Lead - Evolve - Impact

People who live in rural and remote regions face restricted access to healthcare services due to varied barriers. Currently, health equity is a vital factor driving health services, and is explored through the experiences of individuals in rural NSW. The ongoing healthcare crisis in rural NSW has primarily centred around augmenting the number of general practitioners and community nurses, yet challenges persist in securing funding, employment, and retention. A potential solution to assist rural healthcare is community paramedicine, which presents a fresh approach to primary healthcare in regional areas by leveraging the existing paramedic workforce to reach patients anywhere.

More than one in four paramedics are suffering from a diagnosable level of post-traumatic stress disorder (PTSD) symptoms. Self-compassion is a known protective factor against PTSD in both military and civilian populations, yet whether this was also true for paramedics was unknown. This study, involving 334 paramedics, found that levels of self-compassion (how paramedics respond toward themself during difficult times) explain unique variance in their levels of PTSD symptoms; and more specifically, “over-identification” is the key component. Since we know self-compassion levels are readily increased through even brief intervention, these findings open up exciting possibilities for prevention and treatment strategies.

Ambulance service culture has moved from a male dominated profession to be more inclusive of females in the workforce. During this transition, experiences of women in paramedicine have largely been unreported. This study explores the perceptions and experiences of women who have worked in the profession during the gradual feminisation of Australian paramedic culture, through creative arts-based research. The project consists of an online survey, semi-structed interviews with creative element, and researcher generated creative outputs, to explore the rich and deep experiences of women. By un-silencing female paramedics, new knowledge can be generated to fill a gap in paramedicine literature.

In the last twenty years, there has been a substantial rise in the demands placed on modern paramedic systems. The traditional response model of deploying more ambulances to meet the increasing demand is no longer sustainable. In this presentation, we invite you on a journey through a collection of research papers that delve into novel and pioneering practices within the field of paramedicine. Our main objective is to answer a fundamental question: What does the ideal paramedic system encompass?

Chaplains are included in several Australian ambulance organisations, however despite evidence demonstrating strong connections between spiritual beliefs and health outcomes, little is known about their role or value. This exploratory sequential mixed methods study identified a role built on professional caring relationships, that provided proactive and reactive care in paramedic workspaces. Incorporating emotional, psychological and spiritual care, chaplaincy promoted wellbeing, reduced barriers to help-seeking and supported paramedics in accessing support. Perceived religiousness of chaplains and other organisational factors acted as barriers to paramedics using chaplaincy, however pre-existing relationships were also influential in determining whether paramedics would seek chaplain support.

This presentation will discuss the findings from an Australasian review on the current state-of-play of Fatigue Risk Management Systems (FRMS) in ambulance services, specifically the fatigue monitoring tools, mitigation strategies and general fatigue management. The findings provide insight into existing FRMS frameworks and present opportunities to enhance fatigue management across the paramedic sector and promote collaboration between services.

This presentation aims to provide guidance on the future of community paramedicine programs in Australia. Utilising qualitative methodology using a systems-based analysis, 29 participants from seven countries were selected and provided their insights on community paramedicine program development. The result spotlight the crucial role of community involvement, strategic collaboration, and effective communication in successfully implementing and managing community paramedicine programs. By interpreting these shared international experiences and insights, we can better inform the design and implementation of community paramedicine programs in Australia, thereby influencing policy decisions and practical approaches in the community health sector.

In accordance with global recommendations for improving survival from out of hospital cardiac arrest, the provision of telephone CPR advice has been established as a standard of care for ambulance service dispatch. However, patients at overdose prevention sites may frequently present as unconscious with agonal breathing, despite not suffering a cardiac arrest and urgently needing oxygenation, ventilation, and naloxone. This retrospective cohort study of over 1.6 million patients in British Columbia, Canada, sought to examine the performance of MPDS ® in identifying patients at overdose prevention sites requiring chest compressions.

This phenomenological study examined the experiences of paramedics interacting with aged care staff throughout the potential transfer of a resident to hospital. It aimed to analyse this interaction from an underrepresented perspective to describe the essential features of the paramedic experience of this interprofessional relationship. Our study found that paramedics have predetermined expectations of aged care staff during their interactions. In circumstances where staff fail to meet these expectations, the interaction is viewed in a negative light and this impacts on clinical decision-making and potentially on resident healthcare outcomes in this environment.

Australian paramedics experience high levels of fatigue, which is associated with poor health and safety outcomes. Understanding how paramedics perceive and experience fatigue is critical in effective fatigue management. Thirty Australian paramedics participated in a qualitative interview exploring lived experiences of fatigue; data were thematically analysed. Themes include normalisation of fatigue to cope, poor relationships between paramedics and employers related to fatigue management, and fear and stigmatisation of formally reporting fatigue. Under-reporting fatigue and limited knowledge of fatigue management policies and screening tools was evident. To address these barriers, we recommend co-designed fatigue risk management policies, alternate fatigue screening tools, and education.

What is the role of ‘000’ paramedics in society? Should we only focus on resuscitation, or adapt into increasing low acuity demand? Where do Community Paramedics fit in to the picture? Our team - including professors of Paramedicine, Medicine, and Nursing - interviewed 56 influential people including national and state Members of Parliament, national and state Chief Officers, the heads of RACGP and ACEM, ambulance Chief Executives, frontline ED and GP physicians, nurses, paramedics, and patients themselves. This session will share what everyone - from the highest placed individuals in medicine in the country to the patients we serve - thinks the future of emergency paramedicine is.

In Australia, one in 12 people aged 65 and over have a diagnosis of dementia – which is also the second leading cause of death for all Australians. Paramedics play a crucial role in person-centred dementia care, particularly within the community care space. As consensus has been established on paramedicine’s integration into inter-disciplinary care teams, the lack of clarity regarding the paramedic role in dementia care requires attention. This scoping review therefore aimed to identify and report paramedic interactions with people living with dementia in the out-of-hospital setting.

Established guidelines for medication safety focus on hospital, pharmacy, nursing and operating theatre settings, with little to no mention of paramedic practice. A systematic review published in 2022 qualitatively established the factors that contribute to paramedic medication errors. This study builds on that work, quantifying those factors both in terms of their contribution to known errors and their prevalence within paramedic practice.

Understanding patient experience contributes to quality, safe, and effective healthcare. This research explored the experience of patients who received an emergency ambulance response and paramedic-led healthcare that resulted in a decision for them to not attend a hospital ED. Constructivist Grounded Theory methods were used to generate and analyse data from semi-structured interviews with 21 participants who received paramedic-led healthcare from an Australian jurisdictional ambulance service between August 2020 and October 2021 that resulted in non-conveyance.

Organ donation is a life-saving intervention for patients with end-stage organ failure, yet the demand for organs surpasses the supply, leading to a significant disparity in transplant waiting lists. To address this, innovative strategies like uncontrolled donation after circulatory death (uDCD) programs have been proposed. This study presents a scoping literature review that comprehensively evaluates the involvement of prehospital healthcare professionals in identifying potential organ donors and the barriers impacting this process. Although established uDCD systems hold promise in alleviating waitlist burdens, a lack of consensus on criteria, strategies, and ethical considerations hinders efficient and ethical utilisation. Further research is needed to address these gaps and establish evidence-based guidelines within an Australasian context.

The findings indicated that all participants had experienced WSH in the profession of paramedicine. Four major themes emerged from the analysis; 1. power dynamics between men and women in paramedicine, 2. the influence of an "old boys club" culture, 3. instances of workplace sexual harassment in paramedicine, 4. feelings of silence, invisibility, and hopelessness. This study discussed the implications of WSH on individuals, organisations, and service delivery within paramedicine. Whilst a small study, the findings could offer guidance, support, and potential recommendation for changes in paramedicine and related professions.

The limit of IN Fentanyl is 200 mcg in one service; 400 in another. Half our ICPs RSI/DSI; the rest don’t. Opioids are indicated during labour in 4 states; contraindicated in another 4. Clinical guidelines - directly or indirectly - determined the medical treatment 4.5 million people received last year. How are there so many differences? What is the right treatment? And why does a $4.8 billion industry disagree so much on fundamental medical treatment?

Published in 2011, the Fluid Expansion As Supportive Therapy (FEAST) study demonstrated that fluid bolus' used for sepsis resuscitation in Sub-Saharan African children increased mortality compared to maintenance fluid alone. We will discuss the strengths and limitations of this study, the impact of the study results on sepsis guidelines and care, and how the results of this study might change your everyday practice.

A presentation of the results of a qualitative study undertaken which aimed to understand the perspectives of patients with chronic pain who have received management in the paramedic practice setting.

Simulation and clinical practice have long served as the foundations of clinical education and assessment in various health fields, including paramedicine. More recently, the incorporation of extended realities in simulation practice has emerged as a possible addition to undergraduate paramedicine programs, complementing existing practical methods. The primary aim of this study was to determine if immersive or traditional simulation provided greater ratings of self-perceived performance. This randomised controlled trial provided a direct comparison between a traditional simulation program (standard simulation rooms) and an immersive simulation program (360-degree projection simulation room). This research suggests that undergraduate paramedicine students expressed higher ratings of self-perceived performance in traditional forms of simulation.

Prehospital emergency anaesthesia is a procedure that carries risks, including oxygen desaturation and hypoxia. Preoxygenation with a bag-valve-mask and reservoir bag with 15L.min-1 oxygen flow is traditionally utilised to reduce these risks. In this experimental study, the impact of alternative preoxygenation methods such as a refill valve attachment rather than reservoir bag, and the addition of nasal cannulae was investigated. Percentage of expired oxygen was analysed at 1 minute and 3 minutes of preoxygenation. Between reservoir bag and refill valve attachment, there was no significant difference in expired oxygen percentage. However, outcomes improved with the addition of nasal cannulae.

The field of healthcare is constantly evolving and many accrediting bodies and organisations globally, are promoting the use of self-directed learning (SDL) as a critical skill for ‘lifelong learning’. Therefore, there is greater emphasis within tertiary education, including paramedicine, for students to become self-directed learners. This project explored the drivers that improve the student learning experience, in undergraduate clinical science programs that utilised SDL. Understanding these factors will allow educators to implement SDL strategies more effectively within tertiary curriculum, ensuring students are better equipped to enter the professional workplace and engage in ‘lifelong learning’.

This session delves into evidence-based paediatric burn care in the pre-hospital setting, emphasising the crucial role of early interventions in saving skin cells. Participants will explore guidelines, literature, and collaborative approaches to enhance patient outcomes and mitigate the longterm impact of burn injuries.

Over the last twenty years, prehospital medicine has seen a continued increase in both presentation and awareness of CPR-Induced Consciousness (CPRIC). Its occurrence in the prehospital field causes technical and ethical challenges for clinicians both physically and mentally. Lack of treatment guidelines, data collection, and an agreed upon definition for CPRIC have restricted advancements on the topic. Thus, our author team used the Delphi methodology to survey an international panel of prehospital clinicians in order to create CPRIC definitions, management guidelines, and a reporting framework which can be used for reporting purposes.

Workplace sexual harassment is an alarming worldwide issue that can cause severe adverse effects for victims, especially women from traditionally male-dominated professions. Recent enquiries and studies have shown paramedics and doctors are exposed to concerning rates of sexual harassment. However, there is little understanding of whether this also affects paramedic students who perform duties in the same environment as paramedics. This systematic scoping review aimed to explore paramedic and medical students’ experiences of sexual harassment whilst undertaking clinical placement. The session will discuss the seven themes revealed from the thematic analysis, in addition to the content analysis results identifying the three most reported adverse effects of sexual harassment.

Introduction: TBI is the leading cause of global mortality and morbidity. Objective: This study examined severe TBI patient outcomes based on transportation. Methods: This retrospective, quantitative analysis examined patient outcomes in patients transported to Inkosi Albert Luthuli Central Hospital (IALCH) from January 2017 to December 2018. This study covered 12+-year-olds. This study included GCS- and CT-classified severe traumatic brain injury (TBI) patients. Results: 167 of 202 cases were male. 41.1% of patients were injured by motor vehicle collisions. Direct admissions had higher mortality than interhospital transfers (p < 0.001). Direct IALCH admissions were shorter than inter-hospital transfers. New injury severity score (NISS), revised trauma score (RTS), and Glasgow Coma Scale (GCS) predicted mortality well, with NISS being the most accurate. Conclusion: Severe TBI patients admitted straight to a level 1 trauma hospital have worse outcomes than those transferred from another institution. In severe traumatic brain damage, physiological / anatomical scoring systems and predictors can help predict death.

A short description of my journey into Wilderness Medicine and how I have applied it to my daily clinical practice. This will include my motivations for pursuing this as an area of specialist practice, the training I have undertaken along the way and some advice for others who may wish to follow a similar pathway.

In this session the paramedic shares their journey from working as a Branch Station Officer in a remote area to seeking a work opportunity that offers better work/life/study balance. They discovered private sector work in mining and construction and secured a position with Corporate Protection Australia (CPA) in their health and medical sector. Working as a paramedic in this dynamic environment, they often found themselves as the sole medical personnel on-site, dealing with low acuity cases and occasionally challenging decisions. They offer advice to other paramedics considering this industry, emphasizing the importance of being proactive, assertive, and well-prepared while embracing the endless opportunities the private sector has to offer.

A brief introduction to Event Medicine, my journey and how this unique speciality has evolved and how it positively impacts the greater health care continuum. I will discuss what motivated me to pursuing this path less travelled, my experiences along the way and advice for those interested in being involved with this exciting and evolving speciality.

A short description of my journey into Wilderness Medicine and how I have applied it to my daily clinical practice. This will include my motivations for pursuing this as an area of specialist practice, the training I have undertaken along the way and some advice for others who may wish to follow a similar pathway.

What is chronic pain? How is chronic pain different from acute or traumatic pain? How can paramedics alter their approach when treating these patients? This presentation will discuss evidence-based practice and assessment/ management strategies for paramedics to consider when treating this patient cohort; including the application of the biopsychosocial model and a holistic approach.

Undergraduate paramedic programs cannot prepare work-ready graduates. These programs provide a wide theoretical, philosophical, conceptual and critical thinking foundation for graduates to build their clinical practice. A period of supported learning by educated facilitators is critical to reducing the transitional learning gap from university to real-life paramedic practice. Paramedicine has yet to clearly define a conceptual framework for this period of supported learning. This discussion will explore the work of the ACP Preceptorship working group towards a definition and position statement on preceptorship for the profession in Australasia.

In this presentation, Advocacy and Government Relations Manager, Jemma Altmeier, will talk about the College advocacy agenda highlighting the activities and tactics used to engage decision-makers, collaborate with stakeholders, and influence government policy and legislation.

Changing consumer demands have necessitated ambulance services to transform their approach to patient care. Evidence-informed clinical practice guidelines for physical health have expanded, but not for mental health. This descriptive phenomenological study sought to understand the lived experiences of paramedics caring for mentally unwell individuals in the community. Eighteen Australian paramedics were interviewed, illuminating four central themes: 1) Are we ready for this - the paramedic and patient interaction?, 2) The barriers to accessing care for mental health consumers in a one size fits all system, 3) It's just all a little bit grey, paramedic education and training on mental health presentations, and 4) The Paramedic, The Clinician, and The Person. The findings emphasise the need for improved education, training, support, and enhanced access to specialised services and referral networks.

This presentation explores the dynamics of community paramedicine programs in Australia and Aotearoa New Zealand, examining both their facilitators and challenges. Based on insights from 37 participants through surveys and interviews, four overarching themes emerged: (1) clarifying paramedic roles, (2) manoeuvring funding and legislative complexities, (3) addressing fixed paramedic mindsets, and (4) capitalizing on health workforce shortages. The result of this study highlights the significance of interprofessional understanding of paramedic roles, health system challenges that hinders wider paramedic contribution to health care, the impact of fixed mindset roles for paramedics on the growth the profession and the current opportunities due to current health workforce shortages.

Paramedic practice continues to evolve internationally, and there is a duty to ensure paramedic education reflects the complexity of contemporary paramedic practice, and outlines the features required for competent practice in diverse contexts. This research used a novel six-step model to identify and explore paramedic practice across Canada. The draft framework contains 27 professional activities across five domains: person-centered care, collaborative care, safe care, self care and professional care.

The majority of burn presentations seen in a Burns Unit in Australia and New Zealand are small in size but can still be complex to manage. In this presentation the aetiology of burn injured patients that are transferred to hospital will be discussed along with current management strategies. Recent findings from the Burns Registry of Australia and New Zealand (BRANZ) will be reviewed along with common presentations including minor burns.

This session discusses the pre-hospital management of hyperthermia using mass gathering events to set the scene to explore the difference between environmental hyperthermia and hyperthermia associated with drug ingestion and acute behavioural disturbance. We will immerse you into the world of paramedicine at events, highlight the aetiology, pathophysiology, assessment findings and treatment based on contemporary evidence-based practice, while having some fun along journey.

Tanie is a current Monash postgraduate Honours student and Ric Bouvier scholarship holder, in which she is researching parent/carer and paramedic decision making for transport of Children with Special Health Care Needs. An area of research interest which has been inspired by her eldest son having a chronic health condition since infancy. Tanie is inspired to share her son’s journey through the often-hectic prehospital emergency space into the Emergency Department to enhance prehospital care for all families like hers – those with beautiful, diverse, complex and challenging Children with Special Health Care Needs.

“Just because we can doesn’t mean we should.” The widening scope of practice for the ICP has begun to capture patient cohorts that lie at the fringes of well-defined research that support pre-hospital RSI. This session will explore the patient with airways-burns to understand if we are applying best practice in this low frequency, high acuity trauma.

A discussion on the latest in clinical management of environmental hypothermia including the use of case studies to highlight aetiology, pathophysiology, assessment findings and treatment based on recommendations of the International Commission for Mountain Emergency Medicine, The European Resuscitation Council, The Australia and New Zealand Committee on Resuscitation and the Wilderness Medicine Society.

Management of children, particularly in the trauma setting has always tended to be a stressful patient cohort for many Paramedics. This session aims to shine a light on strategies to assist in maximising the understanding of common threads of assessment and treatment of both adults and children, and a focus on minimising aspects of paediatric care that create that stress. The session has a focus on the impact of Human Factors, and the ability of Paramedics to minimise this impact via the development and fostering of clinical resilience.

This session places the paramedic as a detective tasked with the prehospital assessment and care of the older person with delirium, an acute disorder of attention and cognition. The session will uncover the epidemiology of this condition, share assessment and care objectives, and discuss how registered paramedics can add value to the care of this cohort of patients.

Endurance Medical Services (EMS) is an industry leader in specialist remote and austere medicine services, typically multi-day endurance events, such as ultramarathons. Ryan, Wilderness Paramedic and Associate Medical Director, presents an overview to the approach of providing medical support to these logistically complex events, a selection of case studies from the field, and subsequent learnings that everyone can apply to their own practice.

Treatment of acute stroke is time critical and requires early and accurate decision making to ensure patients receive the appropriate reperfusion therapies within the appropriate times. Prior to 2015 patients with an occlusion of a large cerebral vessel had a very poor prognosis however the advent of endovascular clot retrieval has drastically changed this. Pre-hospital clinicians are now more important than ever within stroke systems of care. This session will explore the importance of clinical assessment and retrieval decision making across metropolitan, regional and remote areas of Australia.