Australasian Ambulance Our Patients, Our People, Our Future

Transcription

1 Australasian Ambulance Our Patients, Our People, Our Future The Council of Ambulance Authorities CAA Focus on cardiac arrest; IRCP 2015; Awards for on-screen stars SUMMER

2 From the CEO It is a major undertaking to convene and deliver a three day program, workshops, tours and social functions to inform, inspire and entertain delegates and speakers. I extend my personal thanks to the Conference Committee, Ambulance Victoria, IRCP, presenters, exhibitors, sponsors and delegates for your contribution to an outstanding event in Melbourne. The opportunity for Australian and New Zealand paramedics and academics to share their expertise and insights as part of the 11th International Roundtable on Community Paramedicine (IRCP) was a significant feature of this year s Conference. The IRCP delegates also enjoyed a day trip to Bendigo to see rural services in action, courtesy of Ambulance Victoria and Peter O Meara, Professor of Paramedicine at La Trobe University s Rural Health School. No trip to the country would be complete without seeing some native wildlife and sampling a traditional afternoon tea (refreshments). A special thanks to David Mann OAM for hosting the delegates and arranging access to some of our special fauna. Our international presenters first-hand accounts of their life-saving projects were equally compelling and an important facet in understanding how we might all deliver the best and most appropriate services based Produced by: The Council of Ambulance Authorities, 609/434 St Kilda Rd, Melbourne, 3004, Australia Editors: Chris Hornsey, Helen Conlin Design: Mario Enzo Design December 2015 Disclaimer: This document has been prepared to promote and inform discussion. All images reproduced with the permission of relevant ambulance services. on our shared knowledge. The Resuscitation Academy instigated by Seattle s Dr Michael Sayre was an invaluable session. The CAA Awards for Excellence provided another opportunity to celebrate and share successful projects. See page 6 and visit for more information on each of the projects nominated this year. Ambulance Victoria s Responding to our community display at Melbourne s Hisense arena was an impressive culmination to three days of non-stop activity. The continued outstanding support of our sponsors and exhibitors is greatly appreciated. We look forward to next year s Conference in Brisbane, Queensland, on 19 and 20 October and hope you will join us. David Waters Acting CEO, CAA National Registration Victorian Minister for Health and Minister for Ambulance Services Jill Hennessy led the case for paramedic registration at the COAG meeting in November, supported by WA, QLD and SA Health Ministers. The meeting voted for a move towards a national registration of paramedics to be included in the National Registration Accreditation Scheme marking a significant breakthrough in the campaign for registration. Ministers agreed that the matter would return to the Australian Health Ministers Advisory Council (AHMAC). Cardiac Arrest 2 3 Emergency Management 4 5 Awards 6 7 Research Agenda 8 IRCP Presentation Links 14

3 SUMMER Ambulance services are not taxis The performance of clinical outcomes that our paramedics deliver are outstanding and some of the best in the country. We want to work out how we can entrench that as part of the broader health system. Ms Hennessy said patient centred care was another important factor in delivering optimum services. She said Ambulance Victoria s community advisory service, based on similar models in the State s 86 health services, provided an incredibly important source of information to assist with planning and improving services. Victoria s Health Minister Jill Hennessy is also the Minister for Ambulance Services a joint portfolio reinforcing an intrinsic but underutilized link. Speaking on the last day of the Conference Minister Hennessy stressed the State s pride in the sector and every single paramedic and administrator who make an important contribution to the community s well-being. Ms Hennessy applauded the remarkable work of paramedics but was at pains to remind her audience of the challenges facing the government, paramedics and the community. One of our great challenges in Victoria is the increasing demand being made on our ambulance services, she said. The growth rate of that demand is something that makes it very, very challenging to provide a sustainable high quality ambulance service. Part of our great agenda is to get better integration between ambulance services and particularly acute hospital services. Ms Hennessy said that will mean undertaking particular work that focuses on ambulance services providing pre-emergency care. Ultimately we are going to have to do a better job around the provision of primary care, access to GPs, nurses, better responses in aged care facilities, ensuring that we have a strong accessible primary care approach and that we have a sustainable non-emergency transfer approach. The Minister said she took every opportunity to remind Victorians that ambulance services are not taxis. If you make unreasonable demands and make unreasonable use of paramedic services you jeopardise their ability to be available for life-threatening circumstances and life-threatening incidents. We also appreciate that when people are calling our ambulance services it is often because there are gaps in other parts of the health system. The Minister said medical research provided a further opportunity to improve integration and how we might utilize translational research in a variety of settings outside the acute hospital sector. Ultimately the debate about health care is not just about beds and our hospitals but it is about points of care whether that is in the home, whether it is dialysis, chemo day beds in the community. We are going to have to think creatively about how we utilize the incredible and critical clinical skills of paramedics and ensure their role in the broader health debate is given pre-eminence. The Minister highlighted good mental health and well-being as a high priority both for paramedics and the wider community. We know we have a particular challenge around first responders and their mental health and well-being we are right to reflect upon post-traumatic stress disorder, general mental health and wellbeing and what else needs to be done. She said it was important to recognise that the stress comes not just as a reaction to a traumatic event but the consequences of a long term career of being exposed to trauma. To provide the best care and support for paramedics the Minister said it was also necessary for people in the workforce to take ownership and leadership of this issue. From the Government s perspective we spend a lot of money on training and supporting our paramedics and we want them to have long and fulfilling careers and we also want to ensure that they are cared for and care for each other as well. The Minister concluded by remarking on paramedics remarkable humility and incredible sense of humour. Reflecting upon what it is that you do and achieve in your life and how it is that you have quality and fulfilling work and quality and fulfilling relationships is an issue that we should not ignore as we strive to deliver pre-eminent care, fantastic clinical outcomes and continuous improvement.

4 2 CAA MAGAZINE Ten steps to survival Someone who has a cardiac arrest in King County has a greater chance of survival than anyone else in the world. The survival rate for cardiac arrest in King County [Washington, USA] hit an all-time high of 62 percent in By comparison, the cardiac survival rates in New York City, Chicago, and other urban areas have been recorded in the single digits. news/2014/may/19-cardiac-survival.aspx Dr Michael Sayre is a Professor at Washington University s Division of Emergency Medicine, an emergency physician and serves as the Medical Director for the Seattle Fire Department Medic One program, and an enthusiastic ambassador for his State s success in treating cardiac arrests. His presentation on systems of care following cardiac arrest canvassed 10 steps to survival (from low hanging fruit to high hanging fruit), which have made a dramatic difference in Seattle. Significant factors in the stakes to increase survival rates include getting the community and emergency services involved, understanding the issues which might hamper appropriate treatment in an emergency setting and building a data base of information. Explaining the learning process, Dr Sayre said establishing a cardiac registry was essential as was effective telecommunicator CPR. We found our diagnosis wasn t as good as we thought, he said. Even with [a correct] diagnosis, there are still barriers, such as a non-english speaking caller, or they are too distraught. High performance CPR was important for first responders other than paramedics, understanding that while it might not start the heart, it works because blood is being circulated and keeps the brain alive: it puts dying on hold. Rapid dispatch is critical and in Seattle dispatch times have been cut from 75 seconds to 45 seconds. Recording resuscitations, next on the list, is a powerful tool for teaching and debriefing. In the heat of an emergency you don t really monitor how long things take to happen. Introducing defibrillators into police and fire services was an important step given they are often first on the scene in any emergency. Dr Sayre said there was a great deal of relief when they heard mouth to mouth resuscitation was not necessary. An immediate response program, which encourages public use of a range of applications, is a work in progress. Dr Sayre said there was more to learn including how best to tackle the challenge of marketing to the public. Teaching CPR in schools and the community and providing transparent accountable information was a priority. Showing people what you are doing and how you are doing it is essential. Finally, a culture of excellence is vital. It s a lot of hard work keeping people focussed, he said. The things that matter are teams, goals, feedback and leadership. Dr Sayre spoke separately about the Seattle-based Resuscitation Academy which strives to improve cardiac arrest rates one community at a time. As a member of the Academy s faculty, Dr Sayre was proud of its achievements since An online course was launched in October. For further information visit Resuscitation Academy CAA plans to build on the work of the acclaimed American Resuscitation Academy following the CAA/Ambulance Victoria Masterclass held before the Conference and led by Dr Sayre. Stay tuned for more information in 2016.

5 SUMMER Ian Jacobs Oration Patients don t care about the colour of your shirt Ambulance Tasmania CEO Dominic Morgan made hearts beat a little faster as he delivered the inaugural Ian Jacobs Oration. The Tasmanian initiative Early Access to Defibrillation which paid homage to Professor Jacobs passion and commitment to resuscitation, is a simple program, cost effective and on track to save lives working with all emergency services. Mr Morgan reminded delegates of the stark statistics around cardiac arrest: America s out-of-hospital cardiac arrests account for anywhere between 250,000 and 350,000 deaths a year; in Australia there are reports of 60,000 out-of-hospital cardiac arrests annually. He said Tasmania s demographics, a static population of 514,000, the oldest in Australia with 58% living outside an urban area, presented a particular challenge which would not respond to the traditional EMS approach to cardiac arrests. The early access to Automated External Defibrillator (AED) program evolved to meet these challenges and built community engagement to achieve better outcomes. Access to an AED within minutes of a cardiac arrest can improve chances of survival by more than 85%. If defibrillation is delayed, the survival rate is less than five per cent. Dire statistics for a potentially survivable outcome, he said. Mr Morgan said the Tasmanian program involved a public communication campaign about AEDs and the compilation of a comprehensive register of defibrillators held in the public domain. One of the keys ways to get success around such a big program, trying to tap into every member of our state actually thinking about cardiac arrest and what their role might be, is to have an overarching and powerful governance committee. We had the Department of Health and Human Services, University of Tasmania, the Heart Foundation, the Resuscitation Council and the Royal Hobart Hospital, all actively working to break down barriers, to make things happen, to get early access to defibrillators up and running. He said one of the biggest challenges to sustained introduction had been legal liability concerns; are we creating a liability if we ask you to take your defibrillator? Mr Morgan said the State s Solicitor General was instrumental in designing the system to circumvent the problem. The key was that we are unable to speak to them (registered AED keepers). If there is any suggestion that we have prospectively rung and encouraged someone to respond [to a cardiac arrest], then they would be legally acting as agents of the Crown. But if we provide information by talking text, the duty of care is not created. In addition to compiling a registry of community held defibrillators, Ambulance Tasmania is now targeting big business and manufacturing to get defibrillators into large community public event spaces. Tasmania has achieved what we very proudly think no other state or territory, or New Zealand, has achieved all four emergency services signed up on a memorandum of understanding. If you have a cardiac arrest in down town Tasmania it may well be a police officer who shocks your heart. Getting them involved, getting them to understand the patient doesn t care what colour your shirt is when you shock their heart has been the biggest thing to overcome and has been well accepted. Mr Morgan said the collective community view has been that AEDs were there for someone else to use. But the comprehensive communications campaign including phone apps, radio and television advertisements and social media, is proving to be effective in raising awareness and increasing AED registrations. To date, 600 AEDs are now registered in Tasmania compared with 2,000 in Victoria which has a population of 5.8 million. The costs are dropping fast and we know these will be as popular as fire extinguishers in the next five years, he said. With support from Ambulance Victoria, Ambulance Tasmania is undertaking rigorous evaluation of the program, including looking at why community members respond the way they do. Since the program was introduced there has been a 100% response rate. If every state and territory in this country and New Zealand is not doing this within five years I will eat my hat. Ian Jacobs BAppSc (WAIT) DipEd (Murd), PhD (WAust), RN, FRCNA, FANZCP, FERC, FAHA Professor Ian Jacobs lived to save lives. His local, national and international profile as a resuscitation giant highlighted his tireless and passionate commitment to the science of resuscitation. The Ian Jacobs Oration is a tribute to his selfless community involvement and his inspirational quest to restore the beat of hearts stilled too soon.

6 4 CAA MAGAZINE Looking after our Community It is a long list from booming birth rates 84 babies a week in Melbourne s western suburb of Wyndham to gender diversity in ambulance services. The Commissioner concluded his address by saying: Our chief officers are all capable, confident and competent... we work as one. EMV Commissioner Craig Lapsley Emergency Management Victoria (EMV) was established in 2014 with the role of: Leading emergency management in Victoria by working with communities, government, agencies and business to strengthen their capacity to withstand, plan for, respond to and recover from emergencies. In that short time, EMV Commissioner Craig Lapsley has laid the ground work to build trust, strong community networks, effective communications and instil a natural ability to grasp possible consequences in any given scenario. Addressing the CAA Conference on strategic directions for EMV, the Commissioner said knowing a community inside and out, understanding its social and economic composition, the demographics, are key factors in managing any crisis. Equally important was a united front among services and agencies. He cited visiting north east Victoria in the aftermath of fires last year where he encountered a 70 year old woman who was welcoming and cheery despite losing much of her property. Why? Trucks had turned up the night before to take her cherry crop to the Christmas market. The trucks got in because police and the incident controller understood that was important, he said. Fifteen years ago we would have blocked roads for up to three weeks. He warned that we were still narrow in our understanding of diversity in our communities. We think we are broad but we are not. In Melbourne we have grown up with Italians, Greeks and Chinese who started their generational change after moving in decades ago. We are a lot bigger than that today and are we up for it? The Commissioner, who has asked the question of agencies, referred to Life Saving Victoria s program to attract residents of Indian and Pakistani heritage as an excellent example of meeting the challenges facing the state. End of era The sound of sirens in the distance, looming storms, and oppressive heat, anything that might signify an impending emergency will almost certainly continue to register on Bill Thomson s personal radar for years to come. But from December, after more than 30 year s paid service, plus 11 years of volunteer service at the Pemberton Sub Centre with St John Ambulance WA, Bill will no longer have to take an active role in emergency management. He is retiring as Manager of St John s Emergency Management Unit, a post he has held for 16 years. Bill was also a founding member of CAA s Emergency Management Forum (EMF). His sage advice and good humour were hallmarks of his involvement. His invaluable experience and knowledge informed CAA s position on EM issues, and fostered a strong and united Forum. The CAA Board thanks Bill for his outstanding contribution and wishes him well in his future endeavours. Bill Thomson, St John Ambulance WA

7 SUMMER Emergency management we work as one There has been a huge investment in the ambulance sector across Australia, New Zealand and the UK. The fact that there are less agencies responsible for major incidents is a big thing. We were helped, certainly in London, with one police force, one ambulance service and one fire service. One of the key lessons remains around maintaining good communications right through the chain. Peter Rau: regarding the role of ambulance, he referred to Victoria s deadly Black Saturday 2009 bushfires: My observations were a whole range of organisations working pretty closely together there were different coloured shirts in the centre of the complex. [but] as soon as it was really busy, each organisation would retreat to its cubby hole and you would see the same shirts together. Fast forward to now, under the guidance of EMV, that doesn t happen. L R: Peter Rau, Glenn Weir, Peter Bradley, Robert Cameron, Craig Lapsley and Paul Holman (standing) Commissioner Lapsley joined a multi-agency panel to discuss Responding to the ever-evolving risk environment. Panel members included Robert Cameron, Assistant Secretary, Crisis Co-ordination Branch of Emergency Management Australia; Peter Rau, Chief Officer of the Metropolitan Fire Brigade; Glenn Weir, Acting Assistant Commissioner, State Emergencies and Security Command with Victoria Police; Peter Bradley, CEO, St John New Zealand and Paul Holman, Director of Emergency Management at Ambulance Victoria, who acted as moderator. The moderator directed questions to each of the panel around the integration and preparedness of the pre-hospital sector in emergency settings including terrorist incidents. Glenn Weir: I think we in Australia have enjoyed the tyranny of distance and disaster management by CNN almost. It hasn t been until the last two years that we have seen a significant threat and we have had to turn our minds... particularly from a policing sense... to local impacts from global issues and the emergence of ISIS. The threat by radicalised sectors of the community has made us reassess, certainly in policing, but across the whole range of our work practices our capability, what we need to put resources into. Now for the first time, police and emergency sector workers, we are targets. We have seen examples of deliberate incidents to draw first responders in, to then have a subsequent activity against us. We need to balance that risk assessment and getting the job done against any paranoia. Peter Bradley, former CEO of the London Ambulance Service, commented on his experience following the London bombings in 2005 and the Christchurch earthquake. He cited a report on the Christchurch earthquake: It was strikingly obvious that those organisations that responded most effectively had emergency responses that mirrored normal operations as closely as possible. We have come a long way, the relationship with police and fire has developed. I think the ambulance service used to be seen as the Cinderella service, the poor cousin. The ambulance service has changed, is changing. Ambulance Victoria is embedded. It is not about fire any more, 2009 was all about fire, but not now. Robert Cameron commended the reforms for emergency management outlined earlier by Commission Lapsley, describing them as nationally leading. During a recent national briefing in the eight jurisdictions, Mr Cameron said: pre-hospital was visible, active and plugged right in. He reiterated the highly visible connections adding that the service was also valued. Paul Homan added that The community is very unforgiving in terms of disasters but a disaster by its very nature is when things don t go right, otherwise we just call it a very busy day. So we are never going to be able to get it right. We need to be able to learn from what we do and get it better each time. Focus on community is the way to go. I think it is an unrealistic expectation on us that we can get it right but we can have a culture of getting better and learning from those disasters. Concluding the session he said: We would not have had a panel like this a decade ago. I think we are part of team. We have come a long way, we have a long way to go but everyone here is about looking after our communities.

8 6 CAA MAGAZINE Celebration for screen stars David Waters & Ray Creen The winners of the 2015 CAA Awards for Excellence celebrated their on-screen success at a gala dinner held in Melbourne. There were drum rolls aplenty (courtesy of The Grinners band) as the finalists were called to the stage and winners announced. Acting CEO David Waters commended the nominations from across Australia and New Zealand. This year we have seen more examples of the importance of electronic communications in everything we do, from dispatch systems to training volunteers in remote locations. Our Awards for Excellence provide an opportunity to celebrate thevery best of our services and our paramedic workforce. The winners Education Charmaine Marshall, St John Ambulance, WA for Vollie TV Finalist David Bugeja & Beck Lawler, AV for Design and Implementation of a Carers and/or Accompanying Persons Survey and Patient Experience Survey Questions Clinical The Team from the Queensland Ambulance Service (QAS) for the Digital Clinical Practice Manual Project Finalist Clinical Performance and Safety Directorate, South Australian Ambulance Service for Extended Care Paramedics management of Behavioural and Psychological Symptoms of Dementia within the Residential Aged Facility Management Desiree O Brien and NSW Ambulance for the Command Program. Finalist NSW Ambulance For their project: Today is the day we make tomorrow different Technical Ryan Lovett from NSW Ambulance for the CADLink project. Finalist QAS for the Integrated Realtime Operations Management System iroam The Star Award The CADLink project won the 2015 Star Award for Excellence. Mr Waters said the Awards Dinner had become a significant feature of CAA s annual conference as an important social and professional opportunity to connect and foster strong ties.

9 SUMMER Award stars show off their trophies with David Waters and David Leggett. The trophy for the 2015 winners paid tribute to the ANZAC Centenary and Australia s legendary John Simpson and his donkey. Artist Wayne McGinness designed the steel trophies based on the artwork of Ian Kaye-Eddie, whose painting of Simpson was framed for this year s finalists. Awards sponsor David Leggett, CEO of software company SDSI, was again a star of stage and screen as he entertained with his insights into what the world of electronic gadgetry might hold in the future. Three CAA Board members, who had retired from the Board, but not necessarily from active service, were also recognized for their ongoning contributions to the sector. Robert Morton, former CEO at SAAS, has taken up a post as the Chief Executive of the East of England Ambulance Service NHS Trust. Greg Sassella, former CEO of Ambulance Victoria retired after more than 30 year s service in the sector. Ray Creen, the former CEO of NSW Ambulance has moved on to become the CEO of St John Ambulance South Australia. Greg Sessalla Mr Waters thanked each for their passion and commitment to CAA, their respective services and the sector. Details of this year s winners and the entries judged are available in a special edition of the Australasian Ambulance Magazine available at Robert Morton Award trophy

10 8 CAA MAGAZINE Research Agenda Little research was required at this year s conference to ascertain the extent of wide-ranging, in-depth critical investigations being undertaken by CAA member services and academics. Australasian and international guests applauded the extent of research being undertaken in the field of pre-hospital care. Professor Judith Finn, Director of the Australian Resuscitation Outcomes Consortium (Aus-ROC), said she was pleasantly surprised by the sophisticated research available in Australia. Commending the CAA s new research forum and register to delegates, she encouraged everyone to continue to build collaborative links to facilitate sharing important research. It showcases the extent and breadth of the research, she said. Susan Long, President of IRCP sponsor, North Central EMS Institute (NCEMSI) and Director of Clinical and Support Services for AllinaHealth in Minnesota, was equally enthusiastic and looking forward to sharing the information with colleagues in her home state. The poster exhibition also highlighted a range of impressive projects from an mobile app to support clinical education with a tablet forming part of the exhibit to training videos and campaigns to support paramedics at work and educate the public on the role of paramedics and ambulance services. Exhibitors also played a role in fostering research with their impressive displays of equipment, technology and in the case of the Byron Group a little bit of history too. The Bryon stand captured delegates attention with framed photographs of ambulances through the years, now on display at the Temora Ambulance Museum in NSW. The research, whether displayed in static or animated presentations, helped keep the conversation flowing during the breaks. The Only Total epcr Solution Highly Available Data Advanced Analytics Fully Supported and Managed Proven Track Record with Multiple Integration Points

11 SUMMER Wellington Free Ambulance is wellaware New Zealand s Wellington Free Ambulance (WFA) is wellaware of the health, safety and well-being issues for its 466 staff and volunteers, including 154 paramedics. But in 2013, when Dr Kristin Murray took up the post of Executive Manager People and Capability, limited knowledge of internal support services was a problem. Dr Murray told delegates that because of staff exposure to trauma, vicarious trauma in the case of call takers, and indications that PTS symptoms were evident as early as two years on the job for some people, a system that supported staff was essential. She said WFA wanted to act ahead of new national legislative requirements for health and safety. We wanted to lead the way, she said. People were saying they didn t feel supported or looked after by the organisation. We introduced more focus on wellness. It wasn t just about an ambulance at the bottom of the cliff, but about how could we prevent some things from happening. To create a greater sense of interest and ownership, the campaign for change and chose the name wellaware from a short list of options. wellaware has five main features: health and safety; employee assistance program (EPA); peer support/cism; on-site chaplaincy and an online health program. Dr Murray said wellaware had led to a 70% increase in peer support contacts; a 34% rise in referrals; and a 69% reduction in spending on the EAP. Things are being resolved at peer support level. People would rather talk to someone who gets me, she said. wellaware has also improved training for peer supporters, assistance for leaders to identify vicarious trauma, and the introduction of wellaware heroes one for wellness and one for health safety. Dr Murray s advice for those considering a similar program: ask people what would help them; a good communications strategy is essential; wellness champions should be selected early; and a culture of safety and wellness must be embedded across the organisation. Are we there yet? No we are not. But we can safely say we are tracking in the right direction. For further information contact Wellington Free Ambulance or watch Dr Murray s presentation at MEDIS - Labelling Systems for the Professional NEANN s Medical Equipment and Drug Identification System - MEDIS, eliminates search and select stress, has clear, easy to read labels and artwork that eliminates search and select issues. With an increased area for identification, labelling and artwork this system design coupled with our newly developed EnvironFrei material provides a more effective working product. This new material is free from hazardous elements and delivers a strong fabric that further reduces the chance of cross-contamination. AG Cuffill Syringe with Integrated Manometer Measuring pressure and inflating the airway cuff Simple and easy operation Re-useable - up to 100 uses Accurate, accessible and safe. Flow-Safe II Disposable CPAP System Over 50% Less Oxygen Consumption Built-in manometer and pressure relief valve Has provisions for Nebulizer with in-line capability to administer medication without removing mask Now used in 3 Australian Aumbulance Services. Visit to view our monthly specials on selected products. Don t forget to register to be able to see these amazing specials.

12 10 CAA MAGAZINE Ambulance Victoria Responding to Our Community With the temperature at 34 degrees on the final day of the Conference, delegates had a glimpse of weather conditions that can make the hearts of emergency service workers skip a beat.

13 SUMMER After starting the week with rain and a meagre 16 degrees, the warmth was welcome. But by the middle of the month, Melbourne was preparing for one of its hottest and driest Octobers on record, creating conditions that can trigger bush fires and other hazards which demand immediate emergency response. With that edge in the air, Ambulance Victoria s Responding to the Community display at Hisense Arena allowed delegates, and the public, to go behind the scenes to see the equipment, vehicles and personnel always on standby. The display was a rare opportunity to see Ambulance Victoria s impressive capacity away from an emergency setting. AV s new AW139 helicopter was a major attraction alongside MICA vehicles, motorcycle and bicycle response units, urban search and rescue equipment, a Field Primary Care Clinic and a range of protective suits, modelled by mannequins. Conference MC David Mann also interviewed highly qualified paramedics at each part of the display to explain their role and specialised equipment to delegates. For further information visit Ambulance Victoria s website: www. ambulance.vic.gov.au/index.html or visit this link for a guided tour of the display caa-conference

14 12 CAA MAGAZINE IRCP in Melbourne Regional Victoria set the scene for the 11th International Roundtable on Community Paramedicine (IRCP). Delegates and presenters from America and Canada joined local paramedics for a pre-conference tour where they had an unexpected encounter with some local residents. The group first travelled to the historic gold mining town of Maldon to meet the local Community Emergency Response Team (CERT), volunteers who act as first responders in areas where there is no nearby ambulance branch. La Trobe University s Bendigo campus was the second stop on the tour where Susan Furness, Course Coordinator, Senior Lecturer and Senior Profession Mentor at the Rural Health School, Department of Paramedicine, provided further insights into rural issues for paramedics and the communities they serve. Ambulance Victoria paramedics based in Bendigo welcomed the delegates to their station where they had an opportunity to discuss some of the professional challenges and inspect the facilities and vehicles. The tour group had some free time to wander the wide streets of the grand city which flourished during the gold rush ( ) and is now home to more than 100,000 people. The international visitors hailed their meeting with an emu chick only two hours old, a koala, a crocodile and a snake, as an outstanding highlight of their time in Victoria. Ircp Mission The IRCP promotes the international exchange of information and experience related to the provision of flexible and reliable health care services to residents of rural and remote areas using novel health care delivery models and to be a resource to public policy makers, systems managers, and others. While its focus is on rural and remote medicine, the lessons learned may prove beneficial to the better provision of urban health care. IRCP Chair Gary Wingrove said the delegates experience in Melbourne and Victoria was exceptional. One of the great things about IRCP is that it is an environment that has no restrictions and people participate willingly, he said. Mr Wingrove said the event often involved a completely different audience but the emphasis is always on sharing information in keeping with the IRCP Mission. While the 2014 IRCP might have boasted the largest number of delegates, Melbourne scored other accolades. Susan Long, President of IRCP sponsor, North Central EMS Institute (NCEMSI) and Director of Clinical and Support Services for AllinaHealth in Minnesota, said this year s event was one of the best. It is the one I have been most excited about because of the variety, scope, depth and sharing, she said.

15 SUMMER I am fascinated by the scope of work here and the research, she said, adding that she had come all the way to Australia, on her first visit, to find out some of the things happening in her back yard. You re too busy when you re home to keep track. The friendliness, willingness to share, the hospitality and the openness has been the thing. Presenters from Australia, New Zealand, Canada and the USA canvassed a range of issues from paramedic practitioners and virtual simulation to specific examples of filling the gaps in community Paramedicine. Gerry Schriemer and Dale Weiss from the Paramedic Chiefs of Canada invited delegates to join them when they host the next IRCP in Saskatoon, Saskatchewan in A link to some IRCP slide presentations is available at Gary Wingrove

16 14 CAA MAGAZINE Webcasts To view a selection of the conference presentations visit Thank you to all of our conference speakers!

17 SUMMER Nurse Practioner Jackie is an emergency nurse and an intensive care paramedic at St John New Zealand. She is also a proponent of a paramedic nurse practitioner role. She said New Zealand has 150 nurse practitioners, Australia 1200 and the USA 205,000. An official report on the future of nurse practitioners in New Zealand described the relatively new profession as a unique blend of nursing and medical knowledge, clinical leadership, scholarship, research, planning and advocacy. The paramedic element adds another dimension. With more than 20 years working at caring for people in dramatic and clinical settings, Jackie resolved there was another step she could take, with the support of her boss at St John, and husband, Shane Clapperton (one and the same person). In a joint presentation to the first day of the International Roundtable on Community Paramedicine (IRCP) in Melbourne, Jackie and Shane explained the merits of their model for a paramedic nurse practitioner. Shane said Jackie s expert skills were put to the test through a Nurse practitioner led clinic when only one GP practice was available to see out of town visitors who attended the country s largest music festival, Rhythm and Vines, held in Gisborne on the east coast of New Zealand s north island, on New Year s Eve. He said St John with the support of the Nurse Practitioner clinic treated 921 patients over five days where 18,000 people were seeing in the New Year. It benefited patients on site and didn t clog up ED (Emergency Department), he said. We worked with ED, they supplied equipment and drugs. For the Emergency Department, the 31st was manageable as we were able to work collaboratively and treat and hold people at the concert during the busy periods in ED. The NZ surf life saving championships, which attracts a crowd of more than 4,000, was a similar scenario. For Jackie the new role is about advancing the profession in the best possible way to support their community. Gisborne has a population of 40,000, 48% of whom are Maori, living in the most socio-economically deprived area of New Zealand. It also has the highest rate of child suicide in the country. Jackie was committed to play a bigger role in the community s health inspired by a Maori proverb: He aha te mea nui o te ao What is the most important thing in the world? He tangata, he tangata, he tangata It is the people, it is the people, it is the people Jackie found a mentor and also developed special prescription pads and electronic forms to use on the road, or the wing. Air ambulances, while expensive, are more practical when vast distances are involved. Both Jackie and Shane said there had been great support for the model but there was often limited understanding about how it operates and there are still other issues to resolve including funding and how the model would work best. Jackie described the position as a pioneering role saying she was uncertain about what lay ahead, aside from continuing to care for the people in her community. Philips HeartStart FR3 Defibrillator for professional responders Making lifesaving faster, easier, better... The HeartStart FR3 is Philips best professional-grade AED with advanced features for the professional responder. The HeartStart FR3 reduces deployment time by eliminating steps and helps you start the right therapy on your patient faster.

18 16 CAA MAGAZINE How does your service measure up? Corey Grant-Wakefield, a lecturer at Queensland University of Technology (QUT) who holds degrees in nursing and paramedics and works as a nurse, posed the questions at the conclusion of his presentation Integrating LGBTIQ paramedics into the workforce. Can you confidently say your paramedics do not discriminate against one another, whether it is directly or indirectly? Have they been provided with training in LGBT patient centred care? According to the research undertaken with Dr David Lim, Lecturer at QUT s School of Clinical Sciences, services which can answer yes are very much in the minority. The team expanded their literature review to include the experience of all LGBTIQ health care professionals, not just paramedics. Over 18 months they researched 33 papers published between 1982 and 2015 from the US, Canada, the UK, Sweden, China and Australia. In Australia, it is illegal to discriminate directly or indirectly - against a person on the basis of sexual orientation, gender identity or intersex status, which is recognised in the CAA professional competency standards. However the current reality for health care professionals is in stark contrast to the pictures painted by these policies, Corey said. He said attempts at integration amounted to being gay for a day by involvement in the Mardi Gras or Pride parades, which were temporary and fleeting and often in place of year round visibility and inclusionary efforts. Services instead should be looking at adopting rigid, visible inclusion policies in conjunction with anti-discrimination legislation. Our patients are receiving care from professionals who are undereducated about LGBTIQ specific issues and they are receiving this care from a non-reflective workforce. Corey said psychosocial and psychological issues experienced by LGBTIQ workers are also glossed over in education for health professionals with the main focus, reported as AIDS centred. In the 21st Century this lack of education is simply unacceptable, bordering on dangerous. Corey said after his presentation that the reaction to the research had been quite positive, aside from a recent encounter at a conference where two people insisted it wasn t relevant because homophobia and trans-phobia didn t occur within the sector. He said the study demonstrated that workplaces which are inclusionary are associated with increased loyalty from LGBTI staff, and promote a positive image of LGBTIQ to the broader community. Visit to hear Corey s presentation. As an outsider looking in Group Captain Catherine McGregor held the plenary delegates spellbound on the subject of resilience using her life story and anecdotes of encounters in a world that most, particularly ardent cricket fans, can but dream. Catherine is speechwriter and strategic adviser to the Chief of the Australian Air Force, an author and cricket writer who served more than 40 years in the armed forces including several overseas deployments and received an Order of Australia medal. She is also a transgender woman. I won t labour the point of resilience but as an outsider looking in I have nothing but enormous regard for the work that you do. Comparing the work of paramedics to her experience in the Australian Defence Forces, Catherine said: The environment you confront is more dynamic and dangerous than the one we generally confront; we tend to have some level of predictability about the operational environment... and we are psychologically and physically prepared. I was horrified to hear that on routine call outs you don t know what you are going to see when that call occurs on the most routine jobs. I was also horrified to hear of the incidence of self harm. The risk of self harm amongst people from ambulance and people from paramedical services is four times the national average. That is of incredible concern. In response to that, as someone who has had a share of suffering over my life, most especially over the last four years, I don t interrupt resilience as just sucking it up and not showing that you are not hurting. I think resilience is taking progressive steps to deal with the hit when you take it. Catherine s recent suffering related to her transition to being a woman at the age of 56. Such was her pain that she contemplated ending her life. She encountered pockets of incredible resistance and anger. But overwhelmingly the response of people has been extraordinary. Catherine said while the ADF had approved gender transition policies in place and she knew her job was safe, the cricket world would be different when it came to sharing her story.

19 SUMMER But cricket has embraced me in a way that has been very touching. The cricket world, in many ways, has been more inspirational than the ADF. If my story has any resonance I think it is because in all of our lives we make compromises. We pursue external solutions to internal maladjustments or problems, we sacrifice dreams, we sacrifice our core passion and our creativity sometimes to conform to someone else s idea of who we are. I nearly died without being me. I nearly died without the world never knowing who I was. I think that s the ultimate waste of a life. it s never too late to become who you really are. Following the resounding ovation, Catherine joined a Chief Executive Officers panel: Diana Crossan CEO, Wellington Free Ambulance; Tony Walker, CEO, Ambulance Victoria; David Foot, CEO, ACT Ambulance Service; and Tony Ahern, CE, St John Ambulance WA. Each of the CEOs shared similar sentiments about the often gruelling scenarios faced by paramedics, the toll it takes on them and their families. Power-PRO XT Reduce the risk of injuries when raising and lowering. Power-LOAD Reduce the risk of injuries when loading and unloading. Stryker products reduce the risk of injury while on the job. For more information Copyright 2014 Stryker

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24 The Council of Ambulance Authorities The Council of Ambulance Authorities CAA esa.act.gov.au ambulance.qld.gov.au Providing leadership for the provision of Ambulance Services