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OBJECTIVE: To identify barriers to, describe the development of and evaluate the implementation of a behavioural theory informed strategy to improve staff personal protective equipment (PPE) compliance during COVID-19 in a regional Australian Emergency Department. METHODS: Barriers to PPE use were identified through staff consultation then categorised using the Theoretical Domains Framework. The Behaviour Change Wheel was used to develop a strategy to address the barriers to PPE compliance. The strategy was refined and endorsed by the site COVID taskforce. Data were collected through direct observation. Descriptive statistics were used to summarise PPE compliance and inductive content analysis for free text data of staff behaviours. RESULTS: 73 barriers were identified, mapped to 9 intervention functions and 42 behaviour change techniques. The predominant mechanisms were: (1) Executive communication reinforcing policy and consequences; (2) implementation of a PPE Marshal; (3) face to face reinforcement / modeling; (4) environmental restructuring including electronic medical record modifications. The PPE Marshal observed 281 PPE activities. PPE compliance varied between 47.9% (Buddy check) and 91.8% (Bare below elbow). The PPE Marshal intervened on 121 occasions, predominantly through buddying, explaining and demonstrating correct PPE use, most frequently with medical staff (72%). CONCLUSION: We describe an evidence-based process to overcome barriers to PPE compliance that maximize safe work practice in a time critical situation. Staff require enabling, access to equipment and reinforcement to use PPE correctly.

Additional file 2: Supplementary file 2. SPIRIT_checklistR0

Additional file 1: Supplementary file 1. SW RCT _checklist_completedR0

Additional file 4: Supplementary file 4. Grant fundingR0.

Additional file 3: Supplemantary file 3. Ethics approvalR0

Additional file 2. StaRI checklist.

Additional file 2. Search strategy.

Additional file 1. Implementation plan – redacted.

Additional file 1: Supplementary Table 1. Studies detailing systems for recognising and responding to clinical deterioration in emergency department patients. Supplementary Table 2. Systems for recognition of clinical deterioration in Emergency Department patients.

Additional file 2. Supplementary Material 2. Questionnaire used for EDWHAT.

Additional file 1. Supplementary Material 1. STROBE Statement—Checklist of items that should be included in reports of cross-sectional studies

Implementation plan. This is a deidentified version of the implementation plan used for implementation at the sites. (DOCX 238 kb)

Complete survey. This additional file is the full survey completed by participants. (PDF 93 kb)

Data dictionary. (PDF 236Â kb)

Major trauma case peer review tool. (PDF 422Â kb)

This study describes clinical staff opinions on the availability and suitability of resources to provide trauma care to children and their families and any perceived strengths, gaps and potential interventions to strengthen care.

Background: To determine the incidence and characteristics of major traumatic injury treated in the Australian Capital Territory (ACT) over a 5-year period. Methods: A retrospective analysis of ACT Level 1 Trauma Centre registry data from July 2007 to June 2012 was conducted. Inclusion criteria were: major trauma (Injury Severity Score (ISS) > 15), intensive care unit admission, hospital stay > 3 days or penetrating injury. Results: There were 931 patients with an ISS > 15, a 12.5% increase over the 5-year period (P = 0.003). Unadjusted mortality rates in the ISS > 15 group remained stable at 9.9%. About half of all injuries occurred outside the ACT. The largest age group represented was 16–24 years. Road trauma was the most prevalent injury mechanism, but its incidence reduced over the 5-year period (52.2–40.3% [P = 0.005]). There was a 3.1% increase in admissions following violence. Conclusion: The largest demographic affected by major trauma in the ACT and surrounds is young people. Injury prevention should remain focused on road trauma but also target violence and high-risk recreation activities. Further investigation around the circumstances of major traumatic injury in young people is required. Funding and cross-border agreements should be reviewed to minimize financial disadvantage to the ACT.

Background: To summarize and synthesize research that explored the experience of surviving life-threatening injury in adolescents, young persons and adults. Methods: Informed by systematic literature review strategies, a description of the experience of individuals who survived life-threatening injury was sought by reviewing 13 studies with qualitative data on the phenomena. Data were managed using NVivo software and synthesized using thematic analysis to elicit meaning. Results: The review synthesized a substantial number (n = 273) of participant experiences of traumatic surviving life-threatening injury and revealed that during the initial 3 years following life-threatening injury, the individual goes through a shifting, iterative process in order to reconstruct various aspects of their injury and themselves, including mental, emotional, spiritual, physical and relational facets. Three major themes were illuminated: a time of chaos, negotiating injury and reconciling injury. In order to navigate through the experience of injury, family members were key sources of affirmation and support in anchoring the person to their life, in reconstructing themselves in the aftermath of injury and in coming to terms with the impacts of injury. Conclusion: This qualitative synthesis describes the iterative process individuals go through following life-threatening injury and the overwhelming need to reconstruct aspects of self as a way to create meaning. It demonstrates the need to gain further understanding of the influence of the family in recovery from injury and indicates that education is required to provide practical strategies to assist clinicians to develop appropriate and relevant patient goals and expectations.