HARU Report

CASE

A patient in their 20s called the Queensland Police Service (QPS) threatening self harm.

QAS Medical Director Dr Stephen Rashford

Upon QPS arrival, the patient was found barricaded in a shower. As the QPS officers made their way in, the patient approached them with a knife. These officers used nonlethal force by way of a taser, followed by physical restraint. Upon QAS paramedic arrival, the patient was found to be highly agitated, with extensive blood loss on scene. A tourniquet was placed on the left proximal arm. Multiple incisional wounds to both arms and the chest were noted (twenty-five wounds to the left of sternum, three to the right of sternum, multiple arm wounds). The patient became progressively more lethargic, with no sedation needed by the attending crews. The patient was provided appropriate baseline cares, including supplemental oxygen, intravenous access and minimal crystalloid infusion. HARU met the crew enroute to the major trauma service hospital. At this time the patient’s condition was: • A–patent, self-maintained • B–RR 28/minute SpO2 100% on 15l/min oxygen • C–HR 110 bpm, weak peripheral pulses with delayed capillary return (peripheral circulatory failure) • Overall, the patient was pale and diaphoretic. • The tourniquet was loosened, and the wound dressed with a compressive bandage. • FAST (ultrasound): negative for intraperitoneal blood, no pericardial effusion, views of left thorax could not exclude haemothorax. Complex cases need careful thought at all phases of care to synthesise information and identify best clinical course.

Overall Assessment and Plan:

Haemorrhagic shock with multiple potential blood loss sites–external blood loss in shower and on the ground or a haemothorax.

Prenotification call to the major trauma service prior to departure (short distance). One unit of packed red blood cells, 1g of TXA; patient responded well to the blood transfusion.

At the Emergency Department:

Highly agitated with SBP 120 mmHg. Emergently ventilated, with significant hypotension post induction.

Small left pneumothorax present. Haemodynamics normalised after three units of packed red blood cells and one unit of cryoprecipitate.

Discussion

It can be difficult to estimate external blood loss. This patient had lost considerable blood on scene. The left hemithorax ultrasound view was difficult. Clinicians should balance the use of technology/investigations with value of clinical evaluation–both pre and in-hospital. Don’t forget your clinical examination–look, feel and then listen.

This patient needed volume resuscitation prior to mechanical ventilation, due to the blood loss amplifying the reduction in preload experienced with positive pressure ventilation.

Severe agitation and blood loss are a very difficult combination to address.

All patients with severe agitation and disturbed vital signs should be treated as critically ill, with early monitoring instituted especially if sedation is considered. Ensure a dedicated clinician manages the airway and overall management.

QAS flu program set to get underway

It is that time of year again. Following a very successful Winter Strategy in 2020, with approximately 88 per cent of the QAS workforce vaccinated against influenza (98 per cent of operational staff), the Winter Strategy 2021 is hoping to achieve similar results reports QAS Specialist Pharmacist Natalie Schutt.

Above

QAS Specialist

Pharmacist

Natalie Schutt

Influenza season is one of the busiest periods for QAS and an effective staff immunisation strategy is important to ensure staff have timely access to the influenza vaccination. This year, the QAS is offering four convenient and free options for staff to obtain their influenza vaccination. Where can I get my influenza vaccination?

The following options will be available to all QAS staff: 1. QAS Nurse Immuniser/Paramedic led influenza vaccination program 2. Pharmacy Guild of Australia–Community Pharmacy program 3. General Practitioner–reimbursement program 4. Hospital and Health Services Clinics.

QAS Paramedic-Nurse Immuniser/ Paramedic influenza vaccination program – Available TBC

The QAS Paramedic-Nurse/Paramedic Immuniser Program will be available in nominated LASNs. These clinics are mobile and will be available on the ramp of your local hospital or at an ambulance station. This means you can obtain your vaccination while on duty. Keep an eye out for the immunisation team in the following locations:

1. Townsville 2. Mackay 3. Rockhampton 4. Bundaberg 5. Sunshine Coast 6. Brisbane 7. Ipswich 8. Logan 9. Toowoomba 10. Gold Coast 11. Cairns Pharmacy Guild of Australia – Community Pharmacy Program – Available from 1 April to 31 July 2021

The QAS has an arrangement with Community Pharmacies who are affiliated with the Pharmacy Guild of Australia to provide FREE vaccinations to QAS staff.

Local General Practitioner – subject to your GPs availability

All QAS employees may attend their local GP to receive their influenza vaccination and the QAS will reimburse the employee (up to $30) for the vaccination cost.

Hospital and Health Services Clinics

Some LASNs have established arrangements with their HHS for QAS staff to receive the influenza vaccination at the local hospital.

Frequently Q A asked influenza vaccination questions

What is Influenza?

Influenza is a highly contagious viral infection of the respiratory tract and contributes to serious morbidity and mortality across all age groups and demographics in the community.1

How is the influenza virus transmitted?

The influenza virus is transmitted from person to person through droplets containing the virus (coughing or sneezing) or direct contact with respiratory secretions.2 This is why it is important for you to wear appropriate PPE, wash your hands regularly and cover your mouth when you sneeze or cough.

Why should I get the influenza vaccine?

The influenza vaccine is the most common vaccinepreventable disease in Australia. While the vaccine does not offer 100 per cent protection against the flu, it does: • reduce your risk of getting the flu • reduce the severity of symptoms if you do catch the flu and most importantly • helps protect those around you.3 Paramedics play an important role in providing a rapid prehospital emergency response, an essential healthcare service to the community and transporting critically unwell patients. Help protect yourself and your vulnerable patients from contracting the influenza virus by getting vaccinated.

Why is it important as a healthcare worker to be vaccinated against Influenza?

Healthcare workers are often exposed to the influenza virus during the course of their work, which may contribute to the rates of infection during the influenza season. Influenza is a vaccine-preventable disease and Queensland Health (QHealth) recommends that healthcare workers receive the annual influenza vaccine due to their proximity to vulnerable people.4

Can I catch the flu from the influenza vaccination?

No. The influenza vaccine cannot give you the flu as there is no live virus in the vaccine.5 What are the side-effects of the influenza vaccine?

Common side effects of the influenza vaccine include: • pain, redness or swelling at injection site (usually only lasts for one to two days) • fever, tiredness and/or muscle aches and pains.6 Some people may confuse these side effects as the early stages of the flu. However, this is a sign that the vaccination has triggered an immune response, which is what the vaccination is designed to do. These side effects may start within a few hours of receiving the vaccination and may last up to two days.7

Will getting the influenza vaccine prevent me from getting COVID-19?

No. However, influenza can lower a person’s immunity and make them more susceptible to other illnesses, such as COVID-19. The influenza vaccine will assist with reducing the severity and spread of the flu, which will help protect those around you from simultaneously contracting influenza and other illnesses.8

Take home message to protect yourself, your family and your patients.

• Get your annual influenza vaccination • Wear your PPE (Standard and Droplet precautions) • Regularly wash your hands thoroughly or use an alcohol-based hand sanitiser • Cover your mouth and nose when you sneeze or cough

AND wash your hands • If you are unwell, please STAY HOME.

Can I have both my Influenza vaccination and COVID-19 vaccination?

Yes, but it is recommended that you have the vaccinations two weeks apart.

References

1,7,8 https://www.ncirs.org.au/sites/default/files/2020-04/ Influenza-FAQs_7%20April%202020_Final.pdf 2,3,5 https://immunisationhandbook.health.gov.au/vaccinepreventable-diseases/influenza-flu 4 https://www.health.qld.gov.au/__data/assets/pdf_ file/0029/444872/vaccination-of-healthcare-workers.pdf 6 Product information

Busy border town celebrates 100 years of ambulance services

Hundreds of people took the opportunity to attend an event at Goondiwindi Station in March to celebrate 100 years of ambulance services in the border town.

The popular event was organised by staff and volunteers and featured old memorabilia and historical vehicles, plus station tours and sausage sizzles. Goondiwindi’s rich history stems back to March 1921 when the Queensland Ambulance Transport Brigade (QATB) Centre was founded in the township.

The first Superintendent was Mr C.H.N. Brewster who operated the service from rented premises with a Ford ambulance vehicle. The Provisional QATB committee was led by Mr E.G. Marsh as Chairman. During the period 1921-1922 the committee purchased a plot of ground in a convenient part of town as a site to build ambulance premises when funds permitted.

Above, in white band

QATB Centre Goondiwindi circa 1920s.

Above, clockwise from top left

Herb Brewster with vehicle circa late 1920s.

QAS 100 year anniversary cake.

Hundreds of people attended

Goondiwindi’s celebratory event.

Opposite, clockwise from top left

Current Goondiwindi Station staff with

Southern Downs MP James Lister and the Honourable Councillor Lawrence Springborg, AM, Goondiwindi Mayor. Former officers were among the many who turned out to celebrate Goondiwindi’s centenary. Former Goondiwindi Station OIC Derrick Scheuer, QAS Heritage and History Manager Mick Davis, Goondiwindi Mayor Lawrence Springborg and former Goondiwindi Station OIC Stephen Johns. The event provided an opportunity to present a number of awards.

At the same time, permission was obtained from the Railway Department to run a rail ambulance car to operate between Dirranbandi and Inglewood. Although an order was placed in 1922, the completed rail unit was not delivered until mid-1923. This rail car was built by Ruddle Engineering of Brisbane and the total cost was £252,10s. In its first year of operation, it travelled 2,740 miles. In 1922 Honorary Centres were opened at Talwood (Honorary Bearer J.R. McSweeney) and Kurrumbul (Honorary Bearer P.D. Roney).

In 1924, under the terms of the Hospital Act, the Goondiwindi Hospital Board exercised its power to take over the control of the local ambulance service. The Hospital Board conducted the service until 1953. On 22 January 1953, representatives of the Goondiwindi Chamber of Commerce met with the Goondiwindi Hospital Board which had expressed its willingness to hand over the control of the Hospital Ambulance to the QATB. Subsequently a public meeting was convened on 4 February 1953 with the resulting resolution: ‘That this meeting unanimously agrees that the State Executive of the QATB be requested to proceed with the establishment of an ambulance centre in Goondiwindi to serve the interests of transport and first aid to residents’. The centre was gazetted on 2 April 1953. Mr V.E. Medland Superintendent QATB Hughenden Centre was appointed Superintendent. He resigned on 16 March 1960 and Superintendent H.J. (Jack) Trenaman of the Mount Larcom Centre was appointed to the position. At the time of Superintendent Trenaman’s appointment, the committee considered that it would be uneconomical to carry out further alterations or major repairs on the brigade building and decided that in the near future it should replace the building with new premises which would be more suitable for brigade operations.

During 1961-1962, the existing ambulance property was sold to the Shell Company of Australia for £5,000 and a site suitable for ambulance premises in Marshall Street was purchased for £500. Plans were prepared for the construction of a new centre building and Superintendent’s residence. Fast forward to 2021 and Goondiwindi remains a busy area to service today.