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Gardiner FW, Schofield Z, Hendry M, Jones K, Smallacombe M, Steere M, Beach J, MacIsaac M, Greenberg R, Crawford C, Trivett M, Morris J, Spring B, Quinlan F, Churilov L, Rallah-Baker K, Gardiner E, O’Donnell J. A novel COVID-19 program, delivering vaccines throughout rural and remote Australia. Front Public Health 2023; 11:1019536. [PMID: 37529430 PMCID: PMC10390067 DOI: 10.3389/fpubh.2023.1019536] [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: 08/15/2022] [Accepted: 06/27/2023] [Indexed: 08/03/2023] Open
Abstract
Background The Royal Flying Doctor Service of Australia (RFDS) established a unique SARS-CoV-2 vaccination program for vaccinating Australians that live in rural and remote areas. This paper describes the preparation and response phases of the RFDS response. Methods This study includes vaccinations conducted by the RFDS from 01 January 2021 until 31 December 2021 when vaccines were mandatory for work and social activities. Prior to each clinic, we conducted community consultation to determine site requirements, patient characteristics, expected vaccination numbers, and community transmission rates. Findings Ninety-five organizations requested support. The majority (n = 60; 63.2%) came from Aboriginal Community Controlled Health Organizations. Following consultation, 360 communities were approved for support. Actual vaccinations exceeded expectations (n = 70,827 vs. 49,407), with a concordance correlation coefficient of 0.88 (95% CI, 0.83, 0.93). Areas that reported healthcare workforce shortages during the preparation phase had the highest population proportion difference between expected and actual vaccinations. Areas that reported high vaccine hesitancy during the preparation phase had fewer than expected vaccines. There was a noticeable increase in vaccination rates in line with community outbreaks and positive polymerase chain reaction cases [r (41) = 0.35, p = 0.021]. Engagement with community leaders prior to clinic deployment was essential to provide a tailored response based on community expectations.
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Affiliation(s)
- Fergus W. Gardiner
- Royal Flying Doctor Service of Australia, Canberra, ACT, Australia
- The Rural Clinical School of Western Australia, The University of Western Australia, Perth, WA, Australia
| | - Zoe Schofield
- Royal Flying Doctor Service of Australia, Canberra, ACT, Australia
- CDU Menzies School of Medicine, Darwin, NT, Australia
| | - Miranda Hendry
- Royal Flying Doctor Service of Australia, Canberra, ACT, Australia
| | - Kate Jones
- Royal Flying Doctor Service of Australia, Canberra, ACT, Australia
| | | | - Mardi Steere
- Royal Flying Doctor Service of Australia, Canberra, ACT, Australia
| | - Jenny Beach
- Royal Flying Doctor Service of Australia, Canberra, ACT, Australia
| | | | | | - Candice Crawford
- Royal Flying Doctor Service of Australia, Canberra, ACT, Australia
| | - Melanie Trivett
- Royal Flying Doctor Service of Australia, Canberra, ACT, Australia
| | - Judah Morris
- Royal Flying Doctor Service of Australia, Canberra, ACT, Australia
| | - Breeanna Spring
- Royal Flying Doctor Service of Australia, Canberra, ACT, Australia
- Molly Wardagua Research Centre, Faculty of Health, Charles Darwin University, Darwin, NT, Australia
| | - Frank Quinlan
- Royal Flying Doctor Service of Australia, Canberra, ACT, Australia
| | - Leonid Churilov
- Melbourne Brain Centre at the Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Elli Gardiner
- Royal Flying Doctor Service of Australia, Canberra, ACT, Australia
| | - John O’Donnell
- Royal Flying Doctor Service of Australia, Canberra, ACT, Australia
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Edwards KH, Franklin RC, Jones R, Kuhnert PM, Khanna S. Using a Quality Framework to Explore Air Ambulance Patients' Journey Outcomes in Central Queensland, Australia. Prehosp Disaster Med 2023; 38:57-64. [PMID: 36366838 DOI: 10.1017/s1049023x22001480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION In Australia, aeromedical retrieval provides a vital link for rural communities with limited health services to definitive care in urban centers. Yet, there are few studies of aeromedical patient experiences and outcomes, or clear measures of the service quality provided to these patients. STUDY OBJECTIVE This study explores whether a previously developed quality framework could usefully be applied to existing air ambulance patient journeys (ie, the sequences of care that span multiple settings; prehospital and hospital-based pre-flight, flight transport, after-flight hospital in-patient, and disposition). The study aimed to use linked data from aeromedical, emergency department (ED), and hospital sources, and from death registries, to document and analyze patient journeys. METHODS A previously developed air ambulance quality framework was used to place patient, prehospital, and in-hospital service outcomes in relevant quality domains identified from the Institutes of Medicine (IOM) and Dr. Donabedian models. To understand the aeromedical patients' journeys, data from all relevant data sources were linked by unique patient identifiers and the outcomes of the resulting analyses were applied to the air ambulance quality framework. RESULTS Overall, air ambulance referral pathways could be classified into three categories: Intraregional (those retrievals which stayed within the region), Out of Region, and Into Region. Patient journeys and service outcomes varied markedly between referral pathways. Prehospital and in-hospital service variables and patient outcomes showed that the framework could be used to explore air ambulance service quality. CONCLUSION The air ambulance quality framework can usefully be applied to air ambulance patient experiences and outcomes using linked data analysis. The framework can help guide prehospital and in-hospital performance reporting. With variations between regional referral pathways, this knowledge will aid with planning within the local service. The study successfully linked data from aeromedical, ED, in-hospital, and death sources and explored the aeromedical patients' journeys.
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Affiliation(s)
- Kristin H Edwards
- James Cook University, College of Public Health, Medical, and Veterinary Sciences, Townsville, Queensland, Australia
| | - Richard C Franklin
- James Cook University, College of Public Health, Medical, and Veterinary Sciences, Townsville, Queensland, Australia
| | - Rhondda Jones
- James Cook University, College of Public Health, Medical, and Veterinary Sciences, Townsville, Queensland, Australia
| | - Petra M Kuhnert
- The Commonwealth Scientific and Industrial Research Organization (CSIRO) Data61, Darwin, Northern Territory, Australia
| | - Sankalp Khanna
- CSIRO, Australian e-Health Research Centre, Brisbane, Queensland, Australia
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3
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Edwards KH, Franklin RC, Edwards MT, Stewart RA. Requesting air ambulance transport of patients with suspected appendicitis: The decision‐making process through the eyes of the rural clinician. Aust J Rural Health 2022. [DOI: 10.1111/ajr.12956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 03/23/2022] [Accepted: 11/27/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Kristin H. Edwards
- College of Public Health, Medical and Veterinary Sciences James Cook University Townsville Queensland Australia
| | - Richard C. Franklin
- College of Public Health, Medical and Veterinary Sciences James Cook University Townsville Queensland Australia
| | - Mark T. Edwards
- LifeFlight Retrieval Medicine Australia Brisbane Queensland Australia
| | - Ruth A. Stewart
- College of Medicine and Dentistry James Cook University Townsville Queensland Australia
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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.
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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
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Medical retrieval of pregnant women in labour: A scoping review. Australas Emerg Care 2022:S2588-994X(22)00085-9. [DOI: 10.1016/j.auec.2022.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 10/01/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022]
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Ebinger M, Audebert HJ. Shifting acute stroke management to the prehospital setting. Curr Opin Neurol 2022; 35:4-9. [PMID: 34799513 DOI: 10.1097/wco.0000000000001012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The earlier the treatment, the better the outcomes after acute ischemic stroke. Optimizing prehospital care bears potential to shorten treatment times. We here review the recent literature on mothership vs. drip-and-ship as well as mobile stroke unit concepts. RECENT FINDINGS Mobile stroke units result in the shortest onset-to-treatment times in mostly urban settings. SUMMARY Future research should focus on further streamlining processes around mobile stroke units, especially improving dispatch algorithms and improve referral for endovascular therapy.
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Affiliation(s)
- Martin Ebinger
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin
- Klinik für Neurologie, Medical Park Berlin Humboldtmühle
| | - Heinrich J Audebert
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin
- Klinik für Neurologie mit Experimenteller Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
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7
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Bringing CT Scanners to the Skies: Design of a CT Scanner for an Air Mobile Stroke Unit. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12031560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Stroke is the second most common cause of death and remains a persistent health challenge globally. Due to its highly time-sensitive nature, earlier stroke treatments should be enforced for improved patient outcome. The mobile stroke unit (MSU) was conceptualized and implemented to deliver the diagnosis and treatment to a stroke patient in the ultra-early time window (<1 h) in the pre-hospital setting and has shown to be clinically effective. However, due to geographical challenges, most rural communities are still unable to receive timely stroke intervention, as access to specialized stroke facilities for optimal stroke treatment poses a challenge. Therefore, the aircraft counterpart (Air-MSU) of the conventional road MSU offers a plausible solution to this shortcoming by expanding the catchment area for regional locations in Australia. The implementation of Air-MSU is currently hindered by several technical limitations, where current commercially available CT scanners are still oversized and too heavy to be integrated into a conventional helicopter emergency medical service (HEMS). In collaboration with the Australian Stroke Alliance and Melbourne Brain Centre, this article aims to explore the possibilities and methodologies in reducing the weight and, effectively, the size of an existing CT scanner, such that it can be retrofitted into the proposed search and rescue helicopter—Agusta Westland AW189. The result will be Australia’s first-ever customized CT scanner structure designed to fit in a search-and-rescue helicopter used for Air-MSU.
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Tran L, Lin L, Spratt N, Bivard A, Chew BLA, Evans JW, O'Brien W, Levi C, Ang T, Alanati K, Pepper E, Garcia-Esperon C, Parsons M. Telestroke Assessment With Perfusion CT Improves the Diagnostic Accuracy of Stroke vs. Mimic. Front Neurol 2021; 12:745673. [PMID: 34925211 PMCID: PMC8681858 DOI: 10.3389/fneur.2021.745673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/25/2021] [Indexed: 11/16/2022] Open
Abstract
Background and Purpose: CT perfusion (CTP) has been implemented widely in regional areas of Australia for telestroke assessment. The aim of this study was to determine if, as part of telestroke assessment, CTP provided added benefit to clinical features in distinguishing between strokes and mimic and between transient ischaemic attack (TIA) and mimic. Methods: We retrospectively analysed 1,513 consecutively recruited patients referred to the Northern New South Wales Telestroke service, where CTP is performed as a part of telestroke assessment. Patients were classified based on the final diagnosis of stroke, TIA, or mimic. Multivariate regression models were used to determine factors that could be used to differentiate between stroke and mimic and between TIA and mimic. Results: There were 693 strokes, 97 TIA, and 259 mimics included in the multivariate regression models. For the stroke vs. mimic model using symptoms only, the area under the curve (AUC) on the receiver operator curve (ROC) was 0.71 (95% CI 0.67–0.75). For the stroke vs. mimic model using the absence of ischaemic lesion on CTP in addition to clinical features, the AUC was 0.90 (95% CI 0.88–0.92). The multivariate regression model for predicting mimic from TIA using symptoms produced an AUC of 0.71 (95% CI 0.65–0.76). The addition of absence of an ischaemic lesion on CTP to clinical features for the TIA vs. mimic model had an AUC of 0.78 (95% CI 0.73–0.83) Conclusions: In the telehealth setting, the absence of an ischaemic lesion on CTP adds to the diagnostic accuracy in distinguishing mimic from stroke, above that from clinical features.
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Affiliation(s)
- Lucinda Tran
- Department of Neurology and Neurophysiology, Liverpool Hospital, Liverpool, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Liverpool, NSW, Australia
| | - Longting Lin
- South Western Sydney Clinical School, University of New South Wales, Liverpool, NSW, Australia
| | - Neil Spratt
- Department of Neurology, John Hunter Hospital, Newcastle, NSW, Australia.,Brain and Mental Health Program, Hunter Medical Research Institute, Newcastle, NSW, Australia.,School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, NSW, Australia
| | - Andrew Bivard
- Melbourne Brain Centre, University of Melbourne, Parkville, VIC, Australia
| | | | - James W Evans
- Neurosciences Department, Gosford Hospital, Gosford, NSW, Australia
| | - William O'Brien
- Neurosciences Department, Gosford Hospital, Gosford, NSW, Australia
| | - Christopher Levi
- Department of Neurology, John Hunter Hospital, Newcastle, NSW, Australia
| | - Timothy Ang
- Neurology Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Neurology Department, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Khaled Alanati
- Department of Neurology, John Hunter Hospital, Newcastle, NSW, Australia
| | - Elizabeth Pepper
- Department of Neurology, John Hunter Hospital, Newcastle, NSW, Australia
| | | | - Mark Parsons
- Department of Neurology and Neurophysiology, Liverpool Hospital, Liverpool, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Liverpool, NSW, Australia.,Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
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Gardiner FW, Rallah-Baker K, Dos Santos A, Sharma P, Churilov L, Donnan GA, Davis SM, Quinlan F, Worley P. Indigenous Australians have a greater prevalence of heart, stroke, and vascular disease, are younger at death, with higher hospitalisation and more aeromedical retrievals from remote regions. EClinicalMedicine 2021; 42:101181. [PMID: 34765955 PMCID: PMC8573152 DOI: 10.1016/j.eclinm.2021.101181] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/14/2021] [Accepted: 10/14/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND We aimed to determine whether heart, stroke, and vascular disease (HSVD) prevalence and emergency primary evacuation (EPE), hospitalisation, and mortality differ by patient characteristics. METHODS An Australian-wide incidence population based study, with prospective data collected form the 1 July 2019 to the 30 October 2020. FINDINGS Indigenous Australians reported significantly higher prevalence of HSVD at 229.0 per-1000 as compared to 152.0 per-1000 non-Indigenous Australians: risk ratio 1.5 (95% CI 1.2-1.8). 583 remote patients received an EPE for HSVD, consisting of 388 (66.6%; 95% CI: 62.6-70.4) males and 195 (33.0%; 95% CI: 29.6-37.4) females. There were 289 (49.6%; 95% CI 45.4- 53.7) patients who identified as Indigenous, and 294 (50.4%; 95% CI 46.3- 54.6) as non-Indigenous. The mean Indigenous age during EPE was 48.0 (95% CI 45.9-50.1) years old, significantly lower than the non-Indigenous mean age of 55.6 (95% CI 53.8-57.4). Indigenous patients hospitalised for HSVD were younger, the majority younger than 65 years (n=21175; 73.7% 95% CI 73.2-74.2) as compared to non-Indigenous patients (n= 357654; 33.1% 95% CI 33.0-33.15). When adjusted for HSVD prevalence, remote Indigenous patients had a higher hospitalisation rate as compared to non-remote Indigenous patients (rate ratio: 1.6; 95% CI 1.3-2.0) and remote non-Indigenous patients (rate ratio: 1.2; 95% CI 1.0-1.5). More Indigenous patients died of HSVD before the age of 65 years (n=1875; 56.5% 95% CI 54.8-58.2) as compared to non-Indigenous patients (n= 16161; 10.6% 95% CI 10.45-10.8). INTERPRETATION Indigenous Australians have a higher prevalence, and younger age during EPE, and hospitalisation for HSVD than non-Indigenous Australians. FUNDING This is a self/internally-funded study, with the lead organisation being the Royal Flying Doctor Service (RFDS) of Australia. For the duration of the study period, the RFDS provided in-kind support including one full-time equivalent (FTE) and resources (office space, computer, research software, and office equipment). There was no external funding source that had a role in study design or data analysis or interpretation.
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Affiliation(s)
- Fergus W Gardiner
- The Royal Flying Doctor Service, Canberra, Australia
- Corresponding author. Dr Fergus W Gardiner, Royal Flying Doctor Service, Level 2, 10-12 Brisbane Avenue, Barton ACT 2600 Australia
| | - Kristopher Rallah-Baker
- School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Australia
| | - Angela Dos Santos
- Department of Medicine (Austin Health), The University of Melbourne, Victoria Australia
| | | | - Leonid Churilov
- Department of Medicine (Austin Health), The University of Melbourne, Victoria Australia
| | - Geoffrey A Donnan
- Department of Medicine (Austin Health), The University of Melbourne, Victoria Australia
| | - Stephen M. Davis
- Department of Medicine (Austin Health), The University of Melbourne, Victoria Australia
| | - Frank Quinlan
- The Royal Flying Doctor Service, Canberra, Australia
| | - Paul Worley
- Riverland Mallee Coorong Local Health Network, Murray Bridge, Australia
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Davis SM, Donnan GA. Ischemic Penumbra: A Personal View. Cerebrovasc Dis 2021; 50:656-665. [PMID: 34736251 DOI: 10.1159/000519730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/16/2021] [Indexed: 11/19/2022] Open
Abstract
The concept of the ischemic penumbra was defined over 40 years ago by Lindsay Symon and his group and is now an established principle of all acute ischemic stroke therapies. These reperfusion treatments rescue threatened, critically hypoperfused brain tissue and have been proven to improve clinical outcomes. We have been fortunate to have observed and played a small part in the penumbral story from its beginnings in the 1970s to its pivotal position today. Over this period, we have witnessed penumbral imaging evolve from positron emission tomography through to magnetic resonance imaging and now predominantly computed tomography perfusion, with the advent of automated imaging facilitating case selection for reperfusion therapies. We and others have conducted clinical trials using penumbral imaging to extend the time window for intravenous thrombolysis and select patients for thrombectomy. Together with the concept of fast- and slow-growing ischemic infarct patterns, this embeds the penumbral principle in everyday clinical management. The opportunity now exists to make penumbral imaging even more portable, affordable, and more widely available using mobile platforms, novel imaging techniques, digital linkage, and artificial intelligence.
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Affiliation(s)
- Stephen M Davis
- Departments of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Victoria, Victoria, Australia
| | - Geoffrey A Donnan
- Departments of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Victoria, Victoria, Australia
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The Role of a Physician-Staffed Helicopter in Emergency Care of Patients on Isolated Danish Islands. Healthcare (Basel) 2021; 9:healthcare9111446. [PMID: 34828492 PMCID: PMC8625314 DOI: 10.3390/healthcare9111446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/13/2021] [Accepted: 10/22/2021] [Indexed: 11/17/2022] Open
Abstract
Emergency calls may lead to the dispatch of either ground ambulances or helicopter emergency medical services (HEMS). For residents on isolated islands, the HEMS can reduce the time to hospital admission and lead to improved outcomes. This study investigated the emergency care for residents on isolated islands with a focus on the role of a physician-staffed helicopter. The data were obtained from Danish national registries and databases. We included data on emergency calls from isolated islands from the time of emergency call to discharge. We identified 1130 emergency calls from which 775 patients were registered with a hospital admission. Of these, 41% were transported by the HEMS and 36% by a ground ambulance. The median time to admission was 83 min (IQR 66-104) and 90 min (IQR 45-144) for the HEMS and ground ambulance, respectively (p = 0.26). The overall 30-day mortality was 6.2% (95% CI: 4.6-8.1%), and 37% of all the patients were admitted to the hospital with an unspecified diagnosis. The emergency calls from isolated islands led to the dispatch of the HEMS in 41% of the cases. The use of the HEMS did not significantly reduce the time to admission but was used in a greater proportion of patients with an acute cardiac disease (66%) or stroke (67%).
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Gardiner FW, Gillam M, Churilov L, Sharma P, Steere M, Hannan M, Hooper A, Quinlan F. Aeromedical retrieval diagnostic trends during a period of Coronavirus 2019 lockdown. Intern Med J 2021; 50:1457-1467. [PMID: 33040422 PMCID: PMC7675287 DOI: 10.1111/imj.15091] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 09/30/2020] [Accepted: 10/03/2020] [Indexed: 01/10/2023]
Abstract
Background Little is known on the trends of aeromedical retrieval (AR) during social isolation. Aim To compare the pre, lockdown, and post‐lockdown AR patient characteristics during a period of Coronavirus 2019 (COVID‐19) social isolation. Methods An observational study with retrospective data collection, consisting of AR between 26 January and 23 June 2020. Results There were 16 981 AR consisting of 1983 (11.7%) primary evacuations and 14 998 (88.3%) inter‐hospital transfers, with a population median age of 52 years (interquartile range 29.0–69.0), with 49.0% (n = 8283) of the cohort being male and 38.0% (n = 6399) being female. There were six confirmed and 230 suspected cases of COVID‐19, with the majority of cases (n = 134; 58.3%) in the social isolation period. As compared to pre‐restriction, the odds of retrieval for the restriction and post‐restriction period differed across time between the major diagnostic groups. This included, an increase in cardiovascular retrieval for both restriction and post‐restriction periods (odds ratio (OR) 1.12, 95% confidence interval (CI) 1.02–1.24 and OR 1.18 95%, CI 1.08–1.30 respectively), increases in neoplasm in the post restriction period (OR 1.31, 95% CI 1.04–1.64) and increases for congenital conditions in the restriction period (OR 2.56, 95% CI 1.39–4.71). Cardiovascular and congenital conditions had increased rates of priority 1 patients in the restriction and post restriction periods. There was a decrease in endocrine and metabolic disease retrievals in the restriction period (OR 0.72, 95% CI 0.53–0.98). There were lower odds during the post‐restriction period for retrievals of the respiratory system (OR 0.78, 95% CI 0.67–0.93), and disease of the skin (OR 0.78, 95% CI 0.6–1.0). Distribution between the 2019 and 2020 time periods differed (P < 0.05), with the lockdown period resulting in a significant reduction in activity. Conclusion The lockdown period resulted in increased AR rates of circulatory and congenital conditions.
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Affiliation(s)
- Fergus W Gardiner
- Federation Office, The Royal Flying Doctor Service, Canberra, Australian Capital Territory, Australia.,The Rural Clinical School of Western Australia, The University of Western Australia, Perth, Western Australia, Australia
| | - Marianne Gillam
- Department of Rural Health, University of South Australia, Adelaide, South Australia, Australia
| | - Leonid Churilov
- Department of Medicine (Austin Health) and Melbourne Brain Centre at Royal Melbourne Hospital, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Pritish Sharma
- Federation Office, The Royal Flying Doctor Service, Canberra, Australian Capital Territory, Australia
| | - Mardi Steere
- Central Operations, The Royal Flying Doctor Service, Adelaide, South Australia, Australia
| | - Michelle Hannan
- Queensland Section, The Royal Flying Doctor Service, Adelaide, South Australia, Australia
| | - Andrew Hooper
- Western Operations, The Royal Flying Doctor Service, Adelaide, South Australia, Australia
| | - Frank Quinlan
- Federation Office, The Royal Flying Doctor Service, Canberra, Australian Capital Territory, Australia
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13
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Gardiner FW, Richardson A, Roxburgh C, Gillam M, Churilov L, McCuaig R, Carter S, Arthur C, Wong C, Morton A, Callaway L, Lust K, Davidson SJ, Foxcroft K, Oates K, Zhang L, Jayawardane S, Coleman M, Peek M. Characteristics and in-hospital outcomes of patients requiring aeromedical retrieval for pregnancy, compared to non-retrieved metropolitan cohorts. Aust N Z J Obstet Gynaecol 2021; 61:519-527. [PMID: 33426679 DOI: 10.1111/ajo.13308] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/23/2020] [Accepted: 12/16/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Limited access to obstetrics and gynaecology (O&G) services in rural and remote Australia is believed to contribute to suboptimal birth outcomes. AIMS To describe the characteristics of pregnancy aeromedical transfers, in-hospital outcomes, and patient access to O&G services, as compared to whole of Australia data. MATERIALS AND METHODS We conducted a cohort study of women who required aeromedical retrieval for pregnancy-related issues between the 1 January 2015 and 31 December 2017. RESULTS Hospital outcome data were collected on 2171 (65.2%) mothers and 2438 (100.0%) babies. The leading retrieval reason was threatened preterm labour and delivery (n = 883; 40.7%). Most patients were retrieved from rural and remote areas (n = 2224; 93.0%). Retrieved patients were significantly younger (28.0 vs 30.0 years, 95% CI 27.7-28.3), more likely to be overweight or obese (52.2% vs 45.1%, 95% CI 47.5-56.9) and to have smoked during their pregnancy (14.0% vs 9.9%, 95% CI 12.5-15.5) compared to Australian pregnant women overall. Over one-third of transferred women gave birth by Caesarean section (n = 812; 37.4%); the median gestational age at birth was 33.0 (95% CI 32.7-33.3) weeks. Early gestation is associated with low birth weights (median = 2579.5 g; 95% CI 2536.1-2622.9), neonatal resuscitation (35.4%, 95% CI 33.5-37.3), and special care nursery admission (41.2%, 95% CI 39.3-43.2). There were 42 (1.7%, 95% CI 1.2-2.2) stillbirths, which was significantly higher than seen Australia-wide (n = 6441; 0.7%). CONCLUSION This study found that pregnant women retrieved by the Royal Flying Doctor Service were younger, with higher rates of obesity and smoking.
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Affiliation(s)
- Fergus W Gardiner
- Royal Flying Doctor Service, Canberra, Australian Capital Territory, Australia.,The Rural Clinical School of Western Australia, The University of Western Australia, Albany, Western Australia, Australia
| | - Alice Richardson
- Statistical Consulting Unit, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Carly Roxburgh
- The Rural Clinical School of Western Australia, The University of Western Australia, Albany, Western Australia, Australia
| | - Marianne Gillam
- Department of Rural Health, University of South Australia, Adelaide, South Australia, Australia
| | - Leonid Churilov
- Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia.,The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Ruth McCuaig
- King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Sean Carter
- King Edward Memorial Hospital, Perth, Western Australia, Australia
| | | | - Cynthia Wong
- Townsville University Hospital, Townsville, Queensland, Australia
| | - Adam Morton
- Mater Health Services Public Hospital, Brisbane, Queensland, Australia
| | - Leonie Callaway
- Royal Brisbane Women`s Hospital, Brisbane, Queensland, Australia
| | - Karin Lust
- Royal Brisbane Women`s Hospital, Brisbane, Queensland, Australia
| | - Sarah J Davidson
- Royal Brisbane Women`s Hospital, Brisbane, Queensland, Australia.,Duke University School of Medicine, Durham, North Carolina, USA
| | - Katie Foxcroft
- Royal Brisbane Women`s Hospital, Brisbane, Queensland, Australia
| | - Kiri Oates
- Dubbo Hospital, Dubbo, New South Wales, Australia
| | - Lucy Zhang
- Dubbo Hospital, Dubbo, New South Wales, Australia
| | | | - Mathew Coleman
- The Rural Clinical School of Western Australia, The University of Western Australia, Albany, Western Australia, Australia
| | - Michael Peek
- Australian National University Medical School, College of Health and Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia
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14
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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: 0.2] [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.
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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
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