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Objectives: Depression and anxiety are prominent in paramedics, as is the prevalence of shift work disorder (SWD), a circadian sleep condition comorbid with mental health disorders. However, the role of mental health risk factors for SWD is largely unknown. This study investigated whether mental health levels in recruit paramedics before shift work predicted greater risk of SWD at 6-months into their career and explored whether shift and sleep factors mediated this relationship., Design: A longitudinal study., Setting: Victoria, Australia., Participants: Recruit paramedics were assessed at baseline (n = 101; ie, pre-shift work) and after 6-months (n = 93) of shift and emergency work., Measurements: At both time points, participants completed self-reported measures of depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder Questionnaire-7), and SWD (SWD-Screening Questionnaire). Participants also filled a sleep and work diary for 14-days at each timepoint., Results: After 6-months of emergency work 21.5% of paramedics had a high SWD risk. Logistic regression models showed baseline depression predicted 1.24-times greater odds for SWD at 6-months. Through Lavaan path analysis we found shift and sleep variables did not mediate the relationship between baseline mental health and SWD risk. Baseline depression was associated with increased sleepiness levels following paramedics' major sleep periods at 6-months. Pre-existing depression levels also predicted greater perceived nightshift workload., Conclusions: Our results highlight depression symptoms before emergency work are a risk factor for SWD within 6-months of work. Depression represents a modifiable risk factor amenable to early interventions to reduce paramedics' risk of SWD., (Copyright © 2022 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.)

Paramedics provide care in medical emergencies to patients with varying ages and from a range of settings, cultures, backgrounds and experiences. As such, the paramedic needs a very diverse skill set which is difficult to obtain at university. For this reason, undergraduate paramedic students often engage in clinical placements to apply their knowledge to real world experiences. Most of these placements, however, are in hospitals or ambulance settings, but part of the diverse community that paramedics treat are children with special needs, including children with disabilities. This study measured the attitudes of paramedic students to people with disabilities and explored the effectiveness of paramedic student clinical placements in special needs schools. 109 paramedic students enrolled in their first year of the Bachelor of Paramedicine at Monash University undertook placements in special needs schools across Victoria, Australia. These students completed the Interactions with Disabled Persons Scale. Of these students, 5 participated in two focus groups to gain a deeper understanding of their placement experience. The results showed that paramedic students enjoyed their placements and gained a more positive attitude towards special needs students, but also felt challenged and overwhelmed. Also found were four main characteristics that students believed paramedics needed to be effective; empathy, being genuine, the ability to listen to someone even though they are not speaking to you verbally, and the ability to gain the trust of someone quickly where gaining trust is difficult. This study was the first time an entire cohort of paramedic students have undertaken placements at special needs schools. The findings provide a baseline and incentive for further exploration of the benefits of the placement of paramedic students (and student from a variety of healthcare professions) in special needs schools, as well as other marginalised communities., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objective: This study aims to describe the demographic and employment characteristics of first-year graduates from a Victorian-based paramedicine course and investigate factors that influenced their choice in place of practice., Design: Cross-sectional study using data from the Nursing and Allied Health Graduate Outcomes Tracking study., Setting: Victoria, Australia., Participants: First-year graduates (2019) from the Monash University range of paramedicine programs., Main Outcome Measures: Variables of interest included principal place of practice and the reasons for working in the current location., Results: Over half of the 2018 paramedicine course graduates responded to the 2019 Graduate Outcomes Survey. Nearly all were registered as paramedics (including double registrants as nurses), and over a fifth were from a rural background; however, less than that were working in a rural area. Of those with complete data, the most cited reasons for current work location were 'spouse/partner's employment or career', 'opportunity for career advancement' and 'scope of practice within the role'., Conclusion: This study provides important insight into the factors associated with rural practice location amongst paramedicine graduates, specifically rural origin or personal, lifestyle and professional influences. The study adds to the sparse literature about paramedic practice location decision-making and highlights the need for further systematic longitudinal research examining the 'where' and 'why'., (© 2021 National Rural Health Alliance Ltd.)

Aim: We aimed to investigate the impact of temporal changes in the epidemiology and management of traumatic out-of-hospital cardiac arrest (OHCA) on emergency medical service (EMS) attempted resuscitations and survival outcomes., Methods: A retrospective observational study of traumatic OHCA cases involving patients aged > 16 years in Victoria, Australia, who arrested between 2001 and 2018. Unadjusted and adjusted logistic regression was performed to assess trends in survival outcomes over the study period., Results: Between 2001 and 2018, the EMS attended 5,631 cases of traumatic OHCA, of which 1,237 cases (22.0%) received an attempted resuscitation. EMS response times increased significantly over time (from 7.0 min in 2001-03 to 9.8 min in 2016-18; p trend < 0.001) as did rates of bystander cardiopulmonary resuscitation (CPR) (from 37.8% to 63.6%; p trend < 0.001). Helicopter EMS attendance on scene increased from 7.1% to 12.4% (p trend = 0.01), and transports of patients with return of spontaneous circulation (ROSC) to designated major trauma centres also increased from 36.6% to 82.4% (p trend < 0.001). The frequency of EMS trauma-specific interventions increased over the study period, including needle thoracostomy from 7.7% to 61.6% (p trend < 0.001). Although the risk-adjusted odds of ROSC (OR 1.06, 95% CI: 1.03-1.10) and event survival (OR 1.05, 95% CI: 1.01-1.09) increased year-on-year, there were no temporal changes in survival to hospital discharge., Conclusion: Despite higher rates of bystander CPR and EMS trauma interventions, rates of survival following traumatic OHCA did not change over time in our region. More studies are needed to investigate the optimal EMS interventions for improved survival in traumatic OHCA., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Aim: We aimed to assess temporal changes in the incidence of OHCAs of presumed cardiac and non-cardiac aetiologies., Methods: We conducted a retrospective cohort study of OHCAs in Victoria, Australia between 2000-2017. Annual adjusted incidence rates in presumed cardiac and non-cardiac OHCA were calculated with 95% confidence intervals (95% CI), assuming a Poisson distribution. Annual percent changes in the adjusted rates were calculated from Poisson regression models., Results: During an 18-year period, 90,688 emergency medical service (EMS)-attended OHCAs were included. Of those, 64,422 (71.0%) were of presumed cardiac and 26,266 (29.0%) were of non-cardiac aetiology. Over the 18-year period, there was a 12.6% (95% CI: 10.8%, 14.4%) relative decline in presumed cardiac events and this was driven largely by a reduction in cases with an initial shockable rhythm (23.4%; 95% CI: 19.8%, 27.0%) and cases in patients aged 65-79 years (48.6%; 95% CI: 45.0%, 50.4%). Conversely, there was a 28.8% (95% CI: 27.0%, 32.4%) relative increase in non-cardiac events over the 18-year period, and this was driven by an increase in initial pulseless electrical activity events (93.6%; 95% CI: 86.4%, 100.8%) and cases in patients aged ≥80 years (93.6%; 95% CI: 86.4%, 100.8%). Precipitating events with the largest 18-year increase in incidence were non-traumatic exsanguination (115.2%; 95% CI: 95.4%, 133.2%), respiratory (66.6%; 95% CI: 59.4%, 73.8%), and neurological (63.0%; 95% CI: 50.4%, 77.4%)., Conclusion: Our data indicates that by 2052, non-cardiac aetiologies could be the leading cause of OHCA in our region. These findings have important EMS-system and public health implications., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objective: To assess the effect of patient and system characteristics on emergency medical service (EMS) delays prior to arrival at hospital in suspected ST-elevation myocardial infarction (STEMI)., Methods: This was a retrospective observational study of 1739 patients who presented with suspected STEMI to the EMS in Melbourne, Australia between October 2011 and January 2014. Our primary outcome measure was call-to-hospital time, defined as the time in minutes from emergency call to hospital arrival. We examined the association of patient and system characteristics on call-to-hospital time using multivariable linear regression., Results: The mean call-to-hospital time was 60.1 min (standard deviation 20.5) and the median travel distance was 13.0 km (interquartile range 7.2-23.1). In the multivariable model, patient characteristics associated with longer call-to-hospital time were age ≥75 years (2.3 min; 95% confidence interval [CI] 0.6-4.0), female sex (1.9 min; 95% CI 0.3-3.4), pre-existing mental health disorder (4.0 min; 95% CI 1.9-6.1) or musculoskeletal disease (2.7 min; 95% CI 1.0-4.4), absence of chest pain (3.0 min; 95% CI 1.1-4.8), and presentation with clinical complications. System factors associated with call-to-hospital time include lower dispatch priority (12.7 min; 95% CI 9.0-16.5) and non-12-lead electrocardiography (ECG) capable ambulance first on scene (4.5 min; 95% CI 3.1-5.8). Patients who were not initially attended by a 12-lead capable ambulance were less likely to receive a 12-lead ECG within 10 min (18.5% vs 71.0%, P < 0.001)., Conclusion: A range of patient and system factors may influence EMS delays in STEMI. However, optimising dispatch prioritisation and widespread availability of prehospital 12-lead ECG could lead to substantial reduction in time to treatment., (© 2020 Australasian College for Emergency Medicine.)

Aim : The aim of this study was to describe temporal trends in the incidence, characteristics, and outcomes of hanging-related out-of-hospital cardiac arrest (OHCA). Method : A retrospective study of all hanging-related OHCA in Victoria, Australia, between 2000 and 2017 was conducted. Trends in incidence, characteristics, and outcomes were assessed using linear regression and a non-parametric test for trend, as appropriate. Predictors of survival to hospital discharge were identified using multivariable logistic regression. Results : Between 2000 and 2017, emergency medical services (EMS)-attended 3,891 cases of hanging-related OHCA, of which 876 cases (23%) received an attempted resuscitation. The overall incidence rate of EMS-attended cases was 3.8 cases per 100,000 person-years increasing from 2.3 cases per 100,000 person-years in 2000 to 4.7 cases in 2017 ( p for trend <0.001). Incidence rates increased approximately two-fold in young adults (18-44 years) and three-fold in middle aged adults (45-64 years). Despite improvement in the rate of bystander cardiopulmonary resuscitation (from 49% in 2000-2005 to 75% in 2012-2017), the survival to hospital discharge rate remained unchanged (3% overall). Among adult survivors with 12-month follow-up (n = 10), five patients responded to telephone interviews. Of those, three (60%) reported severe functional disability. Five patients responded to telephone interviews, of which 3 patients reported severe functional disability. An initial shockable rhythm (OR 23.17, 95% CI: 5.75, 93.36) or pulseless electrical activity (OR 13.14, 95% CI: 4.79, 36.03) were associated with survival. Conclusion : The incidence of hanging-related OHCA doubled over the 18 year period with no change to survival rates. New preventative strategies are needed to reduce the community burden of these events.

Aim: Paediatric traumatic out-of-hospital cardiac arrest (OHCA) is a rare event with few survivors. We examined long-term trends in the incidence and outcomes of paediatric traumatic OHCA and explored the frequency and timing of intra-arrest interventions., Methods: We retrospectively analysed data from the Victorian Ambulance Cardiac Arrest Registry for cases involving traumatic OHCA in patients aged ≤16 years arresting between January 2000 to December 2017. Trends were assessed using linear regression and a non-parametric test for trend., Results: A total of 292 cases were attended by emergency medical services (EMS), of which 166 (56.9%) received an attempted resuscitation. The overall incidence of EMS-attended cases was 1.4 cases per 100,000 person-years, with no significant changes over time. Unadjusted outcomes also remained unchanged, with 23.5% achieving return of spontaneous circulation and 3.7% surviving to hospital discharge. The frequency of trauma-specific interventions increased between 2000-2005 and 2012-2017, including needle thoracostomy from 10.5% to 51.0% (p trend <0.001), crystalloid administration from 31.6% to 54.9% (p trend = 0.004) and blood administration from 0.0% to 6.3% (p trend = 0.01). The median time from emergency call to the delivery of interventions were: 12.9 min (IQR: 8.5, 20.0) for cardiopulmonary resuscitation, 19.7 min (IQR: 10.7, 39.6) for external haemorrhage control, 29.8 min (IQR: 22.0, 35.4) for crystalloid administration and 31.5 min (IQR: 21.0, 38.0) for needle thoracostomy., Conclusion: The incidence and outcomes of paediatric traumatic OHCA remained unchanged over an 18 year period. Early correction of reversible causes by reducing delays to the delivery of trauma-specific interventions may yield additional survivors., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Objectives: While postgraduate studies have begun to shed light on informal interprofessional workplace learning, studies with preregistration learners have typically focused on formal and structured work-based learning. The current study investigated preregistration students' informal interprofessional workplace learning by exploring students' and clinicians' experiences of interprofessional student-clinician (IPSC) interactions., Design: A qualitative interview study using narrative techniques was conducted., Setting: Student placements across multiple clinical sites in Victoria, Australia., Participants: Through maximum variation sampling, 61 participants (38 students and 23 clinicians) were recruited from six professions (medicine, midwifery, nursing, occupational therapy, paramedicine and physiotherapy)., Methods: We conducted 12 group and 10 individual semistructured interviews. Themes were identified through framework analysis, and the similarities and differences in subthemes by participant group were interrogated., Results: Six themes relating to four research questions were identified: (1) conceptualisations of IPSC interactions; (2) context for interaction experiences; (3) the nature of interaction experiences; (4) factors contributing to positive or negative interactions; (5) positive or negative consequences of interactions and (6) suggested improvements for IPSC interactions. Seven noteworthy differences in subthemes between students and clinicians and across the professions were identified., Conclusions: Despite the results largely supporting previous postgraduate research, the findings illustrate greater breadth and depth of understandings, experiences and suggestions for preregistration education. Educators and students are encouraged to seek opportunities for informal interprofessional learning afforded by the workplace., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Introduction: Paramedics rely on establishing a health provider-patient relationship with patients that promotes two-way communication, patient satisfaction, and facilitates appropriate patient assessment and treatment. Paramedics also must have an ability to empathize with patients and their family members in order to develop a successful health provider-patient relationship. The objective of this study was to assess paramedics' empathy and attitudes toward patients with specific conditions., Methods: This was a cross-sectional study using a convenience sample of first-, second-, and third-year, Australian undergraduate paramedic students. Student empathy levels were assessed using two standardized self-reporting instruments: the Jefferson Scale of Physician Empathy (JSPE) Health Professional (HP) version and the Medical Condition Regard Scale (MCRS)., Results: A total of 94 paramedic students participated in the study. The JSPE demonstrated that male paramedic students had higher mean empathy scores than did female paramedic students (113.25 and 107.5, respectively; P = .042). The JSPE empathy level scores were lowest among first-year paramedic students (mean = 107.53); age was not found to be a significant variable on empathy scores. The Medical Condition Regard Scale revealed lowest scores in compassion towards substance abuse (mean = 46.42)., Conclusions: The results of this study provide the discipline of paramedic health care with useful data, and provide students, academics, and other educators with important information regarding the improvement of the health provider-patient relationship and paramedic education curriculum development.

The Listening Style Profile (LSP-16) measures people's self-reported preferences for four listening styles that we habitually use when we listen. Research in this area is important for health care education since listening is a fundamental skill in all the health care professions. The aim of this study was to investigate the factor structure of the LSP-16's subscales when completed by a group of respondents from a large Australian university. Data from the LSP-16 completed by 860 undergraduate health science students enrolled in eight different courses (response rate of 59%) were analyzed using maximum likelihood confirmatory factor analysis. The model fit indices of the maximum likelihood analysis demonstrate that the resultant models did not fit the data well. One item exhibited model misfit and reliability estimates and factor loadings were modest. The confirmatory factor analysis results did not support the overall latent factor structure of the LSP-16 as initially proposed by its authors. Further work is required to examine the underlying construct validity and other measurement properties of the LSP-16.

Purpose: It has been identified that health science students, and in particular undergraduate nutrition and dietetics (N&D) students, have distinctive learning needs. The purpose of this study was to investigate the learning styles of undergraduate N&D students enrolled at a large Australian university. An awareness of the learning styles of undergraduate N&D students will assist university educators in providing appropriate learning opportunities and developing curricula to equip N&D graduates with the essential skills they need to work effectively in the modern practice environment., Methods: The Kolb Learning Style Inventory (K-LSI), Index of Learning Styles (ILS) and Success Types Learning Style Type Indicator (STLSTI) were distributed to 162 students enrolled in a Bachelor of Nutrition and Dietetics program at one metropolitan university., Results: One hundred twenty-nine questionnaires were returned, providing a response rate of 79.6%. The K-LSI showed that students were inclined toward converging (practical) and assimilating (reasoning) learning styles while the ILS identified the students as intuitive (innovative). The STLSTI results indicated an intraverted, sensing, feeling, judging approach to learning., Conclusions: It is recommended N&D educators take into consideration the learning styles of dietetics students when developing curricula and evaluating teaching approaches. Analysis of learning styles can inform the planning, implementation, and assessment of teaching and learning activities to create effective learning environments, appropriate learning opportunities, and a contemporary curriculum for N&D students.

This study examined the construct validity of the Paramedic Graduate Attribute scale (PGAS) using factor analysis and Rasch Analysis. A convenience sample was used in the study involving paramedics from all states and territories in Australia. Participants were asked to rate the importance of 47 graduate attribute items. Principal components analysis (PCA) was undertaken on the 47 items followed by Oblique Oblimin rotation. For the Rasch analysis item fit, item invariance and dimensionality were examined. A total of 872 paramedics participated in the study (23% response rate). PCA of the 47 items revealed seven factors with eigenvalues greater than 1, accounting for 40.6% of the total variance. The subsequent Rasch analyses based on the seven factors produced seven misfitting items and confirmed a 7-factor solution. The 7-factor PGAS produced a good fit to the Rasch Model and exhibited good reliability and unidimensionality, offering the Australian paramedic discipline a set of empirically based graduate attributes.

Research has highlighted poor mathematical ability amongst qualified and student nurses. Three major classifications of errors: i)conceptual, ii)arithmetical and iii)computational have been identified. These errors involve being unable to formulate an equation from information given, unable to operate a given equation, or simple arithmetical errors respectively. The objective of this study was to determine if a sample of Australian second year undergraduate nursing students, from the state of Victoria, could accurately calculate drug dosages and perform some basic mathematical calculations that would be required in the workplace. A descriptive survey collecting demographical data, attitudes towards drug calculation performance and basic mathematical and drug calculation questions was administered to the 52 undergraduate nurses who participated in the study. The average score was 56.1%. Interestingly 63.5% of the students denied any drug calculations issues. On average those who completed a minimum of year 12 mathematics, or who had entered the course directly from secondary education achieved scores over 50%. Of all the errors that occurred 36.0% were conceptual, 38.9% were arithmetical and 25.1% were computational. Some Victorian nursing students currently have deficiencies in performing accurate calculations, with both arithmetical and conceptual errors, indicating fundamental flaws in their mathematical understanding and demonstrating an unacceptable level to practice safely., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Introduction: Accurate estimation of a patient's age and weight are skills expected of all healthcare clinicians, including paramedics and nurses. It is necessary because patients may be unable to communicate such information due to unconsciousness or an altered state of conscious. Age and weight estimation influence calculation for medication dosages, defibrillation, equipment sizing, and other invasive procedures such as intubation. The objective of this study was to identify whether undergraduate paramedic and nursing students were able to accurately estimate a patient's age and weight based on digital patient photos., Methods: A prospective, observational study involving undergraduate paramedic and nursing students from two Australian universities was used to estimate the age and weight of seven patients (adult and pediatric). Each patient image appeared in a PowerPoint presentation for 15 seconds, followed by a short pause, with the next patient image commencing automatically., Results: The findings demonstrated variable accuracy in age and weight estimation of the patients. Age estimations of pediatric patients were more accurate than estimations for adult patients. The majority of patient weights were under-estimated, with university undergraduate students in one university displaying similar estimations to the other university counterparts., Conclusions: Results from this study identified variations in students' ability to accurately estimate a patient's age and weight. This study shows that consideration should be given to age and weight estimation education, which could be incorporated into undergraduate healthcare curriculum.

Unlabelled: The aim of this study was to examine the usefulness of DVD simulations in a clinical teaching context, their impact on student learning, and their potential as a supplemental learning option for clinical placements/fieldwork education rotations that might assist in reducing the burden on the health care system., Methods: Eleven clinical DVD simulations were developed by Monash University academic staff from four academic departments: nursing, occupational therapy, paramedics, and physiotherapy. Undergraduate students (n = 394) from these health science groups viewed the DVD simulations. Student perceptions and attitudes about the clinical relevance of the DVD simulations were assessed on a 7-point Likert-type scale standardized questionnaire (7 indicating the highest satisfaction score). Qualitative data were also collected from three focus groups that involved 24 students, assessing if and how the DVD simulations influenced the clinical fieldwork education placement learning experiences of the students., Results: Overall, students' responses to the questionnaire indicated that they were satisfied with the DVD simulations with relation to attention (mean 4.25, SD 0.95), learning potential (mean 5.25, SD 1.16), clinical relevance to practice (mean 4.36, SD 0.60), and information-processing quality (mean 5.45, SD 0.23). Qualitative data supported the notions of interdisciplinary teamwork, clinical placements, clinical placement education, and DVD quality evaluation and feedback., Conclusion: Students viewed the simulations as being educationally, professionally, and clinically relevant. The cost benefit of using DVD simulations to replace or supplement components of clinical fieldwork education should be investigated further.

Purpose: The study aimed to evaluate the usability of DVD simulations, the impact on student learning, clinical placement orientation, and the potential for using DVD simulations to reduce the clinical placement burden on the health care system with nursing students., Method: A total of 11 DVD simulations were developed by Monash University academics. Second year students (N=191) from the Bachelor of Nursing course at Monash University, viewed a range of DVDs. Students' perceptions and attitudes about the clinical relevance of the simulations were assessed by having them complete a 7-point Likert self-report scale. Qualitative data was also collected from two focus groups (N=7)., Results: Overall, nursing students perceived the DVD simulations positively in relation to learning attention (M=4.93, SD=1.02, CI 4.25-4.54), learning potential (M=4.45, SD= 1.30, CI 5.13-5.50), clinical relevance to practice (M=5.32, SD=0.65, CI 4.36-4.55), and information processing quality (M=5.62, SD= 1.02, CI 5.47-5.76). The following themes emerged from the focus groups: provided familiarisation for clinical placements, learning wastage occurs in varying amounts, simulations could replace some clinical placement rotations, supportive of multidisciplinary approach and integration, and simulations should have pedagogical integration into weekly clinical cases., Conclusion: Nursing students reported that the simulations were educationally, professionally, and clinically relevant. The cost benefit of using DVD simulations as an alternative and potential replacement to elements of nursing clinical placements should be investigated further.

Objective: This study aimed to evaluate the usability of DVD simulations, the impact on student learning satisfaction and the potential for using DVD simulations to reduce the clinical placement burden on the current healthcare system. The clinical DVD simulations were underpinned by interprofessional educational principles that supported clinical placements for paramedic students., Method: Eleven DVD simulations were developed by academic staff members from Monash University with input and feedback from a team of healthcare professionals. Students (N = 97) from the Bachelor of Emergency Health at Monash University viewed the DVD simulations. Students' perceptions, attitudes and thoughts about the clinical relevance of the simulations were assessed by completing a standardised self-report 7-point Likert scale questionnaire (7 indicating the highest satisfaction score). Qualitative data assessing if and how the DVD simulations had influenced paramedic students' clinical placement learning experiences were also collected via two focus groups (n = 6)., Results: Overall, paramedic students positively perceived the DVD simulations with relation to learning satisfaction (mean (SD) 5.14 (1.14), 95% CI 4.91 to 5.37) and information processing quality (mean (SD) 5.50 (0.83), 95% CI 5.33 to 5.67). The simulations maintained students' attention and concentration (mean (SD) 4.35 (0.95), 95% CI 4.15 to 4.54) and provided clinical authenticity and relevance to practice (mean (SD) 4.27 (0.65), 95% CI 4.14 to 4.40). A number of themes emerged from the focus group data including the impact on employment, greater appreciation of healthcare teamwork and notion of interdisciplinary teamwork, the fact that DVD simulations have the capacity to replace some clinical placement rotations and should be integrated into standard curriculum, and that varying amounts of learning wastage occur during clinical placements., Conclusions: DVD simulations with an interprofessional education focus were developed. Paramedic students reported the simulations as being educationally, professionally and clinically relevant. The students also identified some aspects of current clinical placements that may be replaced by using DVD simulations. The cost benefit of using interprofessional DVD simulations to supplement and replace certain clinical placement rotations should be investigated further.

Background: Undergraduate paramedic students undertake clinical placements in a variety of locations. These placements are considered an essential element for paramedic pre-employment education. However, anecdotal evidence suggests some students have not had positive experiences on their emergency ambulance placements. The objective of this study was to identify the type of experiences had by students during ambulance clinical placements and to provide feedback to the ambulance services., Methods: In this pilot study we employed a cross-sectional study methodology, using a convenience sample of undergraduate paramedic students available in semester one of 2007 to ascertain the students' views on their reception by on-road paramedics and their overall experience on emergency ambulance clinical placements. Ethics approval was granted., Results: There were 77 students who participated in the survey, 64% were females, with 92% of students < 25 years of age and 55% < 65 Kg in weight. There was a statistically significant difference in average height between the genders (Male 179 cm vs Female 168 cm, p < 0.001). Clinical instructors were available to 44% of students with 30% of students excluded from patient management. Thirty percent of students felt there was a lot of unproductive down time during the placement. Paramedics remarked to 40% of students that they doubted their ability to perform the physical role of a paramedic, of this group 36% were advised this more than once., Conclusion: This study demonstrates that for a small group of students, emergency ambulance clinical placements were not a positive experience clinically or educationally. Some qualified paramedics doubt if a number of female students can perform the physical role of a paramedic.

Objectives: There are many patient assessment challenges in the prehospital setting, especially the estimation of external blood loss. Previous studies of experienced paramedics have demonstrated that external blood loss estimation is highly inaccurate. The objective of this study was to determine if undergraduate paramedic students could accurately estimate external blood loss on four surfaces commonly found in the prehospital environment., Methods: This prospective, observational, blinded study used a convenience sample of undergraduate students studying at Monash University during 2006. Students were provided with four clinical vignettes using four different surfaces and varying simulated blood amounts., Results: Accurate estimation occurred with the vinyl simulation (100 ml), with a mean value of the estimations of 98 ml (95% Confidence Interval (CI) 84-113 ml). Carpet and concrete surfaces were both associated with large under-estimations. The carpet simulation (1,000 ml) had a mean value for the estimations of 347 ml (95% CI 320-429 ml). The concrete simulation (1,500 ml) had a mean value for the estimations of 885ml (95% CI 771-999 ml). Conversely, the clothing simulation (500 ml) emphasized over-estimation, with a mean value for the estimations of 1,253 ml (95% CI 1,093-1,414 ml). There was no relationship between increased accuracy and clinical experience, exposure, educational qualifications, or age of students., Conclusions: External blood loss estimation by undergraduate paramedic students generally is too inaccurate to be of any clinical benefit. Particularly, absorbent and impermeable surfaces precipitated inaccuracies by undergraduate paramedic students.

The aim of this project was to promote internationalisation of prehospital education collaboratively between students and teachers from EMS Education and Training, Montana, USA, and Monash University Centre for Ambulance and Paramedic Studies (MUCAPS), Victoria, Australia. The project required students and teachers to engage in a series of face to face lectures, which was reinforced through distance education strategies, such as online learning. The overall project aim was to establish an objective and descriptive view of the internationalisation of prehospital and community based emergency health education using e-learning as the educational approach. A cross sectional survey design using paper based evaluation was adopted in this project. Results revealed a positive student reaction, with flexible pedagogical processes broadening student learning and facilitating an international dimension otherwise not achievable. Given the current state of globalisation, internationalisation has the capacity to improve educational standards, quality, student interactions and specific learning outcomes in prehospital education.

Objective: Existing research suggests that the rate of depressive illness and depressive symptoms are high in people living with HIV/AIDS, but investigations on the causes of depression provide conflicting results. Social, psychological and biological factors have all been suggested as possible causes of depression in people living with HIV/AIDS. The suggestion that depression may be the result of the neurotropic effects of the virus on the central nervous system leading to an 'organic' or secondary depression has major implications in the treatment of HIV/AIDS. The aim of the current study was to further investigate the nature and underlying aetiology of depression in people living with HIV/AIDS., Method: One hundred and twenty-nine people living with HIV/AIDS recruited for the study from outpatients clinics and primary care settings completed a range of self-report symptom measures including the Beck Depression Inventory (BDI), SF-36, SPHERE and a personality measure, the NEO Personality Inventory (NEO-PI). They also completed a battery of neuropsychological tests (CANTAB) and a structured clinical interview (SCID-DSM-IV). Medical and sociodemographic data were also recorded., Results: Approximately one-third scored > or = 14 on the BDI and 27% met criteria for a current 'mood disorder' on the SCID. Depressive symptoms were strongly related to personality style, having a past psychiatric history and current stressful psychosocial situation. There was no association between depression and HIV disease status. There was no evidence in this study cohort of a distinct subtype of 'organic' or secondary depression., Conclusions: These results suggest that at least for 'well' people living with HIV/AIDS, there is no distinct subtype of depression and early treatment approaches can be modelled on those used for other non-HIV groups. Further longitudinal studies will be required to dissect out the multiple factors underlying depression in HIV/AIDS.

The Motor Assessment Scale (MAS) and the Functional Independence Measure (FIM) are commonly used in Australian rehabilitation centres but there have been few systematic studies using them to measure recovery after stroke, especially with regard to upper limb function. The aims of this study were to provide a profile of upper limb recovery in a non-surgical stroke population using measures of impairment and disability. The records of 153 subjects were audited for upper limb MAS sub-scores, the FIM sub-score for upper body dressing, and the total FIM score at admission and discharge from rehabilitation. Significant improvement occurred for all outcome measures. There was no relationship between the MAS scores and the functional task of upper body dressing. The results emphasize the importance of using outcome measures that assess both impairment and disability, and indicate that substantial improvements in upper limb function frequently occur after stroke. Although the MAS has limitations, it is a valuable tool for measuring upper limb outcome after stroke because it provides a more accurate profile of true upper limb recovery than the FIM.