ORCID Profile
0000-0002-1823-5620
Current Organisations
Royal Brisbane and Women's Hospital
,
Queensland Ambulance Service
,
Queensland Children's Hospital
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Publisher: Wiley
Date: 18-06-2017
Abstract: Paediatric status epilepticus (SE) is a medical emergency and a common critical condition confronting pre-hospital providers. Management in the pre-hospital environment is challenging but considered extremely important as a potentially modifiable factor on outcome. Recent data from multicentre clinical trials, quality observational studies and consensus documents have influenced management in this area, and is important to both pre-hospital providers and emergency physicians. The objective of this review was to: (i) present an overview of the available evidence relevant to pre-hospital care of paediatric SE and (ii) assess the current pre-hospital practice guidelines in Australia and New Zealand. The review outlines current definitions and guidelines of SE management, regional variability in pre-hospital protocols within Australasia and aspects of pre-hospital care that could potentially be improved. Contemporary data is required to determine current practice in our setting. It is important that paediatric neurologists, emergency physicians and pre-hospital care providers are all engaged in future endeavours to improve clinical care and knowledge translation efforts for this patient group.
Publisher: Elsevier BV
Date: 12-2020
Publisher: Elsevier BV
Date: 10-2023
Publisher: BMJ
Date: 22-12-2014
DOI: 10.1136/EMERMED-2012-201969
Abstract: To evaluate the feasibility, limitations and costs involved in providing prehospital trauma teams with packed red blood cells (pRBCs) for use in the prehospital setting. A retrospective cohort study, examining 18 months of historical data collated by the Queensland Ambulance Service Trauma Response Team (TRT) and the Pathology Queensland Central Transfusion Laboratory was undertaken. Over an 18-month period (1 January 2011-30 June 2012), of 500 pRBC units provided to the TRT, 130 (26%) were administered to patients in the prehospital environment. Of the non-transfused units, 97.8% were returned to a hospital blood bank and were available for reissue. No instances of equipment failure directly contributed to wastage of pRBCs. The cost of providing pRBCs for prehospital use was $A551 (£361) for each unit transfused. It is feasible and practical to provide prehospital trauma teams with pRBCs for use in the field. Use of pRBCs in the prehospital setting is associated with similar rates of pRBC wastage to that reported in emergency departments.
Publisher: BMJ
Date: 05-05-2013
DOI: 10.1136/EMERMED-2013-202395
Abstract: To describe the characteristics, clinical interventions and the outcomes of patients administered packed red blood cells (pRBCs) by a metropolitan, road based, doctor-paramedic trauma response team (TRT). A retrospective cohort study examining 18 months of historical data collated by the Queensland Ambulance Service TRT, the Pathology Queensland Central Transfusion Laboratory, the Royal Brisbane and Women's Hospital and the Princess Alexandra Hospital Trauma Services was undertaken. Over an 18-month period (1 January 2011 to 30 June 2012), 71 trauma patients were administered pRBCs by the TRT. Seven patients (9.9%) died on scene and 39 of the 64 patients (60.9%) transported to hospital survived to hospital discharge. 57 (89.1%) of the transported patients had an Injury Severity Score (ISS) > 15, with a mean ISS, Revised Trauma Score (RTS) and Trauma-Injury Severity Score of 32.11, 4.70 and 0.57, respectively. No patients with an RTS < 2 survived to hospital discharge. 53 patients (82.8%) received additional pRBCs in hospital with 17 patients (26.6%) requiring greater than 10 units pRBCs in the first 24 h. 47 patients (73.4%) required surgical or interventional radiological procedures in the first 24 h. There is a potential role for prehospital pRBC transfusions in an integrated civilian trauma system. The RTS calculated using the initial set of observations may be a useful tool in determining in which patients the administration of prehospital pRBC transfusions would be futile.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 22-02-2022
Publisher: Wiley
Date: 27-10-2022
Abstract: To report the arrival ionised calcium (iCa) and fibrinogen concentrations in trauma patients treated with packed red blood cells by the road‐based high‐acuity response units of a metropolitan ambulance service. A retrospective review of trauma patients treated with packed red blood cells by high‐acuity response units between January 2012 and December 2016. Patients were identified from databases at southeast Queensland adult trauma centres, Pathology Queensland Central Transfusion Laboratory, Gold Coast University Hospital blood bank and the Queensland Ambulance Service. Patient characteristics, results of laboratory tests within 30 min of ED arrival were analysed. A total of 164 cases were analysed. The median injury severity score was 33.5 (interquartile range 22–41), with blunt trauma the commonest mechanism of injury ( n = 128, 78.0%). Fifty‐eight of the 117 patients (24.4%) with fibrinogen measured had a fibrinogen concentration ≤1.5 g/L 79 of the 123 patients (64.2%) with an international normalised ratio (INR) measurement had an INR .2 97 of 148 patients (63.8%) with an iCa measured, had an iCa below the Pathology Queensland reference range of 1.15–1.32 mmol/L. Arrival fibrinogen concentration ≤1.5 g/L and arrival iCa ≤1.00 were associated with in‐hospital mortality with odds ratio 11.90 (95% confidence interval 4.50–31.65) and odds ratio 4.97 (95% confidence interval 1.42–17.47), respectively. Hypocalcaemia and hypofibrinogenaemia on ED arrival were common in this cohort. Future work should evaluate whether outcomes improve by correction of these deficits during the pre‐hospital phase of trauma care.
Publisher: Wiley
Date: 15-08-2023
Abstract: To determine the independent predictors for clinician fatigue and decline in cognitive function following a shift in the ED during early stages of the COVID‐19 pandemic. This was a prospective, quasi‐experimental study conducted in a metropolitan adult tertiary‐referral hospital ED over 20 weeks in 2021. The participants were ED doctors and nurses working clinical shifts in an ED isolation area or high‐risk zone (HRZ) with stringent personal protective equipment (PPE). The participants' objective and subjective fatigue was measured by the Samn–Perelli fatigue score and a psychomotor vigilance ‘smart game’ score, respectively. Postural signs/symptoms and urine specific gravity (SG) were measured as markers of dehydration. Sixty‐three participants provided data for 263 shifts. Median (interquartile range) age was 33 (28–38) years, 73% were female. Worsening fatigue score was associated with working afternoon shifts (afternoon vs day, adjusted odds ratio [aOR] 5.16 [95% confidence interval (CI) 1.32–20.02]) and in non‐HRZ locations (HRZ vs non‐HRZ, aOR 0.23 [95% CI 0.06–0.87]). Worsening cognitive function (game score) was associated with new onset postural symptoms (new vs no symptoms, aOR 4.14 [95% CI 1.34–12.51]) and afternoon shifts (afternoon vs day, aOR 3.13 [95% CI 1.16–8.44]). Working in the HRZ was not associated with declining cognitive function. Thirty‐four (37%) of the 92 participants had an end of shift urine SG .030. Working afternoon shifts was associated with fatigue. There was no association between HRZ allocation and fatigue, but our study was limited by a low COVID workload and fluctuating PPE requirements in the non‐HRZs. Workplace interventions that target the prevention of fatigue in ED clinicians working afternoon shifts should be prioritised.
No related grants have been discovered for Daniel Bodnar.