ISRE Report

QAS publishes research looking to the skies for out of hospital cardiac arrest

In a career first, Information Support, Research and Evaluation (ISRE) Unit Cardiac Research Fellow Dr Tan Doan looked to the skies for answers in a bid to better understand the exposure-response relationship between Queensland temperatures and out of hospital cardiac arrest (OHCA).

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Dr Doan said research shows that heatwaves can increase the risk of OHCA by up to 1.5 times.

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ISRE Unit Cardiac

Research Fellow

Dr Tan Doan with CCP and 2019 KJM Patron’s

Research Grant recipient Adam Rolley.

By pairing thirteen years of meteorological data with QAS cardiac arrest records from 2007-2019, findings revealed that heatwaves can increase the risk of OHCA by up to 1.5 times. Dr Doan said the study highlighted the need for sector-wide preparedness and planning in the face of temperature extremes. “We know that environmental conditions affect the health of the population and— understanding how this impacts community demand for emergency health care and patient clinical presentations is vital,” Dr Doan said. “Living in a sub-tropical climate, it is incumbent upon us to plan for and adapt to the forces of nature, and in the case of OHCA, along with other acute cardiovascular diseases, mitigating temperature-related burden is especially important.

“These conditions claim the lives of many thousands of Queenslanders each year.

Our research will contribute to life-saving developments and we are very proud to be fronting this work.”

As a specialist mathematical modeller with more than a decade’s experience,

Dr Doan said the research was possible because of the combined diligence and dedication of paramedics and the ISRE Unit’s clinical coders ensuring the veracity of patient care records from beginning to end.

“Our cardiac outcomes database is one of the most robust and reliable resources available to the prehospital research community and we thank everyone for their role in maintaining its standard. It is an invaluable resource to inform progressive updates to clinical and operational service delivery as new insights are uncovered.” QAS Medical Director, and study co-author, Dr Stephen Rashford ASM, said the work, published in Occupational and Environmental Medicine, built upon initial findings highlighted in the QAS OHCA Annual Report 2019. “While early days, this research—currently confined to cardiac arrest patients within Brisbane, to be expanded to other clinical presentations and across regional Queensland—will contribute to saving lives by laying vital groundwork for all ambulance jurisdictions to better understand the impact of the environment on service delivery,” Dr Rashford said.

“Broadly, we know extreme heat and cold make the body work harder, putting stress and strain on its systems. Whether it’s heat or cold, our findings will be the catalyst for further research investigation and investment in this important clinical space, both here and abroad where the literature is sparse.

Article details–Access via CKN: Doan TN, et al. Ambient temperatures, heatwaves and out-of-hospital cardiac arrest in Brisbane, Australia. Occup Environ Med 2021. doi:10.1136/oemed-2020-107018.

Queensland’s extreme 2020 temperatures

Hottest day Warmest days on average Coolest days on average Coldest day Coldest night

Coolest nights on average Warmest nights on average Warmest night Warmest on average overall Coolest on average overall Wettest overall

Wettest day Strongest wind gust 48.7 °C at Birdsville Airport on 5 Dec 35.0 °C at Julia Creek Airport 22.1 °C at Applethorpe 8.0 °C at Applethorpe on 14 Jul -3.8 °C at Oakey Aero on 24 Aug | -3.8 °C at Applethorpe on 25 Aug -3.8 °C at Oakey Aero on 25 Aug | -3.8 °C at Applethorpe on 27 Sep 9.6 °C at Applethorpe 25.1 °C at Horn Island 33.3 °C at Cunnamulla Post Office on 10 Jan | 33.3 °C at Windorah Airport on 3 Dec 28.3 °C at Normanton Airport 15.9 °C at Applethorpe 3289.7 mm at Tully Sugar Mill 427.0 mm at Bellenden Ker Top Stn on 20 May 144 km/h at Dalby Airport on 2 Dec

Source: Bureau of Meteorology, 2020

Research heating up: Temperature stability of OHCA medication in focus

In a QAS first, a multicentre in-field study using High Performance Liquid Chromatography (HPLC) will explore the impact of temperature on selected cardiac medications carried by paramedics. Leading the research is Critical Care Paramedic and recipient of the 2019 KJM Patron’s Research Grant, Adam Rolley, along with Dr James Falconer and Associate Professor Kathryn Steadman from the UQ School of Pharmacy, Dr Esther Lau from the QUT School of Clinical Sciences, QAS Specialist Pharmacist Danielle Ironside and Advanced Care Paramedic Jordan Grice.

“Using standard issue QAS drug kits, our team will log ambient and kit temperatures for six months, then check the concentration of the cardiac medications using specialised HPLC testing at monthly intervals,” Adam said. “Worldwide, HPLC is considered the gold standard in producing accurate and timely analysis of drug concentration and this study will be highly beneficial in understanding ‘real-world’ exposure outcomes for these vital medications.

“Any paramedic knows the varied conditions our kits can get exposed to at scene or during our travels—it doesn’t have to be a particularly hot day for us to feel the impacts in Queensland, which is why our study site selection has a broad focus.”

Adam commended the behind the scenes support provided by many paramedics across the state.

“I extend my heartfelt thanks to my operational peers and their managers in the North West, Townsville, Metro North and West Moreton LASNs, and KJM Foundation. Their positivity from ‘proposal to project realisation’ has been overwhelming— together, everyone’s help has seen this vital research green-lit.”

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Adam is leading a team exploring the impact of temperature on selected cardiac medications carried by paramedics.

A feat of fate for Team Fantastic

You never know what stories a spring clean of the house will uncover. For Beenleigh 2IC Trevor Wyeth, it was the realisation that two of his close QAS colleagues assisted his wife Tamara as a 16-year-old when she suffered a nasty fall from a horse reports Matt Stirling.

It was a 12-year-old photo of Tamara lying in hospital that left Trevor stumped when he recognised the two fresh-faced paramedics flanking the bed.

ACP Wade Singleton and Mount Gravatt OIC Phil Campbell have formed a friendship with Trevor during their careers working within the Metro South LASN. Unbeknownst to Trevor, the pair also played a role in one of the most pivotal moments of his wife Tamara’s life.

In January 2009, a teenage Tamara was riding on the family property in Richlands when she was thrown from her horse.

“I remember riding my horse when she decided to dismount me. Next minute I’m on the ground trying to get some help but no one was coming,” Tamara said. Miraculously, given her injuries, Tamara made her way to a nearby shed and managed to call her Mum.

After being bundled into a car to head back up the hill to the house, Tamara’s family realised she was in a bad way and called for an ambulance.

The mechanism of Tamara’s fall meant Wade and Phil, then a firstyear student, were careful to play everything by the book. “Even though Tamara had been moved into the car, we still went with full spinal immobilisation,” Wade said. “It went smoothly once we got Tamara out of the vehicle—that was a hassle.”

Tamara would spend four days in the Intensive Care Unit of the former Mater Children’s Hospital recovering from fractures to her ribs, scapula, clavicle, a small chip in her spine, a pneumothorax, and a lacerated spleen. Now working as an orthopaedic nurse at Princess Alexandra Hospital, Tamara reflects on the incident and recovery as the start of her interest in health care.

“Definitely this whole incident created who I am as far as my career,” Tamara said.

“I now understand how frustrating it would have been for these poor guys trying to get me out of the car to maintain my C-spine. I just wanted to go to bed.”

The next day Wade and Phil, or ‘Team Fantastic’, as many communications operators from that period will remember them, went to visit Tamara in the hospital and the iconic snap was taken.

A few weeks after she fell from the horse, an appreciative Tamara and her Mum dropped by the station to give Wade and Phil a copy of the photo, as well as some baked goods and engraved keyrings. The paramedics copy of the photo then remained on the wall of Durack Station for many years without anyone realising Trevor’s connection until Trevor recently found his wife’s version.

“I was just cleaning at home and found the photo and was like ‘I know them—that’s Phil and Wade,” Trevor said.

“I told Tamara and she just said, ‘tell them I’m sorry for hopping in the car’.” Interestingly, Trevor and Tamara were high school sweethearts and had been dating for more than a year when the fall occurred. Wade said he is still able to recall the incident word-for-word ‘because it was such a good outcome, because it was potentially so bad and because it was done right’.

“It’s a job that’s always stuck and now we find out Tamara’s in the family,” he said.

When Trevor and Tamara caught up with Wade and Phil for a photo recently, Phil was even able to bring along the engraved keyring given to him 12 years ago. Tamara said the careful actions of the responding paramedics and the precautions undertaken helped her recovery. “Who knows if they didn’t stick to the book. I may have spent extra weeks in hospital or had my spleen removed,” she said.

“It’s unique that my husband now knows the guys who saved me and goes mountain-bike riding with them.

“I’m glad I got Team Fantastic.”

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Flashback: Phil and Wade with then 16‑year‑ old Tamara after she was transported to hospital.

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A picture of one of the engraved keyrings.

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Wade Singleton (left) and Phil Campbell (right) with Tamara and Trevor Wyeth.