FRONT LINE TO RECOVERY

10th International Spark of Life ConferencePullman melbourne on the Park

neonatal Satellite meeting – 16 april 2015Sol Conference 17-18 april 2015

Scientific Programmeabstracts & Information

maJor SPonSor

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CONFERENCE LOGO

The Conference Logo, “The Spark of Life”, symbolises the vital essence of energy which keeps the human heart beating and the drive to breathe. It is the energy spark which is still present when the heart stops because of accident or illness; and which can be fanned to the flame or full life again, by timely cardiopulmonary resuscitation.

The conference logo was the concept of Professor John Pearn and was designed by John Pearn and Mr Paul Ramsden, Artist of Brisbane, as a voluntary service.

We acknowledge and thank the following sponsor:

MAJOR SPONSOR

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THE COUNCILThe Australian Resuscitation Council is a national voluntary coordinating body which represents all major groups involved in the teaching and practice of resuscitation. It consists of:

• AustralasianCollegeforEmergencyMedicine• AustralianCollegeofCriticalCareNursesLtd• AustralianCollegeofNursing• AustralianDefenceForce• AustralianandNewZealandCollegeofAnaesthetists• AustralianandNewZealandIntensiveCareSociety• AustralianRedCross• CardiacSocietyofAustraliaandNewZealand• CollegeofEmergencyNursingAustralasia• CouncilofAmbulanceAuthorities• NationalHeartFoundationofAustralia• ParamedicsAustralasia• RoyalAustralasianCollegeofSurgeons• RoyalAustralianCollegeofGeneralPractitioners• RoyalLifeSavingSocietyAustralia• StJohnAmbulanceAustralia• SurfLifeSavingAustralia• StateBranchesoftheCouncil

CONFERENCE COMMITTEE

Mrs Carol Carey (Conference Convenor)

Executive CommitteeDrRichardAickinProfessor Julie Considine ProfessorHughGranthamDrNatalieHoodA/Professor Helen LileyA/Professor Peter MorleyA/Professor Michael Parr A/Professor Jim Tibballs A/Professor Tony Walker ProfessorDarrenWalters

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VENUEThe Tenth Spark of Life International Conference is being held at Pullman Melbourne on the Park, East Melbourne on 16-18 April 2015.

REGISTRATION CENTRERegistration opening times as follows:• Thursday16April2015-NeonatalSatellitemeeting7.00am• Thursday16April2015-Cocktailreception.Theregistrationdeskwillbeopenforthosewishingtoregister

for the two day SOL conference.• Friday17AprilandSaturday18April2015–7.30am–5.30pm

NAME BADGESPlease wear your name badge at all times during your attendance at the Conference.

Key to Name Badges• NeonatalSatelliteMeetingOnly-WhitenamebadgewithBLUE dot.• NeonatalSatelliteMeetingandSOLConferenceDelegates–WhitenamebadgewithRED dot.• SOLConferenceDelegates–Whitenamebadge• AccompanyingPersons–WhitenamebadgewithGREEN dot (Cocktail Party or dinner if tickets purchased)

LUNCH, MORNING AND AFTERNOON TEA (Neonatal Satellite Meeting 16 April 2015)Lunch, morning and afternoon tea will be available.

LUNCH,MORNINGANDAFTERNOONTEA(SOLConference17-18April2015)Arrival tea & coffee, morning tea, lunch and afternoon tea will be served in the Trade Exhibition Area on both days.

WELCOMINGCOCKTAILPARTYThe Welcoming Cocktail Party for Conference delegates and registered paying accompanying persons will be held on Thursday 16 April from 6pm to 8pm in the Trade Exhibition Area.

CONFERENCE DINNERTheConferenceDinnerwillbeheldintheBallroomatPullmanMelbourneonthePark,7.30pmfor8pm.Dresswillbe lounge suit. If you have registered and paid for the dinner there will be a ticket/s in your registration envelope.

TRADE EXHIBITIONThe Trade Exhibition will be situated on the Mezzanine floor. The Trade Exhibition is an integral part of the Conference and all companies have made a significant contribution to the management of the meeting.

POSTER PRESENTATIONThe poster presentations will be incorporated into the Trade Exhibition Area on the Mezzanine floor. Posters will be displayed throughout the conference.

SLIDEPREVIEWROOMA slide preview room will be open during the scientific sessions; presenters are requested to preview their presentations prior to the commencement of the session in which they are participating.

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INTERNATIONALKEYNOTESPEAKERS

Professor Maaret CASTREN (Finland)Maaret Castrén is a nurse, an anesthesiologist and an emergency physician.SheisatthemomentworkingastheMedicalDirectoroftheEmergencyCare,HUCSinHelsinki,Finland.Shebecamethefirstprofessor of Emergency Medicine in Sweden at Karolinska Institutet 2007,andthefirstprofessorinEmergencyMedicineinFinlandatTurkuUniversity 2012. She has an international research group validated as excellent, near to outstanding when the Karolinska research groups were validated by external experts. Maaret has been the Chair of European Resuscitation Council since 2012 and is the Co-chair for the ILCOR guidelines congress 2015.

Professor Gavin PERKINS (UK)GavinPerkinsisProfessorofCriticalCareMedicineattheUniversityofWarwickandConsultantPhysicianatHeartofEnglandNHSFoundationTrust and Medical Emergency Resuscitation Team (MERIT) Consultant with West Midlands Ambulance Service.

Prof Perkins graduated from the University of Birmingham and trained in the West Midlands region, initially as a respiratory physician before specialising in critical care medicine. He has a long-standing interest in cardiac arrest care and has established research programmes to explore the effectiveness of CPR feedback devices, mechanical CPR devices and debriefing as tools to improve outcomes from cardiac arrest.

HecurrentlyservesasaDirectorofResearchfortheUKIntensiveCareFoundationandChairoftheResuscitationCouncil(UK)AdvancedLifeSupportCommitteeandEuropeanResuscitationCouncilBLS/AEDWorkingGroup.HealsoChairstheInternationalLiaisonCommitteeforResuscitationBLS/AEDTaskForce.

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MrJonathonWEBBER(NewZealand)Jonathon Webber is an Advanced Qualified Lifeguard with over 25 years’ experience at Piha Beach on Auckland’s West Coast and an Honorary Senior ClinicalTutorintheDepartmentofAnaesthesiologyattheUniversityofAuckland and Resuscitation Officer at Auckland City Hospital.

Jonathon’s voluntary roles include: Senior Advisor to Pakistan Aquatic Life Saving, Board Member for WaterSafe Auckland, and member of the PihaSLSCCalloutSquad.ForSurfLifeSavingNorthernRegion(NZ),hehasheldtherolesofDirectorofLifesaving,DirectorofRegionalServices,DutyOperationsOfficer,andMedicalAdvisoryGroupmember.HecurrentlyrepresentsSurfLifeSavingNewZealandontheNewZealandResuscitation Council and is a member of the International Life Saving FederationRescueOperationsandMedicalcommittees.

Jonathon has authored and co-authored several journal articles, textbook chapters and national surf lifesaving policies. He has presented and published work on drowning detection and response, lifeguard perception andperformanceofCPR,leisure-relatedinjuriesatNZbeaches,andairway management, first aid training and resuscitation in the aquatic environment.

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AUSTRALASIAN VISITOR

A/ProfessorIanCIVIL(NewZealand)Ian is a graduate of the University of Auckland School of Medicine completing his MBChB in 1976 . His initial surgical training was undertaken in Auckland where he completed his general surgical fellowshipin1983.Inthemid-80sheworkedintheUSAforthreeyears, first as a vascular surgery fellow at the Cleveland Clinic and then as a trauma fellow in the Southern New Jersey Regional Trauma Center in Camden, NJ.

AfterreturningtoNZin1987,IantookupacombinedUniversityofAuckland/RoyalNZArmyMedicalCorpsappointmentinwhichheservedfor5years.In1990-1heledtheNZArmyMedicalTeamtothefirstGulfWar.

He has served on a number of international trauma organisations becoming President of the Association for the Advancement of Automotive Medicine (AAAM) in 1999 and President of the International Association for the Surgery of Trauma and Intensive Care (IATSIC) from 2007-2009. Ian is a founding member of the Australasian TraumaSocietyandservedasPresidentfrom2011-2013.HewasaRACSCouncillorfrom2003-2012andfrom2010-2012servedasPresident.

Ian is a member of the Editorial Boards for the World Journal of Surgery and the World Journal of Emergency Surgery, Associate Editor ofTrafficInjuryPrevention,SeniorEditoroftheAustralianandNZJournalofSurgeryandDeputyEditorofINJURY.

In 2012 Ian was appointed Clinical Leader of the Major Trauma National Clinical Network for the Ministry of Health and ACC, and ClinicalLeaderofthePerioperativeHarmAdvisoryGroupfortheHealth Quality and Safety Commission. Ian is an Associate Professor ofSurgerywiththeUniversityofAucklandandpracticesasaGeneraland Vascular surgeon at Auckland City Hospital where he is the DirectorofTraumaServices.

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NOTES

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NEONATAL SATELLITE MEETING THURSDAY16APRIL2015

Pre-HospitalandEmergencyRoomManagementofPerinatalEmergencies-Workshop

WORKSHOPLEADERS:A/Prof Helen LileyNeonatal Paediatrician, Mater Mothers’ Hospital, Brisbane

Ms Belinda FlanaganMidwife,Paramedic,PhDStudent University of the Sunshine Coast, Queensland

HelenandBelindawillleadanexpertteamofworkshopfacilitatorsinthisday-long,skillsbased,practicalworkshoponmanagementofperinatalemergenciesinapre-hospitaloremergencydepartmentsetting.

Workstationswillusesmallgroupsandsimulation-basedteachingtoaddressprinciplesandhands-onskillsofmanagingthefollowingtypesofscenariosinapre-hospitalorEDsetting:

• Verypreterminfant• Anoldertermbabywhohascollapsedathome• Normalandcomplicatedvaginalbirth• Anewborntermbabywhodoesn’tstarttobreathe• Stillbirth

Registration & refreshments 07:30--08:15

Welcome and introduction of faculty 08:15–08:30

What’s new in newborn resuscitation (plenary talk) 08:30–09:00

Workstations (1st rotation) 09:00 – 12:00

Lunch 12:00–13:00

Workstations (2nd rotation) 13:00–16:00

Key points in managing maternal emergencies (plenary talk) 16:00–16:30

Sche

dule

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INVITED SPEAKERS SOL CONFERENCE

Dr Richard AICKINRichardisChairmanofboththeNewZealandResuscitationCouncil(NZRC)andtheAustralianandNewZealandCommitteeonResuscitation(ANZCOR).HeisaPaediatricEmergencyPhysicianattheStarshipHospital,Auckland,NewZealand.

Prof Stephen BERNARD StephenisaseniorIntensiveCarePhysicianatTheAlfredHospitalandDirectorof Intensive Care at Knox Private Hospital in Victoria, Australia. He is also Medical Advisor to Ambulance Victoria.

His research interests include the treatment of neurological injury after resuscitation from cardiac arrest. He is chief investigator of a recently completed clinical trial of large-volume, ice-cold intravenous crystalloid fluid for the rapid induction of therapeutic hypothermia during resuscitation from cardiac arrest. He is also co-investigator in a number of other clinical trials including therapeutic hypothermia after severe traumatic brain injury (POLAR) and tranexamic acid in severe trauma (PATCH).

Dr David CALDICOTTDavidisanEmergencyConsultantattheEmergencyDepartmentoftheCalvaryHospitalinCanberraandaClinicalSeniorLecturerintheFacultyofMedicineatthe Australian National University. He is a spokesperson for the Australian Science Media Centre on issues of illicit drug use and the medical response to terrorism anddisasters.DaviddesignedandpilotedtheWelshEmergencyDepartmentInvestigationofNovelSubstances(WEDINOS)projectintheUK,auniqueprogramusing regional emergency departments as sentinel monitoring hubs for the emergence and spread of novel illicit products. He is currently replicating this work inAustraliawiththeACTInvestigationofNovelSubstances(ACTINOS)Group.

Prof Judith FINNJudithisDirectorofthePrehospital,ResuscitationandEmergencyCareResearchUnit (PRECRU) in the School of Nursing, Midwifery and Paramedicine at Curtin University(Perth,WesternAustralia).SheisalsoDirectoroftheAustralianResuscitation Outcomes Consortium (Aus-ROC) – a NHMRC Centre of Research Excellence administratively based at Monash University (Melbourne, Victoria). Judith is currently the Co-Chair of the ILCOR “EIT - Education, Implementation and Teams” Task-force.

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Mr Michael GALEMike is the National Course Coordinator for the Australian Resuscitation Council andanactiveInstructorandDirectorinallARCCourses.HehasbeeninvolvedinARC Courses since their commencement in 2005 and is one of the Educators on the ARC Instructor Course. He has been involved in inter-professional education for over 25 years in resuscitation, acute and critical care and continues to practice clinically as a Registered Nurse in an Angiography and Cardiac Intervention suite in Western Australia.

Mike is part of the editorial team for the ARC Adult Advanced Life Support Manuals and Neonatal Emergency Response Manuals, and leads the development of the supporting educational material for the ARC provider and instructor courses.

Dr George HERIOTGeorgeisacurrentspecialtytraineeinInfectiousDiseases.Hespentmuchof2014 mired in Ebola preparedness at the designated Victorian receiving centre for viral haemorrhagic fever, and has previously published on the ethics and legalities of withholding acute life support measures for hospital inpatients.

Dr Natalie HOODNatalie is a paediatric emergency physician who has been the medical advisor to SLSA for ten years and their representative on the Australian Resuscitation Council.SheisamemberoftheILCORFirstAidTaskForce.Intheroleasanevidence reviewer and question owner for a number of the first aid topics Natalie has been actively involved in the formulation of the ILCOR CoSTR first aid treatment recommendations. As an active, patrolling lifesaver, she can focus on applicability of these recommendations to the frontline aquatic environment.

Dr Stuart LEWENAStuartisapaediatricemergencyphysicianandClinicalDirectorofPaediatricEmergency Medicine at The Royal Children’s Hospital Melbourne. He is a member of the RCH Resuscitation Committee and has recently been involved in a review oftheirpoliciesandguidelinessurroundingRecognitionoftheDeterioratingPatient and Escalation of Care. He has been an Advanced Paediatric Life Support instructorfor13years,isthecurrentPresidentofAPLSAustraliaandtheAustralianrepresentativeontheAPLSInternationalWorkingGroup.

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A/ProfPeterMORLEYPeter Morley is Chairman of the ARC, where he represents the Australian and New ZealandIntensiveCareSociety.HealsorepresentstheARContheInternationalLiaison Committee on Resuscitation, where he also holds the position of Evidence Evaluation Expert.

A/Prof Michael PARRMichaelParrisDeputyChair/Secretary-TreasurerandChairoftheALS Sub-CommitteeoftheARC(representingtheAustralian&NewZealandCollegeofAnaesthetists).MichaeltrainedintheUK,NewZealand,USAandAustralia.HeisDirectorofIntensiveCareatLiverpoolHospital,andatMacquarieUniversityHospital.Heisaneditorof‘Resuscitation’,ANZCArepresentativetotheAustralian Resuscitation Council and a member of ILCOR ALS subcommittee.

Prof Michael READELTCOL Reade trained in anaesthetics and intensive care at Royal North Shore, the Austin, the John Radcliffe in Oxford and the University of Pittsburgh. He has a doctorate in applied molecular biology from Oxford and a masters in clinical trials. In November 2011 he was appointed the inaugural Professor of Military Medicine andSurgery,andistheClinicalDirectoroftheRegularArmy’sonlyfieldhospital.He has deployed six times, most recently commanding the Australian Specialists at the NATO Hospital, Kandahar, Afghanistan. His research focusses on the management of traumatic coagulopathy and trauma systems design.

A/ProfTonyWALKERTony Walker ASM is a qualified Intensive Care Paramedics with an extensive career in ambulance working in a range of senior clinical governance, education and operational roles. Tony is currently Acting Chief Executive of Ambulance Victoria and also holds an adjunct appointment as Associate Professor, Paramedic Sciences in the College of Health and Biomedicine at Victoria University. He isaFellowofParamedicsAustralasiaandDeputyConvenoroftheAustralianResuscitation Council Advanced Life Support Committee. In 2005 he was awarded theAmbulanceServiceMedal(ASM)intheAustraliaDayHonourslist,andin2012wasawardedtheHeartFoundation’sPresident’sAwardinrecognitionofhissignificant contributions to their work in improving cardiovascular health.

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DEDICATION TO PROFESSOR IAN JACOBSPresentedby:A/ProfessorPeterMorleyFriday 17 April 2015

Professor Ian Jacobs served the Australian Resuscitation Council tirelessly for over 25 years in various roles, including Chairman 2000-2014. His contribution to the national and international resuscitation community was immense.

Members of the Australian Resuscitation Council were privileged to have worked with this passionate supporter of resuscitation.

The international resuscitation community lost an inspirational leader, a prolific academic, and a great friend. He will be sadly missed.

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SOL CONFERENCE PROGRAMFRIDAY17April2015

0830–1030 Welcome Chair:NationalChairman A/Prof Peter Morley (1x30mins) “Dedication to Ian Jacobs” ARC National Chairman 2000–2014

Plenary I “Don Harrison Perpetual Lecture” Australasian Visitor (2 x 45 mins) Resuscitation in Trauma A/Prof Ian Civil Important things I have learnt.

EmergencyMedicalDispatch ProfMaaretCastren The good, the bad and the ugly

1030-1100 MorningTea

1100-1300 PlenaryII Chair:ProfHughGrantham (4x30mins) MechanicalCPR ProfGavinPerkins What you need to know!

ResuscitationOutcomes ProfJudithFinn Separating fact from fiction

Drowning MrJonathonWebber An update – what we need to know

Advances in Trauma Care A/Prof Ian Civil New and promising therapies

1300-1400 Lunch

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FREE PAPER SESSIONS

Session 1 CommunityIssues&Training–Chair:ProfDarrenWalters Ballroom1

1400-1415 ACSMassMediaCampaignsInfluenceonPrehospitalBehaviourForAcuteCoronarySyndromes:AnEvaluationofTheAustralianHeartFoundation’sWarningSignsCampaign.Authors:Janet Bray1,2,3,DionStub2, Philip Ngu2, Susie Cartledge1,2, Michelle Stewart4, Wendy Keech4, Harry Patsamanis4, James Shaw2,JudithFinn1,3

1415-1430 ACSAssociation of Gender with Decreased Treatment and Increased Mortality for Victorian Patients Admitted with St-segment Elevation Myocardial Infarction. Authors: L. Kuhn1, K. Page2, M.A. Rahman3,4, L. Worrall-Carter3,4

1430-1445 TRAININGDo Cardiac Rehabilitation Programs Offer Cardiopulmonary Resuscitation Training In Australia AndNewZealand? Authors: S Cartledge,JBray,JFinn.

1445-1500 TRAININGA Randomised Control Trial To Compare Retention Rates of Two Cardiopulmonary Resuscitation Instruction Methods In The Novice. Author: Swee Han LIM,SingaporeGeneralHospital

1500-1515 TRAININGAreFirstYearMedicineStudentsAdequatelyTrainedinPerformingCPR?Author/s:D. Johnstone;D.Wallaceand N Harvey.

1515-1530 BLSReturn of ConsciousnessDuringOngoing Cardiopulmonary Resuscitation: A Systematic Review. Author/s: A Olaussen,MShepherd,ZNehme,KSmith,SBernard,BMitra.

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Session 2 InHospitalCardiacArrest&CardiacArrestOutcomes–Chair:DrRichardAickinBallroom2

1400-1415 IHCACharacteristics and Outcomes of Patients Requiring Medical Emergency or Cardiac Arrest Team Activation Duringthefirst72HoursofEmergencyAdmission:ARetrospectiveCohortStudy.

Author/s: J Considine,1,2DJones,3DPilcher,4 J Currey1,4

1415-1430 ALSCerebral Autoregulation And Outcome Following Cardiac Arrest. Author/s: P Pham, J Bindra, M Jaeger, A Aneman

1430-1445 QoLA Comparison Of Three Quality-Of-Life Measurement Tools In Out-Of-Hospital Cardiac Arrest Survivors: A Report FromThe Vicotrian Ambulance Cardiac Arrest Registry (VACAR). Author/s: K Smith, E Andrew, MLijovic,ZNehme,SBernard

1445-1500 IHCAFactorsAssociatedwithIn-hospitalDeathFollowingMedicalEmergencyorCardiacArrestTeamActivationDuringthefirst72HoursofEmergencyAdmission:ARetrospectiveCohortStudy.Author/s:J Considine,1,2 DJones,3DPilcher,4 J Currey1,4

1500-1515 QolComparison Of Out-Of-Hospital Cardiac Arrest Occuring Before And After Paramedic Arrival: Survival To HospitalDischargeAnd12-MonthFunctionalRecovery.Author/s:ZNehme, E Andrew, S Bernard, K Smith

1515-1530 IHCATheEarlyImpactOfIntroducingAPost-ArrestTeamAndProtocolInTheEmergencyDepartment.Author/s:Janet Bray1,2,3, Louise Segan1, Stephen Bernard1,2,4, Dion Stub2,5, Biswadev Mitra1,2, Karen Smith1,4,6, Judith Finn1,3,7

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Session3 Out-Of-HospitalCardiacArrest–Chair:A/ProfBillLord Ballroom3

1400-1415 OOHCADuration Of Resuscitation Efforts Following Ems Witnessed Out-Of-Hospital Cardiac Arrests. Author/s: ZNehme, E Andrew, S Bernard, K Smith

1415-1430 OOHCAAirwayManagementInOut-Of-HospitalCardiacArrest:TheNewZealandPerspective. Author/s:P Davey1, BDicker1,2

1430-1445 OOHCAEffect Of Heat On Out-Of-Hospital Cardiac Arrests In Melbourne. Author/s: S Heschl,EAndrew,ZNehme, S Bernard, K Smith

1445-1500 OOHCAPrevious Paramedic Exposure To Cardiac Arrest Treatment Is Associated With Patient Survival. Author/s: K Dyson,JBray,KSmith,SBernard,LStraney,JudithFinn

1500-1515 OOHCAAreEcgFindingsUsefulAsAScreeningToolForAcuteAngiographyInPatientsFollowingOut-Of-HospitalCardiacArrest?Author/s:S. Ashby,E.Granger,M.Connellan,J.Otton

1515-1530 OOHCAPublic Access Defibrillation—Results From The Victorian Ambulance Cardiac Arrest Registry. Author/s: M Lijovic1,2, S Bernard1,2,3,ZNehme1,2, T Walker1,4, & K Smith1,2,5 OOHCA

1530-1600 Afternoontea

1600-1730 PlenaryIII Chair:A/ProfPaulMiddleton (3x30mins) QualityCPR A/ProfPeterMorley Niceideabutdoesitreallyimprovesurvival?

Post Resuscitation Care Prof Stephen Bernard Canwedobetter?

PrognosticationinCardiacArrest ProfGavinPerkins Arewegettingitright?1730 Close

1930 ConferenceDinner

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SATURDAY18April2015

0830-1030 PlenaryIV Chair:ProfJulieConsidine (4x30mins) TherapeuticHypothermia ProfMaaretCastren Whatdoestheevidencereallytellsus..?

Community Engagement A/Prof Tony Walker Improving the community response to cardiac arrest

Resuscitation during battle Prof Michael Reade Translating this experience to the civilian setting

Resuscitationtraining MrMichaelGale The future of ALS courses in Australia

1030-1100 Morningtea

1100-1300 PlenaryV Chair:DrFinMacneil (4x30mins) Theuseofoxygeninemergencycare A/ProfMichaelParr Are we over doing it!

SpinalImmobilisation DrNatalieHood Much ado about nothing

Streetdrugs DrDavidCaldicott A rapidly changing field

EmergingInfectiousdiseases DrGeorgeHeriot Implications for resuscitation 1300–1400 Lunch

1400-1530 PlenaryVI Chair:MsTracyKidd (3x30mins) Managingthepaediatricarrest DrRichardAickin Things you need to remember.

Recognisingthedeterioratingchild DrStuartLewena The key to improving survival

Drowningprevention MrJonathonWebber New strategies to address an old problem

1530-1600 Afternoontea

1600-1650 PlenaryVII Chair:A/ProfMichaelParr Q & A Expert Panel Have those questions answered.

1650-1700 Closingremarks A/Prof Peter Morley

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NOTES:

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ABSTRACTSSOL CONFERENCE

KEYNOTEANDINVITEDSPEAKERS

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Friday 17 April PlenaryI–“DonHarrisonPerpetualLecture”RESUSCITATIONINTRAUMA:IMPORTANTTHINGSIHAVELEARNTA/Professor Ian CivilTraumaServices,AucklandCityHospital,Auckland,NZ

Resuscitation in trauma concentrates on the cycles – the cycle of air going in and out and the cycle of blood going round and round. But there is another cycle too, that of resuscitation strategies being “in” then “out” then “in” again. As a junior doctor at the time the Vietnam War had just finished, I was taught that many of the deaths and complications after injury were as a result of inadequate fluid resuscitation. Thus the approach being empathised was that of aggressive fluid resuscitation – crystalloid, colloid, plasma, blood and of course MAST. Time has seen that strategy reverse, but in witnessing this turnaround I have appreciated that the particular approach we take to resuscitation of any of the primary survey elements may in fact be proven to be diametrically wrong. Strongly held beliefs, whether or not supported by available evidence, are unhelpful in the resuscitation of trauma. Important things I have learnt include

• Airwaymanagementisbestperformedbyexpertsandhavingsuchpeopleavailableattherighttimehasimproved the airway care for trauma patients generally.

• Needlethoracentesisisoflimitedvalue.• Pericardiocentesisisofevenlessvalue• Maintaininganormalbloodpressureinthepresenceofuncontrolledbleedingisalmostcertainlygoingto

lead to more shock and a worse outcome• Crisischecklists/decisionsupportimprovesqualityofcareevenforexperiencedpractitioners• DECRAisatwoedgedsword• Damagecontrolisaconceptwhichisrelevantinallspecialtiesandtoallcombinationsofinjury

And finally, one is never too old to learn something new.

EMERGENCYMEDICALDISPATCH–THEGOOD,THEBADANDTHEUGLYProfessor Maaret CastrenHelsinkiUniversity,HelsinkiUniversityHospital,DepartmentofEmergencyCare,Helsinki,Finland

EmergencyMedicalDispatchingisacruciallinkinthechainofsurvivalforthecardiacarrestvictim,andvery little research focuses on this important topic. We now know that there are several prognostic factors linked to the work of dispatchers. The most important is for the dispatcher to recognise that the victim has cardiac arrest. This is vital because only then the dispatcher starts to give telephone guided CPR. This is not easy, since many factors may make the recognition very difficult. Agonal breathing and seizures are two ofthemostimportantonestodifferentiate.Dispatcherdecisionshavetobemaderapidly.Weknowfromstudies that dispatching the EMS units before a minute has passed from the start of the emergency call will increase the likelihood of survival. New technology has been used both in training the dispatchers and also in helping the victim. So called dual dispatching is a new model of working together with the laypersons to help the cardiac arrest victim. After the dispatcher recognises cardiac arrest and starts the dispatch proses, laypersons that are a part of a registry will also get dispatched. Using text messaging laypersons within 500 meters of the victim can be messaged. The first two who answers will be guided to the help. One to fetch a defibrillator and the other to run to the victim to start CPR. Many minutes are saved, and it seems that survival can be increased with this approach.

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Plenary IIMECHANICALCPR–WHATYOUNEEDTOKNOW!Professor Gavin Perkins (UK)The delivery of high-quality manual chest compressions is rarely achieved in practice. Mechanical chest compression devices can consistently deliver high-quality chest compressions. The recent publication of3largepre-hospitaltrialsprovidesimportantnewinformationabouttheroleofthesedevices.Themainfindingsofthethesestudies(CIRC,LINCandPARAMEDIC)wasthattheroutineuseofmechanicalcompression devices in the pre-hospital setting results in similar survival rates to those observed with manualchestcompressions.Asub-groupanalysisfromthePARAMEDICstudyshowedworseoutcomesin patients initially presenting with a shockable rhythm. The authors suggest this may be due to delays associated with delivery of the first shock. There remains limited data on the routine use of devices during in hospital cardiac arrest. Observational studies report favourable outcomes in some patients where mechanical devices are deployed in circumstances where manual CPR is difficult or impossible (e.g. in the back of a moving ambulance, as a bridge to advanced therapies such as percutaneous coronary intervention, extracorporeal membrane oxygenation). If EMS systems adopt mechanical CPR, the available evidence highlights the importance of effective training and implementation strategies to ensure minimal interruptions in chest compressions during device deployment.

RESUSCITATIONOUTCOMES–SEPARATINGFACTFROMFICTIONProfessor Judith FinnPrehospital, Resuscitation and Emergency Care Research Unit (PRECRU) - School of Nursing, Midwifery & Paramedicine / Curtin University, Perth, Western Australia

Since the introduction of CPR in 1960 there has been recognition of the importance of recording and reporting outcomes from resuscitation attempts.1 Moreover, there has long been interest in comparing resuscitation outcomes across different institutions and emergency medical services (EMS) – with a view to identifying factors associated with the best outcomes. However, there was early recognition of the challenges of ensuring that such comparisons are valid, ie comparing ‘apples with apples’ and not ‘apples with some processed fruit’. Indeed, a paper published in 1968 lamented that “efforts to consolidate data from various institutions are often unrewarding, as few series are comparable”.1 The iterations of the ‘Utstein ReportingGuidelines’2 have attempted to improve comparability between hospitals/EMS by standardising the definitions of data elements and outcome measures. Nonetheless, variations in interpretation remain.3 The purpose of this presentation is to a) highlight the importance of collecting ‘accurate’ resuscitation data and reporting outcomes; b) illustrate how outcomes might differ depending on case-mix / inclusion criteria; and c) discuss the evolving focus on patient-centred outcomes and not simply ‘ROSC’.

REFERENCES1. SaphirR.Externalcardiacmassage.Prospectiveanalysisof123casesandreviewoftheliterature.

Medicine1968;47:73-87.

2. PerkinsGD,JacobsIG,NadkarniVM,etal.Cardiacarrestandcardiopulmonaryresuscitationoutcomereports: Update of the Utstein resuscitation registry templates for out-of-hospital cardiac arrest. Resuscitation 2014.

3. NishiyamaC,etal.Applestoapplesorapplestooranges?Internationalvariationinreportingofprocessand outcome of care for out-of-hospital cardiac arrest. Resuscitation 2014;85:1599-609.

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DROWNING,ANUPDATE–WHATWENEEDTOKNOWMrJonathonWebberSurfLifeSavingNewZealand1;DepartmentofAnaesthesiology,TheUniversityofAuckland2;ClinicalSkillsCentre, Auckland City Hospital3Wellington,NewZealand1;Auckland,NewZealand2;Auckland,NewZealand3

In2014,theAustralianandNewZealandResuscitationCouncilspublishedanupdatedguideline(9.3.2)onResuscitationoftheDrowningVictim.Therevisedguidelineplacesanincreasedemphasisonthesafetyofrescuers when attempting rescue and provides advice on: spinal injuries occurring in the water; in-water resuscitation; positioning, assessment and treatment of the patient when on land; oxygen administration; use ofAEDs;hypothermiaandtheuseofchestcompression-onlyCPRindrowning.Medicalconditionsthatmayalso lead to in-water incapacitation are also discussed.

The term “chain of survival” has provided a useful metaphor for the elements of the emergency cardiac care system for sudden cardiac arrest, however interventions and patient management in drowning involves principles and actions that are specific to these situations. The Drowning Chain of Survival is intended to guide lay and professional rescuers in the important life-saving steps that may significantly improve chances of prevention, survival and recovery from drowning incidents.

In drowning, the majority of lives are saved through rapid removal of the patient from the water, and good basic life support. A much smaller number of lives are saved through advanced life support. Without question, the prevention of drowning will always be a better cure than resuscitation from it.

ADVANCESINTRAUMACARE:NEWANDPROMISINGTHERAPIESA/Professor Ian CivilTraumaServices,AucklandCityHospital,Auckland,NZWellington,NewZealand1;Auckland,NewZealand2;Auckland,NewZealand3

Trauma care continues to improve, partly as a result of new or improved treatments and partly as a result of better systems of care. While specific innovations in care can make the difference between life and death in a single patient, it is better teamwork, communication, and systems that are more likely to make the difference in outcome for trauma patients across the board. Trauma quality improvement relies on effective data capture and identification of relevant quality improvement indicators. The American College of Surgeons has pioneered the surgical quality improvement methodology with its National Surgical Quality Improvement Program (NSQIP) and the development of Trauma Quality Improvement Programs (TQIP) likely to deliver quantum improvements in overall trauma care. In a similar vein, initiatives such as telemedicine, the use of checklists, massive transfusion protocols, development of trauma services focussed on care of the elderly, and code crimson are all strategies using existing skills and resources but employing them in a more effective format. Specific new therapies or new uses which have the potential to benefit individual patients include

• Prehospitalultrasound• Intracavitaryfoamtamponade• Operativemanagementofribfractures• Effectivetherapiestoreverseanticoagulants• ECMO• Topicalhaemostaticagents

Asinallofmedicinepromisingnewtherapiesfortrauma(suchasFactorVIIa)oftenfalltothewaysideasthey are shown to be less effective than initially thought, too expensive or because general improvements in care render their use unnecessary. System developments however have historically stood the test of time and it is likely that the same will be true amongst this list as well.

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Plenary IIIPOSTRESUSCITATIONCARE–CANWEDOBETTER?Professor Stephen Bernard Institutions1. Monash University 2. Australian Resuscitation Outcomes Consortium -Centre of Research Excellence3. TheAlfredHospital4. Ambulance Victoria

Heart disease is the leading cause of death in Australia, and sudden out-of-hospital cardiac arrest (OHCA), affects more than 25,000 Australians per year, accounting for over one half of fatal cardiac events. Most OHCA patients transported to hospital remain comatose and are admitted to ICU for continued organ support. Current Australian data indicates that OHCA patients who are admitted to hospital have a subsequent mortality rate of approximately 50% if the initial rhythm is ventricular fibrillation/tachycardia and 90% if the initial rhythm is asystole/ pulseless electrical activity.

There is evidence that differences in outcomes may relate to the treatment provided after admission tohospital.Factorsincludereceivinghospitalcharacteristics,targetedtemperaturemanagement,early percutaneous cardiac intervention, optimisation of haemodynamic parameters, and appropriate prognostication practice.

This presentation outlines recent data on each of these factors.

PROGNOSTICATIONINCARDIACARREST–AREWEGETTINGITRIGHT!Professor Gavin Perkins (UK)This talk will discuss contemporary approaches to decision making about when to start CPR in the field and when to stop, which patients to admit from the emergency department to intensive care and when on-going treatment in intensive care is likely to be of limited benefit. To do this the talk will evaluate clinical decision rules that are used in the field and the intensive care. The talk will highlight the uncertainty associated with many decision rules. It will emphasise the importance of pre-morbid health and the wishes of those close to the family in reaching decisions about treatment.

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Saturday18AprilPlenary IVTHERAPEUTICHYPOTHERMIA-WHATDOESTHEEVIDENCEREALLYTELLUS?Professor Maaret CastrenHelsinkiUniversity,HelsinkiUniversityHospital,DepartmentofEmergencyCare,Helsinki,Finland

Formanyyearstherapeutichypothermiahasbeenaroutinemethodtotreatthepatientswhohavesurviveda cardiac arrest. It all started in 2002, although there had been publications before this time showing some effect of this treatment. Several methods have been in use, but no studies actually comparing them have ever beendoneonpatients.ForsomeyearstherehasbeenEMSsystemscoolingpatientsduringcardiacarrest.There are today more questions than answers regarding cooling of patients. When to start, how long to cool, whichmethodtouse?Nowweevenaskifthereisenoughevidencetocoolthepatientsatall.Someofthestudies lately published have changed the practise of many hospitals and EMS systems. Have those decisions beenbasedonevidenceornot?Therapeutichypothermiachangedtheprognosticevaluationofthepatient,there was suddenly no way of determining factors predicting possible survival or death of the patient. One prognostic factor is the initial rhythm where the patient is found. Should we use the very expensive intensive carebedsforallrhythms,ormaybeonlycoolthepatientsfoundinventricularfibrillation?Therearemanystudies,andmorecomingallthetime.Whatistheactualevidence,isthereany?Itseemsthatrightnowtheworldiswaitingandthebiggestexcitementforthistreatmenthaspassed.Shouldwegiveup?

COMMUNITYENGAGEMENT:IMPROVINGTHECOMMUNITYRESPONSETOCARDIACARRESTA/ProfessorTonyWalkerASMAmbulance Victoria, Melbourne

Sudden Cardiac Arrest can happen anywhere and at any time to people in the prime of their lives with a 10% reduction in survival for every minute treatment is delayed.

Without early care outcomes can be poor and survival from cardiac arrest depends on a fully integrated system of care that combines early recognition that someone has collapsed and activation of the Emergency Medical Services system (000), early CPR, early access to defibrillation and early advanced care provided by paramedics and transport to hospital care.

The community play a critical link in this system of care and strongly influences cardiac arrest survival. This presentation will explore strategies to improve community response including education and training and the important role that current and emerging technology are playing in driving innovation and improving survival.ª

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RESUSCITATIONDURINGBATTLE:TRANSLATINGTHISEXPERIENCETOTHE CIVILIAN SETTINGProfessor Michael ReadeBurns, Trauma and Critical Care Research Centre, University of Queensland and Joint Health Command, AustralianDefenceForce.Brisbane,Queensland,Australia

The UK and US armed forces have developed sophisticated and continually evolving Clinical Practice Guidelines(https://www.gov.uk/government/publications/jsp-999-clinical-guidelines-for-operations, http://www.usaisr.amedd.army.mil/clinical_practice_guidelines.html and https://www.jsomonline.org/TCCC.html) based on extensive experience of a large number (>50,000 coalition patients) of combat casualties duringthewarsinIraqandAfghanistan.TheAustralianDefenceForceworkedcloselywithNATOalliestodeliver prehospital and hospital trauma care, and consequently implements local modifications of these evidence-based guidelines. Some of these guidelines differ from those used in Australian civilian trauma care. In some cases this is with good reason, given different mechanisms of wounding (primarily penetrating trauma due to blast-fragmentation and ballistic wounding); however there are several examples in which military experience might inform better Australian civilian trauma care. Amongst these are:

• Theutilityofkaolin-andchitosan-basedhaemostaticwounddressings

• Windlass-assistedarterialtourniquetsforexsanguinatingarteriallimbhaemorrhage

• Junctionaltourniquetsforhighfemoralandarterialhaemorrhage

• Resuscitativeendovascularballoonocclusionoftheaorta

• Pressure-point(“Israeli”)bandagesforvenousandcapillarybleeding

• LargeborecentralvenousaccessinpreferencetoperipheralIVaccess

• Bloodproductresuscitationtoviscoelasticclottingendpointsratherthaninfixedratios

• Prehospitalantibiotics

• Nerveblocksforinterhospitaltransport

• Limited-durationhypotensiveresuscitation

• Avoidanceofspinalimmobilisationinpenetratingtrauma

Conversely, several techniques adopted early by the military (such as high-ratio plasma:red cell resuscitation, tranexamic acid, and preference for whole blood or the freshest available packed red cells) are now the subject of clinical trials in the civilian context.

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RESUSCITATIONTRAINING–THEFUTUREOFALSCOURSESINAUSTRALIAMr Michael GaleARC National Course Coordinator

ALS Courses have been facilitated across Australia for many years in a variety of formats and objectives. Since 2005 the ARC has administered ALS Courses through a face-to-face education sessions in centres across the country. With the increasing impact of technology offering alternative methods of educational delivery from the traditional text and face-to-face methods.

Potential format of ALS education in the future will need to consider the increased demands on individuals with time from employers, professional accreditation needs and financial implications without reducing quality. On-line and automated response/feedback learning has offered alternative methods of reducing contact time, overt costs and offers delivery of education at the pace of the candidates.

This presentation will highlight these challenges and potential impact of such alternate modes of education on the ALS courses.

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Plenary VTHEUSEOFOXYGENINEMERGENCYCARE:AREWEOVERDOINGIT!A/Professor Michael ParrIntensive care Unit, Liverpool Hospital, Sydney

InNovember2014theAustralianandNewZealandResuscitationCouncilspublishedGuideline11.6.1Targetedoxygen therapy in adult advanced life support. This was in response to the fact that in the past the use of high concentrations of inspired oxygen has been routine during Advanced Life Support but there is now a growing body of evidence that supplemental oxygen has risks, it should not be considered ‘routine’ and its use should be titrated against monitoring whenever possible.

Adverse effects of oxygen in emergency situations include: worsened ventilation/perfusion match, absorption atelectasis, myocardial ischaemia, reduced cardiac output, reduced coronary, cerebral and renal blood flow, increased peripheral resistance and blood pressure, and increased reactive oxygen species. In the peri-arrest period concern about increased oxidative damage, with increased neuronal death, and poor neurologic outcome has recently been identified. Oxygen therapy is no longer a benign intervention, and as with any drug, its risks and benefits need to be considered on an individual patient basis.

SPINALIMMOBILISATION:MUCHADOABOUTNOTHINGDr Natalie HoodBackground: Spinal immobilisation has been a mainstay of trauma care for decades and is based on the premise that immobilisation will prevent further neurological compromise in patients with a spinal column injury. The aim of this systematic review was to examine the evidence related to spinal immobilisation.

Method: In October 2014, we performed a systematic literature review of English language publications from1966toOctober2014indexedinMEDLINEandCochranelibraryusingthesearchterms(‘spinalinjuries’OR‘spinalcordinjuries’AND‘emergencytreatment’OR‘emergencycare’OR‘firstaid’ANDimmobilisation.EMBASEwassearchedforkeywords‘spinalinjuryOR‘spinalcordinjury’OR‘spinefractureAND‘emergencycare’ OR ‘prehospital care’).

Results:There were 44 studies meeting inclusion criteria for further review. Nine studies were case series (LOEIV)andtherewere35studiesfromwhichdatawereextrapolatedfromhealthyvolunteers,cadaversormultiple trauma patients. There were 14 studies that were supportive, 12 studies that were neutral and 18 studies opposing spinal immobilisation.

Conclusion: There are no published high level studies that assess the efficacy of spinal immobilisation in the pre-hospital and emergency care settings. Almost all of the current evidence related to spinal immobilisation is extrapolated data, mostly from healthy volunteers.

Whatisknown• Spinalimmobilisationisamainstayoftraumamanagementinpre-hospitalandemergencycare

environments.• Spinalimmobilisationisfrequentlyusedinpre-hospitalandemergencycareenvironments.

Whatthispaperadds• Thereisnohighlevelevidencetoassesstheefficacyofspinalimmobilisationinthepre-hospitalor

emergency settings.• Thereisevidencethatforsomepatientsspinalimmobilisationcausesharm.• Decisionstousespinalimmobilisationshouldbebasedoncarefulassessmentofriskversusbenefitin

individual patients.

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STREETDRUGS:ARAPIDLYCHANGINGFIELDDr David CaldicottEmergencyDepartment,CalvaryPublicHospital;FacultyofMedicine,AustralianNationalUniversityCanberra, ACT

The last decade has seen a dramatic change in the nature and numbers of novel psychotropic substances (NPSs) emerging on the market. This evolution not only applies to the products themselves but to the very market in which they are being distributed. The NPSs can provide substantial toxicological challenges to those asked to treat the adverse effects often seen with their ingestion.

In this presentation, we describe some of the categories of NPSs that are emerging on the Australian market, and based on overseas trends, offer suggestions of what might be to come. We will review treatment principles, and surveillance techniques that might have a role to play in minimizing the harm caused by these products.Finally,wewillreviewtheevidencefordrugpoliciesfromapublichealthperspective,andcomparethose which might increase, or decrease, harms from the NPSs

EMERGINGINFECTIOUSDISEASES–IMPLICATIONSFORRESUSCITATIONDr George Heriot, InfectiousDiseasesRegistrarMelbourneHealth

The care of hospitalised patients with emerging infectious diseases poses many challenges, with the complexity of these challenges increasing sharply with severity of illness. Advanced life support is a particular problem due to both the logistical difficulties imposed by strict isolation procedures and competing ethical concerns.

Ebola virus disease provides a useful case study given its novelty, demonstrated nosocomial transmission and high reported mortality rate. Patients in the late stages of Ebola virus disease are at risk of sudden deterioration from a variety of physiological derangements but optimal management and prognosis of critically ill patients remains unclear due to the small number of cases managed in resource-rich settings. Cumbersome isolation requirements complicate standard advanced life support procedures and ancillary interventions, and may irreparably compromise the likelihood of a successful and safe resuscitation attempt.

Pandemic influenza, a potentially more relevant situation for most healthcare providers, comes with different challenges, including higher infectivity, airborne transmission and the potential for a large-scale outbreak of critical illness.

The resuscitation of patients with emerging infectious diseases raises a number of ethical challenges due to the additional duty of care towards providers imposed by the transmissibility of these infections. In an outbreak setting, many difficult determinations will need to be made by providers, institutions and government agencies, both prospectively in the form of policy making and contemporaneously at the time of patient deterioration.

ª

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Plenary VIMANAGINGTHEPAEDIATRICARREST–THINGSYOUNEEDTOREMEMBERDr Richard AickinStarshipHospital,Auckland,NewZealand.

AimTo provide an overview of the current science and practice of resuscitaion of children, with an emphasis on practical tips. BackgroundPaediatric resuscitation is a rare event, and even health professionals working in acute services have infrequent experienceofthis.Rescuersreporthighlevelsofuncertaintyandstressduringpaediatricresuscitations.Frequentsimulation training can help improve confidence and performance, particularly when this occurs in situ, in the usual work environment and with the participation of the full team working in that setting. Resuscitation science undergoes regular detailed review through the ILCOR supported process which underpins our Resuscitation Council guideline development andtrainingprograms.Despitethepaucityofscienceonmanykeyquestionsrelatedtopaediatricresuscitationourcurrent guidelines now have a greater foundation of evidence than ever before.CPRCompression only CPR has been promoted as achieving satisfactory effects in sudden adult collapse and with potential to increase bystander participation and thus improve survival. The survival for children with out of hospital cardiac arrest who receive compression only CPR appears to be much poorer than for those who receive standard (“full”) CPR. The best rate and depth of compressions for Paediatric CPR is very similar to recommendations made for adults (100/min,4-5cmdepthor1/3chestdiameter).Althoughpaediatricspecifictrainingfor2personCPRcontinuestobe15compressionsto2breaths,inothergeneraltrainingandsettings30:2“nomatterwho”remainsappropriate.Ifyoudefault to standard “adult” CPR technique in a child, minimise interruptions and call for help early you will be doing well.DefibrillationThe ideal energy setting for paediatric defibrillation is not known. We do not expect there to be a linear relationship between the effectiveness of defibrillation at a particular energy setting and a child’s age or body weight. 2-4J/Kg is regardedasreasonable(asinglesettingof4J/Kgiseasytoremember).AnunmodifiedAEDcanbeusedsafelyinachild down to 1yr of age (10kg) and should be used if manual defibrillation equipment and expertise is not available. Shockable rhythms are present in around 15% of paediatric cardiac arrests.CirculationCirculatory compromise followed by decompensation is an important pathway leading to paediatric arrest. This can be the result of many different types of disease process and children with early signs circulatory shock can be hard to recognise. Tachycardia is one of the key measurable signs and should be emphasised in initial assessment/triage. Fluidsaretheinitialandmostimportanttreatmentforcirculatorycompromiseinmostsituations.Indiscriminateuseofboluses of intravenous fluid in children can cause harm and should be used with frequent re-assessment for effect and with consideration of the underlying disease process.DrugsThere is little evidence for the efficacy of drugs commonly used in paediatric cardiac arrest, and these should not take priority over other interventions such as CPR, ventilation, defibrillation and fluid resuscitation. Standard dose adrenaline appears to improve the chance of ROSC but not of longer term survival.SummaryGoodqualityCPRandafocusonthemostimportantelementsofpaediatricresuscitationcanresultinsurvivalwithgood neurological outcome in many children suffering cardiac arrest. In common with adult resuscitation the greatest potential for causing harming in a paediatric arrest is in doing nothing. “Any attempt at resuscitation is better than no attempt”.

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RECOGNISINGTHEDETERIORATINGCHILD-THEKEYTOIMPROVINGSURVIVALDr Stuart LewenaEmergencyDepartment,RoyalChildren’sHospital,Melbourne

Whilst paediatric cardiac arrest is different in many respects compared to adults, the two groups do share one important similarity. Across all ages, the early recognition of deterioration has been shown to improve survival, both by prevention of cardiac arrest and improved survival following arrest. Recognition of the deteriorating child however presents unique challenges and can only be effective if supported by a broader system incorporating education, monitoring and measurement utilising age appropriate tools, and appropriate escalation of care. Each of these steps have been referred to as a “chain of prevention” and a failure of any one of these links in the chain will adversely impact on efforts to improve survival.

The unique challenges in paediatrics relate to age specific variation in the significance of physiological variables, an appreciation of paediatric compensatory mechanisms which may falsely mask recognition of deterioration, provider experience in paediatric assessment and the relatively low frequency of paediatric critical deterioration.

This presentation will highlight these challenges via case based discussion and present current best practice with regard to maintaining the “chain of prevention” as a means of early recognition of deterioration, intervention in critical events and improving paediatric survival.

DROWNINGPREVENTION–NEWSTRATEGIESTOADDRESSANOLDPROBLEMMrJonathonWebber1,2,3

SurfLifeSavingNewZealand,Wellington,NewZealand1;DepartmentofAnaesthesiology,TheUniversityofAuckland,Auckland,NewZealand2;ClinicalSkillsCentre,AucklandCityHospital,Auckland,NewZealand3

TheWHOhasidentifieddrowningasaseriouspublichealthissue,claiming372,000livesayearworldwide.Ofthe 60 countries that collect reliable drowning data, Australia has a per capita drowning rate of 1.1 per 100,000 population,andNewZealand1.7.TheserankAustralia46/60,andNewZealand32/60respectively.Theburdenof drowning is most prevalent however in low and middle-income countries where data collection is limited. This presents significant challenges for planning, implementing and attempting to measure outcomes from drowning prevention strategies.

TheInternationalLifeSavingFederationhasused‘The Drowning Chain’ as a model to identify causes of drowning andcorrespondingimprovementstrategies.AnInternationalTaskforceonOpenWaterDrowninghasrecentlydeveloped a set of guidelines for families/individuals recreating at any open water site. These guidelines provide consistency in the messaging used by water safety agencies globally.

In2013-14,drowningwhileattemptingrescueaccountedfor2%ofallfataldrowningsinAustralia.Anumberofstrategies and innovative rescue methods have been developed in an attempt to reduce the risk to professional and lay rescuers, and to increase a drowning person’s chance of survival. Substantial knowledge-gaps in first aid/CPR skills by parents and bystanders have been identified and need to be addressed also.

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NOTES:

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33

ABSTRACTSFREE PAPERS

(Presentation order)

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SESSION1–CommunityIssues&Training

TITLE: MASS MEDIA CAMPAIGNS INFLUENCE ON PREHOSPITAL BEHAVIOUR FOR ACUTECORONARYSYNDROMES:ANEVALUATIONOFTHEAUSTRALIANHEARTFOUNDATION’SWARNINGSIGNS CAMPAIGN

AUTHOR/S: JanetBRAY1,2,3,DionStub2, Philip Ngu2, Susie Cartledge1,2, Michelle Stewart4, Wendy Keech4, Harry Patsamanis4, James Shaw2,JudithFinn1,3

Department/Organisation: Monash University1, Alfred Hospital2, Curtin University3,HeartFoundation4

Background: Important in prevent cardiac arrest is early action in response to cardiac symptoms. This study aimed to examine the awareness of a recent mass media campaign, and its influence on knowledge and prehospital times, in a cohort of acute coronary syndrome (ACS) patients admitted to an Australian hospital.

MethodsandResults:We conducted 199 semi-structured interviews with consecutive ACS patients who were:aged35-75years,competenttoprovideconsentandEnglish-speaking.Questionsaddressedthefactors known to predict prehospital delay, awareness of the campaign and whether it increased knowledge and influenced actions. Multivariable logistic regression was used to examine factors associated with a 1-hour delay in deciding to seek medical attention (patient delay) and a 2-hour delay in presenting to hospital (prehospitaldelay).Themedianagewas62years(IQR=53-68)and68%(n=136)weremale.Awarenessofthe campaign was reported by 127 (64%) patients, with most of these patients stating the campaign: 1) increasedtheirunderstandingofwhataheartattackis(63%);2)increasedtheirawarenessofthesignsandsymptomsofheartattack(68%);and3)influencedtheiractionsinresponsetosymptoms(43%).After adjusting for other predictors, awareness of the campaign was significantly associated with patient delay time of ≤1hour(adjustedoddsratio[AOR]=2.55,95%confidenceinternal[CI]:1.09-5.99,p=0.03)andprehospital delay time ≤2hours(AOR=2.94,95%CI:1.17-7.34,p=0.02).

Conclusion: Our study showed reasonably high awareness of the warning signs campaign, which was significantly associated with shorter prehospital decision-making and faster hospital presentation.

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TITLE:ASSOCIATIONOFGENDERWITHDECREASEDTREATMENTAND INCREASEDMORTALITYFORVICTORIANPATIENTSADMITTEDWITHST-SEGMENTELEVATIONMYOCARDIALINFARCTION

AUTHOR/S:L.KUHN1, K. Page2, M.A. Rahman3,4, L. Worrall-Carter3,4

Department/Organisation:[1]DeakinUniversity–EasternHealthNursing&MidwiferyResearchCentre–DeakinUniversity;[2]HeartFoundationofAustralia;[3]StVincent’sCentreforNursingResearch–ACU;[4]The Cardiovascular Research Centre – ACU, Melbourne, Victoria, Australia

Background:DeathfromST-segmentelevationmyocardialinfarction(STEMI)isavoidablewithearlyreperfusion therapy. International studies report inequity in treatment provision and mortality for women with STEMI compared to men. These differences have not been investigated in an Australian population.

Aim:To determine whether patient sex and age were associated with variation in reperfusion therapy or increasedinhospitalmortalityinpatientswithSTEMIinVictorianemergencydepartments(EDs).

Methods:We undertook retrospective analyses on a government database for patients admitted to Victorian hospitals with STEMI during 2005-10. Patients were analysed according to sex and age (<65 or ≥65 years).

Results:Women were less likely to receive angioplasty with stent and were more likely to receive no reperfusion therapy than men in corresponding younger and older age groups (p=0.006 and p<0.001, respectively). Overall, women in both age groups were more likely to die inhospital than men from equivalent age groups with STEMI (p<0.001, both groups).

Conclusions: Maximising treatment for patients with STEMI saves lives. Consistent with findings from international studies, women in Victoria were less likely to receive treatment for STEMI and were more likely todieduringadmissionthanmen.Furtherresearchneedstoverifythefindingsandcauses,andguidefutureresearch to ensure application of equitable treatment of both sexes. [210]

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TITLE:DOCARDIACREHABILITATIONPROGRAMSOFFERCARDIOPULMONARYRESUSCITATIONTRAININGINAUSTRALIAANDNEWZEALAND?

AUTHOR/S: S CARTLEDGE,JBray,JFinn

Department/Organisation:DepartmentofEpidemiologyandPreventiveMedicine,MonashUniversity,Melbourne, Victoria, Australia

Background:Cardiac rehabilitation (CR) is an ideal environment to train high-risk cardiac patients and their families in basic life support, including cardiopulmonary resuscitation (CPR). However, whether this training is currently offered is unknown.

Aim:1)TodescribetheprevalenceofCPRtraininginCRprogramsinAustraliaandNewZealandand2)toexamine perceived barriers and attitudes towards providing CPR training.

Methods:Weconductedacross-sectionalonlinesurveyofAustralianandNewZealandCRcoordinators.

Results:Of542surveyrequestssuccessfullyemailed,253(47%)completedthesurvey(Australian=208,NewZealandn=45).CPRtrainingwasincludedin28%ofAustralianCRprogramsand58%inNewZealand.In both countries CR programs were predominantly hospital-based, but there were higher rates of stand-aloneCRprogramsinNewZealand(25%vs3%,p<0.05).NewZealandalsoprovidedmoreface-to-faceCPRtraining(30%vs16%,p<0.05)andfamilymembersattendedCRmoreregularly(48%vs29%,p<0.05).CommonbarrierstoCPRtrainingincludedalackofresources(38%)andnotconsideringtoincludingitintheprogram(24%).ThemajorityofrespondentsbelievedthatlaypeopleshouldbetrainedinCPR(93%)andwere comfortable with recommending CPR training to this high-risk group (84%).

Conclusions:While CR coordinators have positive attitudes towards CPR training, it is not currently part of the CR program for many centres, particularly in Australia. This may in part be explained by organisational differencesandthespecificinclusionofCPRtrainingintheNewZealandCRguidelines.

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TITLE:ARANDOMIZEDCONTROLTRIALTOCOMPARERETENTIONRATESOFTWOCARDIOPULMONARYRESUSCITATIONINSTRUCTIONMETHODSINTHENOVICE

AUTHOR:DRSWEEHANLIM

Department/Organisation:SingaporeGeneralHospital,Singapore

Aim:To conduct a randomized control trial to compare the retention rates of two cardiopulmonary resuscitation (CPR) instruction methods: 1. Conventional CPR - chest compression before mouth to mouth ventilation 2. Chest compression only CPR

Methods:Participants were freshman nursing students who have not learnt one man adult CPR. They were randomizedinto2groups:GroupA(GpA):30compressionsbefore2ventilationsandGroupB(GpB):chestcompressiononlyCPR.ParticipantsinGpAweretaughttoperformonlychestcompressionsiftheywerenotwilling or unable to perform mouth-to-mouth ventilation. A 2-hour teaching session was conducted utilizing Laedral Resusci-Annie manikin with a skill metre. All participants were required to take a practical test after the teaching session. Six months later, participants underwent an unannounced assessment where they were required to attend to a cardiac arrest scenario for 5 minutes. Performance were recorded via the skill meter manikin and recorded on film, which was later rated by blinded reviewers.

Results:154participantswererandomizedtoGpAand193toGpBwith107/154(GpA)and146/193(GpB) attending the assessment at 6 months. Mean compression rates were higher in the chest compression only arm(GpB)77.66/minvs57.83/minintheCPRarm(GpA)[p<0.001].Meantotalnumberofcompressionswerealsosignificantlyhigher;319(GpB)vs226(GpA)[p<0.001].Therewasnostatisticaldifferenceinmeancompression depth between 2 groups. Multivariate analysis showed weight to be the only significant variable affecting compression depth in both groups. In those who performed ventilation, only 2/107 had 10 effective ventilations, 7/107 had more than 5 effective ventilations in 5 mins. Many who attempted ventilation had no actual mouth-to-mouth contact, 48/107.

Conclusion:Teaching chest compression only CPR is associated with a significantly higher rate of chest compressions; hence performance of effective chest compressions was better than those who were taught and performed conventional CPR. Majority did not perform effective ventilations, suggestive of poor retention in ventilation skills. In general, performances declined after a post-training interval of 6 months.

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TITLE:AREFIRSTYEARMEDICINESTUDENTSADEQUATELYTRAINEDINPERFORMINGCPR?

AUTHOR/S:D. Johnstone;D.WallaceandNHarvey.

Department/Organisation:James Cook University (JCU), Townsville, Queensland

Similar to other Australian Medical Schools, James Cook University (JCU) requires first year medical studentstosubmitacertificateofcompletionofanAustralianCreditedFirstAidandCPRcourse,fromaRegistered Training Organisation (RTO). To answer the question: “Does the mandatory requirement for an Australian Credited CPR course negate the need for CPR training within the first year of an undergraduate medical curriculum?; a mixed methods study was conducted. The aims were to evaluate the confidence levels of students regarding CPR; assess the competence of students in performing CPR; and to identify perceived/actual gaps in CPR education.

Two hundred and sixteen first year medical students completed the 10 question survey; 54 students participatedinpracticalactivityandofthese34studentswereinvolvedinfocusgroups.Keyfindingsofthisstudy included:

• Norelationshipwasfoundbetweenstudents’reportedconfidencelevelsandcorrectlyansweringtheCPRknowledge questions

• Students’self-reportedlevelofconfidenceinperformingCPRwasgreaterthantheirdemonstratedcompetence;

• Thelongerthegap(i.e.>3months)betweentrainingandassessment,thelesslikelystudentsweretoretain the relevant information.

• Noneofthe54studentsachieved100%competencyonthesimulatedCPRactivity;

• Moststudentsrequestedfurtherpractiseopportunitiesandtheprovisionone-on-onefeedback;

• StudentsalsorequestedtheinclusionofaCPRteachingsessionandassessmentintotheYearonecurriculum.

As a direct outcome of this study, CPR teaching sessions and associated assessment have been introduced intotheYearonemedicalcurriculumfor2015.

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TITLE:RETURNOFCONSCIOUSNESSDURINGONGOINGCARDIOPULMONARYRESUSCITATION:ASYSTEMATICREVIEW

AUTHOR/S:AOLAUSSEN,MShepherd,ZNehme,KSmith,SBernard,BMitra

Department/Organisation:DepartmentofCommunityEmergencyHealthandParamedicPractice,MonashUniversity ; Emergency & Trauma Centre, The Alfred ; Department/Organisation of non-presenting authors: AmbulanceVictoria(AV),HEMS;DepartmentofResearchandEvaluation,AV;DepartmentofEpidemiologyand Preventive Medicine, Monash University ; Emergency Medicine, University of Western Australia ; Intensive Care Unit, The Alfred, Melbourne, VIC, Australia.

Objectives:Cardio-pulmonary resuscitation (CPR) may generate sufficient cerebral perfusion pressure to make the patient conscious. The incidence and management of this phenomenon is not well described. This systematic review aims to identifying cases where CPR-induced consciousness is mentioned in the literature and explore its management options.

Methods:The databases Medline, PubMed, EMBASE, Cinahl and the Cochrane Library were searched from theircommencementtothe8thofJuly2014.WealsosearchedGoogle(scholar)forgreyliterature.Wecombined MeSH terms and text words for consciousness and CPR, and included studies of all types.

Results:The search yielded 1997 unique records, of which 50 abstracts were reviewed. Nine reports, describing 10 patients, were relevant. Six of the patients had CPR performed by mechanical devices, three ofthesepatientsweresedated.Fourpatientsarrestedintheout-of-hospitalsettingandsixarrestedinhospital. There were four survivors. Varying levels of consciousness were described in all reports, including purposeful arm movements, verbal communication, and resuscitation interference. Management strategies directed at consciousness were offered to six patients and included both physical and chemical restraints.

Conclusion:CPR-induced consciousness was infrequently reported in the medical literature, and varied in management.GiventheincreasinguseofmechanicalCPR,guidelinestoidentifyandmanageconsciousnessduring CPR are required.

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SESSION 2 –InHospitalCardiacArrest&CardiacArrestOutcomes

TITLE:CHARACTERISTICSANDOUTCOMESOFPATIENTSREQUIRINGMEDICALEMERGENCYORCARDIACARRESTTEAMACTIVATIONDURINGTHEFIRST72HOURSOFEMERGENCYADMISSION:ARETROSPECTIVECOHORTSTUDY

AUTHOR/S: J Considine,1,2DJones,3DPilcher,4 J Currey1,4

Department/Organisation:1DeakinUniversity,Burwood,Victoria,Australia,2 Eastern Health, Box Hill, Victoria, Australia, 3Austin Health, Heidelberg, Victoria, Australia, 4 Alfred Health, Prahran, Victoria, Australia

The aim of this study was to examine the frequency, timing and outcomes of medical emergency team (MET) or cardiac arrest team (CAT) activations in the first 72 hours of emergency admission to medical or surgical wards. This cohort study was conducted at three health services in Melbourne, Australia: MET or CATactivationsoccurredbetween44%and68%ofpatientsadmittedviaEDatthesesites.Thecohortwere adult patients (≥18years),admittedviatheemergencydepartment(ED)tonon-monitoredmedicalorsurgical units during 2012, and who had a MET or CAT activation within 72 hours of admission: 660 patients (220 per site) were randomly selected. The median age was 77 years, 48.8% were males, 69.7% arrived toEDbyemergencyambulanceand84.3%usuallylivedathome.MedianEDstaywas7.7hours;10.3%ofpatientshadanEDstay≤4hours.Duringthefirst72hoursofemergencyadmission,therewere825MET(634patients)and42CATactivations(35patients).ThemediantimefromleavingEDtoMETorCATactivationwas18.8hours(IQR7.3to37.9).DuringEDcare,29.0%ofpatientshad≥1 documented parameter that fulfilled the hospital-specific MET activation criteria. Immediately following MET activation, 91.1% of patients stayed on the ward, 5.5% were transferred to ICU, and 0.8% of patients died. Immediately following CATactivation,40.7%ofpatientsstayedontheward,37.0%diedand14.8%weretransferredtoICU.METandCATactivationiscommonfollowingemergencyadmission,butoccursmanyhoursafterEDdischargeandare associated with frequent ICU transfer. There is a need to better understand the potential predictability and preventability of MET and CAT activations.

Acknowledgements: This study was generously funded by the Nurses Board of Victoria Legacy Limited Mona MenziesPostdoctoralResearchGrantandanEasternHealthResearchGrant.ThankstoDebraBerry,EmilyPatton,AimeeDaleyandJenYuenfortheirsupportduringdatacollection.

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TITLE:CEREBRALAUTOREGULATIONANDOUTCOMEFOLLOWINGCARDIACARREST

AUTHOR/S:PPHAM, J Bindra, M Jaeger, A Aneman

Department/Organisation:Intensive Care Unit, Liverpool Hospital, South Western Sydney Local Health District,Sydney

Fewclinicalstudieshaveassessedcerebrovascularautoregulation(CVAR)followingcardiacarrest(CA)inrelationtooutcome.Inthisstudynear-infraredspectroscopy(NIRS)(ForeSightMC-2030)monitoredcerebral oxygen saturation was correlated to arterial pressure (invasively in patients and non-invasively (FinapresPRO)inhealthyvolunteers)toderiveTissueOxygenationindex(TOx),avalidatedmeasureofCVAR, using dedicated software (ICM+). Intact CVAR results in a negative or close to zero TOx whereas higherTOxindicatesimpairedCVAR.23comatoseCApatients(8female,17outofhospital)enrolledwithin24 hours of ICU admission and 28 healthy volunteers (15 female) had TOx measured during at least one hour. Patientshaddailymeasurementsforthefirst3daysinICU.Mortalityandneurologicalstatewereassessed3monthsfollowingCA.15patientshaddiedat3monthswithallsurvivorsachievingagoodneurologicaloutcome. The TOx was higher in non-survivors vs. survivors on day 1 and CVAR dichotomised as intact vs. impairedwasdifferentwithanoddsratioforgoodoutcomeifintactof10.83[95%CI1.37-85.44].Onday3TOxremainedhigherinnon-survivorsandtheoddsratioforsurvivalwithintactCVARatday3was19.25[95% CI 1.77 - 209.55]. The TOx was not significantly different between survivors and healthy volunteers. This study demonstrates the clinical feasibility to assess CVAR following CA and highlights the association withclinicaloutcomes.FuturestudytodynamicallyassesstheoptimalcerebralperfusionpressurefollowingCA is warranted.

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TITLE:ACOMPARISONOFTHREEQUALITY-OF-LIFEMEASUREMENTTOOLSINOUT-OF-HOSPITALCARDIACARRESTSURVIVORS:AREPORTFROMTHEVICTORIANAMBULANCECARDIACARRESTREGISTRY(VACAR)

AUTHOR/S: K SMITH,EAndrew,MLijovic,ZNehme,SBernard

Department/Organisation:DepartmentofResearchandEvaluation,AmbulanceVictoria;DepartmentofEpidemiologyandPreventiveMedicine,MonashUniversity;DisciplineofEmergencyMedicine,UniversityofWestern Australia, Melbourne, Victoria, Australia

Introduction: Quality of life (QOL) research is relatively new in the field of out-of-hospital cardiac arrest (OHCA) and few health-related QOL (HRQOL) tools have been validated in this population. The VACAR assesses the QOL and functional recovery of OHCA survivors 12-months post arrest. We sought to measure the correlation between instruments utilised, and assess their validity in the OHCA population.

Methods: Telephone interviews were conducted with adult survivors who arrested between 1 January 2010 and30June2013.InstrumentsincludedtheEuro-QOL5D(EQ-5D)andVisualAnalogueScale(VAS),ShortForm12(SF-12),andGlasgowOutcomeScale–Extended(GOSE).Floor(lowestpossiblescore)andceiling(highestpossiblescore)effectsofEQ-5DandSF-12outcomescoreswereassessed.Spearman’srhocorrelation coefficient was used to assess correlation between tools.

Results:A total of 795 patients/proxies participated (response rate 81%). No floor effects were observed, howeveraceilingeffectof39.0%wasobservedfortheEQ-5Dindexscore.TheSF-12PhysicalComponentSummarycorrelatedwellwiththeEQ-5DVAS(0.670,p<0.01)andEQ-5Dindexscore(0.614,p<0.01).However,theSF-12MentalComponentSummarycorrelatedpoorlywithalltools(<0.300).

Conclusion:TheEQ-5DindexscoreyieldedalargeceilingeffectandthusperformedpoorlyintheOHCApopulation. Variable correlation between instruments may be explained by differences in the content of instruments or the sensitivity of individual tools within this population. However further investigation is important to determine the appropriateness and validity of HRQOL and functional recovery tools in OHCA populations.

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TITLE:FACTORSASSOCIATEDWITHIN-HOSPITALDEATHFOLLOWINGMEDICALEMERGENCYORCARDIACARRESTTEAMACTIVATIONDURINGTHEFIRST72HOURSOFEMERGENCYADMISSION:ARETROSPECTIVECOHORTSTUDY

AUTHOR/S:J Considine,1,2DJones,3DPilcher,4 J Currey1,4

Department/Organisation: 1DeakinUniversity,Burwood,Victoria,Australia,2 Eastern Health, Box Hill, Victoria, Australia, 3Austin Health, Heidelberg, Victoria, Australia, 4 Alfred Health, Prahran, Victoria, Australia

The aim of this study was to examine factors associated with in-hospital death following medical emergency team (MET) or cardiac arrest team (CAT) activation within 72 hours of emergency admission to medical or surgical wards. This cohort study was conducted at three health services in Melbourne, Australia. The cohort were adult patients (≥18 years) admitted to non-monitored medical or surgical units via the emergency department(ED)during2012withaMETorCATactivationwithin72hoursofadmission:660patients(220per site) were randomly selected. The in-hospital mortality rate was 16.5% (n=109). Patients who died were older(medianage81vs76,p<0.001)andmorelikelytoarrivebyambulance(OR=2.2,95%CI:1.45-4.36),have a limitation of medical treatment order in place (OR=4.6, 95%CI:2.98-7.05), and be triaged to category 2(OR=1.8,95%CI:1.18-2.82).PatientswhodiedwerelesslikelytoliveathomebeforeEDattendance(OR=0.39,95%CI:0.24-0.63)andbetriagedtocategory3(OR=0.34,95%CI:0.42-0.97).Patientswhodiedwere more likely to have ≥1observation(s)fulfillingMETcriteriaduringEDcare(OR=1.8,95%CI:1.20-2.82)andonunivariateanalysis,specificallyalteredconsciousstate(OR=6.2,95%CI:2.05-18.93),tachypnoea(OR=2.8,95%CI:1.53-5.01),hypotension(OR=2.0,95%CI:1.17-3.41)orhypoxaemia(OR=2.5,95%CI:1.04-5.92).TherewerenodifferencesinEDlengthofstay.Patientswhosufferin-hospitaldeathfollowingMETor CAT activation within 72 hours of emergency admission have clear differences to those who survive, andnotablyahigherincidenceofphysiologicalderangementduringEDcare.TherelationshipbetweenEDphysiological status and adverse events on the wards warrants further investigation.

Acknowledgements:This study was generously funded by the Nurses Board of Victoria Legacy Limited Mona MenziesPostdoctoralResearchGrantandanEasternHealthResearchGrant.ThankstoDebraBerry,EmilyPatton,AimeeDaleyandJenYuenfortheirsupportduringdatacollection.

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TITLE: COMPARISONOFOUT-OF-HOSPITALCARDIACARRESTOCCURINGBEFOREANDAFTERPARAMEDIC ARRIVAL: SURVIVAL TO HOSPITAL DISCHARGE AND 12-MONTH FUNCTIONALRECOVERY

AUTHOR/S:ZNEHME,E Andrew, S Bernard, K Smith

Department/Organisation:DepartmentofResearchandEvaluation,AmbulanceVictoria;DepartmentofEpidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia

Objectives:Despiteimmediateresuscitation,survivalratesfollowingout-of-hospitalcardiacarrests(OHCA)witnessed by emergency medical service (EMS) are reportedly low. We sought to compare survival and 12-month functional recovery outcomes for OHCA occurring before and after EMS arrival.

Methods:Between1stJuly2008and30thJune2013,weincluded8648adultOHCAcasesreceivinganEMSattempted resuscitation from the Victorian Ambulance Cardiac Arrest Registry, and categorised them into five groups: bystander witnessed cases ± bystander CPR, unwitnessed cases ± bystander CPR, and EMS witnessed cases. The main outcomes were survival to hospital and survival to hospital discharge. Twelve-month survival with good functional recovery was measured in a sub-group of patients using the Extended GlasgowOutcomeScale(GOSE).

Results: Baseline and arrest characteristics differed significantly across groups. Unadjusted survival outcomes were highest among bystander witnessed cases receiving bystander CPR and EMS witnessed cases, however outcomes differed significantly between these groups: survival to hospital (46.0% vs. 53.4%respectively,p<0.001);survivaltohospitaldischarge(21.1%vs.34.9%respectively,p<0.001).Whencompared to bystander witnessed cases receiving bystander CPR, EMS witnessed cases were associated withasignificantimprovementintheriskadjustedoddsofsurvivaltohospital(OR2.02,95%CI:1.75-2.35),survival to hospital discharge (OR 6.16, 95% CI: 5.04-7.52) and survival to 12 months with good functional recovery (OR 5.56, 95% CI: 4.18-7.40).

Conclusion:When compared to OHCA occurring prior to EMS arrival, EMS witnessed arrests were associated with significantly higher survival to hospital discharge rates and favourable neurological recovery at 12 months post arrest.

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TITLE: THE EARLY IMPACT OF INTRODUCING A POST-ARREST TEAM AND PROTOCOL IN THEEMERGENCYDEPARTMENT

AUTHOR/S:JanetBRAY1,2,3, Louise Segan1, Stephen Bernard1,2,4,DionStub2,5, Biswadev Mitra1,2, Karen Smith1,4,6,JudithFinn1,3,7

Department/Organisation: Monash University1 (Melbourne, Australia), The Alfred Hospital2 (Melbourne, Australia), Curtin University3 (Perth, Australia), Ambulance Victoria4(Melbourne,Australia),BakerIDI5(Melbourne, Australia), University of Western Australia6(Perth, Australia), St John Ambulance Western Australia7(Perth, Australia)

Introduction:Post-arrest care is an important link in the Chain of Survival, but the delivery of this care varies. This study aims to examine the early impact of introducing a Post-Arrest Team and Protocol to define rolesandstreamlinetheinitialpostresuscitativemanagementfromarrivalintheEmergencyDepartment(ED).

Methods:This before-and-after study obtained data from the Victorian Ambulance Cardiac Arrest Registry (VACAR) and hospital audit. Consecutive ventricular fibrillation/tachycardic non-traumatic out-of-hospital cardiacarrest(VF/VT-OHCA)patientsadmittedtoatertiary-referralhospitalinMelbourne(Australia)between October 2011 and January 2014 were included.

Results:Overthestudyperiod,109VF/VT-OHCAadmissionswereeligible(65beforeand31after):mean age=64 years (IQR=22), 84% were male, 94% were premorbidly independent. Improvements after introductionofthePATandprotocolwereseenin:1)oxygentitrationinED(34%vs.77%,<0.001);2)commencementoftargeted-temperature-managementpriortoICU(82%vs.100%,p=0.03);3)cardiologyconsultationsinED(79%vs.94%,p=0.06);4)acutecardiacintervention(40%vs.52%,p=0.28);and5)PaO2on ICU arrival (median 151mmHg vs 104mmHg, p=0.87). Unadjusted rates of ICU survival (62% vs 78%, p=0.17) and hospital survival (62% vs. 81%, p=0.07) increased over the study period.

Conclusions:WeobservedimprovementsinkeyareastargetedbythePost-ArrestTeamandProtocol.Datacollection is continuing to enable statistical modelling of survival and neurological outcomes.

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SESSION3–Out-Of-HospitalCardiacArrest

TITLE:DURATIONOFRESUSCITATIONEFFORTSFOLLOWINGEMSWITNESSEDOUT-OF-HOSPITALCARDIAC ARRESTS

AUTHOR/S:ZNEHME, E Andrew, S Bernard, K Smith

Department/Organisation:DepartmentofResearchandEvaluation,AmbulanceVictoria;DepartmentofEpidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia

Objectives:Many emergency medical service (EMS) agencies elect to routinely transport EMS witnessed out-of-hospital cardiac arrest (OHCA) patients with ongoing cardiopulmonary resuscitation (CPR), although the effect of CPR duration on outcomes has not been described. In this study, we assess the relationship between CPR duration and outcomes following EMS witnessed OHCA.

Methods:BetweenJanuary2003andDecember2011,1,056adultEMSwitnessedOHCAofpresumedcardiac aetiology were included from the Victorian Ambulance Cardiac Arrest Registry. Adjusted logistic regression analyses were used to assess the relationship between CPR duration in minutes and survival to hospital discharge.

Results:Return of spontaneous circulation (ROSC) and survival to hospital discharge occurred in 706 (66.9%)and387(37.0%)patientsrespectively.ThemedianCPRdurationwas12.0minutes(IQR:3.0-29.0)intheoverallsample,28.0minutes(IQR:18.0-38.0)inpatientsnotachievingROSC,and3.0minutes(IQR:2.0-5.0) in survivors to hospital discharge. The 90th percentile of CPR duration was 11 minutes in survivors to hospital discharge, with only 2% of survivors having prolonged resuscitation attempts lasting more than30minutes.Afteradjustingforprehospitalconfounders,anarrestintheambulance(OR0.51,95%CI:0.28-0.92, p=0.026) and CPR duration in minutes (OR 0.88, 95% CI: 0.86-0.90, p<0.001) were independently associated with a reduction in the odds of survival to hospital discharge. Patient rearrest did not influence survival outcome after adjustment for CPR duration.

Conclusion:ProlongedresuscitationattemptsmaynotbeusefulfollowingEMSwitnessedOHCA.Furtherstudies are needed to assess functional recovery in survivors with prolonged resuscitation attempts.

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TITLE: AIRWAY MANAGEMENT IN OUT-OF-HOSPITAL CARDIAC ARREST: THE NEW ZEALANDPERSPECTIVE

AUTHOR/S:PDAVEY1,BDicker1,2

Department/Organisation:1 AucklandUniversityofTechnology,SchoolofClinicalSciences,FacultyofHealth and Environmental Science, 2StJohn,NewZealand

Background:Duringout-of-hospitalcardiacarrest(OHCA)theoptimalairwaymanagementstrategyremainscontroversial.AirwaymanagementduringOHCAhasnotbeenpreviouslydescribedinNewZealand.Theaimof the study was to report the frequency of airway adjunct use and compare outcomes between patients receiving oropharyngeal airway (OPA), laryngeal mask airway (LMA) and endotracheal intubation (ETI).

Methods:DatawasextractedfromtheStJohnOHCARegistry(SOHCAR)fortheperiod1-October2013to30-September2014.Thefrequencyofairwayadjunctusewasidentifiedandoutcomescomparedbetweencohorts that received a single airway adjunct. Outcomes were defined as ROSC at hospital handover and survival to discharge.

Results:Duringthestudyperiod1951OHCAhadresuscitationattempted,41.4%ofthesereceivedmorethan one airway adjunct. Analysis of the cohorts that received a single airway adjunct (n=912) identified that 338receivedOPA,394LMAand180receivedETI.UnadjustedratesofROSCathospitalhandoverwerethelowestintheLMAgroup(21.3%)followedbyOPA29.3%,ETI35.6%andnoairway41.8%.UnadjustedsurvivaltodischargewasalsothelowestintheLMAgroup(9.1%)followedbyETI13.3%,OPA22.5%thenthenoairwaygroup35.3%.

Conclusion:Unadjusted survival to discharge and ROSC at hospital handover rates were the lowest amongst cohortsthatreceivedaLMAcomparedtonoairwayadjunct,OPAandETI.Furtheranalysisisrequiredto adjust for clinical variables that could plausibly impact on the selection of airway adjunct and airway management strategy.

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TITLE:EFFECTOFHEATONOUT-OF-HOSPITALCARDIACARRESTSINMELBOURNE

AUTHOR/S:S HESCHL, EAndrew,ZNehme,SBernard,KSmith

Department/Organisation:DepartmentofResearchandEvaluation,AmbulanceVictoria,Melbourne,VIC,Australia

Background:While extreme heat is known to adversely impact health outcomes, its effect on out-of-hospital cardiac arrest (OHCA) has not been described in detail.

Methods:Between1/1/2002and30/06/2014,weextractedOHCAdatafromtheVictorianAmbulanceCardiac Arrest Registry and linked cases to data from the Bureau of Meteorology. We categorised cases accordingtothenumberofconsecutivedaysaboveadailymaximumtemperatureof37°C(1st,2ndor≥3rd day and the day following a ≥3dayheatwave).Summerdays(November-March)<37°Cwasusedasreference.

Results:Weincluded12020OHCAsofpresumedcardiacaetiology,ofwhich677wereondays>37°C,81on days following ≥3dayheatwavesand11262onreferencedays.ThemeannumberofOHCAsevents/dayincreasedwithincreasingconsecutivedays>37°C(Ref:6.2[±2.5],1st day: 6.8 [±2.8], 2nd day: 9.0 [±5.2], ≥3rd day:35.8[±26.8],dayfollowing≥3dayheatwave:27.0[±20.5],p=0.08).Increasingconsecutivedays>37°Cwere associated with older age, fewer male events, an increase in asystole as initial rhythm, a greater number of arrests in private residences and a decrease in EMS resuscitation attempts (p<0.001 for all).

Survivaltohospitaldecreasedsignificantlywithconsecutivedays>37°C(Ref:36.9%,1stday:38.4%,2nd day: 29.1%, ≥3rdday 12.9%, day following ≥3dayheatwave:25.0%,p=0.041)howeverthedifferenceinsurvivaltodischarge was not significant.

Discussion:High environmental temperatures are associated with changes in OHCA characteristics. These findings suggest that strategies need to be developed to reduce excess deaths during heat waves.

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TITLE: PREVIOUS PARAMEDIC EXPOSURE TO CARDIAC ARREST TREATMENT IS ASSOCIATEDWITHPATIENTSURVIVAL

AUTHOR/S:KDYSON,JBray,KSmith,SBernard,LStraney,JudithFinn

Department/Organisation:DepartmentofEpidemiologyandPreventiveMedicine/MonashUniversity&Operations/Ambulance Victoria, Melbourne/Victoria/Australia

Aim:We measured the relationship between previous paramedic exposure to out-of-hospital cardiac arrest (OHCA) and OHCA patient survival.

Methods:We linked data from the Victorian Ambulance Cardiac Arrest Registry with Ambulance Victoria’s employmentdataset.Usingcasedatafrom2003to2012,wedefined‘exposure’asthenumberoftimesaparamedic attended an OHCA (resuscitation attempted) in the three years preceding each case. We used multivariable models to measure the association between exposure and survival to hospital discharge, adjusting for known predictors of survival as well as the number of paramedics on scene and their years of career experience.

Results:Duringthestudyperiod,therewere49,107OHCAsand5,673paramedicsemployed.Resuscitationwasattemptedin44%ofOHCApatients.Anaverageof3.2(SD±1.1)paramedicsattendedeachcase.Paramedicstreatedamedianofeightcasesinthethreeyearsprecedingeachcase(IQR:4.5-13.5).Inthemultivariable model, an interquartile range increase in the median exposure of treating paramedics was associatedwitha13%increaseintherelativeoddsofsurvival(95%CI:6%-21%).Eachmonthincreaseinthe median time since the treating paramedics’ previous OHCA exposure was associated with a significant decline in the odds of survival (AOR 0.97, 95%CI:0.95-0.99). Career experience was not a significant predictor of survival.

Conclusions:The number and recency of previous OHCA exposures is associated with improved OHCA patient survival. These findings suggest that strategies to increase paramedic exposure to OHCA or supplement it, with a method such as with simulation, should be explored.

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TITLE:AREECGFINDINGSUSEFULASASCREENINGTOOLFORACUTEANGIOGRAPHYINPATIENTSFOLLOWINGOUT-OF-HOSPITALCARDIACARREST?

AUTHOR/S:S.ASHBY,E.Granger,M.Connellan,J.Otton

Department/Organisation:StVincent’sHospitalDepartmentofCardiothoracicSurgeryandUNSWMedicine,Sydney, NSW, Australia

Background:In-hospital management of Out-of-Hospital Cardiac Arrest (OHCA) is complex as the aetiologies are varied. Acute coronary angiography has been shown to improve outcomes for patients withcoronaryocclusionasthecause,howeverthesepatientsaredifficulttoidentify.ECGresultsmayhelp identify these patients, but the accuracy of this diagnostic test is under debate, and requires further investigation.

Methods:Arrest and hospital management information was collated retrospectively for OHCA patients who presentedtoasingleclinicalsitebetween2009and2013.Angiographyresultswerethencollectedandchecked for significance with survival to discharge. Presence of a severe lesion (>70%) was then compared to categorisedECGfindings,andtheaccuracyofthetestwascalculated.

Results:104 patients were included in this study, 44 survived to discharge, 52 died and 8 were transferred to other clinical sites. Angiography appears to significantly correlate with survival to discharge. Within the groupthatreceivedangiography,STelevationonECGshowed54.8%sensitivityfordetectingthepresenceofaseverelesion.AcombinedcriterionincludinganyECGpathologyshowed100%sensitivityandnegativepredictive value, however a low specificity and positive predictive value.

Conclusion:Inthecohortinvestigated,STelevationonECGisnotasensitiveenoughscreeningtesttobeused to determine whether OHCA patients have coronary stenosis as the likely cause of their arrest, and moreinvestigationintowhetherscreeningwithacombinedECGcriterion,orwhetherallpatientsshouldreceive angiography routinely following OHCA is needed.

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TITLE:PUBLICACCESSDEFIBRILLATION—RESULTSFROMTHEVICTORIANAMBULANCECARDIACARRESTREGISTRY

AUTHOR/S: M LIJOVIC1,2, S Bernard1,2,3,ZNehme1,2, T Walker1,4 & K Smith1,2,5

Department/Organisation:1.AmbulanceVictoria,2.DepartmentofEpidemiologyandPreventiveMedicine,MonashUniversity,3.TheIntensiveCareUnit,TheAlfredHospital,4.CollegeofHealthandBiomedicine,VictoriaUniversity5.DepartmentofEmergencyMedicine,UniversityofWesternAustralia.1-4Melbourne,VIC, Australia, 5. Perth, WA, Australia

Aim:Weassessedtheimpactofautomatedexternaldefibrillator(AED)usebybystandersinVictoria,Australia on survival of adults suffering an out-of-hospital cardiac arrest (OHCA) in a public place compared to those first defibrillated by emergency medical services (EMS).

Methods:DatawasextractedfromtheVictorianAmbulanceCardiacArrestRegistryforindividualsaged>15yearswhoweredefibrillatedinapublicplacebetween1July2002and30June2013,excludingeventsduetotrauma or witnessed by EMS.

Results:Of2,270OHCAcaseswhoarrestedinapublicplace,2,117(93.4%)werefirstdefibrillatedbyEMSand153(6.7%)werefirstdefibrillatedbyabystanderusingapublicAED.UseofpublicAEDsincreasedalmost11-foldbetween2002/2003and2012/2013,from1.7%to18.5%,respectively(p<0.001).Firstdefibrillation occurred sooner in bystander defibrillation (5.2 versus 10.0 min, p < 0.001). Unadjusted survival to hospital discharge for bystander defibrillated patients was significantly higher than for those first defibrillatedbyEMS(45%versus31%,p<0.05).MultivariablelogisticregressionanalysisshowedthatfirstdefibrillationbyabystanderusinganAEDwasassociatedwitha62%increaseintheoddsofsurvivaltohospitaldischarge(adjustedoddsratio1.62,95%CI:1.12–2.34,p=0.010)comparedtofirstdefibrillationbyEMS.

Conclusion:SurvivaltohospitaldischargeisimprovedinpatientsfirstdefibrillatedusingapublicAEDpriortoEMSarrivalinVictoria.Encouragingly,bystanderAEDuseinVictoriahasincreasedovertime.MorewidespreadavailabilityofAEDsmayfurtherimproveoutcomesofOHCAinpublicplaces.

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53

POSTER PRESENTATIONS (In alphabetical order of presenter)

POSTERWILLBEDISPLAYEDTHROUGHOUTTHEENTIRECONFERENCE

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TITLE:ANOVELAPPROACHTOTEACHINGISBARUSINGANIMATION

J BEER

Centre for Education, Western Health, Melbourne, Victoria, Australia

WesternHealthdevelopedanovel,visuallyengaging3-minutevideoanimationtopromotetheuseofISBARas part of an interprofessional simulation project for junior healthcare professionals from Nursing and Physiotherapy. The program is called Simulation TRaining for InterProfessional Education3(STRIPE3).Thefocus is on an interprofessional approach to the deteriorating patient and consisted of simulation scenarios where patient deterioration would occur and escalation to a more senior staff member would be required.

Participants attended a presentation prior to the simulation, outlining the importance of good communication in the context of the deteriorating patient. Initially this was done using PowerPoint however engaging learners can often be challenging, especially when many students are ‘tech savvy’, easily distracted or simply overwhelmed with new information so it was decided to seek a different approach to teach ISBAR.

Theanimationwasdevelopedfromascriptof350-400wordsusing‘SparkLine’methodology.Thefocuswason why escalation can be difficult, how poor communication can lead to adverse patient outcomes, the ISBAR tool, its ease of use, and some practical tips on its application.

The outcome is a teaching tool that is short, covers a lot of content to engage leaners in a visual and entertaining way, and delivers an important message about communication and patient safety. The animation has been very well received to date and formal evaluation of its use is being undertaken. The ISBAR animation isfreelyavailabletoallastheCommonwealthofAustraliafundedtheSTRIPE3projectin2013/2014.LinktoYouTubetoviewanimationhttps://www.youtube.com/watch?v=h0Ol6CiJAZw

TITLE:‘MREVERYDAYGOESTOWORK’:ASTORYABOUTISBARANDCOMMUNICATION

J BEER

Centre for Education, Western Health, Melbourne, Victoria, Australia

‘MrEverydayGoesToWork’isastoryaboutcommunicationandISBARusingaJourneyMap(picturestory).The story has a literal and a symbolic meaning (an Allegory). It is about Mr Everyday and all the problems he faces on his journey to work, due to poor listening and ineffective communication skills. The story also demonstrates how poor situational awareness and fixation error can affect decision making especially when under pressure.

It is intended to grab attention and to promote discussion about some of the reasons why poor communication can lead to adverse outcomes or delays in action, particularly in situations when things are going wrong. It shows examples of when to ‘catch and act’ problems yourself or when to escalate problems. Parallels with acute healthcare can be drawn from the story, to promote discussion with junior health care professionals about how to improve their communication skills and awareness of their environment.

The Journey Map was developed at Western Health as part of a project called Simulation TRaining for InterProfessional Education3(STRIPE3)andwillbeusedaspartoftheprograminearly2015.ThefocusofSTRIPE3isaninterprofessionalapproachtothedeterioratingpatientusingsimulation,wherepatientdeterioration occurs and escalation of care is required. The Journey Map is a freely available resource as the CommonwealthofAustraliafundedtheSTRIPE3projectin2013/2014.

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TITLE:EMERGENCYRESPONSEREADINESS(ERR)FORPRIMARYSCHOOLSTUDENTS

J.Wilks,HKanasa,DPendergast, K. CLARK

GriffithUniversity,GoldCoast,Queensland;SurfLifeSavingQueensland,Brisbane,Queensland

European researchers have shown that children 11-12 years of age can learn first aid and CPR, demonstrating retention of knowledge in test-retest assessments. The key to effective teaching is age appropriate concepts and techniques. The present study used a leadership model for surf lifesaving instructors to deliver a one day first aid, CPR (Cardio Pulmonary Resuscitation) and beach safety program to 107 year 6 students (mean age 11.4 years). A 50 item quiz administered one week before and again one week after the training day showed statistically significant improvements in knowledge, understanding and emergency response readiness. An eight week follow up quiz confirmed retention of knowledge for correct ratioofcompressionstobreathsforCPR;recalloftheTripleZeroemergencyphonenumber;responsesequenceforemergencysituations(DRSABCD)andvariousemergencyscenarios.Studentsenjoyedtheprogram, especially the mix of team bonding exercises and hands-on practice with CPR manikins. There was also a significant increase in confidence to provide first aid in an emergency situation as a result of the trainingprogram.Findingsreinforcethevalueofschool-basedtrainingthatprovidesageneralfoundationforemergency response readiness.

TITLE:INCIDENCEOFOUT-OF-HOSPITALCARDIACARRESTINRURALANDREMOTENEWZEALAND

B DICKER1,2,PDavey2

1StJohn,NewZealand,2SchoolofHealthCarePractice,AucklandUniversityofTechnology

Background:NewZealand(NZ)isageographicallysmallcountrywithatotallandareaof268,690squarekilometres.NinetysevenpercentofNZ’slandareaisruralorremotewithapopulationdensityof12orlessper square kilometre. The majority of the population are located within urban areas however 14% of the population are located within rural and remote regions. The population demographics and associated health status can differ significantly between urban and rural or remote areas. This study sought to determine if there was a difference in the incidence of out-of-hospital cardiac arrest (OHCA) between urban and rural or remote populations.

Methods:DatawasextractedfromtheStJohnOHCARegistryfortheperiod1-October2013to30-September2014.Forthepurposesofthisstudyruralandremoteareaswerecombinedandweredefinedas having a population density of 12 or less per square kilometre. Urban areas were defined as having a populationdensityofgreaterthan230peoplepersquarekilometre.ThetotalnumberofOHCAthatoccurredwithin the urban or rural areas was calculated and statistical analysis performed.

Results:Duringtheoneyearperiod3,884OHCAwereattendedbyStJohn.Themajorityoftheseincidents,74%, occurred in urban areas. When standardised to 100,000 person years there was a significantly higher incidence rate in the rural areas compared to the urban areas 166.9 versus 84.0 (p<0.0001).

Conclusion:In this study rural populations had a higher incidence of OHCA than urban populations. This finding confirms that the health status of rural and urban populations can differ significantly and is worthy of further investigation.

56

TITLE: STANDARDISATIONOF PAEDIATRIC RESUSCITATIONRESOURCESTOREDUCECLINICALRISK

ANDREA DORIC1,DCharlesworth1,SBurke2

1 Intensive Care Services 2PracticeDevelopment,EasternHealth,Melbourne,Victoria

Objective:To standardise paediatric resuscitation resources to improve the response, management and outcomes of deteriorating children across a health network.

Background:Our health service strives to provide safe and high quality care for children across three acute hospitals. A review of existing paediatric resuscitation resources revealed variability in emergency response equipment and processes for deteriorating children. With medical and nursing staff working across sites, the lack of standardisation posed potential for user error and significant clinical risk.

Methods:Paediatric resuscitation resources, including resuscitation trolley equipment and drugs were reviewed at each site and standardised to reflect current Australian Resuscitation Council guidelines and best practice.

Results:Standardised resuscitation trolleys designed for safety were purchased with equipment stored according to age and weight. Resuscitation drug boxes were standardised to ensure the same drugs in the same format on every trolley across the network. Portable Broselow bags were purchased for each site tobetakentoallPaediatricCodeBluecallsbypaediatricadvancedlifesupportresponders.Disposableintraosseous (IO) devices were introduced and stocked on each trolley to ensure timely IO access if required.

Conclusion:The standardisation of paediatric resuscitation equipment, drugs and procedures is contributing to improved response and management of deteriorating children at our health service.

57

TITLE:PARAMEDICEXPOSURETOOUT-OF-HOSPITALCARDIACARRESTISRAREANDDECLININGIN VICTORIA, AUSTRALIA

KYLIEDYSON,JBray,KSmith,SBernard,LStraney,JudithFinn

DepartmentofEpidemiologyandPreventativeMedicine/MonashUniversity&Operations/AmbulanceVictoria, Melbourne, Victoria

Backgroundandaim: Paramedic exposure to out-of-hospital cardiac arrest (OHCA) may be an important factor in skill maintenance and quality of care. We measured the annual exposure rates of paramedics in the state of Victoria, Australia.

Methods:We linked data from the Victorian Ambulance Cardiac Arrest Registry and Ambulance Victoria’s employmentdatasetfor2003to2012.Paramedicswere‘exposed’toanOHCAiftheyattendedacasewhereresuscitation was attempted. Individual rates were calculated for average annual exposure (number of OHCA exposures for each paramedic/years employed in study period) and the average number of days between exposures (total paramedic-days in study/total number of exposures in study).

Results:Over10-years,therewere49,116OHCAsand5,673paramedicsemployed.Resuscitationwasattemptedin44%ofOHCAs.Thetypical‘exposure’ofparamedicswas1.4(IQR=0.0-3.0)OHCAsperyear.MeanannualOHCAexposuredeclinedfrom2.8in2003to2.1in2012(p=0.007).Exposurewassignificantlyless in those: employed part-time (p<0.001); in rural areas (p<0.001); and with lower qualifications (p<0.001). Annual exposure to paediatric and traumatic OHCAs was particularly low. It would take paramedics an averageof163daystobeexposedtoanOHCAandupto12.5yearsforpaediatricOHCAs,whichoccurrelatively rarely.

Conclusions:Exposure of individual paramedics to resuscitation is low and has decreased over time. This highlights the importance of supplementing paramedic exposure with other methods, such as simulation, to maintain resuscitation skills particularly in those with low exposure and for rare case types.

TITLE:FINDINGADEFIBRILLATOR:THEDEVELOPMENTASMARTPHONEAPP.

RICHARD C FRANKLIN;StevenVandervalk,KarlMohring,ChrisFord,SooSohn

James Cook University, Townsville, Queensland, Australia

Time to defibrillation is a key factor to improving the likelihood of survival of a victim who has had a cardiac arrestduetoVF,howeverAutomatedExternalDefibrillators(AEDs)arenotalwayswheretheeventoccurs,yetmaybecloseby.Toaddressthisissue,in2013agroupofComputerSciencestudentsfromJamesCookUniversityweretaskedwithdevelopingamobileapplicationtoassistinfindinga‘near-by’AED.Thegoalwas to develop an interface which was simple and easy-to-navigate in a crisis, which showed where the nearestAEDislocated.Thesystemalsoneededtoencouragecrowdsourcingtoaddandmaintainrecordsofdefibrillators. At the time of this project there was no application available in the market place which reliably identifiedthelocationofworkingAEDs.Theobjectivesthatneededtobeaddressedwere:asmartphonewastobeabletobeusedtoreliablylocatethenearestAEDandprovidedirectionstotheuserviaagraphicalinterface; the app needed to be able to be used without any prior training; the app needed to be able to beaddedtobythepublic;andthereneededtobeamechanismwhichwasabletovalidatethattheAEDexisted and was working. This presentation explores the development of the app, the challenges which were encountered during its development, the challenges of the real world application the app and will provide recommendations for what is required for the next iteration.

58

TITLE:ACOHORTSTUDYTOINVESTIGATETHERETENTIONOFKNOWLEDGEANDSKILLSOFYEARTHREE NURSING STUDENTSWHO HAD ATTENDED A BASIC CARDIAC LIFE SUPPORT COURSE(BCLS) SIX MONTHS AGO

Chua WK, GOPAL SD,LiuX,MacalingaET,Nagaraju,MPG,OthelloRD,RatnamV,&Sumali,S

School of Health Sciences (Nursing), Ngee Ann Polytechnic, Singapore

Background:Heart disease is the second common cause of death in Singapore and early cardiac intervention increases the chances of survival in victims. Nursing students undergo Basic Cardiac Life Support (BCLS) training in year two of the diploma programme in health sciences (nursing). This study was conducted to assess the level of retention of resuscitation knowledge and skills in these students.

Method:160studentswhohadundergoneBCLStraining(Nov2013)sixmonthsago(theorytest1&practicaltest1)andpassedwereinvited(June2014)toundertakea30-itemmultiplechoicequestions(theory test 2). They also had to perform one- man CPR (Cardio Pulmonary Resuscitation) for five cycles (practical test 2) which was assessed with a 14-steps checklist. The duration taken to perform the five cycles of CPR was also recorded.

Results:Paired t test revealed that there was a significant deterioration of theoretical knowledge, with p value of 0.000, (< 0.05). 100% passed in the theory test 1but only 6.9% passed theory test 2. In practical test 2, 47.5% of students could complete the five cycles within the recommended timeframe. 28.1% could perform correct compressions and 46.9% could perform adequate ventilations, only 8.75% could recall the correct sequence of steps. A repeat of this study was done with 20 students out of the 160 students 5 months (Nov 2014) later.

Conclusion:Results showed that although there was significant deterioration of knowledge and skills after six months after training, refresher trainings which were initiated in the interim of the next 5 months proved to increase the retention of knowledge and skills prior to graduation of these students.

59

TITLE:ACOLLABORATIVEAPPROACHTODELIVERINGSTANDARDISEDADVANCEDLIFESUPPORT(ALS) EDUCATION IN A REGIONAL AREA

LYNNGREIVES

University of Tasmania Rural Clinical School (RCS)– Burnie and Tasmanian Health Organisation – North West (THO-NW), Burnie, Tasmania, Australia

Objectives:To deliver standardised early resuscitation training for health professionals throughout a regional area from one course centre.

Methods:The University of Tasmania Rural Clinical School, based in the hub of Burnie in Northwest Tasmania, became an accredited Australian Resuscitation Council centre to deliver the ALS-1 program. A group of local clinicians with long term commitment to the region were trained as instructors. The programme was piloted in Burnie with all final year medical students and new junior medical staff commencing at the two main regional hospitals. In response to demand from outlying areas in the region, the course was offered at the more remote facilities.

Results:Theprogramhasbeenrunningfor4years,with360participants,includingallfinalyearmedicalstudentsandJuniorDoctors,alongwithemergency,intensivecare,highdependency,andtheatrenursesandsome general nursing staff, at the two main regional hospitals in Burnie and Latrobe. Nursing staff at all theremotesitesintheregion,includingKingIslandhavealsoattendedthecoursealongwithGP’sandothermedical personnel.

Conclusion:A collaboration between a Rural Clinical School and Health Organisation has enabled one course centre to provide standardised ALS education training throughout a rural health area. The collaboration has enabled specialist education to be conducted in outlying areas where staff historically struggled to get to larger centres for professional development courses.

60

TITLE:COMPARISONOFSUPRAGLOTTICAIRWAYSTOSTANDARDTECHNIQUESFORVENTILATIONDURINGSIMULATEDCARDIACARRESTBYSURFLIFESAVERS

LHOLBERY-MORGAN1,2,8, C Angel1,8, M Murphy1,2, R Murphy1,2, S Wall1, N Hood9 N Simpson1,7,8,DSteinfort1,5, S Radford1,4,DJohnson1,3*NDouglas1,6*

1:LifesavingVictoriaClinicalCommittee,2:AmbulanceVictoria,3:DepartmentofGeneralMedicine,AustinHospital,4:IntensiveCareUnit,AustinHospital,5:DepartmentofRespiratoryMedicine,RoyalMelbourneHospital,6:DepartmentofAnaesthesia,RoyalMelbourneHospital7:IntensiveCareUnit,UniversityHospital,Geelong8:SchoolofMedicine,DeakinUniversityGeelong,9:SurfLifeSavingAustraliaBoardofLifesavingandEmergencyDepartment,MonashMedicalCentre.*=equalcontributionfromauthors

C/O Lifesaving Victoria Clinical Committee, 200 The Boulevard, Port Melbourne, Victoria, Australia

Background:Surf Lifesavers are taught to use standard techniques for ventilation during CPR, such as pocket mask rescue breathing and Bag Valve Mask. The ability to train Surf Lifesavers to use supraglottic airways has not been previously assessed.

Methods:113SurfLifesavers,trainedinAdvancedResuscitationTechniques,wereexposedtoatraininginterventionontheuseofsupraglotticairways(theiGelandLMASupreme)insimulatedcardiacarrest.Theprimary outcome (the mean time to first effective ventilation) for each device was compared, as well as a number of secondary outcomes. Non-parametric non-inferiority between devices compared to the Bag Valve Mask (current standard of Lifesaving care) was tested using the Mann-Whitney U test. Correlations between demographic factors and the primary and secondary outcomes were assessed using Spearman rank.

Results: A detailed analysis of the primary outcome measure and the secondary outcome measures and correlations between demographic factors and the outcome measures will be presented at the 2015 ARC Spark of Life Conference.

Participant feedback on the airway management devices and training will also be presented.

Conclusions:The study demonstrates that Lifesavers can be trained to use advanced airway devices used by other healthcare professionals. The themes to be examined in determining the superiority of any one device included the time taken to first effective ventilation, the likelihood of successful insertion and the ease of use of the device.

61

TITLE: CONFIDENCE ACROSS ALL ASPECTS OF RESUSCITATION INCREASED AFTERTRAININGSURF LIFESAVERS IN THE USE OF SUPRAGLOTTIC AIRWAYS FOR AIRWAY MANAGEMENT INSIMULATED CARDIAC ARREST

LHOLBERY-MORGAN1,2,8, C Angel1,8, M Murphy1,2, R Murphy1,2, S Wall1, N Hood9, N Simpson1,7,8,DSteinfort1,5, S Radford1,4,DJohnson1,3*NDouglas1,6*

1:LifesavingVictoriaClinicalCommittee,2:AmbulanceVictoria,3:DepartmentofGeneralMedicine,AustinHospital,4:IntensiveCareUnit,AustinHospital,5:DepartmentofRespiratoryMedicine,RoyalMelbourneHospital,6:DepartmentofAnaesthesia,RoyalMelbourneHospital7:IntensiveCareUnit,UniversityHospital,Geelong8:SchoolofMedicine,DeakinUniversityGeelong,9:SurfLifeSavingAustraliaBoardofLifesavingandEmergencyDepartment,MonashMedicalCentre.*=equalcontributionfromauthors

C/- Lifesaving Victoria Clinical Committee, 200 The Boulevard, Port Melbourne, Victoria, Australia

Background:The effect of simulation based training on confidence to perform skills has not been assessed in Surf Lifesavers previously.

Methods:113SurfLifesavers,trainedinAdvancedResuscitationTechniques,wereexposedtoatraininginterventionontheuseofsupraglotticairwaysinsimulatedcardiacarrest.Domainsofconfidence,includingCPR, basic and advanced airway management, CPR theory and leadership, were assessed before and after training using a five point Likert scale.

Results:Confidenceimprovedsignificantlyinallitemsaftertraining.Foreachitem,thenumberofparticipantsreportinganimprovementinconfidencewere:AdvancedAirwaydevices–92/113,88%,Airwaymanagement–69/113,63%,AirwaymanagementduringCPR–70/113,65%,Soloairwaymanagement–72/113,66%,Pocketmask50/113,45%,BVMonehand–86/113,78%,BVMtwohands–71/113,65%,Patientassessment–50/113,46%,CPR–62/113,56%,CPRoutsidethebeach–46/113,42%,Tidalvolumedelivery–67/113,61%,Handover–65/113,59%,UnderstandingCPR–47/113,43%,Leadership–51/113,47%,LeadershipofART–70/113,64%,Non-lifesaverleadership66/113,60%,Teaching–45/113,41%,CPRtheoryteaching–53/113,48%.Therangeofparticipantsreportingadecreaseinconfidenceinanyitemwas0-7.3%.

Conclusions:This is the first study designed to assess the confidence of lifesavers in the use of airway devices and demonstrates intensive training increased confidence. Confidence in both new skills (supraglottic airways) as well as previously taught skills improved with an intensive education session. This “extension” training may be effective for any level of prehospital care providers and may be valuable to prepare first responders to prepare for low frequency but high acuity events such as cardiac arrest.

62

TITLE:PARAMEDICDEFIBRILLATIONSAFETYUTILISINGEYE-TRACKINGTECHNOLOGY

P JENNINGS, M Boyle, B Williams

DepartmentofCommunityEmergencyHealthandParamedicPractice,MonashUniversity,Melbourne,Victoria

Introduction:The importance of access to early defibrillation for patients in cardiac arrest has been emphasised as a critical part of the chain of survival by resuscitation bodies internationally; as such defibrillation has become a key procedure for paramedics. Such procedures are however not without risk, as electrical current can inadvertently pass to rescuers causing them harm.

Methods:This was an observational study of paramedic student safety in performing defibrillation during resuscitationscenarios.ParticipantsratedtheirdefibrillationsafetyusingaDefibrillationSafetySelf-Assessment(DSSA)formimmediatelyaftercompletingtwodefibrillationscenarios,and4weekslater,after viewing the eye-tracking footage of the scenarios. Independent examiners also rated participant defibrillationsafetyusingaDefibrillationScoringRubric(DSR).

Results:There were 24 participants in the study with 14 (58%) being female and an average age of 24.1 years.Forscenarioone,theagreementbetweenthestudentandassessorprovedsignificantfor“scanningthe incident scene” for all three defibrillation attempts, with the agreement ranging from 29% (p=0.044) to 47%(p=0.007).Forscenariotwo,theagreementbetweenthestudentandassessorprovedsignificantfor“chargingeyecontact”forallthreedefibrillationattempts,withtheagreementrangingfrom40%(p=0.043)to53%(p=0.003).

Conclusion:The results of this study provide students and educators with evidence of perceived verses actual defibrillation safety performance. The results highlight the need for a review of foundation and ongoing training and education practices, and the necessity of curriculum quality assurance processes to ensure safe performance of this skill.

63

TITLE:THEIMPACTOFINCREASINGEMSRESPONSETIMEONSURVIVALFROMOUT-OF-HOSPITALCARDIAC ARREST IN VICTORIA, AUSTRALIA

M LIJOVIC1,2 & K Smith1,2,3

1ResearchandEvaluation,AmbulanceVictoria,2DepartmentofEpidemiologyandPreventiveMedicine,MonashUniversity,3DepartmentofEmergencyMedicine,UniversityofWesternAustralia

1-2 Melbourne, VIC, Australia

3Perth,WA,Australia

BackgroundandAim:Increasing demands on emergency medical services (EMS) have driven an increase in response times worldwide. It is well established that longer response times have a negative impact on out-of-hospital cardiac arrest (OHCA) survival. We investigated the impact of response time on OHCA survival within Victoria, Australia.

Methods:Adult,nonEMS-witnessedOHCAeventsoccurringbetween2004/05to2013/14wereextractedfrom the Victorian Ambulance Cardiac Arrest Registry (VACAR). Regression analyses were restricted to 2010/11to2013/14caseswhereEMSattemptedresuscitation.

Results:MedianresponsetimeforOHCAeventsincreasedbetween2004/05to2013/14(8.0to8.5minutes,p<0.001).Despitethis,thelikelihoodofapatientsurvivingtohospitaldischargeincreased(7%to10%, p<0.001) and bystander CPR rates increased substantially (18 to 41%, p< 0.001) between 2004/05 and2013/14.ForeveryminuteincreaseinEMSresponsetime,theadjustedoddsofapatientpresentinginVF/VTonEMSarrivaldecreasedby4%(95%CI,3-5%)andtheoddsofsurvivaltohospitaldischargeforallpatientsdecreasedby9%(95%CI,7-11%)andby12%(95%CI,10-15%)forVF/VTpatients.Notably,bystander CPR independently increased the odds of survival to hospital discharge by 45% (p<0.001).

Conclusion:Within Victoria, EMS response time for OHCA has increased over the last decade. Survival to hospital discharge has also increased during that time period. The impact of increasing response time has been partially mitigated by rising bystander CPR rates, which currently may have reached saturation. Novel approaches are needed to decrease EMS response times.

64

TITLE: POSTRESUSCITATIONCARE INTHECRITICALCAREENVIRONMENT:ARETROSPECTIVEAUDITOFOXYGENMANAGEMENT

A MILONAS,1 J Considine,2,3 A Hutchinson,1,3DCharlesworth,2ADoric,2JGreen1 1 Northern Health, Epping Victoria, AUSTRALIA, 2 Eastern Health, Box Hill, Victoria, AUSTRALIA, 3DeakinUniversity, Burwood, Victoria, Epping, Box Hill, Burwood, Victoria, AUSTRALIA

The Australian Resuscitation Council (ARC) recommends titration of oxygen to a saturation of 94-98% and ventilation to normocarbia (PaCO2/PvCO235-40mmHg)asbestpracticeinpostresuscitationmanagement.The aim of this study was to examine oxygen management in the first 24 hours post cardiac arrest for 200 randomlyselectedadultpatientsadmittedtotheIntensiveCareUnit(ICU)fromtheEmergencyDepartment(ED)from01/01/2010to31/12/2013.AretrospectiveauditoccurredattwohealthservicesinMelbourne,Australia. The median age was 64 years, 74% were males, 91.5% suffered Out of Hospital Cardiac Arrest and8.5%arrestedinED.In54.0%,theinitialrhythmwasshockable(VentricularFibrillationorPulselessVentricular Tachycardia), median ambulance response time was 7 minutes, median time to return of spontaneouscirculationwas27minutesand94%wereintubatedpre-hospital.OnEDarrival,40.4%werehypercapnic (PaCO2 /PvCO2 >45mmHg), 19.5% were hypoxaemic (PaO2<80mmHg)and33.6%werehyperoxic(PaO2>200mmHg).FIO2(FractionofInspiredOxygen)was1.0in90.5%ofEDpatients(medianduration104 minutes) and 70.0% of ICU patients (median duration 60 minutes). The highest PaO2 was >200mmHg in 31.5%ofEDand42.5%ofICUpatientsand<80mmHgin17%ofEDand67%ofICUpatients.ThehighestPaCO2/PvCO2was>60mmHgin64%ofEDand34%ofICUpatients.Hyperoxiawascommoninthefirst24hoursofpostresuscitationcareinbothEDandICUandhypercapniawasmorecommoninED.TitrationofFIO2 and ventilation rates according to blood gases may improve outcomes of survivors of cardiac arrest through normalisation of oxygen and carbon dioxide levels.

Acknowledgements:ThisstudywasgenerouslyfundedbyaNorthernHealthResearchGrant

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TITLE:POSTRESUSCITATIONCAREINTHECRITICALCAREENVIRONMENT:ARETROSPECITIVEAUDIT OF NEUROLOGICAL MANAGEMENT

A MILONAS,1 J Considine,2,3 A Hutchinson,1,3DCharlesworth,2ADoric,2JGreen1 1 Northern Health, Epping Victoria, AUSTRALIA, 2 Eastern Health, Box Hill, Victoria, AUSTRALIA, 3DeakinUniversity, Burwood, Victoria, - Epping, Box Hill, Burwood, Victoria, AUSTRALIA

To optimise neurological outcomes following cardiac arrest, the Australian Resuscitation Council (ARC) recommends targeted temperature management (TTM), blood pressure control, airway protection and ventilation, oxygenation and seizure control. The aim of this study was to examine neurological management in the first 24 hours post cardiac arrest for adults admitted to the Intensive Care Unit (ICU) from the EmergencyDepartment(ED).Aretrospectiveauditof200adultpatientswhosurvivedcardiacarrestrequiringEDmanagement,andtransfertoICUfrom01/01/2010to31/12/2013occurredattwohealthservices in Melbourne, Australia. The median time to return of spontaneous circulation was 27 minutes and 94% were intubated pre-hospital. ARC recommend a systolic blood pressure (BP) >100mmHg: 15.5% of patientshadasystolicBP<100mmHgonEDarrival.Bloodglucoselevels(BGL)<10mmol/Larerecommendedwithuseofinsulintotreathyperglycaemia.Themedian(BGL)duringEDcarewas14.4mmol/L.MedianBGLlevelsforthosethatdidnotreceiveinsulininfusioninEDwas13.8mmol/L.ThemedianhighestBGLinICUwas15.0mmol/L.MedianhighestBGLinpatientsinwhominsulininfusionwasnotusedduringICUcarewas10.7mmol/L.TTMwasinitiatedduringpre-hospitalcarein30.5%ofpatientsandintheEDforafurther21.5% of patients leaving 48.0% patients without active temperature management. The median duration of TTMinICUwas15.0hours.Themediantimetoreachingthetargettemperatureof33degreesCelsiuswas11.3hours.Improvedtemperatureandglucosemanagementmayimproveneurologicalprotectioninpatientspost cardiac arrest.

Acknowledgements:ThisstudywasgenerouslyfundedbyaNorthernHealthResearchGrant.

66

TITLE:IMPROVINGSURVIVALFROMOUT-OF-HOSPITALCARDIACARRESTINQATAR:ANINFORMED EDUCATIONAL APPROACH

KevinGovendera,ROBIN PAPb*,YuganPillaya,IanHowarda,GuillaumeAliniera

aAmbulanceService,HamadMedicalCorporation,Doha,Qatar,bFacultyofHealthSciences,AustralianCatholic University, Sydney, Australia

*CorrespondingAuthorEmail:robin.pap@acu.edu.au

The survival rate to hospital admission in Qatar following out-of-hospital cardiac arrest is 12.4%. The aim of this project was to improve survival to hospital admission by identifying factors that contributed to poor Cardiopulmonary Resuscitation (CPR), and revising and testing the CPR protocol and its training curriculum, addressing the identified factors. The CPR protocol and training curriculum were revised based on analysis of CPR performance over a 6-month period. Subsequently, a comparative study was performed to assess theeffectivenessofthenewtrainingprogramincontrasttotheformerone.Deviantorsuboptimalcarehad occurred 610 times within the 6-month period. Paramedics who received CPR training from the new tailored CPR training program were rated competent 70.9% of the time according to a Rapid Evaluation Tool, compared to paramedics who received training from the conventional CPR training program, who achieved this rating only 7.9% of the time (p<.001). CPR is an important multiplicand to the formula for improving survival from out-of-hospital cardiac arrest. Twelve broad factors were identified as contributory to poor CPR in Qatar. CPR performance rated as competent in a simulated environment was significantly higher when training was received from a tailored CPR training program.

67

TITLE:THELONGDIVE.POLICYRELATINGTOBREATH-HOLDINGANDPRE-IMMERSIONHYPERVENTILATION.

JOHN H PEARN 1,2;RichardCFranklin1,2,3; Amy E Peden 1,3

1.RoyalLifeSavingSociety–Australia;2.DepartmentofChildHealth,RoyalChildren’sHospital,Universityof Queensland; College of Public Health, Medical and Veterinary Science, James Cook University, Brisbane/Qld/Australia

‘Shallow Water Blackout’ (SWB) is a term commonly used to describe the loss of consciousness underwater caused by a lack of oxygen to the brain following breath-holding. While reasonable rare, there are a small number of deaths each year in Australia from breath-holding. The activity of breath-holding is common and often perceived to be an essential part of some underwater sports, such as underwater hockey, synchronised swimming, lifesaving and freediving (the activity of seeing how deep a person can swim on one breath). It is also common recreationally, as many would remember from their childhood, trying to swim as far as possible underwater on a single breath. In the past, endurance underwater swimming has been afeaturedeventofswimmingcarnivals-withoneschoolawardingthe‘LongDive’medaltotheboywhowon. Pre-dive hyperventilation is also used by some occupationally, although more commonly in low and middle income countries to fish, gather pearls and make repairs to boats. SWB occurs because the normal, protective ‘breakpoints’ – the irresistible urge to breath – have not been triggered before unconsciousness (due to cerebral hypoxia). There are two chemical sensors in the body which detect the levels of oxygen and carbon dioxide (CO2) which protect us from a lack of oxygen. The CO2 sensor is the most sensitive. Hyperventilation, i.e. ‘blowing off’ too much CO2 before submerging can interfere with the sensor, which is not triggered early enough to prevent blackout. This presentation will explore the physiology of breath holding, the development of preventative stratagems and safety policies.

68

TITLE:TRENDSINPEDIATRICINTENSIVECAREUNITADMISSIONANDSURVIVALRATESINCHILDRENINAUSTRALIAANDNEWZEALANDFOLLOWINGCARDIACARREST.

LSTRANEY, LJSchlapbach,GYong,JEBray,JMillar,ASlater,JAlexander,JFinn

DepartmentofEpidemiologyandPreventativeMedicine/MonashUniversity,Melbourne/Victoria/Australia

Background:Cardiac arrest in children is associated with a very high mortality, and survivors are at high risk for poor long term outcome. Only limited data are available on population-based studies on cardiac arrest in children.

Objective:To describe the temporal trends in rates of pediatric intensive care unit (PICU) admissions and mortality for out-of-hospital cardiac arrests (OHCA) and in-hospital cardiac arrests (IHCA) admitted to PICU over the last decade.

Design: Multi-center, retrospective analysis of prospectively collected binational data of the Australian and NewZealandPaediatricIntensiveCareRegistry.AllninespecialistPICUsinAustraliaandNewZealandwereincluded.

Patients:Allchildrenadmittedbetween2003and2012toPICUwhowereagedlessthan16yearsatthetime of admission.

MeasurementandResults:Therewereatotalof71,425PICUadmissionsbetween2003and2012.Overall,cardiacarrestaccountedfor1.86%ofalladmissions(1,329cases)including677casesofIHCA(51.0%)and 652 cases of OHCA (49.0%). Over the last decade, there has been a 29.6% increase in the odds of PICU survivalforallpediatricadmissions(OR:1.3095%CI,1.09-1.54).Incontrast,therewasnosignificantimprovementintherisk-adjustedoddsofsurvivalforOHCAadmissions[OR:1.03(0.50-2.10)p=0.94],orIHCAadmissions[OR:1.03(0.54-1.98)p=0.92].

Conclusions:DespiteimprovementsinoverallPICUoutcomesamongAustralianandNewZealandPICUs,survival of children admitted with OHCA or IHCA did not change significantly over the past decade.

69

TITLE: CARDIOPULMONARY RESUSCITATION QUALITY AND PATIENT SURVIVAL OUTCOME INCARDIACARREST:ASYSTEMATICREVIEWANDMETA-ANALYSIS

M.TALIKOWSKA,H.Tohira,J.Finn

Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin University, Perth, WA, Australia

Aim: To conduct a systematic review and meta-analysis to determine whether cardiopulmonary resuscitation (CPR) quality, as indicated by parameters such as chest compression depth, compression rate and compression fraction, is associated with patient survival from cardiac arrest.

Methods:Fivedatabasesweresearchedtoidentifyrelevantpapers(MEDLINE,Embase,CINAHL,ScopusandCochrane). To satisfy inclusion criteria, studies had to feature a comparative design and document human cardiacarrestcases.Furthermore,CPRqualitymusthavebeenrecordedusinganautomateddevice.Thescope of the review included both in-hospital and out-of-hospital cardiac arrest episodes. Where indicated (I2<75%), meta-analysis using a random-effects model was undertaken to examine the relationship between individual CPR quality parameters and either survival to hospital discharge or return of spontaneous circulation (ROSC).

Results:Databasesearchingyielded8,702results.Reviewofallcitationsledtotheidentificationofsixteen relevant articles. Eleven were included in meta-analysis. Chest compression depth was found to be significantly associated with survival to hospital discharge (mean difference between survivors and non-survivorswas3.65mm(95%CI:1.59,5.70))andwithROSC(meandifference1.34mm(95%CI:0.25,2.43)).Compression rate was not significantly associated with ROSC or survival to hospital discharge. Compression fraction was not significantly associated with survival to hospital discharge.

Conclusions:Compression depth was associated with ROSC and survival to hospital discharge in cardiac arrest patients. There was not enough evidence for the association between other CPR quality parameters andtheoutcomes.Furtherresearchisrequired.

TITLE:AREEARLYWARNINGOBSERVATIONCHARTSREALLYHELPINGOURPATIENTS?

C.WILSON

ParamedicDepartment/FlindersUniversity,Adelaide/SA/Australia

Over the last couple of decades, early detection and management of deterioration in patients has been the focus of much discussion and research. The implementation of earlier assessment and intervention for deteriorating patients by rapidly accessed medical emergency teams has led to more timely and effective management or palliation being instituted for the patient. In addition, there has been the introduction of medicalearlywarningscore(MEWS)orRapidDetectionAndResponse(RaDAR)chartsbeingimplementedto assist all staff, but in particular less experienced staff, to recognise and assess medical assistance to manage their patients. Whilst the intention of this system to provide a recognised pathway for early intervention is excellent, have we instead caused a secondary, more complex problem of decreasing the capacity of staff to independently interpret vital signs and recognise those patients who require medical intervention but do not fall within the mandated criteria for calling for urgent medical review.

This paper intends to raise these issues with the purpose of stimulating further discussion around shortfalls in this system to seek solutions that will optimise the safety of patients.

70

TITLE: OUT-OF-HOSPITAL CARDIAC ARRESTS SURVIVING TO HOSPITAL ADMISSION: 5-YEARSINGLE-CENTREEXPERIENCE

M.R.WITTWER, M.A. ARSTALL

LyellMcEwinHospital;DisciplineofMedicine,UniversityofAdelaide

Objective:Out-of-hospital cardiac arrest (OHCA) is associated with high morbidity and mortality. There is currently no published data describing the population of OHCAs surviving to hospital admission in South Australia. Our primary aim was to investigate characteristics and outcomes of all OHCA admissions at a single centre.

Methods: Consecutive OHCA cases >18 years of age were identified from emergency department admission, and, hospital discharge coding, and our departmental ‘Code-STEMI’ database. Patient demographics, presentation, treatment and outcomes including cerebral performance category (CPC) were recorded and analysed.

Results:Between 2009-2014, 216 OHCA survivors aged 20-90 were admitted to the hospital; 56% presentedwithVF/VTarrest;onepatientpresentedtwicewithinthesameyear.Obviousnon-cardiaccausewas recorded in 46 cases where 22% were discharged with favourable neurological outcome (CPC 1-2). Of the171presentationswithnoobviousnon-cardiaccauseatadmission70%presentedwithVT/VFarrest,40%hadST-elevationonpost-ROSCECG,110(64%)resultedinemergencyand10(6%)urgentcardiaccatheterisations, and 78 (46%) were discharged with CPC 1-2.

Conclusions:Our preliminary description of this data provides valuable insights into the rare population of OHCA patients who survive to hospital admission in the northern suburbs of Adelaide. Consistent with previous findings, about 80% of OHCAs surviving to admission had presumed cardiac cause. Over the 5 years of data collection our system of care has changed according to improved evidence and experience, thus our future analyses will investigate the effect on survival and neurological outcome.

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NOTES:

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TRADE EXHIBITORS

COMPANY ..............................................................................................................................................................BOOTH NUMBER

Intersurgical Australia Pty Ltd ...................................................................................................................................................... 1

AEDEmergency .................................................................................................................................................................................. 2

Teleflex Medical Australia .............................................................................................................................................................. 3

iSimulate ....................................................................................................................................................................................... 4 & 5

LAERDAL .................................................................................................................................................................................... 6,7,8,9

Cardiac Science ................................................................................................................................................................................10

ZOLL ........................................................................................................................................................................................11,12,13

RAPP Australia Pty Ltd ........................................................................................................................................................14 &15

Defibtech ............................................................................................................................................................................................16

ClinicalSkillsDevelopmentService ..........................................................................................................................................18

Physio-Control, Lifepak .................................................................................................................................................................19

RESUS4KIDS .....................................................................................................................................................................................20

Aero Healthcare ...............................................................................................................................................................................21

Abacus ALS ........................................................................................................................................................................................22

POSTER PRESENTATIONS ............................................................................................................................................. Booth 17

Plus Poster Boards

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