Yassr Alhafi, Rachel Peasey, Kelly-Ann Bowles, Luke Perraton
{"title":"An exploration of leadership attributes in paramedicine: A scoping review.","authors":"Yassr Alhafi, Rachel Peasey, Kelly-Ann Bowles, Luke Perraton","doi":"10.1016/j.auec.2026.05.004","DOIUrl":"https://doi.org/10.1016/j.auec.2026.05.004","url":null,"abstract":"<p><strong>Background: </strong>Paramedicine leadership is critical in high pressure emergencies that require rapid decision-making and effective team coordination. Strong leadership supports governance and improves patient outcomes, however, the specific attributes of leadership relevant to paramedicine remain under studied. This scoping review aims to improve an understanding of leadership and its key attributes within the paramedicine profession.</p><p><strong>Methods: </strong>This scoping review followed Joanna Briggs Institute (JBI) methodology and PRISMA-ScR guidelines. Using the PCC framework, Ovid Medline, Ovid Emcare, Ovid Embase, CINAHL, and Scopus were searched from inception to 7 August 2025. Two reviewers independently screened records in Covidence and extracted data. Peer reviewed studies were thematically synthesised and appraised using JBI critical appraisal tools. Leadership patterns were identified through iterative content analysis and narrative contextualisation.</p><p><strong>Results: </strong>Twenty studies (nine rated 'good', and eleven 'fair') from 11 countries were included. Four overarching leadership themes were identified: i) interpersonal skills, ii) professionalism, iii) personal attributes, and iv) learning and teaching capabilities. Transformational and situational leadership models highlighted adaptability, resilience, and ethical governance. The synthesis shows how dynamic interactions among these attributes enhance team effectiveness and crisis response in high-pressure medical settings.</p><p><strong>Conclusion: </strong>Effective paramedic leadership requires structured training in communication, adaptive decision making and ethical governance. This should be supported by system-level reforms that address resource gaps and cultural barriers in emergency care systems.</p>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148036850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Andrea Hetherington, Leisa Bauer, Sheree Rablin, Karen Hay, Faye Jordan
{"title":"Paeds with a wheeze: Improving patient flow with nurse led stretching of inhaled salbutamol.","authors":"Andrea Hetherington, Leisa Bauer, Sheree Rablin, Karen Hay, Faye Jordan","doi":"10.1016/j.auec.2026.05.001","DOIUrl":"https://doi.org/10.1016/j.auec.2026.05.001","url":null,"abstract":"<p><strong>Background: </strong>Acute wheeze is a common emergency department presentation among pre-school aged children. Innovative models of care that safely optimise treatment and streamline patient flow are needed. A nurse-led stretching of inhaled salbutamol pathway was introduced to enable nurses to independently manage bronchodilator weaning. This study evaluated its impact on length of stay within a children's short term treatment area.</p><p><strong>Methods: </strong>A single-site controlled pre-post retrospective cohort study was conducted comparing children aged 1-5 years with wheeze admitted to the children's short term treatment area before and after the implementation of the nurse-led stretching of inhaled salbutamol pathway. A gastroenteritis cohort admitted during the same periods served as a non-equivalent control group to assess temporal confounding. The primary outcome was length of stay; secondary outcome included admission to the paediatric service.</p><p><strong>Results: </strong>The wheeze cohort included 533 children. Median length of stay was similar pre- and post-implementation (420 vs 429 min; p = 0.48). However, escalation to a medical officer or nurse practitioner significantly declined post-implementation (from 70.9% to 49.8%; p < 0.001), while utilisation of criteria-led discharge increased (from 41.0% to 64.3%; p < 0.001).</p><p><strong>Conclusions: </strong>The nurse-led stretching of inhaled salbutamol pathway did not reduce length of stay but demonstrated comparable outcomes to conventional care. This model appears safe and may enhance workforce capacity and ED efficiency.</p>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sarah Tucknott, Lyndall Finn, Kevin N Keane, Dan L Rose, Ciaran Voyce, Damian Jolly, Judith Finn
{"title":"Continuous quality improvement activities undertaken in ambulance services in Australia and New Zealand: A scoping review.","authors":"Sarah Tucknott, Lyndall Finn, Kevin N Keane, Dan L Rose, Ciaran Voyce, Damian Jolly, Judith Finn","doi":"10.1016/j.auec.2026.05.005","DOIUrl":"https://doi.org/10.1016/j.auec.2026.05.005","url":null,"abstract":"<p><strong>Aim: </strong>To describe the Continuous Quality Improvement (CQI) projects undertaken in Australian and New Zealand (ANZ) emergency ambulance services.</p><p><strong>Background: </strong>Continuous Quality Improvement (CQI) is a structured approach to progressively improving processes within an organisation. CQI is well established in hospital settings but the extent of projects in emergency ambulance services is less well known.</p><p><strong>Methods: </strong>Following the Joanna Briggs Institute (JBI) methodology for scoping reviews, a search of five databases, the websites of 10 ANZ emergency ambulance services and grey literature was undertaken. Papers describing CQI projects undertaken by emergency ambulance services were included.</p><p><strong>Results: </strong>Seven papers were included, six of Australian origin. Results were mapped against National Safety and Quality Health Service (NSQHS) ambulance standards. All seven papers related to Standard One, Clinical Governance. Six related to Standard Eight, Recognising and Responding to Acute Deterioration. One related to Standard Two, Partnering with Consumers, and one to Standard Four, Medication Safety. Comments in reports on emergency ambulance service websites suggest CQI programmes exist; however, specific projects are not publicly listed.</p><p><strong>Conclusions: </strong>There is a paucity of publicly available evidence of CQI projects undertaken in the prehospital setting in ANZ. Emergency ambulance services should be encouraged to share information about CQI projects and results.</p>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147984506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Muhamad Adam, Mustikasari, Yeni Rustina, Tuti Herawati
{"title":"Situation awareness in emergency nursing practice: A concept analysis.","authors":"Muhamad Adam, Mustikasari, Yeni Rustina, Tuti Herawati","doi":"10.1016/j.auec.2026.05.002","DOIUrl":"https://doi.org/10.1016/j.auec.2026.05.002","url":null,"abstract":"<p><strong>Background: </strong>Situation awareness (SitAw) is increasingly recognized as a critical cognitive capability in emergency nursing; however, conceptual ambiguity persists regarding its defining attributes and conceptual boundaries, particularly in relation to decision-making in time-critical clinical environments. This concept analysis aimed to clarify the concept of SitAw and its defining attributes within the context of emergency nursing practice.</p><p><strong>Methods: </strong>A concept analysis was conducted using the Walker and Avant framework. Thirty-six articles from multiple disciplines were reviewed to identify the defining attributes, antecedents, consequences, and empirical referents of SitAw relevant to emergency nursing practice.</p><p><strong>Results: </strong>SitAw was consistently characterized by three core defining attributes: perception, comprehension, and projection, forming a dynamic cognitive process through which emergency nurses recognize relevant cues, interpret their significance, and anticipate future patient states. Decision-making did not emerge as a defining attribute but was identified as a decision-oriented readiness resulting from effective SitAw in time-critical settings. Key antecedents included clinical experience, assessment and monitoring skills, access to monitoring technologies, and supportive work environments, while consequences were reflected in patient safety and quality-of-care outcomes.</p><p><strong>Conclusion: </strong>This analysis clarifies SitAw as a foundational cognitive process underpinning effective emergency nursing practice and provides a refined conceptual basis to support future research, education, and patient safety initiatives in emergency settings.</p>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147864806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Urgent care centres and their role in metropolitan healthcare systems in high-income countries: A scoping review.","authors":"Nicole W Carter, Judith Finn, Janie A Brown","doi":"10.1016/j.auec.2026.03.003","DOIUrl":"https://doi.org/10.1016/j.auec.2026.03.003","url":null,"abstract":"<p><strong>Background: </strong>Urgent care centres are expanding within high-income metropolitan healthcare systems as an accessible option for non-life-threatening conditions. Understanding their service scope, patient profiles, and system impacts is critical to informing policy and care delivery.</p><p><strong>Methods: </strong>A scoping review was conducted using the JBI methodology. MEDLINE, EMBASE, CINAHL, and Web of Science were searched up to September 2025. Studies published in English between 1970 and 2025 were included. Two independent reviewers screened all citations, and data were extracted using a standardised template covering patient demographics, service characteristics, and health system outcomes.</p><p><strong>Results: </strong>Twenty-two studies were included, mostly from the United States. Urgent care centres primarily served younger adults, especially women, presenting with minor injuries, infections, and musculoskeletal conditions. Services were disproportionately located in higher-income metropolitan areas. Staffing models ranged from physician-only to multidisciplinary teams, and workforce reporting outside North American studies was limited. Some evidence suggests that reductions in low-acuity emergency department visits occurred when urgent care centres were located near hospitals, although overall effects on emergency department and primary care utilisation were mixed. UCCs reduce per-visit costs, but total system expenditure may increase due to induced demand. Where reported, patient outcomes and satisfaction were generally favourable.</p><p><strong>Conclusions: </strong>Urgent care centres offer value in managing acute, non-emergent care but require policy alignment in workforce, funding, and integration to maximise impact.</p>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147724919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Derek Collings-Hughes , Ashlea Smith , Stephen Ball
{"title":"Drowning in research? A scoping review of the emergency response to medical emergencies occurring in water-based environments","authors":"Derek Collings-Hughes , Ashlea Smith , Stephen Ball","doi":"10.1016/j.auec.2025.08.003","DOIUrl":"10.1016/j.auec.2025.08.003","url":null,"abstract":"<div><h3>Background</h3><div>The water-based environment presents challenges to emergency services responding to medical emergencies. These include logistical difficulties, interagency response requirements, and knowledge of unique clinical conditions. Understanding which water-based incidents need emergency response, their locations, and resource needs is essential for preparing paramedics and other emergency service personnel.</div></div><div><h3>Objective</h3><div>To describe the existing literature examining the prehospital response and management of patients who experience an emergency in a water-based environment.</div></div><div><h3>Review methods</h3><div>This review used a scoping review methodology following JBI guidance. Five databases were searched: Ovid Medline, EMCARE, CINAHL, SPORTDiscus, and Web of Science. Two independent reviewers screened articles against predefined inclusion criteria. Data were extracted using a structured form, in accordance with JBI guidance.</div></div><div><h3>Results</h3><div>The search identified 6122 articles, of which 101 were included in the review. Eight emergency service types were described. A broad range of medical emergencies were reported, although most studies focused on fatal drowning. Research on non-fatal drowning and interagency coordination was limited, and reported outcome varied considerably across studies.</div></div><div><h3>Conclusions</h3><div>Much of the prehospital research on water-based emergencies reports only on fatal drowning, with limited attention to other incident types or agency interoperability. Further research is needed to improve understanding of emergency response, patient outcomes, and interoperability of emergency services in the context of water-based emergencies.</div></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"29 1","pages":"Pages 54-64"},"PeriodicalIF":2.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rachael Middleton, Tanya Capper, Robbie King, Scott Devenish
{"title":"Understanding paramedic attrition: A scoping review exploring why paramedics are leaving the profession","authors":"Rachael Middleton, Tanya Capper, Robbie King, Scott Devenish","doi":"10.1016/j.auec.2025.07.002","DOIUrl":"10.1016/j.auec.2025.07.002","url":null,"abstract":"<div><div>Over the past decade, health care and ambulance organisations worldwide have reported increasing paramedic attrition rates, with many of these leavers exiting the profession entirely. Retaining experienced paramedics is necessary to improve patient outcomes, decreasing onboarding costs, and to continue the progression of the profession. Understanding paramedic attrition has gained more interest in the literature; however, studies have mainly focussed on paramedics leaving their place of employment rather than the profession altogether. It is important that this distinction is made as the influencing factors likely vary, requiring different retention strategies. This scoping review aimed to determine the main factors influencing paramedics to leave the profession and identify areas for further research. A total of 1026 articles were screened, of which 28 were included in the final review. Content analysis of their key findings led to the identification of three main themes and 14 subthemes that illustrate the main factors influencing paramedics’ decisions to leave the profession. This review found that paramedic attrition is driven by a complex combination of organisational, occupational, and personal factors. More research, especially from outside the United States, is needed to better understand why paramedics are leaving the profession and to identify targeted retention strategies.</div></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"29 1","pages":"Pages 22-29"},"PeriodicalIF":2.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144805349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Qiqi Liu , Lijin Zhou , Yuanyuan Tang , Wenlin Cheng , Yifan Zhang , Yanjie Ma , Yanhong Liu , Rui Li
{"title":"In-service training needs and expectations of junior nurses in Chinese emergency departments: A qualitative study based on the COM-B model","authors":"Qiqi Liu , Lijin Zhou , Yuanyuan Tang , Wenlin Cheng , Yifan Zhang , Yanjie Ma , Yanhong Liu , Rui Li","doi":"10.1016/j.auec.2025.08.001","DOIUrl":"10.1016/j.auec.2025.08.001","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to explore the in-service training needs and expectations of junior nurses in Chinese emergency departments, using the Capability-Opportunity-Motivation-Behaviour (COM-B) model to inform the development of targeted training strategies.</div></div><div><h3>Methods</h3><div>A qualitative descriptive design and inductive thematic analysis were used. Semi-structured face-to-face interviews were conducted with 16 emergency department (ED) staff between January and February 2025.</div></div><div><h3>Results</h3><div>The training needs and expectations of junior ED nurses can be summarised into four themes: capability, the depth of mental and physical needs; opportunity, the two-way construction of physical and social opportunities; motivation, the synergy of self-motivation and reflective motivation; and training management: diversified training forms, scientifically reasonable training time, composite team of lecturers, and multidimensional assessment and evaluation.</div></div><div><h3>Conclusion</h3><div>In developing in-service training program, nursing managers should pay attention to the needs of nurses in terms of competence, motivation, opportunity and training management, and design training content and forms that meet actual needs, in order to enhance the professionalism and clinical competence of junior ED nurses, strengthen professional identity and work motivation, reduce the willingness to leave, and promote sustainable development.</div></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"29 1","pages":"Pages 36-44"},"PeriodicalIF":2.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144884342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alys-Marie Manguy , Ed Oakley , Rob Gordon , Lynette Joubert
{"title":"Parent experiences and psychosocial needs during critical paediatric emergencies: A thematic network analysis","authors":"Alys-Marie Manguy , Ed Oakley , Rob Gordon , Lynette Joubert","doi":"10.1016/j.auec.2025.08.002","DOIUrl":"10.1016/j.auec.2025.08.002","url":null,"abstract":"<div><h3>Background</h3><div>Family presence during critical paediatric emergencies is increasingly accepted practice in paediatric emergency departments, within Australia and internationally. However, limited research explores parent experiences in high-acuity, resuscitation-level presentations.</div></div><div><h3>Methods</h3><div>This qualitative study used Attride-Stirling’s thematic network analysis methodology to identify key themes. Semi-structured telephone interviews were undertaken with 20 parents whose child received care during a critical paediatric emergency at the Emergency Department of The Royal Children’s Hospital, Melbourne, Australia.</div></div><div><h3>Results</h3><div>Thematic network analysis identified 136 unique themes relating to parent experiences and self-identified psychosocial care needs, resulting in the two organising themes of ‘Parent perspectives’ and ‘Emergency system interventions’, and the global theme of ‘Family responsive service protocols’. These findings highlight the value of family-centred care approaches in paediatric emergency settings, emphasising the importance of staff communication skills and peri-event psychosocial support throughout the episode of care.</div></div><div><h3>Conclusions</h3><div>Recommendations for practice include enhancing communication strategies, improving pre-arrival preparation, optimising the physical environment, and implementing dedicated family support roles.</div></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"29 1","pages":"Pages 45-53"},"PeriodicalIF":2.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}