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The golden hour – unachievable for a chunk of NZ – a problem?

Thursday, October 3rd, 2019 | Rory | No Comments

Geographical and population disparities in timely access to prehospital and advanced level emergency care in New Zealand

Lilley R, Graaf B, Kool B, Davie G, Reid P, Dicker B, Civil I, Ameratunga S & Branas C. (2019). Geographical and population disparities in timely access to prehospital and advanced level emergency care in New Zealand: a cross-sectional study. BMJ Open. 9.

Open Access https://bmjopen.bmj.com/content/9/7/e026026

 

This is a very interesting study that shows that 16% of NZ doesn’t have access to an ‘advanced-level’ hospital within a hour. They have used a novel approach to identifying this population. With regards to trauma care this is a significant finding and something to consider for rural NZ, especially with planning emergency service networks. The average time the ambulance spends responding, travelling to and on the scene (even scoop and run) seems short based on practical experience in areas staffed by volunteer crews that are often 30 minutes to an hour away when called. This will only worsen this ‘inequity’ though

However, for medical events this hour cut-off is a bit more arbitrary. There are few medical events that require treatment within an hour in a major centre that cannot be initiated in rural practice. STEMI can be and are lysed. Airways can be secured. Vasopressors and antibiotics initiated. There are also CT scanners available in a few rural hospitals with Telestroke and stroke fibrinolysis also being available – although stroke care is a mobile beast with the advancement of clot retrieval. Further, many undifferentiated cases may never require transfer to a major centre once proper assessment and investigations are completed in a capable rural centre (either Hospital/GP). If all these patients were transferred immediately, would this be a good use of NZ’s limited resource?

Involving the established rural sector in this care is going to be important to ensure the best use of these resources.

It would be good to use this methodology to look at more patient centred outcomes in the (hopefully near) future.

Abstract

Objective Rapid access to advanced emergency medical and trauma care has been shown to significantly reduce mortality and disability. This study aims to systematically examine geographical access to prehospital care provided by emergency medical services (EMS) and advanced-level hospital care, for the smallest geographical units used in New Zealand and explores national disparities in geographical access to these services.

Design Observational study involving geospatial analysis estimating population access to EMS and advanced-level hospital care. Setting Population access to advanced-level hospital care via road and air EMS across New Zealand. Participants New Zealand population usually resident within geographical census meshblocks. Primary and secondary outcome measures The proportion of the resident population with calculated EMS access to advanced-level hospital care within 60 min was examined by age, sex, ethnicity, level of deprivation and population density to identify disparities in geographical access.

Results An estimated 16% of the New Zealand population does not have timely EMS access to advanced-level hospital care via road or air. The 700 000 New Zealanders without timely access lived mostly in areas of low-moderate population density. Indigenous Māori, New Zealand European and older New Zealanders were less likely to have timely access.

Conclusions These findings suggest that in New Zealand, geographically marginalised groups which tend to be rural and remote communities with disproportionately more indigenous Māori and older adults have poorer EMS access to advanced-level hospitals. Addressing these inequities in rapid access to medical care may lead to improvements in survival that have been documented for people who experience medical or surgical emergencies.

 

Edit; fixed link. Thanks to Linda Reynolds for pointing out!

Development of the Rural Inter-professional Simulation Course

Monday, February 18th, 2019 | Rory | No Comments

RISC

Gutenstein M, Kiuru S, Withington S. Development of a Rural Inter-professional Simulation Course: an initiative to improve trauma and emergency team management in New Zealand rural hospitals. Journal of Primary Health Care [Internet]. 2019 [cited 2019 Feb 17]; Available from (Open Access): http://www.publish.csiro.au/?paper=HC18071

Fresh publication from three conveners from the Rural Postgraduate Programme and founders of the RISC. A very topical publication especially given two papers recently published (by the same author) in two Australian Journals detailing that rural doctors want and need more training in emergency and trauma.(1,2) Perhaps NZ is ahead of the game on this one!

Information about RISC

Abstract

BACKGROUND AND CONTEXT: New Zealand is a largely rural nation. Despite the regionalisation of trauma services, rural hospitals continue to provide trauma and emergency care. A dedicated rural inter-professional team-based simulation course was designed, as part of a wider strat- egy of using simulation-based education to address the disparity in experience and training for rural hospital teams providing emergency and trauma care.

ASSESSMENT: A pre-course questionnaire identified learning needs. Post-course evaluationand a follow-up survey assessed participants’ perception of the course, and whether lasting changes in clinical or organisational practice occurred.

RESULTS: Three courses were provided over 2 years to 60 interprofessional participants from eight rural hospitals. The course employed an interprofessional faculty and used skill work-shops and high-fidelity trauma simulations to address learning needs identified in pre-courseresearch. Evaluation showed the course to be an effective learning experience for partici- pants. The post-course survey indicated possible lasting changes in team performance and rural hospital protocols. This educational strategy also allowed the collection of research data for investigating rural team dynamics and interprofessional learning.

STRATEGIES FOR IMPROVEMENT: Further development of rural interprofessional simulation courses should include more diverse clinical content, including paediatric and medical sce-narios. Participant access was sometimes limited by typical rural challenges such as hospital staffing and locum availability.

LESSONS: Rural simulation-based education is both effective for rural trauma team training and a vehicle for rural research; however, there are challenges to participant access and course sustainability, which echo the rural–urban disparity.

References

1. Pandit T, Ray R, Sabesan S. Review article: Managing medical emergencies in rural Australia: A systematic review of the training needs. Emergency Medicine Australasia. 2019;31(1):20–8.

2. Pandit T, Sabesan S, Ray RA. Medical emergencies in rural North Queensland: Doctors perceptions of the training needs. Australian Journal of Rural Health. 2018;26(6):422–8.