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Objective: We have previously established that paramedic exposure to out-of-hospital cardiac arrest (OHCA) is relatively rare, therefore clinical exposure cannot be relied on to maintain resuscitation competency. We aimed to identify the current practices within emergency medical services (EMS) for developing and maintaining paramedic resuscitation competency., Methods: We developed and conducted an online cross-sectional survey of Australian and New Zealand EMS in 2015. The survey was piloted by one EMS and targeted at education managers., Results: A total of nine of the 10 EMS responded to the survey. All EMS reported that they provide resuscitation training to paramedics at the commencement of their employment (median 16 h, interquartile range [IQR]: 7-80). With the exception of one EMS that did not provide any refresher training, a median of 4 h (IQR: 1-7) resuscitation training was provided to paramedics annually. All EMS used cardiac arrest simulations and skill stations to train paramedics. Paramedic exposure to OHCA was not taken into account to determine their training needs. Resuscitation competency was tested by EMS: annually (3/9), biennially (4/9) or not at all (2/9). Two EMS used CPR-feedback devices in clinical practice and only one EMS regularly performed formal debriefing after OHCA cases. Barriers to resuscitation competency included: difficulty removing paramedics from clinical duties for training and a lack of paramedic exposure to OHCA., Conclusion: All of the surveyed EMS provided initial resuscitation training to paramedics, but competency testing and refresher training practices varied between services. A lack of individual exposure to cardiac arrest and training time were identified as barriers to resuscitation competency., (© 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.)

Objectives: To provide contemporary Australian data on the public's training in cardiopulmonary resuscitation (CPR) and awareness of hands-only CPR., Methods: A cross-sectional telephone survey in April 2016 of adult residents of the Australian state of Victoria was conducted. Primary outcomes were rates of CPR training and awareness of hands-only CPR., Results: Of the 404 adults surveyed (mean age 55 ± 17 years, 59% female, 73% metropolitan residents), 274 (68%) had undergone CPR training. Only 50% (n = 201) had heard of hands-only CPR, with most citing first-aid courses (41%) and media (36%) as sources of information. Of those who had undergone training, the majority had received training more than 5 years previously (52%) and only 28% had received training or refreshed training in the past 12 months. Most received training in a formal first-aid class (43%), and received training as a requirement for work (67%). The most common reasons for not having training were: they had never thought about it (59%), did not have time (25%) and did not know where to learn (15%). Compared to standard CPR, a greater proportion of respondents were willing to provide hands-only CPR for strangers (67% vs 86%, P < 0.001)., Conclusion: From an Australian perspective, there is still room for improvement in CPR training rates and awareness of hands-only CPR. Further promotion of hands-only CPR and self-instruction (e.g. DVD kits or online) may see further improvements in CPR training and bystander CPR rates., (© 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.)

Objective: Prognostic models are commonly used in the clinical setting. The objective of the study is to evaluate the prognostic accuracy of the Rapid Emergency Medical Score (REMS) or alternate models., Methods: A retrospective cohort study of critical care patients who underwent retrieval service transfer to an ICU in a single state-wide service in Victoria, Australia. All patients aged 18 years and over transferred to an ICU between 1 January 2010 and 30 June 2013. Retrieval and ICU datasets were probabilistically linked. Multivariable logistic regression modelling was used to investigate the capacity of physiological markers and patient characteristics to predict in-hospital mortality in the ICU population. The prediction performance was evaluated using measures of discrimination (C-statistic) and calibration (Hosmer-Lemeshow [H-L statistic] )., Results: There were 1776 ICU patients who were transferred and 1749 (98.5%) had complete data. Of the 1749 patients with complete data, 257 (14.7%) died in-hospital. The REMS calculated at the time of retrieval referral demonstrated borderline predictive capability (C-statistic 0.69, 95% CI 0.62-0.76). Following logistic regression analysis of the REMS components, final variables included in the Retrieval REMS model were age, mean arterial pressure and Glasgow Coma Scale score. This model demonstrated acceptable predictive capability (C-statistic 0.72, 95% CI 0.64-0.79). The median (interquartile range [IQR]) Retrieval REMS for survivors and non-survivors, respectively, were 7 (5, 10) and 9 (7, 11), P < 0.01., Conclusions: The availability of a validated tool such as Retrieval REMS assists recognition of high-risk patients and consideration of this risk in retrieval mission planning and response., (© 2015 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.)

Objectives: The 4 h National Emergency Access Target was introduced in 2011. The Alfred Hospital in Melbourne implemented a hospital-wide clinical service framework, Timely Quality Care (TQC), to enhance patient experience and care quality by improving timeliness of interventions and investigations through the emergency episode and admission to discharge in 2012. We evaluated TQC's effect on achieving the National Emergency Access Target and associated safety and quality indicators., Methods: Retrospective analysis with piecewise regression of 215 125 ED attendances before/after implementation, November 2009 to August 2013; with comparison of proportions of patients discharged, admitted or transferred from ED within 4 h of arrival; left at risk; unplanned ED re-attendances up to 28 days; ED length of stay; and in-hospital mortality., Results: The percentage of patients admitted, discharged or transferred within 4 h rose from 60% in 2010, to 74% in 2013. Median ED length of stay decreased significantly. Rate of unplanned ED re-presentations decreased by 27%, 22% and 17% within 24 h, 48 h and 7 days, respectively; and patient numbers leaving at risk halved from 8% to 4%. Mortality for admitted patients declined from 3.5% to 2.2%. All results were statistically significant., Conclusions and Future Directions: TQC resulted in improvement in timeliness of care for emergency patients without compromising safety and quality. Success is attributed to effective engagement of stakeholders with a hospital-wide approach to redesigning the care pathway and establishing a new set of principles that underpin care from the time of ED arrival., (© 2015 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.)