Paramedic Principles and Practice ANZ: A Clinical Reasoning Approach, 1e [1 ed.] 0729541274, 9780729541275

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PARAMEDIC PRINCIPLES AND PRACTICE ANZ A clinical reasoning approach Matt Johnson, B APP SCI, DIP AMB STUDIES, GRAD DIP EMERG HEALTH, GRAD CERT HEALTH PROF ED, M EMERG HEALTH, FPA Leanne Boyd, DIP APP SCI, B NURS, GRAD CERT CRIT CARE, GRAD CERT HIGHER ED, M NURS, MTEM, PHD Hugh Grantham , ASM, MBBS, FRACGP Kathryn Eastwood, RN, B SC, B NURS, B PARAMED STUDIES, DIP AMB PARA STUDIES, GRAD DIP EMERG HLTH

(MICA), GRAD CERT HIGHER ED, M EMERG HEALTH (MICA), PHD CANDIDATE

Table of Contents Cover image Title page Inside Front Cover Copyright Foreword Preface About the authors Contributors Reviewers The key to improving your clinical practice Acknowledgements CHAPTER 1: Introduction Paramedic principles and practice Essential knowledge Summary

PART 1: PARAMEDIC PRINCIPLES

SECT ION 1: PRINCIPLES OF PARAMEDIC PRACT ICE CHAPTER 2: The paramedic role in healthcare Introduction The role of ambulance services in Australia and New Zealand Professionalism and professional standards Terminology and qualifications The future paramedic role Summary CHAPTER 3: Characteristics of ambulance patients Introduction Who are ambulance patients? From symptom onset to the decision to call an ambulance From calling for an ambulance to ambulance arrival Summary

SECT ION 2: T HE PARAMEDIC’S CLINICAL APPROACH CHAPTER 4: The structured clinical approach Introduction Medicine vs paramedicine? Using a structured approach to combat complexity The emergency model The medical interview model CHAPTER 5: The clinical reasoning process

Introduction Clinical decision making in the face of uncertainty: the paramedic paradigm Problem solving versus decision making The myth of the expert Developing clinical reasoning skills A step-by-step guide to clinical decision making Algorithms and cognitive checks A syndrome approach to patient management Error wisdom Summary CHAPTER 6: The patient interview Introduction The structured patient interview The science and art of communication The paramedic interview setting Paramedic–patient interview structure Barriers to effective communication Summary

SECT ION 3: PAT IENT AND PARAMEDIC SAFET Y CHAPTER 7: Patient safety and paramedicine Introduction The harm caused by healthcare errors Types of medical error

Models of error Reducing diagnostic errors Error defence Error management Evidence-based practice and patient safety EBP, individual patients and clinical reasoning Summary CHAPTER 8: Paramedic health and wellbeing Introduction Wellbeing Paramedic health and safety Stress Managing emotions Fatigue Shift work Occupational violence Injury Student paramedics Getting help Summary

SECT ION 4: PARAMEDIC EDUCAT ION CHAPTER 9: Paramedic education Introduction

Experience versus education The history of paramedic education in Australasia International educational standards Paramedic education in the university setting Course accreditation and professional regulation Continuing professional development and postgraduate education Educational challenges and future directions Summary

SECT ION 5: LEGAL AND ET HICAL CONSIDERAT IONS CHAPTER 10: Legal and ethical considerations in clinical decision making Introduction Ethics and the law Consent Refusal of treatment Elements of consent Case study 1 evaluation Documentation Summary

SECT ION 6: CLINICAL REASONING AND T HE PARAMEDIC MODEL OF PRACT ICE CHAPTER 11: Developing a philosophy of practice Introduction

Models of practice Building a philosophy of practice Summary

PART 2: PARAMEDIC PRACT ICE

SECT ION 7: T HE PARAMEDIC APPROACH T O T HE PAT IENT IN AN ALT ERED CONSCIOUS STAT E INTRODUCTION TO THE PARAMEDIC APPROACH TO THE PATIENT IN AN ALTERED CONSCIOUS STATE IN THIS SECTION AT THE COMPLETION OF THIS SECTION YOU SHOULD BE ABLE TO CHAPTER 12: Hypoglycaemia Introduction Pathophysiology Management of blood glucose At the hospital ED Hospital admission Discharge criteria Hypoglycaemia across the lifespan: paediatric considerations Future research Summary CHAPTER 13: Cerebrovascular accidents Introduction

Pathophysiology Clinical manifestations Ongoing management Investigations Hospital admission Stroke across the lifespan Future research Summary CHAPTER 14: Overdose Introduction Pathophysiology Ongoing treatment Investigations Hospital management Future research CHAPTER 15: Seizures Introduction Pathophysiology Seizure classification Management Ongoing management Hospital admission Summary

SECT ION 8: T HE PARAMEDIC APPROACH T O T HE PAT IENT IN RESPIRAT ORY DIST RESS INTRODUCTION TO THE PARAMEDIC APPROACH TO THE PATIENT IN RESPIRATORY DISTRESS IN THIS SECTION AT THE COMPLETION OF THIS SECTION YOU SHOULD BE ABLE TO CHAPTER 16: Airway obstruction Introduction Pathophysiology Ongoing management Hospital admission Follow-up Summary CHAPTER 17: Asthma Introduction Pathophysiology Ongoing management Follow-up Long-term impact Future research Summary CHAPTER 18: Acute pulmonary oedema Introduction

Pathophysiology Hospital admission Long-term impact Acute pulmonary oedema across the lifespan Ongoing management Ongoing management Future research Summary CHAPTER 19: Chronic obstructive pulmonary disease Introduction Pathophysiology Hospital admission Investigations Follow-up Future research Summary CHAPTER 20: Pneumothorax Introduction Pathophysiology Ongoing management Hospital admission Long-term impact Summary CHAPTER 21: Pulmonary embolism

Introduction Pathophysiology Risk factors Ongoing management Investigations Hospital admission Follow-up Research Summary CHAPTER 22: Pleural effusion Introduction Pathophysiology Ongoing management Investigations Hospital admission Follow-up Summary CHAPTER 23: The paediatric patient with a noisy airway Introduction Pathophysiology Ongoing management Hospital admission Long-term impact Hospital management

Future research Summary

SECT ION 9: T HE PARAMEDIC APPROACH T O T HE PAT IENT SUFFERING A CARDIAC EMERGENCY INTRODUCTION TO THE PARAMEDIC APPROACH TO THE PATIENT SUFFERING A CARDIAC EMERGENCY IN THIS SECTION AT THE COMPLETION OF THIS SECTION YOU SHOULD BE ABLE TO CHAPTER 24: Chest pain Introduction Pathophysiology Myocardial perfusion and myocardial workload Investigations Ongoing management Hospital admission Follow-up Acute coronary syndrome across the lifespan Future research Summary CHAPTER 25: Arrhythmias Introduction Pathophysiology Ongoing management

Hospital admission Arrhythmias across the lifespan Wolff-Parkinson-White Long QT syndrome Commotio cordis Summary CHAPTER 26: Cardiac arrest Introduction Chain of survival Pathophysiology Ongoing management Long-term outcomes Future research Summary

SECT ION 10: T HE PARAMEDIC APPROACH T O T HE PAT IENT WIT H A SEVERE ALLERGIC REACT ION INTRODUCTION TO THE PARAMEDIC APPROACH TO THE PATIENT WITH A SEVERE ALLERGIC REACTION IN THIS SECTION AT THE COMPLETION OF THIS SECTION YOU SHOULD BE ABLE TO CHAPTER 27: Anaphylaxis Introduction Pathophysiology

Investigations Ongoing management Hospital admission Follow-up Long-term role Anaphylaxis across the lifespan Future research Summary

SECT ION 11: T HE PARAMEDIC APPROACH T O T HE PAT IENT PRESENT ING WIT H PAIN INTRODUCTION TO THE PARAMEDIC APPROACH TO THE PATIENT PRESENTING WITH PAIN IN THIS SECTION AT THE COMPLETION OF THIS SECTION YOU SHOULD BE ABLE TO CHAPTER 28: Pain Introduction Pathophysiology Ongoing management Future research Summary CHAPTER 29: Lower back pain Introduction Pathophysiology

Ongoing management Follow-up Outcomes Back pain across the lifespan Future research Summary CHAPTER 30: Renal colic Introduction Pathophysiology Hospital emergency management Investigations Ongoing management Hospital admission Follow-up Long-term role Renal stones across the lifespan Future research Summary

SECT ION 12: T HE PARAMEDIC APPROACH T O T HE T RAUMA PAT IENT INTRODUCTION TO THE PARAMEDIC APPROACH TO THE TRAUMA PATIENT IN THIS SECTION AT THE COMPLETION OF THIS SECTION YOU SHOULD BE ABLE TO

CHAPTER 31: The structured clinical approach to trauma patients Introduction Assessment of the trauma patient Summary CHAPTER 32: Head injuries Introduction Anatomy Pathophysiology Ongoing management Investigations Hospital admission Hospital discharge Head injuries across the lifespan Future research Summary CHAPTER 33: Chest injuries Introduction Pathophysiology Ongoing management Investigations Hospital admission Long-term role Chest trauma across the lifespan Future research

Summary CHAPTER 34: Musculoskeletal injuries Introduction Pathophysiology Ongoing management Investigations Ongoing management of uncomplicated injuries Torn muscle repair Management of specific fractures Complications of musculoskeletal injuries Rehabilitation Long-term impact Future research Summary CHAPTER 35: Traumatic spinal injuries Introduction Pathophysiology Hospital admission Long-term issues and care Life expectancy for SCI survivors Future research Summary CHAPTER 36: Burns Introduction

Pathophysiology ‘Cold burns’ Hospital admission (burns unit) Investigations Ongoing management Follow-up Burns across the lifespan: elderly patients Paediatric airway burns To intubate or not Future research Summary

SECT ION 13: T HE PARAMEDIC APPROACH T O T HE PAT IENT PRESENT ING WIT H ENVIRONMENTAL INJURY INTRODUCTION TO THE PARAMEDIC APPROACH TO THE PATIENT PRESENTING WITH ENVIRONMENTAL INJURY IN THIS SECTION AT THE COMPLETION OF THIS SECTION YOU SHOULD BE ABLE TO CHAPTER 37: Hypothermia Introduction Pathophysiology Ongoing management Future research Summary

CHAPTER 38: Hyperthermia Introduction Pathophysiology Ongoing management Hospital admission Investigations Follow-up and long-term impact Hyperthermia across the lifespan Summary CHAPTER 39: Decompression injuries Introduction Pathophysiology Ongoing management Hospital admission Long-term impact Summary CHAPTER 40: Snake bites Introduction Pathophysiology Ongoing management Hospital management Investigations Hospital admission Long-term impact

Snake bites across the lifespan Future research Summary CHAPTER 41: Spider bites Introduction Pathophysiology Ongoing hospital management Hospital admission Long-term impact Spider bites across the lifespan Summary CHAPTER 42: Marine envenomation Introduction Pathophysiology Hospital management Long-term impact Envenomation across the lifespan Hospital management Future research Summary

SECT ION 14: T HE PARAMEDIC APPROACH T O T HE UNWELL PAT IENT: SPECIFIC CHALLENGES T O PARAMEDIC REASONING INTRODUCTION TO THE PARAMEDIC APPROACH TO THE UNWELL PATIENT:

SPECIFIC CHALLENGES TO PARAMEDIC REASONING IN THIS SECTION AT THE COMPLETION OF THIS SECTION YOU SHOULD BE ABLE TO CHAPTER 43: Acute abdominal pain Introduction Anatomy Pathophysiology Ongoing management Hospital admission Appendicitis across the lifespan Ongoing management AAA across the lifespan Ongoing management Bowel obstruction across the lifespan Summary CHAPTER 44: Sepsis Introduction Pathophysiology Ongoing management Hospital admission Sepsis across the lifespan Research Summary CHAPTER 45: Bleeding from the gastrointestinal or urinary tract

Introduction Pathophysiology Ongoing management GI/urinary tract haemorrhage in the field Hospital management Summary

SECT ION 15: T HE PARAMEDIC APPROACH T O COMPLEX CASES: SPECIFIC CHALLENGES T O PARAMEDIC REASONING AND MANAGEMENT INTRODUCTION TO THE PARAMEDIC APPROACH TO COMPLEX CASES: SPECIFIC CHALLENGES TO PARAMEDIC REASONING AND MANAGEMENT IN THIS SECTION At the completion of this section you should be able to CHAPTER 46: The socially isolated patient Introduction Background Ongoing management Hospital admission Summary CHAPTER 47: The dying patient Introduction Pathophysiology Ongoing management

Hospital admission Death and dying across the lifespan Summary CHAPTER 48: The patient on out-of-hospital dialysis Introduction Pathophysiology Dialysis Ongoing management Follow-up Long-term role ESKD across the lifespan Future research Summary CHAPTER 49: Indigenous Australian patients Introduction Kinship Culture Distribution Epidemiological profile Summary CHAPTER 50: Māori patients Introduction Specific aspects of healthcare for Mori Epidemiological profile

Delayed access to healthcare Death among Mori populations Summary

SECT ION 16: T HE PARAMEDIC APPROACH T O T HE PAT IENT DISPLAYING ABNORMAL BEHAVIOUR INTRODUCTION TO THE PARAMEDIC APPROACH TO THE PATIENT DISPLAYING ABNORMAL BEHAVIOUR IN THIS SECTION At the completion of this section you should be able to CHAPTER 51: The patient displaying abnormal behaviour Introduction Pathophysiology Explanatory models Law and mental health Specific treatment guidelines Investigations Hospital admission Long-term treatment and impacts Mental illness across the lifespan Summary CHAPTER 52: De-escalation in the pre-hospital environment Introduction Theories of aggression

Management of aggression Principles of de-escalation De-escalation in practice

SECT ION 17: T HE PARAMEDIC APPROACH T O OBST ET RIC AND NEONATAL EMERGENCIES INTRODUCTION TO THE PARAMEDIC APPROACH TO OBSTETRIC AND NEONATAL EMERGENCIES IN THIS SECTION AT THE COMPLETION OF THIS SECTION YOU SHOULD BE ABLE TO CHAPTER 53: Imminent birth Introduction Physiology Hospital admission Investigations Follow-up Further research Summary CHAPTER 54: Neonatal resuscitation Introduction Pathophysiology Identifying the newborn at risk of disorders during transition Failure to breathe effectively at birth Failure to establish effective ventilation after birth

Preparing for the birth of a baby Newborn airway management Ongoing management Documentation Birth during transport Discontinuing resuscitation Hospital admission Investigations Follow-up The preterm baby Long-term role Hospital management Future research Summary

PART 3: ESSENT IAL KNOWLEDGE

SECT ION 18: ESSENT IAL CONCEPT S OF PARAMEDIC PRACT ICE INTRODUCTION TO ESSENTIAL CONCEPTS OF PARAMEDIC PRACTICE IN THIS SECTION CHAPTER 55: Perfusion Introduction What is perfusion?

The basics of normal perfusion Disturbances of perfusion Assessment of perfusion Principles of medical management of perfusion Summary CHAPTER 56: The autonomic response Introduction What is the autonomic nervous system? Assessment of autonomic nervous system function Principles of management Summary CHAPTER 57: The inflammatory response Introduction What is inflammation? The basics of normal inflammation Abnormal inflammation Summary APPENDIX 1: Professional role guide APPENDIX 2: Medications commonly encountered in community emergency health Glossary Index

Inside Front Cover Likely dispatch codes Likely dispatch code Abdominal pain Abnormal behaviour Agitated patient Airway obstruction Allergic reaction Altered conscious state Anaphylaxis Animal attack Anxiety Assault Back pain Burns Cardiac arrest Chemical spill Chest pain Choking Collapse Convulsions Deceased patient Diabetic problems Diarrhoea Difficulty breathing Drowning Electrocution Epigastric pain Explosion Fainting Fall Fever Fire Flutter in the chest Fractures Generally unwell Haematuria Haemoptysis Haemorrhage

Chapter reference 30, 43, 44, 45, 46, 53 12, 13, 14, 15, 16, 27, 32, 37, 38, 51 51 16 17, 27, 42 12, 13, 14, 15, 17, 21, 23, 24, 25, 27, 32, 37, 38, 39, 42, 48, 51 41, 42 31 46 32, 49, 50 29, 30, 35, 43, 53 31, 36 17, 21, 26, 37, 42, 48 36 18, 20, 22, 24, 25, 33, 39, 43, 44, 46, 48 16, 17, 23, 27 12, 30, 40, 44 12 47 12 44, 45 16, 18, 19, 41 39, 42 36 43 31 12, 25, 32 31, 32, 33, 34 38 36 25 34 28, 44, 46 45 21 45

Head injury Headache Imminent delivery Infant crying Intoxication Labour Leg pain/numbness Medical problems Melaena Mobility issue Nausea Near fainting Non-breathing (newborn) Not alert Pain Pale and sweaty Palpitations Patient turning blue Post-ictal Psychiatric issues PV (per vagina) haemorrhage (third trimester) Rapid breathing Rash Seizure Seizure, now post-ictal Severe respiratory distress Shooting/stabbing Shortness of breath Snake bite Sting/bite Stroke Sunburn Trauma Unable to move Unconscious Unknown problem Vehicle incident Violent patient Vomiting Weakness Welfare check

32 39, 44 54 28 13 53 35, 43 49, 50 45 29 24, 25 13, 27, 30 54 26 28, 29, 34, 35, 40 24, 25 25 16 15 14, 16, 37, 46, 51 54 47 41 12, 14, 15 27, 32 17 31 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 27, 33, 39, 44, 46, 47 40 42 13, 35, 40 36 28, 31, 33, 34, 35, 49, 50 29 13, 14, 15, 16, 17, 21, 26, 27, 32, 36, 37, 39, 47 44, 46 31, 32, 34 14 40, 42, 44 35, 40 49, 50

Copyright

Elsevier Australia. ACN 001 002 357 (a division of Reed International Books Australia Pty Ltd) Tower 1, 475 Victoria Avenue, Chatswood, NSW 2067 Copyright 2015 Elsevier Australia All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher ’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). This publication has been carefully reviewed and checked to ensure that the content is as accurate and current as possible at time of publication. We would recommend, however, that the reader verify any procedures, treatments, drug dosages or legal content described in this book. Neither the author, the contributors, nor the publisher assume any liability for injury and/or damage to persons or property arising from any error in or omission from this publication. National Library of Australia Cataloguing-in-Publication Data Johnson, Matt, 1964-author. Paramedic principles and practice ANZ: a clinical reasoning approach / Matt Johnson, Leanne Boyd, Hugh Grantham, Kathryn Eastwood. 9780729541275 (paperback) Clinical medicine–Decision making—Textbooks. Emergency medicine—Textbooks. Medical emergencies—Textbooks. Emergency medicine–Diagnosis—Textbooks. Ambulatory medical care—Textbooks. Boyd, Leanne, author. Grantham, Hugh, author.

Eastwood, Kathryn, author. 616.025

Senior Content Strategist: Melinda McEvoy Content Development Specialist: Martina Vascotto Senior Project Manager: Rochelle Deighton Edited by Caroline Hunter, Burrumundi Pty Ltd Proofread by Tim Learner Design by Georgette Hall Permissions by Sarah Thomas and Vijay Rajan Index by Robert Swanson Typeset by Midland Typesetters Printed in China by China Translation and Printing Services

Foreword Matt Johnson, Leanne Boyd, Hugh Grantham, -Kathryn Eastwood and the contributing authors are some of Australia and New Zealand’s most -experienced paramedics, educators, researchers and emergency physicians. So it was with great pleasure that I accepted the invitation to write this foreword for Paramedic Principles and Practice ANZ, a unique and valuable resource that integrates knowledge and decision making in the Australian and New Zealand context that they know and understand so well. Paramedics are required to adapt and improve their range of clinical capabilities to provide care. This brings increased responsibility as professional clinicians to be aware of the potential impact they have on the lives of others. This impact cannot be underestimated. The shift of paramedic education from the vocational to a university model has resulted in clinicians who enter the workforce with a complex understanding of anatomy, physiology, pathology and pharmacology. There is little doubt that this science has been an important step in the development of the paramedic profession. However, new graduate paramedics now have much less clinical exposure where they can learn the art of being a paramedic. I am impressed with the way this text lays out the pathway for graduates to develop and grow to be expert clinicians by bringing together the art and science of paramedicine. The inclusion of real-life stories reinforces this message and brings to life important theoretical models related to developing as an expert clinician and lifelong learner. This text goes beyond the technical aspects of emergency care: it drives and reinforces the importance of professional attitudes, behaviours, clinical competence, teamwork, communication skills and the humanitarian approach required of paramedics. It is a refreshing approach to the complex challenges paramedics face in the context of an ageing population, high instances of chronic health problems, a health system that offers limited access to community-based clinicians and limited technological assistance for paramedic decision making. This book will be a valuable tool for those wanting to provide high-quality, patient-focused care in this challenging healthcare environment. Healthcare starts at the patient, not at the emergency department or at a hospital or clinic door. In this context it is notable that decisions and clinical interventions performed by paramedics often keep patients alive until they can receive more definitive care. Paramedic assessments, decisions and interventions have the capacity to keep patients out of the hospital system entirely, reduce morbidity and reduce the length of hospital stay, all of which have the potential to reduce the social and economic burden on the health system. I recommend this text to you as a resource that will assist you to contribute confidently to the care of your community and to continue to develop your professional practice and career. Excellence is an art won by training and habitation. We do not act rightly because we have virtue or excellence but rather we have those because we

have acted rightly, we are what we repeatedly do. Excellence is not an act but a habit. Aristotle (384–322 BC) Adjunct Professor Ian Patrick, ASM, FPA, LMPA

Preface Medicine is a science of uncertainty and an art of probability. One of the chief reasons for this uncertainty is the increasing variability in the manifestations of any one disease. Sir William Osler (1849–1919) You cannot become a good paramedic by reading a book, regardless of how good the book or how great your memory. Certainly, every case you attend as a paramedic will require you to call upon a detailed knowledge of anatomy, physiology and pharmacology, but to practise effectively in the field of emergency medicine you also need to be able to interpret people and situations. While exams require you to recall facts with certainty, clinical practice is too often lacking in both facts and certainty. To be a safe paramedic you need to elicit accurate information from patients who will differ from you in gender, generation, social situation and health. You then have to determine what (if any) of that information is relevant and finally draw together all of these knowledge sets, skills and attitudes to determine a diagnosis. The process of clinical reasoning is probably the most difficult for students of any medical discipline to learn. Anatomy, physiology and pharmacology will come easily to those blessed with a good memory but will also eventually sink into the minds of the rest of us. Similarly, guidelines and clinical skills can be learned by practice. But how do you take all of this knowledge and use it when you are confronted with a patient? Traditional teaching and texts stretching back 100 years suggest you must first learn the basic biomedical sciences before you engage in solving clinical problems. While the editors of this text do not disagree entirely, it does raise the question: how do you manage a condition if you have not been taught the specifics of the disease that caused it? An alternative method is to apply the clinical reasoning approach to conditions as you learn them. This text does not substitute for other texts which, in far more detail, describe the anatomy, pathophysiology and pharmacology you will need to pass your exams. What the editors hope to offer is a text that allows you to see the links between the pathophysiology of a disease, how this creates the signs and symptoms perceived by the patient and how these need to be managed in the out-of-hospital environment. Clinical reasoning is a real-time, living mystery. Traditional teaching methods offer you the clues that allow you to solve the clinical puzzle. But in real life, paramedics have to extract and sort the clues by importance before they must decide on an answer. To help you to develop this skill, this book is structured in three parts. The chapters in Part 1 articulate the principles that support good paramedic practice: the ability to communicate effectively, gather essential clinical information in difficult environments and use this information to make safe and effective clinical decisions. The chapters in Part 2 present the various conditions that novice paramedics can expect to see as they practise, with each chapter revealing the clinical reasoning process and describing the principles of management for a particular condition. To do this we use a series of case studies, stepping you through each case scenario to link the clues and, importantly, reveal the process of

reaching a safe and effective management plan. Finally, the chapters in Part 3 outline three essential concepts that underpin paramedic practice and are common to a wide range of diseases and injuries: perfusion, the autonomic nervous system and inflammation. The importance of understanding how these concepts integrate into the disease process cannot be overemphasised.

About the authors Matt Johnson Matt joined Ambulance Victoria in 1998 and has practised as a Mobile Intensive Care Paramedic since 2006. He has held the position of Senior Lecturer and Post Graduate Coordinator in the School of Primary Health at Monash University. He is currently the Director of Clinical Education at Cabrini Hospital in Melbourne and holds an adjunct position as Senior Lecturer with HealthPEER (Health Professions Education and Educational Research) in the Faculty of Medicine, Nursing and Health Sciences at Monash University. Leanne Boyd Leanne was appointed as Executive Director Nursing and Cabrini Institute at Cabrini Health in August 2014 and has more than 20 years’ experience in health professional education. Prior to this appointment she worked for Monash University as Director of Academic Programs (Middle East) for the Faculty of Medicine, Nursing and Allied Health and was Head of Department, Community Emergency Health and Paramedic Practice within the School of Primary Health Care. Leanne has Graduate Certificates in Health Professional Education and Critical Care. She also has Masters degrees in Critical Care and Tertiary Education Management. Leanne completed her PhD investigating health program evaluation models in 2009. She has been successful in attracting more than $3 million in tenders/contracts and $2 million in research/consultancy grants during her academic career. She is currently supervising six PhD students. Hugh Grantham Hugh has been passionately involved in paramedic education and professional development since 1987. He was Medical Director of SA Ambulance Service for 18 years prior to taking up his professorial role at Flinders University in 2011. Kathryn Eastwood Kathryn is a Mobile Intensive Care Ambulance (MICA) Paramedic, Registered Nurse (division 1) and Senior University Academic. She is currently completing her PhD in the management of low-acuity patients by ambulance services. She has worked for Ambulance Victoria since 2000 and for Monash University since 2003. Her experience in academia ranges from teaching to curriculum design, subject and course coordination and research. She has been involved in the education of and curriculum design for medical students, nursing students, paramedic students and military personnel. Kathryn has also been a member of the Monash University Human Research Ethics Committee, the Department of Community Emergency Health and Paramedic Practice Research Committee and the Department of Community Emergency Health and Paramedic Practice Course Management Committee for both Undergraduate and Postgraduate Studies.

Contributors Joe Acker, MA (LEADERSHIP), PHD (CANDIDATE), EMT-P (CC), FPA, Senior Lecturer in Paramedic Practice, Charles Sturt University, Port Macquarie, New South Wales, Australia David Anderson, MSTJ, BSC, MBCHB, Fellow, Intensive Care Service, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia Jason Bendall Rosemarie Boland, RN, RM, MN, PHD Perinatal Educator, Paediatric Infant Perinatal Emergency Retrieval, Victoria, Australia Post-Doctoral Research Fellow, Murdoch Children’s Research Institute, Victoria, Australia Honorary Clinical Senior Lecturer, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia Ingrid Ann Brooks, RN, BADVNSG (NURSING EDUCATION), GRADDIPBUSMGT, MEMERGHLTH, FACN, Senior Lecturer, Education Focused, School of Nursing and Midwifery, Monash University, Victoria, Australia Stephen Burgess, BHLTHSC, GRADCERTHLTHPROFED, GRADDIPEMERGHLTH (MICA), MPH, PHD (CANDIDATE), MPA Research and Policy Officer, Benetas, Victoria, Australia MICA Paramedic, Ambulance Victoria, Victoria, Australia Adjunct Senior Lecturer, Department of Community Emergency Health and Paramedic Practice, Monash University, Victoria, Australia Honorary Senior Research Fellow, Geriatric Medicine Aged Care Research Centre, Eastern Health, Victoria, Australia Janet Curtis, MSC (HONS), MEH, MPA, Lecturer, Community Emergency Health and Paramedic Practice, Monash University, Australia Shaunagh Darroch, BSC, MPHARM, GRADCERTACAPRAC, Lecturer, College of Health and Biomedicine, Victoria University, Melbourne, Australia Shaun Ewen, BAPPSC (PHYSIO), MMIL, DED, Professor and Director, Melbourne Poche Centre for Indigenous Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia Philippa Gent, BN, MHPE, GRADDIPPARAMEDICINE, Lecturer in Paramedicine, Australian Catholic University, Victoria, Australia Nick Goodwin, BSC, DIPHLTHSC, MICA Paramedic, Ambulance Victoria, Victoria, Australia Peter Horrocks, RN, ICP, BNURS, MHLTHSC, Senior Lecturer Paramedic Science, School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Queensland, Australia Dianne Inglis, BNURS, DIPHLTHSC (PARAMEDICINE), ADDIPMICP, Clinical Manager, Ambulance Victoria, Australia Paul Jennings, BN, MCLINEPI, GRADCERTBIOSTATS, GCHPE, PHD, FPA, Senior Lecturer, Community Emergency Health and Paramedic Practice, Monash University, Victoria, Australia David Kelly, GRADDIP PREHOSPITAL CARE, BHLTHSC (PARAMEDIC), B PODIATRY MICA Paramedic, Ambulance Victoria, Victoria, Australia Critical Care Paramedic, Queensland Ambulance Service, Queensland, Australia Jeff Kenneally, ASSDIPHLTHSCI (PARAMEDIC), MICA CERTIFICATE, Team Manager, Ambulance Victoria, Victoria, Australia Susan Lee, RN, PHD, MRCNA, Senior Lecturer, Palliative Care Research Team, School of Nursing and Midwifery, Monash University, Victoria, Australia Grainne Lowe, RN, NP, BN (HONS), MN, PHD (CANDIDATE), Lecturer, School of Nursing and Midwifery, Monash University, Victoria, Australia Pip Lyndon-James, MADED, GRADDIP VOCATIONAL WORKPLACE LEARNING, BNURS, ADDIP PARAMEDICAL SCIENCE Lecturer, Paramedicine, University of Tasmania, Sydney Campus, New South Wales, Australia

Intensive Care Paramedic, New South Wales Ambulance Service, New South Wales, Australia Gayle McLelland, RN, RM, MED (I&CT), Lecturer, School of Nursing and Midwifery, Monash University, Victoria, Australia Tegwyn McManamny, BEMERGHLTH (HONS), PHD (CANDIDATE), Lecturer, Department of Community Emergency Health and Paramedic Practice, Monash University, Victoria, Australia Ben Meadley, BAPPSC (HUMAN MOVEMENT), DIPPARAMEDISCI (PREHOSPITAL CARE), GRADDIPICP, GRADDIPEMERGHLTH (MICA), GRADCERTEMERGHLTH (AEROMED RETRIEVAL) Teaching Associate and Unit Coordinator, Department of Community Emergency Health and Paramedic Practice, Monash University, Victoria, Australia Intensive Care Flight Paramedic, Air Ambulance Victoria, Victoria, Australia Paul M. Middleton, RGN, MBBS, DIPIMCRCS (ED), MMED (CLINEPI), MD FRCS (ENG), FANZCP, FCEM, FACEM Clinical Associate Professor, Discipline of Emergency Medicine, University of Sydney, New South Wales, Australia Principal Investigator, DREAM Collaboration, New South Wales, Australia Director, Australian Institute for Clinical Education, New South Wales, Australia Conjoint Associate Professor, Graduate School of Biomedical Engineering, University of New South Wales, New South Wales, Australia Chair, Australian Resuscitation Council, NSW Branch, New South Wales, Australia Chair, Take Heart Australia, New South Wales, Australia Amee Morgans, BAPPSC (HONS), PHD, Senior Research Fellow, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia Alan Morrison, MPET, GRADDIPPADMIN, GRADDIPED, BPARAMEDPRAC, BAPPSC (BIOMEDICAL), DIPHLTHSC, ADVDIPPARASC, MANZCP, MPA Intensive Care Paramedic, New South Wales, Australia Director Education, NSW Ambulance, New South Wales, Australia Adjunct Fellow, School of Science and Health, University of Western Sydney, New South Wales, Australia Adjunct Senior Lecturer, School of Medicine, University of Tasmania, Tasmania, Australia Stephen Mulholland, BPARAMEDSTUD, GRADDIPHLTH (ADMINISTRATION), MICA CERTIFICATE, Senior MICA Team Manager, Ambulance Victoria, Victoria, Australia Stuart Newman, RN, INTCARECERT, DIPTEACHING (NURSING), BED (NURSING), MHA (NSW), MACN, Director, International Programs & Lecturer in Health Services Management, Sydney Nursing School, New South Wales, Australia Paul Oliveri, BHLTHSC (EHS), GCERT ELEARNING Lecturer, School of Medical and Applied Sciences, CQUniversity, Queensland, Australia Practising Paramedic, Queensland Ambulance Service, Queensland, Australia Peter O’Meara, BHA, MPP, PHD, FPA, FANZCP, Professor of Rural and Regional Paramedicine, La Trobe University, Victoria, Australia Virginia Plummer, RN, RM, MSC (HEALTH POLICY & MANAGEMENT), GRADDIP (HEALTH ADMIN), GRADCERTEMERGHLTH (DISASTER PREP & MANAGEMENT), GCHPE, CRITCARECERT, PHD, FCNA, FCHSM, Associate Professor Nursing Research, School of Nursing and Midwifery, Monash University and Peninsula Health, Victoria, Australia Katrina Recoche, RN, MN, BA (SOC/SCI) Lecturer, School of Nursing and Midwifery, Monash University, Victoria, Australia Vice President, Palliative Care Nurses Australia, Queensland, Australia Adam Rolley, GDINTCAREPARAMEDICPRAC, DIPHLTHSC (PRE-HOSPCARE), BCCJ, MPA

Senior Educator, Queensland Ambulance Service, Queensland, Australia Sessional Academic, School of Medicine, University of Queensland, Queensland, Australia Sandra Schmidt, ADVDIPPARAMEDSC, BNURS, GRADCERTAOD, GRADDIPHLTHMGT, MPA, General Manager, Alcohol and other Drugs, Department of Health, Northern Territory, Australia Jade Sheen, BAPPSC (PSYCH) (HONS), GCHE, MCLINFAMTH, DPSYCH (HEALTH), CLINICAL AND HEALTH PSYCHOLOGIST, Senior Lecturer in Clinical Psychology, Deakin University, Victoria, Australia Gavin Smith, PHD, MEH, GRADDIPEMERGHLTH, BPARAMEDSTUD, FPA, MRSV Associate Professor, Paramedicine, Victoria University, Victoria, Australia MICA Paramedic, Ambulance Victoria, Victoria, Australia Brian Stoffell, BA (HONS), LLB (HONS), PHD, Head of Social Health Sciences, School of Medicine, Flinders University, South Australia, Australia Andy Symons David Teuber, BMBS, FACEM, MCLINEPI Senior Lecturer, Emergency Medicine and Prehospital Science, Flinders University, South Australia, Australia Senior Consultant, Emergency Department, Flinders Medical Centre, South Australia, Australia Retrieval Consultant, SAAS-MedSTAR, South Australia, Australia Visiting Medical Officer, Hyperbaric Unit, Royal Adelaide Hospital, South Australia, Australia Vivienne Tippett, BA, GRADDIP PSYCH, MPH, PHD Head, Paramedic Science Program/Director of Research, School of Clinical Science, Queensland University of Technology, Queensland, Australia BNHCRC Lead Researcher, Centre for Disaster and Emergency Management, Queensland University of Technology, Queensland, Australia Deputy Director, JBI Centre for Evidence Based Healthy Ageing, Queensland University of Technology, Queensland, Australia Ruth Townsend, BN, LLB, LLM, DIPPARAMEDSC, GRADDIPLEGALPRACTICE, GRADCERTVET, Solicitor of the Supreme Court of NSW, New South Wales, Australia Mark Trebley, BHSC (PREHOSPITAL CARE), GRADCERTCLINED, GRADCERTINDIGENOUSED, MANZCP, Clinical Training Officer, Int