Scope of research
- Prehospital models of care
- Critical illness ‘journey’
- Prehospital clinical practice
- Out of hospital cardiac arrest – management and outcomes
- Patient outcomes SJA (WA)
- Trauma i.e. traffic accidents
- Prehospital emergency systems modelling – GIS
- Prehospital clinical decision making
- Linguistic analysis of dispatch
The PRECRU team is affiliated with St John Ambulance (Western Australia) and the Faculty of Health Sciences at Curtin University together with local, national and international collaborative partnerships including:
- Warwick University, UK
- University of Washington, USA
- University of Toronto, Canada
- Scottish Ambulance Service, Scotland.
Our research involves both clinical trials of interventions, and observational studies of patient outcomes. The focus of our research includes the prehospital management of cardiac arrest, trauma, stroke, myocardial infarction (‘heart attack’); heart failure, respiratory failure, asthma and acute pain.
Severe respiratory distress with extreme breathlessness and distress (for example, from chronic obstructive pulmonary disease, acute pulmonary odema, pneumonia) is potentially life-threatening. Continuous positive airway pressure (CPAP) applied by face mask is an integral part of hospital treatment but better patient outcomes may be achieved when CPAP is applied earlier by paramedics in the prehospital setting.
We conducted a study of prehospital CPAP for acute pulmonary oedema to assess feasibility in preparation for a randomised controlled trial (RCT). We are now recruiting patients for the RCT of CPAP and usual care versus usual care in the prehospital setting. Recruitment commenced in March 2016 and we plan to enrol 720 patients over two years. Ultimately this study aims to improve prehospital and emergency clinical management of patients who suffer acute respiratory distress in the prehospital setting.
The EXACT study is a phase three multi-centre randomised controlled trial to determine whether reducing oxygen administration to target an oxygen saturation of 90-94 per cent, compared to 98-100 per cent, as soon as possible following successful resuscitation from out of hospital cardiac arrest improves outcome at hospital discharge. The administration of 100 per cent oxygen for the first hours after resuscitation is largely based on tradition and not on any supportive clinical data.
Previous research suggests that the delivery of oxygen at the standard high level (100 per cent) in the hours after a cardiac arrest may increase injury to the brain. This study will investigate if a safe but lower level of oxygen can be administered by paramedics to patients shortly after they have a cardiac arrest and during transportation to hospital. The EXACT study is being undertaken in Western Australia, Victoria and South Australia.
The WA Data Linkage System was established in 1995 to connect all available health and related information for the WA population. This information is used for ethically approved research, planning and evaluation projects which aim to improve the health of Western Australians.
The linkage of St John Ambulance (WA) clinical data to other health data such as WA emergency department attendances, WA hospitalisation records and WA death records allows researchers (with suitable ethics approval) to use the de-identified data to determine the outcomes for patients who receive emergency care in the prehospital setting.
Sudden cardiac arrest is a common event in the community. Therapeutic hypothermia decreases the brain injury caused by the cardiac arrest and is currently used in the hospital after successful resuscitation. However, there may be better outcomes if the brain is cooled by paramedics during resuscitation. We will compare survival rates for those patients cooled early by paramedics using an infusion of ice-saline during cardiac arrest with those patients who are later cooled by the hospital.
As demand for Emergency Department (ED) services continues to exceed any increase that can be explained by population growth, strategies to reduce demand and/or increase supply are being explored. The concept of ambulance paramedics providing an alternative model of care to the current ‘see and transport to ED’ has intuitive appeal and a small number of so-called ECPs have been introduced in NSW and SA. Our project will develop and test (through simulation) the feasibility and safety of empirically derived clinical protocols for an ECP role for the Perth metropolitan area. In addition, we will model the impact of the introduction of ECPs on ED demand and investigate the potential for ameliorating the problem of ED over-crowding in Perth.
As demand for Emergency Department (ED) services continues to exceed any increase that can be explained by population growth, strategies to reduce demand and/or increase supply are being explored. Read more.