Drug calculation ability of qualified paramedics: A pilot study.

BACKGROUND: The inability of paramedics to perform accurate calculations may result in a compromise of patient safety which may result from under or over dosing of drugs, incorrect joules for defibrillation, or a major adverse event such as death. The objective of this study was to identify the drug calculation and mathematical ability of qualified operational paramedics. METHODS: The study used a cross-sectional design with a paper-based calculation questionnaire. Twenty paramedics enrolled in an intensive care paramedic course were eligible to participate in the study. The questionnaire consisted of demographic, drug calculation (seven questions), and mathematical (five) questions. Students were given no notice of the impending study and use of a calculator was not permitted. RESULTS: All eligible students participated in the study. The average time employed as a paramedic was 7.25 years, SD 2.5 years, range four years to twelve years. Four (20%) students got all 12 questions correct, and five (41.6%) got 50% or less. The average score was 8.6 (71.7%) correct, SD 2.8 correct, range 3 to 12 correct questions. There were eight (40%) conceptual errors, 12 (60%) arithmetical errors, and five (25%) computational errors. CONCLUSION: The results from this study supports similar international studies where paramedic's ability to undertake mathematical and drug calculations without a calculator varies, with some results highlighting the paramedics mathematical skills as a potential risk to patient safety. These results highlight the need for regular continuing mathematical and drug calculation practice and education to ensure a lower error rate.

Midwifery student reactions to workplace violence.

PROBLEM: Workplace violence, incidents against people in their workplaces, is a growing problem in Australia causing untold personal suffering as well as costing Australian businesses in productivity. Midwives have been highlighted as a group particularly at risk, yet in Australia there is little research into workplace violence against midwives and even less into midwifery students. AIM: This study aimed to explore Australian midwifery students' responses to workplace violence as well as to gauge the impact of workplace violence on them. METHODS: Cross-sectional survey design was employed. Second and third year students were invited to participate at the end of a scheduled lecture. Fifty-two female midwifery students who had completed their work placement completed a survey indicating their immediate responses to workplace violence as well as the Impact of Event Scale. Data were analysed using descriptive statistics. FINDINGS: Most students notified a co-worker immediately after a workplace violence incident, yet few completed an incident form or received official debriefing. DISCUSSION: There is a need for the reporting of workplace violence against midwifery students to be made easier to access thereby ensuring they can receive the assistance they require. Midwifery students need to understand the processes and supports in place for managing instances of workplace violence. CONCLUSION: Clinical placements can impact on midwifery students' future careers. Universities need to prepare students for the possibility of workplace violence and arm them with appropriate strategies for safely dealing with it.

Assessing student paramedic visual and verbal checks for defibrillation safety-an observational study.

One of the cornerstones in resuscitation training is defibrillation safety, inadvertent "shocking" of the patient when another person has contact with the patient may have a range of safety consequences. The objective of the study was to assess visual and verbal safety checks by paramedic students prior to defibrillation. This was a prospective observational mannequin study of defibrillation safety during a simulated cardiac arrest by paramedic students. The study was conducted in the lounge room of the Department of Community Emergency Health & Paramedic Practice simulation flat, a replica of a complete flat where prehospital simulations are conducted. Each student completed two 10-min cardiac arrest simulations with multiple defibrillation attempts. Each student and an independent Faculty member rated the simulation safety performance using a defibrillation safety self-assessment (DSSA) form. Twenty-four (20 %) students participated in the study with 14 (58 %) being female. For scenario one agreement between student and assessor proved significant for "scanning the incident scene" for all three defibrillation attempts, with agreement ranging from 29 % (p = 0.044) to 47 % (p = 0.007), and stating "stand clear" for defibrillation attempt one and three with the agreement ranging from 47 % (p = 0.007) to 100 % (p < 0.001). For scenario two agreement between student and assessor proved significant for "charging eye contact" for all three defibrillation attempts, with agreement ranging from 40 % (p = 0.043) to 53 % (p = 0.003), and "scanning the scene to ensure all persons are clear of the patient" before defibrillation attempt one and two with agreement ranging from 29 % (p = 0.044) to 46 % (p < 0.007). The results of this study suggest student perception of their performance and what they actually do is vastly different. Further studies using video recording glasses are required so students can gain an accurate and realistic sense of their defibrillation safety performance.

Empathy levels among health professional students: a cross-sectional study at two universities in Australia.

BACKGROUND: Empathy is paramount in the health care setting, optimizing communication and rapport with patients. Recent empirical evidence suggests that empathy is associated with improved clinical outcomes. Therefore, given the importance of empathy in the health care setting, gaining a better understanding of students' attitudes and self-reported empathy is important. The objective of this study was to examine self-reported empathy levels of students enrolled in different health disciplines from two large Australian universities. MATERIALS AND METHODS: A total of 1,111 students from two different universities enrolled in eight different health professions were administered the Jefferson Scale of Physician Empathy - Health Profession Students version, a 20-item 7-point Likert scale questionnaire to evaluate self-reported empathy levels. RESULTS: A total of 1,111 students participated in this study. The majority of participants were from Monash University (n=771), with 340 students from Edith Cowan University. No statistically significant differences were found between universities: Monash University (mean 110.1, standard deviation [SD] 11.8); Edith Cowan University (mean 109.2, SD 13.3, P=0.306). The mean female empathy score (mean 110.8, SD 11.7) was significantly higher than the mean male score (mean 105.3, SD 13.5; P<0.0001; d=0.44). Paramedic students had significantly lower empathy scores (mean 106.3, SD 12.73) than all other participants except nursing students (P<0.0001). CONCLUSION: Results relating to sex are reflective of previous studies. There is some discrepancy in results relating to empathy and its incline/decline as students progress through a program. Further study is warranted to explore why there are variations in empathy levels in students of different health disciplines.

Diagnostic accuracy of prehospital clinical prediction models to identify short-term outcomes in patients with acute coronary syndromes: a systematic review.

BACKGROUND: Although cardiac risk prediction is widely used in various clinical settings, its potential role in enhancing prehospital triage is yet to be understood. OBJECTIVE: To systematically review the diagnostic accuracy of short-term clinical prediction models for potential use in a prehospital population with suspected acute coronary syndrome. METHODS: Eleven electronic medical databases were searched from 1990 to the end of August 2010 for all English-language observational and interventional studies. An online search strategy tool was used to identify grey-literature studies. Eligibility criteria were: 1) an unselected population of adult acute coronary syndrome patients; 2) recruited within the Emergency Department or Emergency Medical Services; 3) reported multivariate analysis encompassing patient history or physical examination; 4) reported short-term outcome measures; 5) were not solely computer protocols; and 6) were not reliant on tests unavailable out of the hospital. Data extraction was conducted by a single reviewer and verified by a second reviewer. Study quality was assessed independently by two reviewers using a validated quality assessment tool. RESULTS: A total of seven clinical prediction models were identified. Only two models reported were derived from a prehospital study population. Six clinical prediction models described good discriminate abilities (c-statistic) of 0.72 to 0.87. Among the range of independent predictors identified, electrocardiogram abnormalities, age, heart rate, and systolic blood pressure provided the strongest prognostic information. CONCLUSION: The models identified provided reasonable diagnostic accuracy for determining short-term outcomes. Methodological weaknesses and variability in the populations investigated limit their use in clinical practice.

Should an alternative to the Glasgow Coma Scale be taught to paramedic students?

BACKGROUND: The accurate assessment of a patient's conscious state using the Glasgow Coma Scale (GCS) is an important skill for paramedics as it may determine the patient's initial and ongoing management. The objective of this study was to determine if undergraduate paramedic students from a large Australian University were able to accurately interpret a variety of conscious states. METHODS: A prospective double-blinded observational pilot study requiring students to interpret the conscious state of four adult patients using the GCS by viewing a simulation DVD package. RESULTS: There were 137 students who participated in the study, of whom 65% (n=87) were female students. The results demonstrated that undergraduate paramedic students were unable to accurately interpret a number of patient conscious states with only 20% and 37% of students able to accurately identify the GCS of patients 2 (GCS=12) and 3 (GCS=7). The motor component of the GCS appeared to be the component where the least accurate interpretation occurred, with only 47% of students being able to accurately identify the criteria that patient 3 displayed. Participants were however able to accurately interpret the GCS of both patient 1 (GCS=14) (86%) and patient 4 (GCS=15) (92%). CONCLUSION: This pilot study demonstrates that undergraduate paramedic students from an Australian university were unable to accurately interpret a patient's conscious state if their GCS score was <14. These findings have provided academic staff with important information for considering alternative teaching and learning strategies and approaches in conscious state assessment in current paramedic curricula.

Mathematical and drug calculation abilities of paramedic students.

AIM: The objective of this study was to determine if undergraduate paramedics could accurately perform common drug calculations and basic mathematical computations normally required in the workplace. METHOD: A descriptive paper-based questionnaire collecting demographical data, student attitudes regarding their drug calculation performance, and answers to a series of basic mathematical and drug calculation questions was administered to undergraduate paramedic students. RESULTS: The mean score was 39.5% with only 3.3% of students (n=3) scoring greater than 90%, and 63% (n=58) scoring 50% or less. Conceptual errors made up 48.5%, arithmetical 31.1% and computational 17.4%. CONCLUSION: This study suggests undergraduate paramedics have deficiencies in performing accurate calculations with conceptual errors indicating a fundamental lack of mathematical understanding.

Undergraduate paramedic students cannot do drug calculations.

BACKGROUND: Previous investigation of drug calculation skills of qualified paramedics has highlighted poor mathematical ability with no published studies having been undertaken on undergraduate paramedics. There are three major error classifications. Conceptual errors involve an inability to formulate an equation from information given, arithmetical errors involve an inability to operate a given equation, and finally computation errors are simple errors of addition, subtraction, division and multiplication. The objective of this study was to determine if undergraduate paramedics at a large Australia university could accurately perform common drug calculations and basic mathematical equations normally required in the workplace. METHODS: A cross-sectional study methodology using a paper-based questionnaire was administered to undergraduate paramedic students to collect demographical data, student attitudes regarding their drug calculation performance, and answers to a series of basic mathematical and drug calculation questions. Ethics approval was granted. RESULTS: The mean score of correct answers was 39.5% with one student scoring 100%, 3.3% of students (n=3) scoring greater than 90%, and 63% (n=58) scoring 50% or less, despite 62% (n=57) of the students stating they 'did not have any drug calculations issues'. On average those who completed a minimum of year 12 Specialist Maths achieved scores over 50%. Conceptual errors made up 48.5%, arithmetical 31.1% and computational 17.4%. CONCLUSIONS: This study suggests undergraduate paramedics have deficiencies in performing accurate calculations, with conceptual errors indicating a fundamental lack of mathematical understanding. The results suggest an unacceptable level of mathematical competence to practice safely in the unpredictable prehospital environment.

Do mannequin chests provide an accurate representation of a human chest for simulated decompression of tension pneumothoraxes?

BACKGROUND: Tension pneumothorax (TPX) is an uncommon but life-threatening condition. It is important that this uncommon presentation, managed by needle decompression, is practised by paramedics using a range of educationally sound and realistic mannequins. The objective of this study is to identify if the chest wall thickness (CWT) of training mannequins used for chest decompression is an anatomically accurate representation of a human chest. METHODS: This is a two-part study. A review of the literature was conducted to identify chest wall thickness in humans and measurement of chest wall thickness on two commonly used mannequins. The literature search was conducted using the Cochrane Central Register of Controlled Trials, MEDLINE, CINAHL, and EMBASE databases from their beginning until the end of May 2012. Key words included chest wall thickness, tension pneumothorax, pneumothorax, thoracostomy, needle thoracostomy, decompression, and needle test. Studies were included if they reported chest wall thickness. RESULTS: For the literature review, 4 461 articles were located with 9 meeting the inclusion criteria. Chest wall thickness in adults varied between 1.3 cm and 9.3 cm at the area of the second intercostal space mid clavicular line. The Laerdal(®) manikin in the area of the second intercostal space mid clavicular line, right side of the chest was 1.1 cm thick with the left 1.5 cm. The MPL manikin in the same area or on the right side of the chest was 1.4 cm thick but on the left 1.0 cm. CONCLUSION: Mannequin chests are not an accurate representation of the human chest when used for decompressing a tension pneumothorax and therefore may not provide a realistic experience.

Cardiopulmonary resuscitation before defibrillation in the out-of-hospital setting: a literature review.

BACKGROUND: Many studies over the past decade have investigated delaying initial defibrillation to perform cardiopulmonary resuscitation (CPR), as it has been associated with increased rates of restoration of spontaneous circulation and/or survival. Since 2006, a number of studies have investigated these procedures. The objective of this study was to undertake a literature review examining the commencement of CPR before defibrillation in the out-of-hospital setting. METHODS: A literature review was undertaken using the electronic medical databases Ovid Medline, EMBASE, CINHAL Plus, Cochrane Systematic Review and Meditext, from their commencement to the end of June 2011. Keywords used in the search included: CPR, defibrillation, ventricular fibrillation, VF, EMS, EMT, paramedic, emergency medical service, emergency medical technician, prehospital, out-of-hospital and ambulance. References of relevant articles were also reviewed. FINDINGS: Of the 3079 articles located, 10 met the inclusion criteria. The results of these studies showed conflicting results. All retrospective studies (n=6) indicated a benefit in performing pre-shock CPR on patients with ventricular fibrillation for durations between 90 and 180 s. Conversely, all randomised controlled trials demonstrated no benefit from providing CPR before defibrillation compared with immediate defibrillation for return of spontaneous circulation, neurological outcome and/or survival to hospital discharge. However, none of the studies reported evidence that CPR before defibrillation is harmful. CONCLUSION: Conflicting evidence remains regarding the benefit of CPR before defibrillation. The establishment of a consistent timeframe of chest compressions before defibrillation in the out-of-hospital setting will provide uniformity in standards in clinical practice and education and training.

Numeracy skills of nursing students.

Research has highlighted poor mathematical ability amongst qualified and student nurses. Three major classifications of errors: i)conceptual, ii)arithmetical and iii)computational have been identified. These errors involve being unable to formulate an equation from information given, unable to operate a given equation, or simple arithmetical errors respectively. The objective of this study was to determine if a sample of Australian second year undergraduate nursing students, from the state of Victoria, could accurately calculate drug dosages and perform some basic mathematical calculations that would be required in the workplace. A descriptive survey collecting demographical data, attitudes towards drug calculation performance and basic mathematical and drug calculation questions was administered to the 52 undergraduate nurses who participated in the study. The average score was 56.1%. Interestingly 63.5% of the students denied any drug calculations issues. On average those who completed a minimum of year 12 mathematics, or who had entered the course directly from secondary education achieved scores over 50%. Of all the errors that occurred 36.0% were conceptual, 38.9% were arithmetical and 25.1% were computational. Some Victorian nursing students currently have deficiencies in performing accurate calculations, with both arithmetical and conceptual errors, indicating fundamental flaws in their mathematical understanding and demonstrating an unacceptable level to practice safely.

Attitudes of undergraduate health science students towards patients with intellectual disability, substance abuse, and acute mental illness: a cross-sectional study.

BACKGROUND: There is a long history of certain medical conditions being associated with stigma, stereotypes, and negative attitudes. Research has shown that such attitudes can have a detrimental effect on patients presenting with stigmatised medical conditions and can even flow on to impact their family. The objective of this study was to measure the attitudes of undergraduate students enrolled in six different health-related courses at Monash University toward patients with intellectual disability, substance abuse, and acute mental illness. METHODS: A convenience sample of undergraduate students enrolled in six health-related courses in first, second and third years at Monash University were surveyed. The Medical Condition Regard Scale--a valid and reliable, self-report measure of attitudes--was administered to students along with a brief demographic form. Mean scores, t-tests, and ANOVA were used to analyse student attitudes. Ethics approval was granted. RESULTS: 548 students participated. Statistically significant differences were found between the courses (p = 0.05), year of the course (p = 0.09), and gender (p = 0.04) for the medical condition of intellectual disability. There was no statistically significant difference between the courses, year of the course, gender, and age group for substance abuse or acute mental illness conditions. CONCLUSION: The findings suggest that students in undergraduate health-related courses, as a group, have a strong regard for patients with intellectual disability and some regard for patients with acute mental illness, but not for patients presenting with substance abuse problems.

The first 7 years of the metropolitan fire brigade emergency responder program - an overview of incidents attended.

PURPOSE: The Melbourne Metropolitan Fire and Emergency Services Board (MFESB) was the first fire service in Australia to implement a service-wide emergency medical response (EMR) program in 2001. No additional scientific analysis of the first responder program has been reported since the pilot program. The objective of this study was to report the first 7 years of responses by firefighters as first responders. PATIENTS AND METHODS: The MFESB have three separate datasets with cardiac arrest information: (i) callout record; (ii) patient care record; and (iii) cardiac arrest record, including data from the automatic external defibrillator. Descriptive statistics were used to summarize the demographic and specific outcome data. Ethics approval was granted. RESULTS: A total of 8227 incidents were attended over the first 7 years. The most incidents attended were cardiac arrest 54% (n = 4450) followed by other medical 19% (n = 1579), and drug overdose 11% (n = 908); the remainder were <10% each. Sixty-three percent of incidents involved males. Average age was 57.2 years, median age 63 years, range from <1 month to 101 years; average response time was 6.1 minutes, median response time 5.6 minutes, range from 9 seconds to 31.5 minutes. Firefighters provided "initial care" in 57% and assisted in 26% of the incidents. Firefighters spent on average 4.8 minutes with the patient before handing over to paramedics; median 3.9 minutes, range of a few seconds to 39.2 minutes. CONCLUSION: This study suggests that the MFESB EMR program is providing firefighter first responders to emergency situations in a short timeframe to assist the ambulance service.

The 10 mL syringe is useful in generating the recommended standard of 40 mmHg intrathoracic pressure for the Valsalva manoeuvre.

OBJECTIVE: The Valsalva manoeuvre (VM) continues to be first-line management for haemodynamically stable supraventricular tachycardia in the acute setting. 40 mmHg of intrathoracic pressure is seen as an essential component of the VM. Anecdotally, blowing into a 10 mL syringe to move the plunger is one method of pressure generation; however, to date its effectiveness has not been tested. The objective of the present study was to assess if blowing into a syringe sufficient to move the plunger could produce the required 40 mmHg of pressure. METHODS: A two-part experimental study tested the pressure required to move the plunger, and sustain that movement for 15 s, in a Terumo syringe. Part one tested a range of syringe sizes. Part two, a repeated measures study, tested the syringe to ascertain if a pressure reduction occurred after repeated use. A sphygmomanometer was attached to the syringe via a 10 cm length of tubing with another length of tubing attached to the sphygmomanometer enabling an investigator to blow into the syringe. RESULTS: In part one, the 10 mL syringe was the only size noted to provide the required 40 mmHg pressure to move the plunger. In part two, the mean for each of the three tests per syringe varied between 37.0 mmHg (95% CI 34.2-39.8) and 40.2 mmHg (95% CI 37.5-43.0). There was no statistically significant fall noted over three uses of the same syringe. CONCLUSION: The present study has demonstrated that blowing into a 10 mL Terumo syringe, to move the plunger, generated 40 mmHg intrathoracic pressure, thereby meeting the recommended intrathoracic pressure for optimum VM performance.

A cross-sectional study of Victorian Mobile Intensive Care Ambulance Paramedics knowledge of the Valsalva Manoeuvre.

BACKGROUND: The Valsalva Manoeuvre (VM) is a primary measure for terminating haemodynamically stable supraventricular tachycardia (SVT) in the emergency care setting. The clinical use and termination success of the VM in the prehospital setting has not been investigated to date. The objective of this study was to determine Melbourne Mobile Intensive Care Ambulance (MICA) Paramedic knowledge of the VM, and to compare this understanding with an evidence-based model of VM performance. METHODS: A cross-sectional study in the form of a face-to-face interview was used to determine Melbourne MICA Paramedic understanding of VM instruction between January and February, 2008. The results were then compared with an evidence-based model of VM performance to ascertain compliance with the three criteria of position, pressure and duration. Ethics approval was granted. RESULTS: There were 28 participants (60.9%) who elected a form of supine posturing, some 23 participants (50%) selected the syringe method of pressure generation, with 16 participants (34.8%) selecting the "as long as you can" option for duration. On comparison, one out of 46 MICA Paramedics correctly identified the three evidence-based criteria. CONCLUSIONS: The formal education of Melbourne's MICA Paramedics would benefit from the introduction of an evidence based model of VM performance, which would impact positively on patient care and may improve reversion success in the prehospital setting. The results of this study also demonstrate that an opportunity exists to promote the evidence-based VM criteria across the primary emergency care field.

Comparison overview of prehospital errors involving road traffic fatalities in Victoria, Australia.

INTRODUCTION: Until early 2003, the Consultative Committee on Road Traffic Fatalities (CCRTF) in Victoria, Australia was the main body investigating and publishing data about prehospital errors resulting from road traffic fatalities. The objective of this study was to identify and interpret prehospital error rate trends associated with road traffic fatalities during a 10-year period of the CCRTF reports. METHODS: This study is a review of the prehospital errors defined in Victorian CCRTF reports of preventable deaths of road traffic fatalities over a 10-year period. RESULTS: Six CCRTF reports contained prehospital data for errors associated with road traffic fatalities. From 1992 to 1998, system errors decreased. However, over the same timeframe, management, technical, and diagnostic errors increased. There was a marked jump in system, technique, and diagnosis errors from 1998 to 2001-2003. However, management errors declined over the same timeframe. The jump in errors in the 1998 to 2001-2003 timeframe coincided with the introduction of advanced life support (ALS) for Victorian paramedics in 2000.The number of preventable deaths decreased from 1992 to 1998, however, there was an increase from 1999 onwards, coinciding with the introduction of the state trauma system and ALS for paramedics. CONCLUSIONS: This study demonstrates that there has been an increase in prehospital error rates, especially from 2000, which coincided with the introduction of ALS for paramedics and the state trauma system in Victoria, even though the state trauma system had an overall decrease in error rates.

Smaller self-inflating bags produce greater guideline consistent ventilation in simulated cardiopulmonary resuscitation.

BACKGROUND: Suboptimal bag ventilation in cardiopulmonary resuscitation (CPR) has demonstrated detrimental physiological outcomes for cardiac arrest patients. In light of recent guideline changes for resuscitation, there is a need to identify the efficacy of bag ventilation by prehospital care providers. The objective of this study was to evaluate bag ventilation in relation to operator ability to achieve guideline consistent ventilation rate, tidal volume and minute volume when using two different capacity self-inflating bags in an undergraduate paramedic cohort. METHODS: An experimental study using a mechanical lung model and a simulated adult cardiac arrest to assess the ventilation ability of third year Monash University undergraduate paramedic students. Participants were instructed to ventilate using 1600 ml and 1000 ml bags for a length of two minutes at the correct rate and tidal volume for a patient undergoing CPR with an advanced airway. Ventilation rate and tidal volume were recorded using an analogue scale with mean values calculated. Ethics approval was granted. RESULTS: Suboptimal ventilation with the use of conventional 1600 ml bag was common, with 77% and 97% of participants unable to achieve guideline consistent ventilation rates and tidal volumes respectively. Reduced levels of suboptimal ventilation arouse from the use of the smaller bag with a 27% reduction in suboptimal tidal volumes (p = 0.015) and 23% reduction in suboptimal minute volumes (p = 0.045). CONCLUSION: Smaller self-inflating bags reduce the incidence of suboptimal tidal volumes and minute volumes and produce greater guideline consistent results for cardiac arrest patients.

Paramedics' ability to perform drug calculations.

BACKGROUND: The ability to perform drug calculations accurately is imperative to patient safety. Research into paramedics' drug calculation abilities was first published in 2000 and for nurses' abilities the research dates back to the late 1930s. Yet, there have been no studies investigating an undergraduate paramedic student's ability to perform drug or basic mathematical calculations. The objective of this study was to review the literature and determine the ability of undergraduate and qualified paramedics to perform drug calculations. METHODS: A search of the prehospital-related electronic databases was undertaken using the Ovid and EMBASE systems available through the Monash University Library. Databases searched included the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, CINAHL, JSTOR, EMBASE and Google Scholar, from their beginning until the end of August 2009. We reviewed references from articles retrieved. RESULTS: The electronic database search located 1,154 articles for review. Six additional articles were identified from reference lists of retrieved articles. Of these, 59 were considered relevant. After reviewing the 59 articles only three met the inclusion criteria. All articles noted some level of mathematical deficiencies amongst their subjects. CONCLUSIONS: This study identified only three articles. Results from these limited studies indicate a significant lack of mathematical proficiency amongst the paramedics sampled. A need exists to identify if undergraduate paramedic students are capable of performing the required drug calculations in a non-clinical setting.

The experience of linking Victorian emergency medical service trauma data.

BACKGROUND: The linking of a large Emergency Medical Service (EMS) dataset with the Victorian Department of Human Services (DHS) hospital datasets and Victorian State Trauma Outcome Registry and Monitoring (VSTORM) dataset to determine patient outcomes has not previously been undertaken in Victoria. The objective of this study was to identify the linkage rate of a large EMS trauma dataset with the Department of Human Services hospital datasets and VSTORM dataset. METHODS: The linking of an EMS trauma dataset to the hospital datasets utilised deterministic and probabilistic matching. The linking of three EMS trauma datasets to the VSTORM dataset utilised deterministic, probabilistic and manual matching. RESULTS: There were 66.7% of patients from the EMS dataset located in the VEMD. There were 96% of patients located in the VAED who were defined in the VEMD as being admitted to hospital. 3.7% of patients located in the VAED could not be found in the VEMD due to hospitals not reporting to the VEMD. For the EMS datasets, there was a 146% increase in successful links with the trauma profile dataset, a 221% increase in successful links with the mechanism of injury only dataset, and a 46% increase with sudden deterioration dataset, to VSTORM when using manual compared to deterministic matching. CONCLUSION: This study has demonstrated that EMS data can be successfully linked to other health related datasets using deterministic and probabilistic matching with varying levels of success. The quality of EMS data needs to be improved to ensure better linkage success rates with other health related datasets.

Is mechanism of injury alone a useful predictor of major trauma?

INTRODUCTION: The Review of Trauma and Emergency Services in Victoria -1999 left unresolved the predictive value of mechanism of injury in pre-hospital trauma triage guidelines. Ethics approval was granted. The objective of this study is to determine if mechanism of injury alone is a useful predictor of major trauma in pre-hospital trauma triage. METHODS: A retrospective cohort study was undertaken of all Victorian ambulance trauma Patient Care Records (PCRs) for 2002. PCRs where patients were physiologically stable, had no significant pattern of injury, but had a significant mechanism of injury were identified and compared with the State Trauma Registry to determine those patients who sustained hospital defined major trauma. RESULTS: There were 4571 incidents of mechanism of injury only, of which 62% were males, median age was 28 years. Two criteria had statistically significant results. A fall from greater than 5m (n=52) of whom 5 (RR 10.86, CI 4.47 to 26.42, P<0.0001) sustained major trauma and a patient trapped greater than 30 min (n=36) of whom 3 (RR 9.0, CI 2.92 to 27.70, P=0003) sustained major trauma. The overall results are not clinically significant. CONCLUSION: This study suggests that individual mechanism of injury criteria have no clinical or operational significance in pre-hospital trauma triage of patients who have an absence of physiological distress and no significant pattern of injury. These results add to the knowledge base of trauma presentation in the pre-hospital setting, especially in Australia, and are the baseline for further studies.