Peter O'Meara

Airtraq vs standard laryngoscopy by student paramedics and experienced prehospital laryngoscopists managing a model of difficult intubation

Two consecutive, randomised, cross‐over trials compared intubation success rates in third‐year paramedic students and experienced prehospital practitioners using the Airtraq or a Macintosh laryngoscope with flexible stylet in a manikin model of a Cormack and Lehane grade III/IV laryngoscopic view. First‐time intubation rates for the Macintosh and Airtraq for students were 0/23 (0%) vs 10/23 (44%) (44% difference, 95% CI 26–63%, p < 0.001) and for experienced laryngoscopists were 14/56 (25%) vs 47/56 (84%) (59% difference, 95% CI 42–72%, p < 0.0001), respectively. First‐time oesophageal intubation rates for students were 15/23 (65%) vs 3/23 (13%) (− 52% difference, 95% CI − 25 to − 72%, p < 0.001) and for experienced practitioners 9/56 (16%) vs 0/56 (0%) (− 16% difference, 95% CI − 9 to − 28%, p = 0.0014). Student paramedics and experienced prehospital laryngoscopists managing a manikin model of a grade III/IV view had increased first‐time intubation rates and had lower rates of oesophageal intubation with the Airtraq compared with a standard laryngoscope.

Would a prehospital practitioner model improve patient care in rural Australia

Background: Existing rural prehospital models have been criticised for being isolated from the healthcare system, and for following inflexible clinical protocols. Greater reliance on clinical judgement and informed decision making in the prehospital setting offer the potential to improve patient care. Methods: Soft systems methodology was used to develop and critically appraise the prehospital practitioner model as an alternative to existing models. This approach started from the philosophical viewpoint that prehospital services should be patient centred. Soft systems methodology was used to structure the elements of prehospital systems and the relations between them into metaphors and pictures that could be analysed. Results: This analysis showed that the most powerful reason for advocating the prehospital practitioner model is that it places prehospital systems within a symbiotic relationship with the healthcare system. Unlike the existing emergency service models or the “chain of survival” model, it is an integrated system that provides a range of services at multiple points during the patient care cycle. Thus, the prehospital practitioner would have roles in the prevention of injury and illness, responding to emergencies, facilitating recovery, and planning future strategies for a healthy community. Conclusions: Implementing this new model would see the prehospital system using its available capacity more effectively to fulfill broader public health and primary care outreach roles than is currently the case. Patients would be referred or transported to the most appropriate and cost effective facility as part of a seamless system that provides patients with well organised and high quality care.

Occupational injury risk among Australian paramedics: an analysis of national data

Objective: To identify the occupational risks for Australian paramedics, by describing the rate of injuries and fatalities and comparing those rates with other reports.

Use of the Airtraq laryngoscope in a model of difficult intubation by prehospital providers not previously trained in laryngoscopy

This study evaluated the ability of prehospital providers who had no previous training in intubation, to use an Airtraq laryngoscope to intubate a manikin model of a Cormack and Lehane grade III/IV view. Volunteers attending the Australian College of Ambulance Professionals conference, Adelaide, in November 2006 received approximately 5 min of Airtraq training. First‐time intubation success rate was 26/33 (79%) (95% CI 61–91%); oesophageal intubation rate was 0/33 (0%) (95% CI 0–11%); median time to intubation was 17 s (IQR 10–25 s (range 5–30 s)); and median subject‐rated difficulty of use score was 21 out of a maximum of 100 (IQR 7.5–35.5 (range 1–65)). Pre‐hospital providers without previous laryngoscopy training achieved high first‐time intubation success rates when managing a model of a grade III/IV difficult intubation with an Airtraq laryngoscope. Users evaluated it as easy to use and achieved intubation within an acceptable breath‐to‐breath interval.

Achy breaky makey wakey heart? A randomised crossover trial of musical prompts

Objective Compared with no music (NM), does listening to ‘Achy breaky heart’ (ABH) or ‘Disco science’ (DS) increase the proportion of prehospital professionals delivering chest compressions at 2010 guideline-compliant rates of 100–120 bpm and 50–60 mm depths? Methods A randomised crossover trial recruiting at an Australian ambulance conference. Volunteers performed three 1-min sequences of continuous chest compressions on a manikin accompanied by NM, repeated choruses of ABH and DS, prerandomised for order. Results 37 of 74 participants were men; median age 37 years; 61% were paramedics, 20% students and 19% other health professionals. 54% had taken cardiopulmonary resuscitation training within 1 year. Differences in compression rate (mode, IQR) were significant for NM (105, 99–116) versus ABH (120, 107–120) and DS (104, 103–107) versus ABH (p<0.001) but not NM versus DS (p=0.478). Differences in proportions of participants compressing at 100–120 bpm were significant for DS (61/74, 82%) versus NM (48/74, 65%, p=0.007) and DS versus ABH (47/74, 64%, p=0.007) but not NM versus ABH (p=1). Differences in compression depth were significant for NM (48 mm, 46–59 mm) versus DS (54 mm, 44–58 mm, p=0.042) but not NM versus ABH (54 mm, 43–59 mm, p=0.065) and DS versus ABH (p=0.879). Differences in proportions of subjects compressing at 50–60 mm were not significant (NM 31/74 (42%); ABH 32/74 (43%); DS 29/74 (39%); all p>0.5). Conclusions Listening to DS significantly increased the proportion of prehospital professionals compressing at 2010 guideline-compliant rates. Regardless of intervention more than half gave compressions that were too shallow. Alternative audible feedback mechanisms may be more effective.

Outside--Looking In: Evaluating a Community Capacity Building Project.

Abstract The Alberton Project was a three-year community capacity building project that ran from 1999 until 2002. It aimed to revitalise the local community surrounding the small Victorian town of Yarram. Evaluation of the project involved participant observation, monitoring of media reports, surveys and interviews. Outcomes are reported with reference to four capacity building domains of vision and leadership, structure and partnerships, community engagement, and resources. The Project demonstrated a high level of administrative competence and an ability to build a strong profile. While members showed themselves to be well motivated and ethical, they battled to engage a wide range of community members. Limitations were identified with the project’s bureaucratic structure compared to alternate social models of organisation that reflect how people interact in a community. Other rural community capacity building projects should consider the value of open organisational structures that invite a more diverse membership from the community.

Paramedic empathy levels: results from seven Australian universities

Purpose Evidence suggests that improved empathy behaviours among healthcare professionals directly impacts on healthcare outcomes. However, the ‘nebulous’ properties of empathic behaviour often means that healthcare profession educators fail to incorporate the explicit teaching and assessment of empathy within the curriculum. This represents a potential mismatch between what is taught by universities and what is actually needed in the healthcare industry. The objective of this study was to assess the extent of empathy in paramedic students across seven Australian universities. Methods A cross-sectional study using a paper-based questionnaire employing a convenience sample of first, second, and third year undergraduate paramedic students. Student empathy levels were measured using a standardised self-reporting instrument: Jefferson Scale of Physician Empathy – Health Profession Students (JSPE-HPS). Findings A total of 783 students participated in the study of which 57% were females. The overall JSPE-HPS mean score was 106.74 (SD=14.8). Females had greater mean empathy scores than males 108.69 v 103.58 (p=0.042). First year undergraduate paramedic mean empathy levels were the lowest, 106.29 (SD=15.40) with second years the highest at 107.17 (SD=14.90). Value The overall findings provide a framework for educators to begin constructing guidelines focusing on the need to incorporate, promote and instil empathy into paramedic students in order to better prepare them for future out-of-hospital healthcare practice.

Can undergraduate paramedic students accurately identify lung sounds

Introduction: The accurate identification of lung sounds during chest auscultation is a skill commonly used by healthcare clinicians, including paramedics, when assessing a patient’s respiratory status. It is a necessary skill as it enables confirmation of a patient’s respiratory condition and guides the paramedic to a provisional diagnosis and the implementation of appropriate management. The object of this study was to identify if undergraduate paramedic students from two Australian universities were able to interpret a variety of lung sounds accurately. Methods: A prospective single-blinded observational study requiring 96 undergraduate paramedic students from two Australian universities to estimate the lung sounds of six audio files. Results: The findings demonstrated variable accuracy in lung sound interpretation of the six audio files. The lung sound that contained a wheeze was most accurately interpreted, whereas coarse crackles were the least accurately interpreted. Monash University undergraduate paramedic students displayed similar lung sound interpretations to Charles Sturt University undergraduate paramedic students. Conclusion: In this study undergraduate paramedic students from two Australian universities were found to be inaccurate at interpreting a variety of common lung sounds. The study has highlighted that a greater emphasis needs to be given to lung sound interpretation in undergraduate paramedic education programmes.

The role of context in establishing University Clinics

Healthcare systems have a vested interest in employing work-ready graduates. The challenge for universities is to find ways to provide workplace learning that incorporates student education and high quality patient care. Inland areas of Australia, similar to other rural locations globally, experience additional challenges including a relatively high incidence of ill health, increasing demand for health services, chronic workforce shortages and ageing of the existing rural health workforce. In this paper, we conceptualise and describe the research findings related to context from a consultative enquiry into university clinics conducted in 2008. Interview participants were drawn from twenty university clinics in Australia and New Zealand. A consistent theme throughout the interviews was tensions that arose between the role of education and healthcare provision within university clinics. Many interview participants described ways they managed these tensions to meet the expectations of students, educators and the community. The patient supply is the most critical factor in the context of university clinic operations. It is vital to both the educator and the healthcare provider roles. In inland areas with sparse populations a number of strategies, such as outreach clinics, hospital or health centre- based clinics and multi-disciplinary sites, will have to be developed if university clinics are to operate effectively for students and patients.

Getting in Touch with Paramedic Student Career Intentions.

Objective: This study of paramedic and nursing/paramedic students aimed to determine the initial career intentions of full-time paramedic students and to identify the key factors that influence their career choices. Design: A longitudinal study design, utilizing surveys and a focus group, was employed. Setting: The study was conducted in an Australian regional university with a large, on-campus paramedic programme. Method: Students were surveyed to ascertain the factors that shape their preferences for employment and a focus group was conducted with final year students to further investigate the responses. Respondents were asked to nominate their preferences for employment and identify key factors that influence their decision-making. Data were analysed using inferential statistics and textual analysis. Results: There were 508 questionnaires returned from 704 paramedic students (72 per cent response rate). Of the respondents 82 per cent were originally from New South Wales and the Australian Capital Territory, the balance from other States/Territories and overseas. Students’ career intentions did not necessarily follow their place of origin with 58 per cent preferring New South Wales or the Australian Capital Territory, 17 per cent Victoria, 3.5 per cent other States, and 7 per cent indicating other employers. The identified influences on student career intentions were personal (53 per cent), professional (20 per cent), organizational (8 per cent), and community factors (3 per cent). Conclusion: Potential employers need to address graduate needs if they expect to attract the most talented graduates. Universities educating paramedics should focus on the needs of students and the profession.