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Since the 1950s, crew members have documented ill health – esp. neurological deficits – after breathing oil fumes that contain a mixture of organophosphate additives, including tricresyl phosphates (TCPs). Industry and military teams investigated reported symptoms, patterns of exposure, chemical constituents of the fumes, and control measures. The industry response was, initially, swift. Boeing researched bleed air filtration options and applied for a patent for bleed-free air supply design in 1954. North American Aviation did a two-year investigation into reports of flight deck fumes and recommended bleed-free ventilation or bleed air filtration. But industry response shifted from finding solutions to rationalizing reality. More rationalizations claimed that chemical exposure limits assure safety. It was argued that for the TCPs in oils, only the ortho isomers were toxic, and they will not comprise more than 0.2% of TCP blend added to oils, so the 'toxic content' would be too low to be a problem. Even the EASA-funded Cabin Air Quality report from 2017 shows outdated thinking and bias against validity of crew reports: "A human exposure study is the long-needed tool to provide an unequivocal and sound dataset to end the misguided discussion on cabin air quality once and for all." In 2023 crews continue to report fume events, ill health, flight safety issues. Very little has been achieved in 60 years. Still only one aircraft type with bleed-free air supply system design exists (B787). No bleed air filters for cabin air are available (only one option for B757 flight deck). No sensors exist to alert crews of oil fumes. There is limited training for crews to recognize/respond to fume events. There is still no standardized fume event reporting system. The new research project is titled "Cabin air quality assessment of long-term effects of contaminants". Crews support this, but after the project is one year in and unions have not been invited to consult or been asked for feedback. What opportunities will there be for labor to get more involved and provide feedback? Crew challenge the work packages of the ongoing research of "CAQ3". Crew demand exposure control measures: 1.) bleed free designs, 2.) less toxic oils and hydraulic fluids, 3.) effective bleed air filtration / air cleaning technology, 4.) real-time detection systems, 5.) mandatory crew education and training, 6.) standardized fume event reporting systems, 7.) disease recognition. Previous EASA-sponsored research was CAQ1, CAQ2, and FACTS. All have collected information. Crew asked: How does the new project FACTS2 = QAQ3 build on what earlier projects have found? Why is the focus still on repeating data collection instead of defining exposure control measures?, EASA Cabin Air Quality Research Workshop, Cologne, Germany, 17-18 January 2023

Health and wellbeing is essential enabling the individual to perform professionally and personally. The demanding workload and high-pressure nature of the paramedic profession, undoubtably has an influence on the paramedic’s health and wellbeing however the individual variance and factors associated with this is poorly understood. The objective of this review is to identify what is known about the occupational factors that influence paramedic health and wellbeing to be able to make recommendations in improving working conditions and thus health and wellbeing of the workforce.

Asthma is one of the largest contributors of respiratory illness throughout Australia. 11% of the Australian population is affected by asthma with a large amount of those residing in rural and remote locations. With fewer asthma related deaths occurring in major cities it’s important to investigate the extent living in rural and remote areas affects the decision making of patients accessing emergency healthcare. The aim of this review is to highlight the difference in circumstances between metropolitan and rural and remote Australia in accessing emergency care during a moderate to severe asthma exacerbation.

Effective service delivery and the wellbeing of the paramedic workforce is reliant on cofounding factors and is effectuated by geographical positioning. It is important to be aware that there may be several disparities between the rural and urban workforce due to differences in circumstances. However, there is currently limited literature available which comments on this. The objective of this scoping review is to investigate where and how these disparities exist in order to make recommendations in achieving equity in the paramedic workforce and thus achieve optimal patient centred care unanimously across these rural and urban populations.

Introduction Access to emergency healthcare services and specialist care – particularly paramedic services – is more restricted in the rural and remote areas of Australia, and this disparity is amplified further as remoteness increases. This review aims to investigate the availability of current research regarding both the expanding nature of paramedicine roles in rural environments, and the impacts of rurality on the quality of out-of-hospital care provided to patients. Methods Arksey and O'Malley's six-step methodological approach was used to perform a scoping review to assess the availability of literature. Key words including paramedic*, regional, rural, remote and role were inputted into the search engines Scopus, CINAHL and PubMed. Titles and abstracts of the 864 results were screened by all authors and inclusion/exclusion criteria applied, resulting in 13 remaining articles. Results The final 13 articles comprised differing data collection types and methodologies from nine separate studies conducted in either Canada, Australia, the United Kingdom, the United States, Saudi Arabia or Qatar. Approximately 2.5 million patients, 534 paramedics, 331 other healthcare professionals and 35 case studies were included in the total combined results of these studies. Conclusion Rural communities demonstrated increased mortality rates in out-of-hospital patients due to several factors including rostering, specialist service locations and limited resource availability. Factors which were beneficial to the outcomes of patients in rural settings included enhanced paramedic scopes of practice, the implementation of community paramedicine programmes and wider roles within the community for paramedics. A lack of research on the exact nature of these changing roles in rural paramedicine is evident.