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Objective: To profile the initial 6‐month experience at the Victorian Heart Hospital (VHH) cardiac emergency (CE). The primary objective was to describe VHH CE patient characteristics, including presenting complaint, final diagnosis and disposition. Secondary objectives were to report on patient numbers, patient source and quality indicator performance including ambulance off‐load by 40 min, waiting time and length of stay (LOS). Methods: A retrospective review included all patients who presented to the VHH CE from 9 March 2023 to 8 September 2023. Patient reports containing the relevant clinical information were generated from the CE electronic medical record system. Diagnoses of MI were checked for accuracy by full record review. Results: There were 3303 CE presentations in the first 6 months of operation, of which 6% were transferred from other sites. Median age was 65 years (interquartile range [IQR]: 53–77), 56% were males; the most common presenting complaints were presumed cardiac chest pain (67%) and arrhythmia (17%). The admission, discharge and transfer rates were 38%, 54% and 8%, respectively. In total, 15% were diagnosed with MI. The most common diagnoses for discharged and admitted patients were non‐specific chest pain (57%) and ST‐elevation MI (22%), respectively. Ambulance off‐load by 40 min was met for 96%. Median waiting time was 6 min (IQR: 3–10). Median CE LOS for discharged and admitted patients was 3.2 h (IQR: 2.5–4.0) and 3.7 h (IQR: 1.8–6.0), with 75% and 56% being <4 h, respectively. Conclusions: The population predominantly had cardiovascular disease as expected. Some performance indicators, including ED LOS, were identified as requiring intervention. [ABSTRACT FROM AUTHOR]

Objective: Many patients who are attended by paramedics do not require conveyance to an emergency department (ED). Our study focuses on comparing the characteristics and outcomes of patients who were advised to follow up with a general practitioner (GP) by an attending paramedic with those of patients who were discharged at scene or transported to hospital. Methods: This was a retrospective data linkage cohort study of ambulance, ED, hospital admission, and death records for all adults attended by paramedics in Victoria, Australia between the 1st of January 2015 and 30th of June 2019. Patients were excluded if they presented in cardiac arrest, resided in a residential aged care facility, or were receiving palliative care services. Outcomes of interest included reattendance by ambulance, ED presentation; and, a high acuity outcome which we defined as a patient who (1) presented to ED and received an Australasian Triage Scale of category 1 (Resuscitation) or 2 (Emergency) AND was admitted to a ward OR (2) was admitted to an Intensive Care Unit, Coronary Care Unit or Catheter laboratory (regardless of triage category) OR (3) died. Outcomes of interest were considered within 48-h of initial EMS attendance. Results: A total of 1,777,950 cases were included in the study of which 3.1% were referred to a GP, 9.0% were discharged at scene without a follow-up recommendation, and 87.9% were transported to hospital. Patients referred to a GP were more likely than those discharged at scene to subsequently present to an ED within 48 h of their attendance (5.3% vs 3.8%). However, GP referral was not associated with any change to high acuity outcome (0.3% vs 0.2%) or ambulance reattendance (6.0% vs 6.0%) compared to discharge at scene. The only factors that were associated with ambulance reattendance, ED presentation, and a high acuity outcome were male gender and elevated temperature. Conclusions: Despite increasing low and medium-acuity casework in this EMS system, paramedic referral to a GP is not common practice. Referring a patient to a GP did not reduce the likelihood of patients experiencing a high acuity outcome or recalling an ambulance within 48 h, suggesting opportunity exists to refine paramedic to GP referral practices. [ABSTRACT FROM AUTHOR]

Objective: The ambulance service in Victoria, Australia implemented a revised clinical response model (CRM) in 2016 which was designed to increase the diversion of low‐acuity Triple Zero (000) calls to secondary telephone triage and reduce emergency ambulance dispatches. The present study evaluates the influence of the revised CRM on emergency ambulance response times and ED presentations. Methods: A retrospective study of emergency calls for ambulance between 1 January 2015 and 31 December 2018. Ambulance data were linked with ED presentations occurring up to 48 h after contact. Interrupted time series analyses were used to evaluate the impact of the revised CRM. Results: A total of 2 365 529 calls were included. The proportion allocated a Code 1 (time‐critical, lights/sirens) dispatch decreased from 56.6 to 41.0% after implementation of the revised CRM. The proportion of calls not receiving an emergency ambulance increased from 10.4 to 19.6%. Interrupted time series analyses demonstrated an improvement in Code 1 cases attended within 15 min (Key Performance Indicator). However, for patients with out‐of‐hospital cardiac arrest or requiring lights and sirens transport to hospital, there was no improvement in response time performance. By the end of the study period, there was also no difference in the proportion of callers presenting to ED when compared with the estimated proportion assuming the revised CRM had not been implemented. Conclusion: The revised CRM was associated with improved Code 1 response time performance. However, there was no improvement in response times for high acuity patients, and no change in the proportion of callers presenting to ED. [ABSTRACT FROM AUTHOR]

Objective: Preventable transmission of blood‐borne viruses (BBV), including human immunodeficiency virus (HIV), hepatitis C virus (HCV) and hepatitis B virus (HBV), continue in at‐risk populations, including people who use alcohol and drugs (AODs). To our knowledge, no studies have explored the use of ambulance data for surveillance of AOD harms in patients with BBV infections. Methods: We used electronic patient care records from the National Ambulance Surveillance System for people who were attended by an ambulance in Victoria, Australia between July 2015 and July 2016 for AOD‐related harms, and with identified history of a BBV infection. Descriptive and geospatial analyses explored the epidemiological and psychosocial characteristics of patients for these attendances. Results: The present study included 1832 patients with a history of a BBV infection who required an ambulance for AOD‐related harms. Amphetamines were reported in 24.7% of attendances where the patient identified HIV history, and heroin was reported more often for patients with viral hepatitis history (HCV: 19.2%; HBV: 12.7%). Higher proportions of attendances with a viral hepatitis history were observed in patients from the most socially disadvantaged areas. Geospatial analyses revealed higher concentrations of AOD attendances with a BBV history occurring in metropolitan Melbourne. Conclusions: Our study describes the utility of ambulance data to identify a sub‐population of patients with a BBV history and complex medical and social characteristics. Repeat attendances of BBV history patients to paramedics could present an opportunity for ongoing surveillance using ambulance data and possible paramedic intervention, with potential linkage to appropriate BBV services. [ABSTRACT FROM AUTHOR]

Background and Aims: Public health measures introduced to contain the spread of the SARS‐CoV‐2 virus likely affected opioid supply and demand, as well as the patterns and contexts of opioid use. We measured opioid‐related harms during the first 2 years of COVID‐19 restrictions in Victoria, Australia. Design: We adopted an interrupted time series analysis design using interventional autoregressive integrated moving average (ARIMA) models. Opioid‐related ambulance attendance data between January 2015 and March 2022 were extracted from the National Ambulance Surveillance System. Setting: Victoria, Australia. Participants: Patients (≥15 years) attended to by an ambulance for opioid‐related harms. Measurements Monthly opioid‐related ambulance attendances for three drug types: heroin, prescription opioids and opioid agonist therapy (OAT) medications. Findings The monthly rate of heroin‐related attendances fell by 26% immediately after the introduction of COVID‐19 restrictions. A reduced rate of heroin‐related attendances was observed during COVID‐19 restrictions, resulting in 2578 averted heroin‐related attendances. There was no change in the rate of attendances for extra‐medical OAT medications or prescription opioids. Conclusions: Strict COVID‐19 restrictions in Victoria, Australia appear to have resulted in a substantial reduction in heroin‐related ambulance attendances, perhaps because of border closures and restrictions on movement affecting supply, changing patterns of drug consumption, and efforts to improve access to OAT. Despite policy changes allowing longer OAT prescriptions and an increased number of unsupervised doses, we found no evidence of increased harms related to the extra‐medical use of these medications. [ABSTRACT FROM AUTHOR]

Objectives: Emergency intubation in children is an infrequent procedure both in the pre‐hospital and hospital setting. The anatomical, physiological and situational challenges together with limited clinician exposure can make this a difficult procedure with high risk of adverse events. The aim of this collaborative study between a state‐wide ambulance service and a tertiary children's hospital was to describe the characteristics of pre‐hospital paediatric intubations by Intensive Care Paramedics. Methods: We conducted a retrospective review of state‐wide ambulance service electronic patient care records (ePCRs) in Victoria, Australia, population: 6.5 million. Children aged 0–18 years who were attended by paramedics over a 12‐month period that required advanced airway management were analysed for demographics and first‐pass success rate. Results: Paramedics attended 2674 cases aged 0–18 years over the 12‐month study period who received basic or advanced airway management. A total of 78 cases required advanced airway management. The median age of patients was 12 years (interquartile range 3–16) and most were male (60.2%). Sixty‐eight patients (87.5%) were intubated successfully on the first attempt, first‐pass success was lowest in children <1 year of age. The most common indications for pre‐hospital intubation were closed head injury and cardiac arrest. It was not possible to report complication rates because of incomplete documentation. Conclusion: Pre‐hospital intubation in children is performed infrequently in an extremely unwell patient group. Continued high‐level paramedic training is required to prevent adverse events and ensure patient safety. [ABSTRACT FROM AUTHOR]

The introduction of long‐acting injectable buprenorphine preparations for opioid use disorder has been widely heralded as a breakthrough treatment, with several studies indicating positive results when using these medications. In many locations, nurse practitioners prescribe, administer, and monitor long‐acting injectable preparations. The objective of this paper is to explore whether a reduction in dispensed needles and syringes is attributable to increased nurse practitioner prescribing of LAIB. We used a retrospective audit of needles dispensed through the health service needle and syringe program vending machine, and individuals treated with long‐acting injectable buprenorphine by the nurse practitioner led model. In addition, we examined potential factors that may influence changes in the number of needles dispensed. Linear regression found that each individual with opioid dependence treated with long‐acting injectable buprenorphine was associated with 90 fewer needles dispensed each month (p < 0.001). The nurse practitioner led model of care for individuals with opioid dependence appears to have influenced the number of needles dispensed at the needle and syringe program. Although all confounding factors could not be discounted entirely, such as substance availability, affordability, and individuals obtaining injecting equipment elsewhere, our research indicates that a nurse practitioner led model of treating individuals with opioid use disorder influenced needle and syringe dispensing in the study setting. [ABSTRACT FROM AUTHOR]

Previous studies examining temporal variations in cardiovascular care have largely been limited to assessing weekend and after-hours effects. We aimed to determine whether more complex temporal variation patterns might exist in chest pain care. This was a population-based study of consecutive adult patients attended by emergency medical services (EMS) for non-traumatic chest pain without ST elevation in Victoria, Australia between 1 January 2015 and 30 June 2019. Multivariable models were used to assess whether time of day and week stratified into 168 hourly time periods was associated with care processes and outcomes. There were 196,365 EMS chest pain attendances; mean age 62.4 years (standard deviation [SD] 18.3) and 51% females. Presentations demonstrated a diurnal pattern, a Monday–Sunday gradient (Monday peak) and a reverse weekend effect (lower rates on weekends). Five temporal patterns were observed for care quality and process measures, including a diurnal pattern (longer emergency department [ED] length of stay), an after-hours pattern (lower angiography or transfer for myocardial infarction, pre-hospital aspirin administration), a weekend effect (shorter ED clinician review, shorter EMS off-load time), an afternoon/evening peak period pattern (longer ED clinician review, longer EMS off-load time) and a Monday–Sunday gradient (ED clinician review, EMS offload time). Risk of 30-day mortality was associated with weekend presentation (Odds ratio [OR] 1.15, p=0.001) and morning presentation (OR 1.17, p<0.001) while risk of 30-day EMS reattendance was associated with peak period (OR 1.16, p<0.001) and weekend presentation (OR 1.07, p<0.001). Chest pain care demonstrates complex temporal variation beyond the already established weekend and after-hours effect. Such relationships should be considered during resource allocation and quality improvement programs to improve care across all days and times of the week. [ABSTRACT FROM AUTHOR]

Objectives: To assess the mental health and wellbeing of health and aged care workers in Australia during the second and third years of the coronavirus disease 2019 (COVID‐19) pandemic, overall and by occupation group. Design, setting, participants: Longitudinal cohort study of health and aged care workers (ambulance, hospitals, primary care, residential aged care) in Victoria: May–July 2021 (survey 1), October–December 2021 (survey 2), and May–June 2022 (survey 3). Main outcome measures: Proportions of respondents (adjusted for age, gender, socio‐economic status) reporting moderate to severe symptoms of depression (Patient Health Questionnaire‐9, PHQ‐9), anxiety (Generalized Anxiety Disorder scale, GAD‐7), or post‐traumatic stress (Impact of Event Scale‐6, IES‐6), burnout (abbreviated Maslach Burnout Inventory, aMBI), or high optimism (10‐point visual analogue scale); mean scores (adjusted for age, gender, socio‐economic status) for wellbeing (Personal Wellbeing Index–Adult, PWI‐A) and resilience (Connor Davidson Resilience Scale 2, CD‐RISC‐2). Results: A total of 1667 people responded to at least one survey (survey 1, 989; survey 2, 1153; survey 3, 993; response rate, 3.3%). Overall, 1211 survey responses were from women (72.6%); most respondents were hospital workers (1289, 77.3%) or ambulance staff (315, 18.9%). The adjusted proportions of respondents who reported moderate to severe symptoms of depression (survey 1, 16.4%; survey 2, 22.6%; survey 3, 19.2%), anxiety (survey 1, 8.8%; survey 2, 16.0%; survey 3, 11.0%), or post‐traumatic stress (survey 1, 14.6%; survey 2, 35.1%; survey 3, 14.9%) were each largest for survey 2. The adjusted proportions of participants who reported moderate to severe symptoms of burnout were higher in surveys 2 and 3 than in survey 1, and the proportions who reported high optimism were smaller in surveys 2 and 3 than in survey 1. Adjusted mean scores for wellbeing and resilience were similar at surveys 2 and 3 and lower than at survey 1. The magnitude but not the patterns of change differed by occupation group. Conclusion: Burnout was more frequently reported and mean wellbeing and resilience scores were lower in mid‐2022 than in mid‐2021 for Victorian health and aged care workers who participated in our study. Evidence‐based mental health and wellbeing programs for workers in health care organisations are needed. Trial registration: Australian New Zealand Clinical Trials Registry: ACTRN12621000533897 (observational study; retrospective). [ABSTRACT FROM AUTHOR]

Rationale: Mobile stroke units (MSUs) are increasingly being implemented to provide acute stroke care in the prehospital environment, but a comprehensive implementation evaluation has not been undertaken. Aim: To identify successes and challenges in the pre‐ and initial operations of the first Australian MSU service from an interdisciplinary perspective. Methods: Process evaluation of the Melbourne MSU with a mixed‐methods design. Purposive sampling targeted key stakeholder groups. Online surveys (administered June–September 2019) and semistructured interviews (October–November 2019) explored experiences. Directed content analysis (raters' agreement 85%) and thematic analysis results are presented using the Interactive Sociotechnical Analysis framework. Results: Participants representing executive/program operations, MSU clinicians and hospital‐based clinicians completed 135 surveys and 38 interviews. Results converged, with major themes addressing successes and challenges: stakeholders, vehicle, knowledge, training/education, communication, work processes and working relationships. Conclusions: Successes and challenges of establishing a new MSU service extend beyond technical, to include operational and social aspects across prehospital and hospital environments. [ABSTRACT FROM AUTHOR]

Objectives: There are currently limited data to inform the management of patients transported by emergency medical services (EMS) with dyspnoea. We aimed to describe the incidence, aetiology and outcomes of patients transported by EMS for dyspnoea using a large population-based sample and to identify factors associated with 30-day mortality. Methods: Consecutive EMS attendances for dyspnoea in Victoria, Australia from January 2015 to June 2019 were included. Data were individually linked to hospital and mortality records to determine incidence, diagnoses, and outcomes. Factors associated with 30-day mortality were assessed usingmultivariable logistic regression. Results: During the study period, there were 2 505 324 cases attended by EMS, of whom 346 228 (14%) met inclusion criteria for dyspnoea. The incidence of EMS attendances for dyspnoea was 1566 per 100 000 person-years, and was higher in females, older patients and socially disadvantaged areas. Of the 271 204 successfully linked cases (median age 76 years; 51% women), 79% required hospital admission with a 30-day mortality of 9%. The most common final diagnoses (and 30-day mortality rates) were lower respiratory tract infection (13%, mortality 11%), chronic obstructive pulmonary disease (13%, mortality 6.4%), heart failure (9.1%, mortality 9.8%), arrhythmias (3.9%, mortality 4.4%), acute coronary syndromes (3.9%, mortality 9.5%) and asthma (3.2%, mortality 0.5%). Predictors of mortality included older age, male sex, pre-existing chronic kidney disease, heart failure or cancer, abnormal respiratory status or vital signs and pre-hospital intubation. Conclusion: Dyspnoea is a common presentation with a broad range of causes and is associated with high rates of hospitalisation and death. [ABSTRACT FROM AUTHOR]

Objective: To determine characteristics, precipitating circumstances, clinical care, outcome and disposition of patients brought to the ED under section 351 (s351, police detention and transport) powers of the Mental Health Act 2014 (Vic) (MHAV). Methods: This is an observational cohort study conducted in two metropolitan teaching hospitals in Victoria. Participants were adult patients brought to ED under s351 of the MHAV. Data collected included demographics, event circumstances, pre‐hospital and ED interventions and outcome. Analyses are descriptive. Results: The present study included 438 patient encounters. Median age was 34 years. In 84% of encounters (368/438) patients were co‐transported with ambulance. The most common primary reason for detainment was suicide risk/intent (296/438, 67.6%) followed by abnormal behaviour without threat to self or others (92/438, 21%). In ED, parenteral sedation was administered in 11% (48/438). Physical restraint was applied in 17.6% (77/438). Psychiatric admission was required in 23.5% (103/438). In 63 cases, psychiatric admission was involuntary (14.4%). Most patients (297/438, 67.8%) were discharged home. A subset of patients had recurrent s351 presentations. Eighteen (5.6%) patients accounted for 22% (96/438) of all events. Conclusion: Most patients brought to ED under s351 of the MHAV had expressed intention to self‐harm, did not require medical intervention and were discharged home. It could be questioned whether the current application of s351 is consistent with the least restrictive principles of the MHAV, especially as there is no apparent monitoring or reporting of the use of these powers. There were a concerning number of patients with multiple s351 events over a short period. [ABSTRACT FROM AUTHOR]

Objective: To describe the demographic profile and clinical case mix of older adults following calls for an emergency ambulance in rural Victoria, Australia. Methods: Retrospective cohort study using ambulance electronic patient care records from rural‐dwelling older adults (≥65 years old) who requested emergency ambulance attendance during 2017. Results: A total of 84 785 older adults requested emergency ambulance attendance, representing a rate of 278 per 1000 population aged ≥65 years. More than 10% of calls were to residential aged care homes. Medical complaints and trauma accounted for 69% and 18% of attendances, respectively. The predominant cause of trauma was ground‐level falls. Common reasons for call‐outs were for pain (17.5%), respiratory problems (9.7%) and cardiovascular problems (8.5%). Increased demand was associated with increasing age and winter months. Conclusions: Older adults from rural Victoria have high rates of emergency ambulance attendance and transportation to an emergency department, particularly with increasing age. [ABSTRACT FROM AUTHOR]

Objective: Relatively little has been reported about the impact of COVID-19 restrictions on emergency ambulance services. We describe the influence of the COVID-19 pandemic on the emergency ambulance system in Victoria, Australia. Methods: We performed an interrupted time series analysis of consecutive calls for ambulance from January 2018 to February 2021, including two waves of COVID-19. The COVID-19 lockdown period included seven months of stay-at-home restrictions (16/03/2020-18/10/2020). Nineteen weeks of post-lockdown data were included (19/10/2020-28/02/2021). Results: In total, 2,356,326 consecutive calls were included. COVID-19 lockdown was associated with an absolute reduction of 64,991 calls (almost 2,100 calls/week). According to time series analysis, lockdown was associated with a 12.6% reduction in weekly calls (IRR = 0.874 [95% CI 0.811, 0.941]), however no change in long-term trend (IRR = 1.000 [95% CI 0.996, 1.003]). During lockdown, the long-term trend of attendances to patients with suspected acute coronary syndromes (ACS, IRR = 1.006 [95% CI 1.004, 1.009]) and mental health-related issues (IRR = 1.005 [95% CI 1.002, 1.008]) increased. After lockdown, the call volume was 5.6% below pre-COVID-19 predictions (IRR = 0.944 [95% CI 0.909, 0.980]), however attendances for suspected ACS were higher than predicted (IRR = 1.069 [95% CI 1.009, 1.132]). Ambulance response times deteriorated, and total case times were longer than prior to the pandemic, driven predominantly by extended hospital transfer times. Conclusion: The COVID-19 pandemic had a dramatic impact on the emergency ambulance system. Despite lower call volumes post-lockdown than predicted, we observed deteriorating ambulance response times, extended case times and hospital delays. The pattern of attendance to patients with suspected ACS potentially highlights the collateral burden of delaying treatment for urgent conditions. [ABSTRACT FROM AUTHOR]

Introduction: Pre-existing disease is a common contributor to mortality and morbidity after injury and resuscitation of injured patients are often altered in hospital based on comorbidities. However, this is uncommon in the pre-hospital phase of care where patients are managed according to clinical practice guidelines. This study aimed to quantify the prevalence of cardiovascular disease (CVD) and liver disease among trauma patients attended by pre-hospital clinicians but who died prior to reaching hospital and assess associations with age. Methods: This was a retrospective review of pre-hospital trauma deaths in the state of Victoria, Australia between 01 Jan 2008 and 31 Dec 2014. The inclusion criteria were (a) patients attended by pre-hospital clinicians, (b) deceased before arrival to hospital, (c) evidence of recent trauma and (d) underwent a full autopsy. Cardiovascular and liver disease status were extracted from autopsy reports. Results: There were 1043 patients included in this study. Most patients were male (77.1%). Intentional self-harm was significantly more common in patients aged ≥65 years (17.4%). CVD was prevalent in 495 (47.5%; 95%CI: 44.4–50.5) cases with myocardial fibrosis the most common abnormality detected. All sub-groups of CVD demonstrated a significant association with increasing age, except right ventricular hypertrophy. Liver disease was present in 235 (22.5%; 95%CI: 20.1-25.2) patients and most common among patients aged 35–64 years. Discussion: CVD was prevalent in almost half of all injured patients included in this study while liver disease was present in about a fifth. The prevalence of CVD was associated with increasing age, while liver disease was more common among middle-aged patients. This high prevalence in our population indicates that pre-existing cardiovascular and liver disease be considered when tailoring pre-hospital life-saving interventions for injured patients. [ABSTRACT FROM AUTHOR]

Background and aims: In Australia, oxycodone has been associated with increasing rates of harm over time, despite reduced use, reformulation to a tamper‐resistant form and in contrast to most prescription opioids. We explored characteristics of oxycodone‐related ambulance attendances to understand whether presentation characteristics could explain increasing oxycodone harm. Design Retrospective study of coded ambulance patient care records related to extramedical oxycodone use, January 2013 to September 2018. Setting: Victoria, Australia. Cases A total of 2788 oxycodone‐related ambulance attendances. Measurements Primary outcomes were temporal changes in characteristics of oxycodone presentations over time (from 2013 to 2018) and following reformulation. Covariates include demographic characteristics, presentation severity, mental health, substance use and poisoning intent. Findings Average age was 41.3 (± 16.4) years with females comprising 56.4% of attendances (n = 2788). The proportion of females in oxycodone‐related attendances increased over time [an average increase in the odds ratios of 5% per year (OR) = 1.05, 95% confidence interval (CI) = 1.01–1.10]. Other temporal trends included a reduced likelihood of naloxone administration (OR = 0.92, 95% CI = 0.85–1.00), heroin involvement (OR = 0.81, 95% CI = 0.66–0.99), comorbid mental health symptoms (OR = 0.87, 95% CI = 0.82–0.92) and unknown intent poisoning (OR = 0.91, 95% CI = 0.85–0.96); and a greater risk of alcohol involvement (OR = 1.06, 95% CI = 1.01–1.11), non‐opioid extramedical pharmaceutical use (OR = 1.05, 95% CI = 1.01–1.10), comorbid suicidal thoughts or behaviours (OR = 1.10, 95% CI = 1.05–1.15) and past history of psychiatric issues (OR = 1.22, 95% CI = 1.16–1.27). Interrupted time–series analysis showed that reformulation was associated with an immediate effect on sex, severity, accidental poisoning and unknown intent poisoning, although these were not sustained over time. Alcohol involvement in the attendance (OR = 1.43, 95% CI = 1.17–1.74, i.e. an average increase in the odds of 43% per year), Glasgow Coma Scale (OR = 1.28, 95%CI 1.04 – 1.57), a previous history of psychiatric issues (OR = 0.80, 95% CI = 0.70–0.92, i.e. an average decrease in the odds of 20% per year, heroin involvement (OR = 0.22, 95% CI = 0.05 – 0.98) and illicit drug use (OR = 0.45, 95% CI = 0.23 – 0.87) showed statistically significant relative changes following the reformulation. Conclusions: The characteristics of oxycodone presentations in Australian ambulances attendances appear to be changing over time, including more female presentations; increasing alcohol use, extramedical use of non‐opioid pharmaceuticals and suicidal thoughts or behaviours and decreasing heroin and illicit drug involvement. [ABSTRACT FROM AUTHOR]

Purpose: This study investigated changes in suicidal ideation, attempts, and nonsuicidal self-injury (NSSI)-related ambulance attendances among adolescents during the COVID-19 pandemic., Methods: An interrupted time series analysis using data from the National Ambulance Surveillance System, a globally unique mental health and suicide surveillance system. Patients aged 12-17 years from the state of Victoria, Australia who were attended by ambulance for suicide attempts, suicide ideation, and NSSI between January 2016 and October 2021 were included. Monthly ambulance attendances during the pre-COVID period (January 2016-March 2020) were compared to those in the peak period of COVID-19 (April 2020-October 2021)., Results: There were 20,125 ambulance attendances for suicide ideation, suicide attempt, and NSSI in adolescents over the study period. During the pre-COVID period, the number of suicide ideation, attempts, and NSSI attendances was increasing by 1.1% per month (incidence rate ratio [IRR]:1.011; 95% confidence interval [1.009-1.013], p < .001). There was no change in the rate of all suicide ideation, attempt, and NSSI for all adolescents during the period of COVID-19. However, when disaggregated by gender, there was a 0.7% increase in the monthly rate of attendances for females (IRR: 1.007 [1.001-1.013], p = .029), and a 3.0% decrease for males (IRR: 0.970 [0.964-0.975], p < .001)., Discussion: Adolescent female suicide ideation, attempt, and NSSI attendances increased during the COVID-19 period, compared with males in the same time period. These findings suggest tailored intervention strategies may be needed to address the increasing trends of self-harm among young people., (Copyright © 2024 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Objectives: People living in residential aged care (RAC) frequently experience ambulance call‐out. These episodes may have unintended consequences, yet remain under‐investigated. Our aim was to examine clinical and sociodemographic features associated with transfer to hospital for this population. Methods: Retrospective cohort study using 6 years of clinical data from Ambulance Victoria (AV). Data analysis included multilevel multivariable logistic regression analysis of factors associated with transport to hospital. Results: Odds of transfer were greater for people in rural areas, those with a history of depression, cardiovascular disease and osteoporosis, and residents prescribed antipsychotic and antidepressant medication. Ambulance call‐out for trauma (commonly low‐level fall) was less frequently transferred to hospital than that for a medical complaint. Conclusion: These results will improve prediction of call‐outs likely to require transfer. Findings include identification of clinical features to be targeted by community and preventative health programs to reduce risk of acute health deterioration and requirement for emergency hospital transfer. [ABSTRACT FROM AUTHOR]

Aim: Out-of-hospital cardiac arrest (OHCA) during COVID-19 has been reported by countries with high case numbers and overwhelmed healthcare services. Imposed restrictions and treatment precautions may have also influenced OHCA processes-of-care. We investigated the impact of the COVID-19 pandemic period on incidence, characteristics, and survival from OHCA in Victoria, Australia.Methods: Using data from the Victorian Ambulance Cardiac Arrest Registry, we compared 380 adult OHCA patients who received resuscitation between 16th March 2020 and 12th May 2020, with 1218 cases occurring during the same dates in 2017-2019. No OHCA patients were COVID-19 positive. Arrest incidence, characteristics and survival rates were compared. Regression analysis was performed to understand the independent effect of the pandemic period on survival.Results: Incidence of OHCA did not differ during the pandemic period. However, initiation of resuscitation by Emergency Medical Services (EMS) significantly decreased (46.9% versus 40.6%, p = 0.001). Arrests in public locations decreased in the pandemic period (20.8% versus 10.0%; p < 0.001), as did initial shocks by public access defibrillation/first-responders (p = 0.037). EMS caseload decreased during the pandemic period, however, delays to key interventions (time-to-first defibrillation, time-to-first epinephrine) significantly increased. Survival-to-discharge decreased by 50% during the pandemic period (11.7% versus 6.1%; p = 0.002). Survivors per million person-years dropped in 2020, resulting in 35 excess deaths per million person-years. On adjusted analysis, the pandemic period remained associated with a 50% reduction in survival-to-discharge.Conclusion: The COVID-19 pandemic period did not influence OHCA incidence but appears to have disrupted the system-of-care in Australia. However, this could not completely explain reductions in survival. [ABSTRACT FROM AUTHOR]

Out-of-hospital paediatric emergencies represent are rare and little is known about characteristics of paediatric patients with severe illness. This study seeks to describe the paediatric population with altered conscious state. A retrospective electronic data review was conducted of paediatric patients (≤ 4 years) attended by road ambulances between January 2006 and December 2013. Patients with a Glasgow Coma Scale (GCS) score ≤9 were included. A total of 4533 children were included in the study, 55.9% of which were male. The majority of patients (48.7%) were between one and four years old. Pre-existing neurologic conditions were identified in 26.8% of patients. Seizures were the most common reason for emergency call (68.7%) and were more frequent in children 1–4 years (80.4%) than in <1 year (32.6%), 5−8 years (75.3%) or 9–14 years (53.9%, p < 0.001). Vital signs (heart rate, systolic blood pressure, oxygen saturation, GCS) improved or remained stable from time of first contact with Emergency Medical Service (EMS) to arrival at hospital. Seizure was the most common reason for ambulance attendances to children with altered conscious state, and most frequently occurred in preschool children. Pre-existing conditions were frequent. Vital signs and level of conscious stateof patients improved during paramedic management. [ABSTRACT FROM AUTHOR]

Background and aims: Despite increases in opioid prescribing and related morbidity and mortality, few studies have comprehensively documented harms across opioid types. We examined a population‐wide indicator of extramedical pharmaceutical opioid‐related harm to determine if the supply‐adjusted rates of ambulance presentations, the severity of presentations or other attendance characteristics differed by opioid type. Design Retrospective observational study of coded ambulance patient care records related to extramedical pharmaceutical opioid use, January 2013 to September 2018. Setting: Australia Cases Primary analyses used Victorian data (n = 9823), with available data from other Australian jurisdictions (n = 4338) used to determine generalizability. Measurements We calculated supply‐adjusted rates of attendances using Poisson regression, and used multinomial logistic regression to compare demographic, presentation severity, mental health, substance use and other characteristics of attendances associated with seven pharmaceutical opioids. Findings In Victoria, the highest rates of attendance [per 100 000 oral morphine equivalent mg (OME)] were for codeine (0.273/100 000) and oxycodone (0.113/100 000). The lowest rates were for fentanyl (0.019/100 000) and tapentadol (0.005/100 000). Oxycodone–naloxone rates (0.031/100 000) were lower than for oxycodone as a single ingredient (0.113/100 000). Fentanyl‐related attendances were associated with the most severe characteristics, most likely to be an accidental overdose, most likely to have naloxone administered and least likely to be transferred to hospital. In contrast, codeine‐related attendances were more likely to involve suicidal thoughts/behaviours, younger females and be transported to hospital. Supply‐adjusted attendance rates for individual opioids were stable over time. Victorian states were broadly consistent with non‐Victorian states. Conclusions: In Australia, rates and characteristics of opioid‐related harm vary by opioid type. Supply‐adjusted ambulance attendance rates appear to be both stable over time and unaffected by large changes in supply. [ABSTRACT FROM AUTHOR]

Objective: To determine whether the characteristics and outcomes of parent‐referred children differ substantially from general practitioner (GP)‐referred children attending a metropolitan ED. Methods: Prospective cross‐sectional observational study of consecutive patients aged less than 16 years of age attending a mixed adult and paediatric metropolitan teaching hospital ED in Melbourne. Data collected included patient characteristics (age, sex, arrival mode and triage category) and outcomes (admission, specialty consultation, treatment time >1 h, intravenous or nasogastric therapy, procedural sedation, procedures, imaging studies and pathology collection). Results: The outcome data of 4580 patients was analysed. Patients brought by parents directly to the ED did not differ from patients referred by their GP in age, sex, or triage category, but were more likely to arrive by ambulance (13% vs 2%, P < 0.01). Low‐urgency GP‐referred children were more likely to require a procedure (22% vs 15%, risk difference [RD] 0.07, 95% confidence interval [CI] 0.02–0.13) and pathology tests (13% vs 8%, RD 0.05, 95% CI 0.01–0.1) than parent‐referred children, but were similar for other outcomes. The proportion of low‐urgency children who had no ED‐specific care interventions was not significantly different between the groups (27% vs 32%, RD −0.06, 95% CI −0.11 to 0). Conclusions: Children brought to ED directly by their parents or carers did not differ substantially from GP‐referred children in their characteristics or outcomes. The use of referral source and triage categories to determine patient suitability for diversion to general practice may need to be reconsidered. [ABSTRACT FROM AUTHOR]

In order to implement intervention strategies to prevent falls from height, epidemiological data are needed. The aim of this study was to map emergency presentations for falls from height in residents aged ≥40 yr of the western region of Victoria, Australia. Emergency presentations following a fall from height (≥1 m) were obtained from electronic medical records for 2014–2016 inclusive. For each Local Government Area, age-standardised incidence rates (per 10,000 population/year) were calculated. The age-standardised incidence rate was lowest in the Northern Grampians (3.4 95%CI 0.8–5.9), which has several main industries including health care, agriculture and manufacturing. The highest rates occurred in Corangamite (26.0 95%CI 19.9–32.0), Colac-Otway (23.7 95%CI 18.5–28.8) and Moyne (22.5 95%CI 16.8–28.3), which are sparsely populated (15,000–20,000 people each). Patterns were similar for men and women. Most falls occurred during "leisure" (38.0%), followed by "other work" (15.4%). Men were more likely than women to experience a fall from height while undertaking work activities. Many falls occurred in the home (53.2%). Future research should inform strategies to prevent falls from height in the region. This could include specific locations such as the home or farm, and during leisure activities or work. [ABSTRACT FROM AUTHOR]

Objective: Penetrating truncal trauma with hypotension is uncommon in Australia. Current pre‐hospital clinical practice guidelines based on overseas studies recommend expedited transport to definitive trauma care and that i.v. fluid should only be administered to maintain palpable blood pressure. Methods: A retrospective review included all adult patients with penetrating truncal trauma and hypotension (systolic blood pressure <90 mmHg) attended by emergency medical services in Victoria between January 2006 and December 2018. Patient pre‐hospital characteristics and hospital outcomes are described using descriptive statistics. Predictors of fluid resuscitation and mortality were examined using logistic regression analyses. Results: Between 2006 and 2018 there were 101 hypotensive, penetrating truncal injury major trauma patients in Melbourne, Victoria transported by road ambulance to a major trauma service. The median age of these patients was 38 years (interquartile range [IQR] 27–50) and 85% were male. Median scene time was 16.6 min (IQR 12–26) and median pre‐hospital time was 53.0 min (IQR 38–66). Intravenous fluid resuscitation was given in 54.5% of cases. The mechanism of injury was stabbing in 91.1% and gunshot wound in 8.9%. Urgent surgery was required in 72.3% of cases, 32.7% of patients were admitted to the intensive care unit and there were eight deaths (8.3%). Conclusion: Penetrating truncal trauma with hypotension is rare in Melbourne, Australia with most patients having the injury caused by stabbing rather than shooting. Compared with outcomes reported in the USA and Europe, the mortality rate is low. [ABSTRACT FROM AUTHOR]

Background: A major review of Victoria's ambulance services identified the need to improve public awareness of the role of ambulances as an emergency service. A communications campaign was developed to address this challenge. This research paper expands on an initial evaluation of the campaign by focusing on the long-term behavioural outcomes.Methods: The behavioural evaluation involved two types of data collection - administrative data (routine collection from various health services) and survey data (cross-sectional community-wide surveys to measure behavioural intentions).Results: Behavioural intentions for accessing two of the targeted non-emergency services increased after the second phase of the campaign commenced. There was also a significant change in the slope of call trends for emergency ambulances. This decrease is also likely attributed to the second phase of the campaign as significant level effects were identified 3 and 9 months after it commenced.Conclusions: A long-term campaign developed through evidence review, stakeholder consultation and behavioural theory was successful in reducing the number of daily calls requesting an emergency ambulance in Victoria and in increasing intentions to use alternative services. This research highlights the importance of collaborative intervention design along with the importance of implementing a robust monitoring and evaluation framework. [ABSTRACT FROM AUTHOR]

Objective: To quantify the potential time saved with pre‐hospital antibiotic therapy in sepsis. Methods: Study data for adult patients transported by Ambulance Victoria (AV), and enrolled into the Australasian Resuscitation In Sepsis Evaluation (ARISE), were linked with pre‐hospital electronic records. Results: An AV record was identified for 240 of 341 ARISE patients. The pre‐hospital case notes referred to potential infection in 165 patients. The median time to first antibiotic administration from loading the patient into the ambulance was 107 (74–160) min. Conclusions: ARISE patients in Victoria were frequently identified pre‐hospital. An opportunity exists to study the feasibility of pre‐hospital antibiotic therapy. [ABSTRACT FROM AUTHOR]

Objective: In Victoria, Australia, Emergency Medical Service (EMS) demand has increased almost 5% per annum over the past 5 years. This may adversely affect response times to time‐critical patients. Additionally, >55% of cases have received Code 1 (lights/sirens) responses. Primary telephone triage occurs using the Medical Priority Dispatch System (MPDS); however, MPDS is reported to be highly sensitive, with common over‐triage. The present study describes the methodology applied to better align the response allocated to MPDS determinant codes with patient acuity. Methods: Data between October 2013 and August 2014 were extracted from the Ambulance Victoria data warehouse. The decision to allocate MPDS determinant codes to a lower response priority and/or secondary triage was based on epidemiological profiling and, in some cases, expert panel review. Results: The review identified 105 MPDS codes receiving a Code 1 response as suitable for a Code 2 (urgent) response, and 221 Code 1 or 2 codes as suitable for secondary triage. Data analysis estimated a reduction in Code 1 responses by 28%, and an increase in the secondary triage caseload by 120%. Modelling also predicted a 2.6 percentage point improvement in the proportion of Code 1 cases attended within 15 min. Conclusion: Analysis of a large EMS dataset supported changes to the EMS response priority for a number of MPDS determinant codes. Such changes should improve the alignment between EMS response and patient acuity, and improve response times to time‐critical patients. Other EMS with electronic data could consider testing this methodology. [ABSTRACT FROM AUTHOR]

Objective: To compare changes in pregabalin prescribing and misuse-related ambulance attendances; to characterise the patients attended by paramedics for pregabalin misuse-related harms; to assess the association of pregabalin misuse with use of other sedatives and with suicidal ideation and self-harm; to compare the characteristics of pregabalin misuse-related harms in people who misuse pregabalin according to whether or not they also used other sedatives.Design, Setting, Participants: Retrospective analysis of data on ambulance attendances in Victoria, January 2012 - December 2017, for which pregabalin misuse-related harms were a contributing factor.Main Outcome Measures: Rates of pregabalin misuse-related ambulance attendances, pregabalin prescription rates (each 6-monthly); patient characteristics, including age, sex, history of drug misuse or psychiatric problems, concurrent use of other sedatives, and current suicidal ideation and self-harm.Results: There were 1201 pregabalin misuse-related attendances during the study period; the rate increased from 0.28 cases per 100 000 population in the first half of 2012 to 3.32 cases per 100 000 in the second half of 2017. The attendance rate was strongly correlated with prescription rates in Australia (r = 0.90; P = 0.001). 593 attendances (49%) were for people with a history that may have contraindicated prescribing pregabalin. Pregabalin was frequently misused with other sedatives (812 attendances, 68%), particularly benzodiazepines (440, 37%); 472 attendances (39%) were associated with suicide attempts. People who misused pregabalin with other sedatives more frequently presented with moderate to severe impairments of consciousness, but the frequency of suicide attempts was similar whether other sedatives were concurrently used or not.Conclusions: Rates of pregabalin misuse-related ambulance attendances in Victoria have increased markedly over the past 6 years. Caution is required when prescribing pregabalin for people taking other sedatives. Limiting the dispensing of this drug may reduce the risks associated with its misuse. [ABSTRACT FROM AUTHOR]

Background: With an increase in the proportion of older people in the community comes an increase in the demand on emergency medical services (EMS) by elderly patients who have fallen.Objective: To describe the epidemiology of elderly falls patients attended by EMS in Victoria, Australia and identify predictors of transport and repeat falls.Methods: A retrospective review included all elderly (age ≥ 65 years) falls patients attended by EMS between 2010 and 2017. Patient characteristics are described using descriptive statistics. Predictors of transport to hospital and repeat falls were identified using multivariable logistic regression analyses.Results: Between 2010 and 2017 EMS attended 324,060 elderly falls patients, which represents 9.7% of EMS attended workload in Victoria. The median age of patients was 83 years (IQR: 76-88) and 60.2% were female. Comorbidities and medication use were common, while private residence (64.3%) and nursing home (20.0%) were common scene locations. Overall, 78.8% of falls events resulted in transport to hospital by EMS. Predictors of transport to hospital included female gender, one or more pre-existing medical conditions or current medications and meeting the pre-hospital trauma triage criteria or hospital major trauma criteria. To investigate predictors of repeat falls, the follow-up period was restricted to 12-months post initial fall, which resulted in 30,997 patients and 42,873 (13.2%) repeat fall incidents. The median number of days between the initial fall and a second fall was 98 (IQR: 27-206). Predictors of repeat falls included living at a nursing home, one or more pre-existing medical conditions and one or more current medications.Conclusions: Older falls patients place significant demand on EMS resources in Victoria, Australia, accounting for 9.7% of EMS attendances. Despite high demand, just 3.8% of elderly falls patients received a 'lights and sirens' emergency transport response to hospital. Furthermore, a large number of falls incidents recorded during the study period were repeat falls. Access to alternative pathways of care like GP referral, allied and community health services may benefit this patient group. Development and enrolment into such programs may improve patient outcomes by minimising falls risk and decrease demand on EMS and hospital resources. [ABSTRACT FROM AUTHOR]

Background: Inhalant misuse is the deliberate inhalation of products containing toluene to induce intoxication. Chronic harms associated with inhalant misuse are well described; including alcohol and other drug use, mental health disorders, and suicidal behaviours. However, the nature of the acute harms from inhalants and characteristics of people who experience those harms are not well understood. Therefore, this study aimed to identify the acute harms associated with inhalant misuse attendances, and to determine whether these differ by age or gender.Methods: Ambulance attendance data (Victoria, Australia) from January 2012 to June 2017 were extracted from a database of coded ambulance records. 779 ambulance attendances involving inhalant misuse were identified. Attendance characteristics were categorised by age and gender. Co-morbidities of current mental health, self-harm and suicidal behaviour were assessed, plus the involvement of alcohol and other drugs.Results: Overall, attendances related to the acute harms of inhalant misuse have decreased over time, although that trend has reversed from January 2015. Gender differentiated the acute harms associated with inhalant misuse. Males were older and presented with concurrent alcohol and other drug use. Females were younger and presented with concurrent suicidal ideation and self-injury. Attendances for under 15-year-olds are increasing; this age group was over-represented, predominantly female, with a strong association with self-injury.Conclusions: Ambulance presentations related to inhalant misuse were associated with acute and serious harms. This study highlights that the acute treatment needs of those misusing inhalants are complex and may need to be tailored to gender and age groups. [ABSTRACT FROM AUTHOR]

Objectives A multidisciplinary approach that emphasised improved triage, early pelvic binder application, early administration of blood and blood products, adherence to algorithmic pathways, screening with focused sonography ( FAST), early computed tomography scanning with contrast angiography, angio-embolisation and early operative intervention by specialist pelvic surgeons was implemented in the last decade to improve outcomes after pelvic trauma. The manuscript evaluated the effect of this multi-faceted change over a 12-year period. Methods A retrospective cohort study was conducted comparing patients presenting with serious pelvic injury in 2002 to those presenting in 2013. The primary exposure and comparator variables were the year of presentation and the primary outcome variable was mortality at hospital discharge. Potential confounders were evaluated using multivariable logistic regression analysis. Results There were 1213 patients with a serious pelvic injury ( Abbreviated Injury Scale ≥3), increasing from 51 in 2002 to 156 in 2013. Demographics, injury severity and presenting clinical characteristics were similar between the two time periods. There was a statistically significant difference in mortality from 20% in 2002 to 7.7% in 2013 ( P = 0.02). The association between the primary exposure variable of being injured in 2013 and mortality remained statistically significant (adjusted odds ratio 0.10; 95% confidence interval: 0.02-0.60) when adjusted for potential clinically important confounders. Conclusions Multi-faceted interventions directed at the spectrum of trauma resuscitation from pre-hospital care to definitive surgical management were associated with significant reduction in mortality of patients with severe pelvic injury from 2002 to 2013. This demonstrates the effectiveness of an integrated, inclusive trauma system in achieving improved outcomes. [ABSTRACT FROM AUTHOR]

Background: Acute diabetic emergencies are often managed by prehospital Emergency Medical Services (EMS). The projected growth in prevalence of diabetes is likely to result in rising demand for prehospital EMS that are already under pressure. The aims of this study were to model the temporal trends and provide forecasts of prehospital attendances for diabetic emergencies.Methods: A time series analysis on monthly cases of hypoglycemia and hyperglycemia was conducted using data from the Ambulance Victoria (AV) electronic database between 2009 and 2015. Using the seasonal autoregressive integrated moving average (SARIMA) modelling process, different models were evaluated. The most parsimonious model with the highest accuracy was selected.Results: Forty-one thousand four hundred fifty-four prehospital diabetic emergencies were attended over a seven-year period with an increase in the annual median monthly caseload between 2009 (484.5) and 2015 (549.5). Hypoglycemia (70%) and people with type 1 diabetes (48%) accounted for most attendances. The SARIMA (0,1,0,12) model provided the best fit, with a MAPE of 4.2% and predicts a monthly caseload of approximately 740 by the end of 2017.Conclusions: Prehospital EMS demand for diabetic emergencies is increasing. SARIMA time series models are a valuable tool to allow forecasting of future caseload with high accuracy and predict increasing cases of prehospital diabetic emergencies into the future. The model generated by this study may be used by service providers to allow appropriate planning and resource allocation of EMS for diabetic emergencies. [ABSTRACT FROM AUTHOR]

Objectives: To describe the incidence of and patterns of 'escalated care' (care in addition to standard treatment with systemic corticosteroids and inhaled bronchodilators) for children receiving prehospital treatment for asthma., Design: Retrospective observational study., Setting: State-wide ambulance service data (Ambulance Victoria in Victoria, Australia, population 6.5 million) PARTICIPANTS: Children aged 1-17 years and given a final diagnosis of asthma by the treating paramedics and/or treated with inhaled bronchodilators from 1 July 2019 to 30 June 2020., Primary and Secondary Outcome Measures: We classified 'escalation of care' as parenteral administration of epinephrine, or provision of respiratory support. We compared clinical, demographic and treatments administered between those receiving and not receiving escalation of care., Results: Paramedics attended 1572 children with acute exacerbations of asthma during the 1 year study period. Of these, 22 (1.4%) had escalated care, all receiving parenteral epinephrine. Patients with escalated care were more likely to be older, had previously required hospital admission for asthma and had severe respiratory distress at initial assessment.Of 1307 children with respiratory status data available, at arrival to hospital, the respiratory status of children had improved overall (normal/mild respiratory distress at initial assessment 847 (64.8%), normal/mild respiratory distress at hospital arrival 1142 (87.4%), p<0.0001)., Conclusions: Most children with acute exacerbations of asthma did not receive escalated therapy during their pre-hospital treatment from ambulance paramedics. Most patients were treated with inhaled bronchodilators only and clinically improved by the time they arrived in hospital., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective The objective of this present study was to describe the initial destination hospital of paediatric patients transported by Ambulance Victoria paramedics within the South Western area of Victoria to determine the proportion of patients that bypassed their closest hospital. Methods All Ambulance Victoria primary ambulance transports for paediatric patients aged 1 month to 14 years in the Barwon South West region between 1 April 2008 and 28 February 2011 were reviewed. Each case was examined to determine the destination hospital location relative to the case scene location, and the overall nature of each case was grouped into one of seven categories (medical respiratory, medical cardiac, medical neurological, medical other, trauma time critical, and trauma non-time critical). Results There were 1191 cases identified, with 978 (82%) being taken to the closest hospital and 213 (18%) to a more distant facility. The average distance travelled from the scene to the destination hospital was 15.2 km, and almost 90% of patients transported to the nearest hospital were within 15 km of that hospital. Time critical trauma cases and respiratory-related medical cases had higher rates of transport to more distant hospitals as their initial destination (26% to non-closest and 23% to non-closest, respectively). Conclusion The patient's condition and their location relative to the larger medical facilities appear to influence the decision of destination hospital. Uncertainty regarding the availability of 24 h hospital services and staffing details may contribute to longer transfers. [ABSTRACT FROM AUTHOR]

Background: Gamma-hydroxybutyrate (GHB) use and attributable harms have been increasing in Australia, however changes over time, including the impact of COVID-19 lockdowns and restrictions on harms requiring an ambulance attendance, are unknown. This study utilised a novel population-based surveillance system to identify the types of GHB-related harms between January 2018 and 31 December 2021 in Victoria, Australia., Methods: A cross-sectional, retrospective analysis of all GHB-related ambulance attendances between January 2018 and 31 December 2021 in Victoria, Australia was undertaken. Paramedic clinical notes and Glasgow Coma Scale scores were used to assess conscious state. Event codes were classified using dispatch information available in the database. Crude rates (per 100,000 population) and descriptive analyses were calculated for metropolitan and regional settings. Adjusted Odds ratios (aOR) with 95% confidence intervals [95% CI] were used to assess the relationship between GCS severity and polysubstance combinations with GHB., Results: There were 6,836 ambulance attendances for GHB recorded during the study period. A statistically significant increase in GHB-related attendance numbers was observed State-wide in 2019 (n = 1,402, p<0.001) and 2020 (n = 2,622, p<0.001), when comparing year on year attendances. While both numbers and rates (per 100,000 population) of GHB-related attendances were significantly lower in regional areas, significant increases were evident in both metropolitan and regional areas in 2019 and 2020 (both p<0.001). Attendances involving GHB and alcohol had higher odds of a severe GCS score (aOR:1.25; 95%: 1.04-1.49; p<0.019). A high proportion of GHB-attendances involved harms of significant concern including: overdose (56%) and a loss of, or altered state of consciousness (45%)., Conclusions: We observed increases in GHB-related ambulance attendances over time in both metropolitan and regional areas, placing a significant burden on ambulance services. Our study demonstrates the value of using ambulance surveillance to obtain representative data on acute GHB-related harms., Competing Interests: Declarations of interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Objective: Amphetamine-type stimulants are increasingly implicated in road trauma incidents. Although ambulances are typically first to attend these emergencies, limited research has used paramedic clinical data to examine the contribution of amphetamine use to road trauma-related ambulance attendances. We describe the clinical and temporal risk profiles associated with amphetamine-related harm in road trauma incidents requiring paramedic attendance in the Australian state of Victoria., Method: This cross-sectional, retrospective observational study examined the Victorian component of a national surveillance data set (National Ambulance Surveillance System) of alcohol and other drug (AOD)-related ambulance attendances to determine the incidence and temporal profile of amphetamine use in traffic-related ambulance attendances from January 2015 to December 2020., Results: Throughout the observation period, Victorian paramedics attended 8,163 alcohol, pharmaceutical, or illicit drug-related cases involving a road trauma. More than one quarter (2,161 cases, 27.4%) of these attendances were deemed related to the use of pharmaceutical and/or illicit drugs. Amphetamine alone was involved in nearly one third (640 cases, 29.6%) of non-alcohol-related road trauma attendances, and co-consumption of amphetamine with drugs other than alcohol occurred in more than one third (35.3%) of all AOD-related traffic incidents. Amphetamine-related road trauma attendances predominantly occurred on the weekend (Fri-Sun) during late night/early morning in metropolitan Melbourne. Between 2015 and 2020, the incidence of amphetamine-related road trauma ambulance attendances increased by 86.8%, from 1.1 per 100,000 population in 2015 to 1.9 per 100,000 population in 2020., Conclusions: Amphetamine-type stimulants are increasingly implicated in road trauma. Co-consumption with other potentially impairing substances reflects a concerning trend of polysubstance use among Victorian drivers.

Objectives. This paper aims to examine whether an adaptation of the International Classification of Disease (ICD) coding system can be applied retrospectively to final paramedic assessment data in an ambulance dataset with a view to developing more fine-grained, clinically relevant case definitions than are available through point-of-call data. Methods. Over 1.2 million case records were extracted from the Ambulance Victoria data warehouse. Data fields included dispatch code, cause (CN) and final primary assessment (FPA). Each FPA was converted to an ICD-10-AM code using word matching or best fit. ICD-10-AM codes were then converted into Major Diagnostic Categories (MDC). CN was aligned with the ICD-10-AM codes for external cause of morbidity and mortality. Results. The most accurate results were obtained when ICD-10-AM codes were assigned using information from both FPA and CN. Comparison of cases coded as unconscious at point-of-call with the associated paramedic assessment highlighted the extra clinical detail obtained when paramedic assessment data are used. Conclusions. Ambulance paramedic assessment data can be aligned with ICD-10-AM and MDC with relative ease, allowing retrospective coding of large datasets. Coding of ambulance data using ICD-10-AM allows for comparison of not only ambulance service users but also with other population groups. [ABSTRACT FROM AUTHOR]

Objectives. To describe a model that matches electronic patient care records within a given case to one or more patients within that case. Method. This retrospective study included data from all metropolitan Ambulance Victoria electronic patient care records (n = 445 576) for the time period 1 January 2009-31 May 2010. Data were captured via VACIS (Ambulance Victoria, Melbourne, Vic., Australia), an in-field electronic data capture system linked to an integrated data warehouse database. The case patient algorithm included 'Jaro-Winkler', 'Soundex' and 'weight matching' conditions. Results. The case patient matching algorithm has a sensitivity of 99.98%, a specificity of 99.91% and an overall accuracy of 99.98%. Conclusions. The case patient algorithm provides Ambulance Victoria with a sophisticated, efficient and highly accurate method of matching patient records within a given case. This method has applicability to other emergency services where unique identifiers are case based rather than patient based. [ABSTRACT FROM AUTHOR]

Background: Paramedics are frequently called to attend seizures in children. High-quality evidence on second-line treatment of benzodiazepine (BZD)-refractory convulsions with parenteral long-acting antiepileptic drugs in children has become available from the ED. In order to address the potential need for an alternative agent, we set out to determine the association of BZD use prehospital and the need for respiratory support., Methods: We conducted a retrospective observational study of state-wide ambulance service data (Ambulance Victoria in Victoria, Australia, population: 6.5 million). Children aged 0-17 years assessed for seizures by paramedics were analysed for demographics, process factors, treatment and airway management. We calculated adjusted ORs (AOR) of the requirement for respiratory support in relation to the number of BZD doses administered., Results: Paramedics attended 5112 children with suspected seizures over 1 year (1 July 2018 to 30 June 2019). Overall, need for respiratory support was low (n=166; 3.2%). Before ambulance arrival, 509 (10.0%) had already received a BZD and 420 (8.2%) were treated with midazolam by paramedics. Of the 846 (16.5%) patients treated with BZD, 597 (70.6%) received 1 BZD dose, 156 (18.4%) 2 doses and 93 (11.0%) >2 doses of BZD. Patients who were administered 1, 2 and >2 doses of BZD received respiratory support in 8.9%, 32.1% (AOR 4.6 vs 1 dose, 95% CI 2.9 to 7.4) and 49.5% (AOR 10.3 vs 1 dose, 95% CI 6.0 to 17.9), respectively., Conclusions: Increasing administration of BZD doses was associated with higher use of respiratory support. Alternative prehospital antiepileptic drugs to minimise respiratory depression should be investigated in future research., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: To determine if a digital communication app improves care timelines for patients with suspected acute stroke/ST-elevation myocardial infarction (STEMI)., Design: Real-world feasibility study, quasi-experimental design., Setting: Prehospital (25 Ambulance Victoria branches) and within-hospital (2 hospitals) in regional Victoria, Australia., Participants: Paramedics or emergency department (ED) clinicians identified patients with suspected acute stroke (onset <4.5 hours; n=604) or STEMI (n=247)., Intervention: The Pulsara communication app provides secure, two-way, real-time communication. Assessment and treatment times were recorded for 12 months (May 2017-April 2018), with timelines compared between 'Pulsara initiated' (Pulsara) and 'not initiated' (no Pulsara)., Primary Outcome Measure: Door-to-treatment (needle for stroke, balloon for STEMI) Secondary outcome measures: ambulance and hospital processes., Results: Stroke (no Pulsara n=215, Pulsara n=389) and STEMI (no Pulsara n=76, Pulsara n=171) groups were of similar age and sex (stroke: 76 vs 75 years; both groups 50% male; STEMI: 66 vs 63 years; 68% and 72% male). When Pulsara was used, patients were off ambulance stretcher faster for stroke (11(7, 17) vs 19(11, 29); p=0.0001) and STEMI (14(7, 23) vs 19(10, 32); p=0.0014). ED door-to-first medical review was faster (6(2, 14) vs 23(8, 67); p=0.0001) for stroke but only by 1 min for STEMI (3 (0, 7) vs 4 (0, 14); p=0.25). Door-to-CT times were 44 min faster (27(18, 44) vs 71(43, 147); p=0.0001) for stroke, and percutaneous intervention door-to-balloon times improved by 17 min, but non-significant (56 (34, 88) vs 73 (49, 110); p=0.41) for STEMI. There were improvements in the proportions of patients treated within 60 min for stroke (12%-26%, p=0.15) and 90 min for STEMI (50%-78%, p=0.20)., Conclusions: In this Australian-first study, uptake of the digital communication app was strong, patient-centred care timelines improved, although door-to-treatment times remained similar., Competing Interests: Competing interests: None of the authors have a financial interest in the Pulsara app or Pulsara Communicare Technology. KB and DAC received a travel grant paid to their institution from Pulsara Communicare Technology. This grant was a contribution to defray the costs of attending an international conference to present the final results. The peer-reviewed abstract submission was accepted prior to receiving the travel grant. The company had no input to the content of the abstracts or the presentations (nor this manuscript)., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

There is substantial evidence supporting the association between alcohol license density and violent crime. However, the impact of different types of alcohol licenses on intimate partner and family violence is sparse. We explored the associations between access to alcohol outlets, and family and intimate partner violence using paramedic clinical records, given this service is often the first to respond to acute crises. Coded ambulance attendance data from 694 postcodes in Victoria, Australia, from July 1, 2016 to June 30, 2018 where alcohol or another drug, mental health or self-harm associated with family or intimate partner violence was indicated were examined. A hybrid model of spatial autoregressive and negative binomial zero-inflated Poisson-based count regression models was used to examine associations with alcohol outlet density and socioeconomic factors. We found that access to a liquor license outlet was significantly associated with family violence-related attendances across all types of outlets, including on-premise (late night) licenses ( β = 1.73, SE: 0.18), restaurant licenses ( β = 0.83, SE: 0.28), and packaged liquor licenses ( β = 0.62, SE: 0.06). Our results demonstrate a significant relationship between alcohol-related harms in the context of family violence and provides evidence of the relationship between alcohol-related family violence in both victims and perpetrators. The findings of this study highlight the need for public health interventions such as licensing policy and town planning changes to reduce these harms by restricting alcohol availability.

Ambulance bypass occurs when the emergency department (ED) of a hospital becomes so busy that ambulances are requested to take their patients elsewhere, except in life-threatening cases. It is a major concern for hospitals in Victoria, Australia, and throughout most of the western world, not only from the point of view of patient safety but also financially-hospitals lose substantial performance bonuses if they go on ambulance bypass too often in a given period. We show that the main cause of ambulance bypass is the inability to move patients from the ED to a ward. In order to predict the onset of ambulance bypass, the ED is modelled as a queue for treatment followed by a queue for a ward bed. The queues are assumed to behave as inhomogeneous Poisson arrival processes. We calculate the probability of reaching some designated capacity C within time t, given the current time and number of patients waiting. [ABSTRACT FROM AUTHOR]

Objective : In Australia, approximately 3 in 4 people with acute stroke use an ambulance. Few examples of merging ambulance clinical records, hospital government data, and national registry data for stroke exist. We sought to understand the advantages of using linked datasets for describing the full clinical journey of people with stroke and the possibility of investigating their long-term outcomes based on pre-hospital management of stroke. Method : Patient-level data from the Australian Stroke Clinical Registry (AuSCR) (January 2013-October 2017) were linked with Ambulance Victoria (AV) records and Victorian Emergency Minimum Dataset (VEMD). Probabilistic iterative matching on personal identifiers were used and records merged with a project specific identification number. Results : Of the 7,373 episodes in the AuSCR and 6,001 in the AV dataset; 4,569 (62%) were matched. Unmatched records that were positive for "arrival by ambulance" in the AuSCR and VEMD (no corresponding record in AV) were submitted to AV. AV were able to identify 148/435 additional records related to these episodes. The final cohort included 4,717 records (median age: 73 years, female 42%, ischemic stroke 66%). Conclusion : The results of the data linkage provides greater confidence for use of these data for future research related to pre-hospital management of stroke.

Background and Purpose: Mobile stroke units (MSUs) improve reperfusion therapy times in acute ischemic stroke (AIS). However, prehospital management options for intracerebral hemorrhage (ICH) are less established. We describe the initial Melbourne MSU experience in ICH., Methods: Consecutive patients with ICH and AIS treated by the Melbourne MSU were included. We describe demographics, proportions of patients receiving specific therapies, and bypass to comprehensive/neurosurgical centers. We also compare operational time metrics between patients with MSU-ICH and MSU-AIS., Results: During a 2-year period, the Melbourne MSU managed 49 patients with ICH, mean (SD) age 74 (12) years, median (interquartile range) National Institutes of Health Stroke Scale 17 (12–20). Intravenous antihypertensives were the commonest treatment provided (46.9%). Bypass of a primary center to a comprehensive center with neurosurgical expertise occurred in 32.7% of patients with MSU-ICH compared with 20.5% of patients with MSU-AIS. Compared with patients with MSU-AIS, patients with MSU-ICH had faster onset-to-emergency-call, and onset-to-scene-arrival times at the median and 75th percentiles., Conclusions: MSUs can facilitate ultra-early ICH diagnosis, management, and triage.

Objectives MePACS is a triage and support-based personal alarm emergency response system designed to assist older and/or disabled people to live safely in their homes. The aim of this study was to estimate avoidable ambulance attendances and transports to emergency departments and quantify the cost savings attributed to MePACS compared with a comparison cohort without a personal alarm system. Methods Alarm activation and demographic data for clients registered in the program from June 2016 to May 2017 and funded through the Personal Alert Victoria program were extracted from routinely collected MePACS electronic data. Information on alarm use, event outcomes and ambulance attendances was extracted. Using published Ambulance Victoria data, a comparison cohort was simulated to model the experience of a similar cohort without access to a personal alarm system who experienced a health emergency and called Australia's emergency call service number. The incremental management cost, incorporating the operation cost of MePACS and ambulance fees, was calculated to compare the potential cost savings of MePACS with the comparison cohort. Results Among 18421 eligible clients, there were 7856 emergency alarm activations due to falls or medical events from 4275 clients (79.5% female; 81.1% aged >75 years; 91.8% living alone). MePACS resulted in approximately one-third of ambulance attendances being avoided. Potential annual cost savings of A$1414732.8 (A$76.8 per person per year; 95% confidence interval A$60.0-93.6 per person per year; P<0.001) were attributed to avoidable ambulance utilisations for 18421 MePACS clients. Conclusion Triage-based personal alarm systems, such as MePACS, provide a cost-saving strategy because of fewer ambulance attendances and transports to emergency departments for older and/or disabled people living in the community. What is known about the topic? Personal alarm systems, either a safety alarm, a panic alarm or a medical alarm, have been widely used to support older people and at-risk groups to live independently. The health effects of personal alarm systems are well documented. There is limited information published on the potential economic benefits of these interventions. What does this paper add? We identified the potential economic benefits associated with the MePACS triage-based personal alarm system operating within Victoria, Australia. Personal alarm systems that are triage based and use the support of family members and carers may provide financial benefits not provided by alarm systems that do not provide this type of service. What are the implications for practitioners? The management of older people and at-risk groups living alone is a health care priority. Alternative models to calling emergency services, such as triage-based personal emergency response systems, may provide a low-cost, effective approach.

Objectives: Although the factors driving emergency department demand have been extensively investigated, a comparatively minimal amount is known about the factors that are driving an increase in emergency ambulance demand. Methods: We conducted a retrospective observational study of consecutive cases attended by Ambulance Victoria in Melbourne, Australia from 2008 to 2015. Incidence rates were calculated, and adjusted time series regression analyses were performed to assess the driving factors of ambulance demand. Results: A total of 2,443,952 consecutive cases were included. Demand grew by 29.2% over the 8-year period. The age-specific incidence increased significantly over time for patients aged < 60 years, but not for patients aged ≥ 60 years. After adjustment for seasonality and population growth, demand increased by 1.4% per annum (incident rate ratio [IRR] = 1.014 [1.011-1.017]). The largest annual growth in demand was observed in patients with a history of mental health issues (IRR = 1.058 [1.054-1.062]), alcohol/drug abuse (IRR = 1.061 [1.056-1.066]), or a Charlson Comorbidity Index [CCI] score ≥ 4 (IRR = 1.045 [1.039-1.051]). Cases involving patients of relative socio-economic/educational disadvantage, younger age, or with no preexisting health conditions according to the CCI also grew faster than the overall patient population. Cases requiring transport to hospital increased by 1.2% annually (IRR = 1.012 [1.009-1.016]), although patients not requiring medical intervention from paramedics increased by 6.7% annually (IRR = 1.067 [1.063-1.072]). Conclusions: Increases in ambulance demand exceeded population growth. Emergency ambulances were increasingly utilized for transport of patients who did not require medical intervention from paramedics. Identifying the characteristics of patients driving ambulance demand will enable targeted demand management strategies.