The prevalence and selected characteristics of non-fatal opioid overdoses attended by ambulance in Australia

Key Points
1. Ambulance attendance at non-fatal opioid overdose is a common event in mainland Australia (among heroin users in particular).
2. The monthly rate of non-fatal opioid overdose attended by ambulance was generally highest in Victoria (Melbourne) followed by NSW with the rates substantially lower in the remaining mainland states over the period Jan  1999 - Feb 2001.
3. Non-fatal opioid overdose victims were most likely to be male in all states with the proportion of males highest in Victoria (77%).
4. Non-fatal opioid overdose victims were aged around 28 years with ages lowest in WA (26) and highest in NSW (30).
5. The rates of transportation varied according to ambulance service practice across the states with around 94% of cases transported in WA and around 19% and 30% of cases transported in Melbourne and NSW respectively.

Ambulance call triage outcomes for patients reporting pain : a retrospective cross-sectional analysis of pain score versus traige level

Objective: To identify any association between the response priority code generated during calls to the ambulance communication centre and patient reports of pain severity.

Methods: A retrospective analysis of patient care records was undertaken for all patients transported by paramedics over a 7-day period. The primary research interest was the association between the response code allocated at the time of telephone triage and the initial pain severity score recorded using a numeric rating scale (NRS). Univariate and multivariate logistic regression methods were used to analyse the association between the response priority variable and explanatory variables.

Results: There were 1246 cases in which both an initial pain score using the NRS and a response code were recorded. Of these cases, 716/1246 (57.5%) were associated with a code 1 ("time-critical") response. After adjusting for gender, age, cause of pain and duration of pain, a multivariate logistic regression analysis found no significant change in the odds of a patient in pain receiving a time-critical response compared with patients who had no pain, regardless of their initial pain score (NRS 1–3, odds ratio (OR) 1.11, 95% CI 0.7 to 1.8; NRS 4–7, OR 1.12, 95% CI 0.7 to 1.8; NRS 8–10, OR 0.84, 95% CI 0.5 to 1.4).

Conclusion: The severity of pain experienced by the patient appeared to have no influence on the priority (urgency) of the dispatch response. Triage systems used to prioritise ambulance calls and decide the urgency of response or type of referral options should consider pain severity to facilitate timely and humane care.

Paramedic identification of stroke : community validation of the Melbourne ambulance stroke screen

Background: Paramedics require an effective prehospital tool to eliminate stroke mimics and to assist in the identification of suitable candidates for thrombolytic therapy. The Faster Access to Stroke Therapies study combined two validated stroke assessment tools (the Los Angeles Prehospital Stroke Screen, LAPSS, and the Cincinnati Prehospital Stroke Scale, CPSS) to form the Melbourne Ambulance Stroke Screen (MASS), and performed an in-field validation by Australian paramedics.

Methods: Over a 12-month period, 18 paramedics participated in the Faster Access to Stroke Therapies study and prospectively collected data contained in the MASS on all stroke dispatches, and for other patients with a focal neurological deficit. Sensitivity and specificity analysis of the LAPSS, CPSS and MASS was calculated and equivalence analysis performed.

Results: Paramedics completed 100 MASS assessments for 73 (73%) stroke/transient ischemic attack patients and 27 (27%) stroke mimics. The sensitivity of the MASS (90%, 95% CI: 81-96%) showed statistical equivalence to the sensitivity of the CPSS (95%, p = 0.45) and superiority to the LAPSS (78%, p = 0.008). The specificity of the MASS (74%, 95% CI: 53-88%) was equivalent to that of the LAPSS (85%, p = 0.25) and superior to the CPSS (54%, p = 0.007). All patients misidentified by the MASS (7 strokes, 7 mimics) were ineligible for thrombolytic therapy.

Conclusion: The MASS is simple to use, with accurate prehospital identification of stroke. It distinguishes stroke mimics, with good recognition of suitable patients for thrombolytic therapy.

The rural and regional ambulance paramedic : moving beyond emergency response - report to the Council of Ambulance Authorities Inc. March 2006

Serious long-term recruitment and retention problems amongst rural health workers in Australiacontribute to inequitable health service access for rural Australians. In response, new healthcaremodels with flexible workforce roles are emerging including expanded-scope paramedic roles.

This research project was born from the view that expanding ambulance paramedics’ scope ofpractice offers the potential to improve patient care and the general health of the community.New healthcare models with flexible workforce roles are clearly needed in rural Australia andexpanded-scope paramedic roles are valuable innovations.

Student perceptions of adverse health events during ambulance clinical placements

This pilot study intended to augment current literature in the clinical placement field by investigating the frequency and nature of adverse health events experiences by paramedic students undertaking ambulance clinical placements. Supports accessed post event were also reviewed. A purposive sample of fifty-six paramedic students completed the questionnaire. The results indicate that a number of students experience adverse health events while on clinical placement, with fourteen cases of verbal abuse, one case of physical abuse, nine cases of sexualised behavior and seven cases of psychological distress reported. While some case related incidents were flagged by ambulance services and followed up by peer support, students did not initiate any formal support processes themselves. Moreover, no student filed a formal report regarding any of the incidents raised. The results of this pilot study require further investigation. In the interim, the benefits of clinical placements must be weighed against their risks, and processes put in place to minimize the risk to students undertaking clinical placements.

An ambulance for retinol.

During inflammation, serum amyloid A proteins transport retinol to infected tissues.

Ambulance electrical system study. Final report.

National Highway Traffic Safety Administration, Washington, D.C.

Air ambulance guidelines.

Mode of access: Internet.

Extrication methods and ambulance operational guidelines. Part II, ambulance operational guidelines. Final report. Volume 2 of 2.

National Highway Safety Bureau, Washington, D.C.

Extrication methods and ambulance operational guidelines. Part 1: extrication methods. Final report. Volume 1 of 2.

National Highway Safety Bureau, Washington, D.C.

Description and analysis of eighteen proven emergency ambulance service systems. Volume I of II.

National Highway Safety Bureau, Washington, D.C.

Description and analysis of eighteen proven emergency ambulance service systems.

National Highway Safety Bureau, Washington, D.C.