Effect of a resuscitation quality improvement programme on outcomes from out-of-hospital cardiac arrest.

Background: Many emergency medical service (EMS) agencies are implementing programmes to improve the quality and performance of resuscitation. We sought to examine the impact of a resuscitation quality improvement programme on outcomes following OHCA.

Methods: An interrupted time-series analysis of adult OHCA patients of medical aetiology.

Use of intramuscular ketamine by paramedics in the management of severely agitated patients.

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 association of ketamine induction with blood pressure changes in paramedic rapid sequence intubation of out-of-hospital traumatic brain injury.

Introduction: Rapid sequence intubation (RSI) is used to secure the airway of traumatic brain injury (TBI) patients, with ketamine frequently used for induction. Studies show that ketamine-induction RSI might cause lower blood pressures when compared to etomidate. It is not clear if the results from that research can be extrapolated to systems that use different dosing regimens for ketamine RSI.

The prevalence of alcohol and other drugs in fatal road crashes in Victoria, Australia.

Background: Driving under the influence of drugs, including alcohol, is a globally recognised risk factor for road traffic crashes. While the prevalence of alcohol and other drugs in fatal road crashes has been examined in other countries, recent data investigating drug driving in fatal Australian crashes are limited. This study aimed to examine how the presence of alcohol and other drugs in fatal road trauma in Victoria has changed over time in different road users.

Impact of a trauma-focused resuscitation protocol on survival outcomes after traumatic out-of-hospital cardiac arrest: An interrupted time series analysis.

Aim: In this study, we examine the impact of a trauma-focused resuscitation protocol on survival outcomes following adult traumatic out-of-hospital cardiac arrest (OHCA).

Methods: We included adult traumatic OHCA patients aged >16 years occurring between 2008 and 2019. In December 2016, a new resuscitation protocol for traumatic OHCA was introduced prioritising the treatment of potentially reversible causes before conventional cardiopulmonary resuscitation (CPR).

Long-term cost-effectiveness of a disease management program for patients with atrial fibrillation compared to standard care - a multi-state survival model based on a randomized controlled trial.

Aim: To assess the long-term cost-effectiveness of an atrial fibrillation disease management program (i.e. the SAFETY program) from the Australian healthcare system perspective.

Impact of temporal changes in the epidemiology and management of traumatic out-of-hospital cardiac arrest on survival outcomes.

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.

Ambulance dispatch of older patients following primary and secondary telephone triage in metropolitan Melbourne, Australia: a retrospective cohort study.

Background: Most calls to ambulance result in emergency ambulance dispatch (direct dispatch) following primary telephone triage. Ambulance Victoria uses clinician-led secondary telephone triage for patients identified as low-acuity during primary triage to refer them to alternative care pathways; however, some are returned for ambulance dispatch (secondary dispatch). Older adult patients are frequent users of ambulance services; however, little is known about the appropriateness of subsequent secondary dispatches.

Residential aged care homes: Why do they call '000'? A study of the emergency prehospital care of older people living in residential aged care homes.

Objective: To describe the clinical characteristics, medical interventions and patterns of ambulance service use related to the emergency, prehospital care of older people living in residential aged care (RAC) homes.

Methods: Retrospective cohort study using secondary analyses of routinely collected clinical and administrative data from Ambulance Victoria and population data from the Australian Bureau of Statistics for the state of Victoria, Australia. Participants included people aged 65 years and over, attended by emergency ambulances from 2008 to 2013, with data captured in the Ambulance Victoria electronic record.

Collateral damage: Hidden impact of the COVID-19 pandemic on the out-of-hospital cardiac arrest system-of-care.

Aim: Out-of-hospital cardiac arrest (OHCA) during COVID-19 has been reported by countries with high case numbers and overwhelmed healthcare services. Imposed restrictions and treatment precautions may have also influenced OHCA processes-of-care. We investigated the impact of the COVID-19 pandemic period on incidence, characteristics, and survival from OHCA in Victoria, Australia.

To intubate or not to intubate? Predictors of inhalation injury in burn-injured patients before arrival at the burn centre.

Objective: Inhalation injury occurs in approximately 10-20% of burn patients and is associated with increased mortality. There is no clear method of identifying patients at risk of inhalation injury or requiring intubation in the pre-hospital setting. Our objective was to identify pre-burn centre factors associated with inhalation injury confirmed on bronchoscopy, and to develop a prognostic model for inhalation injury.

Changes in the incidence of out-of-hospital cardiac arrest: Differences between cardiac and non-cardiac aetiologies.

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.

Rationale and design of a risk-guided strategy for reducing readmissions for acute decompensated heart failure: the Risk-HF study.

Aims: Heart failure (HF) readmission commonly arises owing to insufficient patient knowledge and failure of recognition of the early stages of recurrent fluid congestion. In previous work, we developed a score to predict short-term hospital readmission and showed that higher-risk patients benefit most from a disease management programme (DMP) that included enhancing knowledge and education by a nurse. We aim to evaluate the effectiveness of a novel, nurse-led HF DMP in selected patients at high risk of short-term hospital readmission, using ultrasound-guided diuretic management and artificial intelligence to enhance HF knowledge in an outpatient setting.

Management of adult cardiac arrest in the COVID-19 era: consensus statement from the Australasian College for Emergency Medicine.

Introduction: The global pandemic of coronavirus disease 2019 (COVID-19) has caused significant worldwide disruption. Although Australia and New Zealand have not been affected as much as some other countries, resuscitation may still pose a risk to health care workers and necessitates a change to our traditional approach. This consensus statement for adult cardiac arrest in the setting of COVID-19 has been produced by the Australasian College for Emergency Medicine (ACEM) and aligns with national and international recommendations.

What is the prevalence of frequent attendance to emergency departments and what is the impact on emergency department utilisation? A systematic review and meta-analysis.

Patients who frequently attend to emergency departments are a varying group and have complex health care needs. This systematic review and meta-analysis aimed to determine the prevalence of patients who have frequent attendance to emergency departments. A systematic review was performed in line with PRISMA guidelines.

The impact of legislation on acute synthetic cannabinoid harms resulting in ambulance attendance.

Background: Synthetic cannabinoid receptor agonists (SCRAs) have been challenging current drug policy due to the rapid emergence of new variants, and their propensity for acute harm. In Australia, as in other parts of the world, multiple regulatory changes have occurred in response to these new psychoactive compounds, and population surveys indicate use is declining. This suggests that related harms would also be declining.

Characteristic Histopathological Findings and Cardiac Arrest Rhythm in Isolated Mitral Valve Prolapse and Sudden Cardiac Death.

Background The association between mitral valve prolapse (MVP) and sudden death remains controversial. We aimed to describe histopathological changes in individuals with autopsy-determined isolated MVP (iMVP) and sudden death and document cardiac arrest rhythm. Methods and Results The Australian National Coronial Information System database was used to identify cases of iMVP between 2000 and 2018.

The impact of bystander relation and medical training on out-of-hospital cardiac arrest outcomes.

Aim: In this study, we investigate the impact of bystander relation and medical training on survival to hospital discharge in out-of-hospital cardiac arrest (OHCA) patients receiving bystander cardiopulmonary resuscitation (CPR).

Methods: A retrospective analysis was performed on non-traumatic OHCA patients receiving bystander CPR and Emergency Medical Service (EMS) attempted resuscitation from 2015 through 2017. Adjusted logistic regression was used to assess the association between related versus unrelated and layperson versus medically trained bystander CPR providers and survival to hospital discharge.

Paediatric traumatic out-of-hospital cardiac arrest: A systematic review and meta-analysis.

Aim: In this study, we sought to quantitatively describe the survival outcomes, incidence rates, and predictors of survival after paediatric traumatic out-of-hospital cardiac arrest (OHCA).

Methods: We systematically searched MEDLINE, EMBASE, EMCARE, and CINAHL to identify observational or interventional studies reporting relevant data for paediatric traumatic OHCA. The Joanna Briggs Institute critical appraisal tool for prognostic studies was used to assess study quality.

Coles and Woolworths have installed public access defibrillators in all their stores: It is time other Australian businesses followed their lead.

We welcome the recent announcement by Coles and Woolworths that public access defibrillators (PADs) are now available in their stores, as early defibrillation with PADs is associated with significantly increased survival from out-of-hospital cardiac arrests (OHCAs). From 2008 to 2018 there were 120 OHCAs in Victorian supermarkets, overall 26.6% survived; however, when defibrillated by a PAD 66.