QAS paramedic awarded $80k EMF grant

Queensland Ambulance Service (QAS) Critical Care Paramedic Wayne Loudon has secured an $86,623 Emergency Medicine Foundation (EMF) Leading Edge grant to investigate how technology can be used by paramedics in the field to improve early identification of severe head injuries, to ultimately reduce resulting disability and improve patient outcomes.

Head injuries are one of the most common causes of ongoing disability and the Australian Institute of Health and Welfare (AIHW) estimates around 107 people in 100,000 will have a traumatic brain injury (TBI) each year, and 20 per cent of these will be considered severe.

In 2008 alone, it was estimated there were 1,500 moderate and 1,000 severe cases of traumatic brain injury. The long-term cost to the Australian population is approximately $1.2billion.

QAS paramedics are often the first on the scene to assess those with severe head injuries and play a significant role in preventing the secondary brain injury.

Wayne said currently, treatments are administered based on in-direct clinical signs, like changes in pupils.

“Current QAS treatment includes our High Acuity Response Unit (HARU) paramedics placing patients into a medically induced coma to reduce the secondary injury and while there are things we can do, they’re all very much based on temporising actions like using medication to reduce brain swelling,” he said.

Wayne’s two-year EnTRAIN research project will investigate if EEG could provide ‘real-time’ information on the brains’ response to injury and in the future perhaps aid in the clinical management of this group.

The study will involve the application of a small number of gel electrodes to the scalp and will not alter the high level of care provided.

“For our patients and their families this study will not change the high level of care they receive – all they’ll experience are some little EEG stickers on their heads while they’re in the ambulance and it’s all very noninvasive,” Wayne said.

“The project will be performed with the help of the Brisbane HARU team, which will be trained to perform a focused EEG acquisition.

“This research comes off the back of a “SPIDER Project” we did a few years ago with strokes – using an EEG to pick up when brain cells are ischemic (not getting enough blood).

“There is some evidence to show brain swelling and bleeding can be identified on EEG and we may be able to change how we treat people according to those changes, and of course we would be able to identify if patients are suffering any seizure activity after their head injury.”

Wayne said according to research, the risk of TBI is higher in the 15-19 and 75+ age groups, with older Australians having a three times greater incidence rate compared to the general population.

“The standard accident for an older person is a fall, and for younger people they’re often assaults or road traffic crashes,” he said.

Wayne said while some EEG work was being done internationally on mild brain injuries, he believes this is the first time this technique is being used on severe TBI in the prehospital setting.

Wayne is in the final stage of a PhD investigating acute stroke care in the prehospital environment, so for him this research into TBIs was a natural progression to looking at other causes requiring neurocritical care.

Wayne and his team of co-investigators (A/Prof Andrew Wong (RBWH), Dr Stephen Rashford ASM (QAS), Prof Emma Bosley (QAS), Frederik Tremayne (RBWH), Dr Daniel Bodnar (QAS) and Mark Disney (QAS)), is the second paramedic project to receive an EMF grant since the research funding organisation opened its Queensland Research Program to include nurses, paramedics, allied health professionals, rural generalists as well as emergency specialists, according to EMF General Manager Beth Chapman.

“EMF invests in clinician-led research because those at the frontline of emergency medical care are best placed to develop practical solutions for a resilient and capable healthcare system,” Beth said.

“This extends beyond the hospital environment - ambulance and retrieval services work hand in hand with hospital-based clinicians, stabilising and transferring patients for urgent treatment.

“In 2019, Hugo Evison received an EMF JumpStart grant, for the project Clinician decision making in peripheral intravenous cannulation in emergency settings.

“JumpStart provides up to $40,000 seed funding for research involving new collaborations and research teams, with potential to lead to further funding from granting bodies.

“We hope this is just the beginning and EMF is very keen to support and encourage the continued growth in paramedicine research,” Beth said.

Thinking about taking on a research project?

EMF runs two grant rounds per year, click here (or type in https://bit.ly/3EbhEYE) to find out more about them.

In addition to Leading Edge and JumpStart, the Project grant provides up to $300,000 funding to larger projects with the aim of generating data to seek further funding from alternative sources.

This year, EMF launched the new Emerge grant for clinicians to develop research skills. Emerge grants provide up to $10,000 for projects that can be achieved within twelve months. The scheme features a streamlined application process and mentorship as key components.

EMF also introduced a Special Research Grants Program with support from the Motor Accident Insurance

Commission to empower frontline clinicians in regional, rural and remote Queensland involved in the management of trauma patients in their navigation of the research path.

The program aims to create an evidence base for the best emergency care of trauma patients, in particular road trauma patients, in regional, rural and remote Queensland, and to identify key barriers to optimal emergency care in these areas.