Development of a Quality Indicator Set for the Optimal Acute Management of Moderate to Severe Traumatic Brain Injury in the Australian Context.

Background: The aim of this study was to develop a consensus-based set of indicators of high-quality acute moderate to severe traumatic brain injury (msTBI) clinical management that can be used to measure structure, process, and outcome factors that are likely to influence patient outcomes. This is the first stage of the PRECISION-TBI program, which is a prospective cohort study that aims to identify and promote optimal clinical management of msTBI in Australia.

Methods: A preliminary set of 45 quality indicators was developed based on available evidence.

Cost-effectiveness analysis of an ambulance service-operated specialised cardiac vehicle with mobile extracorporeal cardiopulmonary resuscitation capacity for out-of-hospital cardiac arrests in Queensland, Australia.

Objective: Extracorporeal CPR (E-CPR) has been primarily limited to the in-hospital setting. A few systems around the world have implemented pre-hospital mobile E-CPR in the form of a dedicated cardiac vehicle fitted with specialised equipment and clinicians required for the performance of E-CPR on-scene. However, evidence of the outcomes and cost-effectiveness of mobile E-CPR remain to be established.

Prehospital Tranexamic Acid for Severe Trauma.

Background: Whether prehospital administration of tranexamic acid increases the likelihood of survival with a favorable functional outcome among patients with major trauma and suspected trauma-induced coagulopathy who are being treated in advanced trauma systems is uncertain.

Methods: We randomly assigned adults with major trauma who were at risk for trauma-induced coagulopathy to receive tranexamic acid (administered intravenously as a bolus dose of 1 g before hospital admission, followed by a 1-g infusion over a period of 8 hours after arrival at the hospital) or matched placebo. The primary outcome was survival with a favorable functional outcome at 6 months after injury, as assessed with the use of the Glasgow Outcome Scale-Extended (GOS-E).

Epidemiology of open limb fractures attended by ambulance clinicians in the out-of-hospital setting: A retrospective analysis.

Background: Open limb fractures are a time-critical orthopaedic emergency that present to jurisdictional ambulance services. This study describes the demographic characteristics and epidemiological profile of these patients METHODS: We undertook a retrospective analysis of all patients that presented to Queensland Ambulance Service with an open limb fracture (fracture to the humerus, radius/ulna, tibia/fibula or femur) over a two-year period (January 2018 - December 2019).

Results: Overall, 1020 patients were included.

Cost-effectiveness of extracorporeal cardiopulmonary resuscitation for refractory out-of-hospital cardiac arrest: A modelling study.

Background: Extracorporeal cardiopulmonary resuscitation (E-CPR) is a method of CPR that passes the patient's blood through an extracorporeal membrane oxygenation (ECMO) device to provide mechanical haemodynamic and oxygenation support in cardiac arrest patients who are not responsive to conventional CPR (C-CPR). E-CPR is being adopted rapidly worldwide despite the absence of high quality trial data and its substantial cost. Published cost-effectiveness data for E-CPR are scarce.

Acute Opioid Withdrawal Following Intramuscular Administration of Naloxone 1.6 mg: A Prospective Out-Of-Hospital Series.

Study Objective: Large doses of intramuscular (IM) naloxone are commonly used in out-of-hospital settings to reverse opioid toxicity; however, they are used less commonly in hospitals because of concerns about opioid withdrawal, particularly agitation. We aimed to determine the frequency of severe agitation following a single 1.6 mg IM naloxone dose.

Survival after Resuscitated Out-of-Hospital Cardiac Arrest in Patients with Paramedic-Identified ST-Segment Elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention.

ST-segment elevation myocardial infarction (STEMI) is a common cause of out-of-hospital cardiac arrest (OHCA). For these patients, urgent angiography and revascularization is an important treatment goal. There is a lack of data on the prognosis of STEMI patients after OHCA, who are diagnosed and treated by paramedics prior to hospital transport for primary percutaneous coronary intervention (PCI).

Epidemiology, management and survival outcomes of adult out-of-hospital traumatic cardiac arrest due to blunt, penetrating or burn injury.

Background: Survival from out-of-hospital traumatic cardiac arrest (TCA) is poor. Regional variation exists regarding epidemiology, management and outcomes. Data on prognostic factors are scant.

Spatiotemporal variation in the risk of out-of-hospital cardiac arrests in Queensland, Australia.

Background: Spatiotemporal analysis of out-of-hospital cardiac arrest (OHCA) risk is essential to design targeted public health strategies. Such information is lacking in the state of Queensland and Australia more broadly.

Methods: We developed a spatiotemporal Bayesian model accounting for spatial and temporal dimensions, space-time interactions, and demographic factors.

Time to amiodarone administration and survival outcomes in refractory ventricular fibrillation.

Objective: International guidelines recommend amiodarone for out-of-hospital cardiac arrest (OHCA) in refractory ventricular fibrillation (VF). While early appropriate interventions have been shown to improve OHCA survival, the association between time to amiodarone and survival remains to be established.

Methods: Included were adult OHCA in refractory VF, between January 2015 and December 2019, who received a resuscitation attempt with amiodarone from Queensland Ambulance Service paramedics.

Trauma by-pass guideline: A data-driven conformance analysis for road trauma cases in Queensland.

Objective: Study objectives were to (i) develop and test a whole-of-system method for identifying patients who meet a major trauma by-pass guideline definition; (ii) apply this method to assess conformance to the current 2006 guideline for a road trauma cohort; and (iii) leverage relevant findings to propose improvements to the guideline.

Methods: Retrospective analysis of existing, routinely collected data relating to Queensland road trauma patients July 2015 to June 2017. Data from ambulance, aero-medical retrievals, ED, hospital and death registers were linked and used for analysis.

Ambient temperatures, heatwaves and out-of-hospital cardiac arrest in Brisbane, Australia.

Background: The health impacts of temperatures are gaining attention in Australia and worldwide. While a number of studies have investigated the association of temperatures with the risk of cardiovascular diseases, few examined out-of-hospital cardiac arrest (OHCA) and none have done so in Australia. This study examined the exposure-response relationship between temperatures, including heatwaves and OHCA in Brisbane, Australia.

Assessing need for extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest using Power BI for data visualisation.

Objective: To estimate the number of patients in refractory out-of-hospital cardiac arrest (OHCA) potentially suitable for transport to an extracorporeal cardiopulmonary resuscitation (ECPR)-capable hospital in Brisbane, Queensland, Australia, based on outcome predictors for ECPR, ambulance geolocation and patient data.

Methods: A retrospective cohort study was performed using data from all patients in OHCA attended by Queensland Ambulance Service between 1 January 2014 and 31 December 2018. The number of refractory arrest patients who could potentially be transferred to an ECPR-capable centre within 45 min of the time of arrest was modelled using theoretical on-scene treatment times.

Ketamine as a rescue treatment for severe acute behavioural disturbance: A prospective prehospital study.

Objective: Rapidly and safely managing severe acute behavioural disturbance (ABD) in the prehospital setting is important for the welfare of both patient and prehospital clinician alike. We investigated the safety and effectiveness of ketamine as rescue sedation in patients with severe ABD.

Methods: This prospective observational study investigated ketamine use by a state ambulance service as rescue sedation for patients with severe ABD who remained agitated following droperidol administration.

The Pre-Hospital Initial Fluid Therapy Estimate in Early Nasty Burns (PHIFTEEN B, 15-B) Guideline applied to a retrospective cohort of Intensive Care Unit patients with major burns.

Background: Appropriate fluid administration in severe burns is a cornerstone of early burns management. The American Burns Association's (ABA) recommendation is to administer 2 mL-4 mL × burnt Body Surface Area (BSA) × weight in the first 24 h with half administered in the first eight hours. Unfortunately, the calculations involved are complex and clinicians do not estimate the BSA or weight well, which can lead to errors in the amount of fluid administered.

Survival in Patients with Paramedic-Identified ST-Segment Elevation Myocardial Infarction.

Field identification and treatment of ST-segment elevation myocardial infarction (STEMI) by paramedics is an important component of care for these patients. There is a paucity of studies in the setting of paramedic-identified STEMI. This study investigated mortality and factors associated with mortality in a large state-wide prehospital STEMI sample.

Epidemiology of Oxytocin Administration in Out-of-Hospital Births Attended by Paramedics.

Aim: Primary postpartum hemorrhage (PPH) is a life-threatening obstetric emergency that can be mitigated through the administration of a uterotonic to actively manage the third stage of labor. This study describes the prehospital administration of oxytocin by paramedics following attendance of out-of-hospital (OOH) births.

Methods: A retrospective analysis was undertaken of all OOH births between the 1 January 2018 and 31 December 2018 attended by the Queensland Ambulance Service.

Prehospital study of survival outcomes from out-of-hospital cardiac arrest in ST-elevation myocardial infarction in Queensland, Australia (the PRAISE study).

Aim: Patients that experience an out-of-hospital cardiac arrest in the context of a paramedic-identified ST-segment elevation myocardial infarction are a unique cohort. This study identifies the survival outcomes and determinants of survival in these patients.

Methods: A retrospective analysis was undertaken of all patients, attended between 1 January 2013 and 31 December 2017 by the Queensland Ambulance Service, who had a ST-segment elevation myocardial infarction identified by the attending paramedic prior to deterioration into out-of-hospital cardiac arrest.

Insights into the epidemiology of cardiopulmonary resuscitation-induced consciousness in out-of-hospital cardiac arrest.

Objectives: To describe the characteristics and outcomes of cardiopulmonary resuscitation (CPR)-induced consciousness patients from a large database of out-of-hospital cardiac arrest (OHCA).

Methods: Included were adult patients, attended between January 2007 and December 2018 by the Queensland Ambulance Service, where resuscitation was attempted by paramedics. Manual review of records was undertaken to identify CPR-induced consciousness cases.

Prospective study of the safety and effectiveness of droperidol in elderly patients for pre-hospital acute behavioural disturbance.

Objective: Acute behavioural disturbance in the elderly (≥65 years) is a significant issue for emergency medical services with increasing prevalence of dementia and aging populations. We investigated the pre-hospital safety and effectiveness of droperidol in the elderly with acute behavioural disturbance.

Methods: This was a pre-hospital prospective observational 1-year study of elderly patients with acute behavioural disturbance.

Surviving out-of-hospital cardiac arrest: The important role of bystander interventions.

Background: Substantial variations exist in relation to the characteristics and outcomes of out-of-hospital cardiac arrest (OHCA). As such, an understanding of region-specific factors is essential for informing strategies to improve OHCA survival.

Methods: Analysis of a large state-wide OHCA database of the Queensland Ambulance Service, Australia.

Prehospital ST-Segment Elevation Myocardial Infarction (STEMI) in Queensland, Australia: Findings from 11 Years of the Statewide Prehospital Reperfusion Strategy.

Field identification and treatment of ST-segment elevation myocardial infarction (STEMI) by paramedics is an important component of the continuum of care for these patients. This study described real-world clinical practice in prehospital management of STEMI patients in Queensland, Australia. Retrospective analysis of data sourced from the STEMI database of the Queensland Ambulance Service, Australia.

Leveraging Data Quality to Better Prepare for Process Mining: An Approach Illustrated Through Analysing Road Trauma Pre-Hospital Retrieval and Transport Processes in Queensland.

While noting the importance of data quality, existing process mining methodologies (i) do not provide details on how to assess the quality of event data (ii) do not consider how the identification of data quality issues can be exploited in the planning, data extraction and log building phases of any process mining analysis, (iii) do not highlight potential impacts of poor quality data on different types of process analyses. As our key contribution, we develop a process-centric, data quality-driven approach to preparing for a process mining analysis which can be applied to any existing process mining methodology. Our approach, adapted from elements of the well known CRISP-DM data mining methodology, includes conceptual data modeling, quality assessment at both attribute and event level, and trial discovery and conformance to develop understanding of system processes and data properties to inform data extraction.