Stephen Bernard

Alfred Hospital, Melbourne, Victoria, Australia

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Publications (91)394.39 Total impact

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    ABSTRACT: Abstract Objective. The optimal staffing of helicopter emergency medical services (HEMS) is uncertain. An intensive care paramedic-staffed HEMS has operated in the state of Victoria, Australia for over 28 years, with paramedics capable of performing advanced procedures, including rapid sequence intubation, decompression of tension pneumothorax, and cricothyroidotomy. Administration of a wide range of vasoactive, anesthetic, and analgesic medications is also permitted. We sought to explore the characteristics of patients transported by HEMS in Victoria, and describe paramedic utilization of their skill set in the prehospital environment. Methods. A retrospective data review was conducted of patients transported by the HEMS between 1 July 2012 and 30 June 2013. Data were sourced from the Ambulance Victoria data warehouse and the Victorian State Trauma Registry. Interhospital transfers were excluded. Results. HEMS attended 1,519 cases during the study period. A total of 825 primary transport cases were included in analyses. Most patients were male (69.5%) and the majority of cases involved trauma (86.1%). Rapid sequence intubation (RSI) was performed in 36.8% of pediatric and 29.9% of adult major trauma patients, with a procedural success rate of 100%. Ketamine was administered to 18.5% of all trauma patients. The proportion of patients with a severe pain score (≥7) decreased from 33.8 to 3.2% (p < 0.001) between initial and final paramedic assessments. A clinically significant pain reduction of ≥2 points was achieved by 87.0% (95% CI 82.9-90.4%) of adult trauma patients who had an initial pain score >2 points and a valid final pain score. In-hospital mortality following major-trauma was 7.6% (95% CI 5.0-11.0%). Conclusions. The skill set of HEMS intensive care paramedics in Victoria is broad, including a large number of prehospital critical care procedures commonly utilized by physician-staffed HEMS in other jurisdictions. A high RSI procedural success rate was observed across the study period, as were significant improvements in patient physiological parameters and pain scores.
    Prehospital Emergency Care 02/2015; DOI:10.3109/10903127.2014.995846 · 1.81 Impact Factor
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    ABSTRACT: 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. We linked data from the Victorian Ambulance Cardiac Arrest Registry (VACAR) and Ambulance Victoria's employment dataset for 2003 to 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). Over 10-years, there were 49,116 OHCAs and 5,673 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 12.5years for paediatric OHCAs, which occur relatively rarely. 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. Copyright © 2015. Published by Elsevier Ireland Ltd.
    Resuscitation 01/2015; 89. DOI:10.1016/j.resuscitation.2015.01.023 · 3.96 Impact Factor
  • Z Nehme, E Andrew, S Bernard, K Smith
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    ABSTRACT: Despite immediate resuscitation, survival rates following out-of-hospital cardiac arrests (OHCA) witnessed by emergency medical service (EMS) are reportedly low. We sought to compare survival and 12-month functional recovery outcomes for OHCA occurring before and after EMS arrival. Between 1st July 2008 and 30th June 2013, we included 8648 adult OHCA cases receiving an EMS attempted resuscitation from the Victorian Ambulance Cardiac Arrest Registry, and categorised them into five groups: bystander witnessed cases±bystander CPR, unwitnessed cases±bystander CPR, and EMS witnessed cases. The main outcomes were survival to hospital and survival to hospital discharge. Twelve-month survival with good functional recovery was measured in a sub-group of patients using the Extended Glasgow Outcome Scale (GOSE). Baseline and arrest characteristics differed significantly across groups. Unadjusted survival outcomes were highest among bystander witnessed cases receiving bystander CPR and EMS witnessed cases, however outcomes differed significantly between these groups: survival to hospital (46.0% vs. 53.4% respectively, p<0.001); survival to hospital discharge (21.1% vs. 34.9% respectively, p<0.001). When compared to bystander witnessed cases receiving bystander CPR, EMS witnessed cases were associated with a significant improvement in the risk adjusted odds of survival to hospital (OR 2.02, 95% CI: 1.75-2.35), survival to hospital discharge (OR 6.16, 95% CI: 5.04-7.52) and survival to 12 months with good functional recovery (OR 5.56, 95% CI: 4.18-7.40). When compared to OHCA occurring prior to EMS arrival, EMS witnessed arrests were associated with significantly higher survival to hospital discharge rates and favourable neurological recovery at 12 months post arrest. Copyright © 2015. Published by Elsevier Ireland Ltd.
    Resuscitation 01/2015; 89. DOI:10.1016/j.resuscitation.2015.01.012 · 3.96 Impact Factor
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    ABSTRACT: Although the value of clinical registries has been well recognized in developed countries, their use for measuring the quality of emergency medical service care remains relatively unknown. We report the methodology and findings of a statewide emergency medical service surveillance initiative, which is used to measure the quality of systems of care for patients with out-of-hospital cardiac arrest. Between July 1, 2002, and June 30, 2012, data for adult out-of-hospital cardiac arrest cases of presumed cardiac cause occurring in the Australian Southeastern state of Victoria were extracted from the Victorian Ambulance Cardiac Arrest Registry. Regional and temporal trends in bystander cardiopulmonary resuscitation, event survival, and survival to hospital discharge were analyzed using logistic regression and multilevel modeling. A total of 32 097 out-of-hospital cardiac arrest cases were identified, of whom 14 083 (43.9%) received treatment by the emergency medical service. The risk-adjusted odds of receiving bystander cardiopulmonary resuscitation (odds ratio [OR], 2.96; 95% confidence interval, 2.62-3.33), event survival (OR, 1.55; 95% confidence interval, 1.30-1.85), and survival to hospital discharge (OR, 2.81; 95% confidence interval, 2.07-3.82) were significantly improved by 2011 to 2012 compared with baseline. Significant variation in rates of bystander cardiopulmonary resuscitation and survival were observed across regions, with arrests in rural regions less likely to survive to hospital discharge. The median OR for interhospital variability in survival to hospital discharge outcome was 70% (median OR, 1.70). Between 2002 and 2012, there have been significant improvements in bystander cardiopulmonary resuscitation and survival outcome for out-of-hospital cardiac arrest patients in Victoria, Australia. However, regional survival disparities and interhospital variability in outcomes pose significant challenges for future improvements in care. © 2015 American Heart Association, Inc.
    Circulation Cardiovascular Quality and Outcomes 01/2015; 8(1):56-66. DOI:10.1161/CIRCOUTCOMES.114.001185 · 5.66 Impact Factor
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    ABSTRACT: The significance of pre-arrest factors in out-of-hospital cardiac arrests (OHCA) witnessed by emergency medical services (EMS) is not well established. The purpose of this study was to assess the association between prodromal symptoms and pre-arrest clinical observations on the arresting rhythm and survival in EMS witnessed OHCA. Between 1st January 2003 and 31st December 2011, 1,056 adult EMS witnessed arrests of a presumed cardiac aetiology were identified from the Victorian Ambulance Cardiac Arrest Registry. Pre-arrest prodromal features and clinical characteristics were extracted from the patient care record. Backward elimination logistic regression was used to identify pre-arrest factors associated with an initial shockable rhythm and survival to hospital discharge. The median age was 73.0 years, 690 (65.3%) were male, and the rhythm of arrest was shockable in 465 (44.0%) cases. The most commonly reported prodromal symptoms prior to arrest were chest pain (48.8%), dyspnoea (41.8%) and altered consciousness (37.8%). An unrecordable systolic blood pressure was observed in 34.4%, a respiratory rate<13 or >24/min was present in 43.1%, and 45.5% had a Glasgow coma score<15. In the multivariable analysis, the following pre-arrest factors were significantly associated with survival: age, public location, aged care facility, chest pain, arm or shoulder pain, dyspnoea, dizziness, vomiting, ventricular tachycardia, pulse rate, systolic blood pressure, respiratory rate, Glasgow coma score, aspirin and inotrope administration. Pre-arrest factors are strongly associated with the arresting rhythm and survival following EMS witnessed OHCA. Potential opportunities to improve outcomes exist by way of early recognition and management of patients at risk of OHCA. Copyright © 2014. Published by Elsevier Ireland Ltd.
    Resuscitation 12/2014; 88. DOI:10.1016/j.resuscitation.2014.12.009 · 3.96 Impact Factor
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    ABSTRACT: To examine the effect of the "after-hours" (18:00-07:00) model of trauma care on a high-risk subgroup - patients presenting with acute traumatic coagulopathy (ATC).
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    ABSTRACT: Cardio-pulmonary resuscitation (CPR) may generate sufficient cerebral perfusion pressure to make the patient conscious. The incidence and management of this phenomenon is not well described. This systematic review aims to identifying cases where CPR-induced consciousness is mentioned in the literature and explore its management options.
    Resuscitation 11/2014; DOI:10.1016/j.resuscitation.2014.10.017 · 3.96 Impact Factor
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    ABSTRACT: Background-Out-of-hospital cardiac arrest (OHCA) is a significant global health problem. There has been considerable investment in improving the emergency medical response to OHCA, with associated improvements in survival. However, concern remains that survivors have a poor quality of life. This study describes the quality of life of OHCA survivors at 1-year postarrest in Victoria, Australia. Methods and Results-Adult OHCA patients who arrested between 2010 and 2012 were identified from the Victorian Ambulance Cardiac Arrest Registry. Paramedics attended 15 113 OHCA patients of which 46.3% received an attempted resuscitation. Nine hundred and twenty-seven (13.2%) survived to hospital discharge of which 76 (8.2%) died within 12 months. Interviews were conducted with 697 (80.7%) patients or proxies, who were followed-up via telephone interview, including the Glasgow Outcome Scale-Extended, the 12-item short form health survey, and the EuroQol. The majority (55.6%) of respondents had a good recovery via the Glasgow Outcome Scale-Extended >= 7 (41.1% if patients who died postdischarge were included and nonrespondents were assumed to have poor recovery). The mean EuroQol index score for respondents was 0.82 (standard deviation, 0.19), which compared favorably with an adjusted population norm of 0.81 (standard deviation, 0.34). The mean 12-item short form Mental Component Summary score for patients was 53.0 (standard deviation, 10.2), whereas the mean Physical Component Summary score was 46.1 (standard deviation, 11.2). Conclusions-This is the largest published study assessing the quality of life of OHCA survivors. It provides good evidence that many survivors have an acceptable quality of life 12 months postarrest, particularly in comparison with population norms.
    Circulation 10/2014; 131(2). DOI:10.1161/CIRCULATIONAHA.114.011200 · 14.95 Impact Factor
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    ABSTRACT: To assess the impact of automated external defibrillator (AED) use by bystanders in Victoria, Australia on survival of adults suffering an out-of-hospital cardiac arrest (OHCA) in a public place compared to those first defibrillated by emergency medical services (EMS). We analysed data from the Victorian Ambulance Cardiac Arrest Registry for individuals aged >15 years who were defibrillated in a public place between 1 July 2002 and 30 June 2013, excluding events due to trauma or witnessed by EMS. Of 2270 OHCA cases who arrested in a public place, 2117 (93.4%) were first defibrillated by EMS and 153 (6.7%) were first defibrillated by a bystander using a public AED. Use of public AEDs increased almost 11-fold between 2002/2003 and 2012/2013, from 1.7% to 18.5%, respectively (p<0.001). First defibrillation occurred sooner in bystander defibrillation (5.2 versus 10.0min, p<0.001). Unadjusted survival to hospital discharge for bystander defibrillated patients was significantly higher than for those first defibrillated by EMS (45% versus 31%, p<0.05). Multivariable regression analysis showed that first defibrillation by a bystander using an AED was associated with a 62% increase in the odds of survival to hospital discharge (adjusted odds ratio 1.62, 95% CI: 1.12-2.34, p=0.010) compared to first defibrillation by EMS. Survival to hospital discharge is improved in patients first defibrillated using a public AED prior to EMS arrival in Victoria, Australia. Encouragingly, bystander AED use in Victoria has increased over time. More widespread availability of AEDs may further improve outcomes of OHCA in public places. Copyright © 2014. Published by Elsevier Ireland Ltd.
    Resuscitation 10/2014; 85(12):1739-1744. DOI:10.1016/j.resuscitation.2014.10.005 · 3.96 Impact Factor
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    ABSTRACT: Many patients who suffer cardiac arrest do not respond to standard cardiopulmonary resuscitation. There is growing interest in utilizing veno-arterial extracorporeal membrane oxygenation assisted cardiopulmonary resuscitation (E-CPR) in the management of refractory cardiac arrest. We describe our preliminary experiences in establishing an E-CPR program for refractory cardiac arrest in Melbourne, Australia.
    Resuscitation 09/2014; DOI:10.1016/j.resuscitation.2014.09.010 · 3.96 Impact Factor
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    ABSTRACT: Preventable bystander delays following out-of-hospital cardiac arrest (OHCA) are common, and include bystanders inappropriately directing their calls for help. We retrospectively extracted Utstein-style data from the Victorian Ambulance Cardiac Arrest Registry (VACAR) for adult OHCA occurring in Victoria, Australia, between July 2002 and June 2012. Emergency medical service (EMS) witnessed events were excluded. Cases were assigned into two groups on the basis of the first bystander call for help being directed to EMS. Study outcomes were: likelihood of receiving EMS treatment; survival to hospital, and; survival to hospital discharge. A total of 44,499 adult OHCA cases attended by EMS were identified, of which first bystander calls for help were not directed to EMS in 2,842 (6.4%) cases. Calls to a relative, friend or neighbour accounted for almost 60% of the total emergency call delays. Patient characteristics and survival outcomes were consistently less favourable when calls were directed to others. First bystander call to others was independently associated with older age, male gender, arrest in private location, and arrest in a rural region. The risk-adjusted odds of treatment by EMS (OR 1.33, 95% CI 1.20-1.48), survival to hospital (OR 1.64, 95% CI 1.37-1.96) and survival to hospital discharge (OR 1.64, 95% CI 1.13-2.36) were significantly improved if bystanders called EMS first. The frequency of inappropriate bystander calls following OHCA was low, but associated with a reduced likelihood of treatment by EMS and poorer survival outcomes.
    Resuscitation 09/2014; 85(1):42-48. DOI:10.1016/j.resuscitation.2013.08.258 · 3.96 Impact Factor
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    ABSTRACT: Background: While internationally reported survival from out-of-hospital cardiac arrest (OHCA) is improving, much of the increase is being observed in patients presenting to emergency medical services (EMS) in shockable rhythms. The purpose of this study was to assess survival and 12-month functional recovery in patients presenting to EMS in asystole or pulseless electrical activity (PEA). Methods: The Victorian Ambulance Cardiac Arrest Registry was searched for adult OHCA patients presenting in non-shockable rhythms in Victoria, Australia between 1st July 2003 and 30th June 2013. We excluded patients defibrillated prior to EMS arrival and arrests witnessed by EMS. Twelve-month quality-of-life interviews were conducted on survivors who arrested between 1st January 2010 and 31st December 2012. The main outcome measures were survival to hospital discharge and 12-month functional recovery measured by the Extended Glasgow Outcome Scale (GOSE). Results: A total of 38,378 non-shockable OHCA attended by EMS were included, of which 88.0% were asystole and 11.6% were PEA. Of the patients receiving resuscitation, survival to hospital discharge was 1.1% for asystole and 5.9% for PEA (p< 0.001), with no significant improvement observed over the 10 year study period. In survivors with 12-month follow-up data, the combined rate of death, vegetative state or lower severe disability was 66.7% (95% CI 41.0-80.0%) for asystole and 44.7% (95% CI 30.2-59.9%) for PEA. Conclusion: Survival outcomes following OHCA with initial rhythms of asystole or PEA did not improve over the 10-year study period. Our findings indicate high rates of death within 12 months, and unfavourable functional recovery for survivors.
    Resuscitation 08/2014; 85(11). DOI:10.1016/j.resuscitation.2014.07.015 · 3.96 Impact Factor
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    Karen Smith, Stephen Bernard
    Resuscitation 06/2014; 85(9). DOI:10.1016/j.resuscitation.2014.06.018 · 3.96 Impact Factor
  • Z Nehme, E Andrew, S Bernard, K Smith
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    ABSTRACT: Background: Success rates from cardiopulmonary resuscitation (CPR) are often quantified by Utstein-style outcome reports in populations who receive an attempted resuscitation. In some cases, evidence of futility is ascertained after a partial resuscitation attempt has been administered, and these cases reduce the overall effectiveness of CPR. We examine the impact of partial resuscitation attempts on the reported outcomes of out-of-hospital cardiac arrest (OHCA) in Victoria, Australia. Methods: Between 2002 and 2012, 34,849 adult OHCA cases of presumed cardiac aetiology were included from the Victorian Ambulance Cardiac Arrest Registry. Resuscitation attempts lasting <= 10 min in cases which died on scene were defined as a partial resuscitation. We used logistic regression to identify factors associated with a partial resuscitation attempt in the emergency medical service (EMS) treated population. Survival outcomes with and without partial resuscitations were compared across included years. Results: The proportion of partial resuscitations in the overall EMS treated population increased significantly from 8.6% in 2002 to 18.8% in 2012 (p for trend < 0.001), and were largely supported by documented evidence of irreversible death. Partial resuscitations were independently associated with older age, female gender, initial non-shockable rhythm, prolonged downtime, and lower skill level of EMS personnel. Selectively excluding partial resuscitations increased event survival by 7.6% (95% CI 4.1-11.2%), and survival to hospital discharge increased by 3.1% (95% CI 0.5-5.7%) in 2012 (p < 0.001 for both). Conclusion: In our EMS system, evidence of futility was often identified after the commencement of a partial resuscitation attempt. Excluding these events from OHCA outcome reports may better reflect the overall effectiveness of CPR. Crown Copyright
    Resuscitation 06/2014; 85(9). DOI:10.1016/j.resuscitation.2014.05.032 · 3.96 Impact Factor
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    ABSTRACT: To develop methods for distinguishing patients with in-hospital cardiac arrest (IHCA) from patients with out-of-hospital cardiac arrest (OHCA) in routinely collected intensive care unit registry data, and to explore the utility of the methods for describing trends in adult ICU cardiac arrest (CA) admissions and outcomes.
    Critical care and resuscitation: journal of the Australasian Academy of Critical Care Medicine 06/2014; 16(2):104-11. · 2.15 Impact Factor
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    ABSTRACT: Background and objective: Emergency medical service (EMS) practitioners' experience and exposure to out-of-hospital cardiac arrest (OHCA) and advanced life support (ALS) procedures could be an important factor in procedural success and patient survival. We systematically reviewed the literature to examine these associations. Methodology: We searched for publications using MEDLINE, EMBASE, CINAHL, CENTRAL and Web of Science. We included studies examining any type of EMS practitioner (e.g. paramedics, physicians) and OHCA patients of all ages and aetiologies. Two reviewers independently extracted data. Results: The search identified 1658 citations, of which 11 observational studies of variable quality were included. The majority of studies did not adjust for important confounding factors and reported across different EMS personnel structures. OHCA survival was not consistently associated with various definitions of career experience in three studies, or with previous OHCA exposure in another study. Endotracheal intubation (ETI) was the only ALS procedure examined. Successful ETI placement was associated with the previous number of ETIs performed in four of five studies, but not career experience in three of four studies. Only one study examined OHCA outcome, and reported an increase in survival to hospital discharge when practitioners had high ETI exposure. Conclusions: There is no clear evidence of an association with EMS practitioner career experience or exposure to OHCA cases and ALS procedures, with the exception of exposure to ETI and successful placement. However, most studies in this field had substantial risk of bias. Therefore, further studies are required before any definitive conclusions can be drawn.
    Resuscitation 05/2014; 85(9). DOI:10.1016/j.resuscitation.2014.05.020 · 3.96 Impact Factor
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    ABSTRACT: Aim and Methods: We conducted a retrospective single centre review to examine the incidence and outcomes of patients who received VAECMO after presenting to hospital with AMI. Results: From January 2009 until January 2014 138 patients were treated with VAECMO, of whom 33 (24%) had AMI. 23 of the 33 (70%) had cardiac arrest requiring either CPR or defibrillation prior to cannulation. 10 (30%) were undergoing chest compressions (CC) during ECMO cannulation. 16 (48%) required VAECMO after initial support with an intra-aortic balloon pump. 24 (72%) had primary percutaneous intervention; 6 (18%) had emergent coronary artery grafting surgery; and 6 were not revascularised. 21 (63%) were cannulated for VAECMO after and 12 (36%) prior to attempts at revascularisation. 21 patients (64%) survived their VAECMO run: 17 (51%) were successfully weaned and 4 (11%) were bridged to long term ventricular assist device. Overall survival to hospital discharge was 48% (16 patients). 13 patients died while on VAECMO. Of the non-survivors: 7 had catastrophic intracranial injury diagnosed on ECMO; 4 had documented neurological recovery but no cardiac recovery; and 4 patients died of progressive multisystem organ failure without assessment of neurological function. Survivors had higher pH and lower lactate at cannulation. Cardiac arrest prior to and CC during cannulation were more common in non-survivors. Conclusions: AMI accounts for almost 25% of patients requiring VAECMO. Survival to hospital discharge was 48%. Factors at initiation of VAECMO have been associated with survival: survivors had higher pH and lower serum lactate levels at cannulation; cardiac arrest prior to ECMO and chest compression during cannulation were associated with non-survival. Optimal timing of VAECMO and revascularisation need further investigation
    EuroELSO, Paris; 05/2014
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    ABSTRACT: To examine the impact of population density on incidence and outcome of out-of-hospital cardiac arrest (OHCA). Data were extracted from the Victorian Ambulance Cardiac Arrest Registry for all adult OHCA cases of presumed cardiac aetiology attended by the emergency medical service (EMS) between 1 January 2003 and 31 December 2011. Cases were allocated into one of five population density groups according to their statistical local area: very low density (≤ 10 people/km(2)), low density (11-200 people/km(2)), medium density (201-1000 people/km(2)), high density (1001-3000 people/km(2)), and very high density (> 3000 people/km(2)). Survival to hospital and survival to hospital discharge. The EMS attended 27 705 adult presumed cardiac OHCA cases across 204 Victorian regions. In 12 007 of these (43.3%), resuscitation was attempted by the EMS. Incidence was lower and arrest characteristics were consistently less favourable for lower population density groups. Survival outcomes, including return of spontaneous circulation, survival to hospital and survival to hospital discharge, were significantly poorer in less densely populated groups (P < 0.001 for all comparisons). When compared with very low density populations, the risk-adjusted odds ratios of surviving to hospital discharge were: low density, 1.88 (95% CI, 1.15-3.07); medium density, 2.49 (95% CI, 1.55-4.02); high density, 3.47 (95% CI, 2.20-5.48) and very high density, 4.32 (95% CI, 2.67-6.99). Population density is independently associated with survival after OHCA, and significant variation in the incidence and characteristics of these events are observed across the state.
    The Medical journal of Australia 05/2014; 200(8):471-5. · 2.85 Impact Factor
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    ABSTRACT: Objective: To examine the impact of population density on incidence and outcome of out-of-hospital cardiac arrest (OHCA). Design, setting and participants: Data were extracted from the Victorian Ambulance Cardiac Arrest Registry for all adult OHCA cases of presumed cardiac aetiology attended by the emergency medical service (EMS) between 1 January 2003 and 31 December 2011. Cases were allocated into one of fi ve population density groups according to their statistical local area: very low density ( 10 people/km2), low density (11–200 people/km2), medium density (201–1000 people/km2), high density (1001–3000 people/km2), and very high density (> 3000 people/km2). Main outcome measures: Survival to hospital and survival to hospital discharge. Results: The EMS attended 27 705 adult presumed cardiac OHCA cases across 204 Victorian regions. In 12 007 of these (43.3%), resuscitation was attempted by the EMS. Incidence was lower and arrest characteristics were consistently less favourable for lower population density groups. Survival outcomes, including return of spontaneous circulation, survival to hospital and survival to hospital discharge, were signifi cantly poorer in less densely populated groups (P < 0.001 for all comparisons). When compared with very low density populations, the risk-adjusted odds ratios of surviving to hospital discharge were: low density, 1.88 (95% CI, 1.15–3.07); medium density, 2.49 (95% CI, 1.55–4.02); high density, 3.47 (95% CI, 2.20–5.48) and very high density, 4.32 (95% CI, 2.67–6.99). Conclusion: Population density is independently associated with survival after OHCA, and signifi cant variation in the incidence and characteristics of these events are observed across the state.
    The Medical journal of Australia 05/2014; 200(8):471. DOI:10.5694/mja13.10856 · 3.79 Impact Factor
  • Stephen Bernard
    BMJ (online) 04/2014; 348:g2735. DOI:10.1136/bmj.g2735 · 16.38 Impact Factor

Publication Stats

6k Citations
394.39 Total Impact Points

Institutions

  • 2008–2015
    • Alfred Hospital
      • Intensive Care Unit
      Melbourne, Victoria, Australia
    • SA Ambulance Service
      Tarndarnya, South Australia, Australia
  • 2006–2015
    • Monash University (Australia)
      • Department of Epidemiology and Preventive Medicine
      Melbourne, Victoria, Australia
  • 2014
    • Victoria University Melbourne
      Melbourne, Victoria, Australia
  • 2003–2014
    • Ambulance Victoria
      Melbourne, Victoria, Australia
    • University of Vic
      Vic, Catalonia, Spain
  • 2012
    • Baker IDI Heart and Diabetes Institute
      Melbourne, Victoria, Australia