QAS
INSIGHT Spring 2016
Corporate strategy | Vaccinations | Ambulance Week
FROM THE COMMISSIONER
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IMPROVING CARE FOR PATIENTS WITH ABD
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QAS TO GET NEW EARF
2016 CAA CONFERENCE
QAS STRATEGY
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17
PTS TWIN STRETCHER VEHICLES
YOUR PERSONAL BODY ARMOUR
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KJM GRANT TAKES PARAMEDIC ON SAFARI
20 QAS Insight is published by the Queensland Ambulance Service Media and Communications Unit. October 2016 edition contributors: Michael Augustus, Michael
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ARE YOU PROTECTED?
QAS Insight | Spring 2016
COOLANGATTA 30TH ANNIVERSARY
26 Franks, Fiona Randall, Eileen Stead, Dr Colin Page, Tony Hucker, Dr Stephen Rashford, Emma Crowley, Stevie Angel, Kara Rufford, Willem Van Aswegen.
Fast Facts
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Gateway to the West
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HARU report
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QAS begins White Ribbon Accreditation
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ECG Challenge
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Closing the gap
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Townsville's go to guy
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Ambulance Week
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2016 QAS Remembrance Service and Commissioner’s Achievement Awards 32 In the media
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Thank you
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Appointments and farewells
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Cover: Officer-in-Charge Nathan Station Trish Murray and Vince Little Editor: Edda Mwangi Graphic Design: Studio 55
Minister’s Message The important work each and every QAS staff member and volunteer does can never be overstated.
is nearly complete – a clear demonstration that QAS innovation is contributing to positive patient outcomes.
On Wednesday, September 14 my Parliamentary colleagues and I joined the rest of the state in saying thank you for the work you do during Ambulance Week celebrations. Members of Parliament honed their CPR skills at a display at Parliament House just as many Queenslanders did at various station open days across the state.
This educational initiative is important for the early treatment of heart attack patients within our community.
I also had the privilege of joining ambulance officers and volunteers from across Queensland at the Remembrance Service and Commissioner’s Achievement Awards in Brisbane. It was a moving ceremony where we remembered and paid our respects to the 32 ambulance officers who have lost their lives while performing their duties. I also had the honour of joining QAS Commissioner Russell Bowles in presenting the 2016 Commissioner’s Achievement Awards, recognising the excellent work of ambulance officers and volunteers. I personally thank you all for your ongoing commitment, dedication and professionalism. The distinction with which you do your jobs was also clear during the busy winter months. As workloads increased during the busy flu season, you showed that you are always ready to meet new challenges. It’s momentum that I know you will continue to carry to the end of the year.
Using clot-busting drugs, the QAS statewide cardiac reperfusion strategy provides extensive training and support to paramedics across urban, rural, isolated and remote locations. Paramedics are supported by senior critical care paramedics and QAS doctors who provide decision support and assist ECG interpretation via a consult line where required. Time is cardiac muscle – the earlier people receive treatment for heart attacks the better the outcome, which is why this initiative is fantastic for the health of all Queenslanders. I am also pleased to say all QAS employees on operational flights will now be covered by a new Group Personal Accident Insurance policy. The policy will not be limited to flight paramedics and provides up to $3 million for serious injury or loss of life in case of an accident during operational flights. Your safety is important to us and this policy will ensure you and your family can access the help you need in case of serious injury.
QAS is also continuing play its part in improving the overall health system.
Hon. Cameron Dick MP
I am delighted that the rollout of decision-supported thrombolysis training to all Queensland paramedics
Minister for Health Minister for Ambulance Services
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From the Commissioner As our state’s ambulance service, we are trusted to look to the future to ensure we remain capable of delivering timely, quality care to our patients and a growing Queensland community. The Queensland Ambulance Service Strategy 2016-2021 is our roadmap to achieving this and realising our vision of ‘Excellence in Ambulance Services’. A series of roadshows on the Strategy are currently running until December and I, along with members of the senior executive, am travelling to Local Ambulance Service Networks (LASNs) discussing how each team and individual can play a part in achieving the objectives laid out in the Strategy. The roadshows started in the state’s south-east corner in September and have given us the opportunity to hear first-hand what staff think about the strategy and what you believe we can do to achieve our vision. I look forward to further hearing from all of you as the roadshow continues around the state and encourage all staff to become involved and have their say. We know that better organisational performance, continual improvement and innovation will deliver better outcomes for our community and patients, particularly in the face of these changing future demands.
Friday, October 16. More than 200 QAS staff, family and volunteers gathered in Brisbane for the event – the first time we combined our two Brisbane-based signature Ambulance Week events into one ceremony. During the ceremony we honoured and paid our respects to the 32 officers who have lost their lives while performing their duties. I was joined by the Honourable Cameron Dick MP, Minister for Health and Minister for Ambulance Services, to present the 2016 Commissioner’s Achievement Awards as we celebrated the excellent work of QAS staff and volunteers. Congratulations to all award recipients on the day and those who received awards across the state in the course of Ambulance Week. I am honoured to be Commissioner, and I am immensely proud of the work that each and every one of you does. Thank you to all staff who have taken the time to complete the White Ribbon Workplace Accreditation Program survey. QAS, along with 12 other public sector agencies, is undertaking the accreditation program to further support employees affected by Domestic and Family Violence (DFV). The program accredits workplaces taking active steps to prevent and respond to DFV, with a particular emphasis on violence against women. Participating in this program will help us to better recognise, prevent and respond to violence and to promote respectful, safe and inclusive workplace cultures and strengthen support for our people. Time is running out to complete the survey. I encourage those among you who haven’t yet completed it to do so by October 14, 2016.
The Strategy provides measurable outcomes that address our changing environment and again, I encourage all staff to review it. I’d also like to thank everyone involved in making this year’s Ambulance Week in September a success. It was impressive seeing the range of community events and CPR training sessions across the state that highlighted the professional, community-oriented service we have. The week culminated in the 2016 QAS Remembrance Service and Commissioner’s Achievement Awards on
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QAS Insight | Spring 2016
Russell Bowles QAS Commissioner
Are you protected?
By Fiona Randall: Clinical Nurse Consultant – Infection Control and Nurse Immu by Fiona Randall Clinical Nurse Consultant – Infection Control and Nurse Immuniser
Do you have a documented history of vaccination for:
or
Do you have a documented copy of pathology results indicating:
Hepatitis B x 3 vaccines
Hepatitis B antibodies
MMR x 2 vaccines
Measles +ve IgG
Varicella x 1 vaccine
Mumps +ve IgG
Pertussis x 1 vaccine (every 10 years)
Rubella +ve IgG Varicella +ve IgG
Influenza x 1 vaccine (annually) 5
Are you protected? (cont.) Did you know that paramedics are at high risk of acquiring and transmitting vaccine preventable diseases such as Hepatitis B, Measles, Mumps, Rubella, Varicella (chickenpox) Pertussis (whooping cough) and Influenza? This risk is high because paramedics often provide care for infectious patients in an enclosed environment before the patient is diagnosed with an infectious disease.
Vaccination is the safest and most reliable method for protecting you and your patients from these diseases. Don’t assume that you are fully vaccinated. Healthcare workers are often unaware that they are not fully protected from vaccine preventable diseases. A recent Australian study indicated that 49 per cent of the healthcare workers assessed required one or more of the recommended vaccinations to comply with the Australian Immunisation guidelines for healthcare workers.
QAS Officer Timothy Noonan had a single dose of MMR vaccine when he was at high school and believed he was immune to measles. Unfortunately the single dose did not provide him with adequate protection and he developed the disease following exposure to an infectious case in the community.
Paramedic Timothy Noonan
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At first, Tim’s cold-like symptoms were mild and he thought he just had a case of the “man flu”. As he was not too unwell he continued to work during this time. He was not aware he had been exposed to an infectious person and he certainly did not know that he was infectious with measles. It wasn’t long before Tim became severely unwell and required hospitalisation for measles complications. As was Tim’s experience, measles is not the mild disease that many people believe it to be. Tim’s disease was severe and it has had a lasting effect on his lungs, as well as his liver function. Tim has shared his story to help raise awareness of the importance of ensuring you are protected against measles and the other vaccine preventable diseases. He doesn’t want anyone else to go through what he has been through.
QAS Insight | Spring 2016
Paramedic Marianne Payne
Officer Marianne Payne would like you to help her protect her unborn child from vaccine preventable diseases. Marianne has been screened to ensure she is protected against Measles, Mumps, Rubella and Varicella. She will also be having a Pertussis (dTpa) booster in the last 10 weeks of her pregnancy to prevent her from developing this disease and exposing her newborn. Marianne is also relying on family, friends and colleagues to be vaccinated so her unvaccinated newborn is protected by herd immunity.
Last year paramedics were called to approximately 3000 incidents of women in labour, imminent deliveries and babies born. It is a privilege and a joy for officers like Rachel Prentice to be able to experience such a special occasion. Our paramedics want to do all that is possible to deliver these babies safely. An important part of caring for neonates and infants includes protecting them from vaccine preventable diseases such as Pertussis. To help provide a cocoon of protection for these babies, it is important for QAS paramedics to have a Pertussis (dTpa) booster vaccination every 10 years.
Paramedic Rachel Prentice (left)
Marilyn Taskis
Paramedics are often involved in treatment and transport of patients who are at high risk of serious complications, or even death from vaccine preventable disease. It is important for the QAS to protect vulnerable patients like Marilyn Taskis from transmission of infections. Marilyn normally enjoys a very busy, active lifestyle. Unfortunately, Marilyn’s age, medications and chronic diseases have impaired her immune system. This results in her being more susceptible to serious complications from vaccine preventable diseases such as influenza. Marilyn has the influenza vaccine every year, however, her impaired immune response to the vaccine may only result in short-term protection against the disease. Marilyn has to rely on her healthcare professionals and paramedics to have the annual influenza vaccine to help protect her from influenza.
REFERENCE LIST Shefer, A., Arkinson, W., Friedman, C., Kuhar, D., Mootrey, G., Bialek, S., . . . Wallace, G. (2011). Immunization of Health-Care Personnel: Recommendations of the Advisory Committee on Immunization Practices (ACIP). Centre for Disease Prevention and Control, Morbidity and Mortality Weekly Report, 60(7). Bolyard, E., Tablan, O., W., W., Pearson, M., Shapiro, C., Deitchman, S., & Committee., T. H. I. C. P. A. (1998). Guideline for infection control in health care personnel, 1998. American Journal of Infection Control, 26, 289-354. Leung, V., Harper, S., Slavin, M., Thursky, K., & Worth, L. (2014). Are they protected? Immunity to vaccine-preventable diseases in healthcare workers at an Australian hospital. Australian and New Zealand Journal of Public Health, 38(1), 83-86. doi:10.1111/1753-6405 Maltezou Helena, & Poland Gregory. (2016). Immunization of Health-Care Providers: Necessity and Public Health Policies. Healthcare, 4(3), 47. Jacobson, R., Grill, D., Oberg, A., Tosh, P., Ovsyannikova, I., & Poland, G. (2015). Profiles of influenza A/H1N1 vaccine response using hemagglutination-inhibition titers. Human Vaccines & Immunotherapeutics, 11(4), 961-969.
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Improving care for patients with Acute Behavioural Disturbance (ABD) By Dr Colin Page Clinical Toxicologist and Emergency Physician, Princess Alexandra Hospital and Tony Hucker QAS Clinical Quality and Patient Safety Director
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QAS Insight | Spring 2016
QAS is rolling out the sedative drug Droperidol this October and updating training for managing ABD patients. In many cases, sedation will be the last resort when managing patients with ABD. Whatever the cause of the patient’s agitation they are a vulnerable group and need our care. Clinical Quality and Patient Safety Director Tony Hucker spoke to Dr Colin Page — a clinical toxicologist and emergency physician from the Princess Alexandra Hospital (PAH) — about the Droperidol rollout. Colin clinically manages ABD in the emergency department at PAH and has been part of a group in Queensland and New South Wales that has conducted research in the area over the past 10 years.
Tony: You have completed some impressive research in the area of acute behavioural disturbance. What have you learnt? Colin: In the beginning we thought as emergency physicians we knew how to sedate patients who failed deescalating strategies. Our research revealed the opposite. We were taking too long to sedate and there were many instances of over sedation and under sedation. Multiple drugs, doses and routes of administration were used and there appeared to be no clear pathway to managing what is a very stressful and anxiety provoking aspect to our jobs. Researching all these aspects as well as looking at patient safety, we now 10 years later have a much better understanding of how to manage ABD. Personally I now manage ABD completely different to what I used to do. Tony: We are on a journey to improve the way we manage patients suffering acute behavioural disturbance. Our Advanced Care Paramedics up until now have sought advice before sedating patients with ABD. Can you share any handy tips or tricks that will assist officers who may have not yet had to sedate a patient with ABD? Colin: The biggest change to how I manage ABD compared to 10 years ago is I now have a very clear plan in my mind as to what to do when faced with a patient with ABD. This approach is evidenced based and encompasses both effectiveness as well as patient and staff safety. This approach is also mirrored in the new QAS ABD protocols. So no specific tips or tricks except keeping to the protocol just like you would do in providing Advanced Cardiac Life Support in a cardiac arrest situation. Tony: In the past, we sedated patients using Midazolam. What have you noticed about the way patients behave when comparing the sedative effects of Droperidol versus Midazolam?
Colin: Our research in emergency departments has shown that both agents are effective for the management of ABD and their onset of action when used intramuscularly is similar. However patients sedated with Midazolam are often over sedated (Sedation Assessment Tool (SAT) scores -2 or -3) in comparison to Droperidol and this is associated with adverse events e.g. requirement for airway support. In addition Midazolam often requires additional sedation i.e. its duration of effect is shorter than Droperidol. Early data from our QAS ABD audit is suggesting that this is also true in the prehospital situation. Tony: What advice should we give police during the restraint-sedation phase of our care? Colin: I think the police do a very good job in restraining patients with ABD. Moving solely to the intramuscular route for the administration of sedation will mean that patients will require a shorter period of restraint in comparison to the intravenous route for the administration of Droperidol. The use of physical restraint should always be kept to a minimum and de-escalation techniques should continue even after sedation has been administered. Tony: Obviously, no treatment strategy is perfect. Do you have advice for officers where sedation has not been effective? Colin: It’s important to remember that Midazolam and Droperidol are both very effective agents for ABD. However they are not perfect. The change to Droperidol should mean safer and longer sedation for patients with ABD. Monitoring for adverse effects is still very important and in a failure-to-sedate situation, calling for Critical Care Paramedic (CCP) backup will still be required. WhenCCP backup is unavailable call the QAS Consult and Advice line.
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Fast Facts!
x 1000
QAS vehicles travelled
38.94M km
over – that’s more than 1000 times the distance to the moon (15/16 FY)
Every 27 seconds
an ambulance is dispatched in Queensland* *Based on 1,132,703 responses 15/16FY, or 3,103 Daily Average
Every 42 seconds
in Queensland, an ambulance is called** **Based on 737,803 Triple Zero Calls 15/16FY, or 2,016 Daily Average 15/16FY
QAS to get new eARF A new electronic ambulance report form (eARF) for operational iPads is currently being developed. This new application will replace the existing VACIS eARF and will lead to the discontinuation of Toughbooks within QAS. The eARF is designed specifically for QAS and will streamline data entry and further enhance patient care by incorporating electronic forms including the Death and Cardiac Arrest Forms, Supported/Autonomous Fibrinolysis checklist, Supported/Autonomous pPCI checklist and the soon to be released Emergency Examination Authority (replacing the current Emergency Examination Order). To ensure the application is designed with the end user in mind, key stakeholders including paramedics, Officersin-Charge, the Medical Director and senior executives are currently being consulted on the application’s structure. It is scheduled for release as a platform later this year.
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QAS Insight | Spring 2016
Gateway to the west
Despite being one of the smallest operations centres; Toowoomba is the gateway to the west and covers a huge area including many remote and rural communities. The centre has been in operation since its formation in 1991 when we went from the Queensland Ambulance Transport Brigade (QATB) to QAS. Before the establishment of the Toowoomba Operations Centre, Triple Zero (000) calls went to the local ambulance station and they would then attend the incident themselves or send a crew. Today, 20 Emergency Medical Dispatchers (EMDs) and five Operations Centre Supervisors are responsible for the deployment and management of resources of three Local Ambulance Service Networks (LASNs). This management also involves the receipt and processing of in excess of 145 Triple Zero (000) calls per day. The three LASNs are: ▸▸ Darling Downs LASN covering an area of 88,650 square kilometres ▸▸ South West LASN covering an area of 319,870 square kilometres ▸▸ parts of West Moreton LASN.
An average of
94% Triple Zero
(000) call answering within 10 seconds
More than
145
Triple Zero (000) calls managed per day
Toowoomba Operations Centre Manager Caleb Moore said the staff at the centre have reached exceptional benchmarks in customer service with continued improvements in key performance indicators (KPIs), reaching a 94 per cent average of Triple Zero (000) call answering within 10 seconds. “They are an exceptional group of people, whose skill and ability can’t be underestimated,” Caleb said. “To do what they do, which often means being restricted on the phone, to extract information from often highly traumatised callers while sending help and giving instructions for patient care is worthy of the utmost respect and admiration. “Their strong customer focus shows they are carers to the core and often they have to make strategic decisions which are not always understood by others.” Caleb credits their continuing improvements in KPIs to their focus on customer service and delivering high-quality ambulance services. “If there is one thing the staff have responded to, it’s the realisation of the impact they have from an operation centre in Toowoomba to the communities we serve,” he said. “They really are valued and are doing a significant job in the community.”
>20:3 20 EMDs covering 3 LASNs
More than
400,000
square kilometres covered
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HARU report
By Dr Stephen Rashford, QAS Medical Director
A 25-year-old man fell from a ladder, striking his head on the concrete below. An Advanced Care Paramedic (ACP2) crew arrived eight minutes later, finding the patient semi-prone with an altered level of consciousness. A Critical Care Paramedic (CCP) arrived a few minutes after the ACPs, with the High Acuity Response Unit (HARU) already dispatched. The initial examination was as follows: ▸▸ GCS 7 (E1 V1 M5) equal movements of all limbs ▸▸ Pupils were unequal, with the left side dilated ▸▸ Boggy haematomas were present on both sides of the head ▸▸ BSL 8.5 mmol/L ▸▸ HR 50 BP 180/100 mmHg SpO2 96% Room Air ▸▸ abrasions were noted across the left chest and lateral abdomen ▸▸ an irregular respiratory pattern was present, with a rate of 24 breaths/min ▸▸ there were no palpable rib fractures and no evidence of surgical emphysema ▸▸ no bony clavicle or sternal injury was noted ▸▸ the abdominal examination was benign, with no abnormality detected ▸▸ the pelvis was symmetrical, with no external evidence of injury ▸▸ no major limb injuries were detected. The provisional diagnosis was one of severe head injury, with lateralizing signs present (dilated left pupil).
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QAS Insight | Spring 2016
The ACPs and CCP provided the following treatment: ▸▸ high flow supplementary oxygen ▸▸ soft Collar and spinal care ▸▸ intravenous access was achieved and TKVO fluids started ▸▸ the patient was then extricated and placed within the ambulance. Shortly before arrival of HARU, the patient became agitated. The CCP administered 1mg of Midazolam intravenously. The GCS reduced to 3/15 shortly thereafter. The HARU arrived shortly after the sedation was given. Re-examination after the arrival of HARU was unchanged. HARU then led the paramedics in a rapid sequence intubation (RSI) procedure – Ketamine 100 mg, Fentanyl 100 microg and Rocuronium 100mg. The endotracheal tube was passed first time, with no hypoxia or significant hypotension. The patient was ventilated to an end tidal CO2 of 30 mmHg and Hypertonic Saline was administered. The left pupil reduced in size. The patient was transferred directly to the CT scanner, bypassing the resuscitation room. The CT revealed an extensive extradural haematoma involving the vertex. A small subdural haematoma was also present. Rapid transfer to the operating theatre occurred.
Learnings 1
F alls have the highest risk of extra-axial blood collections (EDH/SDH).
2
omprehensive examination of the patient C must occur, especially looking for lateralizing neurological signs (pupil size, limb movements).
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lmost certainly the patient exhibited Cushing’s A sign associated with brain herniation – significant hypertension and bradycardia. This is ominous – expect a precipitous deterioration to occur, often preceded by a large vomit then pre-arrest.
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nti-emetics are ineffective at stopping vomiting A in this severe head injury scenario. There is no requirement for the administration of ondansetron. Detailed care of the patient care and positioning is the key to addressing the aspiration risk.
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ven small doses of Midazolam can have profound E effects and should be used with caution.
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ypoxia and Hypotension must be avoided — no H matter what the cause, whether it is due to the injury or an iatrogenic cause. They increase the mortality risk by 150-200 per cent.
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SI is a team sport, with all paramedics playing R a part. A well done RSI will improve the patient outcome incrementally. A RSI with an adverse event will significantly reduce survival chances. High performance is critical if this procedure is being performed outside the hospital setting.
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ypertonic saline was used. The evidence for H general administration for all severely head injured patients is equivocal, therefore this therapy is reserved for those patients with clinical evidence of brain herniation.
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uitable patients may be transferred directly to S the CT scanner but this requires good patient assessment, evidence of stability and a discussion with the receiving emergency physician. For isolated head injury cases, this drastically reduces time to definitive care and should be proactively sort by HARU.
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ll clinical levels should play close A attention to oxygenation, ventilation and circulatory support. These measures will reduce the effects of secondary brain injury and improve patient outcomes.
In October the QAS Medical Director, Dr Stephen Rashford, will take six months leave from the QAS to work with the London Air Ambulance (LAA). The LAA is recognised as a world-leading acute care service. Dr Rashford said “I am looking forward to working in London, being able to examine a number of novel new therapies for the treatment of critically injured patients. I am very confident that the QAS has contemporary approaches to patient care, but it is important we remain vigilant for opportunities to refine our care”. In Steve’s absence, Dr Dan Bodnar will act as Medical Director. Staff will have noticed that Dan has relieved Steve for periods of leave over the past few months. Dan is also an emergency physician, with appointments at the Lady Cilento Children’s Hospital and the Royal Brisbane and Women’s Hospital. We wish Steve a safe trip and welcome Dan for the next six months. 13
Brisban e, Australi a
r
QAS is co-hosting the 2016 Council of Ambulance Authorities (CAA) conference in Brisbane from October 19 to 20 with this year’s theme centred on leadership, learning and professional practice. QAS Commissioner Russell Bowles said the conference was an important event in the ambulance calendar that allowed different ambulance jurisdictions to come together and learn from each other.
Leadership, Learning & Professional Practice
The Co u
Octobe
and the path to paramedic registration, respectively. “Our very own Gold Coast Local Ambulance Service Network Critical Care Paramedic Peter Davidson will also feature, detailing his role in the rescue of eight sailors during the doomed 1998 Sydney to Hobart yacht race, where six sailors perished and five yachts were lost,” Russell said. “Peter recently appeared on the SBS television program Insight; and his inspirational story epitomised what it is to go above and beyond the call of duty.
“For many decades, our service has proudly partnered with the CAA to improve pre-hospital service delivery — from developing policies to conducting important in-field research, to name a few collaborations,” Russell said.
“I, and more than 250 ambulance managers from across the globe look forward to hearing from him and the many other motivational speakers featured throughout the conference.
A host of well-regarded speakers will feature, including Australian Army Soldier Corporal Mark Donaldson VC and Australian Health Practitioner Regulation Agency Chief Executive Officer Martin Fletcher, speaking on leadership
“A pre-conference meeting of the Global Resuscitation Alliance - Resuscitation Academy Masterclass will ensure the QAS remains in touch with the latest trends and research into this mainstay of our clinical practice.
“We are lucky to work alongside such a trusted and resourceful organisation and conferences like these allow us, and ambulance jurisdictions from across the globe, to come together to listen and learn from each other.”
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QAS Insight | Spring 2016
f il o nc
“Dr Freddie Lippert, CEO of Copenhagen Emergency Medical Services, renowned for his research in this area, will chair this important meeting and I’m sure there will be much we can learn from his findings.”
Venue: Rydges South Bank, Brisbane Dates: Wednesday, October 19 – Thursday, October 20
Ambulance Au t es riti ho
2016
CAA Conference
19–20
CAA
QAS begins White Ribbon accreditation
QAS has begun the process of becoming a White Ribbon Accredited Workplace. The accreditation program recognises workplaces that promote respectful, safe and inclusive workplace cultures by taking active steps to prevent and respond to domestic and family violence. An employee survey is the first step of the process and measures the organisation’s awareness of the issue of violence against women. All staff were encouraged to complete the short 5-minute survey online before Friday, October 14 to help QAS understand how we can best support our staff. All forms of violence experienced by men and women, inside and outside of our workplaces are unacceptable. QAS participation in the 15-month accreditation program demonstrates our role in creating cultural change and supporting the health, safety, and wellbeing of all our employees.
ECG Challenge by Eileen Stead QAS Senior Clinical Educator
Winter Edition Answer: Subarachnoid Haemorrhage (SAH) One hour after arrival to the ED, this patient now presents with a GCS 3 and results of non-contrast CT reveal a Grade V SAH (WFNS Scale). The patient’s condition further worsened with herniation of the brainstem and death within 18 hours of the original event. The 12 Lead ECG collected on scene revealed widespread, deep T wave inversion and a prolonged QT interval, which may occur in cases presenting with a sudden rise in intracranial pressure, as seen with a non-traumatic subarachnoid haemorrhage. Risk Factors for Subarachnoid Haemorrhage: ▸▸ Increasing age
▸▸ Heavy alcohol use
▸▸ Cocaine use
▸▸ Female gender
▸▸ Oral contraceptives,
▸▸ Diabetes Mellitus
▸▸ Hypertension
▸▸ Aneurysm characteristics
▸▸ Hypercholesterolaemia
▸▸ Smoking
▸▸ Marfan Syndrome and other connective tissue diseases
When assessing the patient with headache (particularly severe and of sudden onset), papilloedema, and vomiting, one should hold a high degree of suspicion of the presence of subarachnoid haemorrhage, especially in the cohort of patients with multiple risk factors. Interestingly, seasonal influences (peak of winter), and morning presentations (when ICP can be raised) have been documented as increasing the incidence of SAH in susceptible patients .
REFERENCE LIST Wani, A. (2016). Vices of my blood — Risk factors of subarachnoid hemorrhage. Neurology India, 64(4), 692. Retrieved from http://go.galegroup.com.libraryproxy.griffith.edu.au/ps/i. do?p=EAIM&sw=w&u=griffith&v=2.1&it=r&id=GALE%7CA458089051&sid=summon&asid=2df695947d00c33c4d423fd194ebfffa Andreasen, T. H., Bartek, J., Jiri, B., Andresen, M., Springborg, J. B., & Romner, B. (2013). Modifiable risk factors for aneurysmal subarachnoid hemorrhage. Stroke, 44(12), 3607-3612. doi:10.1161/STROKEAHA.113.001575 Dunn, L. (2002). Raised Intracranial Pressure. J Neurol Neurosurg Psychiatry, 73(Suppl 1). i23-i27 Lai, P. M., Dasenbrock, H., & Du, R. (2014). The association between meteorological parameters and aneurysmal subarachnoid hemorrhage: A nationwide analysis. PLoS One, 9(11), e112961. doi:http://dx.doi.org.libraryproxy.griffith.edu.au/10.1371/journal. pone.0112961
A look at the QAS Strategy
By Fiona Randall: Clinical Nurse Consultant – Infection Control and Nurse Immu
The Queensland Ambulance Service Strategy 2016-2021 is out and a series of roadshows are underway until December at LASNs across the state to discuss the document and what it means for each of us. The Strategy provides a game plan for our organisation and sets out how we can all play a part in our vision for ‘Excellence in Ambulance Services’. Why do we need a strategy? Queensland’s population is growing and ageing. Additionally, high levels of chronic disease, health-related risk behaviours and greater health challenges within certain areas of the community are all projected to increase demand on our health system. Addressing these future challenges requires a plan – this Strategy has been developed to provide the QAS with that plan. The Strategy is focused on ensuring that our patients continue to receive the care that they need, when they need it. It also identifies what is expected of each team and individual, and provides measurable indicators of success that we can all work towards. In developing our game plan, the Strategy also takes into account a range of different drivers including, but not limited to, government direction, Queensland Health policy, social and economic changes and our operating environment.
Our future challenges By 2026, Queensland’s population is projected to increase by one-third to over 6
million people
In Queensland today,
17.7% of the population
are people with a disability.
Of these 6 million, 1.1 million people will be aged over 65, an 83% increase on 2011 population figures By 2045, it is projected we will have more people aged over 60 than under 18 for the first time
6.9% of people on the Gold Coast are over 75 and consume 30% of our resources and capacity
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New PTS twin stretcher vehicles hit the streets The first of the new generation twin stretcher Patient Transport Services (PTS) vehicles have started to hit the streets this October. QAS is rolling out 30 of these vehicles in the 2016-17 financial year as part of the annual vehicle replacement program. These vehicles are fitted with two Stryker powered stretchers and power loaders, along with a seating capacity for up to six people including the driver. The base vehicle is a 519 Mercedes Sprinter long wheel high roof van, and includes many state-of-the-art safety features currently utilised in other Mercedes Sprinter vehicles operated by QAS. The new patient transport twin stretcher vehicles improve patient monitoring through the addition of internal mirrors and a non-recording CCTV which allows the driver to view the patients on a screen at the front of the vehicle. Other improvements in the design include the addition of a ‘Grab n Go’ style locker for easy access and access to the stair chair at the side door for enhanced ergonomics. The face-to-face limousine style seating also provides added room for managing walking patients.
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QAS Insight | Spring 2016
Your personal body armour The use of personal protective equipment (PPE) protects officers and patients from exposure to occupational hazards including infectious diseases and hazardous chemicals. The particular PPE you use will vary according to the nature of the scenario. As a minimum you should wear protective gloves and glasses for all clinical care where the risk of exposure is present. From the frontlines - by Eileen Stead It was just after midday when I was called to a male allegedly assaulted, with an altered level of consciousness. Upon our arrival the police on scene directed me and my partner to a male in his 30s lying supine near the road, on the council strip alongside. On approach I could see that the patient had extensive injuries to his face, with multiple haematomas and haemorrhaging from several open wounds. We quickly set up and while conducting my primary assessment, I leant over the patient’s face to assess his pupils. It was at this point that during exhalation the patient’s blood sprayed into the air and a droplet hit my open eye. I sat back straight away and asked my partner to assess my face to see if any blood could be seen. I then
From July 2015 to July 2016 the SHE system recorded:
13 incidents where paramedic
officers reported blood or body fluid splashes to the eye
9 incidents where paramedic officers reported blood or body fluid splashes to the mouth
Your personal protective equipment (PPE) will only help protect you if it’s worn.
proceeded to flush my eye with normal saline and flushed my eye with normal saline while my partner took over treatment of the patient. Shortly after loading the patient, we notified the Operations Centre for a supervisor to meet us at the receiving hospital to lodge the incident. When we arrived at hospital I had bloods taken. The patient, who eventually recovered, refused to consent to testing for infectious diseases, but admitted to being an IV drug user. My initial bloods returned results that were clear, and these were followed up by regular bloods during the following six months. As you can imagine, this was an exceptionally stressful time for me and my family, one that could’ve been avoided entirely if I’d been wearing protective eyewear — which was sitting in my safety kit. It wasn’t because I wasn’t informed or had only been in the job a short time – I’d been there nine years. This incident was an important example of how your life can change in the blink of an eye. Thankfully, I did not become infected with any diseases and have retold this story many, many times in the 14 years that have followed, to educate other staff so they can hopefully avoid future contamination and the months (and possibly years) of angst that follow.
What’s in my PPE kit? ▸▸ Carry-all bag ▸▸ Safety glasses or over spectacles
▸▸ Scott mask with P3 CBR filters ▸▸ 2 x ear plugs
▸▸ Sun hat
▸▸ 2 x face mask P2
▸▸ Wet weather clothing
▸▸ Safety vest
▸▸ Rescue helmet
▸▸ Disposable coveralls
▸▸ Rescue helmet storage bag
▸▸ Sunscreen/insect repellent
▸▸ Safety goggles
▸▸ Hand sanitiser
▸▸ Rescue gloves
KJM grant takes paramedic on safari With the Kenneth James McPherson (KJM) Patron’s Day grants presentation around the corner on November 8, QAS Insight had a chat with a past recipient of the development grant category about his experiences and lessons learnt. In Swahili, safari means journey and paramedic Nathan Daley’s safari took him from Cunnamulla to Tanzania in East Africa after receiving funding through the KJM Dr Peter Stephenson Overseas study grant. Nathan originally travelled to Tanzania in 2013 to complete his Masters in Public Health at James Cook University after receiving the grant. It was here that he met people who wanted to set up a medivac service and decided to return six months later as a volunteer. His time in Tanzania expanded in his world view and showed him how people in a resource-poor environment can be innovative and understand better than anyone how to overcome the unique challenges they face. “It showed me that while the need is great, developing communities are making great strides in driving their own development. Our role as people from a more fortunate society, should be to listen and assist on their terms and not in a paternalistic way,” Nathan said.
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QAS Insight | Spring 2016
“I remember working with a senior Tanzanian doctor at a small hospital for the poor in the outskirts of Arusha in the country’s north. I had been trying unsuccessfully to explain what a paramedic does, finally in exasperation he turned to me and said ‘you keep telling me what you can’t do, you have the privilege of education and so the responsibility to use it to help people!’ “His words hit home and I think of them often.” Nathan’s time in Tanzania has given him some take-home lessons for his Cunnamulla station. “It’s enhanced my belief that paramedics can have a wider role in health care, particularly in rural and remote areas which are resource poor compared to metropolitan areas,” he said. His trip to Tanzania also exposed him to a rich culture and expanded his world view.
Expand your horizons and apply for the 2016 KJM Grants Closes: October 17, 2016 Visit: http://ow.ly/dDss304I0FQ
“I remember assisting with the delivery of a breach baby in a remote part of northern Tanzania where communication with the mother had to go through three languages, English to Swahili to Arabic and back again. A good result for the mother and child and the village had a great laugh at my terrible Swahili and general communication confusion,” Nathan said. His time in Tanzania also changed his personal outlook on life.
“A Tanzanian elder told me that westerns chase time while Tanzanians wait for time to come to them, it’s a world view I wish I could adopt,” he said. Nathan is mindful that he only got a small glimpse of what development work is about and is keen to return. “I am very motivated to return to East Africa to continue development work and to do research. I hope to be able to return in 2017,” he said.
“I have a new perspective on health goals, I now feel rural and remote communities should have a greater say in what good health looks like to them.”
Paramedic Nathan Daley
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Closing the gap Our one-of-a-kind Indigenous Paramedic Program is adding to its numbers with three officers due to graduate as Advanced Care Paramedics this November. A total of 19 officers are now working in regional and rural areas from Cape York to Bundaberg. The recruits play an important role in improving health outcomes in Indigenous communities and contribute local knowledge and understanding while helping to make QAS more diverse. Recruits progress through various assessments to eventually become qualified paramedics or Advanced Care Paramedics. The first major milestone is a Certificate IV in Ambulance which allows them to conduct independent services in their communities. Students are then enrolled into a diploma before proceeding to a bachelor’s degree and are supported during their studies until they obtain the Advanced Care
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QAS Insight | Spring 2016
Paramedic (ACP2) qualification and graduate from the program. QAS Insight caught up with Alisha Peter from Doomadgee who recently obtained her Certificate IV in Ambulance through the program and talked to her about what the program means to her and her community. “I always wanted to work in health so as to give back to my community and also benefit myself,” Alisha said. “I can already see the difference my presence makes – the community is more open with the QAS during medical situations because they know they will see a familiar face.
Alisha Peter at an Indigenous Paramedic Recruit Program ceremony in July
“We’ve also gained the trust of people in the community with a lot of people being more proactive about their health and coming to seek our advice.” For Alisha, becoming a paramedic recruit has gone beyond delivering health outcomes, it’s helped inspire others who want to follow in her footsteps. An integral part of the program is the support recruits receive from QAS and Alisha had nothing but praise for the outstanding support she continues to receive from Local Ambulance Service Networks (LASNs) and Officers-inCharge (OICs). “I can’t speak highly enough of the officers in the LASNs and OICs. Whether on-road or off-road, they make time for you and are great in helping build your confidence and trust,” she said.
For now Alisha intends to stay on-road with the QAS while she completes her studies. “I’m enrolled at the Central Queensland University where I plan to complete my degree in Paramedic Science so I can become an ACP2,” she said.
“Taking on this course has inspired a lot of people in the community and shown they can also do the job we do. I’ve had lots of kids come up to me and ask about becoming paramedics.”
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Townsville’s go-to-guy
Mick Hielscher, Townsville’s go-to-guy for all things fleet and equipment notches up a decade of service in QAS on October 30. Mick is the Resource Readiness Coordinator of the Townsville Local Ambulance Service Network (LASN). In simple terms, his domain covers the ambulances paramedics drive, the life-saving equipment in those vehicles, logistics during natural disasters, getting stations ready prior to and after the wet season, generators in the Operations Centre and the equipment in ambulance stations. “I have a saying if the vehicle and the equipment does not get to the job we cannot save a life,” Mick said. “Knowing that what I do helps provide patient care and saves lives in the community gives me a feeling of achievement in what I do.” Mick provides a 24-hour service and is always on hand especially during natural disasters. During Tropical Cyclone Yasi he was among those who worked long hours before and after to provide patient care and keep communications going in the Townsville LASN. “We had to provide fuel and services for vehicles and generators to keep the Operations Centre and the radio room on Castle Hill going. That meant fuelling by hand with pumps and drum as we had no power to these sites and the fuel companies did not have enough fuel tankers to transport fuel to all locations,” he said. “It was the biggest logistical event that I’ve been involved in since I joined the QAS.” Mick credits the Townsville LASN's success to the rest of his team.
“We work together to provide the same outcome, which is Excellent Patient Care for the Townsville community and that is what makes them special in this LASN,” he said. This sentiment is reciprocated by his colleagues, with Townsville LASN Assistant Commissioner Robbie Medlin singing his praises. “Mick is called out day and night, is always obliging, receives 1,000 phone calls a day on everything and anything and keeps us on track to respond to our patients,” Robbie said. “He is the go-to-guy when our staff are looking for an answer as to why a vehicle or equipment issue has occurred and we always know that he’ll respond to every call immediately. “He maintains our fleet and response capability while ensuring rotation and maintenance of our fleet. More recently, he was a major contributor to the setting up and successful response to the V8 Supercars held in Townsville in July. “There is really nothing he can’t get done. Without his diligence, dedication, integrity and commitment we would not be able to deliver the service we deliver.”
130 years. Five men. A new station. One big anniversary.
nummI esruN dna lortnoC noitcefnI – tnatlusnoC esruN lacinilC :lladnaR anoi F yB
Thirty years ago this September, the first sirens sounded and the wheels were set in motion as ambulance operations commenced from a new station in Coolangatta Road. Burleigh Heads paramedic Garth McMillan (centre) was back then one of the station’s first officers in 1986.
As we celebrate the anniversary of operations in Coolangatta Road, Troy Williams (far left), Philip Wingrave (left), Philip Bartel (right) and Steve Hunston (far right) are the station’s longest serving officers. Collectively they have serviced the area surrounding the only station they’ve called home for 120 years. Not far behind them follows a long line of current staff who have also passed through the station at one time or another including Commissioner Russell Bowles, Metro South Assistant Commissioner Peter Warrener and eTimesheet Senior Operations Supervisor Peter Fiechtner. The local community were invited to celebrate the milestone at a fun-packed station open day that was followed by a trip down memory lane for staff at a private reunion on Saturday, September 10.
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QAS Insight | Spring 2016
The old Coolangatta Ambulance Station gang back together again
Steve Hunston and Henry Weeks
Coolangatta Ambulance Station open day visitors
Ernie Pohlman with his QATB badge
27at Starting the CPR training young the station open day
Timeline - Ambulance services in Coolangatta 1922 Ambulance services were established in Coolangatta on March 27 at rented premises in McLean Street
1925 The service transferred to rented premises in Dutton Street
In June the service entered into the lease of a property in McLean Street, opposite the Beach House Resort
First permanent ambulance vehicle in Coolangatta, Queensland, circa 1920
1987
1989
Philip Bartel started at the station on August 29
Troy Williams started at the station on November 21
1986 The Griffiths Street building became too small to service the growing area and the current station in Coolangatta Road was erected. Garth McMillan was one of the new station’s original officers
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QAS Insight | Spring 2016
1930
1936 The Griffiths Street station opened on February 29
1934 A block of land was purchased in Griffiths Street to construct a new station
Ambulance vehicle about to cross the border gate from Tweed Heads to Coolangatta, Queensland, circa 1930
1978 Philip Wingrave started at the station on October 31
>>> 1990
2022
Steve Hunston started at the station on August 27
Centenary of ambulance services in Coolangatta
2016 30th anniversary of the Coolangatta Road building
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Ambulance Week
Ambulance Week celebrations swept the state from September 12 to 16 resulting in lots of community events such as station open days, CPR training sessions and the all important cake cutting and sausage sizzles. Here's a tiny snapshot of what went down.
Paramedics and Emergency Medical Dispatchers joined with their partners, friends and family to show QAS’s commitment to diversity and inclusiveness in the Brisbane Pride March in September. Thousands of people from the LGBTIQ community walked from Fortitude Valley to New Farm Park, where paramedics set up a QAS stall and gave free CPR lessons in the Pride Festival precinct.
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2016 QAS Remembrance Service and Commissioner’s Achievement Awards More than 250 QAS staff, family and volunteers gathered in Brisbane for the 2016 QAS Remembrance Service and Commissioner’s Achievement Awards on Friday, September 16. It was the first time we have combined our two Brisbane-based signature Ambulance Week events into one ceremony. During the ceremony, QAS Chaplain Neale Proellocks led the Remembrance Service to honour and pay our respects to the 32 officers who have lost their lives while performing their duties. QAS Commissioner Russell Bowles and Cameron Dick then presented the 2016 Commissioner’s Achievement Awards as well as a range of service medals, including the Humanitarian Overseas Service Medal, National Emergency Medal, National Medal and clasps, Long Service Medal and clasps, and Local Ambulance Committee Badge and Certificates.
Hon. Cameron Dick MP and QAS Commissioner Russell Bowles
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QAS Insight | Spring 2016
2016 Commissioner’s Achievement Awards winners Customer Focus – putting customers first through a commitment to excellence in customer focus and service: Jessica Heal – Advanced Care Paramedic, Roma Station
Fostering Innovation – driving ideas into action through innovative approaches: Scott Warner – Advanced Care Paramedic, Ipswich Station
Excellence in Performance – supporting a culture of excellence and unleashing the potential of people and organisations to provide outstanding performance – Joint winners: Quality Assurance Unit – Trevor Tighe, Robert Hartley, Guy Law, Greg Trapnell, Felicity O’Mahoney and Geoffrey Hayes Sondra Vandeleur – Manager Legal and Regulatory Services, Corporate Services
Courage and Integrity – fostering a culture of courage and ownership of actions: Tracey Eastwick – Manager of Operations, Mackay Local Ambulance Service Network
Excellence in Leadership – empowering people through excellence in leadership, collaboration and team development – Joint winners: Michael Low – Senior Operations Supervisor, Wide Bay Local Ambulance Service Network Cathy Ihm – First Responder and Dayboro Local Ambulance Committee Secretary
Young Hero of the Year – awarded to a young person who has played a significant role in the chain of survival in an attempt to save the life of another and shown maturity, courage and/or leadership in a difficult or demanding situation Mia Gofton – Halifax, North Queensland
Commissioner’s Achievement Award – presented to an individual, project or team which demonstrates achievements that exceed core expectations High Acuity Response Unit
In the media Zero Tolerance message after alleged assault in Cairns QAS is continuing to take a tough stand against any forms of violence directed at our staff. Assistant Commissioner Michelle Baxter recently spoke to media about our zero tolerance for all forms of physical attacks and verbal threats against QASÂ staff. This followed the alleged assault of a female paramedic from Cairns in the early hours of Thursday, September 28. The story ran on statewide and national media getting our zero tolerance message out to the community.
Lots of kudos during Ambulance Week It would take hundreds of pages to detail all the positive coverage QAS received during Ambulance Week. From various awards across the state to community events and training sessions, QAS staff and volunteers were legends. Here’s a small snapshot of some of the coverage.
Good news gems QAS Media is always on the hunt for a good news story. Here’s what happens when you, our eyes on the frontline, send us some gems.
Thank you!
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QAS Insight | Spring 2016
I just wanted to let you and all those at the Queensland Ambulance Service know my mother, Helen, passed away quietly on Monday this week (September 19). Knitting all those trauma teddies was one of the things that kept her going and once she could no longer knit, or get into the garden, we all knew the end was near - and so it came to pass. Our thanks to you and your team. Mum was very proud of the article in the QAS (Insight) magazine. It was with great sadness that we received news of the passing of Helen Kable in September. Helen thoughtfully knitted close to 600 trauma teddies for sick and injured children despite her own personal battle after being diagnosed with terminal cancer. She featured in the Winter edition of QAS Insight and her son Scott sent us some kind words.
I would like to personally thank the two paramedics (Robyn and Renee from South Mackay Ambulance Station) that recently saved my life. The paramedics who I wish to thank attended my emergency call on the evening of Saturday 10th September and performed CPR when I suddenly collapsed. There is no doubt that I wouldn’t be alive today if it wasn’t for their timing, specialist training and their sheer guts and determination to save my life! My wife and mother in-law who were also present at the time, wish to highly commend these dedicated medics for their overall professionalism and management throughout the entire situation. My wish now is to personally thank these two heroes.
Nicholas – Marian
I would like to express our heartfelt gratitude to every person involved with helping our little boy when he was very unwell last week (July 27) in Toowoomba. It was the worst experience of my life, but the Emergency Medical Dispatcher that stayed on the line with me whilst waiting for the ambulance was my sanity in the loneliest and darkest minutes of being alone in an emergency situation. The Paramedics on scene were amazing, their expertise and action gave me confidence that it will be okay. I will forever be grateful to you for what you did for us. You are heroes in every sense of the word!
Ina – Darling Heights
Thank you to the three ambulance officers (from Deception Bay – Steve, Shannon and the Driver) for the gifts that were given to Charli so she was not so scared about getting into the ambulance to go to the hospital - they helped a great deal. They came to Pelicans day care centre at Deception Bay. They were so good with our little girl. And she is still playing with the teddy and mouse.
Stacey – Deception Bay
Appointments and farewells Retired officers keeping busy Who said retirement was all about putting your feet up. Rather than go fishing or get ready for the festive season, QAS Retired Officers Association (ROA) are hard at work with two major events this October and November. First up this October is the association’s Annual General Meeting (AGM) on October 25, 2016 at the Kedron Wavell RSL. QAS Commissioner Russell Bowles will be in attendance at the key meeting that will consider an update to the ROA Constitution to enable its branches to be better aligned with the QAS Local Ambulance Service Networks (LASNs).
event for 3,000 children with special needs at the Brisbane Convention Centre. It’s no wonder interest in ROA is increasing across the state with retiring QAS employees keen to tap into benefits that include catching up with old friends continuing to remain active in the ambulance family.
AGM event information: Date: Tuesday, October 25 Time: 9.30am (Members and Guest are requested to be seated by 10.00am) Venue: Kedron Wavell RSL Club, (Longtan Room) Kittyhawk Drive, Chermside
This will be closely followed by the South East Queensland Special Children’s Christmas Party in November where ROA will be lending their support at an invitation-only
On the subject of retired officers, QAS said farewell to the following officers in the month of August: Name
Position title
Years of service
Division/Location
Douglas Nordin
Emergency Medical Dispatcher
36 years
Townsville LASN
Geoffrey Stower
Paramedic
36 years
Pittsworth
Herbert Burrows
Patient Transport Officer
45 years
Fairview
Lisa De Jager
Paramedic
15 years
Beerwah
John Furnell
Paramedic
23 years
Ayr
Congratulations to the following QAS officers who’ve taken up new permanent appointments in August: Employee
Appointment Date
Position Title
Division/Unit
Warren Kellett
18/07/2016
Executive Manager Operations
Central Queensland
Jessika Brind
8/08/2016
Executive Manager
North West LASN
Emma McKenzie
25/07/2016
Senior Operations Supervisor
Policy Development
Conor Fardon
8/08/2016
Principal HR Consultant
Human Resources
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QAS Insight | Spring 2016
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QAS Strategy 2016–2021 Our Vision: Excellence in Ambulance Services Our Mission: We will deliver timely, quality and appropriate, patient focused ambulance services to the Queensland community
Our Values:
Patients first
Health and safety
Ideas into action
Unleash potential
Be courageous
Empower people
For more information and to download your copy, visit the QAS Portal