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Objective Administration of a sedative agent is required for safe transport of prehospital patients with severe agitation to EDs. Ambulance services in Australasia use ketamine, droperidol or midazolam as first line agent but the optimal agent is uncertain. In Victoria, intramuscular (IM) ketamine is used. The present study aimed to examine the prehospital characteristics and ED outcomes of patients with severe agitation after IM ketamine administration. Methods A retrospective review was conducted for patients who received IM ketamine for severe agitation over a 2-year period. Data were sourced from Ambulance Victoria and linked to hospital data. The primary outcome was time to sedation. Data collected included baseline characteristics, adverse events and ED outcomes. Results Three hundred and fifty-eight prehospital cases transported to 32 hospitals were included. Outcome data were available for 305 patients (21 hospitals). Median age was 31 years (IQR 23-40). 71.2% were male. Adequate sedation was achieved in 96.9% of cases in a median time of 5.0 min (IQR 3.0-7.0; range 1-31 min). Adverse events were transient hypoxia (5.0%), hyper-salivation (4.2%) and emergence reactions (0.8%). A total of 45 (14.8%) patients were intubated; two prehospital. Conclusion Intramuscular ketamine is effective with a low rate of prehospital complications in severely agitated patients in the prehospital setting. Given the variation in ambulance practice in Australasia, prospective, randomised trials in the prehospital setting comparing ketamine to other sedating agents such as droperidol in patients with severe agitation are required.

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.

Aim Few studies have described the epidemiological profile of paediatric trauma patients attended by emergency medical services (EMS). This study describes the characteristics of paediatric trauma patients attended by EMS in Victoria, Australia. Method A retrospective review was conducted of all paediatric trauma patients (≤15 years) attended by EMS in Victoria, Australia between 1 July 2012 and 30 June 2017. Descriptive analyses were conducted. Results Paediatric trauma patients represented 2.2% of the EMS emergency caseload during the study period. Most patients were male (59.9%), and the median age was 8 years. The most common final paramedic diagnoses were pain (21.4%), lacerations (14.1%) and fractures (12.5%). Falls, sporting injuries and traffic-related trauma were the most common mechanisms of injury. The majority of patients were transported to hospital (69.5%) and 55.9% received clinical treatment by paramedics. A total of 19.3% of patients were transported to the paediatric major trauma facility in Victoria. Analgesia was administered to 57.9% of treated patients, with administration increasing with age. A splint was applied most commonly to patients aged 5 to 12 years, and spinal immobilisation was most commonly used in patients aged 13 to 15 years. Patients aged ≤4 years had the highest proportion of patients with an initial pain score of 0 (49.5%), indicating no pain. Conclusion The characteristics of paediatric trauma patients differ according to age. Pain, lacerations and fractures are the most common reasons for EMS attendance. Understanding the characteristics of paediatric trauma patients may assist in refining protocols to improve patient outcomes. Conflict of interest None Funding None

In many developed countries, a lack of community-based mental health services is driving increased utilization of emergency medical services (EMS). In this descriptive study, we sought to describe the demographic and clinical characteristics of mental health-related EMS presentations in Victoria, Australia.A retrospective observational study of EMS presentations occurring between January and December 2015. Computer Aided Dispatch and electronic patient care record data were extracted from an electronic data warehouse. Characteristics of EMS-attended mental health presentations were described and compared to other EMS-attended patients using descriptive statistics.Of the total 504,676 EMS attendances, 48,041 (9.5%) were mental health presentations. In addition, 4,708 (6.6%) cases managed by a paramedic or nurse via the EMS secondary telephone triage service also involved mental health complaints. EMS-attended mental health patients were younger and more often female compared to other patients attended by EMS. Most mental health patients were transported to hospital (74.4%); however, paramedics provided treatment to significantly fewer mental health patients compared to other EMS-attended patients (12.4% vs. 50.3%, p0.001%). The majority of mental health patients (76.8%) had a documented mental health history. Social or emotional issues were the most common presentation in mental health patients aged ≤15 years (19.1%); whereas, for patients aged ≥65 years, anxiety was the most common clinical presentation (41.2%). For patients undergoing secondary triage, 52.5% were frequent callers or anxiety presentations. A total of 27.7% of triaged patients were referred to an alternative service, while 24.6% were managed under an existing care plan.Mental health-related cases represent one in ten EMS attendances in Victoria. A large proportion of mental health presentations receive little intervention by EMS, and could benefit from community-based services provided by mental health clinicians.

Aim Recent increases in demand for mental health services have not been matched with community resources, resulting in increased demand on emergency medical services (EMS). We sought to describe the clinical profile, demand patterns and care provided to mental health patients accessing EMS in ?Victoria, Australia. Methods We conducted a retrospective observational study of cases occurring between January and December 2015. Computer Aided Dispatch and electronic patient care record data were extracted from the Ambulance Victoria data warehouse. Characteristics of mental health presentations were described using descriptive statistics. Results Of the total 504,676 EMS attendances, 48 041 (9.5%) were mental health-related. Additionally, 4708 mental health-related secondary triages were included, representing 6.6% of the Victorian secondary triage caseload. Emergency mental health patients were younger and more often female than other patients attended by EMS (p Conclusion For mental health-related cases, EMS were predominantly utilised as a transport mechanism rather than for active medical intervention. The role of alternative services in provision of care for mental health patients requires further investigation. Conflict of interest None declared. Funding None declared.