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Introduction: In Australia, aeromedical retrieval provides a vital link for rural communities with limited health services to definitive care in urban centers. Yet, there are few studies of aeromedical patient experiences and outcomes, or clear measures of the service quality provided to these patients.Study Objective: This study explores whether a previously developed quality framework could usefully be applied to existing air ambulance patient journeys (ie, the sequences of care that span multiple settings; prehospital and hospital-based pre-flight, flight transport, after-flight hospital in-patient, and disposition). The study aimed to use linked data from aeromedical, emergency department (ED), and hospital sources, and from death registries, to document and analyze patient journeys.Methods: A previously developed air ambulance quality framework was used to place patient, prehospital, and in-hospital service outcomes in relevant quality domains identified from the Institutes of Medicine (IOM) and Dr. Donabedian models. To understand the aeromedical patients' journeys, data from all relevant data sources were linked by unique patient identifiers and the outcomes of the resulting analyses were applied to the air ambulance quality framework.Results: Overall, air ambulance referral pathways could be classified into three categories: Intraregional (those retrievals which stayed within the region), Out of Region, and Into Region. Patient journeys and service outcomes varied markedly between referral pathways. Prehospital and in-hospital service variables and patient outcomes showed that the framework could be used to explore air ambulance service quality.Conclusion: The air ambulance quality framework can usefully be applied to air ambulance patient experiences and outcomes using linked data analysis. The framework can help guide prehospital and in-hospital performance reporting. With variations between regional referral pathways, this knowledge will aid with planning within the local service. The study successfully linked data from aeromedical, ED, in-hospital, and death sources and explored the aeromedical patients' journeys. [ABSTRACT FROM AUTHOR]

Introduction: Tenecteplase is a thrombolytic protein drug used by paramedics, emergency responders, and critical care medical personnel for the prehospital treatment of blood clotting diseases. Minimizing the time between symptom onset and the initiation of thrombolytic treatment is important for reducing mortality and improving patient outcomes. However, the structure of protein drug molecules makes them susceptible to physical and chemical degradation that could potentially result in considerable adverse effects. In locations that experience extreme temperatures, lyophilized tenecteplase transported in emergency service vehicles (ESVs) may be subjected to conditions that exceed the manufacturer's recommendations, particularly when access to the ambulance station is limited.Study Objective: This study evaluated the impact of heat exposure (based on temperatures experienced in an emergency vehicle during summer in a regional Australian city) on the stability and efficacy of lyophilized tenecteplase.Methods: Vials containing 50mg lyophilized tenecteplase were stored at 4.0°C (39.2°F), 35.5°C (95.9°F), or 44.9°C (112.8°F) for a continuous period of eight hours prior to reconstitution. Stability and efficacy were determined through assessment of: optical clarity and pH; analyte concentration using UV spectrometry; percent protein monomer and single chain protein using size-exclusion chromatography; and in vitro bioactivity using whole blood clot weight and fibrin degradation product (D-dimer) development.Results: Heat treatment, particularly at 44.9°C, was found to have the greatest impact on tenecteplase solubility; the amount of protein monomer and single chain protein lost (suggesting structural vulnerability); and the capacity for clot lysis in the form of decreased D-dimer production. Meanwhile, storage at 4.0°C preserved tenecteplase stability and in vitro bioactivity.Conclusion: The findings indicate that, in its lyophilized form, even relatively short exposure to high temperature can negatively affect tenecteplase stability and pharmacological efficacy. It is therefore important that measures are implemented to ensure the storage temperature is kept below 30.0°C (86.0°F), as recommended by manufacturers, and that repeated refrigeration-heat cycling is avoided. This will ensure drug administration provides more replicable thrombolysis upon reaching critical care facilities. [ABSTRACT FROM AUTHOR]

Background Violence against women is pervasive worldwide, and a high proportion of the most damaging violence is perpetrated by male intimate partners. The Australian government is committed to action to prevent such violence; however, strategies require input and collaboration from all agencies engaging patients, including ambulance services. To date no Australian ambulance service has published comprehensive guidelines or strategies to improve health outcomes for intimate partner violence patients in line with national strategies. Objective To propose key actions for Australian ambulance services to undertake to reduce the impacts of intimate partner violence in line with national strategies. Methods We reviewed the Australian government's National Plan to reduce violence towards women and its supporting literature, and created key actions for Australian ambulance services. Results Our review has yielded four key actions that Australian ambulance services could undertake immediately for the benefit of intimate partner violence patients. Actions include collaboration with external agencies, education, data collection and championing values promoting zero tolerance of violence towards women. Conclusions Australian ambulance services are currently underserving intimate partner violence patients and must undertake immediate action. Successful strategies to address knowledge and policy gaps will require significant input and guidance from key organisations, including advocacy groups, police and EDs. It is likely that EDs will need to take the lead in creating comprehensive policies and guidelines from which ambulance services can derive their own policies. Failure to address this practice gap might result in paramedics becoming a barrier for intimate partner patients to receive appropriate care and support. [ABSTRACT FROM AUTHOR]

Objective: For many years, ambulance services throughout Australia have been administering methoxyflurane as a first-line analgesic agent. However, there is a paucity of literature regarding its efficacy, safety and usage profile. The present study was designed to examine the efficacy of methoxyflurane in adults. Methods: An observational case series was conducted over a 10 month period. Adults to whom methoxyflurane was administered while traveling by ambulance to an urban teaching hospital were enrolled. Data analysed included indications for use, verbal numerical pain scores, depth of sedation and adverse effects. Data were collected via paramedic, patient and ED staff surveys. Results: Eighty-three adult patients were enrolled over a 10 month period. A mean reduction in verbal numerical rating scale (VNRS) scores of 2.47 ± 0.24 (on a 10-point scale) was recorded 5 min post methoxyflurane, with a total reduction of 3.21 ± 0.24 at time of arrival at the ED. Both VNRS scores were significantly different from baseline ( P < 0.0001). Fifteen patients (18.1%, 95% CI 9.8–26.4%) reported mild side-effects either during or shortly after administration. A total of 68 (81.9%, 95% CI 72.0–89.5%) of the paramedics and 60 (72.3%, 95% CI 61.4–81.6%) of the patients interviewed said that they felt satisfied with the level of analgesia provided by methoxyflurane. Conclusion: The use of methoxyflurane as a prehospital analgesic significantly reduced pain in patients, with no significant side-effects attributed to its use. The majority of patients and paramedics interviewed were satisfied with its effects and indicated a willingness to use it again. [ABSTRACT FROM AUTHOR]

Background: Since their emergence from the operating theatre over a decade ago, supra-glottic airways (SGA) have become increasingly common in the management of out-of-hospital cardiac arrest (OOHCA) with laryngeal masks (LM) the most common SGA. The proliferation of LMs in the prehospital setting has occurred despite lower than expected rates of successful insertion being reported., Methods: We conducted a single-centre, prospective parallel-group, 'open label' randomised controlled trial in subjects with OOHCA (aged greater than or equal to 12 years of age; weighing greater than or equal to 30 kg) were allocated to either the i-gel supraglottic airway (IG-SGA) or the Portex Soft Seal Laryngeal Mask (PSS-LM) within a large Australian ambulance service. Our hypothesis was that use of the IG-SGA, when compared to the Portex PSS-LM, would result in a higher rate of successful insertion in patients presenting with OOHCA. The primary outcome was successful insertion of the SGA., Main Findings: There were 51 patients randomised. Subjects had an average age of 65 years and 40% were female. There were no apparent differences in key demographic characteristics between groups. The IG-SGA had a significantly higher success rate than the PSS-LM (90% versus 57%; p=0.023), resulting in a 58% greater likelihood of successful insertion than the PSS-LM (RR 1.58; 95% CI 1.11-2.24). The IG-SGA was associated with significantly lower median "ease of insertion" scores., Conclusion: The i-gel supraglottic airway was associated with higher successful insertion rates in subjects with out-of-hospital cardiac arrest., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)