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Objective: To assess the safety and effectiveness of peripheral vasoactive drugs initiated during pre‐hospital care and retrieval missions, in Queensland, Australia. Methods: Three years of retrospective data was gathered from two sources. Medical notes were reviewed using a search for any patient having 'inotrope' recorded on an electronic medical record. Each case was reviewed to include only peripheral infusions of adrenaline or noradrenaline. Clinical Governance records were searched for adverse events related to vasoactive drugs, alerted for review to ensure complete capture. Results: A total of 418 patients received peripheral infusions of adrenaline and noradrenaline over the 3‐year period. No major complications were recorded either immediately or at Clinical Governance review. Minor complications were recorded in 4.7% of the cases, of which 3.5% occurred with peripheral vasoactives during the presence of the retrieval team. The frequency of use of peripheral vasoactives increased over the study period. Conclusions: In this retrospective data set there were no major complications of peripheral vasoactive drugs. Minor complications were similar to in‐hospital use and related to vascular access and drug delivery. [ABSTRACT FROM AUTHOR]

Objective: The introduction of emergency telemedicine care models is a common theme in health jurisdictions that include rural and remote populations. How the availability of these models influences the way clinicians manage traumatic road crashes is not yet fully understood. This study seeks to compare road crashes where telemedicine was and was not used and to identify any variables that may increase the likelihood of telemedicine usage by treating clinicians. Methods: Road crashes reported in the state Department of Transport and Main Roads (Queensland, Australia) crash database between January 1, 2019, and November 30, 2020 (n = 23,734) were compared to videoconferencing call logs to determine which crashes resulted in treatment that was supported by telemedicine (n = 204). Analysis was performed to examine differences in characteristics related to the crash depending on whether telemedicine support was requested. Results: Road crashes where telemedicine support was requested on average involved more casualties (1.6 vs. 1.41; t(11,287) = −3.26, p < 0.001, relative risk = 1.13). Crashes that occurred in rural settings accounted for most requests for telemedicine (65.68%; X2 = 159.2, p < 0.001) and a greater percentage of crashes in remote locations (3.36% vs. 2.35%; X2 = 256.97, p < 0.001, relative risk = 1.43). The use of telemedicine support for crashes was associated with a 13% increase in the mean number of casualties, compared to crashes where telemedicine support was not used. Conclusion: Telemedicine support is requested by clinicians providing emergency treatment in the management of road crashes that produce more severe injuries, involve multiple casualties, and take place in more rural settings or remote locations. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to explore data and Aboriginal and non‐Aboriginal researchers' experiences and reflexivity in co‐designing research about a rural Aboriginal well‐being program to inform practice and policy. Setting: Gumbaynggirr, Birpai, Kamilaroi and Awabakal countries located in regional and rural New South Wales, Australia. Participants: Rural and regionally located research team who co‐designed processes to challenge the status quo about a critically framed, rural‐based Aboriginal well‐being research project. Design: Researchers drew on data from a research project in an interpretive cycle of collaborative Yarning. Data included 90 published articles, 12 Yarning transcripts and 26 reflective journal text sets, as well as researcher experiences and reflexivity. Results: The Duguula Gayirray (Yarning together), Yandaarray (walking together) and Duguula Nguraljili (sharing together) co‐design practice model was developed to represent key actions in the context of an Aboriginal well‐being program in a rural context. Actions were supported by seven interpersonal ways of being and were underpinned by respectful relationships between community and researchers. Discussion Duguula Gayirray, Yandaarray and Duguula Nguraljili are critical to co‐design practice and are grounded in respectful relationships. Our experiences led us to critique our perceptions of power sharing, equitable partnerships and collaborative knowledges towards opportunity for collective research co‐design. Conclusion: Duguula Gayirray, Yandaarray and Duguula Nguraljili transformed our understanding of achieving liberation from dominant western research in the context of a rurally located Australian Aboriginal well‐being program. This study contributes to progression of Aboriginal health research practice and policy recommendations, enabling real cultural change in health care with rurally located Aboriginal communities. [ABSTRACT FROM AUTHOR]

Objective: The purpose of the present study was to investigate the use of respiratory support via continuous positive airway pressure (CPAP) and non‐invasive ventilation (NIV) in a medical retrieval service in Queensland, Australia, with reference to transport considerations and patient safety. Methods: In this unblinded retrospective case series over a 13‐month period, a clinical database was reviewed for the use of CPAP/NIV. Retrieval metrics as well as clinical data were recorded. Results: A total of 128 patients were transferred either by rotary (80%) or fixed wing (20%). The median transport time was 65 min. The median total mission time was 3.7 h. Fifty‐two percent of patients were female. The median age was 69 years and 93% had a background of cardiorespiratory disease. Sixty‐five percent of patients were receiving CPAP/NIV before arrival of the retrieval team. The main diagnoses were respiratory failure (29.7%), acute pulmonary oedema (26.6%) and chronic obstructive pulmonary disease (25.8%). There were no incidences of pneumothorax, intubation in transit, vomiting, desaturation, hypotension, cardiac arrest or death. In two cases NIV was abandoned due to mask intolerance and in one case there was a decrease in Glasgow Coma Scale by 2. In no cases was there a detrimental outcome for the patient. Conclusion: The use of NIV and CPAP appears to have a low‐risk profile in aeromedical retrieval even for prolonged periods of time in an adult population. [ABSTRACT FROM AUTHOR]

Previous literature has applied system-focused structures to understand the success of First Nations Peoples' nutrition and exercise group programmes. Existing system-focused measures have included biomedical outcomes, access and service utilization. By broadening the focus of programme success beyond the system, we can evaluate programmes from a First Nations Peoples' lifeworld perspective. Critical hermeneutics and yarning using a lens of Habermas' Theory of Communicative Action to the literature has the potential to transform understandings of "success" in First Nations Peoples' nutrition and exercise group programmes. In this literature interpretation, we explored the critical success factors from a lifeworld perspective, giving scope to go beyond a system perspective to include a cultural, social or personal perspective. Our yarning led us to understand that there is a communicative relationship between explicit system structures and implicit lifeworld concepts that are critical success factors for First Nations nutrition and exercise group programmes. We have developed a set of reflective questions to guide others in considering a lifeworld perspective. Our findings represent a shift away from success measured by the dominant power structure to respect the lifeworld culture, knowledges and values of First Nations Peoples towards shared understanding and mutual decision-making. [ABSTRACT FROM AUTHOR]

Primary aeromedical retrievals are a direct scene response to patients with a critical injury or illness using a medically equipped aircraft. They are often high‐acuity taskings. In Australia, information on primary retrieval taskings is housed by service providers, of which there are many across the country. This exploratory literature review aims to explore the contemporary peer‐reviewed literature on primary aeromedical retrievals in Australia. The focus is on adult primary aeromedical retrievals undertaken in Australia and clinical tools used in this pre‐hospital setting. Included articles were reviewed for research theme (clinical and equipment, systems and/or outcomes), data coverage and appraisal of the evidence. Of the 37 articles included, majority explored helicopter retrievals (n = 32), retrieval systems (n = 21), compared outcomes within a service (n = 10) and explored retrievals in the state of New South Wales (n = 19). Major topics of focus included retrieval of trauma patients and airway management. Overall, the publications had a lower strength of evidence because of the preponderance of cross‐sectional and case‐study methodology. This review provides some preliminary but piecemeal insight into primary retrievals in Australia through a localised systems lens. However, there are several areas for research action and service outcome improvements suggested, all of which would be facilitated through the creation of a national pre‐hospital and retrieval registry. The creation of a registry would enable consideration of the frequency and context of retrievals, comparison across services, more sophisticated data interrogation. Most importantly, it can lead to service and pre‐hospital and retrieval system strengthening. [ABSTRACT FROM AUTHOR]

In this case, we describe the completion of emergency front-of-neck access by a novice provider facilitated by specialist telehealth support. A facility with limited advanced airway skills requested telehealth support for a critically unwell patient with severe hypoxic respiratory failure and acute delirium. Attempts to temporise his physiology with ketamine-facilitated non-invasive ventilation were unsuccessful, and he proceeded to rapid sequence intubation. Ultimately, intubation was unsuccessful and attempts at ventilation by laryngeal mask also failed. A Cannot Intubate, Cannot Oxygenate scenario was identified. The referring team had significant anxiety about performing a surgical front-of-neck access procedure. However, with telehealth support, this was ultimately completed by a novice provider, and the patient stabilised. The key issue identified was the need for the telehealth provider to take clinical governance of the procedure. The referring team also required assistance in completing an adequate neck incision, responding to bleeding, and determining the preferred technique. [ABSTRACT FROM AUTHOR]

This perspective article summarises the experience of conducting a multicentre research project. We describe expected and unexpected hurdles we experienced as well as suggesting possible solutions for researchers embarking on multicentre studies. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to provide 'adequate analgesia' (which decreases the pain score by ≥2 and to <4 [0-10 scale]) and determine the effect on patient satisfaction. Methods: We undertook a multicentre, cluster-randomised, controlled, intervention trial in nine EDs. Patients with moderate pain (pain score of ≥4) were eligible for inclusion. The intervention was a range of educational activities to encourage staff to provide 'adequate analgesia'. It was introduced into five early intervention EDs between the 0 and 6 months time points and at four late intervention EDs between 3 and 6 months. At 0, 3 and 6 months, data were collected on demographics, pain scores, analgesia provided and pain management satisfaction 48 h post-discharge (6 point scale). Results: Overall, 1317 patients were enrolled. Logistic regression (controlling for site and other confounders) indicated that, between 0 and 3 months, satisfaction increased significantly at the early intervention EDs (OR 2.2, 95% CI 1.5 to 3.4 [P< 0.01]) but was stable at the control EDs (OR 0.8, 95% CI 0.5 to 1.3 [P = 0.35]). Pooling of data from all sites indicated that the proportion of patients very satisfied with their pain management increased from 42.9% immediately pre-interven-tion to 53.9% after 3 months of intervention (difference in proportions 11.0%, 95% CI 4.2 to 17.8 [P = 0.001]). Logistic regression of all data indicated that 'adequate analgesia' was significantly associated with patient satisfaction (OR 1.4, 95% CI 1.1 to 1.8 [P<0.01]). Conclusions: The 'adequate analgesia' intervention significantly improved patient satisfaction. It provides a simple and efficient target in the pursuit of best-practice ED pain management. [ABSTRACT FROM AUTHOR]

Introduction: In Professional Association of Diving Instructors (PADI) Open Water Diver certification courses that cater to tourists, instruction is often condensed and potentially delivered in a language that is not the candidate's native language. Objective: To assess the incidence of middle ear barotrauma (MEBt) in open-water diver candidates during a condensed four-day certification course, and to determine if language of instruction affects the incidence of MEBt in these divers. Method: The ears of participating diving candidates were assessed prior to commencing any in-water compression. Tympanic membranes (TM) were assessed and graded for MEBt after the confined and open-water training sessions. Tympanometry was performed if the candidate had no movement of their TM during Valsalva. Photographs were taken with a digital otoscope. Results: Sixty-seven candidates participated in the study. Forty-eight had MEBt at some time during their course. MEBt was not associated with instruction in non-native language (adjusted odds ratio = 0.82; 95% confidence intervals 0.21-3.91). There was also no significant association between the severity of MEBt and language of instruction. Conclusion: Open-water diver candidates have a high incidence of MEBt. Education in non-native language does not affect the overall incidence of MEBt. [ABSTRACT FROM AUTHOR]

The article discusses a study on a sharpened Romberg test (SRT) after three days on a live-aboard dive boat. The researchers aimed to examine the impact of the sea legs condition, an experience involving an impairment in balance on returning to shore, on the SRT. Results of the study indicated that there was no significant effect on SRT performance caused by sea legs after three days at sea.

The article presents the stories of the scholars of Services for Australian Rural and Remote Allied Health Professionals (SARRAH). One story refers to the Clinton Gibbs wherein after acquiring the Post Graduate scholarship at SARRAH, his confidence increases as well as his salary. Another mentions Andrew Fernando in which he had found his niche in life with the help of SARRAH. Moreover, it also notes the success scholar story of Maureen McKellar.

Objective: The introduction of emergency telemedicine care models is a common theme in health jurisdictions that include rural and remote populations. How the availability of these models influences the way clinicians manage traumatic road crashes is not yet fully understood. This study seeks to compare road crashes where telemedicine was and was not used and to identify any variables that may increase the likelihood of telemedicine usage by treating clinicians. Methods: Road crashes reported in the state Department of Transport and Main Roads (Queensland, Australia) crash database between January 1, 2019, and November 30, 2020 ( n  = 23,734) were compared to videoconferencing call logs to determine which crashes resulted in treatment that was supported by telemedicine ( n  = 204). Analysis was performed to examine differences in characteristics related to the crash depending on whether telemedicine support was requested. Results: Road crashes where telemedicine support was requested on average involved more casualties (1.6 vs. 1.41; t (11,287) = -3.26, p < 0.001, relative risk = 1.13). Crashes that occurred in rural settings accounted for most requests for telemedicine (65.68%; X 2  = 159.2, p < 0.001) and a greater percentage of crashes in remote locations (3.36% vs. 2.35%; X 2  = 256.97, p < 0.001, relative risk = 1.43). The use of telemedicine support for crashes was associated with a 13% increase in the mean number of casualties, compared to crashes where telemedicine support was not used. Conclusion: Telemedicine support is requested by clinicians providing emergency treatment in the management of road crashes that produce more severe injuries, involve multiple casualties, and take place in more rural settings or remote locations.