Project Overview

This PhD (Health Science) project seeks to investigate the prehospital management of chest pain/acute coronary syndrome (ACS) in rural/remote Western Australia (WA).  
Acute coronary syndrome (ACS) is an umbrella term for myocardial infarction and unstable angina. The underlying pathophysiology is the result of “..transient or permanent thrombotic occlusion of the coronary vascular tree leading to myocardial ischaemia and infarction.”(1)  Chest pain is the major symptom of ACS, but not all episodes of chest pain are due to ACS, and not all ACS patients experience chest pain,(1) especially women, older adults and people with diabetes. ACS is a time-critical emergency because the extent of the damage to the heart muscle is linked to the time taken to implement coronary reperfusion interventions such as thrombolysis (administration of fibrinolytic drug)  or primary percutaneous coronary intervention (PCI) (performed in a cardiac catheterisation lab).(1)  ACS is a potentially life-threatening emergency because it can lead to a cardiac arrest.(2) 
Primary PCI is the preferred reperfusion therapy in patients with ‘S-T elevated myocardial infarction’ (STEMI), if it can be performed within 90 minutes of first medical contact; otherwise fibrinolytic therapy is preferred for those without contra-indications.(1)  In metropolitan Perth, there is a STEMI Pathway(3) – to guide the timely transport and management of suspected STEMI patients to one of the metropolitan primary PCI capable Hospitals. In some Ambulance Services in rural locations in Australia, paramedics administer prehospital thrombolysis (Tenecteplase).(4) However, in rural WA, the current SJ-WA clinical practice guidelines do not include prehospital thrombolysis by paramedics. The suspected ACS patient is transported to the nearest Hospital / Nursing Post as soon as possible, with pre-notification of the Facility.(5) 

References 
1. Chew DP, Scott IA, Cullen L, et al. National Heart Foundation of Australia & Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the Management of Acute Coronary Syndromes 2016. Heart Lung Circ. 2016;25(9):895-951. 
2. American Heart Association. What is a Heart Attack?  [updated 2 Dec 2022; cited 30 May 2024]. Available from: https://www.heart.org/en/health-topics/heart-attack/about-heart-attacks 
3. St John WA. STEMI Pathway.  [updated October 2020; cited 30 May 2024]. Available from: https://clinical.stjohnwa.com.au/docs/default-source/flowcharts/circulation/acute-coronary-syndrome---stemi-pathway.pdf?sfvrsn=32252dd8_2 
4. Khan AA, Williams T, Savage L, et al. Pre-hospital thrombolysis in ST-segment elevation myocardial infarction: a regional Australian experience. Med J Aust. 2016;205(3):121-5. 
5. St John WA. Clinical Practice Guideline - Chest Pain / Acute Coronary Syndrome  [updated August 2022; cited 30 May 2024]. Available from: https://clinical.stjohnwa.com.au/clinical-practice-guidelines/circulation/acute-coronary-syndrome

Aims

The significance of this PhD is that it provides an opportunity for the doctoral candidate to collaborate with prehospital clinicians and apply analytical skills using real-world data, with the aim to better understand the effect of the tyranny of distance in cardiac emergencies in rural and remote areas in Western Australia.

Objectives

The objectives of this project are to: 
1. Conduct a Scoping Review to examine extant literature about the management of chest pain/ACS in rural/remote locations in Australia and internationally; or conduct a Systematic Review to examine the safety and efficacy of prehospital thrombolysis. 
2. Survey ambulance services across Australia and New Zealand to compare their management of chest pain/ACS in rural/remote locations. 
3. Conduct a retrospective cohort study, using de-identified St John WA (ambulance) data, to describe the incidence and prehospital (ambulance) management for chest pain/ACS patients attended by St John WA. 
4. To compare prehospital (ambulance) management for chest pain/ACS and patient outcomes between different geographical areas in terms of relative remoteness, using the ARIA (Accessibility/Remoteness Index of Australia) classification.

Significance 

The significance of this PhD is that it provides an opportunity for the doctoral candidate to develop and apply analytical skills using real-world data, with an aim to better understand the impact of the tyranny of distance in cardiac emergencies in rural and remote areas in Western Australia.

The Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU) is a successful research group in the Curtin School of Nursing; with a long-standing collaborative research partnership with St John (Ambulance) WA (SJ-WA).  PRECRU PhD students join a productive and supportive research team, with opportunities to build collaborative research networks with prehospital emergency care researchers and clinicians nationally and internationally.  The successful applicant will be provided with a PRECRU desk (secure office), a computer, statistical software, and research methods training as required. PRECRU also encourages and contributes to funding doctoral candidates to present their work at a national and international conference.  
The project feasibility is ensured by the availability of the project data, and content knowledge and methodologic expertise of the proposed supervisors. Prof Judith Finn (PRECRU Director) is a NHMRC Leadership Fellow with an international profile in prehospital and cardiovascular research. Dr Stephen Ball (PRECRU Deputy Director) is a national expert in prehospital research; with expertise in epidemiological modelling and spatial analysis. This PhD project builds on the successful partnership between PRECRU at Curtin University and SJ-WA. Furthermore, the project contributes to an emerging focus of PRECRU research on emergency care in rural/remote WA.

An internship may be available for this project. A three-month industry-based research project internship with St John WA will be discussed.

• Future Students

• Faculty of Health Sciences

• Higher Degree by Research

• Australian Citizen
• Australian Permanent Resident
• New Zealand Citizen
• Permanent Humanitarian Visa

• Merit Based

The annual scholarship package, covering both stipend and tuition fees, amounts to approximately $70,000 per year.

In 2024, the RTP stipend scholarship offers $35,000 per annum for a duration of up to three years. Exceptional progress and adherence to timelines may qualify students for a six-month completion scholarship.

Selection for these scholarships involves a competitive process, with shortlisted applicants notified of outcomes by November 2024.

1

All applicable HDR courses.

The applicant will need to demonstrate an interest in quantitative research methods, such as epidemiology, biostatistics, and spatial analysis. A background in the use of statistics, spatial analysis software, or computer programming would be an advantage; however, training will be provided as required. Whilst clinicians (including paramedics) are most welcome to apply, a clinical background is not essential. PRECRU PhD students are expected to publish academic papers during their candidature and will be supported to achieve this. Fluency in English is essential, and the successful applicant will be required to work both independently and as part of a team.

 

Please send your CV, academic transcripts and brief rationale why you want to join this research project via the HDR Expression of Interest form to the project lead researcher, listed below. 

You must be enrolled in a Higher Degree by Research Course at Curtin University by March 2025.

Project Lead: Professor Judith Finn