title: Paramedic exposure to out-of-hospital cardiac arrest is rare and declining in Victoria, Australia.
abstract: OBJECTIVE
  Paramedic exposure to out-of-hospital cardiac arrest (OHCA) may be an important factor in skill maintenance and quality of care. We aimed to describe the annual exposure rates of paramedics in the state of Victoria, Australia.
  
  
  METHODS
  We linked data from the Victorian Ambulance Cardiac Arrest Registry (VACAR) and Ambulance Victoria's employment dataset for 2003-2012. Paramedics were 'exposed' to an OHCA if they attended a case where resuscitation was attempted. Individual rates were calculated for average annual exposure (number of OHCA exposures for each paramedic/years employed in study period) and the average number of days between exposures (total paramedic-days in study/total number of exposures in study).
  
  
  RESULTS
  Over 10-years, there were 49,116 OHCAs and 5673 paramedics employed. Resuscitation was attempted in 44% of OHCAs. The typical 'exposure' of paramedics was 1.4 (IQR=0.0-3.0) OHCAs per year. Mean annual OHCA exposure declined from 2.8 in 2003 to 2.1 in 2012 (p=0.007). Exposure was significantly less in those: employed part-time (p<0.001); in rural areas (p<0.001); and with lower qualifications (p<0.001). Annual exposure to paediatric and traumatic OHCAs was particularly low. It would take paramedics an average of 163 days to be exposed to an OHCA and up to 12.5 years for paediatric OHCAs, which occur relatively rarely.
  
  
  CONCLUSIONS
  Exposure of individual paramedics to resuscitation is low and has decreased over time. This highlights the importance of supplementing paramedic exposure with other methods, such as simulation, to maintain resuscitation skills particularly in those with low exposure and for rare case types.
authors: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Ambulance Victoria, Victoria, Australia. Electronic address: Kylie.dyson@monash.edu.
authors: Kylie
authors: K
authors: Dyson
authors: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Discipline of Emergency Medicine, University of Western Australia, Perth, Australia; Alfred Hospital, Melbourne, Australia; School of Nursing and Midwifery, Curtin University, Perth, Australia.
authors: Janet
authors: J
authors: Bray
authors: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Ambulance Victoria, Victoria, Australia; Discipline of Emergency Medicine, University of Western Australia, Perth, Australia.
authors: Karen
authors: K
authors: Smith
authors: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Ambulance Victoria, Victoria, Australia; Alfred Hospital, Melbourne, Australia.
authors: Stephen
authors: S
authors: Bernard
authors: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
authors: Lahn
authors: L
authors: Straney
authors: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Discipline of Emergency Medicine, University of Western Australia, Perth, Australia; School of Nursing and Midwifery, Curtin University, Perth, Australia.
authors: Judith
authors: J
authors: Finn
mesh_terms: D000293:Adolescent; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data*; D002648:Child; D002983:Clinical Competence; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D012189:Retrospective Studies; D014739:Victoria
keywords: Clinical competence; Experience; Exposure; Out-of-hospital cardiac arrest; Resuscitation; Workload