Australasian Emergency Care最新文献

Background: Patients who did not wait (DNW) for care in Emergency Departments (EDs) are individuals who present seeking treatment but leave before medical assessment. This cohort is an important focus for emergency research, as DNW events may reflect barriers to timely care, pose clinical and safety risks, and provide insight into broader system pressures within emergency services.

Methods: Retrospective study of DNW patients presenting to a metropolitan tertiary ED between January 1 and December 31, 2023. Descriptive statistics were generated for clinical and treatment variables, and multivariate logistic regression explored factors influencing 48-hour hospital representation.

Results: In total, 813 DNW patients were identified, representing approximately 1% of triaged patients. Most arrived by private transport and were allocated low-priority triage categories. Whilst 4% of cases had their presenting complaint completely managed by triage nursing staff, only 1.4% received nurse-initiated investigation or treatment. Overall, 9% represented to a local health district ED within 48 h. Multivariate logistic regression did not identify clinical factors significantly associated with subsequent hospital representation.

Conclusion: DNW patients are common and frequently represent to other facilities to address healthcare needs. Earlier nurse-initiated treatments may accelerate patient care and potentially reduce DNW cases; however, this requires further research.

Most patients attended to by emergency ambulance service paramedics in Australia are aged greater than 65 years. Empathy-based interventions have been reported to improve attitudes toward the older person and enhance patient outcomes, yet empathy is reported as an understudied area of paramedic practice and little is known about paramedics' level of empathy, or the impact of empathic care, for the older person. The aim of this study was to identify what is known about the provision of empathic care toward the older person by paramedics and paramedic students, in out-of-hospital healthcare. Following the JBI methodology for scoping reviews, six papers were identified and thematically analysed. Four elements of empathic and non-empathic care were jointly identified by paramedics and the older person: 1) communication, 2) individualised care, 3) time and 4) professionalism. One additional theme identified by paramedics and students was concern for their own wellbeing when providing empathic care. Empathic care of the older person in the paramedic-led out-of-hospital context enhances patient outcomes, strengthens the person-paramedic relationship, and enhances the provision of holistic person-centred care. Programs for student and registered paramedics must include evidence-based education on practicing empathy towards the older person, along with strategies to address barriers to providing empathic care.

Background: The HIRAID® emergency nursing framework (History including Infection risk, Red flags, Assessment, Interventions, Diagnostics, reassessment and communication) decreases patient deterioration; improves patient and carer experience; and improves nurses' confidence in patient assessment and communication. In this paper, the effect of HIRAID® on emergency nurses' documentation is reported.

Methods: Patients presented with chest, abdominal, hip or limb pain, fever or shortness of breath; were triaged to categories 2, 3 or 4, and had emergency department stay > 60 min (n = 884: 441 control and 443 intervention). Data were collected via record audit using the modified D-catch tool and HIRAID® framework.

Results: There were significant increases a structured approach to documentation (77.1% vs 93.5%, p < 0.001), and median accuracy of nursing record structure scores (2.0 vs 3.0, p < 0.001). HIRAID® increased overall quantity (median=2.3 vs 3.0, p < 0.001) and quality (median=2.0 vs 2.5, p < 0.001) scores for initial nursing assessment documentation, and quantity and quality scores for documentation of all HIRAID® elements. The time to documentation from arrival did not change (median=74.5 vs 79.5 min, p = 0.475).

Conclusion: HIRAID® improves emergency nurses' documentation of: i) initial patient assessment and management; ii) communication with colleagues, patients and families; and iii) plan of care without increasing time to documentation.

Background: Migrant populations are known to experience substantial barriers when accessing emergency healthcare and are often observed to rely heavily on emergency services as they age. Despite the rapid growth of the older Indian community within Australia's ageing population, the challenges they face in navigating emergency care remain underexplored. This study explored emergency healthcare challenges from the perspectives of older Indian migrants in Melbourne, Australia.

Methods: We conducted a qualitative study including semi-structured in-depth interviews and focus group discussions with 55 participants in Melbourne, Australia, comprising 23 permanent and 33 temporary migrants. Data were analysed thematically through an inductive-deductive approach informed by constructivist and symbolic interactionist principles.

Results: Participants identified challenges related to prolonged waiting times, limited knowledge of triage and ambulance pathways, differing understandings of what constitutes an emergency, and expectations of timely symptom relief. For temporary migrants, cost concerns and dependence on adult children further complicated decisions about emergency care.

Conclusions: These findings suggest that barriers to emergency healthcare among migrants are multifaceted and shaped by structural conditions, knowledge gaps and access constraints. Addressing these challenges requires policy, healthcare and community-based responses to support more equitable emergency care for older migrants in Australia.

Background: There is an evidence gap on the cost-benefit of community paramedics compared with usual care (emergency ambulance paramedics) for non-emergency patients.

Methods: A prospective, controlled cost-benefit analysis was conducted from both healthcare system and patient out-of-pocket perspectives over a seven-day horizon. Fifty-two presentations were included (30 intervention, 22 control). Costs were measured bottom-up using 67 variables, and consequences were quantified using Willingness-To-Pay.

Results: Overall, community paramedics demonstrated an incremental net benefit of $3281 per presentation (95%CI -$41 to $7257) and were cost-beneficial in 97% of bootstrap replications. Healthcare system costs were lower for community paramedics by $3093 per patient (95%CI -$339 to $7030), and patient costs were lower by $45 (95%CI -$46 to $136). Participants were willing to pay $144 (95%CI $92 to $208) for community paramedics instead of usual care, with six reasons provided: avoiding the emergency department, speed, convenience, perceived expertise, interpersonal strengths, and reassurance. Community paramedics needed to see one patient every 2.1 shifts to be cost neutral, and in the previous year provided an estimated benefit of $13.4 million (95%CI -$0.2 to $29.7 million).

Conclusions: Point estimates favour community paramedics across all primary measures and, while limited by sample size, represent a promising economic signal.

Background: Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is increasingly used to control non-compressible torso hemorrhage in advanced trauma systems. However, its feasibility during active helicopter transport remains unclear. This study evaluated whether trained Helicopter Emergency Medical Services (HEMS) teams can perform REBOA in flight under realistic conditions.

Methods: A prospective high-fidelity simulation study was conducted with fourteen HEMS clinicians organized into seven physician-nurse teams. Standardized hemorrhagic shock scenarios were performed in full-motion helicopter simulators replicating AW109 and Bell 412 cabins. The primary outcome was successful in-flight REBOA deployment. Secondary outcomes included time to balloon inflation, first-attempt success, and procedural performance using the Objective Structured Assessment of Prehospital REBOA Application (OSAPRA).

Results: Successful deployment was achieved in all simulations (100%). Median time to balloon inflation was 7:32 min. First-attempt success occurred in 78.6% of cases. Higher OSAPRA scores were associated with shorter procedural times. Inflation times were shorter in the AW109 compared to the Bell 412, although overall success was similar.

Conclusions: In-flight REBOA deployment is technically feasible in high-fidelity simulation. Operator competence and cabin configuration may influence performance, supporting further research prior to clinical implementation.

Introduction: Intimate partner violence (IPV) is a major contributor to poor health outcomes, particularly for women in rural areas. Geographical and social isolation can impede access to support networks and limited availability of specialised services can further compound vulnerability. Within this context, rural emergency departments have become key access points for IPV support; presenting an opportunity to explore how identification and response are approached in these rural settings.

Objective: This scoping review synthesises current research on clinician IPV identification and response practices in rural emergency departments (EDs) to inform future improvements in care and service delivery.

Design: This scoping review followed the Joanna Briggs methodology drawing on a search of four databases yielding ten peer-reviewed articles published between 2011 and 2025 that explored clinician IPV identification and response practices in rural EDs.

Findings: Five themes emerged: (1) Training and preparedness for IPV Practice, (2) Clinician Attitudes & Readiness, (3) Structural Barriers in Rural EDs, (4) Identification & Documentation Practices (5) Organisational and System Supports.

Conclusion: Rural EDs face complex barriers to effectively identifying and responding to IPV, including workforce limitations, confidentiality concerns, and systemic under-resourcing. Enhancing emergency clinicians' IPV practices requires greater focus on trauma-informed organisational approaches, supported by workforce training that reflects the realities of rural healthcare and the communities it serves.

Introduction: Caller emotion influences the flow of emergency ambulance calls for out-of-hospital cardiac arrest (OHCA) however limited research has examined how call-takers manage emotion. We aimed to identify how and where emotion manifests in OHCA calls and how call-takers respond.

Methods: We analysed 107 consecutive OHCA calls to St John Western Australia (January-April 2021) containing emotion-related barriers to bystander cardiopulmonary resuscitation (B-CPR). Calls were ranked using the Emotional Content and Cooperation Score; 62 calls scoring 4 or 5 were included. We developed a schema of emotion displays, mapped their occurrence in calls, and transcribed call interactions. Conversation Analysis was used to examine interactional patterns.

Results: Callers displayed emotion through shouting, crying, "wobbly voice," and impatience (e.g., "just send the ambulance!"). Emotion was heightened at call onset, initial questioning, and when callers had to move the patient for B-CPR. Call-takers managed emotion using directness, boundary-setting, and empathy; sometimes emotion was not explicitly addressed to maintain call progression.

Conclusions: Emotion is a disrupting factor in OHCA calls. Call-takers need a range of strategies to manage emotion according to the contexts in which they arise. Training using real-life call transcripts may enhance call-takers' skills, reducing delays in OHCA recognition and B-CPR.

Background: Emergency medical service (EMS) providers play a critical role in delivering timely prehospital care and rely on a resilient workforce to respond effectively to emergencies. This study aimed to integrate frontline and decision-maker perspectives to identify key challenges and opportunities for strengthening EMS workforce resilience in Thailand.

Methods: Data were derived from a nationwide survey of 500 EMS personnel, including open-ended responses, and semi-structured interviews with six EMS decision-makers. Secondary content analysis was conducted to examine frontline perspectives, while primary thematic analysis of interviews was performed using NVivo. Findings were integrated to identify system-level priorities for strengthening EMS workforce resilience.

Results: Qualitative analyses identified challenges across five key domains: wellness, safety, competence, structure and resources, and policy and governance. Frontline providers reported high workload, mental health strain, and resource limitations. Decision-makers highlighted gaps in workforce planning, training, coordination, and governance. Integration of both perspectives identified system-level priorities for strengthening EMS workforce resilience.

Conclusion: Strengthening EMS workforce resilience requires coordinated organizational and policy interventions that address workforce wellbeing, operational capacity, and governance simultaneously. The findings provide evidence to support workforce planning and health system resilience in Thailand.

Background: Most of the available evidence regarding nursing leadership in emergency and critical care settings does not show how it is experienced in low-income healthcare systems. This study aimed to analyze the association between self-reported leadership behavior among emergency and critical care nurses and selected organizational outcomes.

Methods: An explanatory mixed-method design was conducted in a tertiary public hospital in Honduras. The quantitative phase included emergency and critical care nurses surveyed by using a validated questionnaire. Binary logistic regression was performed to identify factors associated with transformational leadership. The qualitative phase involved 17 nurses who participated in in-depth semi-structured interviews and analyzed using thematic analysis.

Results: Humanized care was a positive predictor (p = 0.042), while self-perceived clinical experience (p = 0.001) and teamwork incentive (p = 0.013) were negatively associated to transformational leadership. Qualitative findings revealed two main themes: (1) leadership conceptualized as guidance, adaptability, and transformational influence in high-pressure environments; and (2) structural barriers including workload, staffing shortages, limited supervision, and organizational culture constraints.

Conclusion: These findings indicate that nursing leadership in emergency and critical care settings is shaped by both individual and systemic factors, highlighting the need for targeted educational and organizational investments in resource-limited contexts.