ORCID Profile
0000-0003-1700-190X
Current Organisations
Flinders University School of Medicine
,
RACGP
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
Publisher: Informa UK Limited
Date: 03-01-2014
Publisher: Elsevier BV
Date: 06-2017
Publisher: Elsevier BV
Date: 11-2014
Publisher: Cambridge University Press (CUP)
Date: 02-2006
DOI: 10.1017/S1049023X00015831
Abstract: The 26 December 2004 Tsunami resulted in a death toll of ,000 persons, making it the most lethal tsunami in recorded history. This article presents performance data observations and the lessons learned by a civilian team dispatched by the Australian government to “provide clinical and surgical functions and to make public health assessments”. The team, prepared and equipped for deployment four days after the event, arrived at its destination 13 days after the Tsunami. Aspiration pneumonia, tetanus, and extensive soft tissue wounds of the lower extremities were the prominent injuries encountered. Surgical techniques had to be adapted to work in the austere environment. The lessons learned included: (1) the importance of team member selection (2) strategies for self-sufficiency (3) personnel readiness and health considerations (4) face-to-face handover (5) coordination and liaison (6) the characteristics of injuries (7) the importance of protocols for patient discharge and hospital staffing and (8) requirements for interpreter services. Whereas disaster medical relief teams will be required in the future, the composition and equipment needs will differ according to the nature of the disaster. National teams should be on standby for international response.
Publisher: Elsevier BV
Date: 10-2016
DOI: 10.1016/J.IJCARD.2016.06.244
Abstract: To date there has been limited published data presenting the characteristics and timeliness of the management in an Emergency Department (ED) for culturally and linguistically erse (CALD) patients presenting with chest pain. This study aimed to describe the presenting characteristics and processing times for CALD patients with chest pain compared to the Australian-born population, and current guidelines. This study was a cross sectional analysis of a cohort of patients who presented with chest pain to the metropolitan hospital between 1 July 2012 and 30 June 2014. Of the total study population (n=6640), 1241 (18.7%) were CALD and 5399 (81.3%) were Australian-born. CALD patients were significantly older than Australian-born patients (mean age 62 vs 56years, p<0.001). There were no differences in the proportion of patients who had central chest pain (74.9% vs 75.7%, p=0.526) ambulance utilisation (41.7% vs 41.1%, p=0.697) and time to initial treatment in ED (21 vs 22min, p=0.375). However, CALD patients spent a significantly longer total time in ED (5.4 vs 4.3h, p<0.001). There was no difference in guideline concordance between the two groups with low rates of 12.5% vs 13%, p=0.556. Nonetheless, CALD patients were 22% (95% CI, 0.65, 0.95, p=0.015) less likely to receive the guideline management for chest pain. The initial emergency care was equally provided to all patients in the context of a low rate of concordance with three chest pain related standards from the two guidelines. Nonetheless, CALD patients spent a longer time in ED compared to the Australian-born group.
Publisher: Elsevier BV
Date: 12-2008
DOI: 10.1016/J.RESUSCITATION.2008.07.017
Abstract: To determine whether in patients with an ambulance response time of >5min who were in VF cardiac arrest, 3min of CPR before the first defibrillation was more effective than immediate defibrillation in improving survival to hospital discharge. This randomised control trial was run by the South Australian Ambulance Service between 1 July, 2005, and 31 July, 2007. Patients in VF arrest were eligible for randomisation. Exclusion criteria were: (i) <18 years of age, (ii) traumatic arrest, (iii) paramedic witnessed arrest, (iv) advanced life support performed before arrival of paramedics and (v) not for resuscitation order or similar directive. The primary outcome was survival to hospital discharge with secondary outcomes being neurological status at discharge, the rate of return of spontaneous circulation (ROSC) and the time from first defibrillation to ROSC. For all response times, no differences were observed between the immediate defibrillation group and the CPR first group in survival to hospital discharge (17.1% [18/105] vs. 10.3% [10/97] P=0.16), the rate of ROSC (53.3% [56/105] vs. 50.5% [49/97] P=0.69) or the time from the first defibrillation to ROSC (12:37 vs. 11:19 P=0.49). There were also no differences between the immediate defibrillation group and the CPR first group, for response times of 5min: survival to hospital discharge (50.0% [7/14] vs. 25.0% [4/16] P=0.16 or 12.1% [11/91] vs.7.4% [6/81] P=0.31, respectively) and the rate of ROSC (71.4% [10/14] vs. 75.0% [12/16] P=0.83 or 50.5% [46/91] vs. 45.7% [37/81] P=0.54, respectively). No differences were observed in the neurological status of those surviving to hospital discharge. For patient in out-of-hospital VF cardiac arrest we found no evidence to support the use of 3min of CPR before the first defibrillation over the accepted practice of immediate defibrillation.
Publisher: World Scientific Pub Co Pte Ltd
Date: 03-2012
DOI: 10.1142/S0218957712500091
Abstract: Relatively little has been published on the range of risk factors contributing to musculoskeletal injuries in ambulance officers. This study aims to identify perceived risk factors for back, neck and shoulder musculoskeletal injuries and claims in relation to working conditions, and the physical and psychological demands of the job. This was a cross-sectional study using an internet-based survey in an Australian ambulance service. The survey included demographic questions and questions on psychosocial factors related to the job and the way in which work is organized, musculoskeletal injuries sustained and claims submitted in the previous 12 months and two open ended questions on perceived risk factors for injury and injury risk mitigation strategies. Ambulance officers who felt they were able to take sufficient breaks were less likely to sustain a back, neck or shoulder musculoskeletal injury, and those who perceived their work required high levels of physical effort were more likely to submit a claim for these injuries. Two important perceived causal factors contributing to musculoskeletal injuries were the uncontrolled environment and non-adherence to manual handling techniques. However, suggested risk mitigation strategies of improving fitness and manual handling training, were not supported by the quantitative analysis.
Publisher: Wiley
Date: 12-2008
DOI: 10.1111/J.1742-6723.2008.01137.X
Abstract: A pilot study exploring the differences between high- and low-fidelity mannequins in the assessment of clinical performance. Standardized clinical scenarios were used to test 12 intensive care paramedics (ICP). Each ICP was randomly assigned to a scenario using either a high-fidelity (SimMan) or low-fidelity mannequin (Laerdal Heart Start 2000), followed by a crossover assessment using the alternative scenario. We examined both the objective and subjective outcomes. Objective performance was assessed by three independent assessors, all accredited Advanced Paediatric Life Support instructors. Subjective outcomes were measured by assessment questionnaires and a rating scale. The overall proportion that passed the high-fidelity mannequin scenario was 0.47 compared with 0.58 in the low-fidelity mannequin scenario. The difference was -0.11 (95% CI -0.32-0.11). The subjective outcomes were charted and presented within the article. The ICP preferred the use of high-fidelity mannequin for assessment purpose. There was no significant objective difference between the two mannequins.
Publisher: Elsevier BV
Date: 2017
DOI: 10.1016/J.AUCC.2016.04.002
Abstract: The aim of this review is to summarise research from a range of countries describing the differences in time taken to seek medical care for chest pain and factors which contribute to delay times. An integrative literature review was undertaken using the Medline, CINAHL and Scopus databases for publications between 1994 and 2014. Articles dealing with delay time, and the factors associated with delay time, were extracted from the literature. The search yielded 395 articles of which 205 full-text articles were assessed for eligibility. Finally, twenty-three articles met the inclusion criteria for the review. It was found that time to seeking treatment (delay times) varied between countries, ranging from 1.6 to 12.9h, with a mean of 3.4h. The mean delay times reported in all the selected studies were greater than the recommended time-frame for seeking treatment. As well, time to decision to seek treatment (decision time) was reported as a major component of delay time. Meanwhile, the utilisation rates of ambulance services ranged from 3.1% in Brazil to 61.0% in Australia. A majority of the reviewed studies reported on the factors associated with longer delay times, including old age, female gender, ethnicity, low education level, history of chronic disease, lack of knowledge of the symptoms, and underutilisation of ambulance services. Only three studies included a sub-analysis by ethnicity, reporting that ethnic groups had longer delay times than Caucasians. Variability in delay times occurred across countries and within continents. The mean time taken to seek care for chest pain in the countries reviewed did not meet the recommended times according to international guidelines. Demographic and social factors, as well as cognitive and emotional factors, influenced delay times. Further research on these influencing factors is recommended, including the impact of ethnicity on patient's care-seeking behaviours for chest pain.
Publisher: Wiley
Date: 09-1994
Publisher: Elsevier BV
Date: 10-2014
Publisher: Wiley
Date: 11-10-2016
Abstract: The present study aimed to describe and examine similarities and differences in the current service provision and resuscitation protocols of the ambulance services participating in the Aus-ROC Australian and New Zealand out-of-hospital cardiac arrest (OHCA) Epistry. Understanding these similarities and differences is important in identifying ambulance service factors that might explain regional variation in survival of OHCA in the Aus-ROC Epistry. A structured questionnaire was completed by each of the ambulance services participating in the Aus-ROC Epistry. These ambulance services were SA Ambulance Service, Ambulance Victoria, St John Ambulance Western Australia, Queensland Ambulance Service, St John Ambulance NT, St John New Zealand and Wellington Free Ambulance. The survey aimed to describe ambulance service and dispatch characteristics, resuscitation protocols and details of cardiac arrest registries. We observed similarities between services with respect to the treatment of OHCA and dispatch systems. Differences between services were observed in the serviced population the proportion of paramedics with basic life support, advanced life support or intensive care training skills the number of OHCA cases attended guidelines related to withholding or terminating resuscitation attempts and the variables that might be used to define 'attempted resuscitation'. All seven participating ambulance services were noted to have existing OHCA registries. There is marked variation between ambulance services currently participating in the Aus-ROC Australian and New Zealand OHCA Epistry with respect to workforce characteristics and key variable definitions. This variation between ambulance services might account for a proportion of the regional variation in survival of OHCA.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2016
DOI: 10.1161/CIRCOUTCOMES.115.002488
Abstract: High-sensitivity troponin T (hs-TnT) assays promise greater discrimination of evolving myocardial infarction, but the impact of unguided implementation on the effectiveness of care is uncertain. We evaluated the impact of hs-TnT reporting on care and outcome among chest pain patients presenting to 5 emergency departments within a multicenter randomized trial. Patients were allocated to hs-TnT reporting (hs-report) or standard reporting (std-report Roche Elecys). The primary end point was death and new or recurrent acute coronary syndrome by 12 months. A total of 1937 patients without ST-segment elevation were enrolled between July 2011 and March 2013. The median age was 61 (interquartile range, 48–74) years, and 46.3% were women. During the index hospitalization, 1466 patients (75.7%) had maximal troponin ng/L within 24 hours. Randomization to hs-report format did not alter the admission rate (hs-report: 57.7% versus std-report: 58.0% P =0.069). There was no difference in angiography (hs-report: 11.9% versus std-report: 10.9% P =0.479). The hs-reporting did not reduce 12-month death or new/recurrent acute coronary syndrome in the overall population (hs-report: 9.7% versus std-report: 7.2% [hazard ratio, 0.83 (0.57–1.22) P =0.362]). However, among those with troponin levels ng/L, a modest reduction in the primary end point was observed (hs-report: 2.6% versus std-report: 4.4%, [hazard ratio, 0.58 95% confidence interval, 0.34–0.1.00 P =0.050). High-sensitivity troponin reporting alone is associated with only modest changes in practice. Clinical effectiveness in the adoption of high-sensitivity troponin may require close coupling with protocols that guide interpretation and care. URL: www.ANZCTR.org.au . Unique identifier: ACTRN12611000879965.
Publisher: Wiley
Date: 08-06-2016
DOI: 10.1111/EJN.13277
Publisher: Springer Science and Business Media LLC
Date: 13-10-2011
Publisher: Elsevier BV
Date: 05-2018
DOI: 10.1016/J.RESUSCITATION.2018.02.029
Abstract: The aim of this study was to investigate regional variation in the characteristics, incidence and outcomes of out-of-hospital cardiac arrest (OHCA) in Australia and New Zealand. This was a population-based cohort study of OHCA using data from the Aus-ROC Australian and New Zealand OHCA Epistry over the period of 01 January 2015-31 December 2015. Seven ambulance services contributed data to the Epistry with a capture population of 19.8 million people. All OHCA attended by ambulance, regardless of aetiology or patient age, were included. In 2015, there were 19,722 OHCA cases recorded in the Aus-ROC Epistry with an overall crude incidence of 102.5 cases per 100,000 population (range: 51.0-107.7 per 100,000 population). Of all OHCA cases attended by EMS (excluding EMS-witnessed cases), bystander CPR was performed in 41% of cases (range: 36%-50%). Resuscitation was attempted (by EMS) in 48% of cases (range: 40%-68%). The crude incidence for attempted resuscitation cases was 47.6 per 100,000 population (range: 34.7-54.1 per 100,000 population). Of cases with attempted resuscitation, 28% survived the event (range: 21%-36%) and 12% survived to hospital discharge or 30 days (range: 9%-17% data provided by five ambulance services). In the first results of the Aus-ROC Australian and New Zealand OHCA Epistry, significant regional variation in the incidence, characteristics and outcomes was observed. Understanding the system-level and public health drivers of this variation will assist in optimisation of the chain of survival provided to OHCA patients with the aim of improving outcomes.
Publisher: World Scientific Pub Co Pte Ltd
Date: 03-2011
DOI: 10.1142/S0218957711500023
Abstract: This study aims to determine whether pre-employment medical, physical or psychological assessments can predict future back, neck and shoulder musculoskeletal injuries and claims in an Australian ambulance service. This was a retrospective observational study based on linked datasets. Poisson regression analysis was undertaken to determine which pre-employment personality traits, using the Fifteen Factor Questionnaire and 36 medical and functional capacity evaluation variables, predicted the number of injuries and claims in ambulance officers. Ambulance officers who at pre-employment assessment demonstrated more conceptual, intuitive and anxious personality traits, and those ambulance officers who had hypermobile joints, self-limited weights lifted, played less sport or exercised less, were more likely to sustain future back, neck or shoulder musculoskeletal injuries or submit workers compensation claims. In idual pre-employment risk factors were found to predict musculoskeletal injuries and claims in a cohort of ambulance officers. Anxious as opposed to stable personality types and conceptual rather than practical personality types appear to be at greater risk of an injury or submitting a claim, as were recruits with hypermobile joints. Identification of in idual risk factors at recruitment may assist in the selection of suitable applicants into the ambulance service as well as providing a focus for career counseling where relevant.
Publisher: Wiley
Date: 06-1993
Publisher: BMJ
Date: 04-2016
Publisher: Cambridge University Press (CUP)
Date: 10-2006
DOI: 10.1017/S1049023X00004027
Abstract: The ECHO Team was the second Australian team to arrive to Banda Aceh, Indonesia in response to the Southeast Asia Earthquake and Tsunami. The ECHO Team continued the work of the first Australian Team which consisted of members of the Alpha and Bravo Teams. The ECHO team left Australia on 08 January 2005. The following describes some of the more significant logistical challenges encountered by the ECHO Team.The issues the ECHO Team confronted were those expected during a mission to help to manage a disaster.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 13-09-2016
DOI: 10.1161/CIRCULATIONAHA.116.021989
Abstract: Patients successfully resuscitated by paramedics from out-of-hospital cardiac arrest often have severe neurologic injury. Laboratory and observational clinical reports have suggested that induction of therapeutic hypothermia during cardiopulmonary resuscitation (CPR) may improve neurologic outcomes. One technique for induction of mild therapeutic hypothermia during CPR is a rapid infusion of large-volume cold crystalloid fluid. In this multicenter, randomized, controlled trial we assigned adults with out-of-hospital cardiac arrest undergoing CPR to either a rapid intravenous infusion of up to 2 L of cold saline or standard care. The primary outcome measure was survival at hospital discharge secondary end points included return of a spontaneous circulation. The trial was closed early (at 48% recruitment target) due to changes in temperature management at major receiving hospitals. A total of 1198 patients were assigned to either therapeutic hypothermia during CPR (618 patients) or standard prehospital care (580 patients). Patients allocated to therapeutic hypothermia received a mean (SD) of 1193 (647) mL cold saline. For patients with an initial shockable cardiac rhythm, there was a decrease in the rate of return of a spontaneous circulation in patients who received cold saline compared with standard care (41.2% compared with 50.6%, P =0.03). Overall 10.2% of patients allocated to therapeutic hypothermia during CPR were alive at hospital discharge compared with 11.4% who received standard care ( P =0.71). In adults with out-of-hospital cardiac arrest, induction of mild therapeutic hypothermia using a rapid infusion of large-volume, intravenous cold saline during CPR may decrease the rate of return of a spontaneous circulation in patients with an initial shockable rhythm and produced no trend toward improved outcomes at hospital discharge. URL: www.clinicaltrials.gov . Unique identifier: NCT01173393.
Publisher: Springer Science and Business Media LLC
Date: 23-10-2015
Publisher: Wiley
Date: 18-09-2013
Abstract: Clinical communication and recognising and responding to a deteriorating patient are key current patient safety issues in healthcare. The aim of this literature review is to identify themes associated with aspects of the hospital clinical handover between paramedics and ED staff that can be improved, with a specific focus on the transfer of care of a deteriorating patient. Extensive searches of scholarly literature were conducted using the main medical and nursing electronic databases, including Cumulative Index to Nursing and Allied Health Literature, Medline and PubMed, during 2011 and again in July 2012. Seventeen peer-reviewed English-language original quantitative and qualitative studies from 2001 to 2012 were selected and critically appraised using an evaluation tool based on published instruments. Relevant themes identified were: professional relationships, respect and barriers to communication multiple or repeated handovers identification of staff in the ED significance of vital signs need for a structured handover tool documentation and other communication methods and education and training to improve handovers. The issues raised in the literature included the need to: produce more complete and concise handovers, create respectful and effective communication, and identify staff in the ED. A structured handover tool such as ISBAR (a mnemonic covering Introduction, Situation, Background, Assessment and Recommendations) would appear to provide a solution to many of these issues. The recording of vital signs and transfer of these data might be improved with better observation systems incorporating early warning strategies. More effective teamwork could be achieved with further clinical communications training.
Publisher: Cambridge University Press (CUP)
Date: 12-2010
DOI: 10.1017/S1049023X00008700
Abstract: Sudden, out-of-hospital cardiac arrest (OHCA) has an annual incidence of approximately 50 per 100,000 population. Public access defibrillation is seen as one of the key strategies in the chain-of-survival for OHCA. Positioning of these devices is important for the maximization of public health outcomes. The literature strongly advocates widespread public access to automated external defibrillatiors (AEDs). The most efficient placement of AEDs within in idual communities remains unclear. A retrospective case review of OHCAs attended by the South Australia Ambulance Service in metropolitan and rural South Australia over a 30-month period was performed. Data were analyzed using Utstein-type indicators. Detailed demographics, summative data, and clinical data were recorded. A total of 1,305 cases of cardiac arrest were reviewed. The annual rate of OHCA was 35 per 100,000 population. Of the cases, the mean value for the ages was 66.3 years, 517 (39.6%) were transported to hospital, 761 (58.3%) were judged by the paramedic to be cardiac, and 838 (64.2%) were witnessed. Bystander cardiopulmonary resuscitation (CPR) was performed in 495 (37.9%) of cases. The rhythm on arrival was ventricular fibrillation (VF) or ventricular tachycardia (VT) in 419 (32.1%) cases, and 315 (24.1%) of all arrests had return of spontaneous circulation (ROSC) before or on arrival at the hospital. For cardiac arrest cases that were witnessed by the ambulance service (n = 121), the incidence of ROSC was 47.1%. During the 30-month period, there only was one location that recorded more than one cardiac arrest. No other location recorded recurrent episodes. This study did not identify any specific location that would justify defibrillator placement over any other location without an existing defibrillator. The impact of bystander CPR and the relatively low rate of bystander CPR in this study points to an area of need. The relative potential impact of increasing bystander CPR rates versus investing in defibrillators in the community is worthy of further consideration.
Location: United Kingdom of Great Britain and Northern Ireland
Start Date: 2010
End Date: 2014
Funder: National Health and Medical Research Council
View Funded ActivityStart Date: 2012
End Date: 2016
Funder: National Health and Medical Research Council
View Funded ActivityStart Date: 2016
End Date: 2020
Funder: National Health and Medical Research Council
View Funded ActivityStart Date: 2016
End Date: 2021
Funder: National Health and Medical Research Council
View Funded ActivityStart Date: 2011
End Date: 2014
Funder: Health Workforce Australia
View Funded ActivityStart Date: 2008
End Date: 2011
Funder: SA Government Department of Health
View Funded ActivityStart Date: 2012
End Date: 2014
Funder: Flinders University
View Funded Activity