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Cairns, Australia

Rojek A.,Royal Brisbane and Womens Hospital | Little M.,Cairns Base Hospital
EMA - Emergency Medicine Australasia | Year: 2013

The creation of hospitals safe from disaster is an area of increasing public policy. The vulnerability of hospitals to damage and destruction during an event has profound implications for the health of a community. Although hospital evacuations do occur in Australia, their prevalence is unknown and what leads to a successful evacuation is poorly understood. This article reviewed the worldwide hospital evacuation literature to determine the prevalence of hospital evacuations and common precipitants for evacuation. Factors leading to safe evacuation and areas of ongoing challenge were identified. The findings highlight the need for more structured and detailed reporting of hospital responses to disaster. A number of lessons can be learned from hospitals that have experienced evacuation. Most critically, all hospitals must have a practised, detailed hospital evacuation plan existing before an impending threat. There are also areas for improvement in the areas of assessing the risk to the facility, communications, leadership, logistics, staffing and planning. These lessons should be included into comprehensive, detailed evacuation plans for all Australian hospitals, supported by a national framework that standardises planning and response. © 2013 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Cong M.L.,Royal Flying Doctor Service | Gynther B.,Remote Area Mental Health Service | Hunter E.,Remote Area Mental Health Service | Schuller P.,Cairns Base Hospital
Emergency Medicine Journal | Year: 2012

Objective: Aeromedical retrieval services face the difficult problem of appropriate levels of sedation for transport of acutely agitated patients to definitive care. This paper describes a technique using ketamine, which is titratable and avoids problems associated with airway management. Method: A 3-year review of a new technique of ketamine sedation by aeromedical retrieval teams from the Cairns base of the Queensland section of the Royal Flying Doctor Service of Australia. Clinical records were systematically reviewed for ketamine administration and signs of adverse events during transport and in the subsequent 72 h. Results: 18 patients were sedated during retrieval with intravenous ketamine. Effective sedation was achieved in all cases, with no significant adverse events noted during retrieval or 72 h afterwards. Conclusion: Ketamine sedation is effective and safe in agitated patients with a psychiatric illness in the aeromedical setting and does not lead to worsening agitation in the subsequent 72-h period.

Taylor W.R.J.,Mahidol University | Taylor W.R.J.,University of Oxford | Taylor W.R.J.,Hopitaux Universitaires Of Geneva | Hanson J.,Cairns Base Hospital | And 6 more authors.
Chest | Year: 2012

Respiratory distress develops in up to 25% of adults and 40% of children with severe falciparum malaria. Its diverse causes include respiratory compensation of metabolic acidosis, noncardiogenic pulmonary edema, concomitant pneumonia, and severe anemia. Patients with severe falciparum, vivax, and knowlesi malaria may develop acute lung injury (ALI) and ARDS, often several days after antimalarial drug treatment. ARDS rates, best characterized for severe Plasmodium falciparum, are 5% to 25% in adults and up to 29% in pregnant women; ARDS is rare in young children. ARDS pathophysiology centers on inflammatory-mediated increased capillary permeability or endothelial damage leading to diffuse alveolar damage that can continue after parasite clearance. The role of parasite sequestration in the pulmonary microvasculature is unclear, because sequestration occurs intensely in P falciparum, less so in P knowlesi, and has not been shown convincingly in P vivax. Because early markers of ALI/ARDS are lacking, fluid resuscitation in severe malaria should follow the old adage to "keep them dry." Bacteremia and hospital-acquired pneumonia can complicate severe malaria and may contribute to ALI/ARDS. Mechanical ventilation can save life in ALI/ARDS. Basic critical care facilities are increasingly available in tropical countries. The use of lung-protective ventilation has helped to reduce mortality from malaria-induced ALI/ARDS, but permissive hypercapnia in unconscious patients is not recommended because increased intracranial pressure and cerebral swelling may occur in cerebral malaria. The best antimalarial treatment of severe malaria is IV artesunate. © 2012 American College of Chest Physicians.

Hayes B.,Cairns Base Hospital | Bonnet A.,Charles Sturt University
Journal of Renal Care | Year: 2010

Job dissatisfaction, stress and burnout are linked to high rates of nurses leaving the profession, poor morale and poor patient outcomes. Haemodialysis (HD) nursing is uniquely characterised by the intense-prolonged interaction with patients who require complex technological care. A review of nine papers found that factors affecting job satisfaction were aspects of nursing care, organisational factors and length of time that a nurse has been working in nephrology nursing. Factors affecting job stress and burnout were due to interpersonal relationships with physicians, patient care activities, violence and abuse from patients, organisational factors and a lack of access to ongoing education. © 2010 European Dialysis and Transplant Nurses Association/European Renal Care Association.

Calver L.,University of Newcastle | Page C.B.,Princess Alexandra HospitalQLD | Page C.B.,University of Queensland | Downes M.A.,Calvary Materials Newcastle | And 5 more authors.
Annals of Emergency Medicine | Year: 2015

Study objective We investigate the safety and effectiveness of droperidol for sedation of acute behavioral disturbance in the emergency department (ED). Methods This was a prospective observational study in 6 EDs (August 2009 to April 2013). Adult patients requiring parenteral sedation for acute behavioral disturbance received droperidol 10 mg. If this did not sedate the patient within 15 minutes, further sedation was allowed but droperidol 10 mg was recommended as part of a sedation protocol. The primary outcome was the proportion of patients with an abnormal QT interval, defined by the at-risk line on the QT nomogram. Secondary outcomes were effectiveness determined by the time to sedation measured on the Sedation Assessment Tool, use of additional sedation, adverse events, and injury to staff or patients. Results There were 1,009 patients with an ECG performed within 2 hours of droperidol administration, with a median dose of 10 mg (interquartile range [IQR]10 to 17.5 mg). Thirteen of the 1,009 patients had an abnormal QT (1.3%; 95% confidence interval 0.7% to 2.3%), but 7 of these had another cause attributed for prolonged QT (methadone, escitalopram, amiodarone, or preexisting). In 1,403 patients sedated with a median total dose of droperidol of 10 mg (IQR 10 to 20 mg), the median time to sedation was 20 minutes (IQR 10 to 30 minutes) and 97% were sedated within 120 minutes. Additional sedation was required for 435 patients (31.0%; 95% confidence interval 28.6% to 33.5%). Adverse events occurred in 70 patients (5%) and oversedation without complications in 109 (8%), the latter more common for patients receiving benzodiazepines as additional sedation (16/109 [15%]). There were no cases of torsades de pointes. Injuries occurred in 34 staff members and 4 patients. Conclusion The study supports the use of high-dose droperidol as a safe sedating agent for patients with acute behavioral disturbance in the ED. There is no evidence of increased risk for QT prolongation with the doses used in this study. © 2015 American College of Emergency Physicians.

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