Palliative paramedicine: Comparing clinical practice through guideline quality appraisal and qualitative content analysis.

BACKGROUND: Palliative care is an emerging scope of practice for paramedicine. The COVID-19 pandemic has highlighted the opportunity for emergency settings to deliver palliative and end-of-life care to patients wishing to avoid intensive life-sustaining treatment. However, a gap remains in understanding the scope and limitations of current ambulance services' approach to palliative and end-of-life care. AIM: To examine the quality and content of existing Australian palliative paramedicine guidelines with a sample of guidelines from comparable Anglo-American ambulance services. DESIGN: We appraised guideline quality using the AGREE II instrument and employed a collaborative qualitative approach to analyse the content of the guidelines. DATA SOURCES: Eight palliative care ambulance service clinical practice guidelines (five Australian; one New Zealand; one Canadian; one United Kingdom). RESULTS: None of the guidelines were recommended by both appraisers for use based on the outcomes of all AGREE II evaluations. Scaled individual domain percentage scores varied across the guidelines: scope and purpose (8%-92%), stakeholder involvement (14%-53%), rigour of development (0%-20%), clarity of presentation (39%-92%), applicability (2%-38%) and editorial independence (0%-38%). Six themes were developed from the content analysis: (1) audience and approach; (2) communication is key; (3) assessing and managing symptoms; (4) looking beyond pharmaceuticals; (5) seeking support; and (6) care after death. CONCLUSIONS: It is important that ambulance services' palliative and end-of-life care guidelines are evidence-based and fit for purpose. Future research should explore the experiences and perspectives of key palliative paramedicine stakeholders. Future guidelines should consider emerging evidence and be methodologically guided by AGREE II criteria.

A scoping review of COVID-19 online mis/disinformation in Black communities.

Background: Mis/disinformation has reached an epidemic level with the COVID-19 virus and can be largely attributed to the growing digitalization of information and its rapid transmission via social media. Approximately 96% of Canadians and 80% of Americans report encountering COVID-19 dis/misinformation on at least one social media site/app. COVID-19 dis/misinformation promotes scepticism and a lack of confidence in COVID-19 interventions. Black people have been disproportionately affected by the COVID-19 pandemic in terms of negative impacts on their livelihoods and are also more likely to be hesitant to receive the COVID-19 vaccine. Dis/misinformation contributes to high rates of COVID-19 infection and low uptake of COVID-19 vaccination. Hence, the purpose of this scoping review was to map out the nature and extent of current research on COVID-19 disinformation among Blacks in Africa and the African diaspora. Methods: We searched and reviewed articles from major databases such as MEDLINE, EMBASE, and CINAHL. Our search strategy involved the following concepts: 1) COVID-19, including variants; 2) misinformation, conspiracy theories, and fake news, and modes of misinformation transmission such as social media; and 3) Blacks or people of African descent, or the African diaspora. We retrieved 600 articles that were independently screened by two researchers. We included studies focusing on 1) Black people living inside or outside Africa; and 2) COVID-19 online dis/misinformation among this population. A total of 19 studies fit our inclusion criteria. We used a thematic analysis to analyse qualitative data. Results: Our findings indicate Black people are accessing and often sharing online disinformation and misinformation primarily through social media platforms such as WhatsApp, Facebook, Twitter, YouTube, and Instagram. Dis/misinformation concerns the origin of COVID-19, transmission, prevention, and treatment of COVID-19, assertions of race immunity to the virus, distrust in government and health organizations, and intervention research and programming. Conclusions: There is a global paucity of literature addressing COVID-19 online dis/misinformation among Black people. Dis/misinformation can fuel vaccine hesitancy and threaten the goal of herd immunity. Knowledge of the impact and implications of COVID-19 online dis/misinformation is necessary to inform public health interventions in Black communities.

The epidemiology of out-of-hospital cardiac arrest in Australia and New Zealand: A binational report from the Australasian Resuscitation Outcomes Consortium (Aus-ROC).

INTRODUCTION: The Australasian Resuscitation Outcomes Consortium (Aus-ROC) out-of-hospital cardiac arrest (OHCA) Epistry (Epidemiological Registry) now covers 100% of Australia and New Zealand (NZ). This study reports and compares the Utstein demographics, arrest characteristics and outcomes of OHCA patients across our region. METHODS: We included all OHCA cases throughout 2019 as submitted to the Epistry by the eight Australian and two NZ emergency medical services (EMS). We calculated crude and age-standardised incidence rates and performed a national and EMS regional comparison. RESULTS: We obtained data for 31,778 OHCA cases for 2019: 26,637 in Australia and 5,141 in NZ. Crude incidence was 107.9 per 100,000 person-years in Australia and 103.2/100,000 in NZ. Overall, the majority of OHCAs occurred in adults (96%), males (66%), private residences (76%), were unwitnessed (63%), of presumed medical aetiology (83%), and had an initial monitored rhythm of asystole (64%). In non-EMS-witnessed cases, 38% received bystander CPR and 2% received public defibrillation. Wide variation was seen between EMS regions for all OHCA demographics, arrest characteristics and outcomes. In patients who received an EMS-attempted resuscitation (13,664/31,778): 28% (range across EMS = 13.1% to 36.7%) had return of spontaneous circulation (ROSC) at hospital arrival and 13% (range across EMS = 9.9% to 20.7%) survived to hospital discharge/30-days. Survival in the Utstein comparator group (bystander-witnessed in shockable rhythm) varied across the EMS regions between 27.4% to 42.0%. CONCLUSION: OHCA across Australia and NZ has varied incidence, characteristics and survival. Understanding the variation in survival and modifiable predictors is key to informing strategies to improve outcomes.

No apparent effect of the COVID-19 pandemic on out-of-hospital cardiac arrest incidence and outcome in Western Australia.

BACKGROUND: We examined the incidence, patient and arrest characteristics, and survival outcomes of out-of-hospital cardiac arrest (OHCA) in Western Australia (WA) in the first wave of the COVID-19 pandemic. METHODS: Adult OHCA cases attended by St John WA Emergency Medical Service (EMS) between 16th March and 17th May 2020 ('COVID-19 period') were compared with those for the same period in 2017-9. We calculated crude OHCA incidence for all OHCA cases and modelled the effect of the 'COVID-19 period' on 30-day survival for OHCA cases with EMS attempted resuscitation; comparing our results with those published for Victoria (Australia), which had a higher incidence of COVID-19. RESULTS: In WA there was no significant difference between the 2020 'COVID-19 period' (n = 423) and the same period in 2017-9 (n = 1,334) in the OHCA incidence in adults (117.9 vs 126.1 per 100,000 person-years, p = 0.23). In OHCA cases with EMS-resuscitation attempted, there was no change in bystander cardiopulmonary resuscitation rates. Despite an increase in EMS response time, neither the crude nor risk-adjusted odds ratio (aOR) for 30-day survival in 2020 was significantly different to 2017-9 (11.7% vs 9.6%; p = 0.45) (aOR = 1.19, 95% confidence interval 0.57-2.51, p = 0.65). This contrasts with a significant reduction in survival to hospital discharge reported in Victoria. CONCLUSION: In WA, with a relatively low incidence of COVID-19, OHCA incidence and survival was not significantly different during the initial wave of the COVID-19 pandemic compared to the three previous years. Our study suggests that OHCA survival may be more closely related to the incidence of COVID-19 in the community, rather than COVID-19 restrictions per se.

PG70 Using high fidelity simulation to prepare trainee advanced critical care practitioners for independent practice

PG70 Table 1Summarised results from questionnairesTheme % Change in confidence Pre vs. Post-Course Post-Course vs. Delayed Clinical knowledge +46.4 -14.6 Practicing within own limitations +12.8 -2.3 Raising concerns +19.4 +2.3 Assessing and treating the unwell patient +48.3 0 Communicating to the MDT +69.2 0 Awareness of the impact of human factors +69.2 0 Discussion and ConclusionThis pilot course suggests trainee ACCPs benefit greatly from targeted high fidelity simulation despite limited previous exposure.Confidence in clinical knowledge was not sustained at immediate post-course levels after three months, perhaps due to decay of skills or exposure to more challenging cases in practice. The delayed survey coincided with the start of the COVID-19 pandemic which may have had an impact.Further evaluations could review the longevity of the benefits from simulation to guide how regularly to offer future sessions.The benefits realised from this pilot will lead to further provision of high fidelity simulation for trainee ACCPs.

PG126 Designing, implementing and evaluating the effectiveness of a new delivery model of the simulation training day for final year medical students, university of Nottingham

Background‘The Simulation Training Day’ is designed to provide the students with the opportunity to rehearse the key clinical skills practiced throughout their Critical Illness attachment, and also to consider many of the other factors that can influence the patient’s outcome. Previously, we conducted it as a face to face session. Participants observe, practice and then reflect upon the immediate management of acutely ill patients through facilitated debriefing.In response to the COVID -19 pandemic, we have amended our approach to the delivery of this training for 2020–21. The aim has been to respond to the constraints that have been imposed on scheduling of their modules, student numbers and availability of resources for teaching.Despite modifying the delivery model, we aim to achieve as many of the educational outcomes as possible.Project DescriptionWe offered the students two different hybrid approaches:An online learning package with one half day face to face simulation course for Nottingham University Hospitals based students.An online learning package and one half day remote simulation course for students from outside Nottingham University Hospitals and for those are shielding.The online learning package involves virtual simulation where students will be asked to watch a series of specially filmed scenarios that raise important discussion points. This will enable face to face and remote simulation sessions to be shortened;group sizes reduced and still allow the same number of themes to be covered as the traditional full day simulation course.A half day interactive live streaming simulation, where trainees participate in a simulation from home/base trust, will cover the same scenarios as face to face simulation.We will evaluate the effectiveness of our revised course by collecting feedback from both the learner’s and faculty’s perspectives. We will generate a set of questions in line with previous traditional ones in order to compare the achievement of learning outcomes for last year traditional format group, this year face to face with online package and this year remote sim with online package. We will also explore any challenges/achievements from the faculty and identify technical issues and improvements for future courses.Summary of ResultsThe course will run from October to March and the findings from these questionnaires from some of the groups will be presented on the conference day.Discussion and Conclusions;RecommendationsIn progress and will be presented in the poster.