Incidence and Predictors of Referral for Coronary Angiography and Revascularization in Non-ST-Segment Elevation Myocardial Infarction.

Background: Routine invasive coronary angiography (ICA) is recommended for patients presenting with non-ST-segment elevation myocardial infarction (NSTEMI), but the rate of adherence to this recommendation in Australia is not known.

Aims: We sought to quantify the proportion of patients who undergo ICA and revascularization in a contemporary cohort of NSTEMI patients, and to determine predictors of clinical outcome.

Methods: This was a population-based cohort study of consecutive patients transported by emergency medical services (EMS) in Victoria, Australia with chest pain who were diagnosed with NSTEMI between January 1, 2015, and June 30, 2019.

Cardiac arrest in the Australian Alps: A 20-year analysis.

Background: Alpine tourism annually attracts over 100 million visitors globally. Age and cardiovascular comorbidities in alpine tourists are increasing, and rates of out-of-hospital cardiac arrest (OHCA) have been hypothesized to be higher due to exertion and physiological stress.

Methods: Cases of alpine OHCA from 2002 to 2021 were identified from the statewide Victorian Ambulance Cardiac Arrest Registry.

Power outages increase the risk of ambulance attendances associated with non-optimal temperatures.

The incidence of power outages is increasing due to rising electricity demand and extreme weather events. However, there is limited and inconsistent evidence on the health risks of non-optimal temperatures following power outages. We collected daily counts of ambulance attendances between 2012 and 2016 from Ambulance Victoria, Australia.

Adherence to ambulance performance indicators and patient outcomes after stroke: An Australian data linkage study.

Background: The impact of Emergency Medical Service (EMS) stroke performance indicators on patient outcomes is unclear. We aimed to evaluate adherence to EMS indicators (15 minutes response, 60 minutes transport to a stroke centre or both) and associations with treatment access and patient outcomes.

Method: Retrospective cohort study using data from the Australian Stroke Clinical Registry and ambulance records from Victoria (2015-2017) for patients (≥18 years) with stroke transported by ambulance.

Smartphone-activated volunteer responders and survival to discharge after out-of-hospital cardiac arrests in Victoria, 2018-23: an observational cohort study.

Objectives: To compare the likelihood of patient survival to discharge and of bystander cardiopulmonary resuscitation (CPR) and defibrillation for cases of out-of-hospital cardiac arrest in which at least one smartphone-activated volunteer responder (SAVR) arrived before emergency medical services (EMS) with cases in which EMS arrived first.

Study Design: Population-based observational cohort study; analysis of Victorian Ambulance Cardiac Arrest Registry (VACAR) data.

Setting: Victoria, 12 February 2018 - 31 August 2023.

Out-of-Hospital Neck of Femur Injury: An Eight-Year Observational Analysis.

Objectives: Pain management for patients with neck of femur fractures is a challenge for out-of-hospital clinicians. This study aimed to describe (1) the characteristics of patients presenting to emergency medical services (EMS) with suspected neck of femur injuries, (2) clinically meaningful pain reduction, and (3) ongoing moderate to severe pain in the out-of-hospital setting.

Methods: A retrospective cohort study of adult patients with suspected neck of femur injuries attended by EMS in Victoria, Australia, between 01 July 2015 and 30 June 2023.

Clinical state transitions in shock-refractory ventricular fibrillation: an observational study.

Aim: To characterise clinical state transitions in patients with out-of-hospital cardiac arrest (OHCA) from refractory ventricular fibrillation or pulseless ventricular tachycardia (VF/pVT) and their association with clinical outcomes.

Methods: We conducted an exploratory observational study of refractory VF/pVT OHCA cases treated by emergency medical services (EMS) between 2010 and 2019 in Victoria, Australia. Refractory VF/pVT OHCA was defined as initial VF/pVT arrests with at least three consecutive defibrillation attempts.

Palliative paramedicine: An interrupted time series analysis of pre-hospital guideline efficacy.

Background: Paramedics are increasingly involved in palliative care and often support community-based palliative care service delivery to facilitate integrated practice. However, the impact of specific palliative care guidelines on clinical practice remains unknown.

Aim: To determine the impact of an ambulance service palliative care guideline on rates of supportive medication administration and non-transport.

Long-term health-related quality of life in survivors of extracorporeal cardiopulmonary resuscitation compared to conventional cardiopulmonary resuscitation- A cohort study using Australian and New Zealand extracorporeal membrane oxygenation registry and the Victorian Ambulance Cardiac Arrest Registry.

Aim: To compare the long-term health-related quality of life (HRQoL) between patients receiving extracorporeal cardiopulmonary resuscitation (ECPR) and conventional cardiopulmonary resuscitation (CCPR) for out-of-hospital cardiac arrest (OHCA).

Methods And Settings: A retrospective cohort study using the Australian and New Zealand extracorporeal membrane oxygenation (EXCEL) registry for ECPR cases and the Victorian Ambulance Cardiac Arrest Registry (VACAR) for CCPR cases. All the adult patients with OHCA who had their cardiac arrest and 12-month HRQoL data recorded between July 2019 and July 2023 were eligible for inclusion.

Trends in paramedic-to-general practitioner referrals following the COVID-19 pandemic and the introduction of a virtual emergency department: an interrupted time series analysis.

Objectives: We aimed to evaluate the impact of the COVID-19 pandemic and subsequent introduction of the Victorian Virtual Emergency Department (VVED) consultation service for paramedics on paramedic-to-general practitioner (GP) referral patterns, case time burden and ambulance reattendance rates.

Methods: We conducted interrupted time series regression assessing paramedic-to-GP referrals with the following two interruptions: (1) the COVID-19 pandemic in March 2020 and (2) VVED integration in July 2022. We included ambulance patients between 2018 and 2023 across Victoria, Australia.

Blood culture collection and administration of intravenous ceftriaxone by paramedics in patients with suspected sepsis (the pass trial).

Objective: To evaluate the feasibility of pre-hospital blood culture (BC) collection and intravenous (IV) antibiotic administration in patients with suspected sepsis.

Methods: In this open-label trial, BCs were collected in all participants, who were then randomised to ongoing care (control) or ongoing care plus 2 g IV ceftriaxone (intervention). Time to antibiotic administration was the primary outcome.

Cricothyroidotomy in out-of-hospital cardiac arrest: An observational study.

Aim: To describe the incidence, characteristics, success rates, and outcomes of out-of-hospital cardiac arrest (OHCA) patients receiving cricothyroidotomy.

Methods: Over an 18-year period, we retrospectively analysed patient care records and cardiac arrest registry data for cricothyroidotomy cases. Multivariable logistic regression analysis was used to examine associations between study characteristics and cricothyroidotomy success.

Out-of-hospital cardiac arrests in Victoria, 2003-2022: retrospective analysis of Victorian Ambulance Cardiac Arrest Registry data.

Objectives: To examine changes in out-of-hospital cardiac arrest (OHCA) characteristics and outcomes during 2003-2022, and 12-month outcomes for people who experienced OHCA during 1 January 2010 - 30 June 2022.

Study Design: Retrospective observational study; analysis of Victorian Ambulance Cardiac Arrest Registry (VACAR) data.

Setting, Participants: OHCA events in Victoria not witnessed by emergency medical services personnel, 1 January 2003 - 31 December 2022.

Changes in out-of-hospital cardiac arrest resuscitation quality during and after the COVID-19 pandemic.

Aim: The impact of personal protective equipment (PPE) on resuscitation quality is largely unknown. We sought to examine the effect of PPE requirements on CPR quality and resuscitation interventions during the COVID-19 pandemic in Victoria, Australia.

Methods: We performed a retrospective cohort study of adult OHCA patients of medical aetiology who received attempted resuscitation.

Prehospital factors predicting mortality in patients with shock: state-wide linkage study.

Background: Patients with shock treated by emergency medical services (EMS) have high morbidity and mortality. Knowledge of prehospital factors predicting outcomes in patients with shock remains limited. We aimed to describe the prehospital predictors of mortality in patients with non-traumatic shock transported to hospital by EMS.

The burden of atrial fibrillation on emergency medical services: A population-based cohort study.

Background: Atrial fibrillation (AF) is a growing burden on healthcare resources, despite improvements in prevention and management. AF is a common cause of hospitalisation, and Emergency Medical Services (EMS) use. However, there is a paucity of data describing the burden of AF on EMS.

Long-term effects of a coalmine fire on hospital and ambulance use: An interrupted time series study.

Background: In 2014, the Hazelwood coalmine fire in regional Victoria, Australia shrouded nearby communities in smoke for six weeks. Prior investigations identified substantial adverse effects, including increases in the use of health services. In this study, we examined the effects on hospital and ambulance use in the eight years following the fire.

Sex Disparities in Resuscitation Quality Following Out of Hospital Cardiac Arrest.

Background: Women are known to be disadvantaged compared with men in the early links of the Chain of Survival, receiving fewer bystander interventions. We aimed to describe sex-based disparities in emergency medical service resuscitation quality and processes of care for out-of-hospital cardiac arrest.

Methods And Results: We conducted a retrospective analysis of patients who were nontraumatic with out-of-hospital cardiac arrest aged ≥16 years where resuscitation was attempted between March 2019 and June 2023.

Outcomes of adult patients discharged at scene by emergency medical services.

Background: The outcomes of patients who call an ambulance but are discharged at scene reflect the safety and quality of emergency medical service (EMS) care. While previous studies have examined the outcomes of patients discharged at scene, none have specifically focused on paramedic-initiated discharge. This study aims to describe the outcomes of adult patients discharged at scene by paramedics and identify factors associated with 72-hour outcomes.

Healthcare and economic cost burden of emergency medical services treated non-traumatic shock using a population-based cohort in Victoria, Australia.

Objectives: We aimed to assess the healthcare costs and impact on the economy at large arising from emergency medical services (EMS) treated non-traumatic shock.

Design: We conducted a population-based cohort study, where EMS-treated patients were individually linked to hospital-wide and state-wide administrative datasets. Direct healthcare costs (Australian dollars, AUD) were estimated for each element of care using a casemix funding method.

Refining ambulance clinical response models: The impact on ambulance response and emergency department presentations.

Objective: The ambulance service in Victoria, Australia implemented a revised clinical response model (CRM) in 2016 which was designed to increase the diversion of low-acuity Triple Zero (000) calls to secondary telephone triage and reduce emergency ambulance dispatches. The present study evaluates the influence of the revised CRM on emergency ambulance response times and ED presentations.

Methods: A retrospective study of emergency calls for ambulance between 1 January 2015 and 31 December 2018.

Temporal trends in the incidence and outcomes of shock-refractory ventricular fibrillation out-of-hospital cardiac arrest.

Aim: We aimed to describe trends in the incidence and outcomes of refractory ventricular fibrillation (RVF) compared to non-refractory ventricular fibrillation (non-RVF) in out-of-hospital cardiac arrest (OHCA).

Methods: Between 2010 and 2019, we included all OHCA cases involving adults ≥ 16 years old with an initial shockable rhythm and who received an attempted resuscitation by Emergency Medical Services (EMS) or a bystander shock prior to EMS arrival in Victoria, Australia. Trends in incidence and survival outcomes over the study period were examined.