Correction: Identifying areas of Australia with high out-of-hospital cardiac arrest incidence and low bystander cardiopulmonary resuscitation rates: A retrospective, observational study.

[This corrects the article DOI: 10.1371/journal.pone.0301176.].

Identifying areas of Australia with high out-of-hospital cardiac arrest incidence and low bystander cardiopulmonary resuscitation rates: A retrospective, observational study.

AIM: This study aims to explore regional variation and identify regions within Australia with high incidence of out-of-hospital cardiac arrest (OHCA) and low rates of bystander cardiopulmonary resuscitation (CPR). METHOD: Adult OHCAs of presumed medical aetiology occurring across Australia between 2017 and 2019 were mapped onto local government areas (LGA) using the location of arrest coordinates. Bayesian spatial models were applied to provide "smoothed" estimates of OHCA incidence and bystander CPR rates (for bystander-witnessed OHCAs) for each LGA. For each state and territory, high-risk LGAs were defined as those with an incidence rate greater than the state or territory's 75th percentile and a bystander CPR rate less than the state or territory's 25th percentile. RESULTS: A total of 62,579 OHCA cases attended by emergency medical services across 543 LGAs nationwide were included in the study. Nationally, the OHCA incidence rate across LGA ranged from 58.5 to 198.3 persons per 100,000, while bystander CPR rates ranged from 45% to 75%. We identified 60 high-risk LGAs, which were predominantly located in the state of New South Wales. Within each region, high-risk LGAs were typically located in regional and remote areas of the country, except for four metropolitan areas-two in Adelaide and two in Perth. CONCLUSIONS: We have identified high-risk LGAs, characterised by high incidence and low bystander CPR rates, which are predominantly in regional and remote areas of Australia. Strategies for reducing OHCA and improving bystander response may be best targeted at these regions.

Out-of-hospital cardiac arrest in residential aged care facilities is independently associated with lower survival in Perth, Australia.

Aim: To compare out-of-hospital cardiac arrest (OHCA) characteristics and outcomes between people aged ≥ 65 years who arrested in a residential aged care facility (RACF) versus a private residence in Perth, Australia. Methods: We undertook a retrospective cohort study of OHCA cases attended by emergency medical services (EMS) in Perth, January 2018-December 2021. OHCA patient and event characteristics and survival outcomes were compared via univariate analysis. Multivariable logistic regression was used to investigate the relationship between residency type and (i) return of spontaneous circulation (ROSC) at emergency department (ED) and (ii) 30-day survival. Results: A total of 435 OHCA occurred in RACFs versus 3,395 in private residences. RACF patients were significantly older (median age: 86 [IQR 79, 91] vs 78 [71, 85] years; p < 0.001), more commonly female (50.1% vs 36.8%; p < 0.001), bystander-witnessed arrests (34.9% vs 21.5%; p < 0.001), received bystander cardiopulmonary resuscitation (42.1% vs 28.6%; p < 0.001), had less shockable first monitored rhythms (4.0% vs 8.1%; p = 0.002) and more frequently had a "do not resuscitate" order identified (46.0% vs 13.6%; <0.001). Among those with EMS-attempted resuscitation or with defibrillation before EMS arrival, ROSC at ED and 30-day survival were significantly lower in the RACF group (6.2% vs 18.9%; p < 0.001 and 1.9% vs 7.7%; p < 0.001). The adjusted odds of ROSC at ED (aOR: 0.22 [95%CI: 0.10, 0.46]) and 30-day survival (aOR: 0.20 [95%CI 0.05, 0.92]) were significantly lower for RACF residents. Conclusion: RACF residency was an independent predictor of lower survival from OHCA, highlighting the importance of end-of-life planning for RACF residents.

Association between initial presenting level of consciousness and patient acuity - A potential application for secondary triage in emergency ambulance calls.

INTRODUCTION: Conscious state assessment is important for the triage of emergency patients. In this study, we measured the association between ambulance patients' conscious state and high versus lower acuity, with a view to informing telephone triage assessment of conscious state. METHODS: Data were analysed from one year of emergency ambulance incidents in Perth, Western Australia. Patient conscious state at the time of paramedic arrival was compared to acuity (based on paramedic assessment and management). We determined the proportion of high-acuity patients across six levels of consciousness (Alert, Confused, Drowsy, Voice Response, Pain Response, Unresponsive) overall, and within individual protocols of the Medical Priority Dispatch System (MPDS). RESULTS: The proportion of high acuity patients increased with each step across the consciousness scale. Applying conscious state as a binary predictor of acuity, the largest increases occurred moving the threshold from Alert to Confused (22.0-48.6% high acuity) and Drowsy to Voice Response (61.9-89.5% high acuity). The Area Under the Curve (AUC) of the Receiver Operating Characteristic was 0.65. Within individual protocols, the highest AUC was in Cardiac Arrest (0.89), Overdose/Poisoning (0.81), Unknown Problem (0.76), Diabetic Problem, (0.74) and Convulsions/Fitting (0.73); and lowest in Heart problems (0.55), Abdominal Pain (0.55), Breathing Problems (0.55), Back Pain (0.53), and Chest Pain (0.52). CONCLUSION: Based on these proportions of high acuity patients, it is reasonable to consider patients with any altered conscious state a high priority. The value of conscious state assessment for predicting acuity varies markedly between MPDS protocols. These findings could help inform secondary triage of ambulance patients during the emergency call.

Effect of rehabilitative exercise and spinal manipulative therapy on veteran with chronic diffuse spine pain: A case report.

INTRODUCTION: Patient is a 57-year-old male veteran with complaints of musculoskeletal origin. The patient was treated with rehabilitative exercise, manual therapy, and spinal manipulative therapy. Treatment helped improve the patient's ability to perform ADLs and is reflected in rehabilitative exercise progression and objective findings. CASE PRESENTATION: The patient is a 57-year-old male veteran who presented with chronic cervical, thoracic, and lumbar pain. Range of motion was decreased and painful during all active ranges of motion. Each region had degenerative changes at various levels confirmed via radiographs. Rehabilitative exercise was directed with results from a Selective Functional Movement Assessment (SFMA). Patient was treated with manual therapy and spinal manipulative therapy (SMT). Rehabilitative exercises were selected to improve the patient's ADLs based on goals, to target chief complaints, and correct SFMA findings. MANAGEMENT AND OUTCOME: The patient's progress was tracked with progression in rehabilitative exercise. The patient's objective findings continually improved throughout the care plan. At the end of the care plan, the patient underwent the same examination, and the objective findings were compared. There was an improvement across all objective testing. DISCUSSION: This case demonstrates the classic veteran with chronic diffuse spine pain that interferes with performance in their normal activities of daily living. This case demonstrated that the combination of soft tissue therapy, SMT and rehabilitative exercise can show an improvement in objective findings and help the patient meet their goals.