiencing cramps, their world turned upside down. “I’d had a good pregnancy, so it was a complete shock when our daughter Alanna was born soon after arriving at the hospital,” said Sonia. Weighting just 1.4kg, Alanna needed specialist care at the Flinders Medical Centre. MedSTAR Kids nurse Belinda Amber and the MedSTAR Kids Emergency Ambulance was called in.

Baby reunion: Stacey Lee from Channel 7 me t with Hayden, Sonia, Alanna and Bel inda

“Alanna was in a pretty good condition when we arrived,” said Belinda. “She needed the CPAP machine to help her breathe, but we didn’t need to intubate her which was a great sign. Like many babies born this early, she needed help regulating her body temperature, support to keep her fluids and sugars maintained and intravenous access.” “Everything is difficult when dealing with very premature babies, from getting access to tiny veins to small airways to calculating minute drug and fluid amounts for immature systems. Things can also change so quickly with premature babies so we need to be ready for anything.” It had been a whirlwind day for Sonia, but she was touched by Belinda’s concern for her welfare as well as Alanna’s. “I’d only had a quick cuddle when she was first born, so the MedSTAR Kids team made sure they let me see her and put my hand on her before they left. It was really reassuring that my little girl was in the best hands.”

After nearly four weeks at Flinders Hospital Alanna was transported back to Ashford Hospital in the special MedSTAR Kids Ambulance and Sonia was able to travel with her, where she could see the highly skilled work of the MedSTAR Kids team first hand. “Alanna still tiny at 33 weeks would regularly forget to breathe, it was such a relief to know that if this did happen on the journey the staff had the equipment and knowledge to give her the proper care required.” Alanna was finally discharged 12 weeks after she was born and so far, she is thriving, which is amazing considering the bumpy start. “We will be forever grateful to the MedSTAR Kids team – I can’t imagine what might have happened if we didn’t have such specialised support.” Belinda has worked with MedSTAR Kids since it launched in 2002 and says her role is unique in nursing.

“We are often called to unusual situations that some doctors and nurses may only see a couple of times in their career. These are situations we are dealing with on a daily basis. By the time we arrive, the baby, parents and staff have all been through a very full-on experience so we try to keep things calm and make people as comfortable as possible with the situation.” For Belinda, the diversity in her job is what she loves most. “We get to meet a lot of people, see many places around the state and are constantly learning something new. You have no idea what each shift will bring or where you will end up,” said Belinda. “We are often looking after such fragile babies in a plane, a helicopter or our specialised ambulance in constricted space with no back up or support, and things can change at the drop of the hat. I love the challenge!”

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ON THE JOB

MEET SAM CHAN ... AND HIS AMAZING TEAM OF ADELAIDE LIFESAVERS HEN Sam Chan crumpled lifeless to the floor in the middle of a high school indoor soccer match, the odds of his survival were terrifyingly small. The 17-year-old Henley High School international student had no idea he had been living with a heart condition, because there had been no warning signs or symptoms. Now he was unconscious, not breathing and in cardiac arrest. Of the 15,000 people in Australia who have an out-of-hospital cardiac arrest every year, only 5 per cent, or 750 patients, survive. From his PE teacher to the Adelaide and Sydney cardiologists who would assess whether he needed a heart transplant, every split-second response in the coming days would be a crossroads that decided if he was among those 750 people. That day, other students quickly alerted Henley High PE teacher Filipe Nogueria to Sam’s predicament and he rushed to the aid of the young goalkeeper, who was facedown on the floor during a regular PE lesson.

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Sam (centre) with Bryan Ward and Alison Barry from SAAS, and the rest of the medical team.

I THANK THEM SO MUCH ... I DON’T KNOW WHAT TO SAY TO THEM. WORDS CAN’T EXPLAIN MY THANKS,” – SAM CHAN

SA AScene DECEMBER 2016

After checking his consciousness and vital signs, Mr Nogueria feared the worst, quickly recognising that Sam’s life hung in the balance. As shocked students watched on, he began first aid and used a defibrillator machine on Sam’s chest while they waited for paramedics to arrive. “We put him in the support position on his side,” Mr Nogueria told The Advertiser.


“We’d been trained to do two breaths and then 30 compressions, which I started doing while the triple-0 assistant was coaching me over the phone.” The response from SA Ambulance Service was equally swift and professional. Just five minutes after another teacher called triple-0, paramedics Alison Barry and Bryan Ward arrived on the scene. Sam’s heart was still not beating. “It was probably about 15 minutes that he was being resuscitated,” Ms Barry said. Those agonising minutes, on Tuesday August 16, finally led to a heartbeat. Once they had stabilised his condition, the paramedics rushed Sam to a waiting team of medical experts at the Royal Adelaide Hospital. It was then that ICU consultant Ben Reddi and his colleagues reached another crossroads — and made the unorthodox, split-second decision to use a medical device usually restricted to surgery. Cardiologists later praised the decision to use the extracorporeal membrane oxygenation machine to pump and oxygenate Sam’s blood, allowing his heart and lungs to rest. “It was a joint decision (because) it’s quite a high-risk intervention,” Dr Reddi said. “The machine gives the heart an opportunity to recover and it keeps the body going once the heart gets better. “Our concern was that if he didn’t have this intervention, that he was unlikely to survive.” During the next two hours, Sam’s life paused at more intersections. His heart had to be restarted at least five times, consultant Dr Truc Huynh said. “All the teams seemed to work seamlessly on the day,” he said.

On-call cardiologist Dr Matt Worthley treated Sam in the days that followed. “The intensive care team was hands-on — I was involved originally as a liaison person between Sam and St Vincent’s Hospital in Sydney,” he said. “There was a thought that he might have needed to urgently go there for a cardiac (heart) transplant and so he needed to be stable and well enough to travel. “That was very much on the cards, but thankfully, due to Ben and all of the intensive care team, he was able to stabilise on the machine (which is) generally used for bypass surgery and used extremely infrequently in a cardiac arrest setting. “Sam will be one of the first couple of people that have been put on this machine when they’ve come into hospital.” Svatka Micik was among many nurses who treated Sam during his 22 days in ICU and a total of 28 days in hospital. Now he is finally on the mend.

“We’re hoping things will stabilise on the medication and his heart function will continue to improve, but time will tell.” No one is more grateful to the team than Sam and his two mums — his biological mother Hairong Hu, of Hong Kong, and his homestay mum Melina Stazzeri, of West Lakes, who he is living with while he finishes schooling in Adelaide. “It’s a miracle that he’s alive,” Ms Stazzeri said. “We didn’t think he was going to get through it — he’s a lucky boy. He’s a very good boy, he’s honest and never complains about his health and he’s never been sick.” Sam was speechless when he was reunited with the team for The Advertiser photoshoot this week. “I thank them so much ... I don’t know what to say to them. Words can’t explain my thanks,” he said ­— Printed courtesy of The Advertiser.

While Sam has responded well to treatment, he will remain on medication and his health will continue to be monitored. “His heart has stabilised now but it’s still poor in its function and he’ll be followed up by a cardiac transplant cardiologist here in Adelaide,” Dr Worthley said. “While we don’t do cardiac transplant in Adelaide ... cardiac transplantation is still on the potential horizon for him.” Dr Worthley emphasised how fortunate the teenager was to be alive. “Sudden cardiac arrest can occur with people that have large hearts that don’t work so well — which is what Sam has,” he said. “Fifteen thousand people in Australia every year have an out-of-hospital arrest but only 5 per cent of people survive, and Sam is one of that 5 per cent.

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STAFF MOVES WELCOME TO DEAN BOEHM

DONNA NANKIVELL

PARAMEDIC INTERNS:

Project Coordinator, Corporate Planning and Project Management Office

Administration Assistant, Country Operations, Limestone Coast

JODIE COOK

CASSANDRA ADAMS

Administration Officer, Staff Wellness and Assistance, Executive Operations Support

Executive Assistant to the Chief Operating Officer

Kristen Jade Arthur, Madeline Bollmeyer, Harley Couzner, Shannon Crowther, Stephanie Davidson, Samuel Delaney, Sharon Duncan, Cameron Graetz, Jessica Hann, Emily Kew, Debbie Neely, Michael Robb, Michael Searson, Jessica Sims, Kelsey Squire, Brittany Walls, Sarah White, Alex Yuill

SONIA CAMBURN Infrastructure Planning and Improvement Manager, Infrastructure Planning and Resourcing

REBECCA BRADING & JORDAN CUMMINGS Customer Service Representatives, Customer Service Centre

TSZ HONG CHAN Learning Technologist, Clinical Education

CHRISTINE ADAMS Administration Assistant, Clinical Education

USHA RAAMKUMMAR

PARAMEDICS:

Clinical Audit Officer, Patient Safety and Quality

Andrew Clark, Leah Brumpton, Bethany Philp, Christopher Smith, Annika Pearce, Bryan Petersen, Matthew deHaas

RENAE ORMSBY Records and Information Officer, Records and Information Management

JASON FISCHER Administrative Officer – Legal, Records and Information Management

SOPHONN MOM Administration Officer, Volunteer Support Unit

REMOTE AMBULANCE OFFICERS: Paula Martin, Nicole Weidenhofer, Adrian Christie

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EMDSO CASUALS: Ryan Kay, Viki Paxtyn, Paul Jacobs, Jemai Couzens


INFORED Jorinde and Liesbeth with the helicopter during their MedSTAR orientation

Every six months, SAAS MedSTAR welcomes another new group of registrars. The current group have brought with them a wealth of medical experience from around the world. When they started in August, they were put through an intensive two week orientation, including clinical scenarios, Team Resource Management (TRM), and Helicopter Underwater Escape Training (HUET). LIESBETH VINKEN Liesbeth is an Emergency physician from Belgium, with 4 years’ experience as team leader of a dedicated multidisciplinary pre-hospital team. She has undertaken training in major incident and disaster medicine; and has been in Adelaide for two years. ADAM COATES Adam started his training in Nottingham UK, working in ED and Anaesthetics. He had extensive experience in medical simulation, as well as track doctor experience. Since arriving in Australia he has worked in ICU at FMC and RAH. JORINDE HELMICH Jorinde did her medical training in the Netherlands, with rotations in ED, ICU, Anaesthetics, Cardiology and more. She’s been working in RAH ED for two years, and on days off, she’s often found on the water, or running with dog Rebel.

Adam Coates and Patrick Fok during a simulation exercise

New doctors brace for submersion during HUET training

Observing a trauma simulation

LUCY BARKER Lucy’s an anaesthetic trainee from the UK and has been working in ICU at the RAH for a year. She loves cycling, playing pool, sampling SA’s wines and watching the Crows. Mass casualty training during orientation

PATRICK FOK After growing up in Washington DC, Patrick completed his Emergency Medicine specialist training in Montreal, undertaking electives in transport, aviation tactical and disaster medicine. He has provided medical support at mass gathering events, and as track doctor at racing events. LUCINDA REMILTON Lucinda grew up in Victor Harbor, completing university in Adelaide. She’s in her final year of emergency medicine training and outside work you’ll find her at Port Elliot SLSC, playing hockey, paddling her kayak or training for a half marathon. MICHAEL HARRISON Mike is a UK trained ED registrar who’s undertaken prehospital work in austere environments, including for the Royal National Lifeboat Institution and West Yorkshire medic response team. Outside work he enjoys windsurfing and cycling despite a habit of falling off both.

MARTIE BOTHA (MEDSTAR KIDS) Martie graduated in South Africa and has been in Adelaide since 2004, working at Modbury, TQEH, RAH and WCH. She lives in Skye (best view in Adelaide) with her husband and daughters and says working at MedSTAR is a dream come true. JOLLY CHANDRAN (MEDSTAR KIDS) From India, Jolly specialised in Paediatric Intensive Care; has worked for six months at WCH PICU and is now enrolled in the College of Intensive Care Medicine training programme. Jolly has two children and her husband is an upper GI surgeon at the RAH. EMILY CRIPPS (MEDSTAR KIDS) Emily is from Tasmania and moved to Adelaide 18 months ago. She’s an Advanced General Paediatric Trainee, with a special interest in paediatric acute care. She enjoys cycling and running and is competing in the Freycinet multisport challenge in October.

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THE SAAS FAM 1.

2.

1.

3.

Our newest paramedic interns: (Back row L-R) Simone Austin, Isabella Coldwell, Guy Richardson, Taylor Martin, Dale Francis, Kristie Nisbett, Brodie Batty, Bianca LaneSullivan, Jonathon Sharp, Andrew Branson, Jovana Rakocevic, Darren Pietsch, Georgia Holland, Marcus Syvertsen (Clinical Educator) Andy Berry. (Front Row L-R:) Rianna Bowley, Jamie-Leigh Gepp, Bridget Sankey, Emily Evans, Chanel Kind, Kim Chuong.

2. Every year SA, Victoria and Tasmania host a round robin exchange for two participants from each ambulance service. In August SAAS hosted two participants from Victoria and two of our volunteers will go to Tasmania in December. The Victorian volunteers toured different SAAS sites across metropolitan Adelaide including MedSTAR/ SOT, Gepps Cross, Fulham Complex, the Mental Health

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Unit, Clinical Education and the EOC. They then went to Whyalla for the volunteer conference. Pictured are Victorian volunteers Ken Pickard and Fawaz Saraya with Mark Virgin (SOT) at the MedSTAR base. 3. Our paramedics joined in the fun with Father Christmas at the Credit Union Christmas Pageant in Adelaide on in November. Paramedics from the SE 8 hour team Erin Tucker and Holly McClure will certainly be on the good list this year after their hard work at the pageant! 4. Congratulations to Whyalla paramedic Angela Rotherham who’s being presented an appreciation award for her 16 years of service by Clinical Team Leader Adrian Stephenson. Angela retired at the end of August and we wish her all the best for the future.


MILY ALBUM 6.

4.

7.

5.

8.

5. Little Olivia was featured in our August edition of SAAScene after her near miss when a car crashed into her front garden. Since her encounter with ECP Ken Green, Olivia loves paramedics and always has to go to ambulance bay to wave to all the people in green uniforms when she joins her mum Chien-Le on her weekend rounds at the Royal Adelaide Hospital.

7.

SAAS was honoured to be named as a supportive employer by the Defence Reserves Support Council and South Australia Employer Support Awards in September. Pictured receiving the award is Andy Long and Amanda Cameron. SAAS were joint winners of the award in the public sector along with the Department of Immigration & Border Protection.

6. This year’s volunteer conference in the north was held on 13 and 14 August in Whyalla. The theme of the conference was mental health: ‘we’re not mad, we’re sad’. It provided attendees training and support to enhance their skills and knowledge on the topic. Approximately 80 volunteers attended the conference while another 50 staff and stall holders were also present. Pictured is the Kadina Crew Karen Druitt, Damon Aldridge, Simone Mayer and Michelle Daniel.

8. On 31 October, the volunteers from Balaklava ambulance station had some Halloween themed fun all in the name of training for an emergency situation. Volunteers came from Kapunda, Mount Pleasant, Mallala and Clare to join in the thrilling fun and learn vital skills for managing a major incident. The night was organised by AVTL Sue Felby with support from team members and the VSU.

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THE SAAS FAM 9.

10.

11.

9. Introducing our new peer support officers at their Critical Incident Stress Management training at the CFS State Training Centre in Brukunga on 6 and 7 September. (L-R) Linda Carter Shepherd, Lisa Gurney, Angela Ross, Darryl Sparrow (Senior PSO), Jodie Paton, Bill Toms, Liz Howard, Sarah Adamson, Kristian Cook, Sarah Evreniadis, Theresa Say, Rebecca Elton, Cathy Blackwell, Joe Magliaro (Psychologist), Alastair Watson (Chaplain), Tim Ridgway (Psychologist), Pat Adams (Senior PSO), Stephen Brown, Sanda Thompson, Rob Jenner (Senior PSO) and David Atchia. 10. Carmela Paravia and Amanda Wells from the Customer Service Centre escorted this brood of ducklings across Greenhill Road to the safety of the parklands. Taking Customer Service to a new level, the SAAS pair stopped traffic while Carmela (pictured) ushered the ducklings

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up the road to a lower kerb where they could be reunited with their mother. 11. New Zealand volunteer Pepe Gudsell was hosted by RTL Jarred Gilbert when she came to the Lower South East in October as part of the New Zealand exchange program. Pepe was part of a group of four volunteers from New Zealand who visited the Far North, West Coast, Lower South East, Fleurieu, Barossa and Kangaroo Island. Two SAAS volunteers Skye-Maree Millar and Andrew Illman went to New Zealand in October. They visited Auckland and Whangarei for the TRAUMED conference and SkyeMaree travelled around the North Island while Andrew went to the South Island after the conference. 12. Paramedics Australasia International Conference in Auckland. Back row (L-R): Holly Heynemann, Nick Williams,


MILY ALBUM 14.

12.

15.

13.

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Lindy Jones, Bill Toms. Middle row: Chris Cotton, Wayne Stoddard, Dana Aldwin, Emma Jacka, Trevor Matthews, Nicky Carlaw. Front row: Cliff Collett, Kim Nguyen, Amanda Bridge, Tracy Callanan, Maxine Byles, Lachlan Ophof, Clare Collihole, Alex Mckenzie. 13. Volunteers past and present gathered for the Bordertown 70th Anniversary celebration on the 22 November. Limestone Coast OM Andrew Thomas said it was an important milestone for the town and the station had a reputation for having a strong, active team who were influential across the entire organisation. 14. SAAS was presented with a special award for our Hands off our Ambos campaign at the Self Insurers of South Australia awards evening. The campaign was a winner in the Best Work Health & Safety Solution category. Pictured are Lee Tregloan (SA Health), Deb Heames (SAAS), Jason Killens (SAAS), Lachlan Ophof (SAAS), Chris Howie (SAAS),

Catherine Marangone (SAAS), Michele McKinnon (SA Health), Anthony Pryzibilla (SAAS), Lucy Saccoia (SAAS). Missing from the photo is Chantelle Puliatti (SAAS). 15. Operations Manager Clinical Development, Neil Clune was recently given a send-off as he prepared to take extended leave from SAAS. Neil is pictured with his manager Keith Driscoll and was presented with a framed gift with his SAAS and St John lapels going back over his 27 years of service. All the best of luck to Neil! 16. The Hands off our Ambos campaign won the best education initiative category at the Council of Ambulance Authorities Brisbane Conference in October. Pictured are: (Back row L-R) Jason Killens, Leeann Faddoul, Kate Clarke, Keith Driscoll, Chris Howie, Rob Shapcott, Matt Meaney. (Front row L-R) Simon Cradock, Lachlan Ophof, Andy Long, Sarah Adamson.

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GANG

GREEN Eric Parsons

EXTRAORDINARY ERIC Trudy Gepp

CELEBRATING 30 YEARS Trudy Gepp has worked at SAAS since before it was SAAS. Starting part time as a switchboard operator in the St John communications room, Trudy moved to the Customer Call Centre when the team started in 1998. Undoubtedly Trudy has seen a lot of change at SAAS – including one occasion when she was literally getting walls painted around her. When she’s not at work Trudy helps run a church kids club, similar to Scouts, but if there’s no badge related to doing something “I make it up myself,” she jokes. “I don’t know who enjoys it more – them or me.” Trudy also cares for two rescued grey hounds – Danni and Annie – who are “the biggest couch potatoes ever”. Trudy’s been involved with teaching craft at summer camps, and has managed to snag four scenic helicopter rides. In fact she’s a pretty wellrounded traveller having recently been to Arno Bay near Port Lincoln and reckons a trip to Tassie might be on the cards next. In a funny twist Trudy actually applied for a different job at St John originally, but got offered a different one by mistake. It seems like it was a pretty good mistake. “I obviously love my job. One would hope I wouldn’t be here if I didn’t.”

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Chatting with Eric Parsons is like chatting with an old friend, even if you’ve never met him before. It’s not really surprising, looking back over his history; he has spent his whole life working and helping people. Eric has lived all over Australia, working all kinds of jobs, with that common thread of helping people. Now semi-retired, he says he still enjoys working with SAAS and can’t see himself “giving it up”, although his ever-patient wife of 36 years may have something to say about that! He couldn’t have done it without her support though, “they broke the mould when they made her, I think,” he says. Eric just loves to do whatever he can for his community, and his team in Moonta. He took it upon himself to turn what was a dried up, disused lawn area on station into a haven for his team, with a BBQ, memorial rose garden and veggie patch. It is now a place for team members to come together to relax and decompress after the stresses of the job. He says he’d hate for people to finish a tough shift and jump straight in their cars and try to drive, without first making sure they are OK. The team is more like family to Eric, and he firmly believes that “when we help each other out, we create an unstoppable force”. Eric was “beyond surprised and deeply moved” at receiving the Volunteer Certificate of Merit, in particular because it is recognition that has come from within the team. “I’ve been doing the job for so long, and now someone has seen something in me. To be recognised by my team, my ambulance family, that is the real reward. But I didn’t get here alone, it’s a team effort, and we all need to realise that we’re doing something extraordinary. We’re changing people’s lives.” Eric’s motto is: “If you can leave a person with a smile on their dial, it was all worthwhile.” Well Eric, you certainly left us with big smiles.


e who you think Do you know someon Gang Green? should be featured in If so, drop us a line at

Kerry and Michelle

SISTERS ARE DOING IT FOR THEIR TOWNS Sisters Kerry McCarthy and Michelle Everett are two of the brightest stars in the SAAS galaxy with a whopping 45 years of service between them, so it’s no wonder they were both worthy recipients of this year’s Volunteer Distinguished Service Award. The sisters are originally from Clare, and despite each of them following their hearts to different regional areas, both feel that their involvement with SAAS was ultimately inevitable. Kerry joined as a volunteer in Kapunda in 1980, after being moved by the kindness and care given by the ambos who had responded to her fourth child many times. She saw the dedicated volunteers who would put their own lives on hold to come help her family at all hours of the day and night, and just knew she had to contribute. One of the things Kerry loves about her team is the “mixed bag” of people she gets to work with; people whom she might never have known otherwise. Whether they stay with the team for a long time or a short time, they “all share the common goal of providing the best possible prehospital care to our rural community and beyond”.

gov.au healthsaasnews@sa.

“You have to remember it’s all about the community. There are times when this is their hour of greatest need, but you can be proud and feel honoured that you could be there for them.”

“We’re a small but proud community, with a history of ambulance involvement dating back over a hundred years. I think that brings a certain responsibility to ensure we provide the service for as long as we’re able.”

the team as a whole that makes the difference. She says that everyone she has worked with over these past 36 years has brought a wealth of individual life experiences that have been invaluable to her, the team and their town.

Michelle was inspired by Kerry’s dedication, but in order to fully commit to the job she waited until her children had grown up before joining. The later start didn’t slow her down, though. Michelle is VTL at Robe, contributes huge numbers of hours to the roster, and enjoys mentoring new team members as they move through their training.

“You get so much more out of it than you ever give; that’s why it’s so rewarding.” Michelle

Michelle says that living in a small community without a hospital presents challenges. “You have to remember it’s all about the community. There are times when this is their hour of greatest need, but you can be proud and feel honoured that you could be there for them.” Would she like more time to herself? Maybe, but to Michelle, it’s worth it to know that she is giving the job the dedication it deserves. “You get so much more out of it than you ever give; that’s why it’s so rewarding.”

Michelle wholeheartedly agrees, and describes her team as a highly diverse one that form an awesome team. They are a dedicated, caring and supportive group of people who support each other and their community. Humility seems to run in the family for these two remarkable women, as both said they felt humbled, honoured and “completely surprised” by their nomination. The sisters can’t say enough how special it is to be awarded the distinction together. We think it’s pretty special too, almost as special as Kerry and Michelle themselves!

Kerry firmly believes that although individual effort is important, it is

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There was a huge turnout, luckily the garage was well equipped for the numbers.

NEW NOARLUNGA AMBULANCE STATION COMMUNITY OPEN DAY On Sunday 16 October SAAS hosted a community open day at the Noarlunga ambulance station to showcase the new state-of-the-art facility and largest station in South Australia.

A quick staff shot before getting back to the festivities. (L-R: Anthony Pryzibilla, Michelle Spencer, Bree Dixon, Jarred Gilbert).

Over 1200 local residents attended. The event was a great success with all of SAAS’s resources on display, free CPR sessions, station tours, and even the MAC rescue helicopter on display. Thank you to everyone who assisted in organising this event, the first in SAAS history. In particular, Bree Dixon, Michelle Spencer and Kate Clarke who went over and above to ensure its success! — Anthony Pryzibilla

Andy H motor illier showe b d off th a few ike fleet an d even e lucky kids h let op o preten d ride n for a .

Operations Manager, Metro South East

e kids ept th ons k . o ll a d e ay and b on th ined inters a a t p r e e t en Fac y and happ

THE $5.3 MILLION NOARLUNGA AMBULANCE STATION, WHICH WAS EXPANDED TO ALLOW FOR ADDITIONAL STAFF AS PART OF TRANSFORMING HEALTH, BECAME FULLY OPERATIONAL IN SEPTEMBER 2016. 32

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PALLIATIVE CARE SO MUCH MORE THAN JUST PAIN RELIEF There is probably no area of medicine subject to more misunderstanding in the community than palliative care. This limited understanding extends to much of the medical community also. Without knowing the range of treatments encompassed by palliative care we, as an ambulance service, run the risk of unnecessarily sending some patients to hospital that might be better served by an extended care paramedic (ECP) referral. While the concept of palliative care has been around for almost as long as medicine it only became a recognised specialty in Australia (and most of the developed world) in the 1990s. Prior to that, care of the terminally ill was variously performed by GPs and general physicians and was largely focused on pain relief. With specialisation came many advances in symptom control which involve treatments many would not associate with palliative care. It also allowed a broader range of terminal illnesses beyond cancer to be treated. These treatments include surgery, radiotherapy and chemotherapy. The only difference is the intent is no longer curative, but palliative, that is aimed at improving quality of life.

As well as pain there are a number of other symptoms that ECPs can treat in the community. These include: • Medico-legal issues such as consent to treatment or declining treatment • Equipment issues such as problems with pumps and sub-cut lines • Agitation and delirium • Assessment of deterioration • Respiratory secretions • Nausea • Non-associated infections (Remember: just because a patient has terminal cancer doesn’t mean they should suffer with a urinary tract infection or pneumonia)

Today only 14% of Australians die at home, yet a recent survey showed 60-70% would like to. Over time we will see a lot more palliative care as it is devolved out of hospitals. Currently, approximately 10% of ECP work is palliative care. If your patient is palliative and wants to stay at home, please ring the ECP once you have details for a referral and see if we can help. — Andrew Noble Relieving Clinical Team Leader Extended Care Paramedics

Some situations will still require hospital treatment either as a result of ECP assessment on scene or phone triage. These include: • Hypercalcaemia, a side effect from some cancers which manifests itself as a sudden onset of confusion/ delirium, fatigue and nausea • Spinal cord compression, the symptoms of which (sudden onset of reduced lower limb strength and sensation) can be well treated with steroids in the first six hours post onset

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WORK NEVER STOPS FOR DEDICATED VOLUNTEER Each year I spend two weeks at the snow in Perisher, NSW doing volunteer Ski Patrol. Perisher covers 1245 hectares, with 47 lifts and averages 15,000 patrons per day. On a busy day, we would treat 70 patients.

Snow cat ambulance.

The majority of patients are treated at the medical centre in Perisher, with more serious injuries/conditions being transported out by NSW Ambulance or Snowy Hydro helicopter service. Sledding a patient down the hill in an Akja.

The role of a Ski Patroller starts in the morning by opening runs and lifts, ensuring that the area is safe for patrons to ski or snowboard. This involves marking or removing hazards, placing signage and opening or closing areas as snow cover permits. Rapid response paramedics use ski-doos to access patients.

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Throughout the day, we respond to accidents, provide first aid, extrication and transport to medical facilities. The major challenge is physical (getting patients off the mountain) as access and egress are seldom straight forward. Knowing your location, pick up points by transport and the most effective way between those points is the key to efficient extrication. Available modes of transport are Akja or cascade sled, skidoo, snow cat ambulance, ski tube, or ambulance. In some cases three modes of transport are used for one patient!

At the end of the day, we are responsible for closing all lifts and runs, ensuring all patrons have left the resort. Given the climate, staying out overnight would ultimately result in hypothermia and death. The most enjoyable aspects of Ski Patrolling for me are being out on skis all day, closely followed by the always challenging scenarios we are faced with, putting all our resources and training to the ultimate test. Check out this video, which gives a great insight to the work of a Ski Patroller at Perisher: https://youtu.be/64t7bVdGS64 — Taylos Bunce Volunteer Ambulance Officer SA Regional Response Team


MORE MOCK MOVES

Clinicians from SAAS, SAAS MedSTAR and the RAH undertaking a mock patient transfer to the new hospital.

More than 200 paramedics, doctors, nurses and from across SAAS, SAAS MedSTAR and CALHN have participated in timed drills to test the transfer of mock patients to the new Royal Adelaide Hospital. Over 20 trial moves have occurred this year to help prepare for the hospital’s opening and relocation of about 250 patients. Clinicians simulated the full two kilometre transfer of acute patients, complete with all medical equipment that might be utilised for the journey. Staff from different wards across the hospital also tested how patients would be moved internally through

the hospital to designated ambulance collection points.

patient with part paralysis to a patient with severe burns.

“Each move was planned with precision and timed with a stopwatch at every leg of the journey,” said Paul Lambert, Executive Director of Activation, new RAH.

The mock transfers are critical in navigating the complex move to the new RAH, explained Chris Howie, Operations Manager.

“We have successfully tested our move processes across different patient scenarios, including prepping patients, transferring them safely onto an ambulance stretcher, gathering up the equipment required on transit, and transporting patients along the fastest route within the hospital.” Clinical scenarios simulated for the moves ranged from a 67-year-old stroke

“The mock moves provide an invaluable opportunity for all clinicians involved. We are building strong relationships, and getting to know each other’s capabilities. This alone will help us be better prepared for the actual move next year.” Additional mock moves will be staged in the lead up to the new RAH’s opening, including hospital-wide exercises led by the multi-agency command team responsible for coordinating the move.

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PARTNERING WITH CONSUMERS

Pictured are some of our CAC members with guest speaker, Sandy Edwards, Acting Commissioner, Health and Community Services Complaints Commissioner (HCSCC). Sandy spoke of the patient’s perception and frustration, particularly for those living with a disability, and how they feel a loss of independence when accessing health services.

What does “Partnering with Consumers” mean?

The CAC provides feedback on a variety of SAAS initiatives including the White Ribbon Accreditation project, Secondary Triage, Salisbury Walk in Service, SA Health Open Disclosure Policy, Community Paramedicine, the Multicultural Phrase Book, Disability Access and Inclusion Plan and the Consumer Card (Bystander Support Services).

Standard 2 is about creating a consumer centred ambulance service. SAAS is committed to engaging with members of the community to have a say in the development of its ambulance service. So how do we partner with consumers? FIRST: We have a Governance structure in place to form partnerships with our consumers. The SAAS Consumer Advisory Committee (CAC) is a partnership with community organisations to improve SAAS’s service quality, equity and management. Members represent the Migrant Resource Centre of SA, Council on the Ageing, Disability Advocacy and Complaints Service of SA, Aboriginal Health Council of SA, Drug and Alcohol Service SA, Carers SA, Local Government Association and Health Consumers Alliance. Other Community Partnerships In addition to the Governance process, SAAS partners with a variety of community groups such as schools, aged care facilities and multi-cultural groups to help educate them about our service. Our engagement with the community contributes to the improvement of the patient experience and patient health outcomes. The education we deliver is designed to meet community needs. It can involve showing aged care residents how to

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CPR lessons for children at the SA MFS Open Day in Port Lincoln.

prepare themselves for a hot day or educating our younger generation in CPR or showing them what the inside of an ambulance looks like. SAAS runs information sessions for our migrant and refugee societies at the Australian Migrant Resource Centre. Consumer Advisor, Paula Hales, presents these sessions and is assisted by interpreters who translate the information she provides into the participant’s preferred language of understanding. These sessions are well received. If you’d like to know more, please contact Paula on 8274 0430 or paula.hales@sa.gov.au. SECOND: Consumers are supported by us to actively participate in the improvement of the patient experience and patient health outcomes. SAAS recently distributed a survey to 250 randomly selected consumers, asking them to measure their consumer experiences. So far, feedback has been positive. Results will be published in a later SAAScene edition.

A new consumer group will soon r eview the Transportation of Mobility Aids project.

CPR lessons for children at the SA MFS Open Day in Port Lincoln.

THIRD: Consumers receive information on our performance and contribute to the ongoing monitoring, measurement and evaluation of performance for continuous quality improvement. The CAC reviews and provides input on Cardiac Arrest Registry reports, Clinical Incident Management reports and SLS feedback reports about consumer acknowledgements, feedback and complaints.


INTRODUCING OUR NEW

CLINICAL HANDOVER AND COMMUNICATIONS PROCEDURE As you would be aware, SAAS is embarking on becoming the first ambulance service in Australia to gain accreditation in the NSQHS Standards. As one of the committees established, the SAAS Clinical Care Committee, has been working to develop various policy and procedure documents as well as systems audit in relation to: •

Clinical Handover (Standard 6)

Patient Identification (Standard 5)

Recognising and Responding to Clinical Deterioration (Standard 9)

As a result, our new Clinical Handover and Communications procedure has now been officially endorsed. The cornerstone of Clinical Handover remains with the SA Health approved ISBAR format which everyone should be familiar with. The procedure defines Clinical Handover as the “transfer of accountability and responsibility of some or all aspects of patient care to another person or professional group on a temporary or permanent basis”. Clinical Handover is a vitally important moment in the course of any patient’s journey through the health system and care needs to be taken to structure and deliver information in a timely and accurate manner.

As part of implementing the procedure SAAS, under the NSQHS Standards framework, is required to audit the procedure and, as such, we are negotiating with metropolitan hospitals to conduct joint auditing within the Emergency Departments. We understand that this is rarely done (if at all) across other ambulance services therefore making us an early adopter of this process. The handover of clinical information is vital to the continuum of patient care and, wherever possible, should involve the patient or family and carers to ensure the most accurate information is passed on to the next person assuming care. The procedure can be viewed on the SAAS intranet via this link: https://www.saambulancestaff.com.au/ NR/rdonlyres/CA126431-777C-40CB-9E4373BD5A1B354F/0/PRO182ClinicalHand overandCommunicationV2020161028.pdf Copies will also be faxed to stations. And, while on the subject of Clinical Handover and Communication, why not check out the eLEARNING MODULE for this.

The module is intended for Paramedic Interns prior to attending their Clinical Practice Guideline workshop. It’s also additional resource material for Ambulance Officers during their Volunteer or Patient Transport Service initial Certificate IV in Health Care (Ambulance) recruit course. Other clinical staff involved in direct patient care may also utilise the material. Clinicians should note they are to only practice to the level of their SAAS Authority to Practice. This course is also valuable for staff that support clinicians including EOC staff. You can access this module in two ways: Click this link: http://saaselearning. com.au/moodle/course/view. php?id=167#section-1 Login here: http://saaselearning. com.au/moodle/ (use the drop-down menu Organisational Ed > Clinical Communication & Handover) Dave Dewar Clinical Lead NSQHS Standard 6 Clinical Care Committee

It is important that all clinical staff accept the responsibility to know and adhere to the principles of the Clinical Handover and Communications procedure and contribute to our positive culture that values high standards of patient care.

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Moonta Vollies Glynn Hartley and Paula Kenny with vehicle movers Ken Jenkins and Ray Benzie.

RETIRED OFFICERS ASSOCIATION VEHICLE MOVES Unable to sit idle after a lifetime career as a roadie, Ken Jenkins joined the SA Ambulance Service Retired Officers Association and moves vehicles around SA in his role as volunteer driver. The driver group assist SAAS with vehicle changeovers and transfers right across metro and country. They perform over 100 vehicle moves per year and last year covered over 34,000 kilometres. The volunteer group also move volunteer recruitment vehicles and trailers, they attend large scale events like the Clipsal 500 and Schoolies at Victor Harbor and give vital support in major bush fires when needed. Ken Jenkins makes around ten trips a year and is the driver coordinator on the volunteer driver team. He says it’s a great way to be involved in the organisation after you retire. “We take the vehicle from Fulham or Port Adelaide to wherever it needs to be and bring another vehicle back to Adelaide. It’s easy and fun, you get to see a bit of the countryside and you get a trip away. I take my wife with me and we treat it as a little holiday.”

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SAAS operations manager Chris Howie commented, “these ROA members, as non-operational volunteers, willingly give up their time to assist SAAS in moving vehicles and equipment around the state. These activities greatly assist various areas such as Fleet, the Volunteer Support Unit and Major Events to facilitate these moves which would otherwise have to be conducted by staff from within those areas”. On a recent trip to Moonta, Ken drove to the Copper Coast with Ray Benzie to retrieve an old vehicle which was going out of commission and replace it with a new one. Ken has around 16 drivers he can approach about jobs but they are always on the lookout for more volunteers. Any SAAS retiree can join the association and get involved with coffee mornings, luncheons and fundraising activities. The ROA also have welfare officers who look after the wellbeing of their members. The association have sourced museum vehicles and equipment from throughout the state which are housed at the Port

Adelaide Station. Working Bees are held at Port Adelaide on the second and fourth Wednesdays of each month and they also have a caravan club. Ken said that’s an important part of the association, being able to help your old colleagues. “There are so many benefits to being an ROA member, if someone needs disability equipment in their home, our membership and welfare officers come out and look after the families of the retired officers. It’s really hard when you have been part of an organisation like SAAS for so long and then all of a sudden it stops. You miss it and there’s a void there, so it’s good to still be involved in some way.” — For queries regarding membership of the Retired Officers Association or to find out more, contact Bill Bourn on 0439 312 215.


MANNUM TRAINING IS FULL STEAM AHEAD In July, Mannum volunteers boarded the historic Paddle Steamer Marion for a training exercise. Team members were put through their paces, rotating through a variety of simulations including a trauma emergency, a medical emergency and a cardiac arrest aboard the vessel. Volunteers who look after the P.S. Marion participated as bystanders, directing crews to patients, providing valuable information and watching as crews assessed their patients, determined treatment priorities and provided clinical interventions. Once patients were stabilised, crews were faced with extrication challenges which required excellent team work, communication and planning to safely transfer patients to shore. The training day concluded and we were called to attend a player at the Mannum oval who had sustained a severe head injury during a football match. “It was good to interact with the P.S. Marion volunteers who made the day very realistic in terms of the amount of people on board the vessel. Then, to be involved in a real life emergency at the football match straight after and finish by putting into practice some of the skills I had learnt that afternoon, was an amazing opportunity as a new recruit,” said Sue Urwin, Ambulance Officer student, Mannum.

“We had some great fun, but on a more serious note it is not uncommon for us to be called out to a house boat, so good practice for us and the patients” said Karen Lyall from the Mannum team. The community engagement and learning outcomes shared between the Mannum team and P.S. Marion volunteers will undoubtedly play a pivotal role in the successful management of medical emergencies aboard the vessel in the future. The use of Go Pro cameras during the training exercise enabled the team to reflect on their clinical practice and learning outcomes through video assisted debriefing. Special thanks to Noel Johncock, Tailem Bend VTL, Peter Keating and VTL Chony Snart for their assistance as safety officers. To Karen Lyall, Phillip McGuire and Cassie Martin who played exceptional patients. Also thanks to Duncan Emmins, David Portolesi, Wendy Kuchel, Brett Kornelissen, Rob Wilcock, Sue Urwin and Evan Jones. — Angela Martin Acting Regional Team Leader Lower Murray

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PARTYING WITH A PURPOSE When news spread that SAAS was having its first ball in recent history, there were collective high-fives and unsurprisingly, tickets sold out weeks before the event. Raising funds and awareness for White Ribbon to tackle men’s violence against women, the ball was a lavish sea of black and white in line with the campaign’s theme colours. Fitting too, that operations manager Rob Elliot’s band Men in Black provided the night’s entertainment (and the man can really sing). SAAS’s Young Professionals Group (YPG) worked tirelessly to coordinate the event, held at the National Wine Centre on 19 August. The 150 guests were hosted by EOC emergency medical dispatcher Therese Hornby as MC, while White Ribbon Ambassador Gary Edwards delivered a confronting keynote speech about the brutal reality of domestic violence impacting countless women in Australia. YPG will run the event annually and it’s a party not to miss. Andrew Tucker, Carissa Tucker and Karina Pascoe

$600

Total proceeds raised to help stop violence against women at this year’s ‘Party with a Purpose’ ball.

What is ‘violence against women’? White Ribbon uses the definition of men’s violence against women found in the United Nations Declaration on the Elimination of Violence against Women: ‘any act of gender-based violence that results in, or is likely to result in, physical, sexual or psychological harm or suffering to women, including threats of such acts, coercion or arbitrary deprivations of liberty, whether occurring in public or private life.’

1. One in three women have experienced physical and/or sexual violence perpetrated by someone known to them. 2. One in four children are exposed to domestic violence. 3. Isolating a woman from her social network is a type of abuse.

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YPG set up a Snapchat geofilter for Party with a Purpose which allowed guests to share the event in real time while making it more digitally accessible. Many guests used the filter which helped increase awareness of the White Ribbon cause and SAAS’s involvement. It had a total of 2283 views.

Chris Howie and Therese Hornby

If you are interested in joining or learning more about YPG, please email Health. SAASYoungProfessionalsGroup@sa.gov.au and we will add you to our distribution list to receive information about future events and opportunities.


The Jaensch family: David, Kelsey, Marcus and Paul

ALL IN THE FAMILY: 3 GENERATIONS OF JAENSCH’S AT SAAS This October’s graduation ceremony had a special significance for one family at SAAS. Three members of the Jaensch family received awards and will make SAAS history as the third generation officially joined the ranks. With a combined family total of 71 years of ambulance work, the youngest member Kelsey joined a line of family members who have dedicated most of their working lives to SAAS and the community. In a very special ceremony on 30 October, Kelsey Ridley officially graduated as a paramedic. Her dad David Jaensch received his second clasp to the National Medal for 35 years’ service. David’s brother Paul Jaensch received his National Service Medal for 15 years’ service. Although David and his wife Chris were careful not to influence any of their three children into doing ambulance work as a career it didn’t take Kelsey long to figure out that ‘paramedics’ was in her blood. She achieved her goal in June 2014, gaining an internship with SAAS after completing her Bachelor’s Degree. This lead to a fixed term contract at Salisbury station in mid-2015 and then in January this year she secured a full time position in Renmark. Kelsey’s grandfather Marcus Jaensch and his wife Audrey received a special invite to attend the graduation. Marcus joined as a volunteer at Murray Bridge in 1972. After three years he left his work as an orchardist to become a full time

ambulance officer until his retirement in 1992. During this time Marcus saw the introduction of such modern clinical inventions as salbutamol, ENTONOX, GTN and Life pack 5’s (early “paddle” type defibrillators). He and his colleagues also saw the introduction of the first F100 ambulances into SA. Marcus also assisted one of his colleagues, Ken Parbs to develop one of the first self-loading stretchers in SA. When Marcus started as a country ambulance officer you had to be married. There were no central or regional communications and at night the phones were switched through to the duty ambos home. The duty ambo would take emergency calls and then dispatch the single duty crew. If a second case came in, that duty ambo would take the call and then recall a partner to do the case leaving their spouse to do the co-ordinating and radio work. David says this particular detail sticks out in his memory. “Many weekend nights my dad was out at multi patient, multi fatality prangs and I can remember mum stressing out over doing the co-ordinating and communications, while still managing incoming general calls on her own, “ said David. With Marcus as his mentor, David also became a volunteer in 1980 while he completed an apprenticeship as a fitter and turner. David’s passion for ambulance work quickly grew and he left his job to become a full time ambulance officer in 1982, working beside his father

in Murray Bridge for six years. David also worked in Mount Barker, Port Lincoln and is currently in Whyalla as an Intensive Care Paramedic and is part of the SAAS REMOTE team. His career so far has seen him perform diverse roles including regional communications officer, Station Office level 1 and 2, Clinical Team leader at Whyalla and Operations Manager for the West Coast. He also currently does ambo stints with Operation Flinders and is a part time commercial diver. David’s brother Paul also followed his family’s footsteps joining the ambulance ranks in April 2001, working out of Naracoorte and Mount Gambier as a casual. Paul moved to Adelaide in September 2001 in Diploma group D301 where he worked from Port Adelaide and Campbelltown stations as a student. He started on the SPRINT team at its inception where he still works. Over the years Paul has represented SAAS at multiple Melbourne Formula One and Clipsal events, on Extrication Teams and contributed time to Operation Flinders. Kelsey’s grandfather, father and uncle are proud that she has continued in what now has become a true family vocation. They proudly came to the graduation ceremony in October to witness the third generation of the Jaensch family officially become part of the SAAS family, and have the photographs, awards and memories to cherish.

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PRACTICE MAKES PERMANENT

It has been several months since the completion of PDW day three, where our operational safety trainers facilitated a session on keeping safe while solo responding for our career operational workforce. Feedback was overwhelmingly positive, with staff particularly enjoying the new, and easier to perform, disengagement techniques. With that in mind, our operational safety trainers would like to encourage you to practice these manoeuvres often to commit them to muscle memory.

DNA sports performance. 2013. Muscle Memory: A Coaches Perspective. [ONLINE] Available at: http://research.omicsgroup.org/ index.php/Muscle_memory Mack, S. (2012). Does Muscle Memory Affect The Percentage in Basketball? Available: http://www.livestrong.com/article/448564muscle-memory-affect-percentagebasketball/#ixzz26i9yQVFS Morley, K. (2012). Muscle Memory. Available: http://sportsnscience.utah. edu/2014/05/04/muscle-memory/

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Muscle memory can be best described as a type of movement with which the muscles become accustomed to over time (DNA sports performance, 2013). Physiologists know that any skeletal muscle activity that is learned can become essentially automatic with practice. Muscle memory is therefore a common term for neuromuscular facilitation, which is the process of the neuromuscular system memorising motor skills. We know that repetition is the mother of skill and that practice

makes permanent. After repeating the same movement over and over, the movement seemingly becomes second nature (DNA sports performance, 2013). We all use muscle memory techniques in our everyday life. Whether it is riding a bicycle or typing on a keyboard, we have taught our muscles to carry out these commands without putting much thought into them. It takes a great deal of practice and repetition for a task to be completed on a strictly subconscious level. For professional sports players it may take hundreds of hours of practice and repeated shots for the brain and muscles to perform at a world class level (Morley, 2012). Once these actions are memorised by the brain, the muscles must be trained to act in a quick, fluid manner (Mack, 2012). This is the goal of repetitively practising our Operational Safety disengagement techniques.


TALKIN' TONGA CHRISTMAS GIFT FOR TONGA SAAS has a longstanding relationship the Tongan Ministry of Health to help the archipelago nation develop an ambulance program. This year Tonga’s existing ambulance, which was donated by another international ambulance service many years ago, had worn out. Given SAAS’s existing relationship with Tonga we were keen to help out, says Executive Director, Clinical Performance and Patient Safety, Keith Driscoll. Rotary group Donations In Kind purchased a van to be sent to Tonga. The van was fitted out to be used as an ambulance by SAAS’s Fleet Services staff and filled with out of date medical

Tongan medical personal who will see the benefits of the new ambulance.

equipment and consumables that had been donated to Rotary. The van was loaded into a 40 ft. shipping container and the surrounding space was then packed with more donated goods. “It just so happened that Tonga’s biomedical engineer, who was trained under an AusAid scholarship, was in Australia. We got him to check everything that we were sending to make sure it could be used in Tonga,” Keith said. “I’d like to extend a large ‘thank you’ to all of the Rotary volunteers and Tongan community members who turned out to help pack the shipping container, and for our staff at Fleet Services for helping to get the van looking more like an ambulance.”

The ambulance being loaded into the shipping container.

FAST FACTS • The Kingdom of Tonga consists of around 170 islands • Tonga is located south of Samoa, about one-third of the way from NZ to Hawaii • Total land area = 748 sq km • Population of 106 000 • 54% of the population is under the age of 25

The full shipping container.

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PEER SUPPORT GOES NATIONAL

AND BEYOND

From its humble beginnings back in 1991, Peer Support is now culturally embedded within SAAS, and one of its greatest achievements is staff have absolute faith in its confidentiality, ensuring stigmas like ‘using it is career limiting’ or ‘man up’ cannot take hold. Despite not being extraordinarily costly to run, mostly due to the tireless efforts of our volunteer peer support officers (PSOs), including program management and Joe Magliaro, SAAS manages to run a widely acclaimed program designed solely to manage the mental health and wellbeing of our staff. This includes services from mental health professionals, training, recruitment and selection, travel, accommodation and PSO workshops. There are about 60 PSOs at SAAS who voluntarily make themselves available to all staff – operational, non-operational, volunteers and even family members – often in their greatest hour of need. Each year, these incredible people selflessly give 700+ hours to help us.

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And their utilisation is on the rise! In 2015–16 PSOs made 2707 contacts with staff; that’s an increase of 11.35% (322 additional contacts) compared to last financial year. 2016 has also been busy for Chris Howie, Operations Manager and manager of the Peer Support program. He has represented SAAS on four significant activities that have catapulted our Peer Support program onto the national stage.

PARLIAMENTARY COMMITTEE SAAS’s Peer Support program has been recognised as one of the benchmarks for modern best practice programs, not just among ambulance services, but within SA Health and the public sector in general. In March, Chris represented SAAS at a Parliamentary Committee on “Work Related Mental Disorders and Suicide Prevention” discussing our Peer Support program. Chris was able to highlight that 11% of all injuries claims submitted across the whole of the public sector were for mental health issues,

with police officers, teachers, nurses and social workers among the highest claimants. By comparison, here at SAAS, in 2014-15 mental stress claims only equated to 5% of the total number of claims submitted. “This presentation enabled me to highlight the strengths of our program and get a true understanding relating to how well our program is regarded across Government here in SA,” tells Chris. SAAS was even specifically mentioned by the Presiding Member of the Committee, the Honourable Stephanie Key MP, when she tabled the report in Parliament on 16 November and stated: “The committee was impressed by the low frequency rate of mental disorders reported by paramedics, given the nature of their work, which often brings them into contact with traumatic events and traumatised people. The ambulance service is justly proud of its peer support program which has been in operation for over 20 years.”


NSW AMBULANCE STAFF WELLBEING AND MENTAL HEALTH AND WELLBEING RESILIENCE SUMMIT STRATEGY In July, Chris attended the NSW Ambulance Staff Wellbeing and Resilience Summit in Sydney as a guest with Joe Magliaro. The conference brought NSW Ambulance staff, experts and leaders together to discuss best practice support models from Australia and overseas to investigate strategies to help meet the needs of the current and future workforce in NSW. This also provided Chris and Joe with an ideal opportunity to consider what others are doing in this area, and what may potentially be leveraged off to improve our services here at SAAS. “This was a great opportunity to meet colleagues from around Australia, benchmark our program against others, and find out what we can do to enhance our own program.”

In late November Chris flew to Melbourne to meet with other employee assistance program managers from services across Australasia, the Council of Ambulance Authorities (CAA) representatives and beyondblue to develop a mental health and wellbeing strategy for all member ambulance services. From this, our aim is to commence work on developing a SAAS specific high level strategy in the not too distant future.

Our Peer Support program is not only highly regarded within our organisation, but other organisations turn to it to help their own staff, and they often seek advice on how to replicate it in their workplaces. This program, and the staff who willingly volunteer so much of their own time to support all of us, is certainly something we should all be extraordinarily proud of.

CAA CONFERENCE Also in November, Chris presented at the national CAA Conference in Brisbane, highlighting the positive impact of the Peer Support program, despite not having massive budgets and an abundance of staff, and how pivotal cultural acceptance is to its ongoing success.

“As a Volunteer at Moonta for almost 9 years, I would like to recognise Julie Frost, our local Peer Support Officer. Through more issues than I would have preferred, over the past couple of years Julie has been my first point of call. She has helped me through physical, emotional and psychological issues. I now affectionately call her ‘My Lighthouse’ when I have high and low tides. Julie is compassionate and understanding, and it seems we are both on the same page. If it’s an email, phone call or catch up, Julie keeps me on an even, upright and subjective keel. I would urge any volunteer who has any sort of issue, don’t keep it to yourself, it can be more destructive if you don’t share your problem. The Peer Support program really does help.” Kevin Partington, Moonta

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NEW RISK MANAGEMENT TRAINING

SA Health released its revised Risk Management Policy in September 2016 to reflect its commitment to risk education. The current focus is the promotion of a greater understanding and awareness of risk management amongst staff across SA Health. This will enable greater consistency in the application of risk management principles and practices across Local Health Networks and SAAS. To complement the updated policy, an Introduction to Risk Management course has been developed. The course and training aligns with the National Safety and Quality Health Service Standard criterion 1.5 (establishing an organisation-wide enterprise risk management system that incorporates identification, assessment, rating, controls and monitoring for patient safety and quality). The Introduction to Risk Management course will provide staff with: • A basic understanding of risk management • Awareness of risk in their day to day working environment • Knowledge of the risk resources available via the intranet • Contact information for local risk management staff

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The risk management training is available on the homepage of SAAS eLearning. All staff have been enrolled into this course and is compulsory for all SAAS employees. Managing risk is a part of every staff’s day-to-day responsibility. By understanding the importance of applying risk management principles to our work duties, all of us are contributing towards building a proactive risk management culture within SAAS. This will result in better safety and quality of care for our patients, and ultimately enhance our organisation’s ability to achieve our strategic and operational goals. — To assist staff in strengthening their risk management practices, a quick reference guide to risk management has been produced. For copies of this guide or further information and queries on risk management, please contact Ken Ng on 8274 0448.


SPRINT SAAS’s Single Paramedic Response and INTervention (SPRINT) Team was established in 2008 and was intended to enable SAAS to more rapidly respond to our most critical patients. With great success in its trial phase, the decision was made to integrate SPRINT into normal operations. Thus the SPRINT team was born. The Bicycle Response Unit (BRU) and Motorcycle Response Unit (MRU) were also developed at that time and although they had their own aims during the trial phase, were merged under the SPRINT banner. Over time, SAAS implemented a number of initiatives to improve service delivery, and the SPRINT team played a pivotal role in some of these, driving change to elements like response determinants and referral pathways, and even equipment development. SPRINT now attend some priority 2 cases without an automatic ambulance back-up, such as Call Direct activations and certain vehicle accidents. Some determinants have been changed to allow ambulances to attend priority 3 after SPRINT has responded priority 2. Priority 3 cases where there appears to be a potential for the patient to be treated at home or referred to a nontransport option like an ECP, GP or other allied health professional, may now be dispatched to SPRINT only. These changes have had a direct impact on the broader resource capacity, enabling emergency ambulances to be more available for other priority 2 cases, to complete cribs or achieve end of shift changeovers more effectively.

On average, SPRINT attends 15-20 cases per day which result in a non-patient carry through appropriate referral or treatment at home, thus avoiding unnecessary dispatch of an ambulance. While this may seem a small number, this is being achieved with just four SPRINT crews working across metropolitan Adelaide over a 16 hour period, and is in addition to the workload in which primary assessment, treatment, and referral to hospital by ambulance occurs. Constant review of equipment and vehicles is another marker of the progressive nature of the SPRINT team. The team has been instrumental in the continual evolution of vehicle layout and kit design, implementation of electric suction and MRx for single responders, and the addition of NIBP to monitors. SPRINT CTL Tony Meli says “as we are a relatively small team, we have the ability to ensure compliance with trial models while maintaining a broad perspective. The team come from diverse backgrounds and bring with them a wealth of experience. We encourage an environment where they can put forward their ideas, take ownership of a project and see it through from planning to implementation. This ensures strong results with developing specific improvements, often with a flow-on effect to other operational areas at SAAS.” MRU in its current form provides coverage during peak workload times like Friday and Saturday nights in the CBD, and plays a pivotal role in major events such as Tour Down Under, City to Bay Fun Run, and Schoolies Festival.

The structure of the team is currently under review to help improve its service delivery model. Currently comprising 25 members, the BRU has had a positive impact on summer CBD resourcing by providing forward triaging of patients. BRU’s ability to rapidly access patients in congested areas can expedite assessment and referral, often to non-ambulance services like the Encounter Youth Green Team or SAPOL, where appropriate. A more robust tracking system is being developed to enhance the safety of BRU members and also improve operational deployment and dispatch capability. Since its inception, the SPRINT team in all its forms has undergone constant review and evolution to bring it to its present state, and along the way has had a significant impact on SAAS’s current and future service delivery model. The team is dedicated to remaining dynamic and will undoubtedly help bring about many more exciting innovations in the future.

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WE’RE ALL ONIONS When I was asked if I would be interested in attending the Roar People ‘Women in Leadership Identity’ workshop in September, I was hesitant to commit two days out of my hectic RTL schedule. Then I stopped and thought about the fabulous opportunity that had been presented to me and asked myself “why do you think you are not worthy of this opportunity to developing yourself as a leader?” While I didn’t have the answer then, I do have the answer now and it relates to onions. During the workshop, I undertook a journey of discovery and self-reflection to uncover my leadership identity and character strengths which help define my personalised leadership style. I learnt that how we view ourselves as leaders is fundamentally linked to our happiness, impact and success. On reflection of our childhood, each of us will bare memories which provide insight into our character strengths and have assisted in shaping our leadership identities through lived experiences. Having said this, ways in which we sense ourselves as leaders can be undermined by organisational obstacles or ‘derailers’ and self-limiting beliefs. I believe that organisational culture can be a derailer to success. Judging an individual’s level of ambition and leadership potential based on a person’s clinical qualification is detrimental to individual and organisational growth. An inspiring future-focused question which came out of the workshop, which as leaders we should be asking our team members, is “what do you

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Angela

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need to be successful?” Solution focused dialogue such as “what does ‘better’ look like for you?” also encourages positive engagement. Through challenging a shift in our culture, I believe that as an organisation we can start encouraging and enabling every individual to reach their leadership potential. A culture of inclusiveness and empowerment where all staff are valued will see our workforce better engaged and free from silos, which inhibit integration, collaboration and productivity. In identifying my character strengths, I discovered that creativity is high on my list and my passion for creative arts, photography and writing is evident both in my leadership identity and in the way I deliver my volunteer training sessions. I engage my team members in reflective practice using go-pro cameras and empower my teams to take ownership of their roles and responsibilities through visual aids and photographic collages. I am also tapping into my creative energy through undertaking my PhD in research. The past nine months have been a turning point in my career. My RTL relief opportunity has enabled me to promote and display my strengths and values of honesty, transparency, fairness and respect, and to empower and inspire others to do the same. I have grown as a leader and am deeply rewarded by the growth and success my teams are achieving. A final thought about onions. Metaphorically speaking, we are all

re s e n

ters fr

om th

e wor

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onions. We each have unique layers of personality, strengths, values, lived experience and attributes and yet often we are judged only by our outer layers. We all have the potential to be leaders. It is up to our organisation to nurture and value each onion. It is up to our existing leaders to peel back the layers of each individual onion to reveal what lies within the core of their being; to better understand their unique identity and character strengths, and support them to reach their full potential. The reason I believed I was not worthy of the opportunity to develop my leadership self was because prior to this workshop, I struggled to recognise my core being and worth as a leader. Now that I am armed with the knowledge of my character strengths and leadership identity and have a greater awareness of what my derailers are, I feel empowered to harness my strengths, develop my weaknesses and be true to my onion self - tears and all. Not only will this knowledge support me on my leadership journey, it will aid me in the nurturing, harvesting and development of my own crop of onions. I would like to sincerely thank Corporate Communications and SAAWN for providing me the opportunity to attend this workshop. — Angela Martin Acting Regional Team Leader Lower Murray


VACCINATION AGAINST VACCINE PREVENTABLE DISEASES:

Team Riverland had their immunisations, then completed their annual fit check.

HIT ME WITH THE BEST SHOT! The review undertaken to assess the level of immunity within the operational on road staff to the vaccine preventable diseases (VPD) Hepatitis B, Measles, Mumps, Rubella and Chicken Pox is now complete. We know who is immune, who isn’t immune and who doesn’t know if they are or not. The Staff Health Clinical Practice Consultant (CPC) will be working with Team Leaders to get all on road staff up to date with any vaccines they may need. What do you need to do? When requested, get a blood test – no cost involved – a serology request form will be posted to you: • SAAS’s CPC will send you a letter requesting serology testing along with an SA Pathology form and a Refusal of Recommended Vaccinations or Screening Form. • You will need to attend for serology/ blood testing at preferably your nearest SA Pathology collection centre within two weeks of the request. • Or complete and return a copy of the Refusal of Recommended Vaccinations or Screening form (Appendix 6) to the CPC via Health. SAASCPCWorkerHealth@sa.gov.au What happens next? CPC will review your blood test results: • Your blood test results will be reviewed SAAS’s CPC to identify your level of immunity.

• CPC will send you a letter via email with a copy your blood test results attached and outline any vaccinations you may need. At PDW (or similar) - Free Vaccines Any recommended vaccinations you require will be ordered specifically for you and be provided to you at a scheduled PDW training day. Note: Where staff refuse to participate in the program the ‘Refusal of VPD Screening or Vaccination Form’ must be completed and emailed to CPC at Health.SAASCPCWorkerHealth@sa.gov. au. The CPC or delegate will meet with the staff member to discuss the risks associated with remaining nonimmune and provide the staff member with an information pack containing Fact Sheets for each VPD they may be exposed to. The staff member must sign to say they have met with the CPC or Immunisation provider and received the VPD Information Pack. PRO-246 Immunisation Against Vaccine Preventable Disease can be found here: https://www.saambulancestaff. com.au/NR/exeres/ ABBA6CB6-308F-481D-991BA2694FC424DA,frameless. htm?NRMODE=Published

For more information, please contact Belinda Purvis, Clinical Practice Consultant on 0475814744.

Recently the Riverland, Port Augusta and Whyalla teams took part in the immunisation program. A couple of quotes from the CTLs:

"I ENCOURAGE EVERYONE TO UNDERTAKE THE IMMUNISATION PROGRAM. IT WAS A VERY EASY PROCESS, TOOK ME 5 MINUTES TO FILL OUT THE BLOOD SEROLOGY FORM AND DONATE A LITTLE BIT OF BLOOD. A WEEK LATER I WAS NOTIFIED OF MY RESULTS. I WAS SHOCKED TO FIND I HAD NO IMMUNITY TO MUMPS! WHILE I WOULD HAVE HAD MY MEASLES, MUMPS, RUBELLA VACCINE IN MY YOUNGER DAYS, FOR WHATEVER REASON IT DIDN’T WORK. DURING OUR TRAINING DAY, I HAD A M.M.R SHOT. NOW I HAVE SOME REASSURANCE THAT I’M PROTECTING MYSELF, MY FAMILY, COLLEAGUES AND PATIENTS.” ADRIAN STEPHENSON CLINICAL TEAM LEADER – WHYALLA “IMMUNISATION IS A SIMPLE AND EFFECTIVE WAY TO PROTECT US, OUR FAMILIES AND OUR PATIENTS AGAINST PREVENTABLE DISEASES. MANY VACCINE PREVENTABLE DISEASES ARE HIGHLY CONTAGIOUS AND CAN BE OVERWHELMING TO COMMUNITIES AND HEALTH CARE SYSTEMS. A SIMPLE SERUM TEST, AND FOLLOW UP TO OBTAIN YOUR REQUIRED IMMUNISATIONS IS AN EASY STEP TO PROTECT YOU AND THOSE IMPORTANT TO YOU.” KIERAN JOHNSON CTL - RENMARK

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RESEARCH NEWS What exactly is research? Well, there are many definitions out there but one used within the Australian Code for the Responsible Conduct of Research is an original investigation undertaken to gain knowledge, understanding and insight. It is a broad concept and there is no simple, single way to define research for all disciplines.1 What are the benefits of carrying out research? Benefits of research may include, for example, gains in knowledge, insight and understanding, improved social welfare and individual wellbeing, and gains in skill or expertise for individual researchers, teams or institutions.4 Why do we need ethical approval to carry out a research study? Research involving human participants must be conducted in a manner that respects and protects all involved, including the researcher, the research participants and the Institution. Obtaining research ethics approval helps to ensure that the research is carried out professionally and takes into account relevant legal, ethical, organisational and cultural standards.2 What is research governance? Research governance is concerned with the principles, requirements and standards of research. It addresses protection of research participants, the safety and quality of research, privacy and confidentiality, financial probity, legal and regulatory matters, risk management and monitoring arrangements and promotes good research culture and practice.3 Who oversees research at SAAS? The RRC is chaired by Professor Hugh Grantham, Senior Medical Officer for SAAS and Head of the Paramedic Unit at Flinders University. Membership includes our Chief Medical Officer, Executive Director of Clinical Performance and Patient Safety, Principal Pharmacist, AusROC Research Fellow, Clinical Director MedSTAR, Safety and Quality Operations

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Welcome to the latest news from the Research Review Committee (RRC) at SAAS. The idea is to give you an update on what’s going on research-wise. But first, let’s answer a couple of common questions from those new to this area.

Manager, Senior Lecturer in Emergency Medicine, Flinders University and the Clinical Audit & Research Manager. There are also plans to include a paramedic, interested in conducting research, as a developmental opportunity. The Committee’s purpose is to: • develop and implement a strategic research agenda that contributes new knowledge to out of hospital care that is translated into practice in order to improve patient outcomes • support research initiatives into out of hospital care through the provision of good research governance, and • support the development and implementation of solutions to operational issues experienced by operational staff. The Committee meets every two months and typically reviews applications from researchers from across Australia, at each meeting. The Committee also plans and monitors SAAS participation in clinical trials. Researchers usually want access to SAAS staff, data or patient records and you may have noticed a number of surveys that have been initiated lately in collaboration with SAAS which can be found on the intranet here: https://www.saambulancestaff. com.au/SAASIntranet/Clinical/ Patient+Safety+and+Quality/Research/ Current+Research+Projects/

Clinical Trial Updates 1. Pre-hospital anti-fibrinolytics for traumatic coagulopathy and haemorrhage (PATCH) – This is underway in MedSTAR 2. Rapid Infusion of Cold Normal SalinE (RINSE) Between 2010 and 2014, SAAS took part in a prospective Phase 3 multi-centre RCT called RINSE. The hypothesis was that paramedic core cooling during cardiopulmonary resuscitation (CPR)

using a rapid infusion of 20mL/kg cold (4 deg C) normal saline improves outcome at hospital discharge compared with standard care in patients with out-ofhospital cardiac arrest (OHCA). The primary outcome measure was alive at hospital discharge with secondary outcome measures of return of spontaneous circulation (ROSC) rates, temperature at hospital arrival and discharge status (to home/rehabilitation/ residential care or deceased on scene/ in hospital). The planned enrolment was 2512 patients. However, the study was halted early due to changes in post-arrest temperature management at some receiving hospitals. Still, this was a large RCT with 1198 enrolments for analysis (618 allocated to paramedic cooling and 580 allocated to standard care). The results were presented at the European Resuscitation Council (ERC) Congress in Prague in October 2015 and the manuscript was recently published and is available on here: Circulation. 2016; http://dx.doi.org/10.1161/ CIRCULATIONAHA.116.021989

A follow up of all RINSE patients is underway to determine quality of life 12 months on so watch this space! 3. rEduction of oXygen After Cardiac arresT - The EXACT Pilot Study This is a feasibility study to determine whether there are any patient safety or logistical issues with randomising OHCA patients who have sustained return of spontaneous circulation (ROSC) to either standard 100% (>10L/min) oxygen, or titrated 50% (2L/min) oxygen. Ambulance Victoria kicked off the study in July 2015 with SAAS joining in soon afterwards in September. By October 2016, we had enrolled 46 collectively without any serious adverse events. The pilot study will continue until approvals are in place to conduct the EXACT Phase 3 study (a RCT to compare an intervention to a standard or experimental intervention), which aims to determine if reduced oxygen in post ROSC OHCA patients improves outcome at hospital discharge. The Australian Resuscitation Outcomes Consortium (Aus-ROC) https://www.ausroc.org.au/

Aus-ROC is a National Health and Medical Research Council funded (2012-


2016) Centre of Research Excellence (CRE) that has amassed over $5 million in grants. EXACT, RINSE and an OHCA Epistry are Aus-ROC endorsed projects assisted by these funds. https://www.ausroc.org.au/research-program/ aus-roc-endorsed-projects/

The Aus-ROC CRE is a collaborative venture that initially involved three universities and three Ambulance Services in three Australian States (Victoria, South Australia and Western Australia), with the primary mission to improve outcomes in patients with outof-hospital cardiac arrest. Aus-ROC has also been awarded another grant of $2,499,626 to establish a CRE in prehospital care and, as a result, SAAS has again joined forces with Ambulance Victoria, St John Western Australia, Flinders University, Monash University and Curtin University to proceed with this venture. The CRE will be led by Professor Peter Cameron in Victoria, Professor Hugh Grantham, Chief Medical Officer Dr Cathrin Parsch and Extended Care Paramedic/Aus-ROC research fellow Cindy Hein.

https://www.nhmrc.gov.au/grants-funding/

outcomes-funding-rounds

No doubt some interesting collaborative research will ensue, with the focus on delivering cutting edge research into policy and practices relating to prehospital care. SA Ambulance Service Cardiac Arrest Registry (SAAS-CAR) This was initially established in 2009 to monitor OHCA managed by SAAS. As an ongoing quality control initiative, it was used primarily to produce reports for SA Health’s Health Performance Agreement and to provide annual reports to the Council of Ambulance Authorities for benchmarking amongst other Australian states and New Zealand. However, these reports contain only limited outcome data such as the number/ percentage of those OHCA patients who were pronounced "life extinct" at scene, versus those who survived "to" a SA Health ED. Recently, SAAS has gained ethical approval to provide more robust reports for external publication and include more definitive “survival” from hospital discharge. So in effect, the SAAS CAR data will be used as an ongoing quality control initiative and for epidemiologic research.

The SAAS-CAR is also an important part of the in the Australian Resuscitation Outcomes Consortium (Aus-ROC) cardiac arrest “Epistry”. https://www.ausroc.org.au/epistry/

The Epistry will comprise core data (with uniform definitions) from the Aus-ROC participating ambulance services which are Ambulance Victoria, SA Ambulance Service, St John Ambulance Western Australia, Queensland Ambulance Service, St John Ambulance NT, St John New Zealand and Wellington Free Ambulance. To date, we already have two publications. We are fortunate to have a strong collaborative relationship with the Paramedic Unit at FMC. In addition to the number of ongoing research studies, there have been the following publications and presentations in the last year involving RRC Chair Professor Hugh Grantham, and Committee members Dr Hein and Dr Hayball: Majd, S., Power, J. H., Koblar, S. A., & Grantham, H. J. (2016). Early Glycogen Synthase Kinase‐3β (GSK‐3β) and Protein Phosphatase 2A (PP2A)

Bernard, S., Smith, K., Finn, J., Cameron, P., Hein, C., Grantham, H.J., et al. (2015). Induction of therapeutic hypothermia during out-of-hospital cardiac arrest. In ERC Symposium on Guidelines: Abstract Presentations. Resuscitation: European Resuscitation Council. ERC Symposium on Guidelines, pp. 3-3. Beck, B., Bray, J., Smith, K., Walker, T., Hein, C., Thorrowgood, M., et al. (2015). Establishing the Australian Resuscitation Outcomes Consortium (Aus-ROC) Epistry. Resuscitation, 96 pp. 108. [10.1016/j.resuscitation.2015.09.254] [Scopus] P.J. Hayball, R.J. Elliott and S. Morris (2014) “Hostile pre-hospital medicine storage- Is there cause for concern for Australian ambulance services?”, Abstract presented at Council of Ambulance Authorities (CAA) Annual Conference in Darwin, August 2014. P.J. Hayball, R.J. Elliott and S. Morris (2015) “Ambulance pharmacist – why haven’t we thought of this role earlier?” Journal of Pharmacy Practice and Research 45: 318-321. P.J. Hayball and C. Wright (2015) “Improving the patient experience: Extended-care paramedic initiated residential medication management review by a consultant pharmacist”, Abstract presented at Council of Ambulance Authorities (CAA) Annual Conference in Melbourne, October 2015.

independent tau dephosphorylation during global brain ischemia and reperfusion following

A. Gaekwad and P.J. Hayball (2016) “Ethylene

cardiac arrest and the role of the Adenosine

glycol poisoning treatment pre-hospital and

Monophosphate Kinase (AMPK) pathway.

hospital: A case report”, Abstract presented at

European Journal of Neuroscience.

Royal Australasian College of Physicians (RACP)

Wechkunanukul, K., Grantham, H.J. and Clark, R.A. (2016). Global review of delay time in seeking medical care for chest pain: An integrative literature review. Australian Critical Care.

Annual Congress in Adelaide, May 2016.

References and links 1 National Health and Medical Research Council. Nhmrc.gov.au. (2015). Australian Code for the

Wechkunanukul, K., Grantham, H.J., Damarell,

Responsible Conduct of Research | National

R.A. and Clark, R.A. (2016). The association

Health and Medical Research Council. [online]

between ethnicity (culturally and linguistically

Available at: https://www.nhmrc.gov.au/

diverse migrants) and the time taken in seeking

guidelines-publications/r39

medical care for chest pain: A systematic

[Accessed 5 Jun. 2016]

review. JBI Database of Systematic Reviews and Implementation Reports.

2 Research Ethics Operational Policy V3.0 04/01/2016 SA Health http://www.

Johnson, M., Boyd, L., Grantham, H. and

sahealth.sa.gov.au/wps/wcm/connect/

Eastwood, K. (2015). Paramedic Principles and

public+content/sa+health+internet/about+us/

Practice ANZ: A clinical reasoning approach.

health+and+medical+research/research+ethics

Melbourne: Elsevier Australia. Majd, S.L., Power, J.H. and Grantham, H.J.

3 Research Governance Policy Directive V3.0 04/01/2016 SA Health http://www.

(2015). Neuronal response in Alzheimer's and

sahealth.sa.gov.au/wps/wcm/connect/

Parkinson's disease: the effect of toxic proteins on

public+content/sa+health+internet/about+us/

intracellular pathways. BMC Neuroscience,16(69).

health+and+medical+research/research+ethics/

Thompson, J., Grantham, H. and Houston, D. (2015). Paramedic capstone education model:

research+governance 4 National Health and Medical Research Council.

Building work ready graduates. Australasian

Nhmrc.gov.au. (2014). Chapter 2.1 Risk and

Journal of Paramedicine, 12(3)

benefit | National Health and Medical Research

Beck, B., Bray, J., Smith, K., Walker, T., Grantham, H.J., Hein, C., et al. (2016). Establishing the AusROC Australian and New Zealand out-of-hospital

Council. [online] Available at: https://www. nhmrc.gov.au/book/chapter-2-1-risk-and-benefit [Accessed 6 Jun. 2016]

cardiac arrest Epistry. BMJ Open, 2016(6) pp. Art: e011027.

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OLIVE OIL AN UNLIKELY RESCUE TOOL!

I think I must’ve been looking forward to an enormous steak accompanying several glasses of local Shiraz a little too much that I had clearly attracted some bad juju! I had just finished performing skills maintenance and training for our south east SAAS REMOTE guys in a joint exercise with local windfarm rescue staff. This culminated in lowering two SAAS REMOTE guys, attendant and stretcher patient, from the rear of a wind turbine some 90m above ground on a system built from scratch. After a long but successful day, SAAS REMOTE having furthered relationships with impressed windfarm rescue staff, I’m enroute to my hotel in Kingston in a drooly state resembling Pavlov’s Dog… Then, the MDT lights up! Naracoorte, P2 for 12yo male stuck in ‘Wet Cave’. As a typical paramedic I’m forecasting the ‘what the?’ factor and… If I’ll even get there! Surely the lad will be out before I get there. And with 90 odd kays ticking down and all SE SAAS REMOTE guys 45 mins the other side of me it’s becoming apparent I might arrive. On arrival a plethora of various rescue agencies greet me with enough flashy lights I’m sure a few local ravers stumbled out of the bush. I’m directed to the entrance and with harness in hand and crawl in. Our lad had slipped while traversing along the side wall over a horizontal void which descended some 6m to a narrow trench like formation at floor level. He’s (R) lateral position floor level with pelvis wedged AP. Para Annika Pearce was in place doing a sensational job at not only

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squeezing into the small void but also maintaining the lad’s composure with Alan Hall being a little less petite assisting from above. Local Cave Rescue had given up on trying to drill the rock around the patient and requested the local hardware store to open for a jack hammer! A disconnect between Cave Rescue having minimal patient knowledge and Paramedics with less rescue experience leading to a stalling in extrication. It was a prime example of what SAAS REMOTE is here for! Except I was now an hour closer and they were probably enjoying the steak! Upon contorting myself to reach our lad from the other side, and almost having to dislocate my shoulder to obtain an IV, Annika and I formulated a plan. This involved seesawing one sling from the head end, securing his torso at armpits, a second sling between his legs. As the pelvis was jammed, slings linked to form a harness and then connected to haul team above. Ready for rapid extrication if required, antiemetic and sufficient pain relief administered with the final touch being olive oil. I requested this from the tourist café to help our lad slip to freedom! Once doused in a good amount of oil, he was pulled free and assisted out the tight passage to the waiting stretcher for the remainder of the extrication. A great job done by all involved! I imagined the dinner I had planned while I ate my jerky and peanuts… Clinton Daniels SOT


REMEMBERING MATES WALL TO WALL RIDE The Wall to Wall is a motorcycle ride to Canberra from every state in Australia. Most of the participants are police officers who ride their own bikes, to attend a ceremony at the National Police Memorial. The purpose of the ride is to remember officers who have lost their lives in the line of duty. SAAS was approached this year by organisers of the SAPOL contingent to see if the Motorcycle Response Unit (MRU) could support the event and provide medical support. I was lucky enough to be the rider that represented SAAS…

TUESDAY 13 SEPTEMBER

I collected the bike from Port Adelaide station and headed to the SA Police Academy for a cooked breakfast and send-off ceremony at the SA Police Wall of Remembrance. We mounted our bikes and headed off under police escort to the Northern Expressway. It was great to be under the escort, as we didn’t need to stop at any intersections! The weather was overcast but thankfully no rain. But when we got to Gawler, it started to pour. Our first stop was a lookout on the outskirts of Tanunda. We had a group shot with the local media, and got my first (and thankfully last) job. One of the riders placed his foot down, and it kept sliding until he was lying on his side with the bike on top of him. Apart from a bruised ego (he was a Harley rider after all) and a bit of a sore leg he was fine – quick assessment found no real injury so he was cleared to continue. It rained and rained and rained and we all looked like drowned rats by the time we hit Loxton for lunch. Our last stop was Mildura, and yes, more rain! I called into the Mildura ambulance station, and had a great chat with the crews, and showed them the bike and equipment.

Wednesday 14 September

Up early and went to the local McDonalds for coffee and briefing. Maccas sponsor the Wall to Wall ride

each year so it was our meeting point every morning. We headed to Griffiths, our NSW overnight stop. The weather cleared for a few hours but by the time we got to the Hay Plain it was bucketing down. There’s nothing like riding across the plain in the pouring rain with trucks passing in the opposite direction! When we reached Griffiths, I couldn’t help myself I just had to go and wash the bike – the sun was out and I wanted it to look nice. I then called into their local ambulance station and had a coffee with the crews and talked about the bike. Dinner and a few beers were in order, then an early night.

Thursday 15 September

I woke up to… more rain! By the time I got to Maccas for the briefing, the bike was wet and full of road grime. Thankfully we only had a four hour ride to Canberra, but 3 hours and 50 minutes of it, it rained.

Friday 16 September

We had a free day to check out Canberra and be a tourist. The skies were clear, so I cleaned the bike and took some photos of it in iconic places, including the National War Museum, Lake Burly Griffin and Parliament House – unfortunately they wouldn’t let me ride in, which was outrageous!

Saturday 17 September

Memorial Ride Day. Lovely weather and everyone buzzing to clean their bikes and make them shine. We had a BBQ lunch and headed to the showgrounds where all the bikes gather and get formed up for the ride. Over 2500 bikes made it to Canberra from across the country. The procession was led by Police Bikes from each state (even WA had one which is a long ride for sure) and the Highway Patrol Vehicles (lights flashing). They were followed by a group of about 20 bikes with the organisers and senior police. Our bike was placed

there with flashing lights of course. All the others followed; it was a fantastic sight to see the bikes riding into Canberra. The ride does a loop around Parliament House and ends up at the National Police Memorial. It’s a very emotional ceremony, with families of officers who have died attending. At the end of the service each state’s senior police representative read out the names of their officers who had lost their lives in the line of duty. SA had two people. After the ceremony, people could place a flower on the wall and look at the names on the plaques.

Sunday 18 September

It was up early for me as I was riding back to Loxton. I left Canberra at 0545 hrs and headed down the Hume Highway to Wagga Wagga. It rained, of course.

Monday 19 September

Finally got back to Adelaide, and she turned the weather on, no rain. Though it did take me two hours to clean the bike! All in all it was a fantastic trip. Participants could not stop thanking us for supporting the event. They really appreciated us being there for medical support. As you can imagine a lot of planning went into getting me to Canberra, including gaining authorisation to practice as a paramedic and the carriage of drugs across borders. Thank you to Tony Meli, Paul Lemmer, Keith Driscoll and Steve Cameron for making it possible for SAAS to support the ride. It was a pleasure and a privilege to represent SAAS and the MRU – one I will remember for a very long time. — Lee Dale Regional Teal Leader, Far North Motorcycle Paramedic

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MY JOURNEY: SOUTH AFRICA TO SOUTH AUSTRALIA It was then that we had our first taste of proper freedom in Australia. My younger sister and I at the ages of six and seven released our tightly gripped hands after cautiously walking the short distance home from the local corner store, something we could never have even dreamt of doing in our birth country of South Africa.

My mother was a single parent who decided that South Africa was no longer somewhere where you could be safe or feel safe, and decided to immigrate in the year 2000 to Australia. She wanted to start a new life and develop a promising future for her family. Though it was exciting, it was a very challenging time for us – we had to learn to adapt to an entirely new environment and culture, and learn how to read, write, speak and count in English (my sister and I could only speak Afrikaans). After living in Australia for five years, we had to return to South Africa to renew our visa. Leaving Australia was very distressing for our little family, as we knew what we were returning to. South Africa has an extremely high crime rate and is very unsafe. We expected the visa renewal to take six months, it took two years. During these years, we lived in a small, heavily secured granny flat located on a property with security alarms, doubled external and internal gates. We lived in a medium sized room containing the kitchen, dining room, laundry, and living area. The fridge separated our beds. We had no hot running water, so we had to carry buckets from the outside sink to fill up the bath. There was no shower. Despite the living circumstances, we grew a lot closer to one another, and

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were grateful – some people didn’t even have water. My mother was employed as a journalist for a leading newspaper and we were home-schooled. The local high school was too dangerous and too full; kids would sit on the cupboards at the back of the classroom and on the floor as there were not enough chairs. On the days we did not have schooling work, mom would take us to some of her inteviews for stories in the newspaper.

"We had no hot running water, so we had to carry buckets from the outside sink to fill up the bath." It was through these experiences where I developed an understanding of different cultures; life-long lessons for us. Mom would almost always be accompanied by police for safety. She took us to meet people who were homeless and living in shacks built from highway road signs, tin sheeting, cardboard boxes, plastic bags and other items. There was no such thing as government assistance to help out with paying rent or buying food. Some were recovering from prolonged and heavy drug addictions and admitted to breaking into houses and


Simone (left) with her sister and mom.

businesses to steal money to fuel their drug addiction. Some people stole to feed themselves and their families. A lot of people did not have shacks to live in and would sleep on flat

"It was through these experiences where I developed an understanding of different cultures; life-long lessons for us." cardboard boxes along the sidewalks of main roads and would sleep against each other to keep warm on cold winter nights. We volunteered in aged care facilities and orphanages, meeting children who had lost their parents to AIDS or drugs, had gone missing, or were tragically killed in car accidents. It may seem harsh to have exposed two young teenagers to such things, however, the reality of it was that it was so common to see these events unfold on a daily and very regular basis – poverty, drug dealings, prostitution, robberies and even broad-daylight shootings or stabbings would take place. Returning to Australia in 2007 proved another culture shock for us. Having

that second priceless opportunity of Australia’s freedom was unexplainable – we were so relieved to be back. Everything that we experienced in South Africa taught us to be grateful and thankful for every passing day; you never know what could happen. It also created an awareness and understanding of the reality of what is happening around the world and led me to passionately develop a need to help within our own Australian community.

"It also created an awareness and understanding of the reality of what is happening around the world and led me to passionately develop a need to help within our own Australian community."

I joined State Emergency Service in 2010, and in 2011 I decided to make the switch to SAAS. I now volunteer in the SA Regional Response Team. I’m intrigued with prehospital care, and wanted to expand my knowledge, so after five years of service, I am also studying the Bachelor of Paramedic Science degree externally. I look forward to soon making the switch to Flinders University to study on campus. After thirteen years of applying for visas, moving fourteen times, including three times overseas, we proudly received our Australian Citizenship in 2013, and were even featured on the 'Dream Australia' TV show telling our immigration story. Simoné Cornelius SAAS Volunteer, Limestone Coast

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A LIFE-SAVING CHANGE BY O LI VIA BAR NE S TUMBY Bay man, Lawrie Smith, who had his life saved by three strangers in the Adelaide Airport in January welcomed the addition of a automated external defibrillator (AED) for the Tumby Bay community. Mr Smith unveiled the AED and a plaque on Friday. He said it was thanks to quick thinking bystanders and access to a AED that he was still alive. “It was almost twelve months ago when something strange happened and I woke up in an ambulance; I remember the man sitting next to me in the ambulance said ‘you’re a lucky guy’,” Mr Smith said. “It wasn’t until a few days later that I found out what had happened and that two off duty nurses and a fireman worked tirelessly to bring me through,” he said. After unveiling the plaque Mr Smith met Christopher Dare, the fireman who had helped save his life. Mr Smith said meeting Mr Dare

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was something he had wanted to do for a long time. “This machine is really important, you never know when it is going to happen,” he said. Mr Dare said meeting Mr Smith was a “surreal” experience. “So often people’s journeys start with us but we don’t get to see the ending, it’s really nice to see someone recovering,” he said. Tumby Bay SA Ambulance volunteer team leader Michelle Parker said it was about a year ago when she realised many other towns on the Eyre Peninsula were getting the defibrillators but Tumby Bay was not one of them. After setting up the initiative of an online fundraising platform it only took about a month to reach the target. “Thanks to the tremendous support of family, friends, businesses and the local community, the fundraising was immensely successful,” Ms Parker said. “The project went online on August 25

and by September 27 we had raised enough for AED and by the end of September we purchased it.” The AED is now in its permanent position on the Tumby Bay Police Station. Ms Parker said there was also money left over after purchasing the AED for Tumby Bay and that would go toward a second one for another location within the Tumby Bay District Council. She said now the AED was in place it was important for the community to learn how to use it. “Every second counts when someone is in cardiac arrest so we would like the community to know they can come down and learn how to use the machine,” she said. Printed courtesy of Port Lincoln Times


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CUSTOMER SERVICES STATS JULY – OCTOBER 2016 Customer Service Centre Inbound call volume

65,858

Revenue & Billing

Call Direct

Ambulance Cover

Case Cards received

Sales

Members

104,393 Case Cards processed

88,397

216

280,195

Members

3758

CONGRATULATIONS LAURA THOMSON! The November Customer Service Centre Star Award goes to Laura Thomson. Laura is a helpful team member with a ‘can do’ attitude, and nothing is too difficult. She has a positive approach to work and is always willing to lend a hand.

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We want to hear from you! SAAScene is your magazine, but we need your input. All you need to do is contact the team at healthsaasnews@sa.gov.au. For more information and submission deadlines go to: SAASnet > People and Support > Our Community > SAAScene


You never know when you’ll need us, but it’s reassuring to know we’re a push of a button away. Get connected to SA Ambulance at the touch of a button.

Call Direct is the only 24-hour emergency monitoring service that connects you directly to SA Ambulance Service. Simply press the red button on your Call Direct unit or pendant and you’ll be immediately connected to one of our highly-skilled call takers who will dispatch an ambulance to you.

Your address and medical information is on hand so paramedics attending will already know where you live and how to access your home if you’re unable to open your door. Call Direct gives you and your loved ones peace of mind that help is only a push of a button away.

To find out more information about Call Direct, simply email HealthSAASCallDirectAdmin@sa.gov.au or call our Customer Service Centre on 1300 13 62 72.