Date of Award
Doctor of Philosophy
School of Medical and Health Sciences
Out-of-hospital cardiac arrest is a leading cause of death and Ambulance Victoria estimated over 30,000 cardiac arrests occur outside of hospital each year in Australia (1, 2). When an out-of-hospital cardiac arrest occurs, first responders, paramedics or other clinicians attached to ambulance, industrial or aeromedical services are often the first providers on scene with the skills and equipment to implement advanced life support (ALS). Despite the essential role of prehospital advanced emergency care in the treatment of out-of-hospital cardiac arrest, at the time this research was commenced, ALS training courses had been designed for those responding to cardiac arrests in controlled environments such as in hospitals. These courses emphasised methodology, processes and teamwork suitable for the controlled hospital environment. In contrast, prehospital clinicians typically face an uncontrolled and unpredictable environment, often working with lay responders, and with the added challenge of extricating and transporting the patient to hospital care. As a result, prehospital ALS providers were not trained in an environment that aligned with their workplace or the teams they regularly worked with. Ultimately, there is evidence that out-ofhospital cardiac arrest has a less than optimal patient survival rate when compared to in-hospital cardiac arrests (3, 4).
The aim of this research was to review the characteristics of prehospital cardiac arrest ALS and identify gaps in the current ALS training courses in relation to preparation for the prehospital environment and then use this knowledge to develop and evaluate a pilot, standardised, prehospital ALS course. In terms of the potential broader benefits to society, a standardised prehospital ALS course could enhance healthcare professional preparedness to deliver prehospital resuscitation and have positive impacts on out-of-hospital survival rates within the community.
A mixed method research design was implemented whereby both qualitative and quantitative data were collected. Using an iterative approach, a prehospital cardiac arrest ALS course congruent with the Australian Resuscitation Council (ARC) guidelines was developed, piloted, and evaluated. Finally, the course was validated by an expert advisory panel.
The implementation of a standardised, validated prehospital cardiac arrest ALS training course may assist in improving patient survival rates from out-of-hospital cardiac arrest. The prehospital course designed from this research has tailored elements of leadership, teamwork, and resource management relevant to the prehospital clinicians working environment. However, whilst this research designed and validated a prehospital resuscitation course, further work is needed to determine whether such a course has an impact on prehospital cardiac arrest outcomes.
Access to chapters 4, 5 & 6 of this thesis is not available
Reid, D. N. (2022). Preparing providers for advanced life support in the prehospital environment. https://ro.ecu.edu.au/theses/2558