ORCID Profile
0000-0001-8657-5646
Current Organisation
Monash University - Peninsula Campus
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Publisher: Emerald
Date: 28-09-2023
Publisher: Wiley
Date: 07-12-2007
DOI: 10.1111/J.1365-2044.2007.05263.X
Abstract: 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.
Publisher: Cambridge University Press (CUP)
Date: 10-2018
DOI: 10.1017/S1049023X18000870
Abstract: Each year, Emergency Medical Services (EMS) personnel respond to over 30 million calls for assistance in the United States alone. These EMS personnel have a rate of occupational fatality comparable to firefighters and police, and a rate of non-fatal injuries that is higher than the rates for police and firefighters and much higher than the national average for all workers. In Australia, no occupational group has a higher injury or fatality rate than EMS personnel. Emergency Medical Services personnel in the US have a rate of occupational violence injuries that is about 22-times higher than the average for all workers. On average, more than one EMS provider in the US is killed every year in an act of violence. The objective of this epidemiological study was to identify the risks and factors associated with work-related physical violence against EMS personnel internationally. An online survey, based on a tool developed by the World Health Organization (WHO Geneva, Switzerland), collected responses from April through November 2016. There were 1,778 EMS personnel respondents from 13 countries 69% were male and 54% were married. Around 55% described their primary EMS work location as “urban.” Approximately 68% described their employer as a “public provider.” The majority of respondents were from the US. When asked “Have you ever been physically attacked while on-duty?” 761 (65%) of the 1,172 who answered the question answered “Yes.” In almost 10% (67) of those incidents, the perpetrator used a weapon. Approximately 90% of the perpetrators were patients and around five percent were patient family members. The influence of alcohol and drugs was prevalent. Overall, men experienced more assaults than women, and younger workers experienced more assaults than older workers. In order to develop and implement measures to increase safety, EMS personnel must be involved with the research and implementation process. Furthermore, EMS agencies must work with university researchers to quantify agency-level risks and to develop, test, and implement interventions in such a way that they can be reliably evaluated and the results published in peer-reviewed journals. Maguire BJ , Browne M , O’Neill BJ , Dealy MT , Clare D , O’Meara P . International survey of violence against EMS personnel: physical violence report . Prehosp Disaster Med . 2018 33 ( 5 ): 526 – 531 .
Publisher: Emerald
Date: 26-07-2018
DOI: 10.1108/IJHG-02-2018-0006
Abstract: The purpose of this paper is to describe and analyse two approaches to paramedic service clinical governance and quality management from the perspective of two groups of paramedics and paramedic managers working in North America. A case study approach was utilised to describe and analyse paramedic service medical direction in North America and contrast this with the professional self-governance and clinical governance systems operating in other high-income countries. Researchers interviewed participants at two remote North American sites, then completed transcription and thematic analysis. Participants identified three themes: first, resourcing, regulatory frameworks and fragmentation second, independent practice facilitators and barriers and third, paramedic roles and professionalisation. Those trained outside North America tended to identify self-regulation and clinical governance as the preferred approach to quality management. Few participants had considered paramedicine becoming a self-regulating health profession. In North America, the “medical direction” model is the dominant approach employed to ensure optimal patient outcomes in paramedic service delivery. In contrast, other comparable countries employ paramedic self-regulatory systems combined with clinical governance to achieve the same ends. This is one of two studies to examine medical direction from the perspective of paramedics and paramedic managers.
Publisher: Springer Science and Business Media LLC
Date: 12-2015
Publisher: Springer Science and Business Media LLC
Date: 18-02-2013
Publisher: Informa UK Limited
Date: 02-01-2022
Publisher: Elsevier BV
Date: 10-2007
DOI: 10.1016/J.AJEM.2007.02.027
Abstract: The objective of the study was to compare intranasal fentanyl (INF) with intravenous morphine (IVM) for prehospital analgesia. This was a randomized, controlled, open-label trial. Consecutive adult patients (n = 258) requiring analgesia (Verbal Rating Score [VRS] >2/10 noncardiac or >5/10 cardiac) were recruited. Patients received INF 180 mug +/- 2 doses of 60 mug at > or =5-minute intervals or IVM 2.5 to 5 mg +/- 2 doses of 2.5 to 5 mg at > or =5-minute intervals. The end point was the difference in baseline/destination VRS. Groups were equivalent (P = not significant) for baseline VRS [mean (SD): INF 8.3 (1.7), IVM 8.1 (1.6)] and minutes to destination [mean (SD): INF 27.2 (15.5), IVM 30.6 (19.1)]. Patients had a mean (95% confidence interval) VRS reduction as follows: INF 4.22 (3.74-4.71), IVM 3.57 (3.10-4.03) P = .08. Higher baseline VRS (P < .001), no methoxyflurane use (P < .01), and back pain (P = .02) predicted VRS reduction. Safety and acceptability were comparable. There was no significant difference in the effectiveness of INF and IVM for prehospital analgesia.
Publisher: CSIRO Publishing
Date: 2002
DOI: 10.1071/AH020104
Abstract: This study aimed to identify and explore the factors that are crucial to the successful operation of rural after-hoursmedical services. It sought to determine the attributes that contribute toward the successful operation of after-hours medical services in rural towns. It drew on computer-assisted telephone interviews with stakeholders, and operational, demographic and financial data. The findings were brought together and analysed within an integrated framework for the guidance of policy makers.In a rural setting, the most important factors for a successful after-hours medical service are related to, 'place', 'process','people' and 'time'. These need to be integrated through effective management of relationships.
Publisher: Cold Spring Harbor Laboratory
Date: 27-07-2023
DOI: 10.1101/2023.07.24.23293095
Abstract: Emergency Medical Services (EMS) staff worldwide have long been at risk of encountering violence and aggression (V& A) at work, including threats, verbal, physical, and sexual assault, and on rare occasions, fatalities occur. Exposure to V& A can result in stress, fear, and burnout. This is an international problem and EMS employers, trade unions and others are working towards tackling it. This paper reports the results of a qualitative study that aimed to explore protecting EMS Staff from aggression and violence in conflict encounters This study took place in 2022 in one UK ambulance service covering a population of three million people. In idual, one-to-one semi-structured interviews were conducted with EMS staff via a Voice over Internet Protocol VoIP (VoIP). Data were analysed through Evolved Grounded theory methodology. Ten EMS staff were interviewed, and the following categories emerged: Rusted, busted and inevitability of Violence & Aggression in EMS Environment, Tolerable or intolerable Violence & aggression in EMS, Gendered violence & aggression and Genderization in EMS, modifiable factors and harm reduction of Violence & aggression in EMS, Professional, ethical & clinical judgments of Violence & aggression in EMS, and Socio-cultural and system frustrations of Violence & aggression in EMS. The Basic Socal Process (BSP) that emerged was one of Emergency Medical Systemic frustration of Aggression and Violence in Conflict Encounters . V& A directed toward EMS staff is complex and our participants revealed how it has long been accepted and may be influenced by systemic frustration in EMS. Staff reported frustrations due to tiredness and in patients from delays in EMS response. Female EMS staff experienced sexual V& A by co-workers and patients, and these voices reverberate with female EMS staff internationally. Our study revealed how EMS has not effectively tackled V& A and many sociocultural constructs accepted within EMS. We call for the voices of our participants to be lified internationally and for purposeful efforts to continue to be made in tackling this issue.
Publisher: SAGE Publications
Date: 2020
DOI: 10.33151/AJP.17.817
Abstract: Workplace violence directed at paramedics by patients and bystanders is a persistent and pervasive issue. There is little available evidence supporting the effectiveness of current interventions in the paramedicine context. No studies have reported on potential barriers and there is little evidence supporting opportunities for more effective interventions. The objective of this study was to make an inventory of current workplace interventions and explore the barriers and opportunities for these interventions as perceived by paramedics. Ten paramedics were interviewed about their experiences and insights into workplace violence. The interview data underwent thematic and narrative analysis. Seven interventions were highlighted, 10 barriers and 12 opportunities for current and future workplace violence interventions were discussed. The majority of the barriers related to culture in society, attitudes of staff, and lack of capacity for the ambulance service to take action following violent events. The opportunities raised included co-design of interventions, culture change for paramedics and communities, accountability for paramedics and perpetrators of violence, increased ambulance service options following violent events, and improving feedback to staff. The findings of this study suggest that interventions are likely to be more effective and sustainable if they are evidence-based, co-designed, address all levels of healthcare, and evaluated. Important areas for future research include a focus on consequences and accountability for perpetrators and strategies for ambulance services and paramedics to participate in public health approaches to reducing violence in communities.
Publisher: Emerald
Date: 04-12-2017
DOI: 10.1108/IJHG-03-2017-0014
Abstract: In North America, delegated practice “medical direction” models are often used as a proxy for clinical quality and safety in paramedic services. Other developed countries favor a combination of professional regulatory boards and clinical governance frameworks that feature paramedics taking lead clinician roles. The purpose of this paper is to bring together the evidence for medical direction and clinical governance in paramedic services through the prism of paramedic self-regulation. This narrative synthesis critically examines the long-established North American Emergency Medical Services medical direction model and makes some comparisons with the UK inspired clinical governance approaches that are used to monitor and manage the quality and safety in several other Anglo-American paramedic services. The databases searched were CINAHL and Medline, with Google Scholar used to capture further publications. Synthesis of the peer-reviewed literature found little high quality evidence supporting the effectiveness of medical direction. The literature on clinical governance within paramedic services described a systems approach with shared responsibility for quality and safety. Contemporary paramedic clinical leadership papers in developed countries focus on paramedic professionalization and the self-regulation of paramedics. The lack of strong evidence supporting medical direction of the paramedic profession in developed countries challenges the North American model of paramedics practicing as a companion profession to medicine under delegated practice model. This model is inconsistent with the international vision of paramedicine as an autonomous, self-regulated health profession.
Publisher: Elsevier BV
Date: 03-2016
DOI: 10.1016/J.IENJ.2015.08.002
Abstract: To explore the potential of mobile eye-tracking to identify healthcare students' area of visual interest and its relationship to performance ratings. Eye-tracking identifies an in idual's visual attention focus, and has been used as a training technique in medicine and in nursing. In this study participants wore a point of view (PoV) camera within a spectacle frame during simulation education experiences. Thirty-nine final year nursing and paramedicine students in idually participated in three 8 minute clinical simulations with debriefing using videoed eye-tracking recordings. Coloured dots on the video depicted the participant's pupil fixation on five targeted areas. Data extracted from the video camera were collated to report time spent on each target (their 'gaze'). The mean total gaze of expert designated targets in the environment for three 8 minute scenarios was 40-77%. Of 35 participants' focus on three main areas of interest, their priority was the patient's head (34%), the patient's trunk (24%) and their clinical assistant (5%), with significant differences between nursing and paramedic disciplines (P < 0.05). Objectively rated clinical performance improved significantly by the third scenario (P ≤ 0.001). Participants were positive regarding use of eye tracking during debriefing. Eye tracking has the potential to enhance debriefing and educational outcomes, although there are limitations to gaze capture in high fidelity environments and resource cost is high. Further study is warranted to enable better understanding of how expert clinicians achieve high levels of performance.
Publisher: Wiley
Date: 29-09-2021
DOI: 10.1111/AJR.12804
Abstract: To investigate the impact of COVID‐19 on the mental health and well‐being of rural paramedics, police, community nursing and child protection staff. An online survey was distributed to investigate the sources of stress and support across in idual, task and organisational domains. The survey was completed by 1542 paramedics, police, community nurses and child protection workers from all states and territories of Australia. This study describes the data for the 632 rural participants. The main measures of well‐being were the Public Health Questionnaire (PHQ9), the Generalised Anxiety Disorder (GAD7), the Maslach Burnout Inventory (MBI), workplace engagement, intention to quit and COVID‐19–related stress. The mean depression and anxiety scores were 8.2 (PHQ9) and 6.8 (GAD7). This is 2–3 times that found in the general community. Over half (56.1%) of respondents showed high emotional exhaustion (burnout). The emotional exhaustion, depersonalisation and personal accomplishment mean scores were 28.5, 9.3 and 34.2, respectively. The strongest associations with burnout and psychological distress were workload, provision of practical support, training and organisational communication. A significant proportion of respondents were seriously considering quitting (27.4%) or looking for a new job with a different employer (28.5%) in the next 12 months. COVID‐19 has increased the workload and stress on rural front‐line community staff. The major sources of stress were related to organisations’ responses to COVID‐19 and not COVID‐19 per se. The data suggest the most effective mental health interventions are practical and preventive, such as firstly ensuring fair and reasonable workloads.
Publisher: Cambridge University Press (CUP)
Date: 30-01-2017
DOI: 10.1017/S1049023X16001497
Abstract: Paramedics respond to emergency scenes in often uncontrolled settings without being aware of potential risks. This makes paramedicine one of the most dangerous occupations. One of these dangers is the risk of contracting infectious diseases. Research in this area is predominantly focused on compliance in the use of protective equipment, attitudes and perceptions of paramedics, infectious disease policy, and exposure rates to blood and body fluids. The purpose of this scoping review was to determine what is known about the impact of infectious disease on the health of paramedics. Using the Arskey and O’Malley methodological framework, a scoping review was undertaken, which allows for a broad search of the available evidence. The literature search identified eight articles for review that reported on paramedic exposure trends the lack of reported blood-borne infections contracted, such as hepatitis B, hepatitis C, and human immunodeficiency virus (HIV) instances of severe acute respiratory syndrome (SARS) infections and the higher prevalence of methicillin-resistant staphylococcus aureus (MRSA) nasal infections amongst paramedics. Exposure to infectious diseases is decreasing, yet it remains significant. The decrease is attributed to prevention strategies however, paramedic knowledge and attitudes as well as the uncontrolled environment paramedics work in can be a barrier. Contraction of infectious diseases is generally low exceptions to this are MRSA colonization, influenza, and SARS. Paramedics are at greater risk of acquiring these infectious diseases compared to the general public. The effect on the health of paramedics is not well reported. Thomas B , O’Meara P , Spelten E . Everyday dangers – the impact infectious disease has on the health of paramedics: a scoping review . Prehosp Disaster Med . 2017 32 ( 2 ): 217 – 223 .
Publisher: Wiley
Date: 31-01-2012
DOI: 10.1111/J.1365-2044.2011.06999.X
Abstract: In a randomised crossover study, 60 ambulance paramedics attempted tracheal intubation of a manikin model of a Cormack and Lehane grade 3/4 view using a Portex stylet, Portex and Frova single-use bougies, and a Portex reusable bougie. Tracheal intubation within 30 s was achieved by 34/60 (57%) using the stylet, 18/60 (30%) using a Portex single-use bougie, 16/60 (27%) using a Frova single-use bougie and 5/60 (8%) using a Portex reusable bougie. The proportion intubating within 30 s was significantly higher with the stylet compared with any bougie (p < 0.001), but significantly lower with a Portex reusable bougie than any other device (p < 0.004). Participants rated the Portex reusable bougie as significantly more difficult to use than the other devices (p < 0.001). There was no evidence of a relationship between previous experience and success rate for any device.
Publisher: Elsevier BV
Date: 11-2018
DOI: 10.1016/J.NEPR.2018.08.006
Abstract: Those transitioning from practice to academia can struggle with the perception that they might lose their hard-won and deeply-held professional identity, while grappling with the difficulty of creating an academic identity. This is a common experience for those entering universities with strong clinical identities. Paramedics, as members of an emerging health profession, share these challenges with nursing and allied health professionals. In this study of paramedic academics in Australia and New Zealand, a majority did not consider themselves to still be paramedics on the basis that they were no longer clinically active. Nor did they consider themselves to be academics as most lacked doctoral qualifications and associated scholarly achievements that made them feel worthy of a place in the 'academy'. This lack of a professional identity as either a paramedic or an academic places them in a 'no man's land' of professional identity. Many are unable to effectively fuse their paramedic and academic identities to become comfortable as 'paramedic academics'. For this to change, there needs to be a partnership between the paramedicine discipline and universities to ensure that paramedics entering academia have a recognised and valued career pathway and are better prepared to make the transition to academia.
Publisher: Wiley
Date: 06-09-2007
DOI: 10.1111/J.1365-2044.2007.05215.X
Abstract: 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.
Publisher: Elsevier BV
Date: 07-2018
DOI: 10.1016/J.INJURY.2018.05.007
Abstract: To describe measures that assaulted EMS personnel believe will help prevent violence against EMS personnel. This mixed- methods study includes a thematic analysis and directed content analysis of one survey question that asked the victims of workplace violence how the incident might have been prevented. Of 1778 survey respondents, 633 reported being assaulted in the previous 12 months 203 of them believed the incident could have been prevented and 193 of them (95%) answered this question. Six themes were identified using Haddon's Matrix as a framework. The themes included: Human factors, including specialized training related to specific populations and de-escalation techniques as well as improved situational awareness Equipment factors, such as restraint equipment and resources and, Operational and environment factors, including advanced warning systems. Persons who could have prevented the violence were identified as police, self, other professionals, partners and dispatchers. Restraints and training were suggested as violence-prevention tools and methods CONCLUSIONS: This is the first international study from the perspective of victimized EMS personnel, to report on ways that violence could be prevented. Ambulance agencies should consider these suggestions and work with researchers to evaluate risks at the agency level and to develop, implement and test interventions to reduce the risks of violence against EMS personnel. These teams should work together to both form an evidence-base for prevention and to publish findings so that EMS medical directors, administrators and professionals around the world can learn from each experience.
Publisher: Rural and Remote Health
Date: 16-10-2019
DOI: 10.22605/RRH4550
Publisher: Hindawi Limited
Date: 11-2010
DOI: 10.1111/J.1365-2524.2010.00971.X
Abstract: 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.
Publisher: Elsevier BV
Date: 04-2015
DOI: 10.1016/J.IENJ.2014.11.001
Abstract: The aims of this quasi-experimental before-and-after study were to first determine whether the use of eye tracking technology combined with video debriefing techniques has the potential to improve the quality of feedback and enhance situation awareness (SA) in simulated settings and second to determine students' satisfaction towards simulated learning. Nursing and paramedicine students from three universities participated in three 8-minute simulation scenarios of acutely deteriorating patients. Eye tracking glasses video recorded the scenarios and tracked right eye movement. On completion, participants were questioned using the Situation Awareness Global Assessment Technique, completed the Satisfaction with Simulation Experience Scale (SSES), and provided textual feedback and received video-based verbal feedback. Participants lacked awareness of presenting medical conditions and patient environments and had poor recall of patient vital signs. Significant improvements in SA scores were demonstrated between the first and third scenarios (P = 0.04). Participants reported greater insight into their performance and were satisfied with simulated learning. Use of visual field review techniques appears to enhance the use of realistic simulated practice as a means of addressing significant performance deficits. Eye tracking and point of view recording techniques are feasible and with applicable debriefing techniques could enhance clinical and situated performance.
Publisher: Instituto Politecnico Nacional/Centro de Investigacion en Computacion
Date: 31-03-2016
Publisher: Cambridge University Press (CUP)
Date: 04-2010
DOI: 10.1017/S1049023X00007937
Abstract: 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. 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 TM presentation for 15 seconds, followed by a short pause, with the next patient image commencing automatically. 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. 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.
Publisher: CSIRO Publishing
Date: 1998
DOI: 10.1071/AH980104
Abstract: The study described in this paper aimed to determine a funding model for an after-hoursprimary medical care service in the rural town of Moe, a socioeconomicallydisadvantaged area of Victoria suffering the rigours of industry restructuring andprivatisation. It has 12.5 equivalent full-time general practitioners servicing 21- 966persons.A break-even analysis of the financial viability compared the expected costs ofproviding the service with the anticipated income. A mixed funding model isrecommended. This would incorporate a general practitioner incentive scheme andState Government underwriting of infrastructure and basic non-medical staffing costsduring the business development phase to supplement the income from the HealthInsurance Commission.
Publisher: BMJ
Date: 02-11-2011
DOI: 10.1136/EMERMED-2011-200187
Abstract: 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? 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. 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 0.5). 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.
Publisher: Hindawi Limited
Date: 05-09-2022
DOI: 10.1111/HSC.13985
Abstract: Community paramedic roles are expanding internationally, and no review of the literature could be found to guide services in the formation of community paramedicine programmes. For this reason, the aim of this restricted review was to explore and better understand the successes and learnings of community paramedic programmes across five domains being education requirements, models of delivery, clinical governance and supervision, scope of roles and outcomes. This restricted review was conducted by searching four databases (CENTRAL, ERIC, EMBASE, MEDLINE and Google Scholar) as well as grey literature search from 2001 until 28/12/2021. After screening, 98 articles were included in the narrative synthesis. Most studies were from the USA (n = 37), followed by Canada (n = 29). Most studies reported on outcomes of community paramedicine programmes (n = 50), followed by models of delivery (n = 28). The findings of this review demonstrate a lack of research and understanding in the areas of education and scope of the role for community paramedics. The findings highlight a need to develop common approaches to education and scope of role while maintaining flexibility in addressing community needs. There was an observable lack of standardisation in the implementation of governance and supervision models, which may prevent community paramedicine from realising its full potential. The outcome measures reported show that there is evidence to support the implementation of community paramedicine into healthcare system design. Community paramedicine programmes result in a net reduction in acute healthcare utilisation, appear to be economically viable and result in positive patient outcomes with high patient satisfaction with care. There is a developing pool of evidence to many aspects of community paramedicine programmes. However, at this time, gaps in the literature prevent a definitive recommendation on the impact of community paramedicine programmes on healthcare system functionality.
Publisher: SAGE Publications
Date: 2019
DOI: 10.33151/AJP.16.715
Abstract: Professionalisation was cited as one of the key drivers for the recent addition of paramedics to the National Accreditation and Regulation Scheme (NRAS) making paramedics the fifteenth health profession in the NRAS. Self-regulation inherently shifts the basis of establishing professional identity and the formal authority for determining professional standards. This has increased discussion of professionalism in paramedicine, however, professionalisation and professionalism are often poorly defined concepts with a myriad of interpretations. A scoping review was conducted to determine the available literature about professionalism and professionalisation in paramedicine. The review utilised 10 academic databases augmented with Google and Google Scholar to capture grey literature 2740 results were refined to 53 sources for review. Several works on paramedic professionalisation explore elements such as autonomy and occupational characteristics. Others consider the process of professionalisation for United Kingdom (UK) and Australian paramedics. Education is discussed as a key factor in professionalism, while the increasing scope and ersity of roles in paramedicine is explored as indicative of professionalisation. Several UK papers relate professionalisation and culture to change processes within paramedicine and paramedic organisations. Academic work on professionalisation and professionalism in paramedicine appears sporadic and may benefit from explorations of a wider range of theories. Paramedicine has been described as constantly and rapidly developing around its practitioners rather than being a stable profession where practitioners enter with clear expectations of their ongoing identity. Further work is needed to understand the process of professionalisation that paramedicine is undergoing within its cultural and professional context.
Publisher: CSIRO Publishing
Date: 2003
DOI: 10.1071/AH030092
Abstract: Medical education in Australia is currently entering a new era, including support for the significant extension of medical students and general practitioner (GP)registrars' training programs in rural communities. This commitment to rural medical student and general practitioner recruitment and retention has made the provision of accommodation in rural communities a vital issue. This study has found that approximately half of all medical students on placement with rural GPs are currently accommodated with their GP supervisor or with other practice staff. This is a burden for many GPs and when the anticipated increase in the frequency and length of rural placements occurs what is currently a burden will become unsustainable. The changing gender and cultural demographics of medical students and rural general practitioners will also contribute to stresses on this accommodation system. It is important to have a systematic approach towards more appropriate and sustainable models of accommodation for both medical students and GP registrars.
Publisher: Wiley
Date: 18-05-2017
Publisher: SAGE Publications
Date: 12-05-2011
Abstract: Aim: To effectively provide clinical placements for students and increase healthcare options for rural communities, an investigation of university clinics was conducted. Method: This project adopted a consultative inquiry strategy and involved two processes: (1) a review of literature and (2) interviews with existing health sciences clinic staff. Results: Low income population groups are more likely to find student-provided services acceptable and have a reliable demand for these services if they are accessible. University clinics reporting high client numbers had a consistent flow of low income clients with chronic problems. Private healthcare providers were often unable to meet the demand from this group. However, multiple methods and flexibility of delivery that fitted in with local services were required rather than single point of access clinics. Discussion: University clinics are an effective way of providing clinical placements for students and some healthcare for rural communities. Key aspects of the community context that make a university clinic viable are the degree of disadvantage in a community, the population density (or dispersion), the workforce available to supply health services in the public and private sectors, and the types of services that are demanded by policy or lobby groups and not yet supplied.
Publisher: Springer US
Date: 2003
Publisher: Hindawi Limited
Date: 08-02-2012
DOI: 10.1111/J.1365-2524.2011.01055.X
Abstract: This study identifies the factors associated with the successful integration of ambulance volunteers and first responders into major ambulance services in Australia and New Zealand and then proposes a model of volunteer management for ambulance services. All ten members of the Australasian Council of Ambulance Authorities completed a questionnaire describing their volunteer and first-responder staff, their numbers and deployment, and the management and integration of volunteers within their respective organisations. Eight senior managers responsible for ambulance volunteers and first responders from six States of Australia and one region of New Zealand subsequently participated in semistructured interviews. Analysis of interview transcripts and publicly available data revealed facilitative factors associated with strong, vibrant ambulance volunteer systems. These facilitative factors are commitment to volunteer models of service delivery a degree of management decentralisation and volunteer input into decision-making commitment of resources towards the volunteer model and the organisational integration of volunteers into the ambulance service. The proposed facilitative model of volunteer management developed aims to encourage the adoption of positive and innovative strategies to improve the integration of ambulance volunteers and first responders in ambulance services. The model consists of four components: leadership integrative processes resource commitment and relative autonomy. The first three of these relate directly to the organisation, while the fourth concerns the volunteers themselves. If these approaches were replicated more widely, a viable and effective volunteer emergency health response system could be established in those areas where it is uneconomic or impractical to provide a salaried ambulance service staffed with professionally qualified paramedics.
Publisher: BMJ
Date: 22-07-2009
Abstract: 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. A prospective single-blinded observational study requiring 96 undergraduate paramedic students from two Australian universities to estimate the lung sounds of six audio files. 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. 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.
Publisher: Wiley
Date: 27-11-2017
DOI: 10.1002/AJIM.22797
Abstract: Violence against emergency medical services (EMS) personnel is a growing concern. The aim of this systematic review is to synthesize the current literature on violence against EMS personnel. We examined literature from 2000 to 2016. Eligibility criteria included English-language, peer-reviewed studies of EMS personnel that described violence or assaults. Sixteen searches identified 2655 studies 25 studies from nine countries met the inclusion criteria. The evidence from this review demonstrates that violence is a common risk for EMS personnel. We identified three critical topic areas: changes in risk over time, economic impact of violence and, outcomes of risk-reduction interventions. There is a lack of peer reviewed research of interventions, with the result that current intervention programs have no reliable evidence base. EMS leaders and personnel should work together with researchers to design, implement, evaluate and publish intervention studies designed to mitigate risks of violence to EMS personnel.
Publisher: Emerald
Date: 19-10-2012
DOI: 10.1108/20470891211275902
Abstract: The purpose of this paper is to assess the extent of empathy in paramedic students across seven Australian universities. A cross‐sectional study was carried out using a paper‐based questionnaire employing a convenience s le of first, second, and third year undergraduate paramedic students. Student empathy levels were measured using a standardised self‐reporting instrument: the Jefferson Scale of Physician Empathy‐Health Profession Students (JSPE‐HPS). A total of 783 students participated in the study, of which 57 per cent 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 year's the highest at 107.17 (SD=14.90). 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.
Publisher: Elsevier BV
Date: 10-2015
DOI: 10.1016/J.NEDT.2015.04.015
Abstract: In this article we present the findings from a scoping review that sought to identify what is known about the experiences of paramedic students transitioning into the workforce. Within the emergency healthcare sector, paramedics are primarily tasked with the assessment, treatment and safe transport of patients to hospital. New paramedics entering the workforce are exposed to the full extent of human emotion, injury and suffering as part of their everyday work. There is evidence from other healthcare disciplines that the transition to practice period can be difficult for new graduates. We utilised Arksey and O'Malley's five-stage scoping review framework to identify what is known about the transition of paramedicine graduates to the workplace. The framework involves identifying relevant studies study selection charting the data and collating, summarizing and reporting results. We identified eleven articles that explored transition of newly qualified paramedics. Thematic content was identified and discussed into four separate categories. Each theme revealing the emotional, physical and social impacts new paramedics face as they strive to find acceptance in a new workplace and culture. Given the significant role that paramedics have in modern healthcare, the transition from student to practitioner is a period of significant stress to the new paramedic. Limited research in this field though inhibits a thorough understanding of these issues.
Publisher: SensePublishers
Date: 2013
Publisher: SAGE Publications
Date: 08-08-2014
Abstract: Community conversations are structured, inclusive conversations that bring together a group of people to engage in meaningful conversation, share knowledge and ideas, and discuss solutions to complex problems. This article focuses on the methodological aspects of using community conversations as a research approach. Participants included paramedics, ambulance service managers, paramedicine students and paramedicine educators, who gathered at La Trobe University in Bendigo in February 2013 to attend a conference titled ‘Paramedic Education and Leadership. Conversations took place over three days, with participants spending around five hours discussing the key issues related to paramedicine student clinical placements. Three stages of community conversations are described, along with the participants’ evaluation of the process, leading to the conclusion that community conversations are a valuable and effective way to bring together groups of people to discuss ideas and solutions to complex social problems.
Publisher: Elsevier BV
Date: 11-2015
DOI: 10.1016/J.NEDT.2015.06.002
Abstract: To determine the elements of quality clinical and field placements through the eyes of paramedic instructors. Qualitative study. Two large paramedic services in two countries where the entry to practice qualification for paramedics has been set at the Bachelors degree level. Fifteen purposively selected paramedic instructors were invited to voluntarily participate. The criterion for inclusion was that they had supervised at least one university paramedicine student on a field placement. Recruitment ceased when saturation was reached. Face to face semi-structured interviews were conducted with participants who were asked their views and expectations of paramedicine student clinical and field placements. Inductive thematic analysis of the transcripts was completed using Nvivo software. The elements of quality clinical and field placements from the perspective of paramedic instructors were identified. With no agreed clinical and field placement paramedicine standards in the countries studied there is variation in the focus of placements, preferred settings, and expectations. Vocationally trained paramedics favoured paramedic service placements, whilst university educated paramedics see benefits in placements in more erse settings. Paramedic services and universities need to collaboratively address the variation in paramedicine university student clinical and field placements. Standards need to be developed that address the purpose of placements, expectations of students and instructors, and be scaffolded across the education spectrum from undergraduate student to graduate paramedic to instructor.
Publisher: SAGE Publications
Date: 02-06-2011
Abstract: Objective: This study of paramedic and nursing aramedic 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-c us 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.
Publisher: BMJ
Date: 18-09-2010
Publisher: Springer Science and Business Media LLC
Date: 29-10-2015
Publisher: Elsevier BV
Date: 11-2013
DOI: 10.1016/J.NEDT.2012.06.021
Abstract: Healthcare systems are evolving to feature the promotion of interprofessional practice more prominently. The development of successful and functional interprofessional practice is best achieved through interprofessional learning. Given that most paramedic programmes take an isolative uni-professional educational approach to their healthcare undergraduate courses, serious questions must be raised as to whether students are being adequately prepared for the interprofessional healthcare workplace. The objective of this study was to assess the attitudes of paramedic students towards interprofessional learning across five Australian universities. Using a convenience s le of paramedic student attitudes towards interprofessional learning and cooperation were measured using two standardised self-reporting instruments: Readiness for Interprofessional Learning Scale (RIPLS) and Interdisciplinary Education Perception Scale (IEPS). Students' readiness for interprofessional learning did not appear to be significantly influenced by their gender nor the type of paramedic degree they were undertaking. As students progressed through their degrees their appreciation for collaborative teamwork and their understanding of paramedic identity grew, however this appeared to negatively affect their willingness to engage in interprofessional learning with other healthcare students. The tertiary institute attended also appeared to influence students' preparedness and attitudes to shared learning. This study has found no compelling evidence that students' readiness for interprofessional learning is significantly affected by either their gender or the type of degree undertaken. By contrast it was seen that the tertiary institutions involved in this study produced students at different levels of preparedness for IPL and cooperation.
Publisher: Elsevier BV
Date: 05-2014
DOI: 10.1016/J.NEDT.2013.10.003
Abstract: We present our findings from a scoping review that sought to identify what is known about nursing and paramedic clinical supervisors' experiences of their supervision practices in rural settings. Our interest in these two groups is based on the central role that nurses and paramedics play in rural health care. Scoping reviews support identification of a broad range of literature, including all types of study designs. We adopted Arksey and O'Malley's five-stage approach: identifying the research question identifying relevant studies study selection charting the data and collating, summarising and reporting results. Databases searched included Academic Search Complete, Springer, Factiva, ProQuest, Ebsco, Informit, VOCEDplus and Scopus. Based on our research question and inclusion and exclusion criteria we selected relevant literature and summarised and reported it using Arksey and O'Malley's framework. The review yielded five articles from four countries: Sweden, Belgium, Malaysia and Australia. From this scoping review, we identified key themes related to supervisors' experiences, including clarification of expectations, support from managers and colleagues, the need for shared understanding between university, students and supervisors and required skills and competence in supervising students.
Publisher: AMPCo
Date: 05-2014
DOI: 10.5694/MJA13.10941
Abstract: To identify the occupational risks for Australian paramedics, by describing the rate of injuries and fatalities and comparing those rates with other reports. Retrospective descriptive study using data provided by Safe Work Australia for the period 2000-2010. The subjects were paramedics who had been injured in the course of their duties and for whom a claim had been made for workers compensation payments. Rates of injury calculated from the data provided. The risk of serious injury among Australian paramedics was found to be more than seven times higher than the Australian national average. The fatality rate for paramedics was about six times higher than the national average [corrected].On average, every 2 years during the study period, one paramedic died and 30 were seriously injured in vehicle crashes. Ten Australian paramedics were seriously injured each year as a result of an assault. The injury rate for paramedics was more than two times higher than the rate for police officers. The high rate of occupational injuries and fatalities among paramedics is a serious public health issue. The risk of injury in Australia is similar to that in the United States. While it may be anticipated that injury rates would be higher as a result of the nature of the work and environment of paramedics, further research is necessary to identify and validate the strategies required to minimise the rates of occupational injury for paramedics.
Publisher: Springer Science and Business Media LLC
Date: 05-10-2015
Publisher: Wiley
Date: 06-05-2015
DOI: 10.1111/AJR.12188
Abstract: Few studies have considered the impact of rural migration on rural community engagement. The objective of this research was to undertake a scoping review about the inclusion and exclusion of newcomers in rural community participation to inform design of inclusive participation processes. The scoping review used the six stages of Arksey and O'Malley's methodological framework. Narrative analysis of the articles was structured using three themes of inclusion and exclusion derived from the literature: interpersonal, socio-cultural norms, and structural and organisational processes. Inclusion and exclusion at the interpersonal level is intricate and often represents broader social rules and tensions that newcomers must navigate in order to become involved. Social norms, such as fear of outsiders and difference, can exclude newcomers from participating in a rural community. Newcomer's awareness of these issues means they are mindful of how they contribute and give respect to the social position of existing residents. Despite this, resistance to change is experienced by newcomers when contributing in organisational contexts. Formal participation processes can harness the practice and value of rural hospitality that newcomers experience as inclusionary. Deliberately designing group processes and operational norms for inclusion can reduce tensions when change occurs and prevent group loss due to exclusionary practices.
Publisher: Wiley
Date: 07-09-2021
DOI: 10.1111/AJR.12786
Abstract: 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. Cross‐sectional study using data from the Nursing and Allied Health Graduate Outcomes Tracking study. Victoria, Australia. First‐year graduates (2019) from the Monash University range of paramedicine programs. Variables of interest included principal place of practice and the reasons for working in the current location. 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 artner’s employment or career’, ‘opportunity for career advancement’ and ‘scope of practice within the role’. 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’.
Publisher: Wiley
Date: 08-2019
DOI: 10.1111/AJR.12543
Abstract: To review and synthesise research related to the ageing farming workforce influence on the health and sustainability of agricultural communities. Using the PRISMA framework as a guide, the CINHAL and Medline databases were searched. Search 1 used the key search terms of ageing OR aging, farm*, workforce. Search 2 used health, sustainability and 'agricultural OR farm communit*. Search 3 combined Searches 1 and 2. Search 4 followed journal citations to identify other relevant articles. A process of narrative synthesis was applied to the results through the prism of rural social capital that described the current state of knowledge and understanding under four themes. Database searches and searching of citations identified 16 contemporary articles. Seven of the papers were from Australia, and the balance from five other high-income countries. The four that themes emerged are: vulnerabilities of ageing farmers economic and climatic drivers social capital and sustainability and integrative strategies, that might offer a way forward. Integrating these forces of nature, economics and sociology to address the ageing farming workforce and the associated health and sustainability of agricultural communities remains a major challenge for researchers, governments, the agricultural sector and rural communities.
Publisher: SAGE Publications
Date: 2020
DOI: 10.33151/AJP.17.787
Abstract: Paramedicine has undergone significant change in the past two decades. While the Anglo-American paramedic system continues to grow there appears to be a dearth of published literature regarding modern categorisation of this evolving paramedic system. The objective of this scoping review is to examine and map the existing evidence to provide an overview of the characteristics and structural similarities and differences of Anglo-American paramedic systems in English-speaking developed countries. Databases, including Embase, MEDLINE, Web of Science, EBSCOhost, CINAHL, Google Scholar and Epistemonikos, will be searched from inception. A grey literature search strategy has also been developed to identify non-indexed relevant literature. Citations and references of included studies will also be searched. Two reviewers will undertake title and abstract screening, followed by full text screening. Data extraction will be conducted using a customised instrument. Inclusion criteria: results examining management, leadership or governance in paramedicine related to the Anglo-American paramedic model in English-speaking developed countries will be included in the review. Included studies will be summarised using narrative synthesis structured around themes of management, leadership and governance in paramedicine.
Publisher: Wiley
Date: 10-2018
DOI: 10.1111/AJR.12464
Abstract: Paramedic services in Australia and New Zealand (Australasia) share many characteristics, with both offering versions of the Anglo-American system of emergency medical response. Their industry and professional bodies are transnational and as a result have similar industry standards and professional expectations. The major difference been the two countries is their sources of funding, with Australian paramedic services generally receiving more government funding than those in New Zealand. Both countries provide a range of services that use a mix of volunteer and professional staff and employ state-of-the-art communications and medical technology to provide high-level clinical services. In common with other higher income countries, they face the challenge of rising usage associated with ageing populations. Both countries are adapting to this through broadening their response models, from a focus on emergency medical response to the provision of a mobile health service that will see the emergence of more practitioners paramedic roles. These emerging models challenge the core missions of paramedic services, as well as the professional identity of paramedics. Despite these trends towards higher level and well-integrated paramedic services in Australia and New Zealand, communities and many other health professionals have limited knowledge or understanding of how paramedic services are organised, the characteristics of paramedics and allied staff and limited appreciation of their potential to make greater contributions to the health and well-being of communities. This article provides an introduction to how paramedics, as members of multidisciplinary teams, are well placed to contribute to improvements in health outcomes.
Publisher: Elsevier BV
Date: 07-2009
DOI: 10.1016/J.NEDT.2008.11.005
Abstract: Publication rates are a vital measure of in idual and institutional performance, yet many nurse academics publish rarely or not at all. Despite widespread acceptance of the need to increase academic publication rates and the pressure university faculty may experience to fulfil this obligation, little is known about the effectiveness of practical strategies to support academic writing. In this small cohort study (n=8) comprising nurses and other professionals involved in university education, a questionnaire survey was used to evaluate the effectiveness of a one-week "Writing for Publication" course combined with a monthly writers support group to increase publication rates. Two year pre and post submissions increased from 9 to 33 articles in peer-reviewed journals. Publications (in print) per person increased from a baseline of 0.5-1.2 per year. Participants reported increased writing confidence and greater satisfaction with the publishing process. Peer support and receiving recognition and encouragement from line managers were also cited as incentives to publish. Writing for publication is a skill that can be learned. The evaluated model of a formal writing course, followed by informal monthly group support meetings, can effectively increase publication rates.
No related grants have been discovered for Peter O'Meara.