Brian J Burns

The University of Sydney · Discipline of Emergency Medicine

Background: Refractory out-of-hospital cardiac arrest (OHCA) has poor outcomes. The benefit of expedited intra-arrest transport with ongoing resuscitation versus more extended on-scene resuscitation for refractory OHCA is not clear. Methods: In this Phase III, multi-center (15 hospitals), randomized, controlled trial conducted in Sydney, Australia,...

Background The aim of this study was to develop a consensus-based set of indicators of high-quality acute moderate to severe traumatic brain injury (msTBI) clinical management that can be used to measure structure, process, and outcome factors that are likely to influence patient outcomes. This is the first stage of the PRECISION-TBI program, which...

Refractory out-of-hospital cardiac arrest (OHCA) has a very poor prognosis, with survival rates at around 10%. Extracorporeal membrane oxygenation (ECMO) for patients in refractory arrest, known as ECPR, aims to provide perfusion to the patient whilst the underlying cause of arrest can be addressed. ECPR use has increased substantially, with varyin...

Importance Rib fractures secondary to blunt thoracic trauma typically result in severe pain that is notoriously difficult to manage. The serratus anterior plane block (SAPB) is a regional anesthesia technique that provides analgesia to most of the hemithorax; however, SAPB has limited evidence for analgesic benefits in rib fractures. Objective To...

Purpose Hypocalcaemia upon arrival (HUA) to hospital is associated with morbidity and mortality in the trauma patient. It has been hypothesised that there is an increased incidence of HUA in patients receiving prehospital transfusion as a result of citrated blood products. This research aimed to determine if there was a difference in arrival ionise...

Background The benefit of rapid transport from the scene to definitive in-hospital care versus extended on-scene resuscitation in out-of-Hospital Cardiac Arrest (OHCA) is uncertain. Aim To assess the use of expedited transport from the scene of OHCA compared with more extended on-scene resuscitation of out-of-hospital cardiac arrest in adults. Me...

Background: Whether prehospital administration of tranexamic acid increases the likelihood of survival with a favorable functional outcome among patients with major trauma and suspected trauma-induced coagulopathy who are being treated in advanced trauma systems is uncertain. Methods: We randomly assigned adults with major trauma who were at ris...

Background The use of extracorporeal membrane oxygenation (ECPR) in refractory out-of-hospital cardiac arrest (OHCA) patients is usually implemented in-hospital. As survival in ECPR patients is critically time-dependent, alternative models in ECPR delivery could improve equity of access. Objectives To identify the best strategy of ECPR delivery to...

Background This study identifies the determinants of unplanned readmission after self-inflicted and non-self-inflicted major injury to inform potential readmission screening. Method A retrospective cohort study of 11,269 individuals aged ≥15 years hospitalised for a major injury during 2013–2017 in New South Wales, Australia was conducted using li...

In Australia, there is a paucity of data about the extent and impact of zoonotic tick-related illnesses. Even less is understood about a multifaceted illness referred to as Debilitating Symptom Complexes Attributed to Ticks (DSCATT). Here, we describe a research plan for investigating the aetiology, pathophysiology, and clinical outcomes of human t...

Objective To investigate the impact of a road safety programme on adolescents’ willingness to engage in risky behaviour as probationary drivers, adjusted for covariates of interest. Method The b streetsmart is a road safety programme delivered to around 25 000 adolescent students annually in New South Wales. Using a smartphone-based app, student a...

PurposeTo describe the characteristics of major injury and identify determinants of long-term unplanned readmission and mortality after self-inflicted and non-self-inflicted injury to inform potential readmission screening.MethodA retrospective cohort study of 11,269 individuals aged ≥ 15 years hospitalised for a major injury during 2013–2017 in Ne...

Background: Hemorrhage is a leading cause of preventable death in trauma. Prehospital medical teams can streamline access to massive transfusion and definitive hemorrhage control by alerting in-hospital trauma teams of suspected life-threatening bleeding in unstable patients. This study reports the initial experience of an Australian "Code Crimson...

Objective investigate the impact of a road-safety program on adolescent willingness to engage in risky behaviour as probationary drivers, adjusted for covariates of interest. Method b streetsmart is a road-safety program delivered to around 25,000 adolescent students annually in New South Wales. Using a smart phone-based app, student and teacher p...

Objective: The objective was to determine whether the use of fentanyl with ketamine for emergency department (ED) rapid sequence intubation (RSI) results in fewer patients with systolic blood pressure (SBP) measurements outside the pre-specified target range of 100-150 mm Hg following the induction of anesthesia. Methods This study was conducted i...

Background The majority of paediatric injury outcomes studies focus on mortality rather than the impact on long-term quality of life, health care use and other health-related outcomes. This study sought to determine predictors of 12-month functional and psychosocial outcomes for children sustaining major injury in NSW. Methods The study included a...

Background: Refractory out-of-hospital cardiac arrest (r-OHCA) is a significant public health concern, affecting an estimated 20,000 victims in Australia annually. There is equipoise in the literature regarding both if, and when, r-OHCA cases should be transported to hospital. Our aim in this study was to identify the current evidence concerning ti...

PurposeThe purpose of this study is to report the relative accuracy of prehospital extended focused assessment with sonography in trauma (eFAST) examinations performed by HEMS physicians.Methods Trauma patients who received prehospital eFAST by HEMS clinicians between January 2013 and December 2017 were reviewed. The clinician’s interpretations of...

Objective Presentations to EDs for major paediatric injury are considerably lower than for adults. International studies report lower levels of critical intervention, including intubation, required in injured children. A New South Wales study demonstrated an adverse event rate of 7.6% in children with major injury. Little is known about the care an...

Introduction Haemorrhage causes most preventable prehospital trauma deaths and about a third of in-hospital trauma deaths. Tranexamic acid (TXA), administered soon after hospital arrival in certain trauma systems, is an effective therapy in preventing or managing acute traumatic coagulopathy. However, delayed administration of TXA appears to be ine...

Background : Timely definitive paediatric trauma care influences patient and parental physical and emotional outcomes. New South Wales (NSW) covers a large geographical area with all three NSW paediatric trauma centres (PTC) located in two approximated major cities, meaning it is inevitable that some injured children receive initial treatment local...

Introduction Despite being a preventable cause of death, drowning is a global public health threat. Australia records an average of 288 unintentional drowning deaths per year; an estimated annual economic burden of $1.24 billion AUD ($2017). On average, a further 712 hospitalisations occur due to non-fatal drowning annually. The Australian state o...

Background Ambulance service blood transfusion is an area of rapid development. In New South Wales, Australia, the blood products carried by ambulance medical teams are often the first available to patients with critical bleeding. In addition to the blood products routinely carried by these teams, the Service created and implemented a method of ini...

BACKGROUND While the accuracy of point of care ultrasound in trauma is well understood, there is limited reporting on the efficacy of prehospital ultrasound by helicopter emergency medical service (HEMS). In severe trauma, early diagnosis and communication of life-threatening injuries has the potential to facilitate timely care. This HEMS ultrasoun...

Background : Injury is the leading cause of childhood death and disability in Australia. Prehospital emergency services in New South Wales (NSW) are provided by NSW Ambulance. The incidence, pre-hospital care provided and outcomes of children suffering major injury in NSW has not previously been described. Methods : This retrospective study was co...

Introduction: Catastrophic hemorrhage remains the leading cause of preventable death. Not all New South Wales (NSW) hospitals stock blood products and, as such, blood products carried by NSW Ambulance retrieval teams are often the first available to critically unwell patients. Objective: To describe the trends, characteristics and predictors of mor...

The use of extracorporeal cardiopulmonary resuscitation (E-CPR) for the treatment of patients with out-of-hospital cardiac arrest who do not respond to conventional cardiopulmonary resuscitation CPR) has increased significantly in the past 10 years, in response to case reports and observational studies reporting encouraging results. However, no ran...

Background Information about children treated in New South Wales (NSW), Australia following major injury has been limited to those treated at trauma centres using mortality as the main outcome measure, restricting assessment of the effectiveness of the Trauma System. This study sought to describe the detailed characteristics as well as functional a...

Objective Analgesia in the prehospital setting is an extremely important, yet controversial topic. Ketamine, a N-methyl D-aspartate (NMDA) receptor antagonist, has been commonly used in the prehospital setting, including recommendations by the US Department of Defense and by the Royal Australian College of Pain Medicine, despite the paucity of high...

Background: Patients with prolonged cardiac arrest that is not responsive to conventional cardiopulmonary resuscitation have poor outcomes. The use of extracorporeal membrane oxygenation (ECMO) in refractory cardiac arrest has shown promising results in carefully selected cases. We sought to validate the results from an earlier extracorporeal card...

Background: Injury remains the leading cause of death and disability for Australian children. There is known variability in the quality of care delivered to injured children in Australia. This study prioritises recommendations developed from an expert review of paediatric trauma cases, for implementation with the aim of improving health service de...

Background: There is known variability in the quality of care delivered to injured children. Identifying where care improvement can be made is critical. This study aimed to review paediatric trauma cases across the most populous Australian State to identify factors contributing to clinical incidents. Methods: Medical records from three New South...

Background: Tick anaphylaxis is a potentially fatal outcome of improper tick removal and management. Objective: To investigate whether killing ticks in-situ with ether-containing sprays or permethrin cream, before careful removal by the mouthparts could reduce this risk. Methods: This was a prospective study at Mona Vale Hospital Emergency Depart...

Background: The use of extracorporeal membrane oxygenation (ECMO) in refractory cardiac arrest (ECPR) has increased exponentially. ECPR is a resource intensive service and its cost effectiveness has yet to be demonstrated. We sought to complete a cost analysis with modelling of cost effectiveness and quality of life outcomes. We sought to complete...

Objective: Prehospital rapid sequence intubation (RSI) is prone to suboptimal documentation. The Greater Sydney Area Helicopter Emergency Medical Service (GSA-HEMS) uses a dedicated Airway Registry (AR) to aid documentation. The AR was only evaluated shortly after its introduction. This first evaluation is followed up to assess the long-term effec...

Background Some critically ill patients require rapid sequence intubation in the emergency department, and ketamine is one sedative agent employed, due to its relative haemodynamic stability. Tachycardia and hypertension are frequent side effects, and in less stable patients, shock can be unmasked or exacerbated. The use of fentanyl as a co‐inducti...

Background To describe pre-hospital, emergency department and acute care assessment and management practices of senior clinicians for patients with acute traumatic spinal cord injury (TSCI) across Australia; and to describe clinical practice variation. Methods We used a descriptive, cross-sectional study design to survey senior clinicians (greater...

Introduction: Catastrophic haemorrhage is recognised as the leading cause of preventable death in trauma and is also prevalent in medical and other surgical aetiology. Prehospital blood product transfusion is increasingly available for both military and civilian emergency teams. Hospitals have well-established massive transfusion protocols for the...

In New South Wales, a coordinated extracorporeal membrane oxygenation (ECMO) retrieval program has been in operation since 2007. This study describes the characteristics and outcomes of patients transported by this service. We performed a retrospective observational study and included patients who were transported on ECMO to either of two adult ter...

Optimal outcomes are as much influenced by critical decision making pathways as by the technical skill of the operator. The complexity and potential cognitive traps underlying critical decision making has long been recognized in the aviation and business communities, however, remains a largely subconscious, unexamined discipline amongst congenital...

Background With the increasing role of point-of-care coagulation testing in trauma, we sought to test the reliability of the thromboelastography (TEG)6s machine in a simulated rotary wing environment. Method A two-arm study was conducted, running TEG6s quality control cartridges in a helicopter flight simulator with realistic vibration and in stab...

Extracorporeal CPR is a second line treatment for refractory cardiac arrest, as written in the latest International Guidelines. Optimal timing, patient selection, location and method of implementation vary across the world. The objective here is to present an international consensus on the pillars of an ECPR program. The major aspect the group agre...

Care of the critically injured begins well before the patient arrives at a large academic trauma center. It is important to understand the continuum of care from the point of injury in the prehospital environment, through the local hospital and retrieval, until arrival at a trauma center capable of definitive care. This article highlights the impor...

We respond to the Tarpgaard et al. article reporting on pre-hospital endotracheal intubation (PHETI) success and complications by Danish critical care teams including critical care anaesthetists. We compare the authors’ results with previously published results from our service’s experience with PHETI in a similar patient population, also with phys...

Background The effective treatment of airway compromise in trauma and non-trauma patients is important. Hypoxia and hypotension are predictors of negative patient outcomes and increased mortality, and may be important quality indicators of care provided by emergency medical services. Excluding cardiac arrests, critical trauma and non-trauma patient...

p>Patient care in the prehospital and retrieval medicine (PHARM) environment presents many technical and non-technical challenges. Clinicians are frequently required to perform complex interventions in a time critical and resource limited setting. Intensive training is required prior to operational deployment, and ongoing training is vital to ensur...

Objectives: The aim of this study was to describe patient demographics, injuries, physiology and interventions performed by retrieval physicians in the care of burns patients in both a pre-hospital and interhospital setting. Methods: A retrospective review of patient records from a large Australian Helicopter Emergency Medical Service was conduc...

Study objective: We examine first-look success in emergency pediatric intubation by a physician-staffed helicopter emergency medical service (EMS). Methods: A database analysis of all pediatric (<16 years) intubations during a 64-month period was undertaken, using data from a prospectively enrolled electronic airway registry form. Recorded findi...

Patients with respiratory distress present a frequent and challenging dilemma for emergency physicians (EPs). The accurate diagnosis and treatment of the underlying pathology is vitally important in these sick patients to ensure the best outcome and minimise harm from unnecessary treatments. Within the last decade, studies have shown lung ultrasono...

Introduction Around 300 people sustain a new traumatic spinal cord injury (TSCI) in Australia each year; a relatively low incidence injury with extremely high long-term associated costs. Care standards are inconsistent nationally, lacking in consensus across important components of care such as prehospital spinal immobilisation, timing of surgery a...

Background: Injury is a leading cause of death and disability for children. Regionalised trauma systems have improved outcomes for severely injured adults, however the impact of adult orientated trauma systems on the outcomes of severely injured children remains unclear. The objective of this study is to review the processes of care and describe t...

Aim: To describe the ECPR experience of two Australian ECMO centres, with regards to survival and neurological outcome, their predictors and complications. Methods: Retrospective observational study of prospectively collected data on all patients who underwent extracorporeal cardiopulmonary resuscitation (ECPR) at two academic ECMO referral cent...

Background Life-like end-tidal capnography (ETCO2) waveforms have been demonstrated in recently deceased and fresh-frozen cadavers following tracheal intubation, offering potential for high fidelity airway simulation training. As the mechanism for carbon dioxide production is not fully understood, it is possible that oesophageal intubation may also...

Background Non-invasive ventilation (NIV) therapy is widely used for the management of acute respiratory failure. The objective of this study was to investigate the current use of NIV during interhospital retrievals in an Australian physician-led aeromedical service. Methods We reviewed patients receiving NIV during interhospital retrieval at the...

Objective There is little current evidence regarding which therapeutic agents are actually used within existing aeromedical services. The Greater Sydney Area Helicopter Emergency Medical Service operates a large, physician-staffed, multimodal, prehospital and interhospital retrieval service. The aim of the present study was to identify the range an...

The prevalence of hypothermia in patients following helicopter transport varies widely. Low outside air temperature has been identified as a risk factor. Modern helicopters are insulated and have heating; therefore outside temperature may be unimportant if cabin heat is maintained. We sought to describe the association between outside air, cabin an...

Objective: Early death following cranial trauma is often considered unsurvivable traumatic brain injury (TBI). However, Impact Brain Apnoea (IBA), the phenomenon of apnoea following TBI, may be a significant and preventable contributor to death attributed to primary injury. This paper reviews the history of IBA, cites case examples and reports a s...

Competent performance of cricothyroidotomy, lateral canthotomy and resuscitative thoracostomy is an expected standard for Australasian emergency physicians, but infrequent exposure to these procedures could impair physician confidence, reducing the likelihood of their execution in a critical timeframe. Training to perform these procedures is a reco...

Study objective: Ketamine is considered a stable induction agent for rapid sequence induction; however, hypotension rates up to 24% are reported. The shock index (shock index=pulse rate/systolic blood pressure [SBP]) may identify patients at risk of adverse hemodynamic change. We investigate whether SBP and pulse rate response to ketamine inductio...

Objective: Prehospital rapid sequence intubation (RSI) of critically ill trauma patients is a high-risk procedure that may be associated with an increased rate of severe complications such as failed intubation, failure of oxygenation, hypoxia, hypotension, or need for surgical airway. The objective of this study was to describe the factors associa...