QAS Insight Magazine - May 2016 edition

QAS

INSIGHT May 2016

Paramedic Safety Taskforce | Uniform update Paramedic registration | HARU report

Contents

FROM THE COMMISSIONER

RAVENSHOE RESPONSE

PARAMEDIC SAFETY TASKFORCE

04

05

06

QAS UNIFORM UPDATE

PARAMEDIC REGISTRATION

HARU REPORT

08

11

12 Anniversary milestones approaching 10 Cerebellar Stroke

16

CCP Intern makes life-saving decision

15

Response to the Health Ombudsman 19

TRAUMA WEEK

EMBRACING DIVERSITY

14

36

AUSTRALIA DAY HONOURS

THANK YOU QAS

40

42

QAS Insight is published by the Queensland Ambulance Service Media and Communications Unit. May 2016 edition contributors: Michael Franks, Emma Mercer, Kara Rufford,

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Tamani Nair, Joanne Mitchell, Leah Watson, Dr Stephen Rashford, Mark Crossman, Mark Hevey, Wayne Loudon and Paola De Tina. Editor: Edda Mwangi. Graphic Design: Nejien Creative

Emergent Large Vessel Occlusion

20

From the First Call

24

Smartphone apps a valuable tool for EMDS

26

Dramatic program educating young drivers

28

Reaching out after suicide

30

Northern exposure: life in the Torres Strait

32

Embracing a more inclusive and diverse culture

36

Social media pitfalls: dos and don’ts of the online world

38

Editorial and photographic contributions are welcome and can be submitted to: QAS.Media@ambulance.qld.gov.au or +61 7 3635 3900.

Minister’s Message I have no doubt all readers would agree that one assault on a paramedic is one too many. The unfortunate reality is that there were 170 deliberate physical attacks and 56 verbal assaults on ambulance officers in Queensland in the 2014-15 financial year.

These numbers are up from the 160 physical assaults and 33 verbal assaults on ambulance officers in the previous financial year. The Queensland Government is taking strong action to help turn these figures around.

Late last year, I established a Paramedic Safety Taskforce to address the issue of violence against paramedics. Members of this taskforce include paramedics, unions and Queensland Ambulance Service senior management, university academics, with Queensland Police Service personnel providing expert advice.

In January, this taskforce delivered an interim report revealing some key recommendations which the government is already progressing. We have invested $1.35 million into a mass media public awareness campaign – Zero Tolerance - No Excuse for Abuse – which aims to minimise violence against both paramedics and frontline health workers.

I was pleased to recently launch this campaign supported by Queensland paramedics who have themselves fallen victim to attacks on the job.

This campaign is telling the real stories of Queensland’s frontline health staff while reinforcing the message that serious assaults on ambulance officers won’t be tolerated and are subject to significant legal penalties.

The government has also fast-tracked enhanced situational awareness and safety training for all paramedics. All frontline ambulance staff are now undertaking this training, which aims to mitigate the risks of violence by helping paramedics to identify, de-escalate and withdraw safely from potentially dangerous or confronting situations.

I am also pleased to report that the Queensland Parliament recently passed new laws proposed by the government that will help tackle alcohol-fuelled violence. Sadly, it is often Queensland’s paramedics who witness first-hand the real consequences of acts of violence.

We hope that these new laws will help to reduce the damage inflicted on both frontline health staff and our communities caused by alcohol, while also mitigating the strain alcohol-related incidents and injuries place on health services, including the Queensland Ambulance Service.

Recently I publicly released the final report of the Paramedic Safety Taskforce, and I have committed to implementing all 15 of the report’s recommendations.

The report is available on the QAS website.

This is not an issue that we can address in isolation.

Sadly, paramedics are not the only group of health workers who can face violent situations. Violence against health workers is a community problem requiring the community’s help to address. I want to assure you that this government is committed to making your workplace as safe as possible.

Hon. Cameron Dick MP Minister for Health Minister for Ambulance Services

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From the Commissioner This year is my 35th year working for the ambulance service in Queensland. As many of you of a similar vintage will attest, we’ve seen some tremendous changes over that time. From the growth in the scope of clinical practice for paramedics, to the technology, modern vehicles, stretchers and defibrillators that we now have access to, the Queensland Ambulance Service continues to adapt and enhance its services to the community.

campaign, and further assessment of our processes, including research and data analysis, staff support and technology options.

The past few months have been incredibly busy for our frontline staff. I would like to take this opportunity to recognise how hard you have all worked in meeting the community’s demand for our services over the summer period. Your dedication is greatly appreciated, not only by myself and the executive team, but importantly, by all Queenslanders.

On the subject of recruitment, Michael Metcalfe has been appointed as the new Assistant Commissioner for the Sunshine Coast Local Ambulance Service Network.

With a QAS career spanning more than 23 years, Michael started as a paramedic in 1991 and has held a number of operational and managerial roles including Assistant Commissioner of Darling Downs LASN in 2014 and his most recent role as Executive Director, Workforce and Infrastructure with the Darling Downs Hospital and Health Service. Congratulations are also in order to Steven Coombs and Andrew Hebbron for their appointments as Director, Central Queensland LASN and Director, West Moreton LASN respectively.

We’re getting busier as we approach flu season and in preparation for this period QAS has been working with Queensland Health and the Hospital and Health Services (HHS) on a winter strategy aimed at improving emergency access and reducing ambulance turnaround times. The HHS have committed to ensuring that ambulances are off-loaded as quickly as possible, aiming to minimise waiting times to less than 30 minutes for every patient.

Another key initiative currently underway is the ongoing work of the Paramedic Safety Implementation Oversight Committee. The final report has been accepted by the Minister and identifies a number of areas of focus to help protect our staff. We are currently working through these recommendations.

This includes better education and training – including a revised situational awareness package developed in consultation with the Queensland Police Service Operational Skills and Tactics Unit – as well as a $1.35 million public awareness and advertising

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We are also well down the path towards the national accreditation and registration of paramedics and you can find out more about the process on page 11.

I’d like to thank all staff who took part in this year’s Working for Queensland Survey that ran from April 18 to 9 May. The survey helps us assess and improve the way we run the service and has already provided a number of beneficial outcomes. I look forward to reviewing this year’s results and finding ways to continue improving our workplaces.

Finally, I would also like to mention the outcome of The Ravenshoe Review, which has been very positive for QAS. While there are some recommendations that will help us to enhance our capabilities, overall the team in Far North Queensland did an excellent job in responding to this tragic event.

Russell Bowles QAS Commissioner

Ravenshoe response

‘swift and well resourced’ The QAS response to the tragic explosion in Ravenshoe on June 9, 2015 has been commended as ‘swift and well resourced’ in the official review handed down in March.

The Ravenshoe Review, headed up by former QAS Commissioner David Melville, found the ambulance service’s response to the explosion at the ‘Serves You Right Café’ – which injured 21 people, two of whom subsequently passed away in hospital.

“Overall the QAS response to the tragic explosion was excellent, with a large contingent of our officers working closely with counterparts from health and emergency services agencies to care for those who were injured,” Commissioner Russell Bowles said.

The service will also ensure Mass Casualty Management (Stor-IT) kits are sited at all current cache sites in Queensland and will work with the Department of Health to investigate the feasibility of live streaming from incident scenes to emergency coordination centres.

“Major mass-casualty incidents such as these provide important opportunities to study our systems and procedures and assess whether there are ways we can refine and enhance our response capabilities, Mr Bowles said.

“Following the event, we initially undertook a Post Incident Analysis (PIA) and examined several aspects of our response.

“This PIA was submitted to the Review team, which subsequently found that: ‘All of the lessons learned in the QAS PIA Report are supported by the Review’.

“Our deployment of resources was swift and well managed and the care provided to our patients by all of the officers on scene was of the highest standard.

“The Review team also found it was satisfied with our level of preparedness as well as the training available and undertaken by staff.

“I could not be more proud of the courage and dedication displayed by all of our staff on that day.”

“While the Review identified some areas where QAS could improve from a ‘systems’ point of view, it concludes that: ‘…the QAS’s response was swift and well resourced’.

Commissioner Bowles said the government had committed to implement all 30 of the recommendations delivered by the Review team, including several relating to QAS which aim to enhance liaison with other health agencies and promote more inter-agency mass-casualty training exercises.

“I would encourage all staff to take the time to read The Ravenshoe Review, which can be accessed here: http://ow.ly/ZsxOe.”

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Taskforce delivers safety recommendations The Taskforce investigating paramedic safety has delivered its final report to the Minister for Health and Ambulance Services.

The Paramedic Safety Taskforce – a collaborative body incorporating senior QAS executives, paramedics, operations centre staff, union representatives, university academics, with Queensland Police Service personnel providing expert advice – has identified a range of options it believes will enhance the safety of QAS staff.

Commissioner Russell Bowles said the recommendations were focused on key areas including education and training; awareness, media and communications; and internal QAS and external processes.

“In delivering this final report, I am pleased to announce some of the initiatives that will be implemented during the remainder of 2016,” Russell said.

“This includes the rollout of the revised SAFE2 training course to all frontline paramedics by December 2016.

The training will ensure paramedics can more easily identify, de-escalate and withdraw safely from certain confronting situations.

“A sedative medication - Droperidol – will also be introduced into clinical practice for all Advanced Care Paramedics (ACPs). This is anticipated for release in October 2016.

“This is an important shift to a more pragmatic and safe approach to the assessment of patients with a high risk of violence and will help to minimise the likelihood of hostile responses to treatment.

A television commercial to increase the public’s awareness of the issue of assaults on health workers was filmed in March at Beenleigh

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“The change in practice will incorporate a new Clinical Practice Procedure Sedation Assessment Tool for ACPs to use for patients in these acute behavioural disturbance scenarios. In addition, new Clinical Practice Procedures and Clinical Practice Guidelines will be issued for paramedics to support ongoing clinical practice and patient safety.

“It has also been recommended that we consider a review of a range of processes that may support or assist with the management of occupational violencerelated risk and prevention. These include data analysis to help identify trends and minimise risk and potential technology options that may assist.”

The Commissioner said public awareness was also a key component of the overall approach.

“While we are very serious about doing everything in our power as an organisation to minimise the harm to our staff, we also need the support of the community to help address this type of anti-social behaviour,” he said.

“In the public sphere, we will continue the ongoing public awareness campaign that is aimed at minimising violence against paramedics. This includes our social media campaign as well as advertising on television, online and in areas near nightlife precincts such as bus stops and billboards.

“It’s an unfortunate fact that violent attacks have occurred against our officers as they deliver care to those in need. We will continue to promote awareness about this issue and the harm it causes to our people in the hope that over time, we will see less and less assaults.”

In the public sphere, we will continue the ongoing public awareness campaign that is aimed at minimising violence against paramedics.

New recruits Julia and Alicia undertake situational awareness training during their induction

Tony Hucker provides advice to the actors during filming of the new public awareness advertisement

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New QAS uniform update The QAS uniform review has continued to evolve and development design is drawing to completion. Operational use of the final design pieces will occur during May, with production to begin shortly after.

On road officers

Polo shirt

Jacket

Cargo pants

Men’s button-up shirt Women’s button-up shirt

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In 2015, QAS trialled more than 300 prototype paramedic and communications officer uniform pieces at 50 diverse locations throughout the state to gain an understanding of the varying Queensland climatic environments QAS officers operate in.

Since then, collaboration with the various work areas has focused on development of the conceptual uniform design. More than 400 operational staff members were interviewed and participated in workshops, while surveys provided feedback and opinions from more than one third of the QAS workforce.

This process ensured QAS operational staff were placed at the centre of the uniform design process and the focus was on fit, form, and function of all uniform items.

The development and production of prototypes has now been undertaken for QAS by the Workwear Group and is a compilation of all the feedback QAS has received to date.

The new QAS uniforms will continue to be teal in colour, with contemporary changes including fabric technologies, improved personal storage solutions and role recognition.

The Statewide Equipment and Vehicle Committee (SEVC) members will play an instrumental role in reviewing the final uniform samples on behalf of their peers, with the uniform trial occurring after the next SEVC meeting in mid-May. A selection of sample images of development pieces produced by Workwear Group are pictured below.

These are indicative only and do not depict the full range of uniform pieces that will be available to staff.

Further information and pictures will be disseminated to staff when the trial uniform pieces are received by QAS in May.

Operations centre officers

Jacket Button-up shirt

Skirt

Polo Pants

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Anniversary milestones

approaching Planning is currently underway to celebrate two important milestones that are fast approaching.

July 1 2016 will be the 25th anniversary of the establishment of the Queensland Ambulance Service and Local Ambulance Committees. Prior to 1991 ambulance services were delivered by Queensland Ambulance Transport Brigades, supported by local boards.

2017 will be an even more significant year – the 125th anniversary of the start of ambulance services in Queensland.

A working group comprising members from the Commissioner’s Office, State LASN Operations, QAS Media, Metro North LASN and Local Ambulance Committees is developing a plan for a schedule of events to celebrate the milestone.

Calling all sporty types If you love competing and wouldn’t mind spending a few days at the beach, the Australasian Police and Emergency Services Games may be just your cup of tea.

The Games, which are expected to attract more than 3,500 competitors from emergency services agencies across Australia, New Zealand and the South Pacific, are being held on the Sunshine Coast from October 8 to 15 this year.

It’s the first time in 15 years Queensland has hosted the biennial event and organisers are hoping for a strong local turnout.

There are more than 50 sports on offer, ranging from triathlon to cycling, boxing, cricket, squash, netball, ten pin bowling and darts.

For more information, check out the Games website: http://www.apandesgames.com.au/

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The path to paramedic registration In November 2015, the Council of Australian Governments Health Council (CHC) agreed to include paramedics in the National Registration and Accreditation Scheme for health practitioners (NRAS) administered by the Australian Health Practitioners Regulatory Agency (AHPRA).

•

AHPRA currently works with 14 registered practitioner boards including chiropractors, dental practitioners, medical doctors, nurses and midwives, optometrists, osteopaths, pharmacists, physiotherapists, podiatrists, psychologists, Aboriginal and Torres Strait Islander health practitioners, Chinese medicine practitioners, medical radiation practitioners and occupational therapists.

An implementation project for the national registration of paramedics is currently being undertaken under the direction of the Australian Health Ministers’ Advisory Council (AHMAC) which is made up of the heads of health departments of the states, territories and the Commonwealth.

Paramedics will become the 15th registered health profession.

•

• •

Anticipated timeframes for the project are as follows: • • •

The objective of NRAS is to: •

•

protect the public by ensuring only health practitioners who are suitably trained and qualified to practise in a competent and ethical manner are registered facilitate workforce mobility across Australia by reducing the administrative burden for health practitioners wishing to move between participating jurisdictions or to practise in more than one participating jurisdiction facilitate provision of high-quality education and training of health practitioners facilitate rigorous and responsive assessment of overseas-trained health practitioners

facilitate access to services provided by health practitioners in accordance with the public interest enable continuous development of a flexible, responsive and sustainable Australian health workforce including innovation in the education of, and service delivery by, health practitioners.

policy details to be settled by mid-2016 legislation to be prepared and passed by participating jurisdictions by mid-2017 national registration of paramedics to commence in the second half of 2018.

Targeted consultation on the project began in March with key organisations representing the paramedic sector, ambulance services, education providers and consumers. This will build on the broader national consultation process undertaken in 2012 as part of the regulatory impact assessment process by the CHC. QAS will continue to engage in this project at both the state level through the Department of Health and at the national level through the Council of Ambulance Authorities.

Paramedics will become the 15th registered health profession.

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HARU Report High Acuity Response Unit case study – By Dr Stephen Rashford A male in his 70s fell from a ladder. He was approximately 90kg, with a past history of ischaemic heart disease. The initial attending paramedics noted his regular medications included Aspirin and Clopidogrel. The collateral history established at the scene revealed he fell approximately 2.5m, glancing the roof of a shed. He struck a fence below the ladder, impacting primarily on the left chest. There were no symptoms prior to the fall to suggest the incident was anything other than an accident.

ACP treatment The initial attending ACPs noted the victim complained of left sided chest pain and moderate dyspnoea.

The initial vital signs were: GCS 15 BP 95/40 HR 110 SpO2 84% on room air The ACPs applied supplemental oxygen and a cervical collar. Intravenous access was obtained and Fentanyl 25mcg was administered. A pelvic binder was applied when the patient was placed in a scoop for extrication.

CCP treatment The CCP arrived a short time later. At this time the patient was deteriorating rapidly. He had developed severe dyspnoea. Bilateral chest wall pain and crepitus was noted, in addition to significant amounts of right sided subcutaneous emphysema. The patient was now hypotensive (70/50).

The CCP undertook immediate right needle decompression with a 14g cannula. This resulted in a positive air rush, with decreased dyspnoea and increase in systolic BP to 90 mmHg. HARU had been attached to the job with the other units.

The CCP called the HARU unit with a comprehensive summary. HARU arrived as the patient was being extricated from the back yard.

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HARU treatment The vital signs at this stage were – GCS 15, RR 28, unequal chest wall movement, poor chest excursion, bilateral rib crepitus, right subcutaneous emphysema, 14g in situ right 2nd ICS, Spo2 93% on 15l/min oxygen.

The patient was clinically shocked (pale, diaphoretic and poor capillary return). The BP was 103/80 and heart rate 90/min.

The provisional diagnosis was a severe chest injury (bilateral rib rib fractures, right tension haemopneumothorax). A significant intra­abdominal bleed could not be excluded, with damage to the liver or spleen suspected.

HARU undertook an immediate FAST ultrasound examination. Focused Assessment with Sonography in Trauma (FAST) is undertaken to rapidly identify intraabdominal bleeding, or bleeding within the pericardial sac. Extended FAST allows an assessment of the lungs and pleural cavity. All HARU officers are trained in FAST, with rigorous ongoing quality assurance activities.

The HARU paramedic noted that the patient had significant bleeding within the abdomen. During a FaceTime consultation with the Medical Director to discuss the anaesthetic induction issues, the patient suffered a recurrent tension pneumothorax and the CCP immediately needle decompressed the right chest again.

Combined paramedic treatment

Audit findings

HARU paramedics commenced a blood transfusion, whilst setting up for a rapid sequence intubation (RSI).

The patient’s condition was rapidly deteriorating and a very small dose of Ketamine was used for anaesthetic induction (20mg) in addition to the muscle relaxant Rocuronium. The HARU paramedic intubated the patient on first pass and then immediately proceeded to a right sided surgical thoracostomy, so as to formally drain blood and air from the right chest cavity. Significant air was released and the lung re-expanded. A left sided surgical thoracostomy was also undertaken, due to the severe haemodynamic compromise present and the signs of significant chest trauma. Air and blood were released on the left as well. A heating blanking was applied and the patient was then rapidly transported to hospital. Tranexamic acid, an anti-fibrinolytic agent, was administered en route to hospital given the high likelihood of acute traumatic coagulopathy. Blood transfusion was continued, with the major trauma service pre-notified of the severity of the presentation.

Extensive discussion at audit given the severity of the injuries. No doubt the quality of pre-hospital care contributed significantly to survival to hospital. The use of FaceTime was discussed – a good tool in the right scenario, where access to a senior consultant emergency physician is immediately available.

The tempo of the case was discussed – this case represented a patient on a precipice that required immediate action following rapid assessment and high quality decision making. Discussion around site of RSI (in ambulance V outside). Significant discussion surrounding the planning and positioning for interventions.

Outcome The patient remained unstable and was transferred to the operating room less than 10 minutes after arrival from hospital. A severely lacerated spleen was removed.

The injury list was extensive: Aortic arch transection, 6 fractured ribs on left, 9 fractured ribs on right, bilateral haemopneumothoraces and pulmonary contusions, right subclavian artery injury, macerated spleen and bleeding from a gluteal artery within the buttock, requiring intervention.

The chest X-ray shows the endotracheal tube is well placed. Extensive surgical emphysema is present across the right chest, with some evidence of lung injury. The left lung is very contused, with some evidence of surgical emphysema. Multiple rib fractures can be seen on both sides of the chest.

The mediastinum is very widened and would prompt consideration of an aortic injury or other cause of mediastinal haematoma.

Lessons 1. Falls of 2 to 3 metres are life-threatening, especially in the elderly.

2. This patient is critically ill with multiple lifethreatening injuries, combining to present an extreme risk for sudden cardiac arrest before hospital arrival.

3. Each team member plays their part – ACP, CCP and HARU. A champion team ALWAYS beats a team of champions. Teamwork and high quality care saved this man.

4. This patient needed high tempo resuscitation that was steady and coordinated, as they were on the brink – discipline and training make the difference.

Scenario practice and good quality assurance pay off. This will result in people surviving to hospital, who previously would have died.

5. The use of FaceTime in selected cases allows real time high level clinical advice in certain cases. Not required for all cases though.

6. RSI induction doses need to be drastically reduced in cases of such severe haemodynamic compromise. Beware of an extended circulation time.

7. This patient needed 360 degree access – do the RSI before loading.

8. Initial vital signs were only mildly abnormal, despite other signs of severe shock. Treat the patient, not the numbers.

9. Collateral history saves lives – always look for anti-platelet agents or anticoagulants and let the hospital know early.

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Trauma week

tests CCP Interns

It’s the most talked about week in the Critical Care Paramedic (CCP) Intern Program and QAS Media recently tagged along to watch CCP Group 24 being put through their paces.

Director Clinical Quality and Patient Safety, Tony Hucker, said Trauma Week exposed interns to the pressures of treating high-acuity patients in very challenging simulated environments.

“CCPs respond to the most serious cases where it is determined the patient has a life-threatening condition or injury where time is of the essence,” he said.

“The aim of Trauma Week is to test the communication, leadership and critical thinking skills that CCPs require to treat and extricate critical patients under difficult circumstances, including intense pressure from bystanders and other emergency services agencies.

“The CCP program uses a blended approach to learning which includes contextualised learning, high-fidelity simulation, clinical placement and an evaluation strategy that ensures our interns produce a high-quality evidence portfolio,” he said.

“At the completion of the program an intern review committee will evaluate the intern’s performance and recommend Commissioner approval for them to be authorised to practice as a CCP.” Group 23 Steven Muir, Jamie Rhodes, Simon Edwards, Brendan West, Ian De Jonge, Luke Adams and Elliot Bates – have recently completed their program.

“This round of scenarios included a drowning, long falls, power tool injuries and a couple of police incidents.”

Group 24 participants Timothy Makrides, Hannah Gaulke, Paige Harris and Robert Deed are due to qualify in November 2016.

Tony said that following the completion of a university graduate diploma, CCP interns undertake a 12-month internship, several hospital placements, supervised practice and medical simulations.

They will join the more than 200 CCPs currently in the QAS ranks.

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CCP Intern makes

life-saving decision

William Akenson owes his life to the actions of Critical Care Paramedic (CCP) Ian DeJonge who made a decision, back when he was an intern, that saved his life after he suffered a cardiac arrest in the back of an ambulance on February 29.

Ian, along with other Townsville paramedics and hospital staff, conducted CPR on William for about an hour and defibrillated him an astounding 10 times before circulation was restored to his body.

Ian’s mentor and CCP of six years, Adam Harders, commended his excellent clinical performance during his internship.

“Ian is the fifth intern I’ve supported through the CCP program” he said.

“Ian is focused and very clear in his thought processes and in this case he rapidly assessed the patient and initiated Advance Life Support protocols.

“He formulated a plan in his head and when the patient condition didn’t change, he made the critical decision to transport him to hospital to continue resuscitation.

“It was Ian’s critical thinking that saved William’s life that day.”

Ian, who qualified as a CCP at the end of April, said the most challenging part of the program was being away from his young family while undertaking training in Brisbane.

“I have been a paramedic for smack on 10 years and so it was a natural career progression to do the CCP program and gain more skills,” he said.

“Generally resuscitation on a patient will cease after 20 minutes, however William’s case presented differently and so I made the decision to extend his resuscitation with a good result.”

Ian and Adam along with Advanced Care Paramedic Amie Payne and CCP Michael Grainger reunited with William Akenson on March 22. He has made a full recovery with no deficits. Also pictured are Cardiac Cath Lab Nurse Manager David Hinds and Emergency Department Staff Specialist Rajesh Sehdev.

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Cerebellar Stroke An unpredictable neurological event, frequently manifesting in a stable manner before deteriorating into a neurological catastrophy – by Mark Hevey

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CEREBELLAR STROKE

Case History

Abdominal exam

You have been dispatched to Stephen, a 64 year old male complaining of nausea, vomiting, headache and vertigo.

• •

After your initial introduction you gain a history and begin a physical assessment of Stephen.

Presenting History • • • •

Woke this morning with nausea, vomiting, headache and vertigo Has never had dizziness like this before The nausea, vomiting and headache have reduced but the vertigo remains No chest pain.

Past Medical history • • • • • • • • •

•

No history of Meniere’s disease, migrainous vertigo or vestibular neuritis Smoker: Yes, 20 per day Alcohol: 2 standard drinks per day Weight: Appears obese History of hypertension, type two diabetes and hyperlipidaemia Medications: Ramipril, Lipitor and metformin Allergies: nil Surgery: nil Past Family history: father died of a stroke at 87, mother still alive in nursing home aged 90 No history of travel recently.

Vital signs • • • • • •

GCS: 15 Pulse: 90/minute Resp: 22/minute BP: 170/110 Temp: 36.8°C/tympanic 12 Lead ECG: NSR.

Soft, non-tender on palpation Denies blood in stools.

Neurological exam •

• •

Modified MASS: No facial droop, arm strength satisfactory, good handshake, speech satisfactory Pupils: PERL with no unusual movement Motor and sensory function appears normal with good muscle strength and ability to sense light touch.

Provisional diagnosis The patient’s family believe Stephen has a middle ear infection and suggest to you that Stephen makes an appointment with his GP. As Stephen stands in preparation to conclude your assessment and walks towards you, you note his poor gait; Stephen appears unsteady and denies any history that would cause an unsteady gait.

You ask Stephen to walk in a straight line - toe to heel, with you standing by his side. Stephen is unable to safely walk in this manner, so you assist him to a chair while your partner prepares for transport.

Your provisional diagnosis is the patient is presenting with a cerebellar event.

As 10% of all cerebellar strokes only present with isolated vertigo (Nelson & Viirre, 2009), any new undiagnosed event should have a provisional diagnosis of cerebellar stroke.

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CEREBELLAR STROKE

Cerebellar Stroke

Gait:

Cerebellar stroke represents only a small percentage of overall acute strokes (2 – 3%), but can be missed by the paramedic as some symptoms will not be identified utilising the modified mass stroke physical examination criteria.

This is a very sensitive test and will exaggerate any unsteadiness.

While most balance/vertigo symptoms are caused by inner ear abnormalities, some are caused by cerebellar stroke (Nelson & Viirre, 2009). There are specific observational tests that can help determine a patient’s cerebellar function; in the prehospital environment it is not practical to perform all of them.

Below is an assessment guide that can be used to assess cerebellar function: (Guide is not exhaustive)

•

Tandem, heel to toe walking. Ask the patient to walk in a straight line with their heels to their toes.

Pronator drift: Finger-to-nose test 1. Ask the patient to touch their nose with the tip of their index finger, then touch your finger tip.

2. Position your finger so that the patient has to fully outstretch their arm to reach it.

3. Ask them to continue to do this finger to nose motion as fast as they can manage.

4. Move your finger, just before the patient is about to leave their nose, to create a moving target (sensitivity).

General inspection: •

Note any truncal ataxia.

Ask the patient to sit up if lying.

Unsteadiness and/or loss of balance may indicate cerebellar disfunction.

Speech: • •

Check phrases like: baby hippopotamus.

Slurred staccato speech is characteristic of cerebellar dysfunction. It results in the individual pronouncing each syllable separately.

Eyes (assess for nystagmus): •

Ask the patient to keep their head still and follow your finger with their eyes. Move your finger throughout the various axes of vision. Look for multiple beats of nystagmus (a few beats can be a normal variant).

Nystagmus at the extremes of gaze is normal and referred to as ‘physiological nystagmus’.

Image by Sports Concussion Australia

An inability to perform this test accurately (past point/ dysmetria) may suggest cerebellar pathology.

Patients may have an intention tremor - as they get closer to a target the tremor worsens at the endpoints of a deliberate movement (Talley, 2005).

References: Nelson, J. A., Viirre, E. (2009). The clinical differentiation of cerebellar infarction from common vertigo syndromes. Western Journal of Emergency Medicine, Vx, n4, 273-277 Talley, N. J. (2005). Clinical Examination: A Systematic Guide to Physical Diagnosis. Chatswood, NSW: Churchill Livingstone

Medical Director comment: This is a very high risk presentation.

The combination of nausea, vomiting, headache and vertigo are an ominous combination. Differentiating the causes of vertigo, central (brain) versus peripheral (middle/inner ear) can be very difficult and requires a very detailed neurological examination, including review of all the cranial nerves.

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There is potential to pass this presentation off as a low acuity scenario, that is suitable for a GP referral.

Some strokes present with very subtle signs, so it is important to remain vigilant to taking a good history and looking for abnormalities in examination.

Dr Stephen Rashford

Response to the Health Ombudsman

Addressing a complaint lodged via the Health Ombudsman – by Mark Crossman

The QAS was recently required to address a complaint via the Office of the Health Ombudsman.

Mrs X made a complaint which outlined her dissatisfaction that her husband was transported to a private hospital and not a major public hospital when her husband presented with symptoms suggestive of stroke.

The Health Ombudsman was provided with two QAS documents which underpin paramedic management of acute stroke patients: • •

Clinical Practice Guideline (CPG) – Stroke/ Transient Ischaemic Attack Clinical Practice Procedure (CPP) – Acute Stroke Referral.

The Acute Stroke Referral CPP was developed following considerable collaborative work between the QAS and Queensland’s Statewide Stroke Clinical Network, National Stroke Foundation and individual hospitals. This collaborative project identified Queensland hospitals capable of accepting acute stroke patients and if appropriate administering thrombolysis.

The collaborative identified the private hospital as a dedicated Acute Stroke Centre and it was subsequently listed as a facility capable of providing 24/7 acute stroke care within the CPP. A dedicated 1300 number provides QAS paramedics direct phone access from the scene to each hospital’s preferred stroke contact which could be a Stroke Unit or Emergency Department. The stroke alert protocol also provides hospitals with early notification when paramedics identify patients with symptoms suggestive of stroke using a predetermined clinical algorithm.

It is extremely important that paramedics discuss with family members the capabilities of hospitals to which the patient is being transported, particularly in the setting of acute stroke.

Acute strokes are classified as haemorrhagic or non-haemorrhagic in cause, with differentiation between the two only achieved via a Computed Tomography (CT) scan. Specific treatment pathways are guided by the CT scan results; hence it is vital the CT scan be facilitated during assessment within the Emergency Department, as occurred for Mrs X’s husband.

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ELVO

Emergent Large Vessel Occlusion Is this the STEMI of acute stroke? – by Wayne Loudon

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ELVO EMERGENT LARGE VESSEL OCCLUSION

The problem: A subset of acute stroke patients (approximately 20%) suffering a large vessel cerebral artery occlusion of the internal carotid artery (ICA) and middle cerebral artery (MCA) suffer significant mortality and morbidity. Even with the use of intravenous thrombolysis, 60% to 80% of patients suffering an anterior circulation (ICA and MCA) stroke either die or do not regain functional independence at 90 days.

The solution: Three recent studies have investigated the use of mechanical thrombectomy (endovascular clot retrieval) for this subgroup of stroke patients: • •

•

•

Image by Stephens, 2008

the Multicentre Randomised Clinical Trial of Endovascular treatment of Acute Ischemic Stroke in the Netherlands (MR CLEAN) the Extending the Time for Thrombolysis in Emergency Neurological Deficits - Intra-arterial (EXTEND-IA) Endovascular Treatment for Small Core and Proximal Occlusion Ischemic Stroke (ESCAPE) (Campbell et al., 2015; Goyal et al., 2015).

A further two studies, SWIFT PRIME and REVASCAT were ceased early due to the clear benefits of endovascular clot retrieval.

Patients who received endovascular clot retrieval within 3.5 hours of symptom onset had a higher rate of improved neurological outcome compared to standard care (80% versus 37%) and had a much greater rate of functional independence post stroke (71% versus 40%) (Campbell et al., 2015). Benefits were seen up to six hours after symptom onset though the earlier the intervention the better the outcomes.

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21

Image by Swedish Mission & Outreach

What role does a paramedic have?

Early paramedic identification of stroke combined with early pre-notification of stroke facilities is vital to reducing the time to imaging and treatment initiation. Several tools have been developed to assist the paramedic with identification and activation of a stroke system with QAS adopting the F.A.S.T. (Face, Arm, Speech, Time) assessment, and more recently, an abbreviated MASS (Melbourne Ambulance Stroke Scale), which are both excellent stroke identification tools. However, the F.A.S.T. was not created to identify reperfusion (thrombolysis or clot retrieval) eligible patients and while the MASS has been utilised to identify thrombolysis eligible patients, it has not been tested for sensitivity for identifying large vessel occlusions, suitable for clot retrieval (Brandler, Sharma, Sinert, & Levine, 2014; Bray, Coughlan, Barger, & Bladin, 2010).

Paramedic identification and triage of reperfusion eligible patients is critical since ‘time is brain’ and thrombolysis is limited to stroke capable hospitals, as indicated in the QAS Stroke Clinical Practice Procedure (QAS, 2015).

Endovascular clot retrieval requires advanced imaging equipment, highly experienced clinicians, and neuro-interventionalists. As a result, this will be an intervention limited to large tertiary facilities that may be geographically remote to the patients location. With the time critical nature of these patients and the well-established delays experienced when secondary transports are required, the argument for early, accurate, ‘in-field’ identification of patients suffering a large vessel occlusion is clear.

But how do we, as paramedics do this?

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Possible solution: Transcranial Doppler Ultrasound (TCD) can rapidly and non-invasively image blood flow in the major basal intracranial arteries. Although TCD does provide a relatively limited view of the basal arteries, it does provide good views of the intracranial arteries that are most commonly affected by large vessel occlusive disease, namely the middle cerebral artery (MCA). TCD has similar diagnostic accuracy when compared with angiography, with a sensitivity and specificity of 90-100% for the MCA and a sensitivity of 70-80% for the vertebral and basilar arteries (Sarkar, Ghosh, Ghosh, & Collier, 2007).

This procedure is limited in approximately 10% of patients due to a ‘poor acoustic window’ via the temporal bone or the foramen magnum; this is usually due to thicker cranial bone. It is also somewhat limited by the high level of technical and procedural skill required.

The use of pre-hospital TCD has been demonstrated in two small-scale studies (Holscher et al., 2008; Schlachetzki et al., 2012). Schlachetzki et al determined transcranial duplex ultrasound to have a sensitivity of 90% and specificity of 98% in a prehospital environment when conducted by a trained physician.

An earlier study showed the ultrasound examination could be completed in two minutes (Holscher et al., 2008). Interestingly it has also been shown that transcranial ultrasound over two hours in combination with intravenous thrombolysis drastically improved recanalization of MCA stroke (Alexandrov et al., 2004).

ELVO EMERGENT LARGE VESSEL OCCLUSION

There are financial and logistical restrictions in terms of equipment and training of paramedics, however recent studies of the use of focussed ultrasound by paramedics in abdominal trauma showed it could be taught in a short period of time with good diagnostic rates (Heegaard et al., 2010: Walcher et al., 2010).

Further investigation may reveal benefits for acute stroke care.

Researchers in Regensburg, Germany developed an education package aimed at the training of paramedics

References: Alexandrov, A. V., Molina, C. A., Grotta, J. C., Garami, Z., Ford, S. R., Alvarez-Sabin, J.,...Investigators, C. (2004).

in general stroke care along with acquisition and interpretation of TCD. The package involves a selfpaced online program with supervised real-time patient acquisition. Initial analysis of the program showed that after a two month program paramedics were able to accurately diagnose large vessel occlusion more often than the control group (stroke registrars) on patients in a controlled hospital setting (F. Schlachetzki, Personal Communication, November 9, 2015).

Campbell, B. C. V., Mitchelle, P. J., Kleinig, T. J., Dewey,

Haslberger, J.,...Boy, S. (2008). Transcranial Ultrasound

H. M., Churilov, L., Yassi, N.,...Investigators, E. I.

from Diagnosis to Early Stroke Treatment 1. Feasibility

(2015). Endovas cular Therapy for Ischemic Stroke with

of Prehospital Cerebrovascular Assessment.

Perfusion-Imaging

Cerebrovascular Diseases, 26(6), 659-663.

Ultrasound-enhanced systemic thrombolysis for acute

Selection. New England Journal of Medicine,

ischemic stroke. New England Journal of Medicine,

372(11),1009- 1018. doi:10.1056/NEJMoa1414792

351(21), 2170-2178. doi:10.1056/NEJMoa041175 Goyal, M., Demchuk, A. M., Menon, B. K., Eesa, M.,

doi:10.1159/000166844 Intracranial Artery Stenosis. (2013). (2). Retrieved from Mayfield Brain and Spine: http://www.mayfieldclinic. com/PDF/PD-Intracranial Stenosis.pdf

Brandler, E. S., Sharma, M., Sinert, R. H., & Levine,

Rempel, J. L., Thornton, J.,...Investigators, E. T. (2015).

S.R.(2014). Prehospital stroke scales in urban

Randomized Assessment of Rapid Endovascular

QAS. (2015). Clinical Practice Manual. Brisbane:

environments - A systematic review.

Treatment of Ischemic Stroke. New

Queensland Ambulance Service.

Neurology, 82(24), 2241-2249. doi:10.1212/

England Journal of Medicine, 372(11), 1019-1030.

Sakar, S., Ghosh, S., Ghosh, S. K., & Collier, A.

wnl.0000000000000523.

doi:10.1056/ NEJNoa1414905

(2007). Role of Transcranial Doppler Ultrasound in

Bray, J.E., Coughlan, K., Barger, B., & Bladin, C. (2010).

Heegaard, W., Hildebrandt, D., Spear, D., Chason, K.,

Paramedic Diagno sis of Stroke: Examining Long-Term

Neilson, B., & Ho, J. (2010). Prehospital Ultrasound

Use of the Melbourne

by Paramedics: Results of Field Trial. Academic

Schlachetzki, G., Herzber, M., Holscher, T., Ertl,

Emergency Medicine, 17(6), 624-630. doi:10.1111/

M., Zimmermann, M., Ittner, K. P.,...Boy, S. (2012).

j.1553-2712.2010.00755.x

Transcranial Ultrasound from Diagnosis to Early Stroke

Ambulance Stroke Screen (MASS) in the Field. Stroke, 41(7), 1363-1366. doi:10.1161/strokeaha.109.571836

Holscher, T., Schlachetzki, F., Zimmermann, M., Jakob, W., Ittner, K. P.,

Stroke. Postgrad Med J, 83, 683-689. doi:10.1136/ pgmj.2007.058602

Treatment - Part 2: Prehospital Neurosonography in Patients with Acute Stroke - The Regensburg Stroke Mobile Project. Cerebrovascular Diseases, 33(3), 262271. doi:10.1159/000334667

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23

From the First Call Early recognition and management of stroke can have a dramatic impact on the outcome for the stroke patient. EMDs are a vital link in this care plan.

The role of the Emergency Medical Dispatcher (EMD) as the first point of contact can be challenging. EMDs have the potential to make the difference, literally between life and death, through proper application of the Medical Priority Dispatch System (MPDS).

EMDs identify the patient’s ‘chief complaint’, send the nearest appropriate patient care resource to the patient, and provide ‘dispatch life support’ (DLS) until that care arrives. The role of the EMD in the overall care plan for patients can be no better demonstrated than with the early recognition of stroke.

The Stroke (CVA) Protocol is one of 32 protocols commonly used by EMDs and represents about 2.6% of all the calls taken by an EMD. In order for an EMD to obtain accurate ‘case entry’ and ‘key question’ information from the caller/patient, the caller’s cooperation is influenced by the quality of the caller engagement. The EMD must listen to what the caller is saying; acknowledging the key information.

To aid EMDs recognition of a stroke (CVA), a Stroke Diagnostic Tool is used within the protocol. This tool is designed to determine potential evidence of stroke symptoms and will assist with the correct response determinant and response priority.

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Please help: I think my Dad is having a stroke.

His speech is garbled, he is not alert and is unable to move his left arm...

The ultimate goal of the EMD is to effectively coordinate the most appropriate available resource, from the closest or most appropriate location.

The EMD must ensure that the response of resources is managed correctly and consistently to ensure the most timely and effective care to all patients.

Through MPDS, EMDs have the capacity to identify potentially life-threatening situations; this is done via careful triage and the use of sophisticated diagnostic tools which aid the provision of life-saving pre-hospital care, through the delivery of Pre-Arrival Instructions (PAIs).

An EMD’s determination and drive can impact on many aspects of pre-hospital emergency medical care.

Effective EMDs can positively influence all aspects of the situation, and can have a significant impact in the following areas: • • • •

The call taker and dispatcher have the ability to have a profound effect on their patients/callers. The chance to perform CPR, help deliver a baby, or use a defibrillator happens on a case basis for paramedics. However, these situations may occur simultaneously for the EMD. EMDs are trained in the skills and knowledge to utilise the scripted protocols and PAIs that are provided in MPDS. PAIs are to be provided directly from the scripted protocols and will be provided to the caller/ patient whenever possible and where appropriate to do so.

Paola De Tina A/Manager Communications Communications Studies Unit

quality of patient care performance of PAIs professionalism of individual EMDs community’s experience.

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Smartphone apps

a valuable tool for EMDs The smartphone revolution of recent years has given emergency services agencies an opportunity to use technology to locate and assist patients in ways never previously imagined.

GPS functionality and applications like the Emergency + App – developed by the national Triple Zero Awareness Working Group – mean Triple Zero (000) callers can now provide their exact latitude and longitude coordinates.

Director Operations State Communication Development, Stephen Moore, strongly encourages Emergency Medical Dispatchers and Call Takers to not only familiarise themselves with the new technology but to actively promote it.

“With a state as large and diverse as Queensland, and with so many tourists and grey nomads visiting us every year, it’s common to receive Triple Zero (000) calls from people who are not sure exactly where they are,” Stephen said.

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... it’s common to receive Triple Zero (000) calls from people who are not sure exactly where they are.

“The growth in smartphone ownership in Australia has been phenomenal in recent years and the new functionality that now exists in these phones is something that ambulance services can use to their benefit.

“EMDs should be thinking about tapping into this new technology if it’s going to help us respond to our patients more quickly.

“I’d encourage all Operations Centre staff to familiarise themselves with the things that smartphones can now do and understand where to find the GPS coordinates in the most popular models.

“I also strongly recommend that they download the Emergency + app promote it to their friends and family and look through it to understand exactly how it works so that they can prompt callers to use it in situations where they’re unable to provide clear directions to the scene.”

“There have been numerous instances across Australia where the Emergency + app has assisted in saving lives.”

Stephen said ambulance services across the country were also considering what might be possible in future considering the rapidly evolving technology in smartphones.

“We’ve seen recent examples from places like Israel where the national ambulance service Magen David Adom now has the capability to receive live video from an emergency caller that can be streamed directly into their CAD system,” he said.

“There is certainly scope in the future for Australian ambulance services to consider these types of enhancements if they can be of benefit to our patients.”

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Dramatic program educating young drivers QAS will continue its support of a dramatic education program aimed at reducing the number of road crashes involving young drivers.

As a paramedic I have seen how dangerous driving can change the lives of multiple people in an instant.

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The RACQ Docudrama program visits dozens of high schools around the state each year and gives students a confronting reality check before prompting them to think and talk about making safe decisions when they’re in a motor vehicle.

The program begins with a mock car crash scenario where students from the school act out a scene involving a wrecked car, a fatality, a drunk driver and a police arrest.

The involvement of paramedics (who arrive in an ambulance but can do nothing to help the ‘deceased’ patient), police officers and funeral home undertakers provides a grim element of realism as the other students watch one of their peers zipped into a body bag and loaded into a hearse.

Meanwhile, another of their fellow students is breathalysed, led away by police and placed in a patrol car.

Following the scenario the students watch a video showing the ‘circumstances’ leading up to the crash.

Education officers from RACQ then facilitate a group discussion about the ‘Fatal Five’ and the choices and strategies students can make to avoid or remove

themselves from unsafe situations – including when they are passengers.

Todd Horne, A/Officer-in-Charge of Carina Station, has participated in a number of docudrama presentations.

“As a paramedic I have seen how dangerous driving can change the lives of multiple people in an instant.

If a docudrama presentation prevents just one young person from driving dangerously, or getting in a car with a dangerous driver, it is worth it,” he said.

RACQ, which took over delivery of the program from the Department of Education in 2014, is very thankful for the ongoing support of QAS. Program coordinator Julie Smith said: “The QAS officers play an invaluable role in the presentation. They put a very human face to the treatment that is required at a road fatality making it all the more ‘real’ and harrowing for the students who witness this.”

In 2016 the program will be delivered to 40 schools within the Metro North, Metro South, Sunshine Coast, Gold Coast and Darling Downs LASNs. The program will also be delivered to seven schools in the Gladstone and Longreach area during May and August.

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Reaching out after suicide As part of their job, paramedics and emergency responders are often confronted with the sad reality of attending more than 2,000 deaths in Australia due to suicide each year.

The tragedy of losing a loved one from suicide has a lasting effect on individuals, families, friends and entire communities and it’s often the case that those bereaved by suicide do not know where to turn for help or how to find support.

The StandBy Response Service is a community-based postvention program that provides coordinated support for people who are affected by the loss of a loved one through suicide.

QAS has played an integral part in developing a unified approach that has over the years spread nationally to most states and territories.

East Coast Queensland StandBy Response Service Coordinator, Lynda Neville, said the initiative came about in the Sunshine and Cooloola Coast area back in 2002. It was the result of a tragic series of events where a young man took his own life in a small hinterland community and precisely 12 months later, his father and sister also took their lives.

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“It was driven very much by the community response of which the QAS was one of the key stakeholders,” Lynda said.

“The QAS, Queensland Police Service and what was the then Noosa Community Health were the main drivers of the program. This was because they realised that there were a lot of services out there that were supporting people but what was happening was one service did not know what the other one was doing.

“One service would assume that the other service had picked up the support, so people were falling through the cracks. So a a pilot program for the StandBy Response Service transpired after a forum was held.

“The idea and premise around that was to have that central point of coordination and also a strong relationship with emergency responders and obviously the ambulance service.

“The ambulance service has probably been the most supportive of them all on the Sunshine Coast.

“We entered into a memorandum of understanding with the ambulance service and also the other key stakeholders and now we are a 24/7 crisis response service to support people who have been affected by suicide.

“The premise around this is to reduce adverse health outcomes as a result of being exposed to death by suicide or a serious attempt at suicide.

“We are very much a crisis response and not an ongoing therapeutic counselling service.

“What the ambulance service provides is when they go to an event they are there to do a job and usually they have another one to go to straight after that so by contacting us, it ensures that the bereaved family and friends get the support they need.

QAS Sunshine Coast Senior Operations Supervisor Michael Riordan, who works closely with StandBy, said the service should be available to every community in Australia.

“What we do is basically go to a suicide and call StandBy and they make steps to see the family and assist them in their time of need. The principle behind that is that you can assist people and get them in the first stages of grief,” Michael said.

“QAS can’t do much for the family post-suicide. We can’t stay with the family. We have to go to the next case.

“We contact StandBy through the Operations Centre mostly and the crews have kits in the ambulance with contact details, which they can give to the family so if they want they can contact StandBy.” Michael said the importance of coordinated support services for families could not be underestimated.

“We have meetings and people who have been affected by suicide come along and talk about how they have been helped by StandBy and it is quite moving really,” he said.

“I would like to recommend that people contact StandBy. They rely on the emergency responders to contact them so that they can help. ” From its inception due to a very tragic and sad circumstance in a Sunshine Coast Hinterland community and the will and drive of the community and emergency services and government stakeholders, the Standby Response Service is able to reach more bereaved families nationwide.

For more information go to their website: www.unitedsynergies.com.au/program/standby-response-service

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Northern exposure:

life in the Torres Strait

When it comes to remote ambulance stations, Thursday Island is right up there – literally – at the top of Queensland.

– By Leah Watson

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Thursday Island station sits amid the Torres Strait Island archipelago about 40 kilometres from the tip of Cape York Peninsula and is a place in which Officer-in-Charge David Cameron feels privileged to work.

“Thursday Island is where my first mentor and one of my best friends was the former Officer-inCharge,” David said. “I was able to gain some insight about this remote part of the world before packing up my family and moving to the most remote station in Queensland.

“Speaking to the past three OICs on Thursday Island, they all told me it was a life-changing and wonderful experience, so when I was offered the position I was excited to be given such an amazing opportunity.”

David, who has worked at Southport, Tully, Mission Beach, South Johnstone and Gordonvale, said making the move to the Torres Strait in November 2015 was a natural progression.

“I travelled around Australia with my family when I was young and I have always had a sense of adventure and an interest in visiting and learning about remote areas of Australia,” he said.

“The workload on Thursday Island varies during the seasons. The variety of cases we respond to provides an opportunity to develop your skills and knowledge and learn about different tropical diseases.

“Thursday Island is where the station is based but we cover 16 different outer islands and we respond as far as the border with Papua New Guinea. Saibai Island is approximately three kilometres from the PNG border so we can see PNG as we do retrievals from Saibai.”

David said the community was well looked after by a tight-knit team comprising five paramedics, two cadets and a field officer.

Image by Feral Arts via Wikimedia Commons

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“We have two paramedics and a cadet that work eight days on and six days off. Each day one paramedic is the designated flight paramedic for the day and the islandbased paramedic the following day,” he said.

“We are flying on a daily basis which can include emergency medical calls, rescues and transfers. We work very closely with the Thursday Island Hospital and Australian Helicopter Service to ensure we have the required training and are prepared and ready to respond to calls. Additional and ongoing training is also essential as safety is paramount when it comes to the helicopter.

“Our field officer Deidree Whap has an amazing knowledge of the vast geography of the Torres Strait and I'm learning from her every day about the culture and history of this beautiful part of the world.”

David said he couldn’t be happier with how his family’s transition to the far north had gone.

“Thursday Island is a wonderful community. It was a huge move to pack up our house and relocate with a newborn baby,” he said.

“My wife, Karlie and our four-month-old daughter Ariya Rose are on the island with me. Karlie is a Critical Care Paramedic and is currently on maternity leave.

“It was overwhelming to start with, but the community has really welcomed us. Our neighbours who arrived at a similar time from Cairns have young children, so it has been a really nice start to our year. There are mothers groups and child care here which makes the transition easier.”

...the community was well looked after by a tight-knit team comprising five paramedics, two cadets and a field officer.

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THE GIRL NEXT DOOR

The girl next door “We used to drive an old Toyota as an ambulance and then we had a Mitsubishi van and it used to be so cramped.

“The stretchers were also really hard back then and you needed two people to lift them.

“Back then it was really meant to be a two-person job, whereas now, even with stretchers, you can operate as one person.”

Being self-sufficient on the road is certainly an important part of being an ambulance officer on Thursday Island, but, like her colleagues at the station, Deidree is aware of the strong sense of community on Thursday Island.

“On the mainland, for example, you’d have to ring for a mechanic to come and change a tyre, but here on Thursday Island you have to do it yourself,” she said.

Like many living and working on Thursday Island, Deidree Whap’s story about how she joined QAS 26 years ago is unique.

“I live next door to the ambulance station and I always watched what they were doing, until one day the superintendent asked me if I wanted to come over and have a look,” Deidree said.

“I followed up with the honorary service – they usually have a group of community members come into the station and they get to have a look around – and if the superintendent ever needed help, they’d call up and that’s how I started.”

After working as an honorary, Deidree became a cadet and was eventually admitted into the Indigenous program in 1989.

“The work has definitely changed a lot since then, which has been good I think,” she said.

“But even when I have gotten a flat, I have had people from the community assisting, saying ‘no, Deidree, you can’t do it yourself’, and I’ve said ‘no, it’s ok we’re trained to do it ourselves’.’’

Likewise, Deidree feels an important connection to Thursday Island.

“I’ve been to Cairns, I’ve worked in Cairns, but that’s only been if they needed relief. Or sometimes we go down there to do some training. I mean, I’ve got options, but when they started to recruit Indigenous people into the workforce they really wanted people to work in their own community and that’s what I’m doing,” she said.

“I’ve also worked in Weipa and Bamaga, but I think my heart is here and I need to give back to the community.

“Just last year, when I got my 25 years, I counted and I’ve worked under one superintendent and 25 OICs. It’s been an interesting journey – QAS has made me the person I am today.”

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Embracing a more

inclusive and diverse culture Every year we recognise and celebrate the world’s women on International Women’s Day on March 8.

– By Leah Watson

Two pioneers Now the Springwood Station Officer-in-Charge, Marcia Love started as an honorary officer at Cleveland on Brisbane’s southern bayside in 1984, before becoming permanent in early 1986.

“When I joined the ambulance service, there were only two female officers in Queensland – myself and a lady in Rockhampton who started five weeks before I did,” Marcia said.

Throughout her 21 years in QAS, Acting Deputy Commissioner, Service Planning and Performance, Dee Taylor-Dutton, says she has witnessed major changes.

“41 per cent of the QAS workforce is female now, which is a significant difference to when I started 21 years ago,” Dee said.

“Gender-based leadership continues to increase in QAS and we have done a lot to develop a more inclusive and diverse culture.

“Each of us can be a leader within our own sphere of influence and commit to valuing further diversity.

“I believe International Women’s Day is all about acknowledging the hard work of many people over many years and celebrating the work women continue to contribute every day to our communities and to our society more broadly.

‘Because of the work of these pioneers, including those first females in QAS, everyone is able to do the job they want to do here, regardless of gender.”

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“On the subject of female officers in Queensland I would like to take the opportunity to acknowledge the women who worked in the ambulance service during the war.

“While their husbands were away at war, defending our shores, the women were caring for our community as well as their children – what an amazing effort under what would have been incredibly difficult circumstances.”

While being pioneers in the industry, early female honorary officers also influenced basic standards, like uniforms, for future women.

“There weren’t any female uniforms when I started, so I was sent down the road to the police station to borrow a skirt from a policewoman. To this day, that policewoman whose skirt I borrowed is still a very close friend,” she said.

“What’s funny is that my father was a police officer for 40 years, in fact all my family were in the police service right back through the generations, so he was none too pleased when I joined the ambulance because he wanted me to be one of the first female police officers.

“Now we’ve started a new tradition because my husband also works for the ambulance service and both our daughters became paramedics.”

Operations Centre Supervisor, Viv King, joined the then Queensland Ambulance Transport Brigade in 1986 when she was 19, which provided her with some unique experiences.

“I was really lucky because I started as an honorary ambulance officer in Cleveland, where there was already a full-time female officer. Marcia Love basically took me under her wing and mentored me,” Viv said.

Of course, not all difficulties encountered on the job were dependent on gender. Like all honorary officers, Viv was trained on the road.

“You were really thrown into the deep end, basically you had a first-aid kit and that was it,” she said.

“My first call as an honorary officer was on my first day and it was to an asthmatic suffering shortness of breath.

“I’ll never forget when the officer I was with told me to draw up Salbutamol. I had no idea how to do that, so he had to talk me through it right there.”

After completing her training as an honorary officer, Viv moved to Wynnum Ambulance Station.

“The guys at Wynnum were brilliant – they took me in with open arms and protected me if I was given a hard time,” she said.

“It was still a little difficult back then though because, for example, there were no toilets or sleeping quarters for women – I had to drag a mattress into the training room and listen to the cockroaches running around every night.

“Something I really remember are the old trundle stretchers we had back then.

“Also, the Superintendent wasn't sure what uniform to put me in so I was given a skirt – it was difficult to maintain good lifting practices and modesty while lifting a trundle stretcher.”

One of Viv’s fellow officers during her time in Wynnum was her now husband and QAS Director Operations, LASN Liaison, Tony King.

“Actually, the first baby birth I was involved in was when I was working with Tony in Wynnum. A year later we got a card from the mother with a picture of the baby on the front. We still have it.”

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Social media pitfalls: dos and don’ts of the online world

Image by Adobe Stock

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Most people with a Facebook account have been guilty of a having a ‘rant’ on occasion.

Whether they’ve endured a difficult shift at work, some frustrating customer service from their bank or internet provider, or didn’t like that decision from the referee during the footy game – Facebook is a popular place for people to vent.

However, for employees of the Queensland Government, it’s important to remember that we all have legal and ethical responsibilites under the Code of Conduct for the Queensland Public Service.

This means that when you are making ‘personal’ comments online and you are identifiable as an employee of QAS, your communications are governed by the Code of Conduct.

For QAS employees, we are also bound by the Ambulance Service Act 1991, which makes it an offence to provide information that could identify patients.

We also must comply with the organisation’s Social Media Use Policy and Media and Communications Guideline when making personal comments online.

This means that where you identify yourself as an employee of QAS, or other people (such as your Facebook, Twitter, Instagram or LinkedIn connections) know you are an employee of QAS, you need to take care not to cross the line.

Specifically, the Social Media Use Policy states: “When using social media in a personal capacity employees should not: •

•

•

imply that they are authorised to speak as a representative, or on behalf, of QAS or the Queensland Government, or give the impression that the views expressed are those of QAS or the Queensland Government use QAS email addresses or any QAS or Queensland Government logos or insignia, as this may give the impression of official support or endorsement of the comment/s use the identity or likeness of another employee, volunteer, contractor or other member of QAS

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use or disclose any confidential information obtained in their capacity as an employee, volunteer or contractor of QAS post material or images that are, or might be construed as, inappropriate, threatening, harassing or discriminatory towards another employee, volunteer or contractor of QAS make any comment or post any material that might otherwise cause damage to QAS or which reflects seriously and adversely on QAS’s reputation.”

Privacy settings ‘But I have my profile set to private’ you say? Ah, well we can tell you, that doesn’t mean too much these days.

There is actually software available that allows people to ‘hack’ into social media accounts, and we’ve all heard the tales of UK tabloids ‘hacking’ into the phones of celebrities.

And while that is a scary thought, the more common route to being disciplined for Code of Conduct breaches, is not through being ‘hacked’.

It’s more likely that colleagues see something they feel is inappropriate for a professional employee of the Queensland Ambulance Service to publish online and are reporting it to the appropriate authority.

And it’s not Facebook or Twitter’s fault – it’s the fault of the person publishing the material.

There is a great quote from a professional social media manager that nicely sums up this topic and it’s one that we use in our QAS Media Training sessions: “Posting a less-than-favourable article/post about your employer reflects deeper issues and would naturally have repercussions, regardless of if the profile was private or public. As the old saying goes, if you’re not willing to say it to their face, don’t say it at all. The internet is not your private journal.”

That last sentence is really worth remembering. The internet is not a private journal and once you publish something there, it’s virtually there forever.

The Social Media Use Policy and Media and Communications Guidelines are available on the QAS staff portal.

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Australia Day honours Congratulations to the following officers, who were named as recipients of the Ambulance Service Medal in the 2016 Australia Day Honours List: Michael Day – Michael started his career with QAS as an Honorary Officer in September 2000 at the Wynnum Ambulance Station and has diligently served the community throughout Queensland for more than 15 years. Michael’s integrity, honesty and consistently high level of performance have been evident across a number of key roles. He epitomises the best qualities and characteristics of a professional ambulance paramedic, contributing valuably to QAS and the Queensland community and he is highly deserving of the honour.

Mark McDonald – Mark started his career with the Queensland Ambulance Transport Brigade in Gatton as an Honorary Officer in January 1977 and has diligently served the community throughout Queensland for more than 37 years.

Mark has contributed in a distinctive way to the development of the QAS during his career, including high-level contributions to the introduction of the original Diploma of Ambulance Studies, service planning, clinical education and student paramedic progression. He has continually demonstrated determination, resourcefulness, consideration and passion.

Jan Tooth – Jan started her career with the QAS in April 1992 as a student ambulance officer. She contributed to the development of the QAS paper Ambulance Report Form, has voluntarily undertaken additional duties to her normal duties as the West Moreton Local Ambulance Service Network Rosters Coordinator, and has worked in the Ipswich area most of her career, earning her a position of admiration and respect in the community.

Congratulations also to the following officers, who received Department of Health Australia Day Achievement Awards: Peter Fiechtner – Peter started with the QATB in February 1973 as an Honorary Ambulance Officer and was appointed as a Driver Bearer in 1974.

Peter has been instrumental in the ongoing development and support of the QAS e-Timesheet system and is a dedicated officer who is passionate about his role and providing support to the QAS LASNs.

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Roy Waterhouse – Roy started with QAS in 1991 in Bundaberg. Roy has undertaken a number of operational and supervisory roles. In his current role, Roy has demonstrated his commitment and dedication to the ongoing development and support of QAS Operations Centre business processes for emergency Triple Zero (000) call taking and the dispatch of QAS resources.

Catherine Dunstan – Catherine’s commitment to processes, procedures and reporting supports operational service delivery for Queenslanders. Catherine has demonstrated her dedication to serving the community and often goes over and above expected work obligations to ensure that all urgent tasks are completed. Her dedication has a positive effect on the ability of frontline staff to perform their roles effectively.

Safe travels, Rodney After a colourful career with QAS extending 35 years, Townsville LASN Assistant Commissioner, Rodney Walz, has hung up his uniform.

Rodney started as an Honorary Officer with the QATB in 1980 after working as a dental technician for about 10 years, eventually being permanently appointed in 1983.

During his time with the service, Rodney witnessed first-hand many momentous changes to the organisation and health practices.

When he started, Rodney drove a Holden Panel Van with a single-stretcher, no air-conditioning and a temperamental valve radio. He also only had oxygen and Entonox to administer to patients to relieve pain.

Rodney plans to enjoy retirement travelling overseas and around Australia with his wife of 39 years, Karen, and to spend time with his two children and beautiful grandchildren.

The QAS family wishes Rodney a safe and happy retirement and thanks him for his years of service.

Five decades not a career but a vocation Advanced Care Paramedic Ronald ‘Ron’ Alexander called it a day on February 28 at the Nambour Ambulance Station after 50 years of dedicated service to QAS. Starting as an honorary paramedic in February 1966 in Townsville at the age of 17, Ron says he always followed two golden rules when approaching any job that he strongly feels that all paramedics could benefit from.

“Never be judgemental, regardless of the circumstances you are faced with and always speak respectfully to people,” Ron said.

He also credited and acknowledged his wife of 43 years, Christine Alexander, whose unwavering support for his work helped Ron get through some confronting situations.

“It is very difficult to do this work if you don’t have the support and understanding of your family,” he said.

Apart from his service to the QAS, Ron also volunteers for St John Ambulance. He also served his country from 1965 in the Australian Army Medical Corps as a Reserve, attaining the rank of Staff Sergeant, before retiring from military service in 2008.

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THANK YOU :) Hi there I wanted to extend my deepest thanks to QAS Caloundra Station. On 2/3/2016 I was unlucky Today (24/12/2015) my deaf uncle was taken

enough to be bucked off my horse and my partner

to Townsville General Hospital from Ayr by

drove me to Caloundra hospital. I was in a pretty

a gentleman called Jason from QAS and a

bad way and it was established I had broken my

nurse from the Ayr Hospital called Roz. Both

back in two places and had to be transferred to the

were wonderful and treated him with so

spinal ward in Nambour. The two gentleman officers

much respect. We were fortunate to get

that transferred me were absolutely fantastic. Not

good news and he was transported back

only was I in fear of paralysis, I couldn’t breathe

to Ayr by Jason again. He has only been an

properly and these guys were amazing in keeping

Ambulance Officer for 6 months but he was

me as comfy and as calm as could be. I know I’m

extremely professional and looked after my

only one of many you guys help and it’s all in a

uncle like he was part of his family.

day’s work. Their concern and caring nature made a horrendous diagnosis and a very bleak time in my

– Leigh

life so much easier to deal with. I was a lucky one.

I’m still 23 hours a day on my back for another four weeks but I will get back to normal. My gratitude for the work you guys do will last a life time. Thank you from the bottom of my heart for your help understanding and caring nature. God bless you all xxx.

– Belinda

I had an ambulance come to my house at Carseldine at about 12.45am on 2/1/2016 and I would just like to thank the two officers. Absolute legends, calmed my wife and I down as she had a bleed whilst 39 weeks pregnant. We had a beautiful boy at 7.44am. They deserve a heap of praise and will have my gratitude forever. It was a young male and female. If possible please pass on my thanks.

– Neil

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MAY 2016

Thank you to Sean and Steven for being there for our daughter Isabelle yesterday (2/3/2016) in Browns Plains. Their patience was absolutely awesome and calming as we were struggling to get Izzy to take her medicine before heading off to the hospital.

You wouldn’t think there was a sick child in the ambulance with the activities/ entertainment going on. Chicken made with gloves by Sean, magic with the lights

by Steven and Sean. Izzy’s spirits were lifted as were mine and her temperature declined. Congratulations to Steven on his appointment as a fine paramedic and Sean, please keep lifting spirits. You are both blessed gifted men. Stay safe on your travels.

From a very appreciative mum, thank you again.

– Priscilla

Having a medical emergency at work is not the best scenario but it helps when the paramedics are based next door.

Caboolture firefighter Rowan Clem met up with his ‘neighbours’ – paramedics Donald Maclean, Andre Stewart and Casey Robinson – for some cake earlier this year to thank them for saving his life after he suffered a heart attack in October 2015.

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