1
|
Russell DJ, Zhao Y, Mathew S, Fitts MS, Johnson R, Reeve DM, Honan B, Niclasen P, Liddle Z, Green D, Wakerman J. The efficiency, timeliness, health outcomes and cost-effectiveness of a new aeromedical retrieval model in Central Australia: A pre- and post-implementation observational study. Aust J Rural Health 2024; 32:17-28. [PMID: 37916478 DOI: 10.1111/ajr.13057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 10/01/2023] [Accepted: 10/15/2023] [Indexed: 11/03/2023] Open
Abstract
OBJECTIVE To assess timeliness, efficiency, health outcomes and cost-effectiveness of the 2018 redesigned Central Australian aeromedical retrieval model. DESIGN Pre- and postimplementation observational study of all patients receiving telehealth consultations from remote medical practitioners (RMPs) or Medical Retrieval and Consultation Centre (MRaCC) physicians between 1/1/2015 and 29/2/2020. Descriptive and inferential statistics measuring system efficiency, timeliness, health outcomes and incremental cost-effectiveness. FINDINGS There were 9%-10% reductions in rates of total aeromedical retrievals, emergency department admissions and hospitalisations postimplementation, all p-values < 0.001. Usage rates for total hospital bed days and ICU hours were 17% lower (both p < 0.001). After adjusting for periodicity (12% fewer retrievals on weekends), each postimplementation year, there were 0.7 fewer retrievals/day (p = 0.002). The mean time from initial consultation to aeromedical departure declined by 18 minutes post-implementation (115 vs. 97 min, p = 0.007). The hazard of death within 365 days was nonsignificant (0.912, 95% CI 0.743-1.120). Postimplementation, it cost $302 more per hospital admission and $3051 more per year of life saved, with a 75% probability of cost-effectiveness. These costs excluded estimated savings of $744,528/year in reduced hospitalisations and the substantial social and out-of-pocket costs to patients and their families associated with temporary relocation to Alice Springs. CONCLUSION Central Australia's new critical care consultant-led aeromedical retrieval model is more efficient, is dispatched faster and is more cost-effective. These findings are highly relevant to other remote regions in Australia and internationally that have comparable GP-led retrieval services.
Collapse
Affiliation(s)
- Deborah Jane Russell
- Menzies School of Health Research, Charles Darwin University, Alice Springs, Northern Territory, Australia
| | - Yuejen Zhao
- Northern Territory Department of Health, Health Statistics and Informatics, Darwin, Northern Territory, Australia
| | - Supriya Mathew
- Menzies School of Health Research, Charles Darwin University, Alice Springs, Northern Territory, Australia
| | - Michelle Susannah Fitts
- Menzies School of Health Research, Charles Darwin University, Alice Springs, Northern Territory, Australia
| | - Richard Johnson
- Northern Territory Health, Central Australian Health Service, The Gap, Northern Territory, Australia
| | - David Mark Reeve
- Northern Territory Health, Central Australian Health Service, The Gap, Northern Territory, Australia
| | - Bridget Honan
- Northern Territory Health, Central Australian Health Service, The Gap, Northern Territory, Australia
| | - Petra Niclasen
- Northern Territory Health, Central Australian Health Service, The Gap, Northern Territory, Australia
| | - Zania Liddle
- Menzies School of Health Research, Charles Darwin University, Alice Springs, Northern Territory, Australia
| | - Danielle Green
- Northern Territory Department of Health, Health Statistics and Informatics, Darwin, Northern Territory, Australia
| | - John Wakerman
- Menzies School of Health Research, Charles Darwin University, Alice Springs, Northern Territory, Australia
| |
Collapse
|
2
|
Honan B, Spring B, Gardiner FW, Durup C, Venkatesh A, McInnes J, Schultz R, Ullah S, Johnson R. Air Medical Retrieval of Central Australian Women in Labor: A Retrospective Observational Study. Air Med J 2024; 43:28-33. [PMID: 38154836 DOI: 10.1016/j.amj.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 09/19/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVE The aim of this study was to describe the characteristics and outcomes of remote-dwelling pregnant women with threatened labor referred for air medical retrieval to a regional birthing center as well as factors associated with birth within 48 hours. METHODS This was a retrospective observational study of all pregnant women in the remote Central Australian region referred to the Medical Retrieval Consultation and Coordination Centre for labor > 23 weeks' gestation between February 12, 2018, and February 12, 2020. Univariate and multivariate statistical analyses were performed. RESULTS There were 116 women referred for retrieval for labor. There were no births during transport, and less than half of the cases resulted in birth within 48 hours of retrieval. Tocolysis was frequently used. Predictors of birth within 48 hours were cervical dilatation ≥ 5 cm, preterm gestational age, and ruptured membranes in the univariate analysis. Nearly one third of this cohort required intervention or had complications during birth. CONCLUSION Birth during transport for threatened labor did not occur in this cohort, and more than half of the retrievals did not result in birth within 48 hours; however, the high risk of birth complications may offset any benefit of avoiding air medical transport from remote regions. Retrieval clinicians should consider urgent transfer in cases of ruptured membranes, cervical dilatation of 5 cm or more, or gestational age less than 37 weeks.
Collapse
Affiliation(s)
- Bridget Honan
- Central Australian Retrieval Service, Alice Springs, Northern Territory, Australia.
| | - Breeanna Spring
- Royal Flying Doctor Service of Australia, Canberra, Australian Capital Territory, Australia; Molly Wardaguga Research Centre, Faculty of Health, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Fergus William Gardiner
- Royal Flying Doctor Service of Australia, Canberra, Australian Capital Territory, Australia; University of Western Australia, Crawley, Western Australia, Australia
| | - Cheryl Durup
- Central Australian Retrieval Service, Alice Springs, Northern Territory, Australia; Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Ajay Venkatesh
- Central Australian Retrieval Service, Alice Springs, Northern Territory, Australia; Alice Springs Hospital, Alice Springs, Northern Territory, Australia; School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia
| | - Jessica McInnes
- Royal Flying Doctor Service of Australia, Canberra, Australian Capital Territory, Australia
| | - Rebecca Schultz
- Alice Springs Hospital, Alice Springs, Northern Territory, Australia; Edith Cowan University, Joondalup, Western Australia, Australia
| | - Shahid Ullah
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Richard Johnson
- Alice Springs Hospital, Alice Springs, Northern Territory, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia; Baker Institute, Melbourne, Victoria, Australia
| |
Collapse
|
3
|
Huynh N, Easwaralingam N, Khan M, Suppiah A. Atypical presentation of Boerhaave's syndrome in a remote Australian setting. BMJ Case Rep 2023; 16:e253964. [PMID: 37813555 PMCID: PMC10565206 DOI: 10.1136/bcr-2022-253964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023] Open
Affiliation(s)
- Nguyen Huynh
- Department of Surgery, Westmead Hospital, Westmead, New South Wales, Australia
- Broken Hill Base Hospital and Health Service, Broken Hill, New South Wales, Australia
| | | | - Maroof Khan
- Broken Hill Base Hospital and Health Service, Broken Hill, New South Wales, Australia
| | - Aravind Suppiah
- Broken Hill Base Hospital and Health Service, Broken Hill, New South Wales, Australia
| |
Collapse
|
4
|
Greene A, Dion PM, Nolan B, Trachter R, Vu E, Trojanowski J. Overcoming distance: an exploration of current practices of government and charity-funded critical care transport and retrieval organizations. Scand J Trauma Resusc Emerg Med 2023; 31:52. [PMID: 37789319 PMCID: PMC10548638 DOI: 10.1186/s13049-023-01125-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 09/26/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND For critically ill and injured patients, timely access to definitive care is associated with a reduction in avoidable mortality. Access to definitive care is significantly affected by geographic remoteness. To overcome this disparity, a robust critical care transport (CCT) or retrieval system is essential to support the equity of care and overcome the tyranny of distance. While critical care transport or retrieval systems have evolved over the years, there is no universally accepted system or standard, which has led to considerable variation in practices. The objective of this mixed-methods study was to identify and explore the current clinical, operational, and educational practices of government and charity-funded critical care transport and retrieval organizations operating across access- and weather- challenged geography. METHODS This study utilized a mixed-methods approach comprising a rapid review of the literature and semi-structured interviews with identified subject matter experts (SME). RESULTS A total of 44 articles and 14 interviews with SMEs from six different countries, 12 different services/systems, and seven operational roles, including clinicians (physician, paramedic, and nurse), educator, quality improvement, clinical governance, clinical informatics and research, operations manager, and medical director were included in the narrative analysis. The study identified several themes including deployment, crew composition, selection and education, clinical governance, quality assurance and quality improvement and research. CONCLUSION This mixed-methods study underscores the paucity of literature describing current clinical, operational, and educational practices of government or charity-funded CCT or retrieval programs operating across access- and weather- challenged geography. While many common themes were identified including clearly defined mission profiles, use of dedicated or specialized transport teams, central coordination, rigorous selection processes, service-sponsored graduate education, and strong clinical governance, there is little consensus and considerable variation in current practices. Further research is needed to identify and harmonize best practices within the CCT and retrieval environments.
Collapse
Affiliation(s)
- Adam Greene
- British Columbia Emergency Health Services, Provincial Health Services Authority, Victoria, BC, Canada.
- School of Medicine, Cardiff University, Cardiff, Wales, UK.
| | - Pierre-Marc Dion
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Brodie Nolan
- Department of Emergency Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Rob Trachter
- Department of Emergency Medicine, Nanaimo Regional General Hospital, Nanaimo, BC, Canada
| | - Erik Vu
- British Columbia Emergency Health Services, Provincial Health Services Authority, Victoria, BC, Canada
- Division of Emergency Medicine, Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
- Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Jan Trojanowski
- British Columbia Emergency Health Services, Provincial Health Services Authority, Victoria, BC, Canada
- Division of Critical Care Medicine, Department of Medicine, Kelowna General Hospital, University of British Columbia, Kelowna, BC, Canada
| |
Collapse
|
5
|
Muyambi K, Gardiner F, Sollid S, Hyldmo PK, Yisma E, Spring B, Bredmose P, Jones M, Walsh S, Schofield Z, Gillam M. Aeromedical retrieval services characteristics globally: a scoping review. Scand J Trauma Resusc Emerg Med 2022; 30:71. [PMID: 36510297 PMCID: PMC9743498 DOI: 10.1186/s13049-022-01053-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Aeromedical emergency retrieval services play an important role in supporting patients with critical and often life-threatening clinical conditions. Aeromedical retrieval services help to provide fast access to definitive care for critically ill patients in under-served regions. Typically, fixed-wing aeromedical retrieval becomes the most viable transport option compared with rotary-wing aircraft when distances away from centres of definitive care extend beyond 200 kms. To our knowledge, there are no studies that have investigated fixed-wing aeromedical services in the member countries of the organisation for economic cooperation and development (OECD). A description of the global characteristics of aeromedical services will inform international collaboration to optimise clinical outcomes for patients. AIM In this scoping review, we aimed to describe the features of government- and not-for-profit organisation-owned fixed-wing aeromedical retrieval services in some of the member countries of the OECD. METHODS We followed scoping review methodology based on the grey literature search strategy identified in earlier studies. This mostly involved internet-based searches of the websites of fixed-wing aeromedical emergency retrieval services affiliated with the OECD member countries. RESULTS We identified 460 potentially relevant records after searching Google Scholar (n = 24) and Google search engines (n = 436). After removing ineligible and duplicate information, this scoping review identified 86 government-and not-for-profit-operated fixed-wing aeromedical retrieval services as existing in 17 OECD countries. Concentrations of the services were greatest in the USA followed by Australia, Canada, and the UK. The most prevalent business models used across the identified OECD member countries comprised the government, not-for-profit, and hybrid models. Three-quarters of the not-for-profit and two-fifths of the hybrid business models were in the USA compared to other countries studied. The government or state-funded business model was most common in Australia (11/24, 46%), Canada (4/24, 17%), and the UK (4/24, 17%). The frequently used service delivery models adopted for patients of all ages included primary/secondary retrievals, secondary retrievals only, and service specialisation models. Of these service models, primary/secondary retrieval involving the transportation of adults and children from community clinics and primary health care facilities to centres of definitive care comprised the core tasks performed by most of the aeromedical retrieval services studied. The service specialisation model provided an extra layer of specialist health care dedicated to the transportation of neonates and paediatrics. At least eight aeromedical retrieval services catered solely for children from birth to 16 years of age. One aeromedical service, the royal flying doctor service in Australia also provided primary health care and telehealth services in addition to primary retrieval and interhospital transfer of patients. The doctor and registered nurse/paramedic (Franco-German model) and the nurse and/or paramedic (Anglo-American model) configurations were the most common staffing models used across the aeromedical services studied. CONCLUSIONS The development and composition of fixed-wing aeromedical emergency retrieval services operated by not-for-profit organisations and governments in the OECD countries showed diversity in terms of governance arrangements, services provided, and staffing models used. We do not fully understand the impact of these differences on the quality of service provision, including equitable service access, highlighting a need for further research.
Collapse
Affiliation(s)
- Kuda Muyambi
- grid.1026.50000 0000 8994 5086Department of Rural Health, University of South Australia, Adelaide, Australia ,grid.1026.50000 0000 8994 5086IIMPACT in Health, University of South Australia, Adelaide, South Australia Australia
| | - Fergus Gardiner
- Royal Flying Doctor Service, Canberra, Australia ,grid.1001.00000 0001 2180 7477Australian National University, Canberra, Australia
| | - Stephen Sollid
- grid.18883.3a0000 0001 2299 9255University of Stavanger, Stavanger, Norway ,grid.55325.340000 0004 0389 8485Division of Prehospital Services, Air Ambulance Department, Oslo University Hospital, Oslo, Norway
| | - Per Kristian Hyldmo
- grid.18883.3a0000 0001 2299 9255University of Stavanger, Stavanger, Norway ,grid.414311.20000 0004 0414 4503Division of Prehospital Care, Sørlandet Hospital, Sørlandet, Norway
| | - Engida Yisma
- grid.1026.50000 0000 8994 5086Department of Rural Health, University of South Australia, Adelaide, Australia ,grid.1026.50000 0000 8994 5086IIMPACT in Health, University of South Australia, Adelaide, South Australia Australia
| | - Breeanna Spring
- Royal Flying Doctor Service, Canberra, Australia ,grid.1043.60000 0001 2157 559XCharles Darwin University, Casuarina, Australia
| | - Per Bredmose
- grid.55325.340000 0004 0389 8485Division of Prehospital Services, Air Ambulance Department, Oslo University Hospital, Oslo, Norway ,grid.420120.50000 0004 0481 3017Norwegian Air Ambulance Foundation, Oslo, Norway
| | - Martin Jones
- grid.1026.50000 0000 8994 5086Department of Rural Health, University of South Australia, Adelaide, Australia ,grid.1026.50000 0000 8994 5086IIMPACT in Health, University of South Australia, Adelaide, South Australia Australia
| | - Sandra Walsh
- grid.1026.50000 0000 8994 5086Department of Rural Health, University of South Australia, Adelaide, Australia ,grid.1026.50000 0000 8994 5086IIMPACT in Health, University of South Australia, Adelaide, South Australia Australia
| | | | - Marianne Gillam
- grid.1026.50000 0000 8994 5086Department of Rural Health, University of South Australia, Adelaide, Australia ,grid.1026.50000 0000 8994 5086IIMPACT in Health, University of South Australia, Adelaide, South Australia Australia
| |
Collapse
|
6
|
Green D, Russell DJ, Zhao Y, Mathew S, Fitts MS, Johnson R, Reeve DM, Honan B, Niclasen P, Liddle Z, Maguire G, Remond M, Wakerman J. Evaluation of a new medical retrieval and primary health care advice model in Central Australia: Results of pre‐ and post‐implementation surveys. Aust J Rural Health 2022; 31:322-335. [PMID: 36484695 DOI: 10.1111/ajr.12954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 11/16/2022] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION In February 2018 the Remote Medical Practitioner (RMP)-led telehealth model for providing both primary care advice and aeromedical retrievals in Central Australia was replaced by the Medical Retrieval and Consultation Centre (MRaCC) and Remote Outreach Consultation Centre (ROCC). In this new model, specialists with advanced critical care skills provide telehealth consultations for emergencies 24/7 and afterhours primary care advice (MRaCC) while RMPs (general practitioners) provide primary care telehealth advice in business hours via the separate ROCC. OBJECTIVE To evaluate changes in clinicians' perceptions of efficiency and timeliness of the new (MRaCC) and (ROCC) model in Central Australia. DESIGN There were 103 and 72 respondents, respectively, to pre- and post-implementation surveys of remote clinicians and specialist staff. FINDINGS Both emergency and primary care aspects of telehealth support were perceived as being significantly more timely and efficient under the newly introduced MRaCC/ROCC model. Importantly, health professionals in remote community were more likely to feel that their access to clinical support during emergencies was consistent and immediately available. DISCUSSION Respondents consistently perceived the new MRaCC/ROCC model more favourably than the previous RMP-led model, suggesting that there are benefits to having separate referral streams for telehealth advice for primary health care and emergencies, and staffing the emergency stream with specialists with advanced critical care skills. CONCLUSION Given the paucity of literature about optimal models for providing pre-hospital medical care to remote residents, the findings have substantial local, national and international relevance and implications, particularly in similar geographically large countries, with low population density.
Collapse
Affiliation(s)
- Danielle Green
- Northern Territory Health, Top End Health Service Darwin Northern Territory Australia
| | - Deborah Jane Russell
- Menzies School of Health Research Charles Darwin University Alice Springs Northern Territory Australia
| | - Yuejen Zhao
- Northern Territory Health, Top End Health Service Darwin Northern Territory Australia
| | - Supriya Mathew
- Menzies School of Health Research Charles Darwin University Alice Springs Northern Territory Australia
| | - Michelle Susannah Fitts
- Menzies School of Health Research Charles Darwin University Alice Springs Northern Territory Australia
| | - Richard Johnson
- Northern Territory Health, Central Australian Health Service The Gap Northern Territory Australia
| | - David Mark Reeve
- Northern Territory Health, Central Australian Health Service The Gap Northern Territory Australia
| | - Bridget Honan
- Northern Territory Health, Central Australian Health Service The Gap Northern Territory Australia
| | - Petra Niclasen
- Northern Territory Health, Central Australian Health Service The Gap Northern Territory Australia
| | - Zania Liddle
- Menzies School of Health Research Charles Darwin University Alice Springs Northern Territory Australia
| | - Graeme Maguire
- Curtin Medical School Curtin University Bentley Western Australia Australia
| | - Marc Remond
- College of Health, Medicine and Wellbeing University of Newcastle Callaghan New South Wales Australia
| | - John Wakerman
- Menzies School of Health Research Charles Darwin University Alice Springs Northern Territory Australia
| |
Collapse
|
7
|
Ting J. Retrieval medicine and pre-hospital care in remote Australia. Intern Med J 2021; 50:763-766. [PMID: 32537927 DOI: 10.1111/imj.14863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 12/03/2019] [Indexed: 11/28/2022]
Abstract
Retrieval medicine and pre-hospital care in remote Australia are challenging, requiring competencies in major trauma, high-risk obstetrics, critical care in adults and children, severe mental health-related agitation and envenomation. They keep a city-based retrieval and pre-hospital care doctor on their toes. Cultural fluencies to enhance care for Aboriginal and remote communities are critical during the long hours taken for the patient journey from the accident scene or clinic to definitive care.
Collapse
Affiliation(s)
- Joseph Ting
- Department of Emergency Medicine, Mater Hospital Brisbane, Brisbane, Queensland, Australia.,Department of Emergency Medicine, Ipswich Hospital, Ipswich, Queensland, Australia.,Retrieval Service, Central Australian Retrieval Service, Alice Springs, Northern Territory, Australia.,School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| |
Collapse
|
8
|
Gardiner FW, Bishop L, Churilov L, Collins N, O'Donnell J, Coleman M. Mental Health Care for Rural and Remote Australians During the Coronavirus Disease 2019 Pandemic. Air Med J 2020; 39:516-519. [PMID: 33228907 DOI: 10.1016/j.amj.2020.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/16/2020] [Accepted: 08/20/2020] [Indexed: 06/11/2023]
Abstract
The aims of this article are to comment on pre-coronavirus disease 2019 (COVID-19) mental health activity in rural and remote Australia, including related air medical retrievals; to discuss how the current pandemic is likely to impact on this vulnerable population's mental health; and to provide potential solutions. The COVID-19 pandemic has resulted in significant air medical activity from rural and remote Australia. COVID-19 and the necessary public health and socioeconomic interventions are likely to significantly compound mental health problems for both the general public and the mental health workforce servicing rural and remote communities. However, the COVID-19 crisis provides a window of opportunity to develop, support, and build novel and sustainable solutions to the chronic mental health service vulnerabilities in rural and remote areas in Australia and other countries.
Collapse
Affiliation(s)
- Fergus W Gardiner
- The Royal Flying Doctor Service, Canberra, Australia; National Centre for Epidemiology and Population Health and The Australian National University Medical School, The Australian National University, Canberra, Australia.
| | - Lara Bishop
- The Royal Flying Doctor Service, Canberra, Australia; National Centre for Epidemiology and Population Health and The Australian National University Medical School, The Australian National University, Canberra, Australia
| | - Leonid Churilov
- Department of Medicine (Austin Health) and Melbourne Brain Centre at Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia
| | - Noel Collins
- The Rural Clinical School of Western Australia, University of Western Australia, Albany, Western Australia, Australia
| | | | - Mathew Coleman
- The Rural Clinical School of Western Australia, University of Western Australia, Albany, Western Australia, Australia
| |
Collapse
|
9
|
Rice B, Wood J, Britton C, Strehlow M, Goodwin S. Medevac Utilization and Patient Characteristics in Rural Alaska 2010 to 2018. Air Med J 2020; 39:393-398. [PMID: 33012479 DOI: 10.1016/j.amj.2020.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/20/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Little is known about medevac utilization in remote, rural Alaska where there is no road access and communities are reliant on medevacs for emergency care. With high financial costs and risks to flight crews, there is an urgent need to understand medevac utilization in rural Alaska. This article aimed to describe medevac utilization and patient characteristics over 9 years in the remote, air transport dependent in Alaska. METHODS Deidentified data (2010-2018) were obtained for all medevacs originating within the Yukon-Kuskokwim Delta. Descriptive statistics were calculated, and chi-square tests of independence were conducted to identify differences. RESULTS Four thousand nine hundred ninety-one medevacs were performed, averaging 555 (standard deviation = 67.7) per year. Medevacs for respiratory complaints were predominant for children, whereas trauma predominated for adults 18 to 40 years old. Traumatic injury was more common in males than females aged < 65 years but was more common in females than males aged ≥ 65 years. Significant variability occurred in medevacs based on the community and the hour of the day. CONCLUSION Medevacs are a critical part of health care in rural, remote Alaska but appear subject to clinical and nonclinical determinants. These baseline data provide a foundation for future studies aiming to increase medevac safety and provide decision-making support.
Collapse
Affiliation(s)
- Brian Rice
- Department of Emergency Medicine, Stanford University, Palo Alto, CA.
| | - Jeremy Wood
- Alaska Native Tribal Health Consortium, Anchorage, AK
| | - Carla Britton
- Alaska Native Tribal Health Consortium, Anchorage, AK
| | - Matthew Strehlow
- Department of Emergency Medicine, Stanford University, Palo Alto, CA
| | - Susan Goodwin
- LifeMed Alaska, Anchorage, AK; Alaska Native Medical Center, Anchorage, AK
| |
Collapse
|
10
|
Franklin RC, King JC, Aitken PJ, Elcock MS, Lawton L, Robertson A, Mazur SM, Edwards K, Leggat PA. Aeromedical retrievals in Queensland: A five-year review. Emerg Med Australas 2020; 33:34-44. [PMID: 32633088 DOI: 10.1111/1742-6723.13559] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 05/18/2020] [Accepted: 05/21/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Aeromedical services are an essential part of the healthcare system. Centralised coordination of aeromedical retrieval tasking offers benefits for safety, timeliness and efficiency in service delivery. The aim of the present study is to review aeromedical retrievals in Queensland exploring patient demographics, temporal patterns and usage characteristics. METHODS This is a retrospective cases series for the period 1 January 2010 to 31 December 2014 incorporating data from Retrieval Services Queensland and Queensland Newborn Emergency Transport Service. Ethics approval was obtained (JCU-HREC H6137 and Public Health Act #RD005673). Descriptive analysis of the de-identified data was undertaken included patient demographics, referral and receiving locations, retrieval platform and acuity of transport request. RESULTS There were 73 042 aeromedical retrievals undertaken during the period, with an average of 40 cases per day (range 16-89). The majority (95%) of retrievals were for Queensland residents. Overall 23.1% of cases were cardiology-related and 12.7% were injury-related. Older adults aged 75-84 years had the highest rate of retrievals relative to the population with a crude rate of 942.4 per 100 000 per annum. Overall 14.9% of cases were Priority 1, which represents the tasking with the highest acuity but majority were Priority 4 (41.6%). One third (37.6%) of all patients were from inner regional locations. CONCLUSIONS Potential investments in health service planning may alleviate the burden on aeromedical services, particularly related to cardiology services in inner and outer regional Queensland. Aeromedical services are pivotal in enabling all sick and injured residents' access to the highest quality of care regardless of the remoteness of their residence.
Collapse
Affiliation(s)
- Richard C Franklin
- Discipline of Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Jemma C King
- Discipline of Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Peter J Aitken
- Discipline of Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.,Prevention Division, Department of Health, Aeromedical Retrieval and Disaster Management Branch, Brisbane, Queensland, Australia
| | - Mark S Elcock
- Discipline of Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.,Prevention Division, Department of Health, Aeromedical Retrieval and Disaster Management Branch, Brisbane, Queensland, Australia
| | - Luke Lawton
- Department of Emergency Medicine, The Townsville Hospital, Townsville, Queensland, Australia.,College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Anita Robertson
- Discipline of Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.,Royal Flying Doctor Service, Townsville RFDS Base, Townsville, Queensland, Australia
| | - Stefan M Mazur
- Discipline of Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.,Department of Emergency Medicine, The Townsville Hospital, Townsville, Queensland, Australia.,SAAS MedSTAR Emergency Medical Retrieval Service, South Australian Ambulance Service, Adelaide, South Australia, Australia.,Emergency Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Kristin Edwards
- Discipline of Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Peter A Leggat
- Discipline of Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
11
|
Gardiner FW, Johns H, Bishop L, Churilov L. Royal Flying Doctor Service Coronavirus Disease 2019 Activity and Surge Modeling in Australia. Air Med J 2020; 39:404-409. [PMID: 32425475 PMCID: PMC7229980 DOI: 10.1016/j.amj.2020.05.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective There is a coronavirus disease 2019 (COVID-19) pandemic. We aimed to describe the characteristics of patients transported by the Royal Flying Doctor Service (RFDS) for confirmed or suspected COVID-19 and to investigate the surge capacity of and operational implications for the RFDS in dealing with COVID-19. Methods This was a prospective cohort study. To determine the characteristics of patients transported for confirmed or suspected COVID-19, we included patient data from February 2, 2020, to May 6, 2020. To investigate the surge capacity and operational implications for the RFDS in dealing with COVID-19, we built and validated an interactive operations area-level discrete event simulation decision support model underpinned by RFDS air medical activity data from 2015 to 2019 (4 years). This model was subsequently used in a factorial in silico experiment to systematically investigate both the supply of RFDS air medical services and the increased rates of demand for these services for diseases of the respiratory system. Results The RFDS conducted 291 patient episodes of care for confirmed or suspected COVID-19. This included 288 separate patients, including 136 men and 119 women (sex missing = 33), with a median age of 62.0 years (interquartile range, 43.5-74.9 years). The simulation decision support model we developed is capable of providing dynamic and real-time support for RFDS decision makers in understanding the system's performance under uncertain COVID-19 demand. With increased COVID-19–related demand, the ability of the RFDS to cope will be driven by the number of aircraft available. The simulation model provided each aviation section with estimated numbers of aircraft required to meet a range of anticipated demands. Conclusion Despite the lack of certainty in the actual level of COVID-19–related demand for RFDS services, modeling demonstrates that the robustness of meeting such demand increases with the number of operational and medically staffed aircraft.
Collapse
Affiliation(s)
- Fergus W Gardiner
- The Royal Flying Doctor Service, Canberra, Australia.,National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Hannah Johns
- Department of Medicine at Austin Health, The University of Melbourne, Melbourne, Australia.,Melbourne Brain Centre at the Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia
| | - Lara Bishop
- The Royal Flying Doctor Service, Canberra, Australia.,National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Leonid Churilov
- Department of Medicine at Austin Health, The University of Melbourne, Melbourne, Australia.,Melbourne Brain Centre at the Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia
| |
Collapse
|
12
|
Edwards KH, FitzGerald G, Franklin RC, Edwards MT. Air ambulance outcome measures using Institutes of Medicine and Donabedian quality frameworks: protocol for a systematic scoping review. Syst Rev 2020; 9:72. [PMID: 32241304 PMCID: PMC7118977 DOI: 10.1186/s13643-020-01316-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 03/01/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Dedicated air ambulance services provide a vital link for critically ill and injured patients to higher levels of care. The recent developments of pre-hospital and retrieval medicine create an opportunity for air ambulance providers and policy-makers to utilize a dashboard of quality performance measures to assess service performance. The objective of this scoping systematic review will be to identify and evaluate the range of air ambulance outcome measures reported in the literature and help to construct a quality dashboard based on a healthcare quality framework. METHODS We will search PubMed, MEDLINE, CINAHL, Scopus, and Cochrane Database of Systematic Reviews (from January 2001 onwards). Complementary searches will be conducted in selected relevant journals. We will include systematic reviews and observational studies (cohort, cross-sectional, interrupted time series) in critically ill or injured patients published in English and focusing on air ambulance delivery and quality measures. Two reviewers will independently screen all citations, full-text articles, and abstract data. The study methodological quality (or bias) will be appraised using appropriate tools. Analysis of the characteristics associated with outcome measure will be mapped and described according to the proposed healthcare quality framework. DISCUSSION This review will contribute to the development of an air ambulance quality dashboard designed to combine multiple quality frameworks. Our findings will provide a basis for helping decision-making in health planning and policy. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019144652.
Collapse
Affiliation(s)
- Kristin H Edwards
- College of Public Health, Medical and Veterinary Sciences, James Cook University, 1 James Cook Drive, Townsville, Queensland, Australia.
| | - Gerard FitzGerald
- Queensland University of Technology, Victoria Park Rd, Kelvin Grove, Brisbane, Queensland, Australia
| | - Richard C Franklin
- College of Public Health, Medical and Veterinary Sciences, James Cook University, 1 James Cook Drive, Townsville, Queensland, Australia
| | - Mark Terrell Edwards
- College of Public Health, Medical and Veterinary Sciences, James Cook University, 1 James Cook Drive, Townsville, Queensland, Australia
- LifeFlight Retrieval Medicine Australia, Edward Street, Brisbane, Queensland, Australia
- Queensland Health, Emergency Medicine Department Rockhampton, Rockhampton Base Hospital, Canning Street, Rockhampton, Queensland, Australia
| |
Collapse
|
13
|
King JC, Franklin RC, Robertson A, Aitken PJ, Elcock MS, Gibbs C, Lawton L, Mazur SM, Edwards KH, Leggat PA. Review article: Primary aeromedical retrievals in Australia: An interrogation and search for context. Emerg Med Australas 2019; 31:916-929. [PMID: 31729193 DOI: 10.1111/1742-6723.13405] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 08/07/2019] [Accepted: 09/20/2019] [Indexed: 11/28/2022]
Abstract
Primary aeromedical retrievals are a direct scene response to patients with a critical injury or illness using a medically equipped aircraft. They are often high-acuity taskings. In Australia, information on primary retrieval taskings is housed by service providers, of which there are many across the country. This exploratory literature review aims to explore the contemporary peer-reviewed literature on primary aeromedical retrievals in Australia. The focus is on adult primary aeromedical retrievals undertaken in Australia and clinical tools used in this pre-hospital setting. Included articles were reviewed for research theme (clinical and equipment, systems and/or outcomes), data coverage and appraisal of the evidence. Of the 37 articles included, majority explored helicopter retrievals (n = 32), retrieval systems (n = 21), compared outcomes within a service (n = 10) and explored retrievals in the state of New South Wales (n = 19). Major topics of focus included retrieval of trauma patients and airway management. Overall, the publications had a lower strength of evidence because of the preponderance of cross-sectional and case-study methodology. This review provides some preliminary but piecemeal insight into primary retrievals in Australia through a localised systems lens. However, there are several areas for research action and service outcome improvements suggested, all of which would be facilitated through the creation of a national pre-hospital and retrieval registry. The creation of a registry would enable consideration of the frequency and context of retrievals, comparison across services, more sophisticated data interrogation. Most importantly, it can lead to service and pre-hospital and retrieval system strengthening.
Collapse
Affiliation(s)
- Jemma C King
- Discipline of Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Richard C Franklin
- Discipline of Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.,World Safety Organization Collaborating Centre for Disaster Health and Emergency Response, Townsville, Queensland, Australia
| | - Anita Robertson
- Discipline of Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.,Royal Flying Doctor Service, Townsville, Queensland, Australia
| | - Peter J Aitken
- Discipline of Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.,Aeromedical Retrieval and Disaster Management Branch, Prevention Division, Department of Health, Brisbane, Queensland, Australia
| | - Mark S Elcock
- Discipline of Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.,Aeromedical Retrieval and Disaster Management Branch, Prevention Division, Department of Health, Brisbane, Queensland, Australia
| | - Clinton Gibbs
- Retrieval Services Queensland, Aeromedical Retrieval and Disaster Management Branch, Prevention Division, Department of Health, Brisbane, Queensland, Australia.,College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.,Department of Emergency Medicine, The Townsville Hospital, Townsville, Queensland, Australia
| | - Luke Lawton
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.,Department of Emergency Medicine, The Townsville Hospital, Townsville, Queensland, Australia
| | - Stefan M Mazur
- Discipline of Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.,Department of Emergency Medicine, The Townsville Hospital, Townsville, Queensland, Australia.,SAAS MedSTAR Emergency Medical Retrieval Service, SA Ambulance Service, Adelaide, South Australia, Australia.,Emergency Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Kristin H Edwards
- Discipline of Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Peter A Leggat
- Discipline of Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.,World Safety Organization Collaborating Centre for Disaster Health and Emergency Response, Townsville, Queensland, Australia.,School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| |
Collapse
|
14
|
O’Sullivan B, Russell DJ, McGrail MR, Scott A. Reviewing reliance on overseas-trained doctors in rural Australia and planning for self-sufficiency: applying 10 years' MABEL evidence. HUMAN RESOURCES FOR HEALTH 2019; 17:8. [PMID: 30670027 PMCID: PMC6341566 DOI: 10.1186/s12960-018-0339-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 12/20/2018] [Indexed: 05/05/2023]
Abstract
BACKGROUND The capacity for high-income countries to supply enough locally trained doctors to minimise their reliance on overseas-trained doctors (OTDs) is important for equitable global workforce distribution. However, the ability to achieve self-sufficiency of individual countries is poorly evaluated. This review draws on a decade of research evidence and applies additional stratified analyses from a unique longitudinal medical workforce research program (the Medicine in Australia: Balancing Employment and Life survey (MABEL)) to explore Australia's rural medical workforce self-sufficiency and inform rural workforce planning. Australia is a country with a strong medical education system and extensive rural workforce policies, including a requirement that newly arrived OTDs work up to 10 years in underserved, mostly rural, communities to access reimbursement for clinical services through Australia's universal health insurance scheme, called Medicare. FINDINGS Despite increases in the number of Australian-trained doctors, more than doubling since the late 1990s, recent locally trained graduates are less likely to work either as general practitioners (GPs) or in rural communities compared to local graduates of the 1970s-1980s. The proportion of OTDs among rural GPs and other medical specialists increases for each cohort of doctors entering the medical workforce since the 1970, peaking for entrants in 2005-2009. Rural self-sufficiency will be enhanced with policies of selecting rural-origin students, increasing the balance of generalist doctors, enhancing opportunities for remaining in rural areas for training, ensuring sustainable rural working conditions and using innovative service models. However, these policies need to be strongly integrated across the long medical workforce training pathway for successful rural workforce supply and distribution outcomes by locally trained doctors. Meanwhile, OTDs substantially continue to underpin Australia's rural medical service capacity. The training pathways and social support for OTDs in rural areas is critical given their ongoing contribution to Australia's rural medical workforce. CONCLUSION It is essential for Australia to monitor its ongoing reliance on OTDs in rural areas and be considerate of the potential impact on global workforce distribution.
Collapse
Affiliation(s)
- Belinda O’Sullivan
- Monash University School of Rural Health, Office of Research, PO Box 666, Bendigo, VIC 3550 Australia
| | - Deborah J. Russell
- Flinders University Northern Territory, PO Box 4066, Alice Springs, NT 0871 Australia
| | - Matthew R. McGrail
- University of Queensland, Rural Clinical School, 78 on Canning Street, Rockhampton, Queensland 4700 Australia
| | - Anthony Scott
- Melbourne Institute of Applied Economic and Social Research, The University of Melbourne, Alan Gilbert Building, Parkville, 3010 Australia
| |
Collapse
|
15
|
Delorenzo AJ, Abetz JW, Andrew E, de Wit A, Williams B, Smith K. Characteristics of Fixed Wing Air Ambulance Transports in Victoria, Australia. Air Med J 2017; 36:173-178. [PMID: 28739238 DOI: 10.1016/j.amj.2017.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 02/04/2017] [Accepted: 02/20/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Air medical transport is important for the transfer of patients in the prehospital and interhospital environment. Few studies have described the services provided by fixed wing ambulances or the broader clinical profiles of patients they transport. Such information may be useful for the planning and allocation of resources, assistance with training, and refining clinical protocols. We sought to describe the characteristics of patients transported by fixed wing aircraft at Air Ambulance Victoria (AAV) and the service AAV provides in Victoria, Australia. METHODS A retrospective data review of patients transported by AAV fixed wing aircraft between January 1, 2011, and June 30, 2015, was performed. Data were sourced from the Ambulance Victoria data warehouse. Retrievals involving physicians were excluded. RESULTS A total of 16,579 patients were transported during the study period, with a median age of 66 years. Most patients were male (58.7%), and cardiovascular/hematologic conditions (27.2%) were most common. Overall, 51.7% of cases were prebooked routine transfers, 47.4% were interhospital routine transfers, and 0.9% were primary responses. Caseloads were largest in the regions furthest from the capital city. CONCLUSION The AAV fixed wing service in Victoria enables regional and remote patients to be transported to definitive care without major disruption to ground ambulances.
Collapse
Affiliation(s)
- Ashleigh J Delorenzo
- Research Assistant, Department of Community Emergency Health and Paramedic Practice, Monash University, Victoria, Australia; Ambulance Victoria, Victoria, Australia.
| | - Jeremy W Abetz
- Medical Student, Department of Community Emergency Health and Paramedic Practice, Monash University, Victoria, Australia; School of Rural Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Emily Andrew
- Research Governance Manager, Ambulance Victoria, Victoria, Australia
| | - Anthony de Wit
- Air Operations Manager, Ambulance Victoria, Victoria, Australia
| | - Brett Williams
- Head of Department, Department of Community Emergency Health and Paramedic Practice, Monash University, Victoria, Australia
| | - Karen Smith
- Adjunct Professor, Department of Community Emergency Health and Paramedic Practice, Monash University, Victoria, Australia; Manager of Research and Evaluation, Ambulance Victoria, Victoria, Australia; Adjunct Professor, Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia; Adjunct Professor, Discipline of Emergency Medicine, University of Western Australia, Perth, Western Australia, Australia
| |
Collapse
|
16
|
|
17
|
Brideson G, Willis E, Mayner L, Chamberlain DJ. Images of flight nursing in Australia: A study using institutional ethnography. Nurs Health Sci 2016; 18:38-43. [DOI: 10.1111/nhs.12225] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 03/31/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Genevieve Brideson
- School of Nursing and Midwifery; Flinders University; Adelaide South Australia Australia
| | - Eileen Willis
- Faculty of Medicine, Nursing and Health Sciences; Flinders University; Adelaide South Australia Australia
| | - Lidia Mayner
- School of Nursing and Midwifery; Flinders University; Adelaide South Australia Australia
| | - Diane J. Chamberlain
- School of Nursing and Midwifery; Flinders University; Adelaide South Australia Australia
| |
Collapse
|
18
|
Galvagno Jr SM, Sikorski R, Hirshon JM, Floccare D, Stephens C, Beecher D, Thomas S. Helicopter emergency medical services for adults with major trauma. Cochrane Database Syst Rev 2015; 2015:CD009228. [PMID: 26671262 PMCID: PMC8627175 DOI: 10.1002/14651858.cd009228.pub3] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Although helicopters are presently an integral part of trauma systems in most developed nations, previous reviews and studies to date have raised questions about which groups of traumatically injured people derive the greatest benefit. OBJECTIVES To determine if helicopter emergency medical services (HEMS) transport, compared with ground emergency medical services (GEMS) transport, is associated with improved morbidity and mortality for adults with major trauma. SEARCH METHODS We ran the most recent search on 29 April 2015. We searched the Cochrane Injuries Group's Specialised Register, The Cochrane Library (Cochrane Central Register of Controlled Trials; CENTRAL), MEDLINE (OvidSP), EMBASE Classic + EMBASE (OvidSP), CINAHL Plus (EBSCOhost), four other sources, and clinical trials registers. We screened reference lists. SELECTION CRITERIA Eligible trials included randomized controlled trials (RCTs) and nonrandomized intervention studies. We also evaluated nonrandomized studies (NRS), including controlled trials and cohort studies. Each study was required to have a GEMS comparison group. An Injury Severity Score (ISS) of at least 15 or an equivalent marker for injury severity was required. We included adults age 16 years or older. DATA COLLECTION AND ANALYSIS Three review authors independently extracted data and assessed the risk of bias of included studies. We applied the Downs and Black quality assessment tool for NRS. We analyzed the results in a narrative review, and with studies grouped by methodology and injury type. We constructed 'Summary of findings' tables in accordance with the GRADE Working Group criteria. MAIN RESULTS This review includes 38 studies, of which 34 studies examined survival following transportation by HEMS compared with GEMS for adults with major trauma. Four studies were of inter-facility transfer to a higher level trauma center by HEMS compared with GEMS. All studies were NRS; we found no RCTs. The primary outcome was survival at hospital discharge. We calculated unadjusted mortality using data from 282,258 people from 28 of the 38 studies included in the primary analysis. Overall, there was considerable heterogeneity and we could not determine an accurate estimate of overall effect.Based on the unadjusted mortality data from six trials that focused on traumatic brain injury, there was no decreased risk of death with HEMS. Twenty-one studies used multivariate regression to adjust for confounding. Results varied, some studies found a benefit of HEMS while others did not. Trauma-Related Injury Severity Score (TRISS)-based analysis methods were used in 14 studies; studies showed survival benefits in both the HEMS and GEMS groups as compared with MTOS. We found no studies evaluating the secondary outcome, morbidity, as assessed by quality-adjusted life years (QALYs) and disability-adjusted life years (DALYs). Four studies suggested a small to moderate benefit when HEMS was used to transfer people to higher level trauma centers. Road traffic and helicopter crashes are adverse effects which can occur with either method of transport. Data regarding safety were not available in any of the included studies. Overall, the quality of the included studies was very low as assessed by the GRADE Working Group criteria. AUTHORS' CONCLUSIONS Due to the methodological weakness of the available literature, and the considerable heterogeneity of effects and study methodologies, we could not determine an accurate composite estimate of the benefit of HEMS. Although some of the 19 multivariate regression studies indicated improved survival associated with HEMS, others did not. This was also the case for the TRISS-based studies. All were subject to a low quality of evidence as assessed by the GRADE Working Group criteria due to their nonrandomized design. The question of which elements of HEMS may be beneficial has not been fully answered. The results from this review provide motivation for future work in this area. This includes an ongoing need for diligent reporting of research methods, which is imperative for transparency and to maximize the potential utility of results. Large, multicenter studies are warranted as these will help produce more robust estimates of treatment effects. Future work in this area should also examine the costs and safety of HEMS, since multiple contextual determinants must be considered when evaluating the effects of HEMS for adults with major trauma.
Collapse
Affiliation(s)
- Samuel M Galvagno Jr
- University of Maryland School of Medicine, Division of Trauma Anesthesiology, Program in Trauma, R Adams Cowley Shock Trauma CenterDepartment of AnesthesiologyBaltimoreMDUSA21201
| | - Robert Sikorski
- University of Maryland School of Medicine, Division of Trauma Anesthesiology, Program in Trauma, R Adams Cowley Shock Trauma CenterDepartment of AnesthesiologyBaltimoreMDUSA21201
| | - Jon M Hirshon
- University of Maryland School of MedicineDepartment of Emergency MedicinePaca‐Pratt Building110 S. Paca Street, 4S‐127BaltimoreMarylandUSA21201‐1559
| | - Douglas Floccare
- Maryland Institute for Emergency Medical Services Systems653 W Pratt StreetBaltimoreMDUSA21201
| | - Christopher Stephens
- R. Adams Cowley Shock Trauma Center, University of MarylandTrauma AnaesthesiologyDepartment of AnesthesiologyBaltimoreMDUSA21201
| | - Deirdre Beecher
- London School of Hygiene & Tropical MedicineCochrane Injuries GroupKeppel StreetLondonUKWC1E 7HT
| | - Stephen Thomas
- Hamad General Hospital & Weill Cornell Medical College in QatarDepartment of Emergency MedicineDohaQatar
| | | |
Collapse
|
19
|
Haren MT, Setchell J, John DL, Daniel M. The impacts of withdrawal and replacement of general practitioner services on aeromedical service trends: a 13-year interrupted time-series study in Tennant Creek, Northern Territory. BMC Health Serv Res 2015; 15:456. [PMID: 26438226 PMCID: PMC4595330 DOI: 10.1186/s12913-015-1110-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 09/23/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Royal Flying Doctor Service (RFDS) provides aeromedical care to patients during fixed-wing transport over vast distances to healthcare unavailable in rural or remote communities. This study examined the relationship between changes in local accessibility to primary healthcare services and rates of aeromedical service use over time. METHODS This was a 13-year interrupted time-series study (1999-2012) in Tennant Creek, Northern Territory. Quarterly aeromedical service use for primary care sensitive conditions were calculated and exposure to general practice (GP) services was characterised over time with events modelled as intervention variables: (a) GP service withdrawal (Nov-2004); and (b) GP service replacement (Dec-2006). Intervention effects were estimated using PROC ARIMA in SAS after examination of the time-series structure. RESULTS GP withdrawal resulted in an immediate and sustained doubling in quarterly aeromedical service use (+11.8 services per quarter) and GP service replacement had no significant effect. DISCUSSION Large and immediate increases in aeromedical service use result from the loss of local GPservices yet, in this case, replacement with a new GP service, 2-years hence, did not ameliorate that effect after six years. CONCLUSIONS These findings demonstrate the immediate impact of GP-service loss on the rates ofaeromedical transfer of patients from this remote community and lend caution to expectations about thetimeline over which newly implemented primary health care services in such contexts can mitigate the impact of such a loss.
Collapse
Affiliation(s)
- Matthew T Haren
- School of Population Health, Division of Health Sciences, University of South Australia, Adelaide, SA, Australia. .,Spatial Epidemiology and Evaluation Research Group, Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia.
| | - John Setchell
- The Royal Flying Doctor Service (RFDS) of Australia, Central Operations, Mile End, SA, Australia.
| | - David L John
- School of Population Health, Division of Health Sciences, University of South Australia, Adelaide, SA, Australia. .,Spatial Epidemiology and Evaluation Research Group, Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia.
| | - Mark Daniel
- School of Population Health, Division of Health Sciences, University of South Australia, Adelaide, SA, Australia. .,Spatial Epidemiology and Evaluation Research Group, Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia.
| |
Collapse
|
20
|
O'Sullivan BG, Joyce CM, McGrail MR. Adoption, implementation and prioritization of specialist outreach policy in Australia: a national perspective. Bull World Health Organ 2014; 92:512-9. [PMID: 25110376 DOI: 10.2471/blt.13.130385] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 01/16/2014] [Accepted: 02/04/2014] [Indexed: 12/28/2022] Open
Abstract
The World Health Organization has endorsed the use of outreach to promote: efficient redeployment of the health-care workforce; continuity of care at the local level; and professional support for local, rural, health-care workers. Australia is the only country that has had, since 2000, a sustained national policy on outreach for subsidizing medical specialist outreach to rural areas. This paper describes the adoption, implementation and prioritization of a national specialist outreach policy in Australia. Adoption of the national policy followed a long history of successful outreach, largely driven by the professional interest and personal commitment of the workforce. Initially the policy supported only new outreach services but concerns about the sustainability of existing services resulted in eligibility for funding being extended to all specialist services. The costs of travel, travel time, accommodation, professional support, staff relief at specialists' primary practices and equipment hire were subsidized. Over time, a national political commitment to the equitable treatment of indigenous people resulted in more targeted support for outreach in remote areas. Current priorities are: (i) establishing team-based outreach services; (ii) improving local staff's skills; (iii) achieving local coordination; and (iv) conducting a nationally consistent needs assessment. The absence of subsidies for specialists' clinical work can discourage private specialists from providing services in remote areas where clinical throughput is low. To be successful, outreach policy must harmonize with the interests of the workforce and support professional autonomy. Internationally, the development of outreach policy must take account of the local pay and practice conditions of health workers.
Collapse
Affiliation(s)
- Belinda G O'Sullivan
- School of Rural Health, Monash University, 26 Mercy Street (Level 3), PO Box 666, Bendigo, Victoria, 3550, Australia
| | - Catherine M Joyce
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | | |
Collapse
|
21
|
Margolis SA, Ypinazar VA, Muller R, Clough A. Increasing alcohol restrictions and rates of serious injury in four remote Australian Indigenous communities. Med J Aust 2011; 194:503-6. [DOI: 10.5694/j.1326-5377.2011.tb03081.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Accepted: 04/12/2011] [Indexed: 11/17/2022]
Affiliation(s)
- Stephen A Margolis
- Education and Research Unit, Royal Flying Doctor Service (Queensland Section), Cairns, QLD
| | | | | | | |
Collapse
|