Emergency medicine

Objectives To quantify factors associated with paramedic transport to hospital for older people in residential aged care facilities (RACFs) and supported accommodation, and to identify modifiable drivers of non-transport. Study Type Retrospective cohort study using routinely collected electronic patient care records, analysed with gradient boosting models and multivariable logistic regression. Setting Ambulance Tasmania attendances to RACFs and supported accommodation across Tasmania, 1January 2018 to 31 December 2024. Study Population All eligible ambulance attendances for people aged 65years or older at these facilities. Main Outcome Measures The primary outcome was transport to hospital. Scene time and clinical status at first assessment, summarised using the National Early Warning Score 2 (NEWS2) and Shock Index, were descriptive variables and candidate predictors. Results Of 23,317 attendances, 19,386 (83.1%) resulted in transport and 3931 (16.9%) did not. Most attendances were low risk. Crew skill set, calendar month, initial pain score, respiratory rate and NEWS2 category were the strongest predictors of transport. In adjusted logistic regression, extended care paramedic attendance was associated with markedly lower odds of transport than attendance by standard paramedic crews (adjusted odds ratio, 0.09 [95% CI, 0.07–0.12]), corresponding to an adjusted transport probability of 0.50 compared with 0.85 for intensive care paramedic crews, 0.86 for standard paramedic crews and 0.69 for other crews. Conclusions Paramedic transport decisions for RACF residents were strongly associated with acute illness severity, but crew skill set was also independently associated with transport. Attendances managed by extended care paramedics had lower adjusted probabilities of hospital transport. These findings suggest that extended-scope paramedic models warrant prospective evaluation in this setting.

Sharon Andrews, Pieter F. Fouche, Belinda Flanagan, Michael McDermott, Melanie Greenwood

Ethnocultural minority communities may require specialised emergency response frameworks during mass casualty incidents (MCIs). This article describes the Sydney Jewish community's preparation for, and medical response to, the Bondi Beach terror attack of 14 December 2025. We present a timeline of events during the attack and outline the immediate medical response and recovery actions undertaken in the first hours and days following the incident, including first-hand accounts of responders from the scene. Alongside this account, we present a novel response model implemented by the New South Wales Community Health Support (CHS). CHS is a community-operated, not-for-profit emergency medical response organisation that provides telehealth advice and dispatches volunteer community first responders (including health professionals and trained emergency healthcare workers) to urgent and emergency health incidents within the local community. CHS operates alongside statutory emergency services and is embedded within the community it serves. It is hoped that the lessons identified from this incident may be valuable to the broader international medical community, emergency management agencies and policymakers, and that it may serve as an exemplar for other communities seeking to strengthen preparedness, coordination and resilience in the face of future MCIs.

Aidan Baron, Jesse Lenn, Zachariah Seidman, Matthew N. Lowy, Jeffrey L. Engelman

Thomas Bradley

Objectives To evaluate the effect of hospital occupancy levels on inpatient and emergency department (ED) flow rates, ED length of stay (ED) and access block, and identify critical occupancy thresholds above which patient flow deteriorates. Design Retrospective cohort study using routinely collected administrative data. Setting Twenty-five public hospitals in Queensland, Australia, over a 5.5-year period (1 April 2017 to 31 August 2022). Main Outcome Measures ED presentation and discharge rates, inpatient admission and discharge rates, hospital occupancy levels, length of stay, access block and 4-h rule compliance. Results The analysis reveals a significant performance shift as hospital occupancy levels increase and identifies site-specific critical ‘choke points’ where patient flow deteriorates. Notably, as occupancy rises, we observed a growing divergence between ED presentations and discharge rates, and between inpatient admissions and discharges, indicating system congestion. Additionally, when assessing flow across the 25 hospitals, the data demonstrates that a 10% increase in bed occupancy rate correlates with a 0.32-h (19-min) extension in ED length of stay (or 33min for patients admitted from the ED). Also, significant disparities in hospital operations were observed between weekends and weekdays, with weekday admissions and discharges up to three times higher than weekends, highlighting the increased operational pressure during the work week. Conclusions The investigation challenges the traditional 85% occupancy target, demonstrating that optimal occupancy levels vary by hospital. The study also underscores the strong correlation between hospital bed occupancy and ED access performance, with higher hospital occupancy correlating with longer ED stays and decreased adherence to performance indicators. As hospitals approach full capacity, the pressure on ED resources intensifies, resulting in longer wait times and delays in care.

Vahid Riahi, Justin Boyle, Hwan-Jin Yoon, Hamed Hassanzadeh, Ibrahima Diouf, Sankalp Khanna, Andrew Staib, Mahnaz Samadbeik, Clair Sullivan, Emma Bosley, James F. Lind

Conflicting demands in crisis care units can be alleviated by a flat team hierarchy and clear treatment protocols

Jacqueline P Huber · Alyssa Milton · Matthew Brewer · Kat Fry · Sean Evans · Jason Coulthard · Nicholas Glozier

Aaron BO Wong · Brian H Le

A 62-year-old woman presented to an emergency department with severe pain two hours after rescuing a wild platypus, with two penetrating injuries to her right hand

Irene M Moyer de Miguel · Jennifer C Jamieson · Lori Coulson · Ingrid Berling

Targeted interventions based on further research are needed to reduce differences associated with social determinants of health

for the Australian and New Zealand Intensive Care Society Paediatric Study Group and Centre for Outcomes and Resource Evaluation

Hospital-in-the-home (HITH) models of care provide sustainable, patient-centred, value-based care; but how can we better recognise deteriorating HITH patients?

Mya Cubitt · Seok Lim

New strategies are needed to further improve survival after out-of-hospital cardiac arrest

Emily Nehme · David Anderson · Ross Salathiel · Anthony Carlyon · Dion Stub · Peter A Cameron · Andrew Wilson · Sile Smith · John J McNeil · Ziad Nehme