Doctoral thesis

Australian civilian hospital nurses’ lived experience of an out-of-hospital environment following a disaster

Mass Gathering Health / Mass Gathering Medicine

Various publications and presentations relating to Mass Gathering and Major Event health

Disaster Health

Various publications and presentations relating to disaster health

11 September, 2019

Environmental influences on patient presentations: Considerations for research and evaluation at mass-gathering events


Free full-text article is available here (PDF)

ABSTRACT

Aim: This paper discusses the need for consistency in mass-gathering research and evaluation from an environmental reporting perspective.

Background: Mass gatherings occur frequently throughout the world. Having an understanding of the complexities of mass gatherings is important to inform health services about the possible required health resources. Factors within the environmental, psychosocial, and biomedical domains influence the usage of health services at mass gatherings. A minimum data set (MDS) has been proposed to standardize collection of biomedical data across various mass gatherings, and there is a need for an environmental component. The environmental domain includes factors such as the nature of the event, availability of drugs or alcohol, venue characteristics, and meteorological factors.

Method: This research used an integrative literature review design. Manuscripts were collected using keyword searches from databases and journal content pages from 2003 through 2018. Data were analyzed and categorized using the existing MDS as a framework.

Results: In total, 39 manuscripts were identified that met the inclusion criteria. Conclusion: In collecting environmental data from mass gatherings, there must be an agreed-upon MDS. A set of variables can be used to collect de-identified environmental variables for the purpose of making comparisons across societies for mass-gathering events (MGEs).



Hutton A, Ranse J, Grey K, Turris S, Lund A, Munn BM. (2019). Environmental influences on patient presentations: Considerations for research and evaluation at mass-gathering events. Prehospital and Disaster Medicine.

06 September, 2019

Frequency and location of mass gatherings in relation to emergency departments: A descriptive study


The full-text article is available here


ABSTRACT

Introduction: As the number of mass gathering events increases, so too does the reliance on tertiary emergency healthcare services. Approximately 1% of event attendees may present to a local emergency department for clinical assessment and/or management. Often, these attendees are transported by ambulance services. The purpose of this study is to determine the frequency and location of events held in New South Wales (NSW), Australia. This information may be used by event and health service personnel to further inform event planning such as staffing, equipment and economic considerations when large events in the community occur.

Methods: This descriptive study used data scraping of an established data warehouse to identify events held in the 2017 calendar year by name, type, location (within the state of NSW) and duration. Using Google Maps, the distance and travel time between these events and the nearest emergency department (ED) was determined. Data was analysed using simple descriptive statistics.

Results: Of the 722 events in NSW analysed, 395 were single-day events. The majority of these were concerts (n=284, 39%), followed by festivals (n=259, 36%) and sporting events (n=176, 24%). The average distance and time to arrive at an ED from an event was 15.0 (±35.8) kilometres and 15.4 (±27.2) minutes, respectively. 

Conclusion: Existing literature has highlighted that event attendees are regularly transported to emergency departments from events. This research has demonstrated that events occur frequently with varying vicinity to nearest EDs, with the majority of events occurring near territory care centres. However, there is limited research on the impact on emergency healthcare services resulting from an event.



Hutton A, Ranse J, Lipscomb R, Hutton G, Rabb H, Crilly J. (2019). Frequency and location of mass gathering events in relation to emergency departments: A descriptive study. Australasian Journal of Paramedicine.

10 June, 2019

End-of-life care content in postgraduate critical care nursing programs: Structured telephone interviews to evaluate content informing practice



Full-text article is available here

ABSTRACT
Background: The provision of end-of-life care remains a significant component of work for clinicians in critical care settings. Critical care nurses report that this area of practice receives limited attention in education and training.

Objectives: The objective of this study was to identify and describe the end-of-life care content in postgraduate critical care nursing programs in Australia.

Methods: Using a descriptive exploratory research design, an Internet search was undertaken in August 2015, identifying 17 education providers offering postgraduate critical care nursing programs. Thirteen individuals agreed to participate in a structured telephone interview regarding end-of-life content in their postgraduate program. Descriptive statistics were calculated to summarise the data obtained.

Results: Twelve participants reported that end-of-life care content was explicitly addressed in their postgraduate critical care nursing programs, yet variation in actual content areas covered was evident. The majority of programs addressed content related to organ donation (92%) and legal and ethical issues (77%). However, content least commonly identified as covered pertained to the work of the nurse in providing direct clinical care to the patient at the end of life and his or her family, including the physical changes experienced by the dying patient (31%), respiratory management encompassing withdrawal of ventilation and symptom management (23%), emotional support of family (23%), care of the body after death (23%), and the process of withdrawing life-sustaining treatment (15%). Participants (92%) agreed that end-of-life content was important in postgraduate critical care nursing programs, with 77% of participants agreeing that more time should be allocated to end-of-life content.

Conclusions: This study provides preliminary evidence of the variation in end-of-life content in postgraduate critical care nursing programs in Australia. Addressing gaps in end-of-life care content in formal education, including clinical care of the dying patient, is urgently needed to address the complexity of this phase of care that is so frequently provided in critical care units


Ranse K, Delaney L, Ranse J, Coyer F, Yates P. End-of-life care content in postgraduate critical care nursing programs: Structured telephone interviews to evaluate content informing practice. Australian Critical Care. [in-press]

07 May, 2019

Australian civilian hospital nurses’ lived experience of the out-of-hospital environment following a disaster: Psychosocial aspects.



I presented at the WADEM World Congress on Disaster and Emergency Medicine on some findings from my PhD studies. In particular, this presentation focused on some psychosocial aspect of being a nurse following a disaster. At the end of the presentation I suggest that we need to have:
1) Specialist healthcare professionals to provide psychosocial support to people in disaster-affected communities.
2) Strategies to assist nurses to have psychosocial support for themselves.



Ranse, J. (2019). Australian civilian hospital nurses’ lived experience of the out-of-hospital environment following a disaster: Psychosocial aspects. Paper presented at the WADEM World Congress on Disaster and Emergency Medicine, Brisbane, 7th May.


The impact on local emergency departments during a “Schoolies Week” youth mass gathering

ABSTRACT

Introduction:
Community-based strategies designed to minimize the impact on local emergency services during mass gathering events (MGEs) require evaluation to provide evidence to inform best practice.

Aim:
This study aimed to describe characteristics and outcomes for people aged 16-18 years requiring emergency care before, during, and after a planned youth MGE “Schoolies week” on the Gold Coast, Australia.

Methods:
A retrospective observational study was undertaken. Presentations from all young adults to the emergency department (ED) or In-Event Health Service (IEHS) over a 21-day period in 2014 were included. Descriptive and inferential analyses were performed to compare across time and to describe characteristics of and outcomes for young adults requiring healthcare.

Results:
A total of 1029 presentations were made by youth aged 16 – 18 to the ED and IEHS over the study period (ED: 139 pre, 275 during, and 195 post; IEHS: 420 during). Patient characteristics and outcomes to the ED that varied significantly between pre, during, and post Schoolies periods included patient’s age (higher proportion of 17-year-olds), residing outside the Gold Coast region, and not waiting for treatment. All were higher during Schoolies week. Of the 24,375 MGE attendees, 420 (1.72% [95% CI, 1.57 – 1.89], 17.2/1,000) presented to the IEHS. The majority were toxicology related (n=169, 44.9%). Transportation to hospital rate was low (0.03% [95% CI, 0.01 – 0.06], 0.3/1,000) for the 24,375 MGE attendees.

Discussion:
Findings from this study support previous research indicating that MGEs can impact local emergency healthcare services. The provision of the IEHS may have limited this impact. The recipients of care delivery, predominantly males with trauma- or toxicology-related problems, warrants further investigation. Research describing the structures and processes of the IEHC could further inform health care delivery in and out of hospital settings.



Crilly, J., Ranse, J., Bost, N., Donnelly, T., Timms, J., Gilmour, K., Aitken, M., Johnston, A. (2019). The impact on local emergency departments during a “Schoolies Week” youth mass gathering. Paper presented at the 22nd World Congress on Disaster and Emergency Medicine, Brisbane, 10th May.

Environmental factors at mass-gathering events: Considerations for health research and evaluation

ABSTRACT

Introduction:
This poster will document the environmental domain variables of a mass gathering. They include factors such as the nature of the event, availability of drugs or alcohol, venue characteristics and meteorological factors.

Method:
A systematic literature was used to develop a set of variables and evaluation regarding environmental factors that contribute to patient presentation rates.

Results:
Findings were grouped pragmatically into factors of crowd attendance, crowd density, venue, type of event, mobility, and meteorological factors.

Discussion:
This poster will outline a set of environmental variables for collecting data at mass gathering events. The authors have suggested that in addition to commonly used variables, air quality, wind speed, dew point, and precipitation could be considered as a data points to be added to the minimum standards for data collection.


Hutton, A., Ranse, J., Lund, A., Turris, S., Munn, B., Gray, K. (2019). Environmental factors at mass-gathering events: Considerations for health research and evaluation. Poster presented at the 22nd World Congress on Disaster and Emergency Medicine, Brisbane, 7th May.

Health care provision during a sporting mass gathering: A structure and process description of on-site care delivery

ABSTRACT

Introduction:
During mass gatherings, such as marathons, the provision of timely access to health care services is required for the mass gathering population as well as the local community. However, effective provision of health care during sporting mass gatherings is not well understood.

Aim:
To describe the structures and processes developed for an emergency team to operate an in-event acute health care facility during one of the largest mass sporting participation events in the southern hemisphere, the Gold Coast marathon.

Methods:
A pragmatic qualitative methodology was used to describe the structures and processes required to operate an in-event acute health care facility providing services for marathon runners and spectators. Content analysis from 12 semi-structured interviews with Emergency Department (ED) clinical staff working during the two-day event was undertaken in 2016.

Results:
Structural elements that underpinned the in-event health care facility included: physical spaces such as the clinical zones in the marathon health tent, tent access, and egress points; and resources such as bilingual staff, senior medical staff, and equipment such as electrocardiograms. Critical processes included: clear communication pathways, interprofessional care coordination, and engagement involving shared knowledge of and access to resources. Distinct but overlapping clinical scope between nurses and doctors was also noted as important for timely care provision and appropriate case management. Staff outlined many perceived benefits and opportunities of in-event health care delivery including ED avoidance and disaster training.

Discussion:
This in-event model of emergency care delivery enabled acute out-of-hospital health care to be delivered in a portable and transportable facility. Clinical staff reported satisfaction with their ability to provide a meaningful contribution to hospital avoidance and to the local community. With the number of sporting mass gatherings increasing, this temporary, in-event model of health care provision is one option for event and health care planners to consider.


Johnston, A., Wadham, J., Polong-Brown, J., Aitken, M., Ranse, J., Hutton, A., Richards, B., Crilly, J. (2019). Health care provision during a sporting mass gathering: A structure and process description of on-site care delivery. Paper presented at the 22nd World Congress on Disaster and Emergency Medicine, Brisbane, 9th May.

Proposing a minimum data set for mass gathering health

ABSTRACT

Introduction:
There is currently no standardized approach to collecting mass gathering health data, which makes comparisons across or between events challenging. From 2013 onward, an international team of researchers from Australia and Canada collaborated to develop a Minimum Data Set (MDS) for Mass Gathering Health (MGH).

Aim:
The process of developing the MDS has been reported on previously at the 2015 and 2017 World Congresses on Disaster and Emergency Medicine, and this presentation will present a final MDS on MGH.

Methods:
This study drew from literature, including the 2015 Public Health for Mass Gatherings key considerations, previous event/patient registry development, expert input, and the results of the team’s work. The authors developed an MDS framework with the aim to create an online MGH data repository. The framework was populated with an initial list of data elements using a modified Delphi technique.

Results:
The MDS includes the 41 data elements in the following domains: community characteristics, event characteristics, venue characteristics, crowd characteristics, event safety considerations, public health considerations, and health services. Also included are definitions and preliminary metadata.

Discussion:
The development of an MGH-MDS can grow the science underpinning this emerging field. Future input from the international community is essential to ensure that the proposed MDS is fit-for-purpose, i.e., systematic, comprehensive, and rigorous, while remaining fluid and relevant for various users and contexts.


Steenkamp, M., Arbon, P., Lund, A., Turris, S., Ranse, J., Hutton, A., Munn, B., Bowles, R. (2019). Proposing a minimum data set for mass gathering health. Paper presented at the 22nd World Congress on Disaster and Emergency Medicine, Brisbane, 8th May.

Chemical, Biological, Radiological, Nuclear, and Explosive (CBRNe) preparedness: Perceptions of Australian emergency department (ED) doctors and nurses


ABSTRACT:

Introduction:
Clinicians working in emergency departments (ED) play a vital role in the healthcare response to chemical, biological, radiological, nuclear, and explosive (CBRNe) events. However, ED clinicians’ individual and workplace preparedness for CBRNe events is largely unknown.

Aim:
The aim of this research was to explore Australian ED nurses and doctors’ perceptions of individual and workplace preparedness related to CBRNe events.

Methods:
The study populations were Australian nurses and doctors who work in EDs. Data was collected via a survey with 43 questions requiring binary responses or a rating on a Likert scale. The survey consisted of questions relating to the participant’s previous disaster training, perceived likelihood of a CBRNe event impacting their ED, perceived level of knowledge, perceived personal preparedness, perception of ED preparedness, and willingness to attend their workplace. Data were analyzed using descriptive and inferential statistics.

Results:
There were 244 complete responses, 92 (37.7%) doctors and 152 (62.3%) nurses. When comparing doctors and nurses, there was a statistical difference between gender (p = < 0.001), length of employment (p = < 0.001), and role in the ED (p = < 0.001). Doctors and nurses had a similar level of previous training except for practical training in mask fitting (p = 0.033). CBRNe events were considered separately. Perceived level of knowledge, perceived personal preparedness, and perception of ED preparedness were significant predictors of willingness to work in all CBRNe event. Perceived likelihood of a CBRNe event impacting their ED was not a predictor of willingness.

Discussion:
This research contributes to an overview of the current status of Australian ED clinicians’ preparedness for CBRNe response. To increase the willingness of ED doctors and nurses attending their workplace for a CBRNe event, strategies should focus on enhancing individuals perceived level of knowledge, perceived personal preparedness, and perception of ED preparedness.



Hammad, K., Ranse, J., Mortelmans, L. (2019). Chemical, Biological, Radiological, Nuclear, and Explosive (CBRNe) preparedness: Perceptions of Australian emergency department (ED) doctors and nurses. Paper presented at the 22nd World Congress on Disaster and Emergency Medicine, Brisbane, 9th May.

Does medical presence decrease the perceived risk of substance-related harm at music festivals?

ABSTRACT

Introduction:
The use of recreational substances is a contributor to the risk of morbidity and mortality at music festivals. One of the aims of onsite medical services is to mitigate substance-related harms. It is known that attendees’ perceptions of risk can shape their planned substance use; however, it is unclear how attendees perceive the presence of onsite medical services in evaluating the risk associated with substance use at music festivals.

Methods:
A questionnaire was administered to a random sample of attendees entering a multi-day electronic dance music festival.

Results:
There were 630 attendees approached and 587 attendees completed the 19 item questionnaire. Many confirmed their intent to use alcohol (48%, n=280), cannabis (78%, n=453), and recreational substances other than alcohol and cannabis (93%, n=541) while attending the festival. The majority (60%, n=343) stated they would still have attended the event if there were no onsite medical services available. Some attendees agreed that the absence of medical services would have reduced their intended use of alcohol (30%, n=174) and recreational substances other than alcohol and cannabis (46%, n=266).

Discussion:
In the context of a music festival, plans for recreational substance use appear to be substantially altered by attendees’ knowledge about the presence or absence of onsite medical services. This contradicts our initial hypothesis that medical services are independent of planned substance use and serve solely to reduce any associated harms. Additional exploration and characterization of this phenomenon at various events would further clarify the understanding of perceived risks surrounding substance use and the presence of onsite medical services.




Munn, M. B., White, M. S., Hutton, A., Turris, S., Tabb, H., Lund, A., Ranse, J. (2019). Does medical presence decrease the perceived risk of substance-related harm at music festivals? Poster presented at the 22nd World Congress on Disaster and Emergency Medicine, Brisbane, 8th May.

Measuring the masses: Guidelines for publication of case reports on mass gatherings

ABSTRACT

Introduction: 
The science supporting event medicine is growing rapidly. In order to improve the ability of researchers to access event data and improve the quality of publishing mass gathering cases, it would be of benefit to standardize event reports to permit the comparison of similar events across local and national boundaries. These data would support the development of practice standards across settings.

Aim:
The authors propose the creation of a publication guideline to support authors seeking to publish in this field.

Method:
Derivation study via analysis of published case reports using the Delphi process.

Results:
Data elements were inconsistently reported within published case reports. Categories of variables included: event demographics (descriptors of date, time, genre, activity, risks), attendance and population demographics, data related to climate and weather conditions, composition and deployment of an onsite medical team, highest level of care available onsite, patient demographics, patient presentations and measures of impact on the local health care system such as transfer to hospital rates. Of note, there was a high incidence of “missing” variables that would be of central interest to researchers.

Discussion:
Approaches to standardizing the collection and reporting of data are often discussed in the health care literature. The benefits of consistent, structured data collection are well understood. In the context of mass gathering event case reporting, the time is ripe for the introduction of a guideline (with accompanying guidance notes and dictionary). The proposed guideline requires the input of subject matter experts (in progress) to enhances its relevance and uptake. This work is timely as there is ongoing work on improving an international event medicine registry. If the evolution of both proceeds in lockstep, there is a good chance that access to a rigorous data set will become a reality.



Turris, S., Rabb, H., Callaghan, C., Munn, M. B., Ranse, J., Lund, A., Chasmar, E. (2019). Measuring the masses: Guidelines for publication of case reports on mass gatherings. Poster presented at the 22nd World Congress on Disaster and Emergency Medicine, Brisbane, 8th May.

Global event data research registry: Taking mass gathering research to the next level

ABSTRACT

Introduction:
Research on events and mass gatherings is hampered by a lack of standardized and central reporting of event data and metrics. While there is work currently being done on report standardization, this will require a plan for recording, storing, and safeguarding a repository of event data. A global event data registry would further the work of standardized reporting by allowing for the collection and comparison of events on a larger scale.

Aim:
To characterize the considerations, challenges, and potential solutions to the implementation of a global event data registry.

Methods:
A review of the academic and grey literature on the current understanding and practical considerations in the creation of data registries, with a specific focus on an application to mass gathering events.

Results:
Findings were grouped under the following domains: (1) stakeholder identification and consultation, (2) research goals and clinical objectives, (3) technological requirements (ie hosting, format, maintenance), (4) funding (budget, affiliations, sponsorships), (5) ethics (privacy, protection, jurisdictions), (5) contribution facilitation (advertising, support), and (6) data stewardship and registry access for researchers.

Conclusion:
This work outlines key considerations for undertaking and implementing an event data registry in the mass gathering space, and compliments ongoing work on the standardization of data collected at mass gathering events. If practical and ethical considerations are appropriately identified and managed, the creation of an event data registry has the potential to make a major impact on our understanding of events and mass gatherings.


Gogaert, S., Scholliers, A., Sherman, H., Munn, M. B., Turris, S., Lund, A., Ranse, J. (2019). Global event data research registry: Taking mass gathering research to the next level. Paper presented at the 22nd World Congress on Disaster and Emergency Medicine, Brisbane, 8th May

Using clinically based vignettes to further develop a mass gathering Triage tool

ABSTRACT

Introduction:
This research builds on a previously developed triage: Mass Gathering Triage Scale (MaGaTT) by Cannon, et al (2017). This tool was targeted towards non-health care professional first responders within mass-gathering events (MGEs). However, this tool had not been evaluated.

Aim:
To further develop the previously designed MaGaTT using vignettes of clinical cases to: 1) determine variation in decision-making, and 2) inform further tool development prior to real-world testing.

Methods:
Volunteer members of St. John Ambulance Australia were surveyed using 18 vignettes of de-identified real patient record forms from MGEs covered by St. John Ambulance Australia (NSW) in 2013-2014. Participants were given the MaGaTT and written instructions on its use. Participants triaged 18 patients, recording their decisions on the online survey. Responses against the vignettes were analyzed using Fleiss Kappa [p-bar] measure. A score of 0.61 – 0.8 represented substantial agreement and a score of between 0.41 and 0.6 represented moderate agreement between participants.

Results:
There were 110 completed responses. The majority of participants were male (n =66, 60%), having completed a Bachelor’s Degree (n =38, 34.5%), and holding the clinical skill level of “first responder” (n=42, 38.2%). The overall agreement [p-bar] for the 18 items was moderate at 0.55. When examined by triage category, the “Resuscitation” category had substantial agreement (0.69), when compared with moderate agreement for “Urgent” (0.52) and “Minor” (0.52) categories.

Discussion:
This research demonstrates that the MaGaTT can be used with moderate agreement and substantial agreement within the resuscitation category. This is similar to triage tools internationally, where high levels of agreement relate to triage categories for patients requiring resuscitation when compared to patients requiring lower levels of clinical care. Slight changes have been made to the original MaGaTT as a result of this research.


Ranse, J., Cannon, M., Roitman, R., & Morphet, J. (2019). Using clinically based vignettes to further develop a mass gathering Triage tool. Poster presented at the 22nd World Congress on Disaster and Emergency Medicine, Brisbane, 10th May.

Core curriculum for event medical leaders

ABSTRACT
Introduction:
The literature on mass gatherings has expanded over the last decade. However, no readily accessible curriculum exists to prepare and support event medical leaders. Such a curriculum has the potential to align event medical professionals on improving event safety, standardizing emergency response, and reducing community impacts.

Methods:
We organized collaborative expert focus groups on the proposed “core curriculum” and “electives.”

Results:
Key features of a mass gathering medical curriculum include operations-focused, evidence-informed, best-known practices offered via low barrier, modular, flexible formats with interactive options, and a multi-national focus.

Core content proposed:

  • Background (Definitions, Context, Risk, Legalities)
  • Event Medical Planning - “The Seven Steps” - (1.) Assessment and Environmental Scan - Event Emergency Action Plan, (2.) Human Resources, (3.) Equipment/Supplies, (4.) Infrastructure/Logistics, (5.) Transportation (To, On, From), (6.)Communication (Pre, During, Post), and (7.) Administration/Medical Direction 
  • Event After-Action Reporting
  • Case-based Activities

Electives mirror Core outline and serve as expanded case-studies of specific event categories. Initially proposed electives include:

  • Concerts/Music Festivals 
  • Running Events 
  • Cycling Events 
  • Multi-Sport Events 
  • Obstacle Adventure Courses 
  • Staged Wilderness Courses
  • Amateur Games 
  • Political Gatherings & Orations
  • Religious Gatherings & Pilgrimages Community Gatherings (e.g., Parades, Fireworks, etc.)

Discussion:
Complex team learning to standardize real-world approaches has been accomplished in other medical domains (e.g., ACLS, AHLS, ATLS, PALS, etc.). A course for event medicine should not re-teach medical content (i.e. first aid, paramedicine, nursing, medicine); it should make available a commonly understood, systematic approach to planning, execution, and post-event evaluation vis a vis health services at events. A ‘train the trainer’ model will be required, with business operations support for sustainable course delivery. The author team seeks community feedback at WCDEM 2019 in creating ‘the ACLS’ of Event Medicine.


Lund, A., Munn, M., Ranse, J., & Turris, S. (2019). Core curriculum for event medical leaders. Poster presented at the 22nd World Congress on Disaster and Emergency Medicine, Brisbane, 8th May

30 April, 2019

How do you actually care during a catastrophe?




I was an invited guest speaker at the AusMed Education conference - Gold Coast Nurses' Conference. This presentation covers aspects of nurses education and willingness to assist following a disaster. Furthermore, this presentation provides insight into a possible experience of what it may be like being a nurse following a disaster.


Ranse J. (2019). How do you actually care during a catastrophe?; invited speaker for Gold Coast Nurses’ Conference … Gold Coast, Qld, 30th April.

------------

In 2018 I was an invited guest speaker at the AusMed Education conference - Disaster Nursing - Not if, But when. I presented on the same topic during this confernece.

Ranse J. (2018). How do you actually care during a catastrophe?; invited speaker for Disaster Nursing - Not If, But When… Brisbane, Qld, 28th June.





17 April, 2019

Nursing students’ role and experiences of disasters in a nursing school


Free full-text article is available here (PDF)

ABSTRACT 
Due to its location in the ‘Pacific Ring of Fire”, Indonesia is frequently prone to natural disasters. Therefore, Indonesian nurses need to have the ability to assist in disaster situations as they are considered an important element of the workforce in disaster preparedness and response. However, the current nursing curricula in Indonesia does not adequately prepare nurses to respond in these situations. The primary aim of this study is to understand the experiences of Master of Nursing students’ roles and experiences in disaster settings in a nursing school in East Java, Indonesia. A single-case study design has been used. Data colection occurred via semi-structured interviews. The participants were enrolled in the Master of Nursing in a School of Nursing at a University in East Java. The data for the study were thematically analysed. Four main themes were identified: ‘personal feelings’, ‘working outside their scope of practice’, ‘lack of disaster preparedness’, and ‘a lack of mental health knowledge and care’. This study found that the Master of Nursing students in a nursing school in East Java, Indonesia were not adequately prepared for responding to disaster situations. This study found that a lack of disaster preparedness, working outside scope of practice, and a lack of mental health knowledge were the prominent issues for these Master of Nursing students. As well as commencing disaster training earlier in their education, providing training in the psychological context of disaster preparedness is recommended.


Hindriyastuti S, Kako M, Ranse J, Hutton A. (2019). Nursing students’ role and experiences of disasters in a nursing school. Padjadjaran Nursing Journal (Jurnal Keperawatan Padjadjaran). 7(1): 38-48.

11 January, 2019

Health care provision during a sporting mass gathering: A structure and process description of on-site care delivery


Free full-text article is available here (PDF)

ABSTRACT
Introduction
Mass gatherings such as marathons are increasingly frequent. During mass gatherings, the provision of timely access to health care services is required for the mass-gathering population, as well as for the local community. However, the nature and impact of health care provision during sporting mass gatherings is not well-understood.

Purpose
The aim of this study was to describe the structures and processes developed for an emergency health team to operate an in-event, acute health care facility during one of the largest mass-sporting participation events in the southern hemisphere, the Gold Coast Marathon (Queensland, Australia).

Methods
A pragmatic, qualitative methodology was used to describe the structures and processes required to operate an in-event, acute health care facility providing services for marathon runners and spectators. Content analysis from 12 semi-structured interviews with emergency department (ED) clinical staff working during the two-day event was undertaken in 2016.

Findings
Important structural elements of the in-event health care facility included: physical spaces, such as the clinical zones in the marathon health tent and surrounding area, and access and egress points; and resources such as bilingual staff, senior medical staff, and equipment such as electrocardiograms (ECGs) and intravenous fluids. Process elements of the in-event health care facility included clear communication pathways, as well as inter-professional care coordination and engagement involving shared knowledge of and access to resources, and distinct but overlapping clinical scope between nurses and doctors. This was seen to be critical for timely care provision and appropriate case management. Staff reported many perceived benefits and opportunities of in-event health care delivery, including ED avoidance and disaster training.

Conclusions
This in-event model of emergency care delivery, established in an out-of-hospital location, enabled the delivery of acute health care that could be clearly described and defined. Staff reported satisfaction with their ability to provide a meaningful contribution to hospital avoidance and to the local community. With the number of sporting mass gatherings increasing, this temporary, in-event model of health care provision is one option for event and health care planners to consider.



Johnston A, Wadham J, Polong-Brown J, Aitken M, Ranse J, Hutton A, Richards B, Crilly J. (2019). Health care provision during a sporting mass gathering: A structure and process description of on-site care delivery. Prehospital and Disaster Medicine.

09 November, 2018

Impacts on in-event, ambulance and emergency department services from patients presenting from a mass gathering event: A retrospective analysis


Free full-text article is available here (PDF) 


ABSTRACT 


Objective
The aim of this study was to describe the in‐event, ambulance and ED impacts of patient presentations from an Australian mass gathering event (MGE) including patient demographics, provision of care, length of stay and discharge disposition.

Methods
This research was set at one MGE in Australia. The MGE had one first aid post and one in‐event health team staffed by doctors, nurses and paramedics. A retrospective analysis of patient care records from providers of in‐event, ambulance and ED services was undertaken. Data analysis included descriptive and inferential statistics.

Results
Of the 20 000 MGE participants, 197 (0.99% [95% CI 0.86–1.13], 9.85/1000) presented for in‐event first aid care, with 24/197 (12.2% [95% CI 8.33–17.49], 1.2/1000) referred to in‐event health professionals. Fifteen of the referred patients (62.5% [95% CI 42.71–78.84]) returned to the MGE following administration of intravenous fluids (n = 13) and/or anti‐emetics (n = 11). Seven (29.2% [95% CI 14.92–49.17], 0.35/1000) were referred to ambulance paramedic care, requiring endotracheal intubation (n = 1) and airway adjuncts (n = 3) prior to transportation to ED; these patients had an ED median length of stay of 7 h (5.5–12.5) receiving imaging and ventilator support. Five were discharged from ED, one required an operation and another required intensive care unit admission.

Conclusions
There was an impact on in‐event, ambulance and ED services from this MGE but the in‐event model of care may have limited ambulance usage and ED visits. The ED length of stay was greater than the national median, perhaps reflecting the appropriateness of transport and nature of care requirements while in the ED.



Ranse J, Lenson S, Keene T, Luther M, Burke B, Hutton A, Johnston A, Crilly J. (2018). Impacts on in-event, ambulance and emergency department services from patients presenting from a mass gathering event: A retrospective analysis. Emergency Medicine Australasia.




17 October, 2018

Lived-relationships: Experiences of nurses in the out-of-hospital environment following a disaster

The World Association for Disaster and Emergency Medicine launched a podcast series in 2018. I was invited to speak on the topic of 'Lived-relationships: Experiences of nurses in the out-of-hospital environment following a disaster'. The podcast relates to some of the findings from my Doctoral studies, focusing on the lived-relationships with patients and their families, colleagues, and self.



Ranse J (Interviewee), Hutton A (Producer). (2018). Lived-relationships of nurses in the out-of-hospital environment following a disaster; audio podcast for World Association for Disaster and Emergency Medicine, 17th October. Series 1, Episode 3. Retrieved from https://wadem.org/resources/podcasts/





13 October, 2018

End-of-life care in postgraduate critical care nurse curricula: An evaluation of current content informing practice




ABSTRACT

Introduction: Despite the frequency with which critical care nurses’ engage in end-of-life care, preparation and support of nurses for this work through professional development opportunities or postgraduate education is reportedly limited.

Objectives: To identify and describe end-of-life care content in postgraduate critical care nursing courses in Australia.

Methods: A purposive sampling technique was used to invite a postgraduate course convener from each higher education institution, identified through a search of the internet as offering a postgraduate course in critical care nursing (n = 17). An individual structured telephone survey was undertaken with each participant (n = 13). Content analysis of participant responses was undertaken to identify and describe the end-of-life content and modes of content delivery.

Results: Participants agreed (92%) that end-of-life care content was important within post-graduate education, with 77% agreeing that more time should be allocated to focus on end-of-life care. The majority of courses addressed legal and ethical issues related to end-of-life care (77%), however this content was predominately covered in the context of organ donation (92%). The content least commonly addressed pertained to the work of the nurse in providing direct clinical care, including the physical changes to the dying patient (31%), the process of withdrawing life sustaining treatment (15%), withdrawal of ventilation and symptom management (23%), emotional support to the family (23%) and care of the body after death (23%).

Conclusion(s): The inclusion of end-of-life care content in critical care curricula is needed to address the complexity of this area of practice, including the care and inclusion of family, the physical care and emotional support of the patient and self-care for the nurse. It is recommended that targeted educational initiatives to improve the care that patients and their families receive and support nurses in the delivery of this care.




Ranse K, Delaney L, Ranse J, Coyer F, Yates P. (2018). End-of-life care in postgraduate critical care nurse curricula: An evaluation of current content informing practice. Poster presented at the ANZICS/ACCCN Intensive Care Annual Scientific Meeting, Adelaide, 11th - 13th October.



14 September, 2018

Impact of patients presenting with alcohol and/or drug intoxication on in-event health care services at mass-gathering events: An integrative literature review



Free full-text article is available here (PDF)


ABSTRACT
Background
There is a growing body of literature relating to mass-gathering events. A common thread amongst this literature, particularly the literature relating to music festivals, is the incidence of patients presenting with substance and/or alcohol intoxication. However, the impact of alcohol and/or drugs on the provision of in-event health care services has not been explored in detail.

Aim
The goal of this review was to develop an understanding of the impact of alcohol and/or drugs on in-event health care services at mass-gathering events.

Method
This paper used integrative review as a methodology. The articles included in this literature review were sourced by searching databases inclusive of Medline (Ovid; US National Library of Medicine, National Institutes of Health; Bethesda, Maryland USA), Scopus (Elsevier; Amsterdam, Netherlands), PsycINFO (Ovid; American Psychological Association; Washington DC, USA), and Pub Med (National Center for Biotechnology Information, National Institutes of Health; Bethesda, Maryland USA). Identified manuscripts that met the inclusion criteria were thematically analyzed.

Results
In total, 12 manuscripts met the inclusion criteria for this review. A thematic analysis of these manuscripts identified three main themes: (i) predictive factors, (ii) patient presentation rates, and (iii) levels of care.

Conclusion
Substance use and/or intoxication can place a strain on in-event medical services at mass-gathering events. Of the various types of mass-gathering events, music festivals appear to be the most affected by substance use and intoxication.



Bulloack M, Ranse J, Hutton A. (2018). Impact of patients presenting with alcohol and/or drug intoxication on in-event health care services at mass-gathering events: An integrative literature review. Prehospital and Disaster Medicine.

21 August, 2018

Working in the dark – The impact of a state-wide black systems event on emergency departments: A case study from clinician perspectives





Free full-text article is available here (PDF)

ABSTRACT
Background: A black system event (BSE) is a large scale black-out where there is a loss of a major power supply. From a health perspective a BSE may disrupt essential equipment within a health service that may be necessary for providing care. There is a paucity of literature relating to BSE and their impact on emergency departments (EDs).

Aim: The research aimed to understand the impact of a BSE on ED clinicians in South Australia.

Method: This research used a cross sectional survey design by surveying South Australian ED clinicians who worked during the BSE. Data was collected via a survey with closed and open questions. Quantitative data was analysed using descriptive statistics and qualitative narrative was analysed using a thematic analysis.

Results: Surveys were returned from 42 nurses and 7 doctors. The respondents were mostly female and most worked in a metropolitan ED. The majority of participants had undertaken some form of disaster education and/or training, despite never been involved in a major incident or disaster. A lack of lighting radiography systems not working, communication systems not working and patient tracking systems not working were the most common ways the ED was impacted.

Conclusion: This research is the first to focus exclusively on the impact of a BSEs on EDs in Australia. Emergency departments are encouraged to educate and train staff to be prepared for BSEs, test electrical systems and improve communication with the ED



Hammad K, Wake M, Zampatti C, Neumann S, Ranse J. (in-press, 2018). Working in the dark – the impact of a state-wide black systems event on emergency departments: A case study from clinician perspectives. Collegian.

10 August, 2018

Phenomenology: Moving from philosophical underpinnings to a practical way of doing


Presentation notes (word document)



Biography
Dr Jamie Ranse is an Early Career Researcher currently working as a Research Fellow in Emergency Care. This is a joint appointment between Griffith University and the Gold Coast Health Service. His work focuses on emergency health care, primarily in the areas of high visibility, high consequence events that are either planned (such as mass gatherings / major events) or unplanned (such as disasters). His work has been supported by competitive research grants, published in peer-reviewed journals and presented at national and international conferences.

Jamie completed his Doctor of Philosophy in 2017 at Flinders University, where he researched the experience of Australian nurses who assist in the out-of-hospital disaster environment. He received the Flinders University Vice-Chancellor's Prize for Doctoral Thesis Excellence.

Jamie is an active member of a number of national and international nursing associations. He is a Fellow of the Australian College of Nursing and College of Emergency Nursing Australasia. He is an Associate Editor for the Australasian Emergency Care Journal, holding the disaster portfolio. Additionally, he Chairs the World Association for Disaster and Emergency Medicine, International Mass Gathering Special Interest Group and Chairs the Australian College of Nursing Disaster Health Community of Interest. Jamie volunteered with St John Ambulance Australia for over 20 years; previously holding the role of Chief Nurse. In this role, he engaged in high-level strategic decisions regarding mass gathering and emergency health care.

He has been involved in a number of research projects using phenomenology as a research methodology. His interest in phenomenology lies in how the underlying philosophical assumptions of phenomenology are applied to the practical way of doing phenomenological research in the health care context.


Ranse J. (2018). Phenomenology: Moving from philosophical underpinnings to a practical way of doing; presentation at the University of Newcastle, School of Nursing and Midwifery, Research Week, Newcastle, NSW, 10th August.



15 May, 2018

Mass gatherings: Impacts on emergency departments


I presented this work to the clinical staff of the Royal Adelaide Hospital, Emergency Department. This presentation provided an overview of mass gathering event health-related topics. In particular, this presentation focused on the impact of mass gathering events on the emergency department. The discussion concluded with questions relating to the preparedness of the emergency department when mass gathering events are situated in the region of the hospital. This discussion explored factors pre, during and post a mass gathering.



Ranse J. (2018). Mass gatherings: Impacts on emergency departments; presentation to nurses and doctors of the Royal Adelaide Hospital, Emergency Department, Adelaide, SA, 16th May.



23 April, 2018

Third-year nursing students’ lived experience of caring for the dying: a hermeneutic phenomenological approach

Background: In preparation for practice as a Registered Nurse, it is essential that students are equipped to care for the dying patient and their family.

Aim: To explore nursing students’ lived experience of caring for a dying patient and their family.

Design: Hermeneutic phenomenology.

Methods: Students who had cared for a dying patient in their final year of study were invited to participate in an interview. Participants’ narratives (n = 6) were thematically analysed.

Findings: Analysis revealed three themes: being caring, unexpectedness in witnessing an expected death and experiencing loss. Students demonstrated family-centred care but recounted unexpectedness in both the dying trajectory and physical changes in the dying patient. When reflecting on experiencing loss, students questioned their own actions, acknowledged the value of relationships and identified ways to cope.

Conclusions: Engaging students in the care of dying patients and providing appropriate preparation/support can influence their experience and the care they provide in the future.


Ranse K, Ranse J, Pelkowitz M. 2018. Third-year nursing students’ lived experience of caring for the dying: a hermeneutic phenomenological approach. Contemporary Nurse. [in-press].

17 April, 2018

Introduction to disaster nursing: for undergraduate students



Ranse, J. [jamieranse]. (2018, 5th April). Introduction to disaster nursing: for undergraduate students. https://youtu.be/dh2Oy5Di1qw

This presentation was developed for undergraduate nursing students at Griffith University in the course: 3803NRS Complex Clinical Care

INTRODUCTION:
This topic will:
1. Discuss the incidence of disasters.
2. Describe the role of undergraduate nursing students following disasters.
3. Discuss the willingness and role of nurses following disasters.
4. Illustrate key concepts in (disaster) triage.
5. Throughout the above; discuss aspects of natural disasters, pandemic-like disasters and disasters that are human-made such as chemical, biological, radiological, nuclear or explosion (CBRNE) in nature

BACKGROUND
Definition of disaster 
A disaster can be defined as ‘a serious disruption of the functioning of a community or a society causing widespread human, material, economic or environmental losses which exceed the ability of the affected community or society to cope using its own resources’ (United Nations Office for Disaster Risk Reduction [UNISDR], 2009, p. 9). From a health perspective, this can relate to natural disasters, pandemic-like disasters or disasters that are human-made such as chemical, biological, radiological, nuclear or explosion (CBRNE) in nature.

Incidence of disasters 
Internationally, on average, there were 384 disasters annually for the decade 2004–2013, affecting 199.2 million people and resulting in 99,820 deaths. During this decade, three disasters led to deaths well above the annual average: the Indian Ocean tsunami [226,408 deaths], Cyclone Nargis [138,366 deaths] and the Haiti earthquake [225,570 deaths] (Guha-Sapir, Hoyois & Below, 2015).

In addition to a human cost, disasters have an economic cost. During the period 1980–2012, the World Bank (2013) reported an estimated US$3.8 trillion loss related to disasters. These disasters were primarily (74%) related to extreme weather events (World Bank, 2013).

Nursing students and schools of nursing 
There is an increasing international body of literature relating to the role of nursing students and schools of nursing following a disaster. From an Australian perspective, the literature is speculative of what some possibilities may be for students in disasters, such as assisting in the department or unit where students undertook their most recent clinical practice experience (Cusack, Arbon, & Ranse, 2010).

Role of nurses in disasters 
Following a disaster, nurses undertake a variety of roles in a variety of settings. Following the 2009 Victorian Bushfires, nurses did not focus exclusively on clinical activities. Instead, nurses undertook minimal clinical activities, spending most of their patient contact time coordinating care, problem solving and providing psychosocial support to colleagues and members of the disaster affected communities (Ranse, Lenson & Aimers, 2010; Ranse & Lenson, 2012).

Willingness of nurses to assist in disasters 
Not all nurses may be willing to assist following a disaster. There are a number of factors that influence a nurses willingness to assist, such as the type of disaster and commitments at home (Arbon, Cusack, et al., 2013; Arbon, Ranse, et al., 2013). Nurses are more willing to assist following a natural disaster when compared to a human-made disaster such as a CBRNE event.

Triage 
The key principle of triage is to do the greatest good for the greatest number of people. In normal day-to-day activities, this involves caring for the patient with the highest acuity and health needs first. However, following a disaster, there may not be an appropriate level of resources to assist in the care of all high-acuity patients. As such, triage is reversed, whereby to achieve a goal of doing the greatest good, those patients with a lower acuity may be cared for in the first instance. There are a number of algorithms designed to support decision-making during triage (Ranse & Zeitz, 2010).


REQUIRED READING AND ACTIVITY

Required readings 

Arbon P, Cusack, L, Ranse J, Shaban R, Considine J, Kako M, Woodman R, Mitchell B, Bahnisch L, Hammad K. (2013). Exploring staff willingness to attend work during a disaster: a study of nurses employed in four Australian emergency departments. Australasian Emergency Nursing Journal.16(3):103-109.

Arbon P, Ranse J, Cusack L, Considine J, Shaban R, Woodman R, Bahnisch L, Kako M, Hammad K, Mitchell B. (2013). Australasian emergency nurses’ willingness to attend work in a disaster: A survey. Australasian Emergency Nursing Journal. 16(2):52-57.

Cusack L, Arbon P, Ranse J. (2010). What is the role of nursing students and faculties of nursing during disasters and emergencies? A discussion paper. Collegian. 17(4):193-197

Activity 
Given what you have learnt from the above two manuscripts and the YouTube presentation provide an answer to the following scenario: You are a nursing student who is on their way home from a clinical shift in the medical ward of a local hospital. As you are commuting home, a bushfire impacts the suburb near your home and the local hospital.
  • Question: Are you willing to assist with this disaster? Provide a justification for your answer. 
  • Question: What do you think your role will be following this disaster? Provide a rationale for your answer.


REFERENCES

Arbon P, Cusack, L, Ranse J, Shaban R, Considine J, Kako M, Woodman R, Mitchell B, Bahnisch L, Hammad K. (2013). Exploring staff willingness to attend work during a disaster: a study of nurses employed in four Australian emergency departments. Australasian Emergency Nursing Journal.16(3):103-109.

Arbon P, Ranse J, Cusack L, Considine J, Shaban R, Woodman R, Bahnisch L, Kako M, Hammad K, Mitchell B. (2013). Australasian emergency nurses’ willingness to attend work in a disaster: A survey. Australasian Emergency Nursing Journal. 16(2):52-57.

Cusack L, Arbon P, Ranse J. (2010). What is the role of nursing students and faculties of nursing during disasters and emergencies? A discussion paper. Collegian. 17(4):193-197

Guha-Sapir, D., Hoyois, P., & Below, R. (2015). Annual disaster statistical review 2014: The numbers and trends. Retrieved from http://www.cred.be/sites/default/file...

Ranse J, Hammad K, Ranse K. (2013). Future considerations for Australian nurses and their disaster educational preparedness: a discussion. Australian Journal of Emergency Management. 28(4):49-53.

Ranse J, Lenson S, Aimers B. (2010). Black Saturday and the Victorian Bushfires of February 2009: A descriptive survey of nurses who assisted in the pre-hospital setting. Collegian. 17(4):153-159

Ranse J, Lenson S, Luther M, Xaio L. (2010). H1N1 2009 influenza (human swine influenza): A descriptive study of the response of an influenza assessment clinic collaborating with an emergency department in Australia. Australasian Emergency Nursing Journal. 13(3):46-52.

Ranse J, Lenson S. (2012). Beyond a clinical role: Nurses were psychosocial supporters, coordinators and problem solvers in the Black Saturday and Victorian bushfires in 2009. Australasian Emergency Nursing Journal. 15(3):156-163.

Ranse J, Shaban R, Considine J, Hammad K, Arbon P, Mitchell B, Lenson S. (2013). Disaster content in Australian tertiary postgraduate emergency nursing courses: A survey. Australasian Emergency Nursing Journal. 16(2):58-63.

Ranse J, Zeitz K. (2010). Chapter 5: Disaster Triage in Power R, Daily E (eds). International Disaster Nursing. World Association of Disaster and Emergency Medicine with Cambridge Press. pp:57-79.

United Nations Office for Disaster Risk Reduction (UNISDR). (2009). UNISDR terminology on disaster risk reduction. (UNISDR-20-2009). Geneva.

Usher K, Mayner L. (2011). Disaster nursing: a descriptive survey of Australian undergraduate nursing curricula. Australasian Emergency Nursing Journal. 14(2): 75-80.

World Bank. (2013). Building resilience: Integrating climate and disaster risk into development: Lessons from World Bank Group experience. Washington, DC: The World Bank.


21 February, 2018

Developing public health initiatives through understanding motivations of the audience at mass gathering events



Free full-text article is available here (PDF)

ABSTRACT
This report identifies what is known about audience motivations at three different massgathering events: outdoor music festivals, religious events, and sporting events. In light of these motivations, the paper discusses how these can be harnessed by the event organizer and Emergency Medical Services. Lastly, motivations tell what kinds of interventions can be used to achieve an understanding of audience characteristics and the opportunity to develop tailor-made programs to maximize safety and make long-lasting public health interventions to a particular “cohort” or event population. A lot of these will depend on what the risks/hazards are with the particular populations in order to “target” them with public health interventions. Audience motivations tell the event organizer and Emergency Medical Services about the types of behaviors they should expect from the audience and how this may affect their health while at the event. Through these understandings, health promotion and event safety messages can be developed for a particular type of massgathering event based on the likely composition of the audience in attendance. Health promotion and providing public information should be at the core of any mass-gathering event to minimize public health risk and to provide opportunities for the promotion of healthy behaviors in the local population. Audience motivations are a key element to identify and agree on what public health information is needed for the event audience. A more developed understanding of audience behavior provides critical information for event planners, event risk managers, and Emergency Medical Services personnel to better predict and plan to minimize risk and reduce patient presentations at events. Mass-gathering event organizers and designers intend their events to be positive experiences and to have meaning for those who attend. Therefore, continual vigilance to improve public health effectiveness and efficiency can become best practice at events. Through understanding the motivations of the audience, event planners and designers, event risk managers, and emergency medical personnel may be better able to understand the motivation of the audience and how this might impact on audience behavior at the event.



Hutton A, Ranse J, Munn B. (2018). Developing public health initiatives through understanding motivations of the audience at mass gathering events. Prehospital and Disaster Medicine.

22 September, 2017

Doctoral thesis: Australian civilian hospital nurses’ lived experience of an out-of-hospital environment following a disaster

AWARDS
Flinders University, Vice-Chancellors Prize for Doctoral Thesis Excellence





ABSTRACT
Disasters disrupt the normal functioning of communities. From a health perspective, disasters may place an increased demand on health services within affected communities. When a disaster occurs, Australian nurses may respond as part of a government or non-government disaster medical assistance team. There is an increasing international literature base of nurses’ personal experiences and descriptions of single disastrous events. However, Australian civilian hospital nurses’ lived experience of the out-of-hospital environment following a disaster has not yet been explored.

Phenomenology is concerned with the essence of things as they are appearing in the conscious awareness of the first person. This phenomenological study uncovered what it may be like being an Australian civilian hospital nurse in the out-of-hospital environment following a disaster. Hermeneutics and phenomenology formed the theoretical framework for this study. While there is no one way to do phenomenology and get back to the things themselves as they are appearing in themselves, for this study, an epoché and reduction were the key methods of phenomenology in guiding a way.

To get to the essence of the phenomenon being uncovered, narrative was obtained from eight participants, using semi-structured interviews at two points in time. Participants were Australian civilian hospital nurses who had worked in the out-of-hospital disaster environment as part of a disaster medical assistance team. From the participant narratives, descriptive moments formed a lived-experience description as an anecdote of what it may be like being a nurse in an out-of-hospital environment following a disaster. The uncovered moments in this study included ‘on the way to a disaster’, ‘prior to starting work’, ‘working a shift in a disaster’, ‘end of a shift’ and ‘returning home’. Phenomenological reflections of the existentials of spatiality, corporeality, communality and temporality overlaid the moments of the lived-experience description. Commentary on the phenomenological reflections provided further depth to the insights of what it may be like being an Australian civilian hospital nurse in the out-of-hospital environment following a disaster.

A nurse’s experience following a disaster, from a spatial perspective, was described in this study as lived-space as shrinking then opening too-wide, and disaster health lived-space as occupying, sharing and giving back. From a corporeal perspective, their experience was described as a nurse’s lived-body, for nursing following a disaster, and a nurse’s lived-body, for patients following a disaster. From a communal perspective, their experience was described as with colleagues, being relationally close; with patients and their families, being an insider; and being with self. From a temporal perspective, their experience was described as kairos time speeding up and condensing and kairos time slowing down and stretching.

Chronos time emerged as a featured backdrop to the life-world of what it may be like being an Australian civilian hospital nurse in the out-of-hospital environment following a disaster. In particular, chronos time was described as intersecting between the uncovered moments and the phenomenological existentials as a way to gain greater insights of a possible experience. These insights, in turn, informed possibilities for future practice, future education and professional development, and future research related to the experience of an Australian civilian hospital nurse in the out-of-hospital disaster environment as part of a disaster medical assistance team following a disaster.


Ranse, J. (2017). Australian civilian hospital nurses’ lived experience of an out-of-hospital environment following a disaster. Doctorate of Philosophy, Flinders University, South Australia.







27 July, 2017

Caring during catastrophe: How nurses can make a difference



I was an invited guest speaker at the AusMed Education conference - Disaster Nursing - Not if, But when.



Ranse J. (2017). Caring during catastrophe: How nurses can make a difference; invited speaker for Disaster Nursing - Not If, But When… Melbourne, Vic, 27th July.


29 April, 2017

Health service impact from mass-gatherings: A systematic literature review


ABSTRACT:

Background: Mass gatherings are events where a large number of people congregate for a common purpose, such as sporting events, agricultural shows, and music festivals. When definitive care is required for participants of mass gatherings, municipal ambulance services provide assessment, treatment, and transport of participants to acute care settings, such as hospitals. The impact on both ambulance services and emergency department services from mass gathering events was the focus of this literature review.

Methods: This research used a systematic literature review methodology. Databases were searched to find articles related to aim of the review. Articles focused on mass gathering health, provision of in-event health services, ambulance service transportation and hospital utilization.

Results: Twenty-four studies were identified for inclusion in this review. These studies were all case-study based and retrospective in design. The majority of studies (n = 23) provided details of in-event first responder services. There was variation in reporting of the number and type of in-event health professional services at mass gatherings. All articles reported that patients were transported to hospital by the ambulance service. Only nine articles reported on patients presenting to hospital.

Conclusion: There is minimal research focusing on the impact of mass gatherings on in-event and external health services, such as ambulance services and hospitals. A recommendation for future mass gathering research and evaluation is to link patient-level data from in-event mass gatherings to external health services. This type of study design would provide information regarding the impact on health services from a mass gathering, to more accurately inform future health planning for mass-gatherings across the health care continuum


Ranse J, Hutton A, Keene T, Lenson S, Luther M, Bost N, Johnston A, Crilly J, Cannon M, Jones N, Hayes C, Burke B. (2017) Health service impact from mass-gatherings: A systematic literature review; paper presented at the 17th WADEM Congress on Disaster and Emergency Medicine. Toronto, Canada 29th April








25 April, 2017

Australian civilian hospital nurses' lived experience of the out-of-hospital environment following a disaster: A lived-space perspective




ABSTRACT:

Study/Objective: This research explored what it may be like being an Australian civilian in-hospital nurse, in the out-of hospital disaster environment following a disaster, as part of a disaster medical assistance team. This presentation will explore the specific aspect of lived-space from a larger phenomenological research project.

Background: In the minutes following a disaster, reports from the media focus on the measurable impact. For example, the magnitude of an earthquake or the number of hectares burnt by a wildfire. Lived-space is concerned with felt space, going beyond these measurable physical, visible and touchable spaces. Lived-space is the way in which we find ourselves in our lifeworld through the spaces of our day-to-day existence

Methods: For this phenomenological study, narrative was obtained from eight Australian civilian hospital nurses following a disaster. Semi-structured interviews were conducted at two points in time. Descriptive moments of a possible lived experience were identified from participant narrative. These moments formed a lived experience description as an anecdote of an experience. A preparatory epoché-reduction and reduction proper was used to guide a reflection on the lived-space of being a nurse, following a disaster from the lived experience description.

Results: Lived-space was described as shrinking then being open too-wide, where nurses were drawn into the disaster lived-space, then returning home to a wide-open but crowded lived-space. Disaster health lived-space was described as occupying, sharing and giving back. Conclusion: This research provides insight into Australian civilian in-hospital nurse in the out-of-hospital disaster environment, following a disaster as part of a disaster medical assistance team. In particular, this work adds a lived-space perspective to the existing literature. These insights may inform future education, research, clinical practice, and policy.


Ranse J, Arbon P, Cusack L, Shaban R. (2017) Australian civilian hospital nurses' lived experience of the out-of-hospital environment following a disaster: A lived-space perspective; paper presented at the 17th WADEM Congress on Disaster and Emergency Medicine. Toronto, Canada 25th April.

13 March, 2017

Health service impact from mass-gatherings: A systematic literature review



Free full-text article is available here (PDF)

ABSTRACT:
Background: During a mass gathering, some participants may receive health care for injuries or illnesses that occur during the event. In-event first responders provide initial assessment and management at the event. However, when further definitive care is required, municipal ambulance services provide additional assessment, treatment, and transport of participants to acute care settings, such as hospitals. The impact on both ambulance services and hospitals from mass-gathering events is the focus of this literature review.

Aim: This literature review aimed to develop an understanding of the impact of mass gatherings on local health services, specifically pertaining to in-event and external health services.

Method: This research used a systematic literature review methodology. Electronic databases were searched to find articles related to the aim of the review. Articles focused on mass-gathering health, provision of in-event health services, ambulance service transportation, and hospital utilization.

Results: Twenty-four studies were identified for inclusion in this review. These studies were all case-study-based and retrospective in design. The majority of studies (n = 23) provided details of in-event first responder services. There was variation noted in reporting of the number and type of in-event health professional services at mass gatherings. All articles reported that patients were transported to hospital by the ambulance service. Only nine articles reported on patients presenting to hospital. However, details pertaining to the impact on ambulance and hospital services were not reported.

Conclusions: There is minimal research focusing on the impact of mass gatherings on in-event and external health services, such as ambulance services and hospitals. A recommendation for future mass-gathering research and evaluation is to link patient-level data from in-event mass gatherings to external health services. This type of study design would provide information regarding the impact on health services from a mass gathering to more accurately inform future health planning for mass gatherings across the health care continuum.



Ranse J, Hutton A, Keene T, Lenson S, Luther M, Bost N, Johnston A, Crilly J, Cannon M, Jones N, Hayes C, Burke B. (2017) Health service impact from mass-gatherings: A systematic literature review. Prehospital and Disaster Medicine. 32(1):

13 February, 2017

Development of a mass-gathering triage tool: An Australian perspective




Free full-text article is available here (PDF)


ABSTRACT
Many health service organizations deploy first responders and health care professionals to mass gatherings to assess and manage injuries and illnesses. Patient presentation rates (PPRs) to on-site health services at a mass gathering range from 0.48-170 per 10,000 participants. Transport to hospital rates (TTHRs) range from 0.035-15 per 10,000 participants. The aim of this report was to outline the current literature pertaining to mass-gathering triage and to describe the development of a mass-gathering triage tool for use in the Australian context by first responders. The tool is based on the principles of triage, previous mass-gathering triage tools, existing Australian triage systems, and Australian contextual considerations. The model is designed to be appropriate for use by first responders.


Cannon M, Roitman R, Ranse J, Morphet J. (2017) Development of a mass-gathering triage tool: An Australian perspective. Prehospital and Disaster Medicine. 32(1).

18 January, 2017

Being health prepared for a disaster

I was interviewed by Chris Coleman on 1206AM Canberra 2CC regarding ways to keep people prepared for a disaster, from a health perspective. The interview was initiated on the background of impending hot weather and high fire danger in the Canberra region.

Key points for being health prepared that were discussed included:
  • Have a current list of medications, ailments and previous medical/surgical history. 
  • Keep this list with other items you might take in an evacuation, such as photo albums or computers 
  • Keep a stocked first aid kit in your car
  • Learn first aid and know basic first aid principles such as how to control bleeding, how to open an airway and how to do CPR 
  • Get to know your neighbours, you might need each other’s help in an emergency

The 27th December 2016: Live interview ‘Being health prepared for a disaster’, on: 1206 2CC (Canberra) can be found below:




On 18th January 2017, a number of large grass fires were burning in the Canberra region, resulting in emergency warnings for the region. I was interviewed by Chris Coleman on 1206AM Canberra 2CC regarding the immediate action people should take to keep safe and be prepared from a health perspective.



27th December 2016: Live interview ‘Being health prepared for a disaster’, on: 1206 2CC (Canberra)

18th January 2017: Live interview, bushfire update ‘Considerations during evacuation’, on: 1206 2CC (Canberra). (During Bushfire Emergency near Sutton, NSW).



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