81 million people. [14] Population Melbourne

has both a single and dual level Emergency Medical Service (EMS) response. The first level of EMS response is provided by an Ambulance Paramedic with varying levels of Advanced Life Support (ALS) skills. The second level of EMS response is the Mobile Intensive Care Ambulance (MICA) Paramedic who has a broader range of ALS skills including intubation, rapid sequence intubation, and a wider range of pharmacological interventions available. In the Melbourne metropolitan service area there were 230 Inhibitors,research,lifescience,medical operational MICA Paramedics eligible for the study. Inclusion criteria for the survey were a MICA Paramedic qualification Inhibitors,research,lifescience,medical and holding an operational position within AV-M. Student MICA Paramedics, ambulance paramedics, and those MICA Paramedics within AV-M holding non-operational, office based, positions were excluded to enable identification of existent practice within the cohort. Ethics Ethics approval for the study was granted by the Monash University Standing Committee on Ethics in Research involving Humans and approval for the study with Ambulance Inhibitors,research,lifescience,medical Victoria MICA Paramedics was granted by the Ambulance Victoria Research Governance Committee. Analysis Data analysis was undertaken using SPSS (Statistical Package for the Social Sciences that Version 17.0, SPSS

Inc., Chicago, Illinois, U.S.A.). Descriptive statistics were used to summarise the demographic and VM data. Results A total of 46 MICA Paramedics volunteered, with a 100% participation rate to study completion, representing a 20% sample of the total Melbourne metropolitan Inhibitors,research,lifescience,medical operational MICA Paramedic workforce. The MICA paramedic responses to the question of posture are contained within Table ​Table1,1, with the largest proportion of responses (34.8%) selecting the “supine with Inhibitors,research,lifescience,medical feet elevated” option, whilst a lesser percentage

(26.1%) elected “supine” posturing. Table 1 Position for the Valsalva Manoeuvre The majority of participants (34.8%) elected the “as long as you can” option for duration of strain (intra-thoracic pressure generation), The data survey form was modelled on the Taylor and Anacetrapib Wong survey tool, resulting in the “11-15 second” option representing an approximation of the 15 mostly seconds identified within the evidence-based VM model. Only 8 of the 46 participants (17.4%) reported this duration, as described in Table ​Table22. Table 2 Duration of the Valsalva Manoeuvre The results listed in Table ​Table33 demonstrate that no paramedic participant elected to utilise a sphygmomanometer to record pressure generation, yet 23 of the 46 participants (50%) reported use of the syringe method to generate the required intrathoracic pressure. Table 3 Method of Valsalva Manoeuvre Overall, MICA Paramedics were largely (65.