ISRE Report

Report into oxytocin reinforces it delivers in preventing primary postpartum haemorrhage

QAS paramedic researcher Brendan Schultz and Queensland University of Technology (QUT) paramedic academic and midwife Shonel Hall have reinforced intramuscular administration of oxytocin as the gold standard in managing out of hospital (OOH) births and primary postpartum haemorrhage, with their research findings recently published in the journal Prehospital Emergency Care.

Brendan, an Operational Research Officer based in the QAS Information Support, Research and Evaluation (ISRE) Unit, was the lead investigator of the study which details the occurrence of OOH births attended by QAS paramedics and found oxytocin can be safely administered as a treatment adjunct to prevent postpartum haemorrhage.

“This study highlights the high quality of care that is provided by our staff when attending our state’s newest mums,” Brendan said.

“Working within two to four minutes of administration, this uterotonic ensures fast placental delivery. On average, paramedics administered this drug within 14 minutes of the baby’s arrival, with placental delivery typically occurring within ten minutes.”

Reflecting on the study and his own experiences in managing obstetric cases, Brendan said oxytocin was a reliable and safe intervention when managing this low-frequency, high-risk cohort.

“No two births are the same, and even the most textbook deliveries can rapidly change pace raising the devasting prospect of serious post-partum bleeding–knowing we have an effective option to prevent this, backed by current literature, is extremely reassuring,” he said.

“Balancing this with respecting a woman’s choice to decline this treatment is paramount, provided we ensure their decision is based on receiving clear, informed and unbiased advice.”

Brendan said the study is one of the first to describe the utilisation of a prehospital uterotonic and its findings reaffirm oxytocin’s place in contemporary paramedicine practice.

“QAS was the first ambulance jurisdiction in the world to incorporate and evaluate oxytocin in the third stage of labour–a decision that has no doubt improved outcomes for many women post-delivery,’’ he said.

“It is amazing to see the recognition of paramedics from vocation to profession and building on foundation research is a core part of this journey.

“Additionally, this work has also allowed us to quantify the number of births paramedics in Queensland attend annually and identify the rate of obstetric complications, which were very low–an incidental but helpful finding to inform clinical practice into the future,’’ he said.

“This publication reinforces the service’s commitment to clinical guidelines that are based on contemporary research. This study would not have been possible without the expertise of ISRE Director Dr Emma Bosley, Medical Director Dr Stephen Rashford and Acting Director, Medical Director’s Office Lachlan Parker.” Shonel said her experiences as a paramedic assisting women in labour drove her desire to learn more–completing her midwifery degree almost five years ago. She enjoys a great balance between her two professions, along with an academic appointment at QUT.

“I’m very passionate about educating and empowering paramedics when it comes to obstetric cases. Relatively straightforward births can turn on a dime and it is imperative paramedics have the right therapies and confidence to manage these events,” Shonel said.

“Having attended more than ten births as a paramedic, some as a single officer in rural areas, I knew early on there was an opportunity to strengthen my skill set and ensure what should be the happiest day of these patients lives stays that way.

“Being able to contribute to the literature alongside my operational peers has been wonderful and I look forward to the next steps this research will take–appraising the outcomes of these patients through hospital linked data.”

Shonel is one of several paramedics within the service who hold midwifery degrees, with QAS veteran of 14 years, Metro North Critical Care Paramedic (CCP) Rory Jackson the most recent graduate.

When paramedicine meets midwifery – Rory’s perfect career pivot

Growing up on a farm in Nobby, halfway between Toowoomba and Warwick, Rory was exposed to births from a very young age. He was often required to help animals on the farm to birth and with guidance from his father, he was taught how to assist stalled deliveries and even gave oxytocin injections to expedite the final stages of labour.

This exposure resulted in Rory developing a keen interest in medicine and especially the wonders of pregnancy and birth, leading to a fulfilling career.

Insight caught up with CCP Rory–who calls both the Metro North and Metro South LASNs ‘home’–to celebrate his achievements in the fields of paramedicine and midwifery.

“As a paramedic I’ve been incredibly lucky and privileged to have been able to support so many mothers birth their babies–there have been 23 in my 14 years on-road,” Rory said.

“Birth is such a monumental event–one of the most important days of a woman’s life–and to be a part of that either on-road or in the hospital as a midwife is truly an honour.

“Supporting women by being a calm and professional presence, empowering them through their labour is incredibly rewarding.

“It’s hard to put into words but it’s such an amazing feeling to assist a mother in bringing new life into the world–encouraging her to realise she can do it and sharing in the absolute elation of when her baby takes its first breath–it’s truly a phenomenal experience.”

Reflecting on his mid-career pivot to midwifery, Rory said he will always be a paramedic and is enjoying a great deal of professional and personal fulfilment from his two professions.

“QAS runs through my blood and I’m so thankful for the wonderful opportunities I’ve been afforded throughout my career here, including working as a Critical Care Flight Paramedic in Toowoomba and Brisbane, Clinical Support Officer, Bicycle Response Team member and in deployments to major disasters including Tropical Cyclone Yasi and the Bundaberg floods,” he said.

“I was also thrilled to be able to take an opportunity ‘across the pond’ to the London Ambulance Service for 12 months too.”

Rory said the exposure he had to so many prehospital births early on in his career galvanised his decision to study midwifery.

“Helping me on that new learning journey were the skill sets I’d honed at the QAS, particularly with respect to critical thinking, communication and patient care,’’ he said.

“Whether it is on the ward or ‘at scene’, I try to bring a personcentred approach to the way I treat my patients and over the years I have seen just how helpful that is to those in my care.

“When I began my midwifery studies, I was the only male to graduate in my cohort and I’ve worked very hard to ensure women and their partners are comfortable with my presence. I’m proud to say my gender has never been an issue for the expectant parents I have cared for.”

Notoriously humble, when Rory was asked if any thankful mothers had named their babies after him, he beamed, ‘Two, both in Vanuatu and within the space of one month–it’s a very touching and lovely gesture’. Rory’s stint abroad was due to a university scholarship focusing on cultural competency.

Another wonderful highlight for Rory was ‘being reunited with a mother I’d assisted during her labour–this time as a paramedic treating her daughter who’d suffered a febrile convulsion’.

“Upon arrival, she exclaimed ‘Oh my god, it’s Rory! You helped me birth her!’ That was heart-warming and a special moment,” Rory said.

Rory said having confidence and knowledge were the cornerstones to success in prehospital deliveries.

“We know most paramedics perceive emergent births to be low-incident yet high-risk events, and that is true, but it’s important to note birth isn’t an emergency until it is,” he said.

“As paramedics we have the recognised skill to manage both straightforward births and obstetric complications, including shoulder dystocia or neonatal resuscitation.

“Even if your experience is limited, there is so much you can offer to labouring women in terms of being the calm, professional and responsive help they need.

“Through my study, I’ve learnt a lot about the impact of hormones and physiology during birth, and the more supported and empowered the women are, the less likely there will be complications. As caregivers we play a major role in influencing this and that’s why ensuring our knowledge is up to date is so important.”

Metro North Manager of Clinical Education Rebecca Taylor said Rory’s achievements in QAS were notable and underscored his reputation as a quiet achiever, enriching the lives of his colleagues and patients alike.

“Rory is highly respected by his peers, he is known for his professionalism, resourcefulness and caring attitude and his additional studies help take our service from strength to strength,” Rebecca said.

“QAS of course, is very lucky to have a clinician of Rory’s calibre, and I thank him wholeheartedly for his dedication to patient care–especially to new mothers and their babies.”

Opposite

■ Critical Care Paramedic and midwife Rory Jackson alongside QAS paramedic researcher Brendan Schultz and QUT paramedic academic and midwife Shonel Hall.

Photo: Jo Hales Above

■ Metro North CCP Rory Jackson’s interest in paramedicine and midwifery was fostered from a young age as he helped animals on the family farm to birth.

Photo: Jo Hales

Workplace Health and Safety under the spotlight

Insight chats with Paul Coffey, Executive Manager, Workplace Health and Safety (WHS) Unit QAS, about the recent release of the QAS Statement of Commitment to Health, Safety and Wellbeing.

The new QAS Statement of Commitment to Health, Safety and Wellbeing was released through a Commissioner’s Update on 2 October 2020. What does this Statement of Commitment mean to you?

It means a great deal to me and I hope it does to everyone in the QAS. It represents a collective commitment to both patient safety and staff safety, and is a confirming, positive message by the Commissioner that everyone’s health, safety and wellbeing is truly a core value of the QAS.

As stated in the Commissioner’s Update, this year, everyone’s health, safety and wellbeing has never been more prevalent, as all of us have had to quickly adapt our work practices and systems to reduce a range of risks arising from COVID-19 and to manage the psychological effects of the pandemic on ourselves, our family, friends and patients.

I believe the statement of commitment addresses the key messages in safety, that is, strong leadership, showing respect and building trust–trust in the system and trust in people.

You mention trust. Where does trust fit into the conversation of health, safety and wellbeing?

From a personal view, when I was a lot younger (laughs), I played a bit of rugby. In a team sport such as rugby, if you did not have trust in the system, that is, your team mates and the coaching staff, you would not function as a team, not play as a team, be disjointed on the field and be unlikely to ever win.

In terms of a work environment, I see no difference. In the QAS we must have trust in the system, that is, trust in what you do as an individual, trust in your work colleagues, trust in delivering excellence in ambulance services and trust in the broader system of Queensland Health. Trust will build strong partnerships and ultimately success.

One of the greatest aspects of my role, is working with senior executives, LASN managers, supervisors/OICs, health and safety advisors and a range of experts in key specialist areas such as Priority One, Fleet and Equipment, QASEC, Infection Prevention and many more. The WHS role is simply part of the overall system and contributing to these working partnerships is very satisfying. October was ‘Safe Work Month’. Weekly messaging centred around the ‘four foundations’ of health, safety and wellbeing. Can you highlight these foundations?

Certainly. The QAS Health and Safety Strategy 2019-2023 focuses on four foundations: safety leadership, work environment, safety culture and work design. So, in October this year, the QAS distributed a series of weekly messaging focusing on these four foundations.

The first of the four safety messages was

safety leadership.

This message highlighted that everyone is a leader in safety. Effective leadership encourages the implementation of individual accountabilities and the organisational values, through collective, everyday actions and behaviours, that are directed to ensuring the health, safety and wellbeing of staff and patients.

This safety message focused on how we can all lead the way in supporting each other following a workplace health and safety incident. The way we respond to a WHS incident and people affected by the incident is key to building a supportive culture–a culture that is fair, respectful and people centred.

The second of these safety messages was

work environment.

This message reinforced the ongoing commitment the QAS has in providing a physically and psychologically safe and healthy work environment, to the highest practicable standard, within a work environment that is a dynamic, 24/7 operating organisation. This includes affording all staff access to a wide range of physical, psychological, social and financial wellbeing resources and supports on the QAS Portal.

The message highlighted the value of the QAS Mental Health and Wellbeing Strategy 2018-2023 that provides a holistic organisational approach in providing comprehensive mental health and wellbeing support to staff and to assist in times of struggle and crisis, allowing staff to provide vital work in the community.

The third of these safety messages was

safety culture.

This message focused on the QAS’s strong, practical, everyday emphasis on participative consultation, supporting proactive health, safety and wellbeing.

The QAS takes active steps to foster an environment of genuine consultation and active participation, recognising that this supports a strong safety culture. A participative consultative approach is especially important when health and safety issues or matters are raised that require immediate resolution.

This message also identified that there is a nice link between a strong safety culture with an inclusive and respectful culture, supporting the new QAS Fair and Inclusive Practice Network (FIPN) and the RESPECT program.

The final message in Safe Work Month this year focused on safety and good work design.

This message that good work design is integrated through QAS statewide activities, LASN operations, technology and into everyday environments, equipment, vehicles and tasks, to support the health, wellbeing, capability and productivity of QAS staff. With oversight through the QAS Statewide Equipment and Vehicle Committee (SEVC), improvements and enhancements are continually being explored and implemented in areas such as uniforms, personal protective equipment, equipment enhancements and vehicle design.

Most importantly, the final message reinforced that health, safety and wellbeing is not just a one-month-a-year proposition, it is a 24/7, 365 days a year commitment by everyone, each and every day at work.

I understand that you are an Occupational Therapist. How did you get into workplace health and safety?

You are correct. I graduated as an Occupational Therapist in 1987 and immediately practised in the treatment and rehabilitation of injured workers under respective workers’ compensation schemes in Queensland and then the Northern Territory. Following post-graduate study in risk management through Monash University, I commenced work as a Safety Inspector with the Queensland WHS Regulator up until 2000. For the next 10 years I worked in both the public and private sector until I joined the Department of Community Safety in 2011. Following the Machinery of Government change in 2012-13, I was fortunate to join the QAS in the role of health, safety and injury management.

Having worked in various private and public sector organisations over 30 years, I can honestly say, the QAS is one of the most dedicated organisations that continues to explore ways to support the physical and psychological health, safety and wellbeing of staff in the operational environment.

I also understand that you like horse racing and the occasional punt. Is that true?

I don’t know where you heard that. I have no comment (laughs). For those who don’t know Paul personally, he has a reputation for picking the horse that comes last in most races! What do you see as the next steps and possible challenges moving forward?

The future looks very positive. If I revert to my earlier analogy–in rugby, teamwork is the key to success. In business, building strong partnerships and working together toward the same goal will lead to successful outcomes.

In the QAS workplace health and safety space, I can say that each Tuesday we hold a Microsoft Teams ‘coffee catch-up’ with all available LASN health and safety advisors. This informal forum allows us to share ideas and key learnings, celebrate successes and discuss complex scenarios (and at times vent some frustrations), with the intent to build a strong WHS team in the QAS, supporting and helping each other as best we can.

We will always have an ongoing challenge of implementing the elements of the QAS statement of commitment and the foundations of the health and safety strategy seamlessly in all aspects of our organisation. It is not always easy, but the benefits will have a positive impact on ourselves and others. That’s why safety leadership is so important.

Above

Paul Coffey,

Executive Manager,

WHS Unit QAS.

Queensland Ambulance Service Our Statement of Commitment to Health, Safety and Wellbeing

Excellent patient care

Be healthy, safe and well

Ideas into actions

Unleash potential

Be courageous

Empower people

A core value of the Queensland Ambulance Service (QAS) is the health, safety and wellbeing of our employees, patients and others. The ability to care for our patients relies directly on our own health, safety and wellbeing and this underpins the provision of quality ambulance and patient care services. To achieve this, we will:

• Lead by example, demonstrating a visible commitment to health, safety and wellbeing in the workplace and delivering on our accountabilities. • Be responsible for taking action and complying with any legal duty or obligation to ensure the health, safety and wellbeing of ourselves, our patients and others. • Have the necessary knowledge, skills and abilities to fulfil our own health, safety and wellbeing responsibilities. • Ensure relevant information, data, training and feedback is readily available and that strong governance mechanisms are in place. • Be physically and psychologically fit for duty, operationally ready and therefore able to deliver QAS services in a professional, safe and competent manner. • Foster a culture of RESPECT where we can step up and be empowered to stamp out inappropriate workplace behaviour, including harassment, discrimination and bullying. • Incorporate health, safety and wellbeing and good work design into organisational and operational planning activities. • Continually improve and build the capacity of the safety management systems through consultation, technology, work practices, assurance and reviewing of performance. • Actively participate in the proactive identification of hazards and risks associated with our own work and be an active participant in continuously seeking improvements. • • Constantly strive to minimise harm through the early reporting and response to workplace incidents, their effective and timely investigation and the ongoing monitoring of risk controls. Enthusiastically provide early intervention and support for employees who sustain an injury or illness to optimise recovery and promote an early and safe return to work. This is our collective commitment.

Russell Bowles ASM October 2020