An investigation into the cost, coverage and activities of Helicopter Emergency Medical Services in the state of New South Wales, Australia

IntroductionDelayed handover of emergency medical services (EMS) patients to EDs is a major issue with hospital crowding considered a primary cause. We explore the impact of the 4-hour rule (the Policy) in Australia, focusing on ambulance and ED delays.MethodsEMS (ambulance), ED and hospital data of adult patients presenting to 14 EDs from 2002 to 2013 in three jurisdictions were linked. Interrupted time series ‘Before-and-After’ trend analysis was used for assessing the Policy’s impact. Random effects meta-regression analysis was examined for associations between ambulance delays and Policy-associated ED intake, throughput and output changes.ResultsBefore the Policy, the proportion of ED ambulances delayed increased between 1.1% and 1.7% per quarter across jurisdictions. After Policy introduction, Western Australia’s increasing trend continued but Queensland decreased by 5.1% per quarter. In New South Wales, ambulance delay decreased 7.1% in the first quarter after Policy introduction. ED intake (triage delay) improved only in New South Wales and Queensland. Each 1% ambulance delay reduction was significantly associated with a 0.91% reduction in triage delay (p=0.014) but not ED length of stay ≤4 hours (p=0.307) or access-block/boarding (p=0.605) suggesting only partial improvement in ambulance delay overall.ConclusionThe Policy was associated with reduced ambulance delays over time in Queensland and only the immediate period in New South Wales. Associations may be due to local jurisdictional initiatives to improve ambulance performance. Strategies to alleviate ambulance delay may need to focus on the ED intake component. These should be re-examined with longer periods of post-Policy data.

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Development of unmanned aerial vehicle (UAV) networks delivering early defibrillation for out-of-hospital cardiac arrests (OHCA) in areas lacking timely access to emergency medical services (EMS) in Germany: a comparative economic study

BMJ Open ◽

10.1136/bmjopen-2020-043791 ◽

2021 ◽

Vol 11 (1) ◽

pp. e043791

Author(s):

Jan Bauer ◽

Dieter Moormann ◽

Reinhard Strametz ◽

David A Groneberg

Keyword(s):

Cost Effectiveness ◽

Emergency Medical Services ◽

Rural Areas ◽

Medical Services ◽

Secondary Outcome ◽

Annual Average ◽

Emergency Medical ◽

Life Years ◽

Timely Access ◽

The Cost

ObjectivesThis study wants to assess the cost-effectiveness of unmanned aerial vehicles (UAV) equipped with automated external defibrillators (AED) in out-of-hospital cardiac arrests (OHCA). Especially in rural areas with longer response times of emergency medical services (EMS) early lay defibrillation could lead to a significant higher survival in OHCA.Participants3296 emergency medical stations in Germany.SettingRural areas in Germany.Primary and secondary outcome measuresThree UAV networks providing 80%, 90% or 100% coverage for rural areas lacking timely access to EMS (ie, time-to-defibrillation: >10 min) were developed using a location allocation analysis. For each UAV network, primary outcome was the cost-effectiveness using the incremental cost-effectiveness ratio (ICER) calculated by the ratio of financial costs to additional life years gained compared with current EMS.ResultsCurrent EMS with 3926 emergency stations was able to gain 1224 life years on annual average in the study area. The UAV network providing 100% coverage consisted of 1933 UAV with average annual costs of €43.5 million and 1845 additional life years gained on annual average (ICER: €23 568). The UAV network providing 90% coverage consisted of 1074 UAV with average annual costs of €24.2 million and 1661 additional life years gained on annual average (ICER: €14 548). The UAV network providing 80% coverage consisted of 798 UAV with average annual costs of €18.0 million and 1477 additional life years gained on annual average (ICER: €12 158).ConclusionThese results reveal the relevant life-saving potential of all modelled UAV networks. Furthermore, all analysed UAV networks could be deemed cost-effective. However, real-life applications are needed to validate the findings.

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THE STATE TUBERCULOSIS SERVICE IN NEW SOUTH WALES

The Medical Journal of Australia ◽

10.5694/j.1326-5377.1943.tb44159.x ◽

1943 ◽

Vol 1 (6) ◽

pp. 131-132

Keyword(s):

New South ◽

New South Wales ◽

The State ◽

South Wales ◽

Tuberculosis Service

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Dust Transport from Inland Australia and Its Impact on Air Quality and Health on the Eastern Coast of Australia during the February 2019 Dust Storm

Atmosphere ◽

10.3390/atmos12020141 ◽

2021 ◽

Vol 12 (2) ◽

pp. 141

Author(s):

Emilie Aragnou ◽

Sean Watt ◽

Hiep Nguyen Duc ◽

Cassandra Cheeseman ◽

Matthew Riley ◽

...

Keyword(s):

Air Quality ◽

Dust Storm ◽

New South ◽

New South Wales ◽

The State ◽

Dust Storms ◽

Eastern Coast ◽

Storm Event ◽

South Wales ◽

Dust Storm Event

Dust storms originating from Central Australia and western New South Wales frequently cause high particle concentrations at many sites across New South Wales, both inland and along the coast. This study focussed on a dust storm event in February 2019 which affected air quality across the state as detected at many ambient monitoring stations in the Department of Planning, Industry and Environment (DPIE) air quality monitoring network. The WRF-Chem (Weather Research and Forecast Model—Chemistry) model is used to study the formation, dispersion and transport of dust across the state of New South Wales (NSW, Australia). Wildfires also happened in northern NSW at the same time of the dust storm in February 2019, and their emissions are taken into account in the WRF-Chem model by using Fire Inventory from NCAR (FINN) as emission input. The model performance is evaluated and is shown to predict fairly accurate the PM2.5 and PM10 concentration as compared to observation. The predicted PM2.5 concentration over New South Wales during 5 days from 11 to 15 February 2019 is then used to estimate the impact of the February 2019 dust storm event on three health endpoints, namely mortality, respiratory and cardiac disease hospitalisation rates. The results show that even though as the daily average of PM2.5 over some parts of the state, especially in western and north western NSW near the centre of the dust storm and wild fires, are very high (over 900 µg/m3), the population exposure is low due to the sparse population. Generally, the health impact is similar in order of magnitude to that caused by biomass burning events from wildfires or from hazardous reduction burnings (HRBs) near populous centres such as in Sydney in May 2016. One notable difference is the higher respiratory disease hospitalisation for this dust event (161) compared to the fire event (24).

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Field Diagnosis and Treatment of Hypokalemic Periodic Paralysis by a Helicopter Emergency Medical Services Team

Air Medical Journal ◽

10.1016/j.amj.2020.12.008 ◽

2021 ◽

Author(s):

Mitchell D. Datlow ◽

Richard B. Utarnachitt ◽

Colleen Records ◽

Wynn Vance ◽

Andrew J. Latimer

Keyword(s):

Emergency Medical Services ◽

Periodic Paralysis ◽

Diagnosis And Treatment ◽

Medical Services ◽

Hypokalemic Periodic Paralysis ◽

Helicopter Emergency Medical Services ◽

Emergency Medical

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“No Entry into New South Wales”: COVID-19 and the Historic and Contemporary Trajectories of the Effects of Border Closures on an Australian Cross-Border Community

Land ◽

10.3390/land10060610 ◽

2021 ◽

Vol 10 (6) ◽

pp. 610

Author(s):

Dirk H. R. Spennemann

Keyword(s):

Public Health ◽

Economic Impact ◽

New South ◽

Community Integration ◽

New South Wales ◽

The State ◽

Cross Border ◽

Health Measures ◽

Border Community ◽

South Wales

Given its intensity, rapid spread, geographic reach and multiple waves of infections, the COVID-19 pandemic of 2020/21 became a major global disruptor with a truly cross-sectoral impact, surpassing even the 1918/19 influenza epidemic. Public health measures designed to contain the spread of the disease saw the cessation of international travel as well as the establishment of border closures between and within countries. The social and economic impact was considerable. This paper examines the effects of the public health measures of “ring-fencing” and of prolonged closures of the state border between New South Wales and Victoria (Australia), placing the events of 2020/21 into the context of the historic and contemporary trajectories of the border between the two states. It shows that while border closures as public-health measures had occurred in the past, their social and economic impact had been comparatively negligible due to low cross-border community integration. Concerted efforts since the mid-1970s have led to effective and close integration of employment and services, with over a quarter of the resident population of the two border towns commuting daily across the state lines. As a result, border closures and state-based lockdown directives caused significant social disruption and considerable economic cost to families and the community as a whole. One of the lessons of the 2020/21 pandemic will be to either re-evaluate the wisdom of a close social and economic integration of border communities, which would be a backwards step, or to future-proof these communities by developing strategies, effectively public health management plans, to avoid a repeat when the next pandemic strikes.

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