Black Saturday and the 2009 Victorian Bushfires

Various publications and presentations relating to Black Saturday and the 2009 Victorian Bushfires

H1N1 2009 Influenza

Various publications and presentations relating to H1N1 2009 influenza outbreak

In the media

Latest interviews and articles from the media

Invited Speaker

Various presentations given as an invited and keynote speaker.

Mass Gathering Health

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

09 October, 2014

Understanding the effect of clinician dependent versus evidence-based pathway for the management of Salmonella-like symptoms in an emergency department.


ABSTRACT
Introduction: On Monday the 13th of May 2013, a surge in patients with vomiting and diarrhoea presented to an Emergency Department (ED) in Canberra. Contract tracing identified a focal point between patients, and pathology samples identified Salmonella as the responsible agent. On the following Wednesday, upon a hospital based disaster being declared, a just-in-time evidence-based pathway was introduced to ensure consistency in patient management. This research aims to describe the effect of this pathway (intervention) versus clinician dependent (control) management of such patients.

Method: This research was retrospective in design. The sample includes 110 patients who presented in May 2013 to one ED, with Salmonella-like symptoms. Data was collected from the Emergency Department Information System. Patient characteristics, such as age and gender are described using descriptive statistics. A Mann-Whitney test was used to compare continuous data and a Fisher exact test was used to compare categorical data, between the two groups. This research has ethics approval from the health care facility.

Results: Over an eight day period, 110 patients presented with salmonella-like symptoms. Of these, 47 were male and 63 were female, with a median age of 30 years (IQR: 20-42). Both age (p=0.65) and gender (p=0.84) were statistically similar between the two groups. Overall, the mean length of stay in minutes (±SD) was 735 (1112). However, the mean length of stay in minutes was statistically different between the two groups, with the control being 975 (1280) and the intervention being 230 (251) (p=0.0001).

Discussion: The length of stay for patients between the two groups was statistically significantly different, suggesting that the implementation of a just-in-time evidence-based pathway for the management of patients with Salmonella-like symptoms reduced the ED length of stay. This finding is useful in that it may assist in the future planning of similar public health emergencies or for use when patients present with Salmonella-like symptoms on a daily basis.






Ranse J, Luther M, Ranse K. (2014). Understanding the effect of clinician dependent versus evidence-based pathway for the management of Salmonella-like symptoms in an emergency department; paper presented at the 12th International Conference for Emergency Nurses, Perth, Australia, 9th October.






Patient presentations to onsite health providers, ambulance paramedics and hospital emergency departments from a mass gathering: a case study.



ABSTRACT:

Introduction: Health providers at mass gatherings aim to minimise the disruption to the health services of the surrounding community. The mass gathering literature focuses on patients presenting to onsite care providers at events, and scantly reports on patients presenting to prehospital care providers (ambulance paramedics) and hospital emergency departments (EDs). In 2012, an outdoor music festival with approximately 20,000 participants was held in Canberra. The festival had one first aid post, and a medical assistance team staffed by doctors, nurses and paramedics. This research describes the characteristics of patients and health service usage from this event.

Method: Data was collected retrospectively from the event onsite care provider (St John Ambulance Australia) patient records. These records were linked to both prehospital (ACT Ambulance Service) and hospital EDs (Canberra Hospital and Calvary Health Care ACT) patient records. A preexisting minimum data set was used to code patient characteristics. Data analysis included descriptive statistics, such as frequencies and means of central tendency.

Results: In total, 197 (9.86/1,000) patients presented for clinical assessment and/or management at the event. Two patients who required hospitalisation bypassed the onsite care providers and were transferred directly via the ambulance service to hospital. The onsite medical assistance team managed 22 patients (1.1/1,000), of whom two were referred to police, five transported to hospital and 15 discharged to the event. In total, seven patients were transported to hospital by ambulance (0.35/1,000). Hospital presentation rate and patient characteristics are currently being determined at the time of this abstract submission.

Discussion: This is the first research to describe patient presentations to onsite care providers, prehospital and hospitals from a mass gathering. This research provides insight into the health service usage associated with mass gathering. Strategies to minimising the disruption to the prehospital and hospital health services of the surrounding community will be discussed.



Ranse J, Lenson S, Keene T, Luther M, Burke B, Hutton A. Patient presentations to onsite health providers, ambulance paramedics and hospital emergency departments from a mass gathering: a case study. 12th International Conference for Emergency Nurses.



02 October, 2014

Drugs, pills top emergency list for evacuation too


I was interviewed by Natasha Body from the Canberra Times. The interview focused on the health preparedness of the community in a disaster.

The full text article is available here

26 September, 2014

Canberra's hospitals ability to cope in a disaster

I was interviewed by Mark Parton on 1206AM Canberra 2CC regarding the ability of Canberra's health system to cope if a disaster or mass casualty incident was to occur in the region.

The interview was initiated on the background of a number of reports in The Canberra Times relating to the overcapacity of Canberra's hospitals, and in particular the Emergency Departments:
My interview highlighted that the health system in Canberra had coped in the past with major incidents. Additionally, I discussed the educational preparedness of nurses and the ability of the health systems to adapt based on previous events. For example, the establishment of influenza assessment clinics as adjunct to the emergency departments in communicable diseases such as H1N109 Influenza.

My interview is below:







19 September, 2014

Patient presentations to onsite health providers, ambulance paramedics and hospital emergency departments from a mass gathering: a case study





ABSTRACT:
Background:
A number of challenges exist in providing adequate health care at a mass gathering. Health providers aim to maximise their efficiency in responding to health emergencies within the mass gathering environment, whilst minimising potential impact of surge presentations to the health service in the surrounding community or region. The mass gathering literature commonly reports on the onsite care from single events, and does not consider the effect on prehospital or hospital services.

Aim:
This research aims to enhance our understanding of the health service requirements of an outdoor music festival.

Methods:
Design: Retrospective review of patient report forms from onsite health services at outdoor music festival.
Setting: One outdoor music festival in 2012 in the Australian Capital Territory with approximately 20,000 participants. The festival had one first aid post and a health team staffed by doctors, nurses and paramedics.
Data collection: Data was obtained and linked between onsite care providers (St John Ambulance Australia), prehospital (ACT Ambulance Service) and hospitals (Canberra Hospital and Calvary Health Care ACT). A pre-existing and used minimum data set1 was used to code patient characteristics from this event.
Data analysis: Descriptive statistics such as frequency distributions and means of central tendency. 

Results:
This is a summary of some of the key findings.

  • Onsite first aid care: The most frequent illness was headaches (n=94), injury was superficial lacerations (n=13), environmental was substance and/or alcohol intoxication (n=12).
  • Onsite health professional care: The most frequent illness was headaches (n=3), injury was fractures (n=2), environmental was substance and/or alcohol intoxication (n=12).
  • Ambulance transport: The most frequent injury was fractures (n=2), environmental was substance and/or alcohol intoxication (n=4). One patient required prehospital endotracheal intubation, Three patients required airway adjuncts, Six patients received intravenous medications from paramedics including opioids.
  • Hospital services: One patient required an open reduction and internal fixation in the operating theatre. One patient required intubation and ventilator support in the Intensive Care Unit.


Discussion:
This is the first research to describe patient presentations to onsite care providers, prehospital services and hospitals from a mass gathering. This research provides insight into the health service usage from one event. Presentation to the onsite health professionals resulted in a longer length of stay in the onsite medical facility. Onsite health professionals may have diverted 15 patients who would have otherwise been seen by local ambulance and hospital services. Multi-site research should be undertaken to explore the health service usage from a variety of mass gatherings.



Ranse J, Lenson S, Keene T, Luther M, Burke B, Hutton A. (2014). Patient presentations to onsite health providers, ambulance paramedics and hospital emergency departments from a mass gathering: a case study; poster presented at the Paramedics Australasia International Conference 2014, Gold Coast, Australia, 18-20 September.

28 August, 2014

What are the research needs for the field of disaster nursing in the next five years? An international Delphi study


Free full-text article is available here (PDF)

ABSTRACT

Background: Internationally there is an increasing amount of peer-reviewed literature pertaining to disaster nursing. The literature includes personal anecdotes, reflections, and accounts of single case studies. Furthermore, issues such as the willingness of nurses to assist in disasters, the role of nurses in disasters, leadership, competencies, and educational preparedness for nurses have been the focus of the literature.

Aim: The aim of this research was to determine the international research priorities for disaster nursing.

Method: This research used a three-round Delphi technique. The first round used a face-to-face workshop to generate research statements with nursing members of the World Association for Disaster and Emergency Medicine (WADEM). The second and third rounds included the ranking of statements on a 5-point Likert scale with nursing members of WADEM and the World Society of Disaster Nursing (WSDN). Statements that achieved a mean of four or greater were considered a priority and progressed.

Results: Participants were from multiple countries. Research statements were generated in the areas of: education, training, and curriculum; psychosocial; strategy, relationship, and networking; and clinical practice. Psychosocial aspects of disaster nursing ranked the highest, with five statements appearing in the top ten research areas, followed by statements relating to: education, training, and curriculum; clinical practice; and finally, strategy, relationship, and networking.

Conclusions: Future disaster nursing research should focus on the area of psychosocial aspects of disaster nursing, in particular, both the psychosocial needs of a disaster-affected community and the psychosocial well-being of nurses who assist in disaster health activities.




Ranse J, Hutton A, Jeeawody B, Wilson R. What are the research needs for the field of disaster nursing in the next five years? An international Delphi study. Prehospital Disaster Medicine. 2014

21 July, 2014

National consistency in industrial awards for disaster release for Australian Nurses: An integrative review of enterprise agrrangements



Free full-text article is available here (PDF)

ABSTRACT
This research explores the types of provisions made available to nurses within Australian public employment agreements to respond to disasters and alternate provisions made available to provide personal property protection and personal care during a disaster. An integrative literature review methodology is used to collect, evaluate, analyse and integrate sources of evidence to inform a discussion on the current enterprise arrangements for nurses with respect to eight Australian jurisdictions. These were evaluated for the industrial provisions made available to nurses wanting to assist in responding to disasters. Only five of these agreements mentioned provisions for nurses to assist in disasters. Where these provisions exist, they vary in their consistency, terminology and the quantity of the entitlements, potentially leading to inequality and variability in the financial support frameworks for nurses involved in disaster events.



Lenson S, Ranse J, Cusack L. (2014). National consistency in industrial awards for disaster release for Australian nurses: An integrative review of enterprise arrangements. Asia Pacific Journal of Health Management. 9(2):53-58.

30 June, 2014

Doing phenomenology and hermeneutics: Australian civilian nurses' lived experience of being in a disasters


This presentation was presented at the Higher Degrees Week - Flinders University, Faculty of Health Sciences, School of Nursing and Midwifery as a progress seminar for my PhD studies.

ABSTRACT
This presentation will focus on the theoretical underpinnings of phenomenology and hermeneutics as they are applied to a research paradigm which aims to: provide insight into the experience of being an Australian civilian nurse within the out-of-hospital environment during a disaster. A purposive sampling technique was employed to recruit participants for this research. Subsequently, data was collected from eight participants using semi-structured interviews at two points in time, one week apart. The first interview was primarily phenomenological, whilst the second was more hermeneutic in nature. Participant narrative was captured on an electronic audio recording device and transcribed. In terms of data analysis, phenomenology is neither inductive nor deductive, rather phenomenology is reductive. This research primarily used an eidetic reduction of participant narrative, returning to the experience as it is in itself; by uncover the uniqueness or ‘whatness’ of the experience. The result of the reduction is a lived experience description, a description of the experience that is recognisable by others of what it may be like being an Australian civilian nurse within the out-of-hospital environment during a disaster.




Ranse J. (2014). Doing phenomenology and hermeneutics: Australian civilian nurses' lived experience of being in a disasters; presentation at the Higher Degrees Week - Flinders University, Faculty of Health Sciences, School of Nursing and Midwifery. Adelaide, South Australia, 30th June.

05 June, 2014

Disasters happen: the realities of being in a disaster


I was invited to the University of New England, Armidale, New South Wales to present on the topic of disaster health and to participate in some research collaboration with academic staff members.

ABSTRACT:
Disasters happen, and health professionals are involved in restoring and maintaining the health and health services of disaster-affected communities. This presentation will provide an overview of what is known about disaster health in the Australian context, such as the willingness of health professionals to assist in a disaster and their educational preparedness. In particular, this presentation will focus on the realities of what it is like to be a health professional in a disaster.





Ranse J. (2014). Disasters happen: the realities of being in a disaster; presentation to Faculty at University of New England, Armidale, NSW, 5th June.

28 May, 2014

Enhancing the minimum data set for mass-gathering research and evaluation: An integrative literature review


Free full-text article is available here (PDF)

ABSTRACT:
Introduction: In 2012, a minimum data set (MDS) was proposed to enable the standardized collection of biomedical data across various mass gatherings. However, the existing 2012 MDS could be enhanced to allow for its uptake and usability in the international context. The 2012 MDS is arguably Australian-centric and not substantially informed by the literature. As such, an MDS with contributions from the literature and application in the international settings is required.

Methods: This research used an integrative literature review design. Manuscripts were collected using keyword searches from databases and journal content pages from 2003 through 2013. Data were analyzed and categorized using the existing 2012 MDS as a framework.

Results: In total, 19 manuscripts were identified that met the inclusion criteria. Variation in the patient presentation types was described in the literature from the mass-gathering papers reviewed. Patient presentation types identified in the literature review were compared to the 2012 MDS. As a result, 16 high-level patient presentation types were identified that were not included in the 2012 MDS.

Conclusion: Adding patient presentation types to the 2012 MDS ensures that the collection of biomedical data for mass-gathering health research and evaluation remains contemporary and comprehensive. This review proposes the addition of 16 high-level patient presentation categories to the 2012 MDS in the following broad areas: gastrointestinal, obstetrics and gynecology, minor illness, mental health, and patient outcomes. Additionally, a section for self-treatment has been added, which was previously not included in the 2012 MDS, but was widely reported in the literature.


Ranse J, Hutton A, Turris S, Lund A. (2014). Enhancing the minimum data set for mass gathering research and evaluation: An integrative literature review. Prehospital Disaster Medicine. 29(3):1-10.


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