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Background: Growing global demand for palliative care services has prompted generalist clinicians to provide adjunct support to specialist teams. Paramedics are uniquely placed to respond to these patients in the community. However, embedding palliative care principles into their core business will require multifactorial interventions at structural, healthcare service and individual clinician and consumer levels. Aim: To develop a palliative paramedicine framework suitable for national implementation, to standardise best practice in Australia. Design: Delphi study utilising questionnaire completion; each round informed the need for, and content of, the next round. Free text comments were also sought in Round 1. Two rounds of Delphi were undertaken. Setting/participants: Sixty-eight participants took part in Round 1, representing six countries, and 66 in Round 2. Participants included paramedics, palliative care doctors and nurses, general practitioners, researchers and carers with lived experience and expertise in palliative paramedicine. Results: Seventeen of the original 24 components gained consensus; 6 components were modified; and 9 new components arose from Round 1. All modified and new components gained consensus in Round 2. Only one original component did not gain consensus across both rounds and was excluded from the final 32-component framework. Conclusion: This study has developed a comprehensive national framework addressing the macro-, meso- and micro-level interventions required to standardise palliative paramedicine across Australia. Future research ought to engage a multidisciplinary team to create an implementation strategy, addressing any perceived barriers, facilitators and challenges for applying the framework into policy and practice. [ABSTRACT FROM AUTHOR]

Paramedicine in Australia was historically male‐dominated, and despite the development within the profession, sexism against women remains a major hurdle for a safe workplace. The aim of this scoping review was to identify experiences of reporting sexism toward female paramedics in Australian ambulance services and identify barriers impacting the decision to submit a report. Literature searches were conducted using eight electronic databases, with grey literature found through Google Scholar, media outlets and hand‐searching. Articles included were those with mention of sexism or associated behaviours reported to a senior authority within the field of paramedicine in Australia. Reporting of sexism within paramedicine was not a primary outcome for any included literature. Behaviours such as sexual assault and harassment are rarely defined, and sexism is often not reported independently. Experiences of women with reporting are primarily negative, and decisions to report sexism are made difficult by various barriers of which victimisation was most prominent. Following a report being lodged, all reported outcomes were inadequate as perceived by the victim. Further research into the reporting of sexism in Australian ambulance services is required to develop resolutions to the identified barriers and provide a safer reporting environment to encourage reporting. [ABSTRACT FROM AUTHOR]

Research has shown paramedics form rapid intuitive impressions on first, meeting a patient and these impressions subsequently affected their clinical reasoning. We report an experiment where theory-based interventions are developed with the goal of reducing reliance on intuitive reasoning by paramedics and paramedic students in simulated patients. Australian paramedics (n = 213; 49% female) and paramedicine students (n = 83; 55% female) attending paramedic conferences completed a 2 × 2 fully between participants experiment. They saw a written clinical vignette designed to be representative of Acute Coronary Syndrome (ACS) in which key clinical information was precise or degraded (stimulus), they then either chose the single most likely diagnosis from a list, or ranked competing diagnoses (response). Outcome variables were diagnostic rate and response time. There were no differences in the proportion of participants choosing ACS across the four stimulus-response conditions (0.75 [0.65, 0.84] vs 0.79 [0.68, 0.87] vs, 0.78 [0.65, 0.87] vs 0.72 [0.59, 0.82], p = 0.42) This is the first study attempting to experimentally examine clinical reasoning in paramedics using a theory-based intervention. Neither of the interventions tested succeeded in altering measures of clinical reasoning. Similar to previous research on physicians, paramedic reasoning appears robust to manipulation. [ABSTRACT FROM AUTHOR]

Background: Australian paramedics must engage in continuing professional development (CPD), including self-directed learning (SDL). This study aimed to examine paramedics' attitudes towards training and learning activities and perceptions about what could increase engagement in self-directed CPD. Methods: A cross-sectional survey was conducted with New South Wales Ambulance paramedics. The 48-item survey examined learning attitudes, attitudes towards SDL and socio-demographic and professional characteristics. Results: Most of the 149 participants (19% consent rate) were male (74.5%) and worked full-time (96.5%). All participants agreed that paramedics should reflect on the quality of their practice (100%) and most were committed to undertaking learning to improve their skills and capability (95.2%). However, 26.3% of participants did not feel motivated to undertake learning and 58.9% did not feel supported. Paramedics reported neutral to modestly positive attitudes towards SDL. Most participants agreed they would be more likely to engage in SDL if they had access to training equipment at their station (91%) and dedicated time during work hours (90.4%). Conclusion: Paramedics are highly committed to undertaking CPD. Increased engagement may be supported by providing SDL materials at work locations and ensuring dedicated time for learning during work hours. [ABSTRACT FROM AUTHOR]

Purpose: Since 2018, Australian paramedics have been regulated under the National Registration and Accreditation Scheme (NRAS) for health practitioners. Established professions have been regulated in Australia for some time, so there is limited knowledge of their entry to regulation. However, as paramedicine has not been previously centrally regulated, this provides a unique case study to explore the transition to regulated practice. Design/methodology/approach: Australian paramedics undertook two surveys: pre- and post-introduction of registration. The first survey was in the month leading up to the commencement of registration (N = 419), and the second survey took place 31 months after registration (N = 407). This paper presents the results of statistical analyses of the post-registration survey including comparisons to the pre-registration survey. Findings: Although support for regulation has increased over time, there remains strong dissent consistent with 2018 levels. After 31 months of regulation, respondents reported increasing knowledge of the scheme and greater ease of navigation. The impacts of regulation are more nuanced and less polarised than in the first survey. Identity is again canvassed, and results suggest a shift from employment status and qualifications as key elements of identity to a community of practice and registration. Originality/value: Paramedics' experiences and understanding of the rationale for registration are developing. Further support is needed to assist with the emerging professional identity and behaviours. Regulation is one of many occupational factors influencing professional identity and professionalism. Exploring the experience of regulation potentially assists regulators in better supporting practitioners and helps better understand professional evolution. [ABSTRACT FROM AUTHOR]

Background: Paramedic practice is diversifying to accommodate evolving global health trends, including community paramedicine models and growing expertise in palliative and end-of-life care. However, despite palliative care specific clinical practice guidelines and existing training, paramedics still lack the skills, confidence and clinical support to provide this type of care. Aim: To elicit paramedics', palliative care doctors and nurses', general practitioners', residential aged care nurses' and bereaved families and carers' experiences, perspectives, and attitudes on the role, barriers and enablers of paramedics delivering palliative and end-of-life care in community-based settings. Design: A qualitative study employing reflexive thematic analysis of data collected from semi-structured online interviews was utilised. Setting/participants: A purposive sample of 50 stakeholders from all Australian jurisdictions participated. Results: Five themes were identified: positioning the paramedic (a dichotomy between the life saver and community responder); creating an identity (the trusted clinician in a crisis), fear and threat (feeling afraid of caring for the dying), permission to care (seeking consent to take a palliative approach) and the harsh reality (navigating the role in a limiting and siloed environment). Conclusion: Paramedics were perceived to have a revered public identity, shaped by their ability to fix a crisis. However, paramedics and other health professionals also expressed fear and vulnerability when taking a palliative approach to care. Paramedics may require consent to move beyond a culture of curative care, yet all participant groups recognised their important adjunct role to support community-based palliative care. [ABSTRACT FROM AUTHOR]

Background: Emergency service workers (ESW) are known to be at increased risk of mental disorders but population-level and longitudinal data regarding their risk of suicide are lacking. Method: Suicide data for 2001–2017 were extracted from the Australian National Coronial Information Service (NCIS) for two occupational groups: ESW (ambulance personnel, fire-fighters and emergency workers, police officers) and individuals employed in all other occupations. Age-standardised suicide rates were calculated and risk of suicide compared using negative binomial regression modelling. Results: 13 800 suicide cases were identified among employed adults (20–69 years) over the study period. The age-standardised suicide rate across all ESW was 14.3 per 100 000 (95% CI 11.0–17.7) compared to 9.8 per 100 000 (95% CI 9.6–9.9) for other occupations. Significant occupational differences in the method of suicide were identified (p < 0.001). There was no evidence for increased risk of suicide among ESW compared to other occupations once age, gender and year of death were accounted for (RR = 0.99, 95% CI 0.84–1.17; p = 0.95). In contrast, there was a trend for ambulance personnel to be at elevated risk of suicide (RR = 1.41, 95% CI 1.00–2.00, p = 0.053). Conclusion: Whilst age-standardised suicide rates among ESW are higher than other occupations, emergency service work was not independently associated with an increased risk of suicide, with the exception of an observed trend in ambulance personnel. Despite an increased focus on ESW mental health and wellbeing over the last two decades, there was no evidence that rates of suicide among ESW are changing over time. [ABSTRACT FROM AUTHOR]

In Australia, paramedics are obliged to practice ethically. Graduates of baccalaureate degrees in paramedicine should therefore possess a common grounding in ethics to meet the professional capabilities expected of registered paramedics. However, there is a lack of clarity regarding ethics education for paramedicine students, including what is taught, how it is taught, and how it is assessed. This paper explores ethics education for paramedicine students in Australia, how it aligns with current professional expectations, and how it may be enhanced. Point-in-time data regarding ethics education was collected from websites of fifteen Australian universities offering undergraduate baccalaureate degrees in paramedicine. Data collection was supported by consultation with academics from several institutions. Content analysis was utilised to categorise and analyse data to explore similarities and differences in curricula. Similarities included approaches to learning and teaching and the use of case-based learning, with variability found across teaching staff profiles and content areas. Findings suggest it is time for collaboration to develop a model ethics curriculum for paramedicine students in Australia. [ABSTRACT FROM AUTHOR]

Providing care to methamphetamine‐related callout events in the prehospital environment is often complex and resource‐intensive, requiring staff to manage agitation and violence‐related side effects of methamphetamines. In Australia, emergency responders are increasingly required to attend events related to methamphetamines, even though reports suggest methamphetamine use across Australia has declined. The aim of the study was to explore Australian police and paramedic experiences attending methamphetamine‐related events. A qualitative descriptive phenomenology design was employed using semi‐structured interviews with employed police (10) and paramedics (8) from Australia. Data were analyzed using thematic analysis. Participants described the complexities associated with providing prehospital care to people affected by methamphetamines. Participants described associated domestic/family violence, increased levels of violence, challenges with communication, and responder emotional and psychological distress and physical injury. Violence associated with methamphetamine use is a critical factor in prehospital care. Workplace violence and family/domestic violence are important issues that require further research to ensure families and staff are well supported and have the services they need to continue responding to people affected by methamphetamine use. [ABSTRACT FROM AUTHOR]

Objectives: Sex-based harassment remains a pernicious and pervasive problem in organisations, as evidenced by the recent #MeToo movement. Little is known about how this issue affects women in the paramedic profession. This study explores the sex-based harassment experiences of women working in a large Australian ambulance service, focusing on harassment from coworkers and managers. Methods: Long-form, semi-structured interviews were undertaken with women paramedics (n = 30) as part of a larger qualitative study of the careers and work experiences of women paramedics. Interviews were recorded and transcribed verbatim, and thematic data analysis was employed to develop rich descriptions of paramedics’ experiences. Results: Of the 30 participants, 25 had experienced sex-based harassment from male colleagues. Most commonly this took the form of gender harassment – that is, comments and jokes designed to belittle and demean women on the basis of their gender. Several participants experienced sexualised forms of harassment, including unwelcome sexual attention and propositions. Participants expressed reluctance to report the behaviour through organisational channels because of the perceived futility of doing so and the potential for reprisals and career repercussions. The preferred responses to harassment were informal, and included avoidance, humour, direct appeals and work withdrawal. Conclusions: Sex-based harassment has a range of damaging consequences for victims and the organisations in which they work. This study is the first to explore how Australian women paramedics experience sex-based harassment in their work. The study has implications for policy and practice to improve gender equality within ambulance services and highlights the need for further research into the extent and nature of the problem across the paramedic profession. [ABSTRACT FROM AUTHOR]

Background: The prevalence of mental and behavioural illnesses in the Australian community is increasing. Paramedics are frequently the first health responders to a mental health crisis, and their workload associated with mental health presentations is also increasing. The present study explored the experience and perspectives of undergraduate paramedic students who participated in a pilot mental health placement., Methods: A pilot workplace learning opportunity was established in which students completed a portion of their community service hours in an inpatient mental health setting at Port Macquarie Base Hospital. Eight students attended and completed the placement and were administered the Clinical Placement Evaluation Questionnaire., Results: Student responses to this placement experience were overwhelmingly positive. The data showed that all the students responded "Strongly Agree" or "Agree" to each of the survey items. Thematic analysis of the qualitative data yielded four central themes related to benefits, additional training and education, nursing staff, and improvements., Conclusions: This pilot study suggests that mental health placements for paramedics have meaningful educational value and can impact student learning. Since this pilot study, mental health placements have been permanently included as part of the undergraduate curriculum in our institution., (© 2024. The Author(s).)

There is growing concern for the health and wellbeing of paramedic students who are required to undertake work integrated learning (WIL) in the ambulance setting to become a registered paramedic. Paramedic culture, barriers to help seeking, and difficulty in accessing peer support is limiting their ability to express emotions and cope with workplace stress. This study aimed to examine whether participation in a peer social support group, using the CARES skills framework, changed paramedic students' emotional expression and emotion-focused coping. A convenience sample of seventy-eight participants were recruited from a paramedic program at a single regional university in Australia. Due to small participant numbers third year students were assigned to the intervention group (n = 44) and second year students were assigned to the control group (n = 34). The intervention group received training on how to undertake a peer social support group using the skills embedded in the CARES framework and were encouraged to meet every two weeks over a twelve-week period. All participants completed online surveys consisting of the DASS-21 stress subscale, General Help Seeking Questionnaire, Emotional Approach Coping Scale, Emotional Expressivity Scale and Multidimensional Scale of Perceived Social Support in week 1 and in week 12. Findings suggest that peer social support participation significantly increased emotional expression and emotion-focused coping when compared to the control group. Furthermore, this intervention significantly reduced participants' reliance upon help seeking without a significant increase in external social support. This is the first known study to investigate the role of peer social support amongst paramedic students, and the findings provide new information on how to help individuals cope with the stressors of working in the ambulance setting. Future studies should investigate whether the positive effects of peer social support are consistent over time and focus on minimising sampling issues. [ABSTRACT FROM AUTHOR]

Background: Since 2002, paramedics have been working in primary care within the United Kingdom (UK), a transition also mirrored within Australia, Canada and the USA. Recent recommendations to improve UK NHS workforce capacities have led to a major push to increase the numbers of paramedics recruited into primary care. However, gaps exist in the evidence base regarding how and why these changes would work, for whom, in what context and to what extent. To understand the ways in which paramedics impact (or not) the primary care workforce, we conducted a realist review.Methods: A realist approach aims to provide causal explanations through the generation and articulation of contexts, mechanisms and outcomes. Our search of electronic databases was supplemented with Google and citation checking to locate grey literature including news items and workforce reports. Included documents were from the UK, Australia, Canada and the Americas-countries within which the paramedic role within primary care is well established.Results: Our searches resulted in 205 included documents, from which data were extracted to produce context-mechanism-outcome configurations (CMOCs) within a final programme theory. Our results outline that paramedics are more likely to be effective in contributing to primary care workforces when they are supported to expand their existing role through formal education and clinical supervision. We also found that unless paramedics were fully integrated into primary care services, they did not experience the socialisation needed to build trusting relationships with patients or physicians. Indeed, for patients to accept paramedics in primary care, their role and its implications for their care should be outlined by a trusted source.Conclusions: Our realist review highlights the complexity surrounding the introduction of paramedics into primary care roles. As well as offering an insight into understanding the paramedic professional identity, we also discuss the range of expectations this professional group will face in the transition to primary care. These expectations come from patients, general practitioners (family physicians) and paramedics themselves. This review is the first to offer insight into understanding the impact paramedics may have on the international primary care workforce and shaping how they might be optimally deployed. [ABSTRACT FROM AUTHOR]

Background: Rapid sequence intubation (RSI) is used to secure the airway of stroke patients. Randomized controlled trial evidence exists to support the use of paramedic RSI for traumatic brain injury (TBI), but cannot necessarily be applied to stroke RSI because of differences between the stroke and TBI patient. To understand if the TBI evidence can be used for stroke RSI, we analysed a retrospective cohort of TBI and strokes to compare how survival is impacted differently by RSI when comparing strokes and TBI.Methods: This study was a retrospective analysis of 10 years of in-hospital and out-of-hospital data for all stroke and TBI patients attended by Ambulance Victoria, Australia. Logistic regression predicted the survival for ischemic and haemorrhagic strokes as well as TBI. The constituents of RSI, such a medications, intubation success and time intervals were analysed against survival using interactions to asses if RSI impacts survival differently for strokes compared to TBI.Results: This analysis found significant interactions in the RSI-only group for age, number of intubation attempts, atropine, fentanyl, pulse rate and perhaps scene time and time- to-RSI. Such interactions imply that RSI impact survival differently for TBI versus strokes. Additionally, no significant difference in survival for TBI was found, with a - 0.7% lesser survival for RSI compared to no-RSI; OR 0.86 (95% CI 0.67 to 1.11; p = 0.25). Survival for haemorrhagic stroke was - 14.1% less for RSI versus no-RSI; OR 0.44 (95% CI 0.33 to 0.58; p = 0.01) and was - 4.3%; OR 0.67 (95% CI 0.49 to 0.91; p = 0.01) lesser for ischemic strokes.Conclusions: Rapid sequence intubation and related factors interact with stroke and TBI, which suggests that RSI effects stroke survival in a different way from TBI. If RSI impact survival differently for strokes compared to TBI, then perhaps the TBI evidence cannot be used for stroke RSI. [ABSTRACT FROM AUTHOR]

The use of crystal methamphetamine is a growing problem in Australia. Methamphetamine users can suffer adverse physical health effects, psychotic symptoms and methamphetamine-related aggressive behaviour. The increasing use and related harms of crystal methamphetamine is presenting serious problems for frontline emergency responders. A population-based retrospective analysis was undertaken of data collected by Ambulance Victoria describing crystal methamphetaminerelated events attended by ambulance across Victoria over six financial years from 2011/12 to 2016/17. Methamphetamine-related events attended by Victoria Ambulance paramedics significantly increased from 2011/12 to 2016/17, particularly in regional Victoria. The most frequent age group requiring ambulance attendance is 25–39 years. The proportion of events requiring police coattendance significantly increased, as did transportation to emergency department/hospital. The substantial increases in methamphetamine-related events attended by ambulance indicate the need for increased resources and support for paramedics, particularly in regional/rural areas. The large increase among young people aged 15–24 years indicates a need for policy action on prevention, harm reduction and expanded treatment services to reduce health problems and methamphetamine-related harms. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to describe the in‐event, ambulance and ED impacts of patient presentations from an Australian mass gathering event (MGE) including patient demographics, provision of care, length of stay and discharge disposition. Methods: This research was set at one MGE in Australia. The MGE had one first aid post and one in‐event health team staffed by doctors, nurses and paramedics. A retrospective analysis of patient care records from providers of in‐event, ambulance and ED services was undertaken. Data analysis included descriptive and inferential statistics. Results: Of the 20 000 MGE participants, 197 (0.99% [95% CI 0.86–1.13], 9.85/1000) presented for in‐event first aid care, with 24/197 (12.2% [95% CI 8.33–17.49], 1.2/1000) referred to in‐event health professionals. Fifteen of the referred patients (62.5% [95% CI 42.71–78.84]) returned to the MGE following administration of intravenous fluids (n = 13) and/or anti‐emetics (n = 11). Seven (29.2% [95% CI 14.92–49.17], 0.35/1000) were referred to ambulance paramedic care, requiring endotracheal intubation (n = 1) and airway adjuncts (n = 3) prior to transportation to ED; these patients had an ED median length of stay of 7 h (5.5–12.5) receiving imaging and ventilator support. Five were discharged from ED, one required an operation and another required intensive care unit admission. Conclusions: There was an impact on in‐event, ambulance and ED services from this MGE but the in‐event model of care may have limited ambulance usage and ED visits. The ED length of stay was greater than the national median, perhaps reflecting the appropriateness of transport and nature of care requirements while in the ED. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Amiodarone is commonly used in the treatment of stable ventricular tachycardia (VT), but its efficacy has not been empirically examined in the prehospital setting. The objective of this study was to examine the safety and efficacy of amiodarone administered by paramedics to patients with stable VT. Methods: Patient records from Victoria, Australia between 1 May 2007 and 30 June 2017 were examined retrospectively. Patients attended by Ambulance Victoria with stable sustained VT who were administered amiodarone by paramedics as the initial treatment were included. Data were used to determine the prevalence of treatment with amiodarone, the incidence of VT termination prior to transfer of care, and the incidence of progression to electrical cardioversion. Results: Sixty‐one patients were identified who met the inclusion criteria. The mean age was 72 years (standard deviation = 14) with 77% (n = 47) being male. Of the patients treated with amiodarone, 52% (n = 32) reverted successfully during paramedic care while 48% (n = 29) did not. Two patients required cardioversion for haemodynamic instability after amiodarone administration. One patient experienced cardiac arrest after receiving amiodarone and was successfully resuscitated by paramedics. Conclusions: Approximately half of the patients treated with amiodarone reverted from VT while under paramedic care. Patient deterioration was rare, with cardiac arrest or requirement for cardioversion occurring very infrequently. Amiodarone was relatively safe and moderately effective for the treatment of sustained stable VT. However, given recent evidence of increased efficacy of procainamide for stable VT, further studies are required in the prehospital setting to compare these two drugs. [ABSTRACT FROM AUTHOR]

Paramedic practice is rapidly changing due to the ongoing pressures on health care systems. Paramedics are increasingly being integrated into primary health care roles, initiating interventions on scene and autonomously making clinical judgements based on operational guidelines. Evolving professional standards have resulted in the advancement of clinical skills, degree-based education and paramedic registration. This expanding professional profile of paramedics in the civilian health system is not being reflected in defence career options. New roles for paramedics in the Australian Defence Force (ADF) could be based on Physician Assistant and Emergency Care Practitioner roles implemented in the United States and United Kingdom respectively. While this would require organisational change, it does not replace the need for medics or medical and nursing officers. Ultimately, the aim is to find a best-fit role that recognises paramedic education, skill and experience to the equivalence of other health services roles. [ABSTRACT FROM AUTHOR]

Background Patients arriving at the Emergency Department (ED) via ambulance can experience a delay in receiving definitive care. In Australia, this phenomenon is referred to as ‘Ambulance Ramping’, ‘Patient Off Stretcher Time Delay’ or ‘Offload Delay’. As a direct consequence of crowding, and in the context of a worldwide increase in ED and ambulance usage, hospital and ambulance service function is hampered. The aim of this review was to synthesize the literature with respect to the conceptualisation, meaning, antecedents and consequences of Ambulance Ramping. Methods This was a scoping review and synthesis of the literature. Six search terms were employed: emergency medical technician; paramedic; ambulance; hospital emergency services; delay; and ambulance ramping. Journal articles that discussed Ambulance Ramping (or similar terms), and were published in English between 1983 and March 2015 were included. PubMed and CINAHL Plus databases were searched, with secondary searches of reference lists and grey literature also undertaken. Results Thirteen papers were selected and inform this review. Several terms are used internationally to describe phenomena similar to Ambulance Ramping, where there is a delay in patient handover from paramedics to ED clinicians. Antecedents of Ambulance Ramping included reduction/limitation of ambulance diversion, patient acuity, the time of day, the day of the week, insufficient ED staff, insufficient ED beds, and high ED workload. Consequences of Ambulance Ramping include: further delays in patients’ ability to receive definitive care and workforce stressors such as missed meal breaks, sick leave and staff attrition. Conclusion While the existing research literature indicates that Ambulance Ramping is problematic, little is known about the patient’s experience of Ambulance Ramping; this is required so that an enhanced understanding of its implications, including those for emergency nurses, can be identified. [ABSTRACT FROM AUTHOR]

Background: Intimate partner violence (IPV) refers to abuse transpiring between people in an intimate relationship. Intimate partner violence is a leading cause of morbidity and mortality for women that paramedics frequently report encountering and yet paramedics rarely receive formal education or training to manage. The response of paramedics to IPV is likely to be directed by their individual knowledge, attitudes, and preparedness; all of which are currently unknown. This study aimed to measure paramedic students' knowledge, attitudes, and preparedness tomanage IPV patients, and provides baseline data to inform the development of contemporary curricula. Methods: We surveyed a cohort of paramedic students from two Australian universities using the Modified Physician REadiness to Manage Intimate partner violence Survey (PREMIS). Internal consistency of previously identified scales was calculated and multiple linear regression was used to measure the association between previous training, knowledge, attitudes, and preparation. Results: We received 260 surveys (80.5% response rate). Results show that actual knowledge, perceived knowledge, and preparedness to manage IPV patients were low. Students with previous training reported higher perceived knowledge (p < .05) and preparedness (p < .01). Participants reported low self-efficacy, confidence, and preparation to manage IPV patients and demonstrated mostly neutral attitudes toward women and patients. Conclusions: Results indicate students require increased IPV education. Education should improve knowledge and preparedness to recognize and refer IPV patients, as well as change neutral and inappropriate attitudes. Incorporating such education and training into the paramedic curricula may improve the preparedness of practitioners, resulting in an improved response to IPV patients. [ABSTRACT FROM AUTHOR]

The transition of the Australian paramedic discipline from vocation education and training to the higher education sector has seen a sharp rise in interest in near-peer teaching (NPT). The objective of this study was to examine satisfaction levels of NPT over one academic semester among undergraduate paramedic students. A repeated measured design was used to investigate NPT and learning among paramedic students at Monash University. A total of 111 students participated in the study:n = 25 near-peer teachers andn = 86 near-peer learners. Near-peer learners perceived feedback from their peers to be more honest, realistic, helpful than from the instructor (beforeM = 3.07 vs. afterM = 2.69,p = .01), while near-peer teachers believed that paramedics have a professional responsibility to teach students (beforeM = 2.00 vs. afterM = 1.16,p = .001). These results in conjunction with wider literature suggest that NPT should be considered for implementation into the existing paramedic higher education curricula. [ABSTRACT FROM AUTHOR]

Background: Peripheral intravenous catheters (PIVCs) are widely used within healthcare settings. There is substantial hospital-based research, particularly in Emergency Departments, supporting the need to reduce inappropriate PIVCs due to associated risks. However, there is limited research into pre-hospital practice. This review aims to determine the rates of pre-hospital PIVC insertions, how many remain unused, and to explore paramedic PIVC decision-making., Methods: A systematic search of research databases was undertaken using an integrative review methodology. Articles published between 2011 and April 2022 were included. The Mixed Methods Appraisal Tool was used to assess the quality of the studies., Results: Fifteen studies were included. Rates of PIVC insertions ranged from 21% to 58%. Up to 72% of PIVCs remained unused in the pre-hospital setting. Paramedic decision-making was not well reported, though erring of the side of caution and inserting a "just in case" PIVC was identified., Conclusion: There are limited articles on pre-hospital PIVC practice, particularly in Australian settings. Research is required to understand factors influencing practice and provide contemporary evidence to inform the development of guidance specific to the pre-hospital setting to reduce the numbers of inappropriate PIVCs., (Crown Copyright © 2023. Published by Elsevier Ltd. All rights reserved.)

Objective:This study aims to determine the number and reasons for emergency paramedic attendances to older adults in Victoria, Australia. A second aim is to investigate the prevalence of psychosocial factors that may contribute to older patients requiring emergency paramedic attendance.Methods:This descriptive retrospective study analyzed all emergency paramedic attendances to patients aged 65 or older between July 1, 2011 and June 30, 2014 in Victoria, Australia. Fully de-identified data were extracted from the Ambulance Victoria Data Warehouse. Data included demographic and clinical variables such as age, gender, case nature (cause), past history, management and transportation, paramedic final assessment (diagnosis), social situation, past history; as well as free text case descriptions.Results:A total of 596,579 patients 65 years or older were attended by emergency paramedics during the study period. This accounted for 24.1% of Ambulance Victoria workload during that period. The mean (SD) age of patients was 79.8(8.2). The majority (70.7%) of cases involved patients at private residences. The most common final assessments were pain (18.7%), cardiac problem (7.2%), infection (6.9%), trauma (6.7%), other/unknown (6.4%), and respiratory problem (5.7%). The vast majority of patients were transported to hospital (82.8%). Psychosocial issues were evident in the free text case descriptions of more than 91,000 cases.Conclusion:Paramedics attended almost 600,000 patients 65 years and older during the study period. Patients suffered from conditions including, pain, trauma, infections, cardiac complaints, and respiratory problems. Free text case descriptions provided more detail and insight into the reasons for emergency paramedic attendance. Psychosocial problems were far more prevalent than indicated by the “final assessment” field. Further research is required to determine the reasons and implications of this. [ABSTRACT FROM PUBLISHER]

Objective The present study aimed to describe and examine similarities and differences in the current service provision and resuscitation protocols of the ambulance services participating in the Aus- ROC Australian and New Zealand out-of-hospital cardiac arrest ( OHCA) Epistry. Understanding these similarities and differences is important in identifying ambulance service factors that might explain regional variation in survival of OHCA in the Aus- ROC Epistry. Methods A structured questionnaire was completed by each of the ambulance services participating in the Aus- ROC Epistry. These ambulance services were SA Ambulance Service, Ambulance Victoria, St John Ambulance Western Australia, Queensland Ambulance Service, St John Ambulance NT, St John New Zealand and Wellington Free Ambulance. The survey aimed to describe ambulance service and dispatch characteristics, resuscitation protocols and details of cardiac arrest registries. Results We observed similarities between services with respect to the treatment of OHCA and dispatch systems. Differences between services were observed in the serviced population; the proportion of paramedics with basic life support, advanced life support or intensive care training skills; the number of OHCA cases attended; guidelines related to withholding or terminating resuscitation attempts; and the variables that might be used to define 'attempted resuscitation'. All seven participating ambulance services were noted to have existing OHCA registries. Conclusion There is marked variation between ambulance services currently participating in the Aus- ROC Australian and New Zealand OHCA Epistry with respect to workforce characteristics and key variable definitions. This variation between ambulance services might account for a proportion of the regional variation in survival of OHCA. [ABSTRACT FROM AUTHOR]

Objective: To report on clinical and socio-demographic factors of a one-year caseload of women attended by a statewide ambulance service in Australia, who presented during pregnancy, prior to the commencement of labor. Methods: Retrospective clinical data collected via in-field electronic patient care record (VACIS®) by paramedics during clinical management was provided by Ambulance Victoria. Cases were electronically extracted from the Ambulance Victoria Clinical Data Warehouse via comprehensive filtering followed by case review. Results: Over a 12-month period, paramedics were called to 2,098 women with pregnancy as a primary or non-primary clinical consideration. Women's ages ranged from 14 to 48 years. The majority were multigravidas (86%). There was a greater chance that ambulance services would be required during business hours than any other time of the day. Paramedics noted pregnant women required ambulance services for a range of primary presenting symptoms both obstetric (n = 1137) and non-obstetric (n = 961). Some women had pre-existing conditions including asthma, hypertension, and diabetes potentially complicating their pregnancies. Paramedics administered analgesia to one third of the women. Paired t-tests revealed significant improvement in the pain relief and overall vital signs of the women encountered. Less than half the women (n = 986, 47%) required interventions. Conclusions: This is a unique population wide analysis of ambulance service resource use exploring the clinical profile of pregnant women requiring ambulance services in one calendar year. To manage obstetric and non-obstetric complications in this population safely and effectively, paramedics require an understanding of the unique physiological adaptions during pregnancy. This study therefore has both educational and practice implications. [ABSTRACT FROM AUTHOR]

Chaplains are embedded in several ambulance services across Australia, however as Australia's religiosity is currently in decline and questions are being asked about retaining chaplains, little is actually known about their role and value within Ambulance services. The aim of this paper is to present the key findings from interviews with chaplains about their role and value of being ambulance chaplains. These findings are then compared with those of paramedics derived from an earlier phase of this study. Thirteen chaplains participated in semi-structured interviews, and data were analysed using framework analysis. The results indicated that ambulance chaplains provided paramedic-centred emotional and spiritual care through proactively and reactively supporting paramedics in their work. Chaplains saw value in their relational approach which facilitated trust and access, did not seek to 'fix' or diagnose but instead offered physical and emotional presence, and promoted supportive conversations. Chaplains and paramedics valued operationally trained and equipped ambulance chaplains who provided a relational, around the clock, 'frontline' staff support presence in paramedic workplaces, regardless of the paramedic's personal religious/spiritual beliefs., (© 2022. The Author(s).)

Paramedic education has been undergoing major development in Australia in the past 20 years, with many different educational programmes being developed across all Australian jurisdictions. This paper aims to review the current paramedic education programmes in Australia to identify the similarities and differences between the programmes, and the strengths and challenges in these programmes. A literature search was performed using six scientific databases to identify any systematic reviews, literature reviews or relevant articles on the topic. Additional searches included journal articles and text references from 1995 to 2011. The search was conducted during December 2010 and November 2011. Included in this review are a total of 28 articles, which are focused around five major issues in paramedic education: (i) principle on paramedic programmes and the involvement of industry partners; (ii) clinical placements; (iii) contemporary methods of education; (iv) needs for specific programmes within paramedic education; and (v) articles related to the accreditation process for paramedic programmes. Paramedic programmes across Australian universities vary with many different practices, especially relating to clinical placements in the field. The further advances of the paramedic education programmes should aim to respond to population change and industry development, which would enhance the paramedic profession across Australia. [ABSTRACT FROM AUTHOR]

Background: Palliative care is an emerging scope of practice for paramedicine. The COVID-19 pandemic has highlighted the opportunity for emergency settings to deliver palliative and end-of-life care to patients wishing to avoid intensive life-sustaining treatment. However, a gap remains in understanding the scope and limitations of current ambulance services' approach to palliative and end-of-life care., Aim: To examine the quality and content of existing Australian palliative paramedicine guidelines with a sample of guidelines from comparable Anglo-American ambulance services., Design: We appraised guideline quality using the AGREE II instrument and employed a collaborative qualitative approach to analyse the content of the guidelines., Data Sources: Eight palliative care ambulance service clinical practice guidelines (five Australian; one New Zealand; one Canadian; one United Kingdom)., Results: None of the guidelines were recommended by both appraisers for use based on the outcomes of all AGREE II evaluations. Scaled individual domain percentage scores varied across the guidelines: scope and purpose (8%-92%), stakeholder involvement (14%-53%), rigour of development (0%-20%), clarity of presentation (39%-92%), applicability (2%-38%) and editorial independence (0%-38%). Six themes were developed from the content analysis: (1) audience and approach; (2) communication is key; (3) assessing and managing symptoms; (4) looking beyond pharmaceuticals; (5) seeking support; and (6) care after death., Conclusions: It is important that ambulance services' palliative and end-of-life care guidelines are evidence-based and fit for purpose. Future research should explore the experiences and perspectives of key palliative paramedicine stakeholders. Future guidelines should consider emerging evidence and be methodologically guided by AGREE II criteria.

This study identifies the factors associated with the successful integration of ambulance volunteers and first responders into major ambulance services in Australia and New Zealand and then proposes a model of volunteer management for ambulance services. All ten members of the Australasian Council of Ambulance Authorities completed a questionnaire describing their volunteer and first-responder staff, their numbers and deployment, and the management and integration of volunteers within their respective organisations. Eight senior managers responsible for ambulance volunteers and first responders from six States of Australia and one region of New Zealand subsequently participated in semistructured interviews. Analysis of interview transcripts and publicly available data revealed facilitative factors associated with strong, vibrant ambulance volunteer systems. These facilitative factors are commitment to volunteer models of service delivery; a degree of management decentralisation and volunteer input into decision-making; commitment of resources towards the volunteer model; and the organisational integration of volunteers into the ambulance service. The proposed facilitative model of volunteer management developed aims to encourage the adoption of positive and innovative strategies to improve the integration of ambulance volunteers and first responders in ambulance services. The model consists of four components: leadership; integrative processes; resource commitment; and relative autonomy. The first three of these relate directly to the organisation, while the fourth concerns the volunteers themselves. If these approaches were replicated more widely, a viable and effective volunteer emergency health response system could be established in those areas where it is uneconomic or impractical to provide a salaried ambulance service staffed with professionally qualified paramedics. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: In Germany, physician-operated emergency medical services (EMS) manage most pre-hospital trauma care. Australia uses a different EMS system, deploying highly trained paramedics for road and air transport of trauma patients. The effect of these different systems on secondary insults to traumatic brain injury (TBI) patients is unclear. There is conflicting evidence regarding which system is preferable. To add to the body of evidence, we compared the profile of injury, pre-hospital management and outcomes of TBI patients from both populations. Methods: Cases aged ≥16 years, with AIS head ≥3, AIS other body parts ≤3, recorded in the Victorian State Trauma Registry (VSTR) and Trauma Registry of the German Society of Trauma Surgery (TR-DGU) from 2002 to 2007 were compared. Results: 10,183 cases (5665 German, 4518 Australian) were included. No difference in sex or median age was observed. There were major between-registry differences in type of injury, trauma circumstance, intent and severity of injury. German cases sustained more serious injury and received more pre-hospital interventions. Mortality was significantly higher amongst German patients even when adjusted for demographics, injury severity and in- and pre-hospital parameters. German patients had a longer hospital and ICU stay. Conclusion: There were clear differences in injury characteristics and outcomes in TBI patients between Germany and Australia. As differences in coding, data collection and patient selection are evident, firm conclusions regarding the contribution of variations in pre-hospital care are not possible. The differences in outcome deserve further exploration in prospective studies. [ABSTRACT FROM AUTHOR]

Chaplains are employed by ambulance services in many states across Australia as one element in a suite of initiatives to support the health and wellness of paramedics. The aim of this paper is to present key findings from a study that explored paramedic perspectives on the role and value of chaplains in the ambulance service. Seventeen paramedics participated in semi-structured interviews. Data were analysed using framework analysis. Two themes were identified: scope of the chaplain's role and organisational factors influencing the chaplain's role. Paramedics highly valued what they believed to be proactive and reactive support provided by ambulance chaplains, regardless of paramedics' personal spiritual or religious beliefs., (© 2021. The Author(s).)

Introduction: We report an experiment using Australian paramedics (n = 64) and Australian paramedicine undergraduates (n = 44), on the processes underlying the formation of an intuitive diagnostic impression, based on limited dispatch information. Previous research has signalled roles for objective likelihood of the disease, subjective typicality of the disease, and the ease with which the diagnosis comes to mind (answer fluency) as important in impression formation., Method: Participants completed four brief written clinical vignettes under time pressure and with a concurrent navigation task to simulate conditions faced by paramedics prior to meeting a patient. Diagnostic impression, confidence and subjective typicality of the vignette were self-reported while answer fluency was measured. The vignettes varied the objective likelihood of a diagnosis of Acute Coronary Syndrome (ACS), a condition often encountered by paramedics., Results: Likelihood, answer fluency, self-reported typicality and confidence predicted the impression but there was no effect of experience. Students and experienced paramedics had comparable accuracy and performance., Conclusion: The results support a role for answer fluency and confidence in forming that impression. We have shown it is possible to experimentally manipulate various factors associated with paramedic diagnostic impressions. These experimental methods can form the basis for additional studies into paramedic decision making., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objective: To determine the adequacy of cool running water first aid provided by healthcare professionals in the early management of children with thermal burn injuries., Methods: A cross-sectional study was undertaken using a prospectively collected registry of children who presented with a thermal burn to the only major paediatric burns centre in Queensland, Australia, from January 2013 to December 2018. Main outcome measures included the type and duration of first aid administered by paramedics, general practitioners and emergency providers at local general hospitals and a children's hospital. In accordance with current Australian guidelines, adequate cooling was defined as 20 min of cool running water within 3 h of the injury., Results: Of the 4537 children who presented to the paediatric burns centre, 3261 (71.9%) received adequate first aid, including 1502 (33.1%) at the scene of injury. Paramedics and general practitioners administered adequate cooling to 184 (25.0%) and 52 (24.2%) of their patients, respectively. ED clinicians adhered to guidelines in the treatment of 1019 (56.3%) children at general hospitals and 411 (76.0%) at the children's hospital. Among ED patients who presented with incomplete prior first aid, the risk of inadequate cooling was significantly greater for those transported via ambulance (P < 0.001)., Conclusion: Deficiencies remain in the cooling of paediatric burns patients at all levels of initial management. There is a need in the healthcare community for improved education regarding the parameters and clinical benefits of cool running water first aid., (© 2020 The Authors. Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College for Emergency Medicine.)

Mental-health-related presentations account for a considerable proportion of the paramedic's workload in prehospital care. This cross-sectional study aimed to examine the perceived confidence and preparedness of paramedics in Australian metropolitan and rural areas to manage mental-health-related presentations. Overall, 1140 paramedics were surveyed. Pearson chi-square and Fisher exact tests were used to compare categorical variables by sex and location of practice; continuous variables were compared using the non-parametric Mann-Whitney and Kruskal-Wallis tests. Perceived confidence and preparedness were each modelled in multivariable ordinal regressions. Female paramedics were younger with higher qualifications but were less experienced than their male counterparts. Compared to paramedics working in metropolitan regions, those working in rural and regional areas were generally older with fewer qualifications and were significantly less confident and less prepared to manage mental health presentations ( p = 0.001). Compared to male paramedics, females were less confident ( p = 0.003), although equally prepared ( p = 0.1) to manage mental health presentations. These results suggest that higher qualifications from the tertiary sector may not be adequately preparing paramedics to manage mental health presentations, which signifies a disparity between education provided and workforce preparedness. Further work is required to address the education and training requirements of paramedics in regional and rural areas to increase confidence and preparedness in managing mental health presentations.

Objectives: Disasters place unprecedented demands on emergency medical services and can test paramedics personal commitment as health care professionals. Despite this challenge, guidelines and codes of ethics are largely silent on the issue, providing little to no guidance on what is expected of paramedics or how they ought to approach their duty to treat in the face of risk. The objective of this research is to explore how paramedics view their duty to treat during disasters., Methods: The authors employed qualitative methods to gather Australian paramedic perspectives., Results: Our findings suggest that paramedic decisions around duty to treat will largely depend on individual perception of risk and competing obligations. A code of ethics for paramedics would be useful, but ultimately each paramedic will interpret these suggested guidelines based on individual values and the situational context., Conclusions: Coming to an understanding of the legal issues involved and the ethical-social expectations in advance of a disaster may assist paramedics to respond willingly and appropriately. (Disaster Med Public Health Preparedness. 2019;13:191-196).

Background: Paramedics are required to provide care to an aging population with multidimensional and complex issues. As such educators need to prepare undergraduate paramedics to recognise, assess and manage a broad range of psychosocial care and support issues beyond somatic conditions. Experiential educational interventions with older people provide realistic and contextualised experience which can improve the provision of holistic patient focused care., Methods: This was a single institution controlled before-after study with parallel groups, conducted in Australia in 2017. It was designed to compare the effectiveness of an educational program related to older people (intervention), verses no intervention (control) on paramedic student attitudes, knowledge and behavior with older patients., Results: A total of 124 second year paramedic students were included in this study; 60 in the intervention and 64 in the control group. Their demographics and Time 1 baseline results were homogeneous. Both groups showed improvement in communication skills with real older patients (p < 0.001, η 2  = 0.41) and (p < 0.001, η 2  = 0.35). The intervention group showed greater improvements in the 'understands the patient's perspective' element for both the self-assessment (p < 0.001) and the clinician assessment (p = 0.01). Multiple linear regression Model 1 found gender (β = - 0.25; p = 0.01) was the best predictor of clinician-assessed communication, with females having higher scores. Knowledge and attitudes remained relatively unchanged for both groups., Conclusions: As the first study to observe, measure and report on the interpersonal communication skills of paramedic student's with 'real' older patients we can report that these skills were from fair to good at baseline and improved from good to very good post the intervention. Overall improvement was notably better in the 'understanding the patients perspective element' for the intervention group who had conducted one-one visits with an older person.

This study explored the self-reported behaviors and perceptions of Australian paramedics in relation to their environmental hygiene practices. A national online survey was conducted with Paramedics Australasia members (N = 417). Participants reported working in ambulances often contaminated with body fluids. Widespread noncompliance with routine and deep cleaning of ambulances, and misunderstandings about environmental hygiene practices were apparent. Improvements to environmental hygiene practices of Australian paramedics are recommended to avoid pathogen transmission and ensure patient safety., (Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Intimate partner violence (IPV) is a common occurrence in Australian society and has far reaching health, social and economic impacts, particularly for females who are the most common victims. It is theorised that paramedics frequently encounter IPV in the field and in some cases are the only agency which deal with IPV victims in the out-of-hospital setting. Thus paramedics have a unique opportunity to increase discovery, treatment and reporting, however there is little formal training in managing IPV for most Australian paramedics. We evaluated the level of basic knowledge as well as self-reported preparedness and frequency of encountering IPV in a selection of 50 Australian paramedics using a cross-sectional descriptive study design with a paper-based questionnaire. Ninety percent of the paramedics reported encountering at least 1 case of suspected IPV in the last year, with the average number of cases being 3.66. Only 22% reported that they felt confident managing IPV cases. Sixty six percent of participants were unaware there is no mandatory reporting of IPV in their region. The vast majority of participants stated that they felt additional education and training would be most helpful to improving their ability to manage IPV cases. Participants had a poor knowledge and poor preparedness for IPV prior to undertaking a targeted education session. There is an urgent need for additional research of the needs and best methods to educate and train paramedics to appropriately respond to IPV cases., (Copyright © 2014 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)

Role dissonance is an uncomfortable experience for graduate paramedics, and some blame their university education for the problem. For paramedics the conflict is between identifying as a rescuer and acting largely as a care giver. With vocational pathways into so many uniformed professions closing down in preference for graduate entrants, young new professionals have to negotiate a rapidly changing work culture. Their older colleagues may be challenged and threatened by the new order. For paramedics the problem is compounded by the newness of its place in the tertiary landscape. Since 9/11 young people have been increasingly attracted to rescue roles. Yet in Australia there is increasing need and scope for health workers in remote and aging populations, a preference not immediately attractive to young people hoping for a more heroic future. While the near professions such as nursing have established their discourses around culture, role and pedagogy, paramedics is still trying to chisel its identity. The myths of paramedic glories past tend to add to the confusion of graduates. Due to a lack of empirical studies of non-clinical aspects of paramedicine, a bricolage methodology was used to refresh data from two discrete qualitative research projects conducted in 2011. Both projects had originally been interested in optimal paramedic preceptorship before and after graduation, but neither had explored the implicit theme which revealed the role of rescue experiences in paramedic culture and identity. The bricolage included a new search of literature from near professions and applied new theoretical frameworks to the analysis of the extant data, to demonstrate how storytelling as an element of paramedic collegiality perpetuates rescue stories that are then used to define paramedic work., (Copyright © 2014 Elsevier Ltd. All rights reserved.)