School of Acute and Primary Health
Permanent link for this collectionhttps://hdl.handle.net/10292/1241
The School of Acute and Primary Health includes Paramedicine, Midwifery, Perioperative Practice and Oral Health.
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Item Enhancing Simulation Training through Immersive Reality: MESH360(Open Access Publishing Association, 2026-06-09) Aiello, Stephen; Cochrane, Thomas; Aguayo, ClaudioThis paper critically evaluates the third prototype design iteration of an immersive reality (XR) enhanced simulation project in healthcare higher education. Drawing from design principles developed since the project’s inception in 2016, the research addresses a gap in current literature: whilst XR has demonstrated positive impacts on clinical skill development, examples of longitudinal studies and engagement with learning theory to inform the design of these environments remain limited. The MESH360 project applies design-based research (DBR) to explore the impact of XR-enhanced simulation for training novice and professional paramedics, triangulating participant feedback, observation, and biometric data. The resulting XR design principles provide a framework for transferable learning designs in high-risk, practice-based environments.Item Prehospital Advanced Versus Basic Life Support: A Cohort Study Comparing Survival to Hospital for Major Trauma Patients in New Zealand(Elsevier, 2025-10-11) Campbell, Nicola; Lilley, Rebbecca; Davie, Gabrielle; Morgaine, Kate; Dicker, Bridget; Kool, BridgetOBJECTIVE: To examine the relationship between prehospital Advanced Life Support (ALS) and survival to hospital for major trauma patients in New Zealand and explore its implications for Emergency Medical Service (EMS) practice. METHODS: A mixed-methods explanatory design was used. Data on major trauma patients attended by road EMS (December 2016-November 2018) was analysed. A multivariable model with propensity scores estimated the odds of survival for patients receiving Advanced versus Basic Life Support (BLS). Semi-structured interviews conducted with EMS stakeholders were analysed using thematic analysis. RESULTS: Among 1118 patients, 661 (59 %) received ALS. Only 52 (5 %) did not survive to hospital. Multivariable modeling estimated ALS recipients had 1.5 times higher odds of survival than BLS-only recipients (OR 1.49, 95 % CI 0.66-3.35). Interviews with five EMS clinical leaders highlighted two likely influences: clinical judgment and evidence use. Despite imprecise quantitative findings, stakeholders supported ALS based on clinical judgment. CONCLUSIONS: A tension between population-level results and provision of care based on clinical judgement exists. Quantitative analysis found no evidence that ALS offers a survival benefit, although considerable uncertainty exists, whereas stakeholders perceive ALS has clinical and equity benefits. Future research should assess equity, disability, and quality of life outcomes of ALS.Item Ethical Challenges in Global Short-term Health Volunteering in Low- and Middle-Income Countries: A Narrative Review(Springer Science and Business Media LLC, 2026-06-04) Ketema, Betelehem; Han, Heuiwon; Tekabe, YodithShort-term medical missions have become a common response to global health needs in resource-limited countries, yet concerns persist about their ethical implications and sustainability. This study aimed to explore the ethical challenges of short-term medical missions and volunteer health initiatives in low- and middle-income countries, with a particular focus on their impact on local health professionals and systems, using Ethiopia as a contextual example. The study adopted a narrative review of literature published between 2010 and 2024. A comprehensive search of MEDLINE, CINAHL Complete, Dentistry & Oral Sciences Source, and Scopus, supplemented by Google Scholar, was undertaken. After screening titles, abstracts, and full texts, along with reference lists of included sources, 61 sources were included. Findings were narratively synthesised to identify major ethical themes and structural contributors. Three recurring themes emerged: violations of clinical scope of practice and inconsistent regulatory oversight; structural power imbalances between foreign volunteers and local professionals; and psychological strain and moral distress among local health professionals. Weak credential verification, dependency on external funding, and limited institutional accountability were identified as contributing factors. Ethical reform in global health volunteering requires a shift from episodic charity to partnership-centred practice that prioritises local leadership, accountability, and sustainability. Key strategies include transparent credential verification, pre-departure ethics and cultural competency training, equitable supervision frameworks, and alignment with international guidelines. By implementing these measures, global health volunteering can strengthen local health services and professionals, build more resilient systems and ensure the benefits endure beyond the mission period.Item Home is Where the Heart is: The Case for Mobile Defibrillators to Improve Out-of-Hospital Cardiac Arrest Survival(New Zealand Medical Association, 2026-05-29) Hutchinson, Heather; Dicker, Bridget; Todd, Verity; Swain, Andrew; Scott, Tony; Garcia, Elena; Maessen, Sarah ERapid defibrillation is vital in out-of-hospital cardiac arrest (OHCA) treatment. In Aotearoa New Zealand, trained responders dispatched by the 111 system (emergency medical services [EMS], Fire and Emergency New Zealand [FENZ] and dispatched first response groups) with defibrillators reach a patient in cardiac arrest an average of 8 minutes after a 111 call in urban areas and 11 minutes in rural areas. However, odds of survival drop dramatically after a delay to defibrillation of only 2 to 5 minutes after collapse.Item Views and Engagement With Clinical Research: A Cross-sectional Survey of New Zealand Midwives and Nurses(Elsevier BV, 2026-05-12) Cronin, Robin ; Bradford, Billie ; Morris, Kimberley ; Blaser, Fiona ; Shen, Ivy ; Gafa, Shekinah ; Ashcroft, Shelley ; McAra-Couper, Judith ; Grigg, Celia ; Aspinall, CathleenBackground In New Zealand (NZ), the combined workforces of midwives and nurses comprise the largest proportion of the health workforce. Their involvement in clinical research is fundamental to delivering evidence-based healthcare, with clear benefits for consumers, clinicians, and organisations. Despite professional expectations to engage with evidence, little is known about their views and engagement with research. Aim To explore views and engagement with research among registered midwives and registered nurses in a large urban health district in NZ. Methods A cross-sectional, online mixed methods survey of registered midwives and registered nurses using an adapted validated tool. Quantitative data were analysed for differences between professions, and qualitative free-text responses were analysed thematically. Results Respondents comprised 77 registered midwives and 217 registered nurses. Almost half (47.3%, 139) had a postgraduate qualification. Few had been part of a research team (25.5%, 75) or had research skills. Main barriers to research involvement were lack of time and funding, alongside work-life balance. A key motivation was reducing health inequities for Māori and Pasifika communities. All respondents supported consumer participation in research. Nurses were more likely than midwives to report that conducting research was part of their role (p = 0.040) and to express concern about its impact on their workload (p = 0.033) and consumer participation (p < 0.001). Discussion Midwives and nurses reported similar positive research views and represent a motivated but underutilised research workforce. However, organisational and individual constraints limit research engagement. Conclusion Targeted investment in research capacity could help realise this untapped potential and improve equitable, evidence-based health outcomes.Item Ventilation Parameters During Adult Cardiopulmonary Resuscitation: A Systematic Review(Elsevier, 2026-05-01) Johnson, NJ; Debaty, G; Yang, BY; Moskowitz, A; Drennan, I; del Castillo, J; Olasveengen, T; Berg, KM; Morrison, LJ; Bray, JE; Bradfield, M; Brooks, SC; Cash, RE; Chung, SP; Considine, J; Dainty, KN; Dassanayake, V; Dewan, M; Dicker, B; Dodge, N; Folke, F; Hansen, CM; Ikeyama, T; Lagina, A; Lukas, G; Masterson, S; Morley, PT; Nehme, Z; Norii, T; Perkins, GD; Pocock, H; Raffay, V; Ristagno, G; Samantaray, A; Semeraro, F; Singh, B; Smith, CM; Smyth, MA; Spartinou, A; Vaillancourt, C; Böttiger, BW; Chia, YW; Couper, K; Crow, C; D’Arrigo, S; Deakin, C; Fernando, SM; Garg, R; Granfeldt, A; Grunau, B; Hirsch, KG; Holmberg, MJ; Kudenchuk, P; Lavonas, EJ; Leong, C; Lok, N; Neumar, RW; Nicholson, T; Nikolaou, N; Nolan, JP; O’Neil, B; Ohshimo, S; Parr, M; Sandroni, C; Scquizzato, T; Skrifvars, M; Soar, J; Welsford, M; Zelop, CBackground Effective ventilation during cardiopulmonary resuscitation (CPR) is challenging, with limited evidence to guide optimal rates, volumes, and other parameters. This systematic review, part of the continuous evidence evaluation process for the International Liaison Committee on Resuscitation, examined whether specific tidal volumes, respiratory rates, inspiratory times, or positive end-expiratory pressure (PEEP) improve outcomes. Methods Studies of adults in any setting (in-hospital or out-of-hospital cardiac arrest) receiving ventilation were included if they compared specific tidal volumes, respiratory rates, inspiratory times, or PEEP. MEDLINE, EMBASE, and CENTRAL were searched from inception to November 10, 2025. Risk of bias was assessed using RoB 2.0 and ROBINS-I; certainty of evidence was evaluated with GRADE. Registered in PROSPERO (CRD420251070065). Results Of 3021 records, 11 studies (3 randomized trials, 8 observational) met eligibility criteria. Certainty of evidence was very low, limited by bias, inconsistency, indirectness, and imprecision. Due to heterogeneity, results were reported narratively using Synthesis Without Meta-Analysis (SWiM) guidelines. Ventilation rates showed mixed associations with neurological, survival, and return of spontaneous circulation (ROSC) outcomes; some studies indicated harm with lower ventilation rates. Most found no differences between higher and lower tidal volumes, although very low tidal volumes were associated with worse outcomes in some studies. When impedance-detected ventilations occurred in ≥50% of chest compression pauses during 30:2 CPR, survival and ROSC were higher. Conclusion Evidence on optimal ventilation during CPR is inconsistent and of very low certainty. Very low ventilation rates and tidal volumes may be harmful. Future research should use robust designs to define evidence-based ventilation targets.Item Implementation of Double Sequential Defibrillation (DSD): An Aotearoa New Zealand Observational Study(Elsevier, 2026-05-21) Dicker, Bridget; Callejas, Pablo; Hutchinson, Heather; Todd, Verity F; Swain, Andy; Garcia, Elena; Shaw, Brayden; Tseng, Bruse; Maessen, SarahBACKGROUND AND OBJECTIVES: Double sequential defibrillation (DSD) was introduced in Aotearoa New Zealand Emergency Medical Services (EMS) in October 2023 for refractory ventricular fibrillation (VF) and ventricular tachycardia (VT). Its usage, paramedic's adherence to guidelines, and clinical impact remain uncertain. This study aimed to (1) compare demographic and clinical characteristics between pre- and post-DSD implementation periods, including subgroup analysis of DSD versus no-DSD (NDSD) patients post- implementation, and (2) evaluate survival outcomes across all subgroups, including early- and late-DSD. METHODS: This retrospective cohort study used data across two 18-month periods: pre-period (April 2022-September 2023) and post-period (January 2024-June 2025). All cardiac arrests receiving more than three prehospital defibrillations were included. Post-period analyses compared NDSD and DSD patients, with DSD classified as early-DSD (≤3 shocks before DSD) or late-DSD (>3 shocks before DSD). Chi-Square and Mann- Whitney U tests assessed group differences, and logistic regression examined associations with survival outcomes. RESULTS: Among 1,401 patients (pre-period n=663; post-period n=738), no significant difference in ROSC or 30-day survival was observed (p>0.05). Forty-three percent of patients received DSD. Compared with NDSD, adjusted models showed lower odds of ROSC with any-DSD (aOR 0.59, 95%CI 0.41-0.85) and late-DSD (aOR 0.46, 95%CI 0.30-0.71). Similar results were seen for 30-day survival. Early-DSD showed no significant associations. CONCLUSIONS: No survival benefit was observed after DSD implementation. Lower survival among DSD patients may reflect confounding due to its use in patients with the poorest prognosis. Further research is needed to clarify optimal timing and drivers of DSD use.Item Magic Mouthguards and Primary Oral Health Care–Evidence for Policy Makers(The New Zealand Dental Association, 2026-03-01) Ihimaera, CN; Silcock, EM; Tuohy, JThe World Health Organization (WHO) advocates for diverse evidence in effective health policy development and practice. This paper describes the ‘Magic Mouthguard’ initiative, an innovative oral health collaboration between a university, a corporate sponsor, and a public high school rugby team. Primarily aimed at injury prevention, the team’s international triumph created unforeseen association between the mouthguards and their athletic achievement. The ‘magic’ of these mouthguards lead to communal uplift derived from feeling cared for and invested in, potentially contributing to the rugby team’s victory. The initiative also advanced equitable access to custom-fitted mouthguards while confronting a systemic inequity by providing oral health treatment to young athletes who often face barriers to accessing oral healthcare, especially within a Māori and Pasifika communities in Aotearoa New Zealand. The story illustrates healthcare innovation by demonstrating that settings are integral to healthcare delivery and trust is foundational for engagement. This highlights how leveraging embedded knowledge and diverse evidence can integrate into oral health practice and promote population-level health.Item Exploring Virtual Reality in Undergraduate Midwifery Education: A Qualitative Systematic Review(Elsevier, 2026-04-04) Welfare, M; Crowther, S; Chapman, L; Frost, JBackground: Virtual reality is a promising pedagogical tool in midwifery education, yet the experiential impact on students remains underexplored. This systematic review investigates how virtual reality is experienced in undergraduate midwifery education, addressing gaps in current literature. Aim: To explore midwifery students’ experiences of using a virtual reality learning tool during their undergraduate education, synthesise existing literature, and guide future studies. Methods: A cross-section of nine databases relating to health, education, and computing was searched between January and February 2025. From 107 identified sources, 81 papers were searched against predefined eligibility criteria. Twenty-one full-text articles were assessed, and another 13 papers were excluded. Eight studies met the criteria for data extraction. Critical appraisal, data extraction, synthesis, and findings were undertaken collaboratively. A deviation from the original approach was expanding the scope to include nursing and healthcare students due to the limited midwifery-specific literature. Findings: Three themes were identified: being safe, learning experience, and learning limitations. Discussion: Participants found that virtual reality enhanced safe, effective care by enabling risk-free skill practice, deeper understanding of complex anatomy, and alignment with diverse learning styles. Experiences were mixed: some saw it as an engaging or best suited to younger learners, while others noted the novelty aspect. Challenges included limited access, high costs, steep learning curves alongside coursework, and issues such as discomfort, cybersickness, cognitive overload, and technical difficulties. Conclusion: This review found that virtual reality engages health students and supports skill development, but the lasting pedagogical impact is unclear, requiring further research to refine use in healthcare settings.Item Children’s Experiences of Midwives Working in Aotearoa New Zealand’s Continuity of Care Model(Elsevier BV, 2026-05-13) Clemons, Janine H; Greenslade-Yeats, James H; Jackson, Talei; Mharapara, Tago L; Staniland, Nimbus A; Ravenswood, KatherineBackground: Aotearoa New Zealand’s Continuity of Care (CoC) midwifery model is recognised for its nationalised, public provision of one-to-one midwifery care. The model has distinctive pressures associated with workload, 24/7 on-call, and emotional intensity. While research has examined how these pressures affect midwives, little is known about how this model shapes the lives of midwives’ children. Aim: This study explores how the CoC model of midwifery can influence midwives' children. Methods: We analysed qualitative interviews from 22 families with children aged 11–19 and adult children aged 20 – 40 + participated alongside a current or former CoC midwife. Iterative thematic analysis and reflexive team interpretation informed theme development. Findings: The overarching interpretation, 'living in the shadow of the call’, describes how families continually reorganised themselves around unpredictable CoC work. Five themes described these dynamics: (1) Living on Alert–chronic unpredictability shaping family life; (2) When Work Enters the Home–emotional spillover and blurred boundaries; (3) Children as Stabilisers–adaptive labour and role reversals; (4) Holding the System Together–reliance on extended networks and shared care; and (5) Growing through the Demands–long-term developmental consequences. Children described the costs of 'living in the shadow of the call’, yet also how these experiences built resilience, independence, emotional maturity, and political awareness. Discussion: Children perceived that CoC midwifery shaped their everyday rhythms, relationships and developmental experiences. Children’s accounts highlight the growth and strain associated with living amongst unpredictable care work. Conclusion: Recognising children’s experiences is essential for developing sustainable continuity models that support midwives and the families who enable their practice.Item Australian Dental Practitioners’ Experience and Confidence in Providing Oral Health Care for People With Cerebral Palsy and Other Disabilities(ANZJDOHT, 2025) Lansdown, Karen; Zagreanu, Claudia; Bulkeley, Kim; McGrath, Margaret; Irving, Michelle; Smithers-Sheedy, HayleyObjective: To investigate dental practitioners’ experience and confidence in providing oral health care for people with cerebral palsy (CP) and other disabilities in Australia. Methods: A cross-sectional online survey exploring dental care for people with CP and other disabilities was distributed to registered dental practitioners. Snowball sampling was used to recruit participants via professional associations and social media. Data was collected between December 2023 and August 2024. Descriptive statistics were used to summarize the findings. Results: Fifty-six surveys were completed by oral health therapists (48%), dentists (25%), dental hygienists (13%), dental therapists (9%), and specialists in special needs dentistry (5%). Most were female (88%) and based in major cities (62%). Clinical experience varied from <10 years (30%), 11 to 20 years (29%) and >20 years (39%). More than half the dental practitioners (57%) had received disability-related training. For most practitioners (64%) people with disabilities made up less than 10% of their patient population. Participants reported moderate confidence and experience working with people with disabilities more generally but were less confident and experienced providing services for people with CP. Commonly reported challenges in working with people with CP and people with other disabilities included perceived difficulties with cooperation (52%), accessibility (57%) and behavioural concerns (70%). Most but not all dental practitioners were aware of appropriate referral pathways (80%). Most dental practitioners were interested in further education, particularly CP-specific training, (91%), online modules (87%) and formal accreditation (59%). Conclusion: Improving oral health for people with CP and other disabilities requires a trained and experienced workforce and accessible services. Building clinical skills, expanding education and improving accessibility are key to supportive effective care. Investment in post graduate education in disability-inclusive practice for oral health practitioners, clearer referral pathways and inclusive infrastructure may build a more confident and responsive dental workforce.Item Undergraduate and Postgraduate Special Needs Dentistry Curricula for Oral Health Therapists: A Delphi Study(Wiley, 2026-04-29) Koh, Dorothy K. L.; Aley, Melanie J.; Leadbeatter, Delyse M.; Sohn, Woosung; Lim, Mathew A. W. T.; Longbottom, Troy; Lansdown, Karen; Rawal, Kadambari; Carrington, Samuel D.; Francis, Jessica; Mandasari, Masita; Cleary, Ceara; Pradhan, ArchanaAim: To develop a consensus-based curriculum outline for special needs dentistry (SND) tailored to oral health therapists (OHTs),ensuring relevance and applicability across undergraduate and postgraduate education in Australia. Methods: A four-round online modified Delphi study was conducted. The first three rounds involved both Australian and international experts, while the final consensus round was limited to Australian experts. Experts were selected using purposive sampling based on their experience in SND education, clinical practice, or curriculum development. Participants completed semi-structured surveys derived from publicly accessible learning outcomes (LOs) in student handbooks of undergraduate oral health programs and postgraduate SND specialist programs. Additional insights were drawn from the International Association for Disability & Oral Health (iADH) and the Australian Dental Council (ADC) competency guidelines. Across the rounds, experts rated the importance of proposed LOs, identified their appropriate educational level (undergraduate/postgraduate), and provided qualitative feedback. Consensus was defined a priori as ≥ 70% agreement. Modifications were made between rounds based on expert feedback. Results: In Round 1, 24 experts completed, with 66 of 67 LOs reaching consensus. In Round 2, 20 experts assessed 98 LOs(including new and revised items, categorized into undergraduate and postgraduate), with 96 (97.9%) reaching consensus. Round3 involved 16 experts reviewing unresolved and newly added items; two items did not reach consensus. The final round resulted in consensus on all outstanding LOs and confirmed the overall framework’s relevance to the OHT scope and context. Key refinements across rounds included improved clarity in applying Bloom’s Taxonomy, clearer undergraduate/postgraduate differentiation, and increased specificity to SND. The final document, “Undergraduate and Postgraduate Special Needs Dentistry Curricula for Oral Health Therapists” can be downloaded from the Appendices in the Supporting Information.Item Applying a Health Care Planning Model to Midwifery: Evidence from Germany and New Zealand(Oxford University Press, 2025-10-01) Fleming, Tania; Griese, Anne; Leinweber, Julia; Schuessler, FrankBackground Midwifery workforce planning is essential to ensure equitable access to maternal care but differs widely across countries. Because a dedicated planning tool is lacking, Germany currently does not perform demand-oriented planning for midwifery services. In contrast, New Zealand facilitates planning through centralized data collection and national coordination. This study investigates how planning approaches affect the distribution and accessibility of maternal health care in Germany and New Zealand. Methods Midwifery workforce and population data from Germany and New Zealand were analyzed using a German physician-based demand planning tool adapted for midwifery services. GIS mapping visualized workforce-to-population ratios, spatial accessibility, and socioeconomic disparities in service distribution. Regional care patterns were compared across both systems. Results Application of the adapted physician-based tool in Germany revealed substantial care gaps in rural and peripheral regions, reflecting the absence of a midwifery-specific planning framework. In contrast, assessment in New Zealand showed a more balanced distribution of midwifery services, including remote areas. Centralized workforce monitoring and register-based planning appear to support more equitable access and responsive resource allocation. Conclusions Germany's lack of a dedicated workforce planning system contributes to regional and social inequities in care provision, particularly affecting women with low socioeconomic status. In contrast, New Zealand's structured approach, including centralized monitoring and targeted planning, supports a more balanced distribution across income groups. Adopting such elements may help improve service equity. This study underlines the relevance of tailored planning systems for maternal health and informs policy development. Key messages • Germany’s lack of midwifery planning leads to inequitable access for rural and low-income groups. • New Zealand’s structured system enables more balanced midwifery service provision.Item Communication Technology Practices Used by Midwives with Pregnant Women/people in Aotearoa New Zealand to Ensure Quality Maternal and Newborn Care(Springer Publishing Company, 2024-07-16) Wakelin, Karen J; McAra-Couper, Judith; Fleming, Tania; Erlam, Gwen D.INTRODUCTION: Communication was identified as a component of high-quality maternity care within an evidence-informed Quality Maternal and Newborn Care framework. Communication technology has been shown to enhance relationships midwives develop with their clients; however, concerns with the safety of the communication have been identified. AIM: This article reports on the contribution that communication technology makes toward quality care when used within a continuity of care relationship between midwives and their pregnant clients. METHODS: This article reports on phase 2A of a multiphase study. Semistructured interviews were conducted with lead maternity carer midwives using the online platform Microsoft Teams. Midwives who had previously undertaken an online survey in phase 1A and had indicated interest in participating in an online interview were emailed an invitation to participate. Fourteen midwives responded to the email invitation. Thematic analysis was used to analyze the interview data. FINDINGS: The findings indicate that communication technology facilitates quality care within a midwifery model of continuity of care. This is achieved in two ways through (a) connectedness and being known and (b) an awareness of challenges which in turn enables midwives to develop strategies for ensuring quality care. DISCUSSION: Communication technology, when used within a continuity of care relationship, facilitates quality care. It does this through enabling a connection continuation of connectedness and knowingness which enables midwives to negotiate safe and appropriate means for contact. It also privileges midwives with knowledge of challenges when using communication technology and enables strategies to be developed.Item Experiences of Bereaved Māori Whānau in Out‐of‐Hospital Death Where Emergency Ambulance Services Respond(Wiley, 2026-04-16) Satchell, Eillish; Moeke‐Maxwell, Tess; Gott, Merryn; Dicker, Bridget; Anderson, Natalie EMāori are disproportionately affected by out-of-hospital deaths due to higher rates of cardiac arrest and lower survival outcomes. Ambulance personnel are often the only healthcare professionals present during events, making their role in supporting bereaved whānau (families) critical. However, it remains unclear if current bereavement care meets whānau cultural and spiritual needs. Using kaupapa Māori research principles, this qualitative interview study explores the experiences of bereaved Māori whānau in Aotearoa New Zealand to understand their experiences during an out-of-hospital death when emergency ambulance services respond. Eight interviews with bereaved whānau were completed, with four themes describing how Te Ao Māori (the Māori world) informed whānau needs. Whānau navigated end-of-life collectively, with whānau kotahitanga (family unity) being central to whānau experiences. Tikanga (traditional customs, protocols) during death and dying was important, with such spiritual and cultural needs typically upheld by whānau independently. Whānau presence during the transition between life and death held emotional and cultural significance. Finally, the presence of Māori responders improved whānau experiences. Overall, bereavement care that acknowledges whānau cultural and spiritual needs remains limited during out-of-hospital deaths. Enhancing cultural safety and increasing Māori workforce representation offer key opportunities to strengthen the provision of end-of-life care by emergency ambulance services.Item Ambulance Personnel’s Experiences With Prehospital Births: A Qualitative Study in Aotearoa New Zealand(SAGE Publications, 2025-06-12) Withanarachchie, Vinuli; Todd, Verity; Dicker, Bridget; Maessen, Sarah EBirths in the prehospital setting are infrequent yet associated with increased odds of maternal and neonatal morbidity and mortality. There is limited understanding of the experiences of emergency medical services staff in handling these potentially high-risk situations. We explored the perspectives of ambulance personnel in Aotearoa New Zealand when responding to out-of-hospital births. Hato Hone St John Ambulance is the largest emergency medical services provider in Aotearoa New Zealand. Between October and November 2023, all Hato Hone St John frontline staff were invited to complete an online survey, including open text questions about their experiences and challenges attending unplanned births. Data was coded and organised into themes using NVivo software and the inductive approach to thematic analysis. One hundred and forty-seven responses were received and included in the survey. Participants encountered a range of challenges in providing intrapartum care in the prehospital setting. Two key themes were identified: (1) navigating complexity and uncertainty in unplanned births, and (2) practical challenges and unsuitable environments; with several subthemes demonstrating that the ambulance personnel responded to obstetric emergencies in diverse circumstances, diligently working to deliver optimal care for both mothers and neonates. This study describes novel challenges faced by ambulance personnel attending unplanned births in Aotearoa New Zealand alongside obstacles previously reported by emergency medical services in other jurisdictions. These findings may be invaluable in guiding further research, curriculum and resource development to better prepare ambulance personnel for the challenging and uncertain situations that characterise prehospital birth events.Item Foetal Movement Information and Maternal Concerns in the Third-Trimester: Findings of an Aotearoa New Zealand National Survey(Wiley, 2026-04-03) Bradford, Billie F; Thompson, John MD; McKinlay, Christopher JD; Dukkipati, Likhit S; Cronin, George D; Waller, Nimisha; McAra-Couper, Judith; Cornwall, Tania; McCowan, Lesley ME; Cronin, Robin SBACKGROUND: Promoting awareness of foetal movement (FM) is a recognised approach to addressing preventable stillbirth. However, provision of information is inconsistent, and rates of presentation for decreased FM may vary by maternal factors. Information is lacking on maternal views of FM information and knowledge of actions if concerned about FM. AIMS: To describe women's views of FM during late pregnancy in Aotearoa-New Zealand (Aotearoa-New Zealand), including factors that influence maternal actions if concerned. MATERIALS AND METHODS: Online survey of women with singleton third-trimester pregnancies in Aotearoa-New Zealand. Multivariable analysis adjusted for maternal factors. RESULTS: Eligible participants comprised European (1042, 63.5%), Māori (266, 16.2%), Pacific (119, 7.3%), Asian (160, 9.8%) and Other (35, 2.1%). Over half were nulliparous (916, 55.9%) and early third-trimester (median 31, IQR 28-34). Most (1366, 83.3%) had been concerned about FM. Groups that were less likely to seek advice when concerned, included Māori (aOR 0.69, 95% CI 0.51%-0.93%, p = 0.02), Pacific (aOR 0.58, 95% CI 0.38%-0.88%, p = 0.01) and parous (aOR 0.73, 95% CI 0.59%-0.90%, p = 0.003) women. Advice seeking was also less likely with a doctor as the main maternity provider (aOR 0.59, 5% CI 0.39%-0.92%, p = 0.02) compared to a midwife, and those who received fewer than recommended antenatal visits (aOR 0.55, 95% CI 0.34%-0.88%, p = 0.01). CONCLUSIONS: This study identified that FM worries are common in the third-trimester in Aotearoa-New Zealand. Yet, some groups of women were less likely to seek advice when concerned, indicating opportunities to reduce inequity and address barriers to accessing care.Item Underuse of Bystander Defibrillation on Females During Out-of-Hospital Cardiac Arrest: A Retrospective Observational Study in Aotearoa New Zealand(Elsevier BV, 2026-02-03) Todd, Verity; Hutchinson, Heather; Withanarachchie, Vinuli; Swain, Andy; Maessen, Sarah; Brett, Aroha; Dicker, BridgetIntroduction Early bystander CPR and defibrillation improve cardiac arrest survival. International studies show women receive fewer bystander interventions after out-of-hospital cardiac arrest (OHCA) than men. We investigated associations between sex and bystander interventions in OHCA in Aotearoa New Zealand. Methods Retrospective cohort study of adult OHCA with attempted resuscitation (January 2019–December 2023). Variables included demographics, ethnicity, socioeconomic deprivation, rurality, location type, and witness status. Logistic regression assessed associations between sex and bystander CPR and bystander defibrillation (shock delivered), adjusting for covariates. Results Of 9377 OHCA events, 29.6% occurred in females. Bystander CPR rates were similar between females (75.7%) and males (77.3%) (AOR 1.06, 95% CI: 0.94–1.18, p = 0.36). However, bystander defibrillation occurred in only 1.9% of females versus 5.4% of males. Females had 65% lower odds of receiving bystander defibrillation in unadjusted analysis (UOR 0.35, 95% CI: 0.26–0.47, p ' 0.001) and 39% lower odds after adjustment (AOR 0.61, 95% CI: 0.44–0.84, p = 0.002). Among shockable rhythm cases, sex disparity was not significant (AOR 0.83, 95% CI: 0.59–1.15, p = 0.26). Conclusion Despite equitable bystander CPR rates, females had significantly lower odds of receiving bystander defibrillation. In shockable rhythm cases, the disparity was not significant after adjustment for covariates, suggesting that patient and event characteristics mediate rather than confound this relationship. Findings highlight the need for targeted interventions addressing strategies to improve bystander defibrillation for females in cardiac arrest.Item Family Experiences of Out-of-Hospital Deaths Where Ambulance Services Respond in Aotearoa New Zealand(SAGE Publications, 2025-12-05) Satchell, Eillish; Gott, Merryn; Dicker, Bridget; Moeke-Maxwell, Tess; Anderson, Natalie EBackground: As ambulance services respond to a growing number of out-of-hospital deaths, supporting bereaved families is increasingly recognised as an important aspect of paramedic care. Actions from ambulance personnel can significantly shape family experiences, underscoring the need for compassionate, evidence-based care in the event of a death. However, currently, little is known about the needs and perspectives of families during these events, particularly from Indigenous and culturally diverse populations. This study explores the experience of Māori and non-Māori families from Aotearoa New Zealand who were present at a death where emergency ambulance services responded. Methods: This qualitative study, underpinned by kaupapa Māori research principles, explored family experiences of emergency ambulance care in the context of a death. Participants were recruited through purposive volunteer sampling, with invitations shared via local and social media. Semi-structured interviews employed a collaborative storytelling approach, where researchers and families co-constructed digital narratives of their experiences. Data were analysed using Braun and Clarke's reflexive thematic analysis. Results: We conducted 21 interviews with 23 bereaved family members. Families described having emotional, cultural and spiritual needs during out-of-hospital deaths. Four themes influenced the experiences of family. Making space for family highlighted the importance of meaningful presence and shared decision-making. Compassionate family care reflected the positive impact of compassionate actions. Communication, which was clear and timely, assisted family understanding. Finally, closure in crisis revealed how follow-up support is needed to help families process and accept death. Conclusion: Care that centres empathy, shared decision making, clear communication and responsiveness to individual family needs can improve the experiences of bereaved families. Greater consideration of family needs during resuscitation and its termination is needed to challenge current care paradigms, which equate family presence with family support. Enhancing cultural and spiritual responsiveness offers an opportunity to provide more holistic and culturally safe bereavement care.Item Preparing for Death, Dying and Bereavement Care: Student Paramedic Perspectives on a Novel Learning Module(Informa UK Limited, 2026-04-07) Anderson, Natalie Elizabeth; Satchell, Eillish; Tseng, Bruce; Shaw, Brayden; McAulay, MelEmergency ambulance personnel are commonly the last health professionals to care for people in the moments before death and the first to provide families with bereavement care, particularly when death is sudden or unexpected. Despite this, paramedic training seldom discusses, simulates or assesses termination of resuscitation, or breaking bad news to family. This paper describes paramedicine students’ experiences of a dedicated learning module designed to prepare them for patient death and caring for bereaved families. A lecture, small-group case studies and actor-led simulations were embedded into paramedic degree students’ final year of study. Students shared their perspectives on learning about death, dying, and bereavement through focus groups or an online survey. Students found talking about death and supporting acute grief unfamiliar and uncomfortable. Eager to provide reassurance in a crisis, many expressed ongoing concerns about saying the wrong thing. Participants wanted greater integration of challenging communication and cultural responsiveness throughout their degree, noting opportunities for learning during clinical placements were precious but limited. Actor-led simulation of patient death and family grief presented an important but unfamiliar divergence from standardized, action-packed resuscitation scenarios. Greater acknowledgement of death, dying and bereavement throughout training could better prepare paramedics for the realities of emergency ambulance work.