Emergency ambulance demand by older adults from rural and regional Victoria, Australia

McManamny, Tegwyn; Cantwell, Kate; Boyd, Leanne; Sheen, Jade; Smith, Karen; Lowthian, Judy

doi:10.1111/ajag.12960

Cited by 5 publications

(6 citation statements)

References 19 publications

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“…We found non-transport in 12.8% of cases in this study; however, when other reasons for non-transport, except patients refusing transport, were excluded, this occurred in only 8.4% of the responses. Younger adults had non-transports approximately twice as often compared with the elderly in previous studies, which we could not confirm in Vienna; our data showed non-transports in elderly patients appearing in 14.0%, which is comparable to 12.3% in Australia and 12.0% in Taiwan and Canada [ 18 , 21 , 22 ]. Thus, many patients are transported to the hospital, meaning that there may potentially be a risk of inappropriate care.…”

Section: Discussioncontrasting

confidence: 99%

“…To our knowledge, this is the first study to research the epidemiology of the metropolitan EMS utilization of elderly patients in Austria. Response rates were in the upper range when compared to other developed countries [ 2 , 18 , 19 , 20 , 21 , 22 ]. However, the response rates of the younger counterparts should also be considered, due to different EMS systems, depending on different countries, urban or rural locations and high- or low-resource settings.…”

Section: Discussionmentioning

confidence: 86%

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The Epidemiology of Pre-Hospital EMS Treatment of Geriatric Patients in the City of Vienna—An Overview

Krammel¹,

Drahohs

Hamp

et al. 2023

JCM

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Background: The city of Vienna, Austria, has a gradually aging population. Elderly people, over 65 years old and living at home or in nursing homes, frequently use Emergency Medical Services (EMS). However, there is no previous data comparing the EMS utilization of elderly- and non-elderly patients in Vienna. Methods: We retrospectively analyzed all EMS incidents in Vienna from 2012 to 2019. Transport- and emergency physician treatment rates, annual fluctuations, and the number of non-transports were compared between elderly (≥65 years) and non-elderly (18–64 years) patients. Results: Elderly people accounted for 42.6% of the total EMS responses in adult patients, representing an annual response rate of 223 per 1000 inhabitants ≥ 65 years. Compared to 76 per 1000 inhabitants in patients 18–64 years old, this results in an incidence rate ratio (IRR) of 2.93 [2.92–2.94]. Elderly people were more likely (OR 1.68 [1.65–1.70]) to need emergency physicians, compared to 18–64 year-olds. Nursing home residents were twice (OR 2.11 [2.06–2.17]) as likely to need emergency physicians than the rest of the study group. Non-transports were more likely to occur in patients over 65 years than in non-elderlies (14% vs. 12%, p < 0.001). Conclusions: The elderly population ≥ 65 years in Vienna shows higher EMS response rates than younger adults. They need emergency physicians more often, especially when residing in nursing homes. The economical and organizational strain this puts on the emergency response system should trigger further research and the development of solutions, such as specific response units dedicated to elderly people.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 86%

The Epidemiology of Pre-Hospital EMS Treatment of Geriatric Patients in the City of Vienna—An Overview

Krammel¹,

Drahohs

Hamp

et al. 2023

JCM

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“…Low acuity clinical presentations dominate paramedic daily workloads ( Rosser, 2020 ), where older people who have fallen account for 6–8% ( Simpson et al, 2017 ; McManamny et al, 2022 ), and people with mental health problems can account for up to 10% ( Shaban, 2005 ). In contrast, studies have observed that paramedics attend an average of less than two cases of OHCA per year in some areas ( Dyson et al, 2015 ), and whilst studies have struggled to demonstrate association between paramedic experience and survival in treatment of cardiac arrests ( Gold and Eisenberg, 2009 ), survival rates are highest amongst those who received bystander CPR and public access defibrillation ( Hawkes et al, 2017 ).…”

Section: Discussionmentioning

confidence: 99%

Heroism and paramedic practice: A constructivist metasynthesis of qualitative research

et al. 2022

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ObjectivesWe aimed to identify, appraise, and synthesise the qualitative literature to develop theory on heroism and paramedic practice.Hypothesis/research questionWhat does published literature tell us about heroism and paramedic practice?SettingParamedics and other healthcare workers (HCWs) faced an outpouring of public support for them early in the COVID-19 pandemic which brought into focus the relationship between them and society, where they are portrayed as heroes.ParticipantsWe conducted a metasynthesis using Evolved Grounded Theory and procedural guidelines of Noblit and Hare to guide analysis. Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols (PRISMA-P) guidelines were also applied.Results151 papers were retrieved and eleven included in the final sample. Studies were moderate to very low quality, involving a wide range of methodologies and settings; none specifically explored heroism and paramedic practice. The following interrelated themes were constructed on heroism and paramedic practice: (a) Myth, Folk law, and storytelling in heroism and paramedic practice (b) The epic journey of heroism and paramedic practice (c) Heroes and Zeroes: The fluctuating Societal Value in heroism and paramedic practice (d) Politicisation, and objectification in Heroism and Paramedic practice.ConclusionParamedics have long been characterised as heroes, but this may not reflect their everyday experiences. Heroism in paramedic practice can provide scripts for prosocial action, inspiring others, and leading to more social heroic actions. Paramedics may however be ambivalent to such heroism narratives, due to politicisation, and objectification in the media and society. This metasynthesis is only one of many possible constructions of heroism and paramedic practice and is the first point in making sense of and developing theory on heroism and paramedic practice.Study registrationPROSPERO: CRD42021234851.

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“…25,26 Thus, these patients have a greater potential for deterioration during an ambulance journey of 200 km or more, with the generalist nurse as the lead clinician in the absence of trained paramedics. 27 Patient transfer guidelines are key to safe and effective transportation of patients. 17 In this study poor preparation, failure to recognise potential complications during transport, and the use of inexperienced or inappropriate escorts were also highlighted by the RFDS as issue.…”

Section: Discussionmentioning

confidence: 99%

Nurse escorts' perceptions of nurse‐led inter‐hospital ambulance transfer in the Wheatbelt region of Western Australia: A descriptive survey study

Mndebele,

Russell,

Coventry

2023

Australian J Rural Health

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IntroductionThe Western Australia (WA) Country Health Service (WACHS) requires the ward or emergency department (ED) registered nurse (RN) to assume the responsibility of conducting nurse‐led interhospital patient road ambulance transfers, in the absence of an available registered paramedic (RP). The generalist nurse escort with no specialised training is allocated to the patient transport from their rostered shifts when the need arises, and, in some instances, this nurse may not have been in an ambulance before. Patients requiring transfer are usually prioritised over hospital patient care because of the life‐threatening nature of these situations and the urgency to get them to tertiary care facilities. This study explored nurses’ perceptions about caring for a patient during road ambulance transfer, with an aim of supporting future policy formulation and decision‐making to guide nurses’ training, induction and ongoing education on interhospital transfers.ObjectiveTo examine the perceptions of hospital‐employed registered nurses caring for a patient during road ambulance transfer from rural Western Australia.DesignA descriptive survey design included 23 questions to clarify the level of experience and training, the prevalence of clinical deterioration and the confidence to manage patient care.FindingsFindings from the surveys indicated that nurses often felt overwhelmed by the responsibility of the patient transfer, unclear guidelines, limited preparation and handover, lack of orientation to the ambulance environment, difficulty escalating care during transfer and no insight into the return to base process.DiscussionTo explore how the RN who normally works within a well‐organised and accessible multidisciplinary team manages caring for a patient in an unfamiliar mobile environment, the study was conducted within WACHS in the Wheatbelt Region of WA involving 27 health care sites. Participating nurses were asked several broad questions to explore their perceptions on how well‐equipped they are in managing clinical care and deterioration during transfer; what are the challenges that they face while doing so and how confident they are about their knowledge, skill level and scope of clinical practice in supporting patients during interhospital transfer?ConclusionWheatbelt nurse escorts were capable, generalist nurses with a demonstrated skill set in managing patient care during transfer when needed. The ‘back of the ambulance’ was a challenging environment for nurses to engage in the type of care usually provided in the hospital setting, which come with a high level of uncertainty and anxiety for both patient outcome and own well‐being.

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Emergency ambulance demand by older adults from rural and regional Victoria, Australia

Cited by 5 publications

References 19 publications

The Epidemiology of Pre-Hospital EMS Treatment of Geriatric Patients in the City of Vienna—An Overview

The Epidemiology of Pre-Hospital EMS Treatment of Geriatric Patients in the City of Vienna—An Overview

Heroism and paramedic practice: A constructivist metasynthesis of qualitative research

Nurse escorts' perceptions of nurse‐led inter‐hospital ambulance transfer in the Wheatbelt region of Western Australia: A descriptive survey study

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