Ben Meadley

Monash University (Australia) · Department of Paramedicine

Objectives Stress‐induced hyperglycaemia (SIH) is an elevated blood glucose level (≥11.1 mmol/L) in patients experiencing physiological stress, in the absence of diabetes mellitus. Although early in‐hospital SIH has been associated with worse outcomes following major trauma, the predictive value of SIH in the prehospital setting has not been establ...

Background: Paramedics working in helicopter teams undertake water and land rescues. Historical assessments of role-related fitness were not developed using physical employment standards methodology. Objective: To compare the historical selection tests with new tests developed via contemporary scientific methodology. Methods: Candidates underg...

Introduction New paramedics commencing emergency work and adjusting to shift work can experience an increase in sleep problems. Sleep disturbances have been closely associated with poor mental health in emergency personnel. It is unknown, however, whether poor sleep experienced in the initial months of emergency work represents an early risk factor...

Introduction In experienced shift workers, researchers have evaluated levels of shift work tolerance (SWT) and sleep behaviours. SWT refers to not experiencing negative consequences associated with shift work, whereas sleep behaviours, describe strategies workers may use to cope with shift work. Neither sleep behaviours nor SWT have been longitudin...

Background and Objectives The appropriate use of blood components is essential for ethical use of a precious, donated product. The aim of this study was to report in‐hospital red blood cell (RBC) transfusion after pre‐hospital transfusion by helicopter emergency medical service paramedics. A secondary aim was to assess the potential for venous bloo...

The centralisation of trauma services in western countries has led to an improvement in patient outcomes. Effective trauma systems include a pre‐hospital trauma system. Delivery of high‐level pre‐hospital trauma care must include identification of potential major trauma patients, access and correct application of lifesaving interventions (LSIs) and...

Objectives Diet quality often changes as shift workers adjust to atypical work schedules, however, limited research exists examining the early effects of starting rotating shift work on diet and body composition. This study explored dietary behavior changes occurring in graduate paramedics during the first year of exposure to rotating shift work, a...

Background: Clinical deterioration is a time-critical medical emergency requiring rapid recognition and intervention. Deteriorating patients are seen across various healthcare settings, including the out-of-hospital (OOH) environment. OOH care is an evolving area of medicine where decisions are made regarding priority and timing of clinical interv...

The consequences of human error range from the benign to the catastrophic. Feedback and formal review of failures in human performance are essential for learning and avoidance of harm in the future. However, anecdotal evidence suggests that paramedicine may sustain a culture where formal review of error may be considered punitive, hampering enhance...

Objectives: Transfusion of a high ratio of plasma to packed red blood cells (PRBC), to treat or prevent acute traumatic coagulopathy, has been associated with survival after major trauma. However, the effect of pre-hospital plasma on patient outcomes has been inconsistent. The aim of this pilot trial was to assess the feasibility of transfusing fr...

Objectives: Emergency intubation in children is an infrequent procedure both in the pre-hospital and hospital setting. The anatomical, physiological and situational challenges together with limited clinician exposure can make this a difficult procedure with high risk of adverse events. The aim of this collaborative study between a state-wide ambul...

Study objectives: To explore potential relationships and longitudinal changes in sleep and mental health in recruit paramedics over the first 6-months of work, and whether sleep disturbances pre-emergency work predict future mental health outcomes. Methods: Participants (N=101, 52% female, Mage=26 years) completed questionnaires prior to (baseli...

We aimed to use the bookmark method to establish minimum standards for selecting intensive care flight paramedics. Two subject matter expert (SME) focus groups reviewed nine videos of decreasing duration showing land and water helicopter rescue tasks. Focus Group 1 (FG1, n = 10) viewed videos individually off-site, whilst Focus Group 2 (FG2, n = 9)...

Ambulance services require candidates to pass physical employment tests (PETs) to be deemed suitable for the paramedic role. Whilst some research has been undertaken to improve to relevance of these tests, they are often arbitrary and not based on research. The first phase in developing PETs is to generate a list of job tasks. To examine the utilit...

Objectives Depression and anxiety are prominent in paramedics, as is the prevalence of shift work disorder (SWD), a circadian sleep condition comorbid with mental health disorders. However, the role of mental health risk factors for SWD is largely unknown. This study investigated whether mental health levels in recruit paramedics before shift work...

Introduction Intravenous cannulation is a common procedure for paramedics. Difficulty is often encountered and may result in escalation of care to an intensive care paramedic (ICP). Ultrasound-guided peripheral intravenous access (USGPIVA) is used in-hospital as an alternative approach. Historically limited to physicians, it is increasingly embrace...

Paramedicine is an evolving and integral component of the health system, though the profession has historically relied on medicine and nursing to drive a research agenda. Now, with a well-established research presence, still lacking is the formalized role of the clinician-academic. In this opinion piece, the authors detail how paramedic clinician-a...

Background Respiratory distress is a common presentation attended by paramedics. Chest auscultation has been shown to have low accuracy for diagnosing respiratory complaints, and this can lead to inaccurate patient assessment and potentially poor patient outcomes. Conversely, lung ultrasound is a relatively simple exam allowing for rapid differenti...

Background The acute derangement of physiological function is a time-critical medical emergency requiring prompt recognition. As autonomous practitioners in resource scarce, high-risk environments, clinical deterioration can impose complex and increased clinical demands on paramedics. Early recognition is imperative to facilitating proactive respon...

Introduction Non-physician performed point-of-care ultrasound (POCUS) is emerging as a diagnostic adjunct with the potential to enhance current practice. The scope of POCUS utility is broad and well-established in-hospital, yet limited research has occurred in the out-of-hospital environment. Many physician-based studies expound the value of POCUS...

Background The use of ultrasound in the out-of-hospital environment is increasingly feasible. The potential uses for point-of-care ultrasound (POCUS) by paramedics are many, but have historically been limited to traumatic indications. This study utilized a scoping review methodology to map the evidence for the use of POCUS by paramedics to assess r...

Physically demanding water and over land winch rescues are critical tasks for helicopter paramedics. To assess the physiological demands of winch rescue, 14 intensive care flight paramedics (12 male, 2 female, mean (±SD) age 44.3 (±5.4) years, experience 7.1 (±5.2) years) completed land and water-based task simulations. For the land task, VO2 was 4...

Introduction Shift work disorder (SWD) involves excessive sleepiness and/or insomnia and is associated with poor health outcomes in those affected. This study assessed the prevalence of and risk factors for SWD during the first six-months of paramedics’ careers. Furthermore, the study explored potential mediators in the relationship between mental...

Tasks performed by search and rescue (SAR) teams can be physically demanding. SAR organizations are faced with mounting challenges due to increased participation in recreation in remote locations and more frequent extreme weather. We sought to describe the physiological response and the methods for data collection during helicopter emergency medica...

Background Rapid Sequence intubation (RSI) is an airway procedure that uses sedative and paralytic drugs to facilitate endotracheal intubation. It is known that RSI could impact blood pressure in the peri-intubation period. However, little is known about blood pressure changes in longer time frames. Therefore, this analysis aims to describe the cha...

Objective: Shift work is an established risk factor for poor health yet is necessary for paramedics to provide continuous care to the public. It is unknown how early into a career shift work may begin to impact health. This study sought to identify changes in cardiometabolic health, diet, aerobic capacity, physical activity and health-related quali...

Helicopter emergency medical service search and rescue (HEMS SAR) paramedics perform physically demanding winch rescues. Rescue organisations require valid physical employment standards (PES) to ensure personnel can adequately perform duties. There are no studies describing validated PES for HEMS SAR. We convened a subject matter expert (SME) focus...

Swimming is a critical task for helicopter rescue paramedics and aerobic capacity is assessed in this occupation to determine job suitability. We evaluated one treadmill-based and one pool-based assessment of maximal aerobic capacity (V̇O2peak) in 14 helicopter rescue paramedics. There was a small absolute difference (p = 0.11, d = 0.46) between V̇...

Introduction Rapid sequence intubation (RSI) is used to secure the airway of traumatic brain injury (TBI) patients, with ketamine frequently used for induction. Studies show that ketamine induction RSI might cause lower blood pressures when compared to etomidate. It is not clear if the results from that research can be extrapolated to systems that...

Objective: Shift work is an established risk factor for weight gain, cardiovascular disease, Type II diabetes mellitus, and impaired health-related quality of life (HRQoL). Prolonged exposure to shift work is common in paramedics and other emergency medical service (EMS) providers. Sub-populations of EMS workers may have varying health outcomes whe...

The health and well-being of paramedics is central to a successful ambulance service and provision of the highest level of clinical care. The Paramedic Health and Wellbeing Research Unit (PHAWRU) at Monash University (Victoria, Australia) is a newly formed unit that comprises a collaborative team of researchers, emergency service end-users and para...

Background: Reviewing prehospital trauma deaths provides an opportunity to identify system improvements that may reduce trauma mortality. The objective of this study was to identify the number and rate of potentially preventable trauma deaths through expert panel reviews of prehospital and early in-hospital trauma deaths. Methods: We conducted a...

In the pre-hospital setting, point-of-care ultrasound (POCUS) is a useful diagnostic tool that can provide additional clinical information to assist with pre-hospital management strategies and choice of hospital destination. Studies describing the clinical utility of paramedic-performed POCUS in the pre-hospital setting are lacking; however with th...

Introduction: Prehospital airway management of the paediatric patient with traumatic brain injury (TBI) is controversial. Endotracheal intubation of children in the field requires specific skills and has potential benefits but also carries potentially serious complications. We aimed to compare mortality and functional outcomes after six months bet...

Background: Paramedic-performed out-of-hospital ultrasound is a novel skill that has gained popularity in some services in recent years. In this setting point-of care ultrasound (POCUS) can provide additional information that can assist with management and guide transport to the most appropriate facility. We sought to explore the different educatio...

Winching emergency medical care providers from a helicopter to the scene enables treatment of patients in otherwise inaccessible locations, but is not without risks. The objective of this study was to define characteristics of winch missions undertaken by Intensive Care Flight Paramedics (ICFP) in Victoria, Australia with a focus on extraction meth...

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...

Care for patients suffering from major trauma varies greatly throughout the world. This may range from no response at all, to advanced systems comprising multiple levels of response. Much of the understanding of the management of civilian trauma has been drawn from military experience in times of war. Holistic, integrated trauma systems are well-es...