QAS
INSIGHT Autumn 2017
Mr Seymour Warrian F O U NDER : CIT Y A MBUL ANCE TR ANSP ORT BRIGADE, 1892
Imagine if he could see how far we’ve come...
125th Anniversary | Trauma in the Park Rockhampton Ops Centre | Graduate Paramedics
Minister’s Message
Contents
125th ANNIVERSARY
TRAUMA IN THE PARK
OXYTOCIN
06
16
24
TUBERCULOSIS
ROCKHAMPTON OPS CENTRE
NEW TOOWOOMBA RECRUITS
26
32
36
AWARENESS SUCCESS
IT’S A MATTER OF PRIDE
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38
GRADUATE PARAMEDICS
PROFILE: GREG COUGHLAN
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QAS Insight is published quarterly by the Queensland Ambulance Service Media Unit, GPO Box 1425, Brisbane 4001. Editorial and photographic contributions are welcome and can be submitted to: QAS.Media@ambulance.qld.gov.au or +61 7 3635 3900.
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Over summer, we experienced both extreme hot weather and a record demand for services across the state’s emergency departments and local ambulance service networks. I recognise that it was a busy time for everyone who serves in the QAS, and I’d like to thank all staff who helped keep our community safe during this time. Every contribution makes a difference, whether through educational awareness, patient care or Triple Zero (000) call taking. In February I visited Ipswich Station to launch the Local area Assessment and Referral Unit (LARU). This included the unveiling of two new generation vehicles, the first of their kind in Queensland.
Shaping the future of the service
5
Arm yourself against the flu
5
Profile: Bob McDermant
14
Morphine and Fentanyl
20
New HARU paramedics
30
Trauma Week tests interns
30
The road too often travelled
31
Profile: Mindy Thomas
34
QAS Commitment to Reconciliation
37
Priority One
40
Nursing a new career
43
Keeping it in the family
44
Farewell David Eeles
48
Departures and Appointments
49
Movers and Shakers
49
Thank You QAS
50
West Moreton has experienced a significant increase in demand for pre-hospital care and LARU will help paramedics treat non-urgent cases and optimise the use of acute ambulance resources for higher priority incidents. The program has already been implemented in Brisbane, Gold Coast, Sunshine Coast, Townsville and Cairns with future plans to continue rolling out across the state. We have also welcomed the latest intake of prospective Emergency Medical Dispatchers. The role that our EMDs play is crucial to the outstanding emergency response that QAS provides. The information that our dispatchers can obtain and disseminate can make a vital difference in the outcome of an incident.
I wish our prospective dispatchers all the best for the course and future placements in operations centres around Queensland. Training for sedation has commenced for Advanced Care Paramedics. This is one of the key outcomes from the Paramedic Safety Taskforce. I cannot stress enough the importance I place on ensuring our paramedics are safe in the workplace, because there is never an excuse for abuse. A national registration scheme for paramedics is something I have been advocating for since becoming Minister for Ambulance Services. A registration scheme will be an important recognition of the highly professional nature of modern paramedicine. I’ll keep you informed of developments in this space, as we navigate this detailed and overdue reform. This year is particularly significant as QAS celebrates the special milestone of 125 years of ambulance services in Queensland. The service has changed from a volunteer organisation to a highly specialised modern profession. Over this 125 years, the constant has been the outstanding devotion to the community that all officers demonstrate. Congratulations on this milestone. I look forward to celebrating with you throughout the year.
Hon. Cameron Dick MP Minister for Health Minister for Ambulance Services
Autumn 2017 editorial contributors: Michael Franks, Emma Crowley, Dr Dan Bodnar, Dr Stephen Rashford, Natalie Schutt, Fiona Randall, John Murray, Tony Hucker and Gary Berkowitz. Graphic design by Nejien Creative.
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From the Commissioner It’s been a warm welcome to the year with hot weather and heatwave conditions impacting much of Queensland. Whether you are based inland, along the coastline or in the far north, west or south, we have all been affected in recent months. I’d like to thank all staff for the effort that you have made to prepare your communities and support them through these testing periods. Your efforts and dedication have not gone unnoticed. You have kept many engaged and aware of the risks to themselves and others, which has no doubt helped minimise the amount of serious heat-related illnesses that QAS has responded to. In January we welcomed five new Indigenous paramedics to the Townsville area. Selina Hughes, Kieta Lenoy, Clive Prior, Gerald Wotton and Sonja Zalar will undertake placements at Palm Island and Kirwan Ambulance Stations.
As an organisation, we are committed to providing opportunities for Aboriginal and Torres Strait Islander people. As a workforce, we are committed to improving health outcomes for these communities and providing services which are both culturally respectful and responsive to their needs. It is the responsibility of every single one of us to close the gap of disadvantage and work towards a healthier future for Aboriginal and Torres Strait Islander people and their communities. If you have not already done so, I encourage you to read and familiarise yourself with the Statement. 2017 will be a busy and fulfilling year for us as we celebrate 125 years of serving Queensland. It’s a significant milestone in our history and a time to reflect on just how far we have come in pre-hospital emergency care. It also provides us with an opportunity to celebrate and engage with our local communities around the state.
against the flu
As we head towards another flu season, it’s important to start thinking about how we can protect ourselves and our vulnerable patients from influenza. There are a number of ways to prevent the transmission of influenza:
Where can you access QAS funded flu vaccinations?
• •
• • • •
•
•
Having the annual seasonal flu vaccine Following standard and additional transmission based droplet precautions for all patients who are unwell with an influenza like illness Maintain good hygiene. Wipe clean all frequently touched surfaces after treatment and transport of all patients Do not attend work when you are unwell
A QAS funded Medimobile vaccination clinic Your local GP (vaccination cost reimbursed by QAS) Pharmacist (vaccination cost reimbursed by QAS) In some LASNs, at your local Hospital and Health Service
For further information about local vaccination service arrangements please speak to your local Health and Safety Advisor.
Flu vaccination reimbursement forms are available on the QAS portal under the ‘Finance’ tab and the ‘Reimbursements and Claims’ section. Russell Bowles QAS Commissioner
They join 26 existing recruits across the state who have joined QAS since the Program’s inception in 2013. I look forward to following the progress of these officers as they hopefully evolve to enjoy long-term careers in paramedicine.
Shaping the future of the service In the week of International Women's Day, the QAS Staff Summit brought together more than 100 female staff and members of the executive team in Brisbane for two days.
Their appointment to the Indigenous Paramedic Program comes on the back of the formal signing of the Queensland Health Statement of Commitment to Reconciliation with Director-General, Michael Walsh. I am honoured to have signed this document on behalf of the Queensland Ambulance Service. The Statement of Reconciliation is as much about our patients as it is about you.
Arm yourself
Director-General Michael Walsh and Commissioner Russell Bowles proudly display signed copies of the Statement at the recent launch.
The summit gave participants an opportunity to put forward their views and share their experiences on key workforce issues in order to help shape and design the future of the service. A second summit will again be held in Brisbane in mid-May and will provide an opportunity for a range of staff from around the state to contribute and voice their views. eep an eye out for a call for nominations K by email from the Commissioner.
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ARM YOURSELF AGAINST THE FLU
There are certain established associations working for the benefit of humanity at large. Of such associations the Ambulance Brigade has now become probably one of the most familiar and important. We can scarcely bring ourselves to believe that it has not existed forever. When any association holds this position in the mind, it may be ranked amongst the most permanent institutions of society.” – Brisbane Telegraph, February 7, 1902
Pioneers and ponies: the early years 2017 is the 125th anniversary of the establishment of ambulance services in Queensland. Since the early pioneering days of the City Ambulance Transport Brigade, when the humble ‘ambulance bearers’ slept on rolls of paper in a newspaper company storeroom, a multitude of incredible advancements in training, equipment, communications and the scope of clinical practice has helped QAS develop into a world-class service. Throughout 2017, QAS Insight will document our rich history and profile some of the pioneers who helped build the Queensland Ambulance Service into the organisation we know today. In this edition, we focus on the formative years from the establishment of the CATB in 1892 through to the Second World War. The story behind the beginning of the CATB is reasonably well known, but always worth re-telling.
Unfortunately for Mr E.G Echlin, who rode the horse Spring Bar in the Brisbane Exhibition Carnival Hurdles Event back in August 1892, he had no such luxury. Echlin was pinned by the legs when Spring Bar took a fall during the race. A number of bystanders rushed to help, but lacking in even the most basic first aid skills, they tried to stand poor old Echlin up and turned what was a simple leg fracture into a compound fracture. Unhelpful to say the least. Dr Sandford Jackson – the Medical Superintendent of the General Hospital – and Seymour Warrian from the Defence Ambulance Corps were at ringside and quickly took over to dress the wound and apply splints, before Echlin was taken off to hospital in a ‘Molly Brown’ horse-drawn cab. The pair were suitably horrified at the initial ‘first aid’ given to Echlin and Warrian knew the time was right to establish the city of Brisbane’s first ambulance brigade. continued >>
The impetus for the creation of our service came during a horse riding event at what is now known as the RNA Showgrounds in Brisbane – home of the ‘Ekka’. Prior to this, limited first aid was provided by police officers at accident scenes, while the Moreton Bay Regiment’s Defence Ambulance Corps was often invited to attend significant events such as Queensland Turf Club race meetings. Regular racegoers will know that the tradition of having an ambulance on hand at the races continues today. Off to hospital with a patient in 1901.
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September 12 On September 12 1892, a group of enthusiastic potential ‘ambos’ met in Annerley in Brisbane’s inner south to form the City Ambulance Transport Brigade.
Their next goal was to get a litter to help transport patients and again they had to rely on financial support to afford it.
125 years later we still mark this momentous occasion with our annual ‘Ambulance Week’ celebrations every September.
The litter – built by the Federal Carriage Co in Elizabeth Street – was a great addition, although the bearers still had to walk, unless they were lucky enough to catch a ride on a bus on their way back from hospital, in which case they’d sit on the step of the bus with the litter towed behind.
The CATB didn’t have to wait long for its first case. Warrian and William Tomkins were on standby at the Eagle Farm races when Dr James Booth requested their services to transport a patient from Taringa to a private hospital at New Farm. Warrian filed the following report: “We proceeded to Taringa to find the patient suffering from ague (malarial fever). But the day being well spent, and with only a stretcher on which to carry the patient, we decided to leave the case till the next day. We carried the patient a mile to the station, thence by rail to Brunswick Street, and a further carry to New Farm, up a winding stairway at St Clairs Hospital to bed. For this transport we received 15 shillings which was divided three ways. Five shillings for each bearer (out of which they paid their own rail fares) and five shillings to the CATB funds, which was the first contribution received. The patient weighed 11 stone and with the additional weight of the stretcher and clothing, it made a very heavy load to carry that distance in the heat of the day.”
The CATB ambulance bearers often walked as far as 55km in a day, running to accidents and pushing the litter in all weather conditions. They were rostered on duty every second night and alternate Sundays and were entitled to just one week of holidays each year. In 1893, its first full year of operation, the Brigade received 400 calls and covered 1,867km – all on foot. As its reputation grew, so did demand, with 789 calls coming in 1894 (38 of which were apparently deemed false alarms).
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Significantly, the CATB was successful in obtaining a Government subsidy of a pound for each pound contributed voluntarily. The number of calls skyrocketed to 2,430 in 1896, which translated to 11,678km of travel. It was time for a better transport option. The following year the CATB purchased its first white pony and jingle – a light horse-drawn two-wheeled cab. With this new capability, the Brigade covered 16,717km from 4,109 call outs in a year. It was also around this time that Honorary officers were incorporated into the Brigade to relieve the permanent officers at night. The CATB’s Wharf Street, Brisbane headquarters in 1901.
How times have changed It’s fair to say that in the late 19th Century the treatment of injured people, when viewed through a modern lens, could be considered relatively ‘unsophisticated’.
In fact, they couldn’t even afford a telephone. However, as was the case on many occasions during the history of ambulance in Queensland, community spirit came to the fore.
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The Brigade leased a premises in Elizabeth Street and soon opened its first branch in Stanley Street, South Brisbane.
continued >>
It goes without saying that things were pretty tough in the early days and the CATB struggled for funds.
They were generously gifted a phone by Elliot Bros in early 1893 and were finally able to connect to the telephone exchange. They were allocated number 177.
By 1895 the Brigade had sourced donated uniforms – the classic blue serge tourist coat and trousers with piping and a cap – started conducting regular training and outgrew its digs at the newspaper company.
Prior to the establishment of the CATB, if the police found an unconscious person in the street, the patient was bundled into a jingle – a light two-wheeled horsedrawn cab – and whisked off to the lock up. An artist’s impression of the CATB’s first case in 1892. Illustration by Louise Blood.
What a contrast to our current operations, where paramedics are on standby in a number of Police Watch Houses throughout Queensland on Friday and Saturday nights.
If they hadn’t regained consciousness by the next morning, the Government Medical Officer was summoned to assess them.
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ARM YOURSELF AGAINST THE FLU
the QATB is born
By the turn of the century, the CATB had moved to new headquarters in Wharf Street and the first regional centres were established in Charters Towers and Townsville, followed by Rockhampton, Warwick and Toowoomba.
The new vehicle certainly helped the bearers reach the patient much more quickly with the litter, although unfortunately the trip to hospital was no faster. Instead of towing the litter behind the vehicle, it was deemed more appropriate to push the litter on foot.
The growth of these regional centres led to the adoption of a more fitting name in 1902 – the Queensland Ambulance Transport Brigade or ‘QATB’.
In the years that followed, the QATB embraced the motor car, the railway and aircraft to improve its ability to transport patients over large distances.
More regional centres quickly followed, with Mackay, Ravenswood, Cairns, Ipswich and Bundaberg all operating prior to a development that would revolutionise ambulance services forever – the adoption of the first motor vehicle in 1908.
A Cadillac ambulance was introduced in 1912 and could carry three stretchers – two slung from the roof and sides and one on the floor of the cabin.
A four-cylinder Clement Talbot chassis was ordered from the Canada Cycle Agency Limited, and a local coach builder fitted the chassis with a specially designed body for ambulance work.
A QATB ambulance in 1915.
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The rapid growth of the QATB would soon take a hit however, with the outbreak of World War I. Considering the military roots of the CATB, it’s not surprising that many ambulance personnel answered the call of duty. A number of them made the ultimate sacrifice and did not return.
A Maryborough QATB ambulance in 1918.
It was a very tough period for Australian society and particularly for our ambulance brigades. With money, equipment and staff very hard to come by, they had to work extremely hard to keep operating during the war years. The fundraising skills that would serve the QATB so well in later years were expertly honed during this time. However, despite the lack of funds, the spirit of innovation was alive and well. Rail ambulances first appeared in Babinda in 1917. The rail cars were a great solution and enabled Brigades to cover large distances and traverse territory that was impassable by road.
One of the early QATB motor vehicles in action at Southport in 1912.
This was particularly important in areas like the Channel Country where flooding was a regular occurrence. Following the war, the establishment of the Queensland Ambulance Association – an auxiliary body of voluntary first aiders – was a timely boost to the community. The Association ran courses to keep skills up to date and also undertook honorary duties at sporting events to take the pressure off the QATB. The QATB grew rapidly again after the war, with more than 40 new centres opening by the time the Great Depression hit. Some of the buildings were particularly impressive and QATB centres became iconic features in many towns around the state. continued >>
The Roma rail ambulance in 1921.
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ARM YOURSELF AGAINST THE FLU
The initial subscription was 10 shillings a year, with a life membership available for five pounds.
The Bundaberg QATB Centre in 1926.
The subscription scheme was eventually abolished in 2003 by the Beattie Government. In a somewhat controversial move, a ‘Community Ambulance Cover’ levy was applied to electricity bills to ensure all Queenslanders had ambulance cover. The ‘ambulance levy’, as it was commonly known, was subsequently removed by the Bligh Government in 2011 with the QAS being directly funded by the Queensland Government. In the next edition of QAS Insight, we focus on the QATB’s developments in training, equipment and communications through the 40s, 50s, 60s, 70s and 80s – prior to the establishment of the Queensland Ambulance Service in 1991.
As was the case across the world, money was very tight in the depression years. In 1934 the QATB’s government subsidy was reduced from a ‘pound for a pound’ to five shillings per pound. Still, there were some important advancements made in this era, including the introduction of the first aerial ambulance in Cairns in 1937. Its first case was transporting a child from Cooktown to Cairns. By the outbreak of World War II in 1939, there were 77 self-governing QATB centres operating around Queensland and the ambulance subscription scheme that would operate for the next six decades was introduced.
Opening day at the Wynnum QATB Centre in 1926.
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Fundraising in full swing as the QATB Chocolate Wheel draws a crowd at the Ekka in 1938.
The Kingaroy Centre in 1935.
A first aid display by Queensland Ambulance Association volunteers in Brisbane in 1942.
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I used to spend a lot of time educating them. If I could teach anybody anything, that’s what I would do. During the early 1960s Bob’s keen interest in education put him at the forefront of local efforts to explore and adopt the method of Cardiopulmonary resuscitation (CPR) as general practice. He worked tirelessly to ensure that the CPR skills of all QATB officers attending the State Training School were fully effective.
We recently caught up with Bob to show him just how far the service has come. In his days on road there were no sterile dressings or any form of resuscitation equipment. Ambulance officers used wooden splints for fractures and patient stretchers were made from canvas.
When learning new skills or techniques, he was sure to impart his knowledge to anyone that was willing to learn.
Having retired from service before the introduction of the first defibrillator, Bob was impressed when shown the new Corpuls3. He was also glad to see canvas stretchers had been retired and made way for the new Stryker powered models.
“I made it part of my duty that with all of the honorary bearers, I would take them aside and teach them all of the latest things that they would never get to see unless they went to a case,” Bob said.
Breathing life into training and education In celebrating our history and its foundations, it’s important to celebrate the men and women who played a role in building Queensland Ambulance Service into the organisation it is today.
Here he treated wounded Australians and on occasion, helped injured Japanese soldiers. He also worked alongside the local Papuan New Guinean people, affectionately known as the ‘Fuzzy Wuzzy Angels’ by Australian troops, and witnessed injuries varying from the unfortunate but humorous to those that were nothing short of horrific.
A Scottish immigrant, Robert ‘Bob’ McDermant, demonstrated at a young age an eager interest in first aid.
“Up there it was mainly getting hit in the head with coconuts. But of course, when you got into the war zones you had anything from fractures to gunshot wounds to horrible injuries that you had to treat,” he said.
It’s a passion that drove him in the 1940s to complete numerous first aid and nursing certificates and develop life-changing relationships with Queensland Ambulance Transport Brigade (QATB) senior paramedics. Bob remembers: “I had a feeling that this was a very good career. I liked the way they worked. I liked the freedom of it. I liked the fact that you were out there as a helping hand and that you could do a lot of good. That was the thing that really interested me.” His early exposure and experience in first aid led to a career as a nursing orderly in the Australian Army in the South Pacific during World War II.
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Bob is credited with making the most profound impact in his career while performing the role of Training Officer at Brisbane QATB, and later Chief Training Officer at the QATB State Council Training School in Brisbane. During the 12 years in which he was in charge of the State Training School, he developed five graduated modules of education, taking ambulance officer education into a new domain of pre-hospital care. Yet his contributions did not begin and end with officer education. Bob was one of the original officers in the new communication and dispatch centre in Brisbane in the 1960s – initially known as the Control Room and later the Communication Centre.
The abilities of modern paramedics have also changed significantly in recent decades, leading to improved pre-hospital emergency care. After seeing the modern equipment and chatting to a couple of current-day paramedics, Bob summed his thoughts up simply. “I would love to be part of it,” he said. Bob was awarded the QAS Distinguished Service Medal in 2013 for his unique and remarkable contributions to ambulance officer education within Queensland. Now aged 96, he lives on the Sunshine Coast with his devoted wife of many years, Gwen.
Upon returning to Brisbane after the war, Bob joined the QATB in 1947 where he would contribute to ambulance officer education until his retirement in 1986, after 39 years of dedicated service. In the early days of his career, he recalls the Brisbane service had undertaken no advancement or change in its training manual for 50 years. This eventually led to a letter from a hospital physician being sent to the Brisbane QATB Superintendent describing ambulance personnel as being ‘no more than truck drivers’ and stating their standards had slipped.
Bob running an education session on inflation techniques in the early QATB days.
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Trauma training
It’s the ACP’s initial assessments and decisions that can be the difference between the patient making it to hospital or not.
builds MCI capability
South East Queensland experiences no shortage of high acuity cases or largescale emergencies. However, given QAS has several thousand frontline operational staff, many paramedics will infrequently find themselves called to high acuity incidents. It is this reality that motivates staff of all clinical levels on the Gold Coast to stay sharp, train together as a team and actively contribute to local planning and training scenarios for significant multi-casualty incidents. Assistant Commissioner John Hammond takes pride in seeing local staff proactively getting involved in exercises and demonstrating their commitment to selfdevelopment and learning.
“Regular exercises and sessions run by our senior clinicians bring together staff in an effort to improve their unified response, as well as their interactions with other stakeholders such as the Gold Coast Hospital and Health Service,” he said. That was precisely the aim when High Acuity Response Unit (HARU) Critical Care Paramedic Gary Berkowitz recently coordinated an evening ‘Trauma in the Park ‘ training session at the Mudgeeraba Ambulance Station. The exercise brought together Graduate, Advanced Care, Critical Care and HARU paramedics, Patient Transport Officers as well as university students. Staff from Gold Coast University Hospital’s Emergency Department observed the scenarios and received a ‘handover’ from paramedics prior to each case debrief. Gary said the exercise had a particular focus on ACPs, given they were the crews that initially responded
to such cases, yet individual officers may deal with critically injured patients relatively infrequently.
The scenarios concentrated on critically injured patients, both adult and paediatric.
“As a large organisation we need every link in the chain of survival to function or the chain itself won’t,” Gary said.
While the scenarios were confronting, they allowed all staff to consolidate their understanding and practical application of the treatment principles required for patient care.
“It’s not myself, or another HARU officer, or a CCP that can make the most difference to patient outcomes. It’s the first crew on scene, hopefully supported by excellent bystander interventions before ambulance arrival.
The evening also exposed staff to the use of contemporary treatments, including blood product administration and participation in current trauma research protocols (Patch and Prophiicy studies).
“It’s the ACP’s initial assessments and decisions that can be the difference between the patient making it to hospital or not.”
Gary and his coordinating team utilised novel approaches to simulating clinical scenarios, including the use of various props.
Trauma in the Park was divided into two scenarios that tested decision-making, team work and patient care. For those watching on, it provided a stage to evaluate and learn.
The night was a great educational event that consolidated the participants’ abilities to provide excellent treatment to Queenslanders.
continued >>
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TRAUMA TRAINING BUILDS MCI CAPABILITY
Scenario One
Scenario Two
ACP Emma-Kate Smith has placed the patient on non-rebreather oxygen, decompressed the chest with a 14 gauge needle, obtained intravenous access and administered fluids. CCP Tash Adams now assesses the need for additional chest decompression.
The outcome after a CCP has decompressed the patient’s chest with a pneumocath.
Griffith University student Amie Jones watches on and makes valuable learnings ‘in the Park’.
HARU paramedic Darren Hatchman performs Rapid Sequence Intubation (RSI) on the patient.
Darren uses pre-oxygenation with high flow nasal prong oxygen as well as bag valve mask on the patient.
A blood transfusion has been administered by a HARU paramedic at the scene.
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A crew arrives on scene and makes vital first assessments. ACP David Kryger applies a tourniquet to control an arterial bleed.
CCP Greg Jones prepares the patient for an RSI.
Paramedics connect the patient to a monitor and attempt to stabilise him after gaining intravenous access and putting him on non-rebreather oxygen.
HARU paramedic Darren Hatchman arrives on scene and conducts a physical assessment of the patient.
CCP Prue Sneddon prepares for an RSI by drawing up Ketamine and Rocuronium.
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Morphine and Fentanyl head-to-head By Acting QAS Medical Director Dr Dan Bodnar
The administration of appropriate analgesic interventions is an essential element of pre-hospital patient care. One of the cornerstone analgesic interventions is the provision of opioid analgesics. Literature from recent conflicts has shown that early use of opioid analgesia in the context of acute traumatic injury is associated with a decreased prevalence of post-traumatic stress disorder1. The QAS currently utilises two opioid analgesics; morphine and fentanyl.
Morphine is extracted from the poppy Papaver somniferum, whilst fentanyl is a synthetic opioid. Fentanyl is approximately 100 times more potent than morphine (i.e. requires a 1/100th of the dose to get the same clinical effect). Generally speaking at appropriate dosages, both morphine and fentanyl have similar efficacy with regard to their analgesic properties, but there are differences in their pharmacological properties which paramedics should know so they can choose the best agent for their patients.
Mechanism of action of opioids Opioid analgesics act upon the mu, kappa and delta opioid receptors located in the spinal cord and in the brain. Stimulation of pain receptors, stimulates the primary afferent neurone that synapse with the relay neurone in the spinal cord. Opioid analgesics reduce the activity of the relay neurone (see Figure 1) either directly or via descending inhibitory pathways (e.g. serotonergic or adrenergic fibres). Pain isn’t altogether blocked via these pathways and patients may report ‘that the pain, though still present, is tolerable’.2 Opioids seem to treat dull pain better than colicky pain, whilst neuropathic pain (nerve pain e.g. shingles) doesn’t seem to respond to opioids.2,3
“Among the remedies which it has pleased Almighty God to give to man to relieve his sufferings, none is so universal and so efficacious as opium.” -Thomas Sydenham (English Physician)
The euphoric effects seen with opioid administration are mediated by the mu receptor, however not all patients receive this euphoric effect with some patients having a dysphoric reaction to opioids.2 Figure 1: Mechanism of action of opioid analgesics (from Neal MJ, Pharmacology at a glance, wiley, 2015)3
continued >>
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MORPHINE AND FENTANYL HEAD-TO-HEAD
Pharmacological differences Administration, onset and offset of action The chemical structures of morphine and fentanyl are quite different (see Figure 2). Fentanyl is quite lipophilic (fat soluble) which means it can cross mucous membranes (e.g. nasal and buccal mucosa) easier than morphine making it a better choice for ‘novel’ administration such as nasal atomisers and buccal ‘lollipops’.
The lipophilic quality of fentanyl also means that it can cross the blood brain barrier more easily and as such, the time to peak analgesic effect after an intravenous administration is approximately three times faster than that of morphine2 (see Table 1).
Figure 2: Chemical Structure of morphine (A) and fentanyl (B)4
Routes of administration
Morphine
Fentanyl
• • • •
• • • • • •
Oral Intravenous Intramuscular Subcutaneous
Intravenous Intramuscular Intranasal Buccal Subcutaneous Transdermal (patches)
Adverse events
Conclusion and the future
In pre-hospital studies, both agents seem to have similar adverse event profiles, although morphine displays a trend to causing more hypotension when used for ischaemic type chest pain.6
Although fentanyl and morphine are similar in efficacy, fentanyl seems to be the more versatile agent for use in the pre-hospital setting. QAS paramedics realise this as exhibited by their preference to use fentanyl.
In the hospital environment, when fentanyl and morphine are compared in the post-operative setting in the context of patient controlled analgesia, the fentanyl cohort seem to have less itchiness, urinary retention and nausea than those patients receiving morphine.7,8
As QAS evolves and continues to develop its scope of practice to meet the needs of the community, other opioids and novel routes of administration may need to be introduced into the armamentarium. In addition, as the patients we treat continue to change, paramedics will need to be more familiar with the diverse means of delivering opioids in the community, especially as it will influence how they treat the patient in front of them.
Time to peak analgesic effect
15 min
5 min
Duration of analgesic effect
4 hours
1 hour
QAS’s experience with opioids
Active Metabolites
Yes (issue for the elderly and those with renal impairment)
No
Since 2013, QAS has had two opioids in its Drug Therapy Protocols. QAS paramedics seem to prefer fentanyl over morphine, with the organisation utilising 32 per cent more fentanyl than morphine in the 2015/16 financial year.
Table 1: Pharmacodynamic comparison between morphine and fentanyl
Morphine has a longer duration of action than fentanyl. This again is related to the fact that fentanyl is quite fat soluble and redistributes faster than morphine.5 The duration of clinical effects with morphine may be increased in the elderly and those with renal impairment, as morphine has an active metabolite (morphine-6-glucouronide). This may cause significant issues if clinicians administer morphine to patients who are not aware that their renal function has been deteriorating e.g. diabetics.
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T roy Lisa Holbrook et al., “Morphine Use after Combat Injury in Iraq and Post-Traumatic Stress Disorder.,” The New England Journal of Medicine 362, no. 2 (2010): 110–17, doi:10.1056/NEJMoa0903326.
2 Tony L Yaksh and Mark S Wallace, “Chapter 18 : Opioids , Analgesia , and Pain Management,” in Goodman & Gilman’s: The Pharmacological Basis of Therapeutics, 12th ed. (McGraw Hill, 2012). 3 Neal, Michael J. Medical Pharmacology at a Glance, edited by Michael J. Neal, Wiley, 2015. ProQuest Ebook Central, .Created from uql on 2017-02-11 4 PubMed Compound, https://www.ncbi.nlm.nih.gov/pccompound, accessed 12/2/2017
Figure 3: Analgesic agents used to treat paediatric trauma patients transported to Townsville, Ipswich, Redcliffe, MCH and RCH.
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Fentanyl seems to be the preferred agent for the treatment of paediatric trauma patients (see Figure 3). This probably relates to the versatility of fentanyl to be administered intranasally.
5 George Brenner and Craig Stevens “Opioid analgesics and antagonists,” in Pharmacology, 4th ed. (Elselvier 2013) 6 Erin R Weldon, Robert E Ariano, and Robert A Grierson, “Comparison of Fentanyl and Morphine in the Prehospital Treatment of Ischemic Type Chest Pain.,” Prehospital Emergency Care : Official Journal of the National Association of EMS Physicians and the National Association of State EMS Directors 20, no. 1 (2016): 45–51, doi:10.3109/1090312 7.2015.1056893.
Did you know that in 2014, it is estimated that Australia produced 220 tonnes of morphine equivalent opiate raw materials, making it one of the largest medicinal opioid producers in the world?9 Did you know that the term ‘morphine’ is derived from Morpheus the Ancient Greek god of dreams and ‘heroin’ is derived from the term hero and was coined as a trademark by Bayer & Co because of the euphoric feeling it provides?
7 E.1; Stavropoulou et al., “303 . Opiod-Induced Adverse Reactions of Intravenous Patient Controlled Analgesia : Comparison of Morphine and Fentanyl for Acute Postoperative Analgesia,” Regional Anesthesia and Pain Medicine 33, no. 5 (2008): e166. 8 Rob Hutchinson, Eun Hae Chon, and Richard Gilder, “A Comparison of a Fentanyl, Morphine, and Hydromorphone Patient-Controlled Intravenous Delivery for Acute Postoperative Analgesia: A Multicenter Study of Opioid-Induced Adverse Reactions,” Hospital Pharmacy 41, no. 7 (2006): 659–63.meperidine, hydromorphone, and fentanyl. Morphine is by far the most commonly used opioid in this setting, yet the selection of morphine as the primary opioid is based largely on tradition. Meperidine should not be considered in the PCA armamentarium due to the associated risk of central nervous system toxicity from its metabolite normeperidine. The objective of this study is to compare the rate of opioid-induced adverse reactions among three IV PCA opioids, fentanyl, morphine, and hydromorphone, in acute post-operative pain management. Although morphine is the most frequently used opioid, the results from three US hospitals indicate that fentanyl IV PCA had a significantly lower rate of common opioid induce adverse reactions (nausea/vomiting, pruritus, urinary retention, or sedation 9 United Nations, “United Nations Publication INCB Narcotic Drugs - Technical Reports Supply of Opiate Raw Materials and Demand for Opiates for Medical and Scientific Purposes,” 2012, http://www.incb.org/documents/Narcotic-Drugs/TechnicalPublications/2013/Part_3_supply_E.pdf.
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Oxytocin in focus By Tony Hucker, Director Clinical Quality and Patient Safety, and Natalie Schutt, QAS Senior Pharmacist
Post-partum haemorrhage and oxytocin Post-partum haemorrhage (PPH), is a potentially lifethreatening obstetric complication. PPH is defined as a blood loss of 500 ml or more in the third stage of labour and is major contributor to maternal morbidity and mortality worldwide (1). The most common cause of PPH is the failure of the uterus to contract after the delivery of the foetus (2). Oxytocin is an endogenous nonapeptide (nine amino acid peptide) hormone that is synthesised in the hypothalamus and released by the pituitary gland during labour and lactation (3). The production and release of oxytocin is controlled by a positive feedback mechanism. As the serum concentration of oxytocin increases there is an increase in strength and frequency of uterine contractions and further stimulation of oxytocin release (see figure 1). The myometrium continues to contract in the third stage of labour to compress the uterine vessels preventing extensive bleeding as the placenta is expelled.
In October 2016, oxytocin was introduced into the QAS Drug Therapy Protocols. Oxytocin is the drug of choice for the prevention and treatment of PPH due to its efficacy and lower incidence of side effects. In comparison to other uterotonics, oxytocin is also available in a preparation that does not require refrigeration, which is favourable in the pre-hospital setting. Synthetic oxytocin is a nonapeptide that stimulates the smooth muscle of the uterus producing contractions (4). The oxytocin receptor (OTR) belongs to the G-protein coupled receptor superfamily, which is located throughout the body. During pregnancy the expression of OTRs in the myometrium increases, particularly at the onset of labour.
James, Kareena and baby Jordan reunite with paramedics Warren Souter and Jaclyn Quixley.
Three mothers were treated with oxytocin by Townsville paramedics during February 2017. Recent case: Kareena is a 25-year-old G2P2 who presents in labour at 39 weeks gestation. She presents lying in the shower ready to birth her baby. The urge to push is obvious and the baby’s head is crowning. Kareena has enjoyed an uncomplicated pregnancy. A normal cephalic delivery progressed without complication. The baby girl cried immediately and was active, she scored full marks for her APGAR. Kareena feels another contraction coming on. Permission is sought and given by Kareena to receive intramuscular oxytocin. She is very appreciative that the risk of primary post-partum bleeding will be minimised.
Receptor activation triggers a number of intracellular signalling cascades to stimulate smooth muscle contraction by increasing intracellular contractions of calcium in the uterine myometrial tissue (5). Due to the poor oral bioavailability Synthetic oxytocin is administered IM or IV. Oxytocin indications for use by paramedics include active management of the third stage of labour (following confirmed delivery of all foetuses) and preventions and/or treatment of primary postpartum haemorrhage at a dose of 10 international units via intramuscular injection. The common side effects of oxytocin include nausea, vomiting, tachycardia and bradycardia.
Warren and Jaclyn admire baby Jordan that they helped deliver. 1. Su, L., Chong, Y., & Samuel, M. (2007) Oxytocin agonists for preventing postpartum haemorrhage. Cochran Database of Systematic Reviews, 2007(3). DOI: 10.1002/14651858. CD005457.pub2
3. World Health Organisation (WHO). (2012). WHO recommendations for the prevention and treatment of postpartum haemorrhage. [Accessed online 3 February 2017] from http://apps.who.int/iris/bitstream/10665/75411/1/9789241548502_eng.pdf
2. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. (2016). Management of Postpartum Haemorrhage (PPH). [Accessed online 3 February 2017 from https://www.ranzcog.edu.au/RANZCOG_SITE/media/RANZCOGMEDIA/ Women’s%20Health/Statement%20and%20guidelines/Clinical-Obstetrics/ Management-of-PostpartumHaemorrhage-C-Obs-43-Amended-February-2016.pdf?ext=. pdf
4. Prevost, M., Zelkowitx, R., Tulandi, T., Hayton, B., Feeley, N., Carter, C. S., . . . Gold, I. (2014). Oxytocin in Pregnancy and the Postpartum: Relations to Labor and Its Management. Frontiers in Public Health. [Accessed online xx February 2017] from https://www.ncbi.nlm.nih.gov/pubmed/24479112 5. Oxytocin. MIMS online (2017). [Accessed online 3 February 2017] from https://www.mimsonline.com.au/Search/Search.aspx . 6. Arrowsmith, S., & Wray, S. (2014). Oxytocin: Its mechanism of Action and Receptor Signalling in the Myometrium. Journal of Neuroendocinology, 26, 356-369.
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Tuberculosis By Fiona Randall, Clinical Nurse Consultant – Infection Control
Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis bacteria.[1, 2] TB usually affects the lungs, but can also affect other parts of the body, such as the brain, the kidneys or the spine.[3]
TB is well controlled in Queensland with around 150 to 200 new cases every year.[4] Of these, in 2013-2014 only 3 per cent of the cases reported in Queensland were multi-drug resistant (MDRTB) and there were no reported cases of extensively drug resistant (XDR) TB).[5, 6]
High risk populations:
Signs and Symptoms of TB
The health services that report higher numbers of TB cases are Metro South, Metro North, Cairns and Hinterland, the Gold Coast and Central Queensland.
TB usually starts off slowly, and sometimes the disease can progress for some time before TB is suspected.[3] The general symptoms of TB disease include: • • • • • •
Unexplained weight loss Loss of appetite Night sweats Fevers Sweating at night Fatigue, always feeling tired [1, 2]
Symptoms of TB of the lungs include: • • •
Coughing (lasting for more than two or three weeks) Coughing up blood Chest Pain [1, 2]
Other symptoms depend on the part of the body that is affected.[3]
The majority of TB notifications come from Australia’s overseas-born population (Table 1). The other group of people who are at increased risk of TB infection are Indigenous Australians.
How is TB spread? TB of the lungs (also known as Pulmonary TB) is spread by micro droplets from an infectious person when they laugh, speak, cough or sneeze into the air. If another person breathes in the bacteria, they may become infected. This does not always mean the person will become unwell.[1-3] A healthy immune system may kill the bacteria immediately before any illness occurs[1, 2]; or in some cases, latent disease may occur [3]. People who have TB in other areas of the body (also known as Extra-Pulmonary TB), and not the lungs, are generally not infectious to others unless there is a draining tuberculous wound.[3]
continued >>
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TUBERCULOSIS
What is latent TB? Not all people who become infected will display symptoms of disease: live, but inactive bacteria will be present in the person. This is known as latent TB. People with latent disease have no signs of infection, their chest x-rays are normal, their sputum tests are negative and they are NOT infectious to others.[1-3] The only way to tell if a person has latent TB infection is by a TST (Tuberculin Skin Test i.e. Mantoux test) or blood test indicating an immune response to Mycobacterium tuberculosis.[3] Without treatment, approximately 10 per cent of people with latent TB will develop active TB in their lifetime. [3, 7] The risk of reactivation is much higher for people with immunocompromise. Reactivation of latent TB usually occurs within a couple of years of the person first becoming infected, but sometimes can occur many years later.[3, 8] People with latent TB can be successfully treated to prevent reactivation; however this may not be possible if the infection is caused by MDR TB or XDR TB.[3, 7]
Infectious Period An infected person is infectious to others from the onset of symptoms.[9] Although treatment courses for TB last for many months, if there is no drug resistance, the risk of transmitting TB is reduced within days to two weeks after commencement of correct TB treatment.[9]
Who is at risk of Infection? People who spend long periods of time or have repeated contact with a person who is infectious are most at risk of infection. For example, around 5 to 10 per cent of household contacts will become infected.[9]
Why don’t all health care workers get vaccinated against TB?
Table 1: Incidence of TB notifications in Australia by population group
The Bacille Calmette-Guerin (BCG) vaccine is not very effective at preventing TB infection. Its main use is decreasing the risk of serious illness in children in areas with a high prevalence of TB[9]. In Australia, the BCG vaccine is recommended for high risk groups such as Aboriginal and Torres Strait Islander neonates living in areas with high incidence of TB; children travelling to countries with high rates of TB or neonates born to a family with a history of leprosy.[9, 10] Annual TB screening is recommended for officers who provide clinical care in LASNs where there is a high incidence of TB in the community (Table 2). For example Cape York & Torres Straight – Northern Peninsula, West Moreton, Cairns and Hinterland, Metro South and Metro North LASNs.[10]
Population group
2012 rate per 100,000
2013 rate per 100,000
All Australians
5.8
5.5
People born overseas
19.5
18.4
Australian Born
4.5
4.6
Indigenous Australian Born Non-
0.7
Indigenous Reference: Toms, Stapledon, Waring, Douglas and the National Advisory Committee for the Communicable Disease Network Australia and the Australian Mycobacterium Reference Laboratory Network (2015). Tuberculosis Notifications in Australia 2012 and 2013.
The vaccine may be considered for health care workers who are at high risk of exposure to drug resistant TB.[9]
What kind of masks should be worn to prevent transmission of tuberculosis? Staff should wear a P2 particulate filter mask when transporting a patient with known or suspected pulmonary TB. If able to be tolerated, the patient should wear a surgical mask.[10]
What needs to be done if QAS officers are informed a patient has TB after they have treated/ transported the patient? The incident should be reported as soon as possible to the OIC. Complete a SHE biological hazard incident report and include information regarding the length of time in contact with the patient; what type of masks (if any) were worn either by the officers or the patient; whether or not the patient was coughing.[10] The OIC will liaise with the local Hospital and Health Service and the Tuberculosis Control Centre to confirm the patient’s diagnosis and seek advice regarding the level of infectivity of the patient and whether or not the affected officers require follow up TB screening.
0.8
Summary
Table 2: 2016 Queensland notification of TB Hospital and Health Service
Total cases
Total Population
Cases per 100,000
Torres & Cape
2
25,498
7.8
West Moreton
15
211,950
7.1
Cairns & Hinterland
13
247,380
5.3
Metro South
53
1,087,222
4.9
Metro North
39
941,181
4.1
Mackay
6
181,977
3.3
Townsville
8
241,318
3.3
Gold Coast
18
560,044
3.2
North West
1
32,615
3
Central Queensland
6
227,135
2.6
Darling Downs
6
276,587
2.2
Sunshine Coast
5
384,114
1.3
Wide Bay
2
263,754
0.8
Central West
0
12428
0
South West
0
26,722
0
Data taken from: Queensland Health Notifiable Conditions Annual Report and the Hospital Health Service population health status profiles.
Consider TB in Indigenous communities and immigrants from countries with a high incidence of TB. If you suspect TB or if a patient is TB positive: • • • • •
Ask the patient to wear a surgical mask Follow airborne precautions and wear an N95/duck billed mask Annual TB screening is recommend in LASNs where there is a high incidence of TB. Testing is provided free of charge by the TB Control Service Inform your OIC if you are advised that you have been exposed to a patient with TB The QAS Infection Control Manual s a great resource for operational staff
1. Communicable Disease Prevention and Control Unit, D.o.H.a.H.S. Tuberculosis - The facts. 2010 13 February 2017]; Available from: https://www2.health.vic.gov.au/Api/downloadmedia/%7BB9E6FB0F-D3B6-47C2-A163-6E150A5A628C%7D. 2.
Queensland Health. Tuberculosis Disease. 2013 [cited 2017 13 February]; Available from: https://www.health.qld.gov.au/__data/assets/pdf_file/0022/442543/fsheet-1-english.pdf.
3. Centers for Disease Control and Prevention, Core Curriculum on Tuberculosis: What the Clinician Should Know, V.H. National Center for HIV/AIDS, STD, and TB Prevention, Editor. 2013, Department of Health and Human Services USA: Atlanta. 4. Queensland Health. Notifiable Conditions Annual Reporting. 2017 [cited 2017 13 February]; Available from: https://www.health.qld.gov.au/clinical-practice/guidelines-procedures/diseases-infection/surveillance/reports/notifiable/annual. 5.
Toms, C., et al., Tuberculosis Notifications in Australia, 2012 and 2013. Communicable Diseases Intelligence, 2015. 39 (2 - June 2015).
6.
Department of Health, Tuberculosis in Queensland, Q. Government, Editor. 2016, State of Queensland (Queensland Health).
7.
World Health Organization, Guidelines on the management of latent tuberculosis infection. 2015, World Health Organization: Geneva.
8.
Communicable Diseases Branch, Guideline: Management of Latent Tuberculosis in Adults, Department of Health, Editor. 2016, State of Queensland (Queensland Health): Brisbane, Australia.
9.
Communicable Diseases Network Australia, CDNA National Guidelines for the Public Health management of TB. 2015, Commonwealth of Australia: Canberra, Australia.
10. Queensland Ambulance Service, Infection Control Framework Version 2.0, D.o. Health, Editor. 2016, State of Queensland (Queensland Health): Brisbane, Australia.
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New HARU paramedics hit the road The new High Acuity Response Unit (HARU) paramedics recently underwent induction training in Brisbane.
scenarios, where the tenets of high-quality contemporary critical care resuscitation were reinforced.
Five new Critical Care Paramedics – four for Brisbane and one for the Gold Coast – commenced a two-and-a-half week program in late January.
Each of the new HARU paramedics will commence a period of on-road mentoring over the next three months.
This initial education involved an introduction to ultrasound technology, lectures by senior clinicians and procedural skill training at the Queensland University of Technology Medical Engineering Research Facility, under the guidance of senior trauma surgeons and emergency physicians. Their final training involved advanced resuscitation
An important role of the HARU program is to disseminate learnings and education relating to the care of critically ill and injured patients. These paramedics are a resource for all paramedics. You will find them increasingly out and about over the next few months – please don’t be shy! Also, look out for the reintroduction of HARU trauma clinical nights later in the year.
Trauma Week tests interns to the limit Critical Care Paramedics (CCPs) attend the most serious accidents, medical emergencies and provide support and leadership to ensure the emergency pre-hospital care provided to Queenslanders is of the highest standard.
The road too often travelled Motorcycle enthusiast David Martin found himself travelling on the road to recovery after suffering a stroke suddenly last year. For David and others like him, it is an unfortunate reality every 10 minutes in Australia.
“I took my recovery into my own hands and started by walking to and from the shops to have my meals and help my rehabilitation. I lost 13 kilos in just a few weeks,” he said.
Just after 2pm on April 26, paramedics Kate Olive and Shane Herbel responded to reports that a man had collapsed at a bank in Capalaba.
“I am still continuing speech therapy to work on my cheek muscles and improve a slur.”
Kate recalls finding David on the ground and requiring the physical support of bystanders to hold him up. “He was clearly exhibiting the signs of a stroke with no muscle movement, slurred speech, sluggish pupils and drooping of the face. His left side was completely catatonic,” she said. Wasting no time and saving valuable minutes, Kate and Shane activated the Stroke Pathway and transported David in a serious condition to the Princess Alexandra Hospital. He arrived at the facility within an hour of his collapse. After spending a few days in the hospital’s Intensive Care Unit, David was moved to the stroke ward where he would spend close to two months continuing to recover before being discharged.
Unrecognisable as the man Kate treated last April, the pair recently reunited at Capalaba Ambulance Station where David also hopes to catch up with Shane again soon. “I have complete admiration for Kate and the next generation of paramedics,” David said. “I’m a product of what you’ve done, what you do for people.” The future is bright for David who looks forward to teaching his 10-year-old granddaughter how to ride a motorbike and his small steps to better health have led to big travel plans abroad. Just nine months after his stroke, David recently spent four weeks traveling across Asia. He has come a long way and says he owes his thanks to Kate and Shane.
So naturally, the pathway to upskilling from an Advanced Care Paramedic (ACP) to a CCP is no easy feat. Thirteen CCP recruits were recently tested to their limits in Brisbane during Trauma Week training and assessments at Whyte Island and Mount Coot-tha. The week marked a significant milestone in the program and required them to demonstrate leadership, high-level care and skills to coordinate and manage high-fidelity medical and trauma cases in difficult environments.
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Fast facts: The recruits hailed from around the state including Cairns, Darling Downs, Mackay, West Moreton and Wide Bay. The participants now enter the final stages of their training program and will be striving hard to obtain what is a much sought-after qualification.
•
QAS responded to more than 12,000 stroke incidents last year
•
A majority of the incidents occurred in Metro North, Metro South, Gold Coast and Sunshine Coast LASNs
•
Stroke is one of Australia’s biggest killers and a leading cause of disability
•
1 in 6 people will have a stroke in their lifetime
•
65 per cent of people living with stroke also suffer a disability that impedes their ability to carry out daily activities unassisted
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Watching over the heartland In the heart of Queensland, at the gateway between our tropical north and southern regions, a dedicated team keeps watch over a vast tract of countryside that straddles the Tropic of Capricorn.
Notable recent cases With a response area of 618,000 square kilometres – which equates to more than 36 per cent of the state – the team at the Rockhampton Operations Centre manages an incredible range of emergency incidents on any given day. From a shark attack on the reef, to a mine collapse in western Queensland or a truck rollover on the Bruce Highway, the scope of cases dealt with by the Rocky crew is as diverse as the geography of its response area, which stretches from the Whitsundays to the Outback. Operations Centre Manager Mindy Thomas is proud of her team and its performance. “It’s a very large response area that covers 50 QAS stations and 15 Primary Health Centres and First Responder Groups,” Mindy told QAS Insight.
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“That means our Emergency Medical Dispatchers are responsible for coordinating approximately 130 paramedics across a 24-hour period.
“This means we often are dealing with protracted incidents that require aero-medical resourcing or maritime transport to support our paramedic crews.
“In January this year we received 4,772 Triple Zero calls, which is an average of 155 per day. We exceeded our KPI by answering 92 per cent of those calls within 10 seconds.
“On any given day we could be responding to an incident on a cattle property, a rescue out on the islands or the reef, a mine collapse or a crash on the highway.
“In addition to that call volume, we took 2,041 non-urgent 13 12 33 calls, 476 calls from Queensland Police and 196 from Queensland Fire and Emergency Services.” Mindy said the Rockhampton Operations Centre had a total staffing of 45, including casuals and part-time employees. “Our case load consists of a combination of trauma and medical cases, however when you take into account the size of the response area, there can be significant distances between our patients and the closest ambulance stations,” she said.
“We also have plenty of travellers, including backpackers and the grey nomads in their caravans, coming through the region, as well as people who go out fossicking in the gem fields. “That can often mean we’re receiving calls from people who are not exactly sure where they are and that can be quite challenging for us. “But we have a really good team here in Rockhampton and we pride ourselves on maintaining high standards of customer service and of staff behaviour. “I absolutely love working here. I really enjoy the role and I love living in Central Queensland.”
Lotus Creek 27/11/2016
Hamilton Island 10/03/2016
Male in 50s rolled on by a beast, fractured leg, located 150km from the closest ambulance station. Helicopter response utilised to transport the patient in a stable condition to Rockhampton Base Hospital
Two golf buggies collided and rolled – seven patients (four adults and three children) five critical and two serious. A single ACP was on scene first. Three helicopters (Rockhampton, Mackay and Townsville) and Water Police transported the patients to the mainland – Rescue Helicopters 8521 and 8412 both transported one patient to Townsville Hospital, R300 transported two patients to Mackay Base Hospital and Water Police transported four patients to the mainland where QAS continued by road to Proserpine Hospital
Yeppoon 02/01/2016 Male in 30s bitten by shark, partial de-gloving of one hand. Co-ordinated response with Coast Guard to transport patient from approximately 30mins off shore to the marina, where crews and the helicopter met. Patient subsequently transported by road to Rockhampton Base Hospital after technical issues with helicopter
Agnes Water 10/01/2017 Plane Crash with four patients – one CPR in progress and three with critical injuries in an inaccessible location. Responded two helicopters and two road crews, and able to utilise community resources to gain access to scene. LARC-1770 Environmental Tours operates two Lighter Amphibious Resupply Cargo vessels with a capacity of 32 passengers each. These fascinating vessels, equally at home on land or sea were originally built for military use, predominantly for transporting troops and equipment in and around coastal areas. Rescue Helicopter 8422 transported one patient to Bundaberg Base Hospital and Rescue Helicopter 8300 transported two patients to Rockhampton Base Hospital
Opalton 22/10/2016 Mine collapse on private property 150km south of Winton. Approximately a six-hour response time to access mine site, unable to task helicopter due to insufficient location information. No GPS coordinates available. Patient declared deceased on scene
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“It was during that time that I started to become really interested in the EMD role, which back then still had the old ‘Communications Officer’ title. “After a few months of thinking about it I decided to bite the bullet and apply. It was the best decision I ever made. “I was successful in gaining a role and started in AFCOM (Ambulance and Fire Communications) at Spring Hill. “Initially I found the job as challenging as heck. The level of expectation I felt from myself and from the people I knew in the organisation to do well was intense. “But that pressure really helped me in the end, because you need to be able to deal with pressure to do the job effectively.” The team from Spring Hill transitioned across to the new Brisbane Operations Centre at Kedron in March 2012. “That was a big change for us, coming across from the room at Spring Hill. I was fortunate to get opportunities to relieve in Professional Development Officer, Operation Centre Supervisor and Quality Assurance roles to gain more experience,” she said.
Profile:
Mindy Thomas You’ll never know if you never ask. It’s a saying that rings true for many, and certainly for Rockhampton Operations Centre Manager Mindy Thomas. One day, while working as an administration officer for the National Native Title Association, Mindy noticed a recruitment advertisement for Indigenous firefighters. “I didn’t want to be a firefighter, but I thought maybe they needed some admin support, so I emailed them and asked if there were any roles available,” Mindy told QAS Insight. “Lucky for me they were actually looking for someone and that’s how I first joined the Department of Emergency Services back in 2001.”
Mindy formed part of the department’s Indigenous Employment Unit, which had been tasked with encouraging more Indigenous Queenslanders to join the fire service. It was the start of a 16-year journey that has culminated in a dream job back in her home community of Central Queensland. “Over the next few years I started to branch out and work on mainstream recruitment across all of the services – fire, ambulance and emergency management,” she said. “From 2004 to 2008 I focused specifically on QAS recruitment, including working on the push to recruit paramedics from interstate and overseas, as well as student paramedics and emergency medical dispatchers.
“In 2015, the Rockhampton OCM role came up and I saw that as a great professional development opportunity. Being back in Central Queensland and closer to my family was also important to me.
“Our purpose was not protesting against the Olympics being held, it was about highlighting the plight of Indigenous people. It was a really interesting time and a great experience. “My Indigenous heritage has been a very important focus for me during my career. My dad’s brother was Tiga Bayles, and my grandmother was Maureen Watson, who was a poet and Indigenous activist. “My family has always been strongly involved in politics and advocating for Indigenous people. “I believe in working hard for what you get – in really doing things off your own bat and not waiting for handouts. “To me it’s really important to earn things on merit. You want to be the best person for the role, regardless of whether you’re Indigenous or not.” Mindy is also the newly elected secretary of the Queensland Ambulance Service Legacy Scheme Incorporated, a charitable organisation that provides a range of services to Queensland Ambulance Service families who have suffered the loss of a loved one. Should an ambulance legacy member die, Queensland Ambulance Service Legacy is there to help the spouse and children who are left behind. “The Queensland Ambulance Legacy scheme strives to ensure that no surviving spouse, partner or child will ever feel forgotten,” Mindy said.
“My mum and brother are in Springsure and my sister and uncle are in Theodore.” Mindy said her family has been a strong influence throughout her working career, which started with the 98.9FM Murri Country Radio Station under the guidance of legendary Indigenous broadcaster and land rights campaigner Tiga Bayles. “Tiga was my uncle and he was the general manager there. The experience at 98.9FM led me into one of the most rewarding experiences of my career, when I worked for the National Indigenous Media Association in the lead up to the Sydney Olympics,” Mindy said. “We followed Indigenous torch bearers during the Olympic torch relay as well as covering the Olympic events and cultural festivities. We also did a lot of work with First Peoples journalists from other nations.
For more information on joining or supporting QAS Legacy visit www.qaslegacy.org 34 QAS Insight
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Volunteers at the heart of the community It has been said that there’s nothing stronger than the heart of a volunteer. It’s a saying that rings true for our Local Ambulance Committee volunteers. Volunteers in Metro South have been working with staff at Lady Cilento Children’s Hospital to take our CPR Awareness Program to parents, carers and family members of sick kids. Close to 80 people have participated in seven sessions held at the facility since July last year. The sessions initially started in an effort to equip parents and carers with a fundamental skill that can turn the worst scenarios into positive outcomes and has since grown into much, much more.
Hold the phone,
meet Toowoomba’s newest recruits They help deliver paramedics to people in need but five Toowoomba Emergency Medical Dispatchers recently shared in their own special deliveries. Cat Bobedyk, Dale Camilleri, Andrea Canning, Kimberley Sheather and Jane Storer made headlines last year when they shared their story of expecting together. Twelve months on there are now five new faces in the Toowoomba Operations Centre: Ethan (15 months), Oscar (15 months), Emily (14 months), Sahara (12 months) and Freddie (nine months). First-time-mum Cat Bobedyk had not long qualified as an Emergency Medical Dispatcher before starting maternity leave and said during pregnancy and in the months since, management was supportive of anything that she or the group needed. “Work has been really supportive of everyone returning and the group is very supportive of each other,” she said. “It’s great having that support and everyone is empathetic to what everyone else might be going through, whether it is lack of sleep at night or just coming back on shift work again.”
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Four of the five women have returned to work including Dale, who in a recent Triple Zero (000) call, talked a couple through the delivery of their own baby girl before paramedics arrived. She has also been paired with Cat and is helping her to find her feet as she juggles newfound motherhood and refreshes her skillset. The group tries to get together with their bubs at least once a month. “Sometimes we try to get out for ice cream and waffles when we get the chance,” she said. There has been just one change since returning to work – ‘it’s louder’. Although the jury is still out on whether ‘there’s something in the water’, the Queensland Department of Justice and Attorney-General reported that Toowoomba had the highest birth rate of any locality in the state last year with 1,467 new arrivals.
To find information on employee entitlements regarding parental leave and breastfeeding at work, visit the HR policies and procedures page on the QAS portal.
Metro South CPR Awareness Leader, June Nielsen, said the sessions could be confronting but overall participants had embraced the opportunity to learn. “You have to remember that some of the people participating in these sessions have just left the bedside of their child or grandchild,” she said.
“The session can be very confronting but having the opportunity to build confidence around performing CPR on an infant or child is something that we have found is greatly appreciated.” The sessions have attracted interest not only from family members of patients at the hospital, but also the broader community. Its success has also had a positive impact on the number of community groups seeking to undertake first aid training sessions. Paramedics from Beaudesert, Springwood and Woodridge Stations have been lending their expertise to the joint initiative to provide an additional soundboard for clinical questions, which has enhanced the experience for participants. With the support of Children’s Health Queensland and the Lady Cilento Children’s Hospital, the sessions have become a regular service offered at the facility.
QAS signs Statement of Commitment to Reconciliation Commissioner Russell Bowles and Director-General Michael Walsh signed the fourth Queensland Health Statement of Commitment to Reconciliation on December 19, 2016. The statement seeks to recognise Aboriginal and Torres Strait Islander people as Traditional Custodians; acknowledge the diversity of Aboriginal and Torres Strait Islander people and cultures; and acknowledge the impacts of past government policies. It reiterates the Queensland Government’s commitment towards closing the gap in life expectancy and halving the gap in child mortality, and articulates that all Queensland Health staff have responsibilities to assist in achieving those commitments.
As employees each of us is expected to acknowledge, understand and respond to the following statements in our everyday work practices: • •
•
•
•
improving Aboriginal and Torres Strait Islander people's health is everyone's business; all Queensland Health staff are bound by the Queensland Government commitment to close the gap in health inequities between Aboriginal and Torres Strait Islander people and other Queenslanders; services must be culturally sensitive and responsive to the needs of Aboriginal and Torres Strait Islander people; we acknowledge and respect the diversity in Aboriginal and Torres Strait Islander people and cultures and their right to equitable, accessible and quality health care; and cultural capability, just like clinical capability, is an ongoing journey of continuous individual learning and organisational improvement, in order to ensure best practice in health service delivery. You can view the full statement online at www.health.qld.gov.au/atsihealth/reconciliation
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Drew with other members of the Queensland Public Service LGBTIQ+ Steering Committee at their first meeting.
It’s a matter of Pride for QAS A need for education, awareness and support has led to West Moreton Chief Superintendent Drew Hebbron becoming a champion for inclusivity and diversity. Drew has been appointed as the Chair of the Queensland Public Service Lesbian, Gay, Bisexual, Transgender, Intersex and Queer+ (LGBTIQ+) Steering Committee. It is a new government initiative with representatives from across the public service. The committee is sponsored by the Public Service Commission and a group called the Inclusivity Champions of Change, which consists of the DirectorsGeneral from the Department of the Premier and Cabinet; the Public Service Commission; Queensland Health; Child Safety, Communities and Disability Services; and Water and Energy. The committee was formed to provide high-level insight and strategic direction to the public service on fostering inclusive workplace cultures, as well as to provide policy direction and advice to government agencies wanting to establish LGBTIQ+ networks within their agencies. There is a significant number of people working across government that aren’t bringing their ‘whole selves’ to work and Drew said this was something that the steering committee wanted to see change. “They’re still coming to work and not feeling comfortable about their sexuality or gender – this is particularly true of people who identify as transgender or intersex. They feel as though it’s still not safe to be themselves, or are unsure how people will react,” he said.
“The idea of the steering committee is to remove that facet from workplace culture to ensure that everyone working for government – especially if they are in more remote areas of Queensland – can feel as though they have support and that the people that they work with will understand the nature of their diverse gender or sexuality so that they can feel safe and be themselves. “Being able to feel safe and be yourself has shown to improve happiness, productivity and workplace loyalty. “The negative impacts of not being able to be yourself at work are depression and other mental illness, high rates of employee turnover, loss of productivity and a negative workplace culture.” It has been an interesting journey for Drew who says his own perceptions have been challenged in recent times. “I didn’t understand the LGBTIQ+ acronym as well as I should. I understood the ‘G’ because that applies to me, but I have been quite blinkered to the rest,” he said. “I hadn’t really considered everybody else’s experience or journey, simply because mine has been very easy. I assumed in some ways that everybody else’s would be the same, which of course they are not.
“We deal with patients from all of these communities already so of course they are part of our workforce. It’s about understanding them better and treating them the same,” he said. With the support of Commissioner Russell Bowles and Deputy Commissioner Dee Taylor-Dutton, Drew said the internal focus was to work towards establishing a QAS LGBTIQ+ network that included allies. “Staff who wish to be an ‘ally’ will receive education in understanding the nature and issues encountered by LBGTIQ+ people, the things that you should and shouldn’t do, and provide an opportunity for those who are confident and comfortable to step forward as champions of workplace inclusion,” he said. “As we go forward, we will hopefully issue these staff members with lanyards or other visual signs that they are a person that you can talk to, a safe person. “We really want to generate the discussions which presently aren’t being had, and through those discussions people will become more comfortable. Because until you talk about it, it’s all very uncomfortable and that was one of the things that I too have found.” In the next 12 months, Drew hopes to see significant work undertaken to establish a QAS LGBTIQ+ network and he wants to hear from you.
“At the moment we are in the very early stages of scoping out what we want to do, but it’s about you and what you want,” he said. “A network would be an ideal outcome because it creates a place for everyone to go and communicate. If you have a question, you can go to the network. If you want to be part of the network, you can go to the network. If you are uncertain about your sexuality and you want to talk to someone, you can go to the network.” It is also hoped that a proposed LGBTIQ+ network would utilise and link in with existing services such as the Priority One LGBTIQ support network counselling line. It would also co-ordinate participation in local events across the state. “The work won’t happen overnight, but I also want see us become more organised, so that when we do participate in pride marches across the state or Wear it Purple Day, it is done in a meaningful and organised way that’s reflective of how seriously we take these events and what they symbolise,” he said. Pride is as much about the organisation feeling of proud about our people, as we have pride in ourselves. Have a suggestion or question for Drew? Email: Andrew.Hebbron@ambulance.qld.gov.au
“What I would like to see is everyone being able to be themselves and walk around the service across the state noticing visual signs of an inclusive workplace where we value diversity in all its facets, because we are a workforce that is representative of the community and we need to look after our people.” Mr Hebbron said paramedics regularly dealt with patients from the transgender, gay, bisexual and intersex communities. Marching alongside colleagues at the 2016 Brisbane Pride Parade.
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Insight into Emotions By John Murray, Priority One Counsellor
As ambulance staff we have to be masters of emotional flexibility. We also need emotional intelligence to sense emotionality in situations and within ourselves, and to use this emotional awareness to better inform our decision making without being overwhelmed by it.
As a species, we have survived and indeed thrived because of our emotions. Our emotions help inform us about, and keep us attached to, what is important individually and as a collective, at least in the immediate and short term.
This means that there are times when we may need to pay less attention to our internal emotional reactions in the moment in order to stay on task, while at other times (or simultaneously) we need the courage to be deeply emotionally engaged and empathic with others in order to best help them.
Fear is arguably the most powerful emotion and is clearly designed to help us identify and avoid danger, thus keeping us safe. It is a priority to keep ourselves and people and things important to us safe, hence the potency of fear and why it is often evoked by many, from advertisers to bullies and others, who want to influence our thinking or behaviour in some way.
The risk is of course that we switch off completely to our emotional experiences. There is greater demand for such emotional flexibility in the caring professions than in most others, so it is important to understand a little more about emotions and our emotional self. Our emotional states drive us to action. Emotions are the ‘supercharge’ behind much of our energy and enthusiasm.
Fear causes us to move away from and avoid situations that are perceived as potentially threatening to matters that are important to us. Yet emotional states also draw us towards matters that are important to us. Those feelings attached to love, connection or belonging are critically important to our survival.
As a species, we have survived and indeed thrived because of our emotions. Emotion can be seen as E-nergy in motion. The word is actually from French emouvoir, meaning ‘to excite’ which is itself derived from two Latin words; ex meaning ‘out of’ and movere ‘to move’.
It is these emotions that have enabled the human race to not only procreate, but to also feel connected and pull together in times of duress for the betterment of the group and thus the individual.
Whenever emotions such as excitement, enthusiasm or joy are present we have more energy to invest towards those values in our life that the emotions are resonating with – we are driven towards action.
Ambulance personnel are emotionally engaged by their work in so many different ways. Because it is important work and it has meaning and purpose, we can be enthused and excited by it. We use this emotionally driven ‘energy supercharge’ to give more, sometimes ‘over-giving’ at our own expense. Simultaneously, the very nature of our work so often demands huge amounts of emotional energy.
Whenever emotions of anger, rage or fear are present we are driven towards different types of actions, often viewed as re-actions against, in defence, in defiance, or in spite. Whatever the case, the energy in the action is emotionally fuelled and active in the immediacy of the feeling state. 40 QAS Insight
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Emotionally supporting those in acute grief, including children, is never easy and is often avoided by many. It takes real courage. It is an emotionally intelligent skill for ambulance personnel to willingly lean into this important supportive role, despite it being personally emotionally taxing. Traumatic events may remind us of the possibility that the people and things that we most value may not actually be very secure or safe, and of the possibility that they may be disrupted in seemingly random ways. Then there are the experiences of perceived unfairness and injustice that we witness, often embedded within potentially traumatic events and sometimes in the workplace itself. The anxiety of personal vulnerability and often anger are commonly triggered emotions associated with these types of experiences.
If supressed over time, the sadness or anger or vulnerability or anxiety that we may feel around certain cases or experiences may drain our emotional energy reserves. The alternative is to share these less pleasant experiences in a safe and appropriate context and allow for the associated emotions to be expressed. This may result in a healthy processing of the experience including the emotive aspects of it. If engaging in out-of-work activities that are personally meaningful and enjoyable, we are usually building emotional reserves. This can include everything from hobbies and play to sleep and relaxation; activities that provide for us a sense of calm, joy and a perception that life-is-good.
Unsupported, these emotional interactions over time can significantly deplete our emotional and physical energy reserves. Unsupported, these emotional interactions over time can significantly deplete our emotional and physical energy reserves, perhaps resulting in burn out and depressive emotional states as there is no energy for action. So how do we keep our emotional energy reserve well charged, amidst the many factors that so readily deplete it? Logically, we could take two approaches. We can minimise the draw of our emotional energies while also promoting factors that recharge our emotional energy. When minimising the draw of our emotional energies, emotional expression is important. While emotions remain unexpressed, energy is required to suppress and contain the emotion. This applies to all types of emotion. Consider your enthusiasm, excitement, or even euphoria around a case that has gone well and resulted in a really good outcome such as assisting in the delivery of a child or identifying and effectively managing a STEMI. It would require a great deal of energy to not share such life-affirming experiences along with the associated emotions. The same applies to experiences and emotions that are not so pleasant.
Engaging in these re-creational activities brings emotional experiences that help significantly to counterbalance the less pleasant experiences of life, so they re-charge our emotional battery. They help us maintain good stress buffers and are an important part of our resilience. The ability to express emotion in addition to suppressing it, depending on the context, supports the growth and resilience that just switching off to emotion doesn’t allow for. This emotional intelligence also helps to grow better relationships in the workplace and with partners and family members at home. How can I help improve my own experiences? Know that you are an emotional being and that your emotional reactions are associated with matters important to you. It is important to be aware of your emotional reactions. Let them inform you as to how best to respond, but keep them appropriately regulated as well. While you can master your emotions well, realise that expression of those emotional reactions in a safe and appropriate context is nonetheless important to your longer term health and wellbeing, to processing confronting and traumatic experiences, to maintaining good energy levels, to feeling more relaxed and to valuing and nurturing yourself. QAS Insight
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GPIP Rhys Greedy and his mentor Leslie Gough at Chermside Station.
Nursing a new career
Graduating to paramedic More than 200 Graduate Paramedic Program (GPIP) interns have recently started temporary 12-month contracts at stations across the state. But before they can find their way on road, the pathway to becoming a paramedic is a comprehensive and detailed process. Toward the end of a tertiary degree in paramedicine or dual degree in paramedicine/nursing, the application process begins for final-year students to apply for graduate internship positions within QAS.
“Several scenarios, hands-on training, manual tasking and other critical factors associated with being an Advanced Care Paramedic were delivered across a very structured period,” he said.
It includes completing an online application; undertaking a nine-hour assessment day held at the Queensland Ambulance Service Education Centre (QASEC) comprising cognitive and psychological testing, scenarios and team activities; a medical examination; and if successful upon completion of their studies, concludes with an appointment to a graduate internship position.
Now on road, Rhys and his fellow interns will complete the 42-week program marked by a progression through four milestones.
This is followed by induction training carried out over a five-week period at QASEC. Group 41 was put through their paces in December 2016, which graduate intern Rhys Greedy described as a compressed version of all practical elements undertaken during the undergraduate degree.
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Each will require the interns to rely heavily upon clinical mentorship, study and an eagerness to engage in every learning opportunity presented along the way.
Jane Hughes is a nurse after a challenge and it’s a desire to do more that’s prompted her to switch her role on the hospital ward for emergency prehospital care on road. For Rhys and many others, this won’t be their first career. He served in the Australian Army within infantry battalions in Townsville and Brisbane and in the roles of platoon signaller and as a member of the Regimental Police. Rhys describes himself as always wanting to be in a career that keeps you on your toes, arriving each day to the unknown. However, it is his experience on the other end of the medical system that drives his patientcentred focus. “Having experienced my own battle with cancer in 2009, this has certainly provided me with a high degree of empathy and wanting to personally touch base with the patients I come across on a weekly basis during their own pre-hospital treatment and transport,” he said.
“I am very much still in a student mindset and taking everything my partner and mentor is instilling into me with his magnitude of experience,” Rhys said.
Rhys is stationed at Chermside in Metro North and is three months into his year-long internship.
“The transition from student to GPIP is quite a significant one however, the program is perfectly designed for us to be shaped into the best possible paramedics that we can be.”
QAS wishes all of its new interns the best during their next phase on road and thanks all of the mentors for imparting their knowledge and skills to the future generation.
The 39-year-old Gold Coast mother-of-two started her 12-month Graduate Paramedic Program internship last month at Southport Ambulance Station and said it had already been eventful. Jane says her clinical experience as a nurse has its benefits and down sides. “The positive side has been the ability to recognise a deteriorating patient and use clinical knowledge and experience to assess them,” she said. “It’s also helped me with identifying a patient’s medications, knowing what the medications are for and the conditions they treat. “The biggest positive though has been communication. Being able to communicate with people from all walks of life to doctors, nurses and allied health professionals, has probably been the most helpful aspect so far. “On the down side, I don’t have doctors around anymore if a patient is deteriorating – it is all on me now.” Although Jane intends to maintain her nursing registration, she’s excited about the future and where her new career as a paramedic will take her.
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Keeping it in the family
Following the footsteps of her brother Warren – a Southport paramedic – Abigail’s journey has taken her from Canberra to the sunsoaked beaches of the Gold Coast. Warren is already a role model and an inspiration to Abigail, but he’s now filling the shoes of mentor as his sister finds her way onroad as a graduate paramedic at Southport station. Every day brings new challenges for the duo, but providing the best treatment for their patients isn’t one of them. “We are both professionals and have been able to separate our personal and professional relationship,” Warren said. Colleagues at Southport have been very welcoming and nicknamed Abigail, ‘Little Waz’. It’s a term of endearment from many that have worked alongside Warren for close to a decade on the coast. “No one is actually sure if she is my sister, my wife or someone who coincidentally has the same last name as me,” Warren said. Abigail describes her brother as a great mentor who is very direct and tells it how it is. “I have found he has shaped my education from his experience and I’ve found it easy to understand his point of view and continuous analogies for our treatment protocols,” she said. “I’m grateful for his attention to detail and his pride within his work.” There’s just one thing that Warren says he can’t mentor his sister in –
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becoming a better table tennis player at the station. Now on the right career path, Abigail says she is exactly where she needs to be. “I’ve tried a lot of different careers. This job wasn’t a calling that I had from a young age. I had to search for it and through life experiences my desires changed, and they changed to find this career path that I have set out on.” In her short time onroad, she has already found the most rewarding aspects of the job.
of my brother while I was also instructing a first-year student on her very first job. “The skills that I was able to implement were reinforced through two years of studying and countless scenarios practising for this very moment. “We were able to get the patient to hospital where he was rushed to the catheterisation lab. Not only did he survive, he wrote us a thank you letter for the fast service that we provided which helped to save his life.
“A highlight for me was attending my very first code 1A cardiac arrest as the primary patient care officer,” she explained.
“For me this was really rewarding to treat a patient and receive feedback for the work we had done, knowing that it changed his and his family’s life.”
“Initially we made contact with the patient and performed CPR, defibrillation and airway management under the guidance
Warren mentored Abigail until the end of March. She is now four months into her GPIP internship.
The organisation consists of an enormous talent pool of both younger and more experienced people. This is its greatest asset and I believe means the future is in safe hands. – Greg Coughlan, outgoing Executive Director of Corporate Services
Making tracks and bridging gaps He started his working career as a teenager planting pineapples in Central Queensland in the early 70s. Breaking class prejudice and transitioning from blue to white collar roles, Greg Coughlan has finished on top as an Executive Director in a world-class organisation. In retirement his focus isn’t on his achievements or the gongs received along the way. Instead, it’s about celebrating and making way for the next generation of talent.
Greg’s career began as many do, in humble beginnings. The son of a publican, he was fresh out of Rockhampton State High School and supporting himself by planting pineapples in the Capricorn Coast town of Zilzie. Before long, he moved to higher-paid work as a meat processor at the nearby Fitzroy River Abattoir. Here, where he was first exposed to industrial workplace issues, he recalls the staff were regularly on strike. continued >> QAS Insight
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MAKING TRACKS AND BRIDGING GAPS
His public service career would soon begin in 1974 when he followed a co-worker to join the railway, which promised a stable income. He began his first government role as an engine cleaner for Queensland Rail (QR). At the time, higher-grade work for an engine cleaner was to also act as a labourer. After six months, Greg went on to complete and pass the ‘fireman’s examination’ and undertook placements in Rockhampton, Gladstone, Sarina and St Lawrence. It’s a career he enjoyed for a decade before his turn in seniority, when he was appointed as a Locomotive Driver in Cloncurry. After a year he transferred to Brisbane, and a year later again, he returned to Gladstone. He developed substantially as a leader during this time, and held state and national positions as an official of the Australian Federated Union of Locomotive Enginemen (AFULE). Today it is regarded as the oldest railway union in the world.
By 1990, Greg had been appointed to the role of Senior Industrial Research and Development Officer for QR. He had navigated his way from a blue collar role to a managerial position, reportedly the first person within the organisation to do so. Being the first of its type, his appointment was even the subject of debate in parliament. Greg soon moved into the role of Manager of Operations Projects. Here he bore the heavy task of navigating the organisation through a period of significant upheaval as extensive industrial change and business reform was implemented in a move towards commercialisation and interstate expansion of the business. It was a move that would eventually lead to the privatisation of the commercial elements of QR. Although it was a difficult period during which QR’s workforce was halved, it was also filled with enormous opportunity. Greg’s unique understanding of the working conditions of the person on the frontline no doubt benefited his ability to enact real and positive change.
“Every aspect of the business from its operations, culture, skills and knowledge base were changed during this period,” he said. “As Managers, we needed to lead that change and do it sensitively and creatively while also taking our workforce with us. We were actively encouraged to bring new thinking and experiences to the workplace.” A series of additional leadership roles would follow including Manager of Train Crewing and Operations Projects, General Manager of Metropolitan Freight and Regional Operations, Manager of Workplace Relations, and General Manager of Human Resources. After 30 years of dedicated service, a sudden health scare in 2004 changed his priorities and Greg left QR to rediscover himself. Ever the workaholic, he went into consulting and founded a small business. He returned to the public service a year later, assuming executive roles with Queensland Health at a time when the organisation was in the spotlight and under public scrutiny as issues arose at Bundaberg Hospital.
Greg pictured (first row, far right) with the QR Freight Management Team in 1994.
When I started back in the 70s, I didn’t know that I was a member of the ‘public service’. Finding the right fit, a year later in 2005 he was appointed as the Executive Director of Human Resources for the Department of Emergency Services. It was later known as the Department of Community Safety. Here he remained until joining Queensland Ambulance Service as Executive Director of Corporate Services when QAS transitioned to the Department of Health in 2013. Greg helped establish a corporate services function within the new organisation and assisted in establishing new relationships and business arrangements between QAS and Queensland Health. A highlight for Greg was working alongside Commissioner Russell Bowles and his management team to put in place practices and processes that have enabled our organisation to establish a sustainable new business model. Forty-three years since paving a career for himself, Greg Coughlan is retiring and leaving behind a
Greg photographed in the Gladstone Observer in 1986 climbing aboard one of the new electric locomotives for a test run before the Premier, Sir Joh Bjelke-Petersen commissioned the Central Queensland part of the multi-million dollar project on September 6.
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very different public service to the one he joined in 1974. “When I started back in the 70s, I didn’t know that I was a member of the ‘public service’. I wasn’t asked for my point of view or consulted on anything. Life was lived by a rule book and if you breached a rule, you were quickly fined by the Discipline Clerk,” he said.
“The public service is much more integrated and engaged today and has changed significantly from the militaristic behaviours of years gone by.” In reaching the decision to call it a day, Greg utilised the example of Maroons and Broncos stalwart Corey Parker – ‘You know when the time is right’.
“For many years I never saw or met anyone who was a manager and any improvements that we wanted to make to our conditions usually only came after we took industrial action. This was our normal.
“It’s time to make way for the next generation in the organisation and enjoy life with my family and travel – just not the ‘sitting in traffic on the way to work’ kind of travel anymore,” he said.
“Starting at the bottom like I did, we never had opportunities to move from blue to white collar roles; everything was seniority based. It wasn’t until the late 80s and early 90s that we saw the introduction of a merit-based system where you could now apply and obtain any role that you were qualified to perform. I think this was probably the biggest and best change that I experienced in my working career.
“The organisation consists of an enormous talent pool of both younger and more experienced people. This is its greatest asset and I believe means the future is in safe hands. “I will miss working with talented, smart people. Particularly young people. They provide new insights and have an eagerness to learn and move forward which is something that an organisation can grow and prosper from.”
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Farewell
Departures and Appointments
David Eeles
Best wishes to the following people who are leaving us after making their valued contributions to QAS.*
We recently said farewell to David Eeles, Deputy Commissioner, Service Planning and Performance after close to 25 years of service. It follows a period of extended leave he has undertaken abroad. Before being appointed as the Deputy Commissioner in 2013, David made his start in the service as Superintendent Aerial Ambulance. During his career he undertook stints as the Assistant Commissioner in the former Northern, Far North and South East Regions, as well as working in roles within head office. David has made a significant contribution to the QAS as we know it today. This includes his work in senior operational leadership positions, as well as the development of Indigenous models of service delivery, the Demand Management Strategy, in capital works and future planning, various ICT initiatives, and leading the modernisation of our vehicles and equipment. We wish David all the best for the future and thank him for the positive impact he has left upon the service.
David earlier in his career in 1997.
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NAME
POSITION TITLE
YEARS OF SERVICE
DIVISION/LOCATION
Jacqueline Taylor
Emergency Medical Dispatcher
10
Sunshine Coast LASN
Christine Dittmann
Patient Transport Officer
12
Sunshine Coast LASN
David Panting
Patient Transport Officer
13
Metro North LASN
Rita Rumler
Patient Transport Officer
13
Sunshine Coast LASN
Lynette Healy
Paramedic
15
North West LASN
Emma Carroll
Paramedic
17
Sunshine Coast LASN
Mark Thompson
Paramedic
17
Darling Downs LASN
Peter Thomson
Paramedic
17
South West LASN
Deborah McLachlan
Paramedic
18
Metro North LASN
Jason Patterson
Officer-in-Charge
19
Mackay LASN
Debra Adler
Administration Officer
26
QCESA
Warren Saal
Paramedic
29
Darling Downs LASN
32
Sunshine Coast LASN
Valerie Mellish
Buderim Local Ambulance Committee Member
Ronald Brown
Paramedic
33
West Moreton LASN
Scott Campbell
Paramedic
33
South West LASN
Warren Selby-Jones
Paramedic
35
Sunshine Coast LASN
Ann Taggart
Workforce Planning Officer
36
Cairns and Hinterland LASN
David Hill
Executive Manager
37
Service Planning and Performance
John Foster
Patient Transport Officer
37
Metro North LASN
Bruce Chalmers
Officer-in-Charge
37
Darling Downs LASN
Ray Quirk
Patient Transport Officer
40
Metro South LASN
Movers and Shakers Congratulations are also in order to those who’ve either joined the QAS family or moved on to a new position or area.* NAME
APPOINTMENT DATE
POSITION TITLE
DIVISION/UNIT
Loretta Johnson
7/11/2016
Executive Manager
South West LASN
Michael Dawkins
14/11/2016
ICT Enterprise Architect
Assurance
Ian Tarr
21/11/2016
Director
Fleet and Equipment
Sondra Vandeleur
5/12/2016
Manager
Legal and Regulatory Services
Rachel Mitchell
12/12/2016
Executive Officer
Corporate Services
Elizabeth Dillon
12/12/2016
Manager
Management Accounting
Sarah Mohammed
26/12/2016
Executive Officer
State LASN Operations
Rebecca Taylor
9/1/2017
Manager
Clinical Education
Megan Kenyon
23/1/2017
Executive Officer
State LASN Operations
* Staff appointments and retirements are provided for the period of November 1, 2016 to February 28, 2017. The appointments list is of classification levels A07 and above and includes those who have been made permanent after acting in a position.
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Thank You QAS Your excellence and dedication to the organisation does not go unnoticed. For the months of January and February 2017 we have received a total of 84 Appreciation Letters from members of the public. This is up 10 from the same time last year. Thank you for all your hard work. Russell Bowles QAS Commissioner
Late night walk (on December 27 on Brisbane’s bayside) with a restless baby and your guys saw me and pulled up and checked to make sure everything was okay. Love your work. Scott – Perth, WA
On Boxing Day (December 26) morning my beautiful father visiting from Melbourne suffered a seizure. Upon calling the ambulance (EMD Christopher Henderson), my sister was able to give CPR to get him breathing again while I helped where possible. Your ambulance officers (Stephen Tooley, Harry Werner, Richard Kirkpatrick and a student paramedic) came within eight minutes and were angels. I just wanted to THANK YOU from the bottom of my heart that you saved my best friend’s life. You were beyond wonderful. We are so lucky to live in a country where these undercover heroes are located. To know we are 100 per cent in safe hands every time we dial Triple Zero (000) is a testament to the training and dedication of your staff on a day-to-day basis. So THANK YOU for changing lives every single day for the better. Sophie – Maroochydore
Even though I have little memory of this night, I would like to thank the officers (Gary Gavin, Florian Kuehl and Janelle White) that attended to help me with a major burn incident (on July 10). I ended up spending nearly four weeks at the Royal Brisbane and Women’s Hospital in the burns ward and am now at home and recovering well. If it wasn't for you guys, I wouldn't be progressing as well as I am. Joanne – Branyan
Thank you, thank you, thank you. I am sitting at home on my comfy couch watching a pretend show about paramedics, almost in tears at the situations they find themselves in. Pathetic I know, but I wanted you to know how much I appreciate your real world and your pain and torment at risking yourselves every day to help others. I see the unsafe environments you put yourselves in all the time and thank God there are people like yourselves to help and protect us when we need it. Please know how much we appreciate you all. Thank you, you amazing souls.
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– William Makepeace Thackeray
Just wanted to thank the Queensland Ambulance Service for their awesome first aid course, just completed as a family of four by Glenn, Bec, Jemma and Kurt. Our trainer was Maree Wein and she was wonderful. I decided to do the course as I need it for my work as a swim instructor and my husband wanted to do it after he was a witness to an accident late last year. Our son is about to get his ‘P’s so we thought that it would be great for him too and then I wondered if our daughter could do it also. I got in touch with our local Officer-in-Charge Jamie McCracken and he arranged it for us. The kids were a little apprehensive to begin with but they were surprised how much they knew from bits and pieces that they had learnt at school and actually really enjoyed it. My husband also has an Epipen so it was great for the kids to actually get to use a training one just in case! I feel confident that if by some chance an accident was to happen, we all would be able to put our newly learnt skills to use if needed. Thanks again and keep up the good work.
I was taken to hospital yesterday (January 21) via ambulance because I had a seven-minute seizure. I don’t remember the ordeal, but the two ambos (Blake Singleton and David Stearne) and the Griffith student apparently were amazing to my wife and our two children – Maya, 7 and Chloe, 1 – when I was on the floor not responsive. My wife told me that the ambos were so calm doing what they needed to do and the whole time they were talking to my kids, keeping them calm and informed. The girls apparently went from being so scared, to wanting to help. I would love to thank them for what they did for me and my family. Chris – Highland Park
Bec – Monto
Cara – Brisbane Chris and his family recently caught up with the crew on the Gold Coast to say thank you.
I just wanted to say a big thank you to your team, in particular Alex (Sheppard) and Dwayne (Simpson) who visited us (January 11) when our three-year-old son broke his arm. My son was in pain and though he didn't speak much to them, they had a truly positive impact on him. Ever since he plays ‘ambulances’ where he grabs his tool box, comes and sits down with his hand on my shoulder and says "Hi, I'm Mr. Ambulance Doctor. What's your name?" He then asks what's happened, and says, “It’s ok, I'm just going to check a few things then make you all better!" before fixing me with hammers, screwdrivers and saws! I thought he would be scared from the experience but their professionalism and kindness has made it such a positive for him. Keep up the great work, and thank you! Emmee – Fernvale
Sophie pictured with her dad during a recent visit to Melbourne following the Boxing Day incident.
Next to excellence is the appreciation of it.
Glen (far left), Bec (left), Jemma (right) and Kurt (far right) with trainer Maree Wein (centre) after completing the course.
I just wanted to express my overwhelming thanks to the wonderful ambulance officers (Jordan Grice and Andrew Speakman) from Ashgrove station who attended me on Wednesday (January 25) when I was scared, alone and weak from blood loss. You saved my life. I lost two litres of blood in all and I particularly wanted to say how incredibly sensitive and empathetic the guys were about my situation. Your professionalism meant that I didn't need to be embarrassed.
I called you today (February 20) from Adelaide, South Australia in a desperate attempt to find my best friend who has messaged me that he took a deliberate overdose because his life just fell apart. I didn't have an exact location or a registration number but you found him. I thank you with all my heart and soul, and I know his family do too. He was too far away for us to find him but you did. You were a godsend for us today. Thanks to you, he is getting the help be needed and realised it was a silly mistake. A chance he wouldn't have had without you. I'm a registered nurse and I think the job you do is incredible. You are heroes to many. Thank you Queensland Ambulance. Samantha – Adelaide, South Australia
Zoe – Ashgrove
QAS Insight
AUTUMN 2017
51