Wellington Free Ambulance

ObjectivesUltrasound competency is critical in modern healthcare, yet no standardized framework currently supports ultrasound skill monitoring across diverse clinical settings and user types. Existing frameworks often lack generalizability, overemphasize exam counts, and fail to assess key skills such as interpretation, limiting ultrasound's safe and effective integration into clinical practice. The objective of this study is to develop a consensus‐based, universal framework for monitoring ultrasound competency across clinical applications and disciplines.MethodsA modified Delphi process was conducted with an international panel of Point‐of‐Care ultrasound experts. Panelists independently evaluated framework elements categorized by competency domains (experience, skills, autonomy), skill domains (indication, acquisition, interpretation, clinical integration), metrics (eg, exam counts, entrustability, interpretation accuracy, etc.), answer sets (score‐based inputs used by assessors), and score criteria (requirements for each score). Consensus thresholds were defined as strong consensus at >84%, and weak consensus at 68–84%. Two Delphi rounds were completed.ResultsNineteen experts participated across 2 Delphi rounds. Strong consensus was reached to include 3 competency domains (experience, skills, autonomy) and 4 skill domains (indication, acquisition, interpretation, and clinical integration). Optional components, including the use of acquisition skill trees and varied answer set granularity, were favored by some participants to allow ultrasound programs to tailor the framework to specific examinations, assessment scenarios, and job roles.ConclusionThe resulting modular framework provides a flexible, consensus‐based approach to ultrasound competency assessment, enabling cross‐program comparisons and evaluation of training methods. Validation across diverse settings is needed to support its use in global competency standards and ultrasound education expansion.

AimThis study aims to explore regional variation and identify regions within Australia with high incidence of out-of-hospital cardiac arrest (OHCA) and low rates of bystander cardiopulmonary resuscitation (CPR).MethodAdult OHCAs of presumed medical aetiology occurring across Australia between 2017 and 2019 were mapped onto local government areas (LGA) using the location of arrest coordinates. Bayesian spatial models were applied to provide “smoothed” estimates of OHCA incidence and bystander CPR rates (for bystander-witnessed OHCAs) for each LGA. For each state and territory, high-risk LGAs were defined as those with an incidence rate greater than the state or territory’s 75th percentile and a bystander CPR rate less than the state or territory’s 25th percentile.ResultsA total of 62,579 OHCA cases attended by emergency medical services across 543 LGAs nationwide were included in the study. Nationally, the OHCA incidence rate across LGA ranged from 58.5 to 198.3 persons per 100,000, while bystander CPR rates ranged from 45% to 75%. We identified 60 high-risk LGAs, which were predominantly located in the state of New South Wales. Within each region, high-risk LGAs were typically located in regional and remote areas of the country, except for four metropolitan areas–two in Adelaide and two in Perth.ConclusionsWe have identified high-risk LGAs, characterised by high incidence and low bystander CPR rates, which are predominantly in regional and remote areas of Australia. Strategies for reducing OHCA and improving bystander response may be best targeted at these regions.

AimBystander cardiopulmonary resuscitation (CPR) significantly increases the survival rate after out-of-hospital cardiac arrest. Using population-based registries, we investigated the impact of lockdown due to Covid-19 on the provision of bystander CPR, taking background changes over time into consideration. MethodsUsing a registry network, we invited all registries capable of delivering data from 1. January 2017 to 31. December 2020 to participate in this study. We used negative binominal regression for the analysis of the overall results. We also calculated the rates for bystander CPR. For every participating registry, we analysed the incidence per 100000 inhabitants of bystander CPR and EMS-treated patients using Poisson regression, including time trends. ResultsTwenty-six established OHCA registries reported 742 923 cardiac arrest patients over a four-year period covering 1.3 billion person-years. We found large variations in the reported incidence between and within continents. There was an increase in the incidence of bystander CPR of almost 5% per year. The lockdown in March/April 2020 did not impact this trend. The increase in the rate of bystander CPR was also seen when analysing data on a continental level. We found large variations in incidence of bystander CPR before and after lockdown when analysing data on a registry level. ConclusionThere was a steady increase in bystander CPR from 2017 to 2020, not associated with an increase in the number of ambulance-treated cardiac arrest patients. We did not find an association between lockdown and bystanders’ willingness to start CPR before ambulance arrival, but we found inconsistent patterns of changes between registries.

Background: The decision for emergency medical services (EMS) personnel not to transport a patient is challenging: there is a risk of subsequent deterioration but transportation of all patients to hospital would overburden emergency departments. The aim of this large-scale EMS study was to identify factors associated with an increased likelihood of ambulance reattendance within 48 hours in low acuity patients who were not transported by ambulance. Methods: We conducted a 2-year retrospective cohort study using data from the St John New Zealand EMS between 1 July 2016 and 30 June 2018 to investigate demographic and clinical associations with ambulance reattendance. Results: In total, 83,171 low acuity patients not transported by ambulance were included, of whom 4,512 (5.4%) had an EMS ambulance reattend within 48 hours. There were significant associations between EMS reattendance and patient age, sex, ethnicity, deprivation, and event location. Patients aged 60-74 years old had the highest likelihood of ambulance recall (OR 2.87, 95% CI: 2.51-3.28). Males were more likely to have an EMS ambulance reattend within 48 hours (OR 1.17, 95% CI: 1.09-1.25). Māori and Pacific Peoples had a similar likelihood of EMS recall to European/Others; however, the Asian cohort showed a reduced likelihood of reattendance (OR 0.76, 95% CI: 0.62-0.93). There were significant associations between EMS reattendance and non-transport reason, time spent on scene, event type, clinical acuity level (status), and pain score. Shorter (<30 minutes) on scene times were associated with a decreased likelihood of ambulance reattendance, whereas longer scene times (>45 minutes) were associated with an increased likelihood. Medical events were more likely to require reattendance than accident-related events (OR 1.22, 95% CI: 1.13-1.32). Non-transported patients with a severe pain score (7-10/10) were at increased likelihood of requiring reattendance (OR 1.60, 95% CI: 1.33-1.92). Discussion: The overall low rate of EMS reattendance is encouraging. Further research is needed into the clinical presentation of patients requiring ambulance reattendance within 48 hours to determine if there are early warning signs indicative of subsequent deterioration.

BackgroundRecent advances in treatment for stroke give new possibilities for optimizingoutcomes. To deliver these prehospital care needs to become moreefficient.AimTo develop a framework to support improved delivery of prehospital care. Therecommendations are aimed at clinicians involved in prehospital andemergency health systems who will often not be stroke specialists but needclear guidance as to how to develop and deliver safe and effective care foracute stroke patients.MethodsBuilding on the successful implementation program from the GlobalResuscitation Alliance and the Resuscitation Academy, the Utsteinmethodology was used to define a generic chain of survival for EmergencyStroke Care by assembling international expertise in Stroke and EmergencyMedical Services (EMS). Ten programs were identified for Acute Stroke Careto improve survival and outcomes, with recommendations for implementation ofbest practice.ConclusionsEfficient prehospital systems for acute stroke will be improved throughpublic awareness, optimized prehospital triage and timely diagnostics, andquick and equitable access to acute treatments. Documentation, use ofmetrics and transparency will help to build a culture of excellence andaccountability.

Introduction Evidence of nephrotoxicity led to abandonment of methoxyflurane anaesthesia. In lower doses via the Penthrox ® inhaler, methoxyflurane is used for analgesia. We aim to review the literature to identify the relevance of methoxyflurane as an effective analgesic agent, identify whether there are any patient safety concerns in modern use, and determine occupational risk to healthcare personnel due to environmental methoxyflurane exposure. Methods Articles were located via PubMed, ScienceDirect, Google Scholar, Anaesthesiology and the Cochrane Library. Results Single low-dose exposure to methoxyflurane may elevate blood fluoride levels below the toxic range, and appears relatively safe for patients. There is limited literature of occupational methoxyflurane exposure within modern parameters. Risks could include nephrotoxicity or hepatotoxicity. Conclusions The safety of occupational methoxyflurane exposure is yet to be proved. Further independent studies quantifying occupational exposure and monitoring the health of personnel exposed to methoxyflurane need to be undertaken to ensure safety.