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Background: Ambulance service blood transfusion is an area of rapid development. In New South Wales, Australia, the blood products carried by ambulance medical teams are often the first available to patients with critical bleeding. In addition to the blood products routinely carried by these teams, the Service created and implemented a method of initiating large‐volume, mixed‐product transfusions using existing blood banks: the Retrieval Transfusion Procedure (RTP). This article describes the trends and characteristics of New South Wales Ambulance RTP activations. Materials and Methods: This retrospective database review examines the patient records for all RTP activations. Key areas of investigation include logistics, product requests, population demographics, etiologies, physiology, mission timings, and transfusions. Results: Ambulance medical teams attended 27 531 missions in the reviewed period, 1573 patients received transfusion, and there were 138 RTP activations. Blood products were sourced from 40 banks and transported by police (46.7%), ambulance (27.1%), and helicopter (13.0%) to refueling stops (39.2%), prehospital scenes (24.2%) and hospitals (15.8%). The median time engaged on each mission was 189 minutes for metropolitan and 222 minutes for rural locations. Seventy‐eight patients were transfused with RTP blood products; 83.3% were traumas, of which 63.1% were motor vehicle collisions. Up to 18 units of blood products were administered before hospital arrival. There was significant (P <.001) improvement in the mean shock index of transfused patients between the first and final observations recorded. Conclusions: Ambulance service extended blood product transfusion is logistically achievable and facilitates emergency transfusions throughout the state with minimal additional infrastructure. [ABSTRACT FROM AUTHOR]

Objective: In trauma patients with potential cervical spine injury, immobilisation with a rigid cervical collar is widely recommended to prevent a secondary spinal cord injury. There is a lack of evidence for the effectiveness of this practice, but increasing evidence for complications from rigid collars. Soft foam collars may mitigate some of these issues and are used in our health service in place of rigid collars in selected patients at risk for traumatic cervical spine injury. The objective of the present study was to describe the neurological outcome of patients according to the cervical stabilisation technique used. Methods: A multi‐centre, retrospective, consecutive, case series of all patients assessed for a traumatic cervical spine injury from October 2017 to July 2018 was conducted. Data were obtained by a medical chart review. The primary outcome was the development of a new neurological deficit because of spinal cord injury while in hospital. Results: Inter‐rater reliability of data abstraction demonstrated very strong agreement (kappa 0.85, 95% confidence interval 0.80–0.90). Of 2036 patients, 1133 were managed in a soft collar. A new neurological deficit because of spinal cord injury developed in two patients managed in a rigid collar. One case managed in a soft collar was uncertain because of an incomplete baseline neurological examination. Conclusion: The use of soft foam cervical collars in patients at risk for a cervical spine injury does not appear to increase the risk for secondary spinal cord injury but larger prospective studies are required before a robust conclusion on safety can be claimed. In trauma patients with potential cervical spine injury, immobilisation with a rigid cervical collar is widely recommended to prevent a secondary spinal cord injury, despite a lack of evidence for this practice, but increasing evidence for complications. Soft foam collars may mitigate some of these issues and do not appear to increase the risk for secondary spinal cord injury. Larger prospective studies are required before a robust conclusion on safety can be claimed. [ABSTRACT FROM AUTHOR]

Specialist graduate emergency nursing education programs are essential to the delivery of high quality and safe healthcare to patients with complex needs in emergency care. Little is known about tertiary emergency nursing programs in Australia. This study aimed to determine the academic and professional characteristics of Australian emergency programs. This embedded mixed-method study examined the academic and professional characteristics of Australian emergency programs in two interdependent phases: (1) document and content analysis of Australian graduate emergency nursing program websites; and (2) semi-structured interviews with the associated convenors. The data underwent framework analysis using eight pre-identified categories of (i) course entry, (ii) fee arrangement, (iii) mode of delivery, (iv) volume of learning, (v) clinical assessment, (vi) employment requirements, (vii) graduate expectations, and (viii) influence of healthcare employers and professional engagement. Prior clinical experience and the requirement for concurrent practising in an emergency care environment influenced were common, however fee arrangements were not clearly articulated. The College of Emergency Nursing Australasia Practice Standards for the Emergency Nursing Specialist featured in part within 12 programs, principally to guide development of clinical assessments. Establishment of emergency nursing graduate practice standards could better inform the design and delivery of emergency nurse programs, and yield benefits in terms of graduate expectations and satisfaction and improved patient care. [ABSTRACT FROM AUTHOR]

Background Context: Despite its potential to cause serious and life-long disability or death, population-based data on traumatic spinal injury in pediatric populations is scarce.Purpose: To quantify and describe the incidence and cost of hospitalizations for traumatic spinal injury among Australian children, and to examine the trend over a 10-year period.Study Design: Population-based retrospective cohort study.Patient Sample: Children aged ≤16 years who were hospitalized for traumatic spinal injury in Australia during 1 July 2002 to 30 June 2012.Outcome Measures: Age-standardized hospital admission rates.Methods: This study used linked hospitalization and mortality data. Age-standardized hospitalization rates were calculated with 95% confidence intervals (CIs). Negative binomial regression was used to examine change in temporal trends in hospitalization rates.Results: There were 4,360 hospitalizations for pediatric traumatic spinal injury during the 10-year study period. Males and older children were more frequently hospitalized, and falls and road trauma accounted for almost three-quarters of hospitalizations. The average overall annual hospitalization rate was 9.43 (95% CI: 9.15-9.72) per 100,000 population, with an annual percent change of 1.2% (95% CI: -0.1% to 2.4%). There was an increase in the annual hospitalization rate for spinal dislocations, sprains, and strains (3.0% [95% CI: 0.8%-5.3%]) and among female children (1.7% [95% CI: 0.0%-3.4%]). The estimated total hospital treatment costs were AUD$43 million over the 10-year study period, with an estimated mean cost per child of AUD$9,867.Conclusions: Pediatric traumatic spinal injury is associated with significant morbidity and mortality. The burden of hospitalized pediatric traumatic spinal injury in Australia is rising, in particular spinal dislocations, sprains, and strains among female children. Targeted prevention strategies are needed to reduce the burden of pediatric traumatic spinal injury. It is recommended that a coordinated national strategy for preventing childhood traumatic spinal injury is developed and implemented in Australia. [ABSTRACT FROM AUTHOR]

Injury remains the leading cause of death and disability for Australian children. There is known variability in the quality of care delivered to injured children in Australia. This study prioritises recommendations developed from an expert review of paediatric trauma cases, for implementation with the aim of improving health service delivery to children sustaining severe injury. A modified-Delphi study was conducted between October 2018 and February 2019. Two rounds of an online survey to rank the suitability and importance of each of the 26 recommendations was conducted. Final decisions on the priorities for change in the paediatric trauma system was determined by a consensus of ≥80% for importance and/or suitability. One hundred and one participants completed Round 1, and 60 participants completed Round 2 of the modified-Delphi. In Round 1, 13 recommendations reached ≥80% and in round 2, 11 recommendations reached ≥80%. Those ranked highest focussed on pre-hospital airway management, streamlining retrieval and transfer processes, improving hospital nursing ratios and radiology reporting. This modified-Delphi study identified the priority areas for recommended change to the NSW paediatric trauma system. Work to address these areas has the potential to provide more coordinated and timely care to children sustaining severe injury. [ABSTRACT FROM AUTHOR]

Emergency nurses are responsible for the initial assessment, management and safety of critically ill patients. HIRAID, an evidence-informed emergency nursing assessment framework, is known to improve emergency nursing patient-assessment in the simulated environment however has not been evaluated in the clinical setting. A pre-post design was used to assess the usability and impact of HIRAID on emergency nurses self-efficacy in the emergency department (ED). Nursing and medical staff from three Australian EDs were surveyed. Descriptive and optimal pooled sample t-tests statistics were conducted. One hundred and two emergency nurses completed the pre-intervention self-efficacy survey and 63 completed the post-intervention self-efficacy and satisfaction survey. Forty-two and 17 medical officers completed the pre- and post-intervention satisfaction surveys, respectively. Nursing staff self-efficacy levels were unchanged pre- and post-HIRAID implementation (Mean (SD): 8.8 (0.21) vs. 8.7 (0.20)) as was medical staff satisfaction (Mean (SD):7.5 (1.43) vs. 7.8 (1.07)), although there was a trend towards improved communication. The HIRAID structured approach to patient assessment is acceptable, feasible, practical and appropriate for use in the clinical environment. Further research will demonstrate the direct effects of HIRAID on clinical performance. [ABSTRACT FROM AUTHOR]

• What is already known about this topic? The standard of the initial patient assessment is critical to the quality and safety of healthcare, particularly as emergency patients often have extended wait times for medical review. Currently, there is no widely used structured approach to patient assessment for emergency nurses and consequently there exists great variability in the quality and documentation of patient assessments. • What does this paper add to the currently published literature? HIRAIDTM is an acceptable and suitable emergency nursing framework for consideration for use by US emergency nurses. • What is the most important implication for clinical emergency nursing practice? HIRAIDTM could provide an evidence-based solution to improve the consistency and quality of emergency nursing in an increasingly inexperienced workforce. Successful uptake requires training and organizational support. Patient assessment is a core component of nursing practice and underpins safe, high-quality patient care. HIRAIDTM , an evidence-informed emergency nursing framework, provides nurses with a structured approach to patient assessment and management post triage. In Australia, HIRAIDTM resulted in significant improvements to nurse-led communication and reduced adverse patient events. First, to explore United States (US) emergency nurses' perceptions of the evidence-informed emergency nursing framework, HIRAIDTM; second, to determine factors that would influence the feasibility and adaptability of HIRAIDTM into nursing clinical practice in EDs within the US. A cross-sectional cohort study using a survey method with a convenience sample was conducted. A 4-hour workshop introduced the HIRAIDTM framework and supporting evidence at the Emergency Nurses Association's (ENA) conference, Emergency Nursing 2022. Surveys were tested for face validity and collected information on nurse-nurse communication, self-efficacy, the practice environment and feedback on the HIRAIDTM framework. The workshop was attended by 48 emergency nurses from 17 US States and four countries. Most respondents reported that all emergency nurses should use the same standardised approach in the assessment of patients. However, the greatest barriers to change were a lack of staff and support from management. The most likely interventions reported to enable change were face-to-face education, the opportunity to ask questions and support in the clinical environment. HIRAIDTM is an acceptable and suitable emergency nursing framework for consideration in the US. Successful uptake will depend on training methods and organizational support. HIRAIDTM training should incorporate face-to-face interactive workshops. [ABSTRACT FROM AUTHOR]