Background Emergency clinicians have a crucial role during public health emergencies and have been at the frontline during the COVID-19 pandemic. This study examined the knowledge, preparedness and experiences of Australian emergency nurses, emergency physicians and paramedics in managing COVID-19. Methods A voluntary cross-sectional study of members of the College of Emergency Nursing Australasia, the Australasian College for Emergency Medicine, and the Australasian College of Paramedicine was conducted using an online survey (June-September 2020). Results Of the 159 emergency nurses, 110 emergency physicians and 161 paramedics, 67.3-78% from each group indicated that their current knowledge of COVID-19 was ‘good to very good’. The most frequently accessed source of COVID-19 information was from state department of health websites. Most of the respondents in each group (77.6-86.4%) received COVID-19 specific training and education, including personal protective equipment (PPE) usage. One-third of paramedics reported that their workload ‘had lessened’ while 36.4-40% of emergency nurses and physicians stated that their workload had ‘considerably increased’. Common concerns raised included disease transmission to family, public complacency, and PPE availability. Conclusions Extensive training and education and adequate support helped prepare emergency clinicians to manage COVID-19 patients. Challenges included inconsistent and rapidly changing communications and availability of PPE.
During the on‐going COVID‐19 pandemic a number of key public health services have been severely impacted. These include elective surgical services due to the synergetic resources required to provide both perioperative surgical care whilst also treating acute COVID‐19 patients and also the poor outcomes associated with surgical patients who develop COVID‐19 in the perioperative period. This article discusses the important principles and concepts for providing important surgical services during the COVID‐19 pandemic based on the model of the RMCancerSurgHub which is providing surgical cancer services for a population of approximately 2 million people across London during the pandemic. The model focusses on creating local and regional hub centres which provide urgent treatment for surgical patients in an environment that is relatively protected from the burden of COVID‐19 illness. The model extensively utilises the extended multidisciplinary team to allow for a flexible approach with core services delivered in ‘clean’ sites which can adapt to viral surges. A key requirement is that of a clinical prioritisation process which allows for equity in access within and between specialties ensuring that patients are treated on the basis of greatest need, while at the same time protecting those whose conditions can safely wait from exposure to the virus. Importantly, this model has the ability to scale‐up activity and lead units and networks into the recovery phase. The model discussed is also broadly applicable to providing surgical services during any viral pandemic.
Objective: Programmes that reduce the time to defibrillation are likely to improve overall survival rates from out-of-hospital cardiac arrests (OHCAs). This research sought to identify human factors common among community responders taking an automated external defibrillator (AED) to a victim of an OHCA that are either barriers or enablers of desired behaviour. Methods: A qualitative methodology was used. Community members who had access to an AED and who had been notified of an incident of OHCA near them were approached to participate in the research. Participants completed a written survey and undertook a semi-structured interview. A thematic analysis was undertaken using NVivo software and triangulated against findings from an automated data-mining package, Leximancer. Results: The study found that 100% of people who were notified of the need for an AED responded. Twelve participants subsequently identified during interviews that they held some form of leadership role in their community. First aid training and previous experience of, and competency in managing emergencies were the strongest motivations for their response. Personal risk was not a concern when responding to victims in immediately life-threatening situations.Conclusion: Prospective programmes may be able to be designed to increase the likelihood that community members with AEDs will respond in advance of emergency medical services by targeting common human factors, such as leadership behaviour, training, competency and experience in managing emergencies, leading to better overall survival rates from OHCA.
ObjectiveThis study aims to present overall survival rates to hospital discharge for out‐of‐hospital cardiac arrest (OHCA) in Tasmania and to identify predictors of survival.MethodsA retrospective observational cohort study was undertaken from 1 January 2010 to 31 December 2014. A probabilistically linked data set was created from paramedic electronic medical records and hospital patient records. Logistic regression was used to assess factors associated with survival of OHCA.ResultsDuring the study, 2949 incidents of OHCA were reviewed and 1146 had emergency management provided, with an overall survival rate to hospital discharge of 135 (12%). A number of independent factors are associated with improved outcomes including if the initial presenting cardiac rhythm was either ventricular fibrillation or ventricular tachycardia (adjusted odds ratio [OR] 8.75, 95% confidence interval [CI] 5.15–14.89) (P < 0.0001) relative to those who were found in a non‐shockable rhythm. Another factor was age group (overall P < 0.001). Those aged 85+ years had a reduced overall survival rate (2.9%), which was lower than those <16 years of age (OR 0.37, 95% CI 0.07–1.94; adjusted OR 0.38, CI 0.03–1.00) (P < 0.001). The odds of surviving OHCA decreased by 9% for every minute defibrillation of a shockable rhythm was delayed were witnessed by a bystander (OR 0.90, 95% CI 0.85–0.95).ConclusionTime to defibrillation for witnessed arrests, other than paramedic witnessed arrest was associated with better overall survival rates than unwitnessed OHCA. Further factors such as the event being of cardiac aetiology, bystander cardio‐pulmonary resuscitation performed, initial presenting cardiac rhythm of ventricular fibrillation or ventricular tachycardia and decreasing age were all associated with increased probability of survival.
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