Aeromedical retrievals in Queensland: A five-year review.

OBJECTIVE: Aeromedical services are an essential part of the healthcare system. Centralised coordination of aeromedical retrieval tasking offers benefits for safety, timeliness and efficiency in service delivery. The aim of the present study is to review aeromedical retrievals in Queensland exploring patient demographics, temporal patterns and usage characteristics. METHODS: This is a retrospective cases series for the period 1 January 2010 to 31 December 2014 incorporating data from Retrieval Services Queensland and Queensland Newborn Emergency Transport Service. Ethics approval was obtained (JCU-HREC H6137 and Public Health Act #RD005673). Descriptive analysis of the de-identified data was undertaken included patient demographics, referral and receiving locations, retrieval platform and acuity of transport request. RESULTS: There were 73 042 aeromedical retrievals undertaken during the period, with an average of 40 cases per day (range 16-89). The majority (95%) of retrievals were for Queensland residents. Overall 23.1% of cases were cardiology-related and 12.7% were injury-related. Older adults aged 75-84 years had the highest rate of retrievals relative to the population with a crude rate of 942.4 per 100 000 per annum. Overall 14.9% of cases were Priority 1, which represents the tasking with the highest acuity but majority were Priority 4 (41.6%). One third (37.6%) of all patients were from inner regional locations. CONCLUSIONS: Potential investments in health service planning may alleviate the burden on aeromedical services, particularly related to cardiology services in inner and outer regional Queensland. Aeromedical services are pivotal in enabling all sick and injured residents' access to the highest quality of care regardless of the remoteness of their residence.

Review article: Primary aeromedical retrievals in Australia: An interrogation and search for context.

Primary aeromedical retrievals are a direct scene response to patients with a critical injury or illness using a medically equipped aircraft. They are often high-acuity taskings. In Australia, information on primary retrieval taskings is housed by service providers, of which there are many across the country. This exploratory literature review aims to explore the contemporary peer-reviewed literature on primary aeromedical retrievals in Australia. The focus is on adult primary aeromedical retrievals undertaken in Australia and clinical tools used in this pre-hospital setting. Included articles were reviewed for research theme (clinical and equipment, systems and/or outcomes), data coverage and appraisal of the evidence. Of the 37 articles included, majority explored helicopter retrievals (n = 32), retrieval systems (n = 21), compared outcomes within a service (n = 10) and explored retrievals in the state of New South Wales (n = 19). Major topics of focus included retrieval of trauma patients and airway management. Overall, the publications had a lower strength of evidence because of the preponderance of cross-sectional and case-study methodology. This review provides some preliminary but piecemeal insight into primary retrievals in Australia through a localised systems lens. However, there are several areas for research action and service outcome improvements suggested, all of which would be facilitated through the creation of a national pre-hospital and retrieval registry. The creation of a registry would enable consideration of the frequency and context of retrievals, comparison across services, more sophisticated data interrogation. Most importantly, it can lead to service and pre-hospital and retrieval system strengthening.

Ambulance use is associated with higher self-rated illness seriousness: user attitudes and perceptions.

OBJECTIVES: The objective was to study the role and effect of patients' perceptions on reasons for using ambulance services in Queensland, Australia. METHODS: A cross-sectional survey was conducted of patients (n = 911) presenting via ambulance or self-transport at eight public hospital emergency departments (EDs). The survey included perceived illness severity, attitudes toward ambulance, and reasons for using ambulance. A theoretical framework was developed to inform this study. RESULTS: Ambulance users had significantly higher self-rated perceived seriousness, urgency, and pain than self-transports. They were also more likely to agree that ambulance services are for everyone to use, regardless of the severity of their conditions. In compared to self-transports, likelihood of using an ambulance increased by 26% for every unit increase in perceived seriousness; and patients who had not used an ambulance in the 6 months prior to the survey were 66% less likely to arrive by ambulance. Patients who had presented via ambulance stated they considered the urgency (87%) or severity (84%) of their conditions as reasons for calling the ambulance. Other reasons included requiring special care (76%), getting higher priority at the ED (34%), not having a car (34%), and financial concerns (17%). CONCLUSIONS: Understanding patients' perceptions is essential in explaining their actions and developing safe and effective health promotion programs. Individuals use ambulances for various reasons and justifications according to their beliefs, attitudes, and sociodemographic conditions. Policies to reduce and manage demand for such services need to address both general opinions and specific attitudes toward emergency health services to be effective.

Universal access to ambulance does not increase overall demand for ambulance services in Queensland, Australia.

OBJECTIVE: To determine the impact of the introduction of universal access to ambulance services via the implementation of the Community Ambulance Cover (CAC) program in Queensland in 2003-04. METHOD: The study involved a 10-year (2000-01 to 2009-10) retrospective analysis of routinely collected data reported by the Queensland Ambulance Service (QAS) and by the Council of Ambulance Authorities. The data were analysed for the impact of policy changes that resulted in universal access to ambulance services in Queensland. RESULTS: QAS is a statewide, publically funded ambulance service. In Queensland, ambulance utilisation rate (AUR) per 1000 persons grew by 41% over the decade or 3.9% per annum (10-year mean=149.8, 95% CI: 137.3-162.3). The AUR mean after CAC was significantly higher for urgent incidents than for non-urgent ones. However projection modelling demonstrates that URs after the introduction of CAC were significantly lower than the projected utilisation for the same period. CONCLUSIONS: The introduction of universal access under the Community Ambulance Cover program in Queensland has not had any significant independent long-term impact on demand overall. There has been a reduction in the long-term growth rate, which may have been contributed to by an 'appropriate use' public awareness program.

Emergency department presentations during the State of Origin rugby league series: a retrospective statewide analysis.

OBJECTIVE: To evaluate the effect of the State of Origin rugby league series on the number of emergency department (ED) presentations in Queensland. DESIGN AND SETTING: Retrospective analysis of Emergency Department Information System data from 25 Queensland EDs for game 10s and matched control 10s during the annual State of Origin series from 2005 to 2012. The Queensland team won seven of the eight series in this period. MAIN OUTCOME MEASURES: Number of patients presenting to Queensland EDs on 24 game 10s and 80 control 10s. RESULTS: Proportionally, a binomial test indicated there were significantly fewer ED presentations on game 10s (49,702) than on control 10s (172,351) (P<0.001). On average, there were 2,154 presentations per 10 on control 10s and 2,071 on game 10s, representing a 4% reduction on game 10s. CONCLUSION: We found that the State of Origin series was associated with fewer ED presentations on game 10s. We believe these results have broader implications for workforce planning and resource allocation.

Australian dust storm: impact on a statewide air medical retrieval service.

INTRODUCTION: The Australian dust storm during the week of September 22, 2009, resulted in the grounding of a large portion of the air medical retrieval fleet in Queensland. We sought to determine whether during this event an increase occurred in cases requiring retrieval as a result of the dust storm, and whether the grounding of the retrieval fleet resulted in any adverse outcomes as a result of its inability to respond. METHODS: A retrospective review of respiratory and injury cases referred to the Queensland Emergency Medical System Coordination Centre from September 8 to October 5, 2009 was conducted. All cases with any respiratory or injury complaints were included. The number of cases, priority for retrieval, and the ability to retrieve these cases within the allocated time were examined and compared with those for a similar time frame in the previous year. RESULTS: A 62.5% increase in respiratory cases was seen, and 13.3% increase in injury cases during the week of the dust storm event, when compared with the previous year. Neither of these results reached statistical significance, but they demonstrate a practically important difference. For the month surrounding the dust storm event, a 48.5% (P = .04) increase in respiratory cases occurred, but no increase in injury cases when compared with the previous year. Only one urgent case was unable to be air medically retrieved during the study period as a result of grounding of the aircraft because of the dust storm event, but contingency arrangements were made for alternative transport. No adverse events were recorded during the study period. CONCLUSION: An increased demand on retrieval services was demonstrated during the period of the dust storm event. Despite grounding of the air medical fleet, all cases except one were able to be retrieved within clinically appropriate time frames or by alternative transport methods. Contingency plans need to be developed to cope with the possibility of similar events in the future, to prevent adverse events from occurring.

Fast versus slow bandaid removal: a randomised trial.

OBJECTIVE: To determine whether slow or fast bandaid removal is less painful. DESIGN, SETTING AND PARTICIPANTS: A prospective, randomised, crossover trial was carried out at James Cook University, Townsville. Participants were healthy volunteers from Years 2 and 3 of the James Cook University medical school program. INTERVENTIONS: Medium-sized bandaids were applied bilaterally in three standard body locations and removed using slow and fast techniques. MAIN OUTCOME MEASURES: Pain scores were assessed using an 11-point verbal numeric pain scale. RESULTS: 65 participants were included in the study. The overall mean pain score for fast bandaid removal was 0.92 and for slow bandaid removal was 1.58. This represents a highly significant difference of 0.66 (P < 0.001). CONCLUSION: In young healthy volunteers, fast bandaid removal caused less pain than slow bandaid removal.