Paramedic exposure to out-of-hospital cardiac arrest is rare and declining in Victoria, Australia

Kylie Dyson; Janet Bray; Karen Smith; Stephen Bernard; Lahn Straney; Judith Finn

doi:10.1016/j.resuscitation.2015.01.023

Paramedic exposure to out-of-hospital cardiac arrest is rare and declining in Victoria, Australia

Resuscitation. 2015 Apr:89:93-8. doi: 10.1016/j.resuscitation.2015.01.023. Epub 2015 Jan 28.

Authors

Kylie Dyson¹, Janet Bray², Karen Smith³, Stephen Bernard⁴, Lahn Straney⁵, Judith Finn⁶

Affiliations

¹ Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Ambulance Victoria, Victoria, Australia. Electronic address: Kylie.dyson@monash.edu.
² Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Discipline of Emergency Medicine, University of Western Australia, Perth, Australia; Alfred Hospital, Melbourne, Australia; School of Nursing and Midwifery, Curtin University, Perth, Australia.
³ Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Ambulance Victoria, Victoria, Australia; Discipline of Emergency Medicine, University of Western Australia, Perth, Australia.
⁴ Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Ambulance Victoria, Victoria, Australia; Alfred Hospital, Melbourne, Australia.
⁵ Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
⁶ Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Discipline of Emergency Medicine, University of Western Australia, Perth, Australia; School of Nursing and Midwifery, Curtin University, Perth, Australia.

PMID: 25637695
DOI: 10.1016/j.resuscitation.2015.01.023

Abstract

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

Methodology: We linked data from the Victorian Ambulance Cardiac Arrest Registry (VACAR) and Ambulance Victoria's employment dataset for 2003-2012. Paramedics were 'exposed' to an OHCA if they attended a case where resuscitation 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: Over 10-years, there were 49,116 OHCAs and 5673 paramedics employed. Resuscitation was attempted in 44% of OHCAs. The typical 'exposure' of paramedics was 1.4 (IQR=0.0-3.0) OHCAs per year. Mean annual OHCA exposure declined from 2.8 in 2003 to 2.1 in 2012 (p=0.007). Exposure was significantly less 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 average of 163 days to be exposed to an OHCA and up to 12.5 years for paediatric OHCAs, which occur relatively 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.

Keywords: Clinical competence; Experience; Exposure; Out-of-hospital cardiac arrest; Resuscitation; Workload.

MeSH terms

Adolescent
Aged
Aged, 80 and over
Cardiopulmonary Resuscitation / statistics & numerical data*
Child
Clinical Competence
Emergency Medical Services / statistics & numerical data*
Female
Humans
Male
Middle Aged
Out-of-Hospital Cardiac Arrest / diagnosis
Out-of-Hospital Cardiac Arrest / epidemiology*
Out-of-Hospital Cardiac Arrest / therapy*
Retrospective Studies
Victoria