UNFINISHED BUSINESS features the archive of #FEAS Feminist Educators Against Sexism alongside work by Australian feminist artists.The exhibition brings into focus a lineage of activist feminist art to invite thinking with practices that interrupt white patriarchal heteronormative narratives.The concept of an expanded zine connects the works, with 'pages' forming in vastly different ways.The exhibition offers irreverent, furious, funny, and tender insights toward connected and equitable feminist futures, unfinished… #FEAS is an international feminist collective committed to developing creative interventions into sexisms in the academy and other places.It is co-led by
Research Statement Research Background All ways fire she gives is a poetic essay by Dr Jo Pollitt created as an invited response to Amanda Bells work in the John Stringer Prize, 2022 and published by Westerly. Developed through embodied, place-based writing, the essay engages with memory fragments, site-specific reflection, and intertextual connections with artworks by Amanda Bell and Bruno Booth. Moving between Katanning and Kaarta Koomba, and between text and performance, the work is enriched by two invited live readings at the John Curtin Gallery and launch of Westerly Vol 68. Research Contribution All ways fire she gives introduces an innovative mode of poetic scholarship, enacting care as a method of composition, performance, and inquiry. By blending writing, response methodology and live performance, the essay extends feminist, ecopoetic and anti-colonial approaches, grounded in assemblage and sensory presence. The live readings at John Curtin Gallery and Westerly launch deepened its impact, transforming the essay into a site of reflection and exchange. This interplay between embodied writing and performance extends the reach of the work, inviting active engagement and shared experience. Research Significance Publication in Westerly, a prominent literary journal renowned for showcasing regionally significant writing, signals the essay’s excellence and cultural relevance. The approach embeds embodied scholarship with poetic experimentation and positions all ways fire she gives as a model of creative research, influencing practices across writing, performance, and feminist scholarship and making it a vital contribution to ongoing conversations in academia and the arts. Pollitt was invited as one of five WA writers to respond to the John Stringer Prize finalists and First Nations curator and artist Amanda Bell’s response to the work was ‘Moorditj’ meaning ‘great, strong and good’ in Noongar.
Introduction The aim of this study was to provide a snapshot of Australian remote and industrial paramedics’ patient clinical presentations, experience with physician consultations and options for patient transport to tertiary care. Methods This exploratory, cross-sectional descriptive study employed a purpose-built online survey. Participants were 78 paramedics working in Australian rural and remote industrial settings recruited in 2015 using web-based, respondent-driven sampling. In addition to a series of closed ended questions, respondents were asked to recall the number of times they encountered specific clinical presentations during the past year. Data were analysed using descriptive statistics and modes were calculated for ordinal data associated with clinical presentations. Results The traumatic presentations that participants recalled encountering at least 10 times the preceding year included back pain (39.7%), minor lacerations (38.5%), joint (36.4%) and hand (30.8%) injuries. Respondents selected headache (64.1%), nausea, vomiting or diarrhoea (52.6%), respiratory infections (50%), ear, nose or throat problems (43.6%) and localised infections or rash (39.7%) as the most common medical presentations. Of the respondents, 38.4% managed patients with mental health presentations a minimum of six times in the preceding year, and 45.3% treated at least one patient in cardiac arrest. While 94.8% of participants said topside support was available, over half described consulting physicians infrequently and if they did, it was typically by telephone. Most respondents (61%) indicated that their worksite was located over 100 km from a hospital. Conclusion Survey findings indicate that paramedic participants recall encountering a wide range of clinical presentations and managing low acuity illnesses more commonly than traumatic injuries. Most respondents were located at least 100 km from the nearest hospital and although almost all had access to topside support, over half stated they consulted physicians infrequently.
Objective Prehospital early warning scores (EWSs) can accurately identify patients at risk of clinical deterioration. We hypothesised that EWSs can identify patients during the prehospital phase who will subsequently require clinical escalation via medical retrieval. Methods A retrospective observational study of adult patients attended in 2018 by Ambulance Victoria in rural regions was conducted. We calculated EWSs using National Early Warning Score 2 (NEWS2) and Rapid Emergency Medicine Score (REMS) methods. Primary outcome was activation of Adult Retrieval Victoria (ARV) within 24h of ambulance attendance. We evaluated sensitivity and specificity for each score, and used multivariable logistic regression analysis to assess the independent association between EWSs and ARV activation. Results A total of 71,401 patients were included, of which 607 (0.9%) required ARV activation within 24 hours. Sensitivity and specificity of NEWS2 were 0.484 (95% CI 0.444-0.525) and 0.806 (95% CI 0.803-0.809) respectively, compared with 0.552 (95% CI 0.511-0.592) and 0.508 (95% CI 0.504-0.512) respectively for REMS. After adjustment for remoteness, distance to hospital, sex, age and hospital service level, a medium/high risk score according to the NEWS2 (OR 4.12; 95% CI 3.50-4.85, p < 0.001) and REMS (OR 2.92, 95% CI 2.26-3.77) was associated with ARV activation. Odds of ARV activation increased with remoteness and decreasing service level of the receiving hospital. Conclusions Prehospital NEWS2 and REMS were associated with medical retrieval within 24h of ambulance attendance. EWSs may allow early identification of ambulance patients requiring medical retrieval, thus facilitating earlier activation and reduced time to definitive care.
Introduction The societal changes triggered by the COVID-19 pandemic and resultant lockdowns have the potential to alter the incidence and nature of injuries within affected populations. We aimed to investigate these changes within Metropolitan London and the impact lockdown had on London's Air Ambulance's (LAA) response to incidents. Methods This retrospective cohort study compared data from all LAA missions in the two-month period following instigation of the 1st UK national lockdown in 2020 to the equivalent period in 2019. Patient demographics, nature and severity of injuries, incident details and LAA mission parameters were assessed. Results LAA saw a significant reduction in the mean (standard deviation) of activations per week under lockdown (32.75 [4.95] versus 54.25 [4.53], p<0.001). The distribution of patients across different trauma aetiologies differed significantly under lockdown, with proportionately more injuries resulting from domestic violence (0.7% versus 3.8%) and deliberate self-harm (DSH [16.5% versus 12.4%]), although the absolute number of DSH fell. Significantly fewer incidents occurred in central areas of London, but injury severity was unaffected by lockdown. After adjustment for confounders, lockdown was associated with shorter drive times, but not overall response times. There was no association between lockdown and aetiology or severity of injuries. Conclusion The COVID-19 pandemic and ensuing UK national lockdown had a substantial impact on major trauma patterns within London and the subsequent LAA response. The feared rise in suicide was not observed, but there was a notable increase in domestic violence frequency.
Background Although bullying and harassment among academic staff has been well researched, research on students bullying and harassing academic teaching staff (ie, contrapower harassment) is less common. Contrapower harassment has been on the rise in academia over the last decade, partly attributable to changes in the student-faculty staff relationship. This study aimed to understand better the extent and impact of students’ contrapower harassment on paramedic academic teaching staff within Australian universities, as well as actions and interventions to address it. Methods This study used a two-phase mixed methods design. In phase 1, a convenience sample of paramedic teaching academics from 12 universities in Australia participated in an online questionnaire. In phase 2, an in-depth interview was conducted with nine participants from phase 1. Results Seventy-six academic teaching staff participated in the study. Survey results showed that most academics surveyed had experienced harassment from paramedic students, with the highest incidence of harassment occurring during student assessment periods. Alarmingly, over 30% of the academics surveyed had been ‘stalked’ by a student and over 50% had felt powerless and helpless when students had attacked them on social media. Problematic students were identified as those who presented with an over-inflated sense of entitlement or with psychological states and traits that find it challenging to accept feedback and failure, and look to externalise their failures. Reasons for increases in contrapower harassment included a complex mix of consumer and demand-driven education, on-demand (and demanding) instant gratification and degree self-entitlement, and an increase in social media and online learning (particularly during the COVID-19 pandemic of 2020). Conclusion Although most of the academics in this study experienced contrapower harassment by students, they also report that most students are level-headed and supportive, and do not carry out this type of harassment. Promoting student professionalism and reassessing student evaluations are starting points for addressing this type of harassment. Further research on the broader systemic issues that influence the contributors to contrapower harassment is needed.
Introduction Non-technical skills (NTS) are a causative factor in many adverse events in healthcare. Although this is the case, NTS have been explored in the paramedic literature in isolation, with no current list of desirable paramedic NTS within the literature. This study aims to gather consensus opinions on which NTS are considered important for an operational paramedic. Methods A modified Delphi technique was utilised to achieve the study aim. Participants were required to rate each NTS on a ten-point Likert scale. For an NTS to reach a consensus, it was required to be rated within two Likert scale points of the mode score by 80% of participants. Results There were 17 participants in the Delphi study (n=17). The study ran for a total of three rounds, and 33 of 35 NTS reached consensus. The top five NTS were communication, problem-solving, situational awareness, professionalism, and interpersonal skills. Two NTS did not reach consensus; these were empathy and cognitive offloading. These two did not reach consensus despite being rated six or higher by all participants. Conclusions The results of this Delphi study have created the first expert-based list of important NTS for a paramedic. This will have significant implications for the paramedic field as we now have a foundation of which NTS is vital for a paramedic to complete their duties. These results can begin to form the foundation of a future paramedic behavioural marker systems will improve paramedic performance and ultimately lead to improved patient safety.
Introduction Healthcare students are often required to perform predetermined numbers of clinical skills to prove competence. The pressures of meeting predetermined clinical skill numbers may result in students overtreating patients. Overtreatment is not without consequence to the patient. This study aimed to investigate perceptions related to possible overtreatment of patients by emergency medical care students in three South African higher education institutions (HEIs). Methods This cross-sectional study used a purpose-designed, anonymous online questionnaire to collect data on possible patient overtreatment from emergency medical care student participants at three South African HEIs. Results Of the participants, 45 self-reported reasonably low incidences of overtreatment of patients. The prescribed skill requirements were deemed appropriate as were practical shift numbers, but there was concern about achieving prescribed skill numbers. Participants generally considered risk versus benefit and clinical mentors generally agreed with student decisions without permitting overtreatment practices. Intravenous (IV) cannulation, oxygen administration and spinal immobilisation were the most common forms of overtreatment with advanced airway management and IV cannulation the most difficult to achieve. Lack of appropriately qualified practitioners and low patient numbers were the most common barriers to achieving required skill numbers. Conclusion There was concern among participants about not reaching prerequisite skill numbers. Self-reported overtreatment of patients by participants was uncommon. The list of self-reported procedures most often forming part of overtreatment seemed to contradict this. The most common forms of overtreatment were clinical procedures that posed potential risk to the patient. There is a need to further explore overtreatment within healthcare student populations.
Aims The Hunter-8 and the ACT-FAST are stroke scales used in Australia for the pre-hospital identification of large vessel occlusion (LVO) stroke but have not previously been compared. Moreover, their use in identifying distal arterial occlusions has not previously been assessed. We therefore aimed to describe the area under the receiver operating curve (AUC) of the Hunter-8 versus the ACT-FAST for the detection of classic LVO. Methods Both scales were performed on consecutive patients presenting with stroke-like symptoms within 24 hours of symptom onset presenting to the emergency department at a tertiary referral hospital between June 2018 and January 2019. The AUC of the Hunter-8 and the ACT-FAST was calculated for the detection of LVO using different definitions [classic LVO (proximal segment of the middle cerebral artery (MCA-M1), terminal internal carotid artery (T-ICA), or tandem occlusions) and extended LVO (classic LVO plus proximal MCA-M2 and basilar occlusions)]. Results Of 126 suspected stroke patients, there were 24 classic LVO and 34 extended LVO. For detection of classic LVO, the Hunter-8 had an AUC of 0.79 and the ACT-FAST had an AUC of 0.77. For extended LVO, the AUC was 0.71 and 0.70 respectively. Conclusion Both scales represent a significant opportunity to identify patients with proven potential benefit from thrombectomy (classic LVO), however M2 and basilar occlusions may be more challenging to identify with these scales.
Introduction Currently, at Tehran Emergency Medical Service (EMS) centre, Emergency Medical Dispatchers (EMDs) are scheduled based on the managers’ experimental estimates. In this study, we planned to evaluate the conformity of managers’ predictions with the Erlang C formula estimates in scheduling EMDs. Methods First, the Emergency Medical Communication Centre (EMCC) performance was evaluated over one week. Afterwards, the number of required EMDs was calculated using the Erlang C formula. Finally, the predictions of the Erlang C formula were compared with those of managers’ judgments. Results During the study period, 79,583 calls were received by the Tehran EMCC. The average number of EMDs per hour ranged between 9.5 and 22.7. The actual number of EMDs was more than Erlang C formula predictions during the 24 hours in all but three time points, i.e. 14:00-1 4:59, 1 5:00-1 5:59 and 1 8:00-1 8:59. In all hours, 90% of calls were answered in less than 10 seconds, and the average waiting time for a total of one week was 7.3 seconds. Also, only 2.1 % of all calls were answered after 10 seconds. Conclusion In the current study, we found that the number of EMDs scheduled based on the managers’ experimental estimates was higher than that of the Erlang C formula calculations. Also, it was found that the waiting time for emergency calls was lower than the defined standards. Although the primary results of the current study indicated that, at least on paper, the Erlang C formula has the potential to be used as a predicting model in the Tehran EMCC, further research is required to evaluate its effect on the actual performance of the EMCCs.
Background The body's natural defences are breached during invasive procedures conducted during paramedic clinical care. Despite the complexity of these procedures, asepsis is a clinical goal for all invasive procedures. In doing so, it is critical that ‘key-parts’ and ‘key-sites’ are protected to decrease the risk of transmitting healthcare-associated infections (HAIs). Although a national framework in Australia for the prevention of HAIs exists, this advice needs adapting to the field of paramedicine to account for variation in practice setting and clinical practice. This project aimed to reach consensus among experts regarding how to maintain asepsis in paramedic practice. Method A modified Delphi process was used with four iterative online rounds. Participants were sought nationally using a snowball (bias) technique and included professionals within healthcare who met the inclusion criteria of extensive experience in one or more of three areas: paramedicine, infection prevention and control, and evidence-based policy development. Results Eleven experts in the field of IPC and paramedicine contributed to a consensus project regarding how to maintain asepsis in paramedic practice. Conclusion This project provides a consensus statement that will allow operational procedures to be reviewed, techniques specific to paramedic practice to be developed and implemented, and scientific research to be conducted.
Introduction Currently, non-transported patients who are attended to by a state-funded ambulance service in Victoria and are advised to visit their general practitioner (GP) do not have informational continuity of care, as there is no communication between the referring paramedic and GP. This research aimed to develop a functional electronic referral (e-referral) proforma from paramedics to GPs that can be used to support handover of patients’ clinical information for non-transported patients. Methods Paramedics, GPs and digital health experts were invited to participate in the study. The study design utilised an online Delphi technique, where participants responded to three rounds of surveys relating to the pertinence, feasibility, content and presentation of an e-referral tool. Questions were open-ended or requested responses on a 5-point Likert scale. Results A total of 21 clinicians participated in the study and developed an e-referral proforma. After three rounds, participants agreed the proforma should contain the following information: the patients’ identifying information, presenting complaint, social concerns, vital sign survey, management or advice given to the patient and reason for referral. Stakeholders stressed that the mode and timing of delivery must be flexible enough so that implementing the e-referral proforma does not become burdensome for clinicians. Conclusion A structured e-referral system between paramedics and GPs is feasible and offers a method to improve informational continuity of care and in turn, patient safety.
Introduction Access to emergency healthcare services and specialist care – particularly paramedic services – is more restricted in the rural and remote areas of Australia, and this disparity is amplified further as remoteness increases. This review aims to investigate the availability of current research regarding both the expanding nature of paramedicine roles in rural environments, and the impacts of rurality on the quality of out-of-hospital care provided to patients. Methods Arksey and O'Malley's six-step methodological approach was used to perform a scoping review to assess the availability of literature. Key words including paramedic*, regional, rural, remote and role were inputted into the search engines Scopus, CINAHL and PubMed. Titles and abstracts of the 864 results were screened by all authors and inclusion/exclusion criteria applied, resulting in 13 remaining articles. Results The final 13 articles comprised differing data collection types and methodologies from nine separate studies conducted in either Canada, Australia, the United Kingdom, the United States, Saudi Arabia or Qatar. Approximately 2.5 million patients, 534 paramedics, 331 other healthcare professionals and 35 case studies were included in the total combined results of these studies. Conclusion Rural communities demonstrated increased mortality rates in out-of-hospital patients due to several factors including rostering, specialist service locations and limited resource availability. Factors which were beneficial to the outcomes of patients in rural settings included enhanced paramedic scopes of practice, the implementation of community paramedicine programmes and wider roles within the community for paramedics. A lack of research on the exact nature of these changing roles in rural paramedicine is evident.
Paramedics are key to the provision of emergency care in the community. Those living with dementia use paramedic services at a high rate, due to a range of issues related to comorbid conditions and other acute events which mean care cannot continue in the home. There is a paucity of literature related to care provided in such instances. Anecdotally, a perception exists that providing care to this group of people is challenging for paramedics in situations where high level assessment and emergency care are paramount. Paramedics in one Australian state were sought to participate in an exploratory study to enhance understanding of how they currently worked with people who lived in the community and had dementia. Sixteen participants were recruited to the study, and they worked in a number of areas, including urban and rural. Experience was broad, ranging from one to 36 years in the paramedic role. Inductive thematic analysis of interviews revealed key themes that framed the paramedic role and permeated interactions, assessment and decision-making. Paramedics participating in this study recognised people living with dementia who had high level impacts of the condition, suggesting those with less visible symptoms may remain hidden. With the projected increase of people diagnosed with dementia it is imperative that paramedics are aware of, and integrate dementia knowledge, skills and confidence into their practice. Deeper exploration of the area that includes volunteer ambulance personnel and further inquiry of the role of paramedics in relation to those living with dementia is needed. A focus on education and professional development to equip paramedics to work with people living with dementia is recommended. The findings suggest that greater work in this area is required.
Unlike practitioners of formal diagnostic sonography, point-of-care ultrasound users must often acquire basic ultrasound skills in far shorter time frames, with less time dedicated to obtaining mastery; therefore, they often rely on conceptual models to achieve this. There is currently no introductory model which point-of-care ultrasound users might adopt to describe the cognitive processes involved in acquiring a basic ultrasound image, and in learning point-of-care ultrasonography. We propose the ‘sonographic OODA loop’ in reference to Boyd's observe–orient–decide–act (OODA) decision loop, as a model which can be used initially by ultrasound-naive clinicians to understand the cognitive and motor processes that occur when they acquire ultrasound images, and hopefully achieve greater insight into their early practice.
Introduction The study of human anatomy forms a foundational knowledge base essential for healthcare professional practice including paramedicine. However, little is known about the experiences and perceptions of undergraduate student paramedics towards learning anatomy. The aim of this study was to investigate this, utilising a questionnaire previously validated in medical students. Methods To explore anatomy learning experiences, a 32-item anatomy learning experiences questionnaire (ALEQ) modified for use with paramedicine students was distributed online to students enrolled in the Bachelor of Paramedic Practice at the University of Tasmania. Quantitative statistics were used to identify differences in responses between student groups. Cronbach's alpha assessed the reliability of the modified ALEQ. Results Fifty-one usable responses were obtained (20% response rate). Psychometric analysis demonstrated good overall reliability (Cronbach's alpha of 0.88). The students perceived several learning activities as positive including textbooks, online learning and practical classes. However, it was generally felt the amount of content to learn was daunting. Furthermore, the students indicated working with cadavers would be highly beneficial for their learning. The relevance of anatomy was also recognised as being important to future clinical practice. Conclusion Despite the low response rate, the modified ALEQ was a reliable instrument to investigate the anatomy learning experiences and perceptions of paramedicine students. Further research with a larger cohort is required to confirm the reliability and generalisability of the results.
Introduction Mental health presentations are a rapidly growing proportion of cases seen by paramedics, often at the frontline of care delivery. How paramedics perceive persons with mental illness is vital, as their experiences in providing care can significantly impact decision-making. This article investigates these experiences and how they may influence patient care. Methods This qualitative descriptive research was conducted with two focus groups of six operational paramedics, and the data recorded and transcribed. The team closely examined the data using thematic analysis through a symbolic interactionist lens to identify, analyse, and interpret patterns of meaning within transcribed data. After thematic analysis, a model for future practice was generated, which pictorially demonstrates the overlap of common themes. Results Five themes ultimately were identified that were profoundly important to the paramedics within the focus groups. Paramedics have varying experiences when caring for people with mental illness. They are empathetic towards the circumstances of the person with mental illness. They perceive that the Stigmatisation of persons with mental illness occurs in some cases. Paramedics are also affected in their clinical decision-making by their training and education and by the profession's cultural influences. Conclusion The Stigmatisation of people with mental illness is apparent in paramedic practice. Despite mental illness being a common presenting problem, paramedics feel underprepared and have difficulty treating those who need help. The patients’ behaviour can often be reflected in the conduct of paramedics. The impact of burnout due to high exposure to people with mental illness, especially in metropolitan areas, may lead to decreased levels of empathy and compassion.
“Change is the law of life, and those who look only to the past or present are certain to miss the future.” John F Kennedy The Australasian College of Paramedicine (ACP) has a distinguished history of supporting, promoting and disseminating research in paramedicine. Central to that outcome has been its longstanding commitment to scientific journal publishing by way of what is currently our journal, the Australasian Journal of Paramedicine. In November 2021, AJP commenced a hiatus on new submissions that will continue until mid-2022. An interim Editor in Chief, Associate Professor Paul Simpson, was appointed to oversee the operations concurrent to a transition strategy being developed. A Journal Advisory Committee (‘JAC’) with international membership was tasked to advise the College on the future direction of the College’s Journal. The JAC have consulted widely with researchers in and outside of paramedicine, and with experienced leaders in the journal publishing space, to identify best practice models that will be sustainable and give the Journal the best opportunity to grow and prosper into the future. It is expected that the new Journal will launch in early 2023, heralding a new decade of excellence and progression with a stronger international focus and a resolute commitment to progressing the scientific discourse in paramedicine. The reopening of submissions for the first edition of the relaunched journal is expected in October 2022.
