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

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.



28 June, 2018

How do you actually care during a catastrophe?



I was an invited guest speaker at the AusMed Education conference - Disaster Nursing - Not if, But when. 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. (2018). How do you actually care during a catastrophe?; invited speaker for Disaster Nursing - Not If, But When… Brisbane, Qld, 28th June.

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).



05 December, 2016

Lighthouse Innovation Teen-startup: Talking disasters and first responders


I was invited by the Lighthouse Business Innovation Centre (Lighthouse) to present at a Teen Start-up in January 2017. The topic of the start-up related to first responders and problem-solving real world situations relating disasters. Unfortunately, I was not available on the dates of the start-up to give a face-to-face presentation. As such, I participated in a prerecorded interview for the workshop participants.



20 October, 2016

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.

Aim: This literature review aims to develop an understanding of the impact of mass gatherings on local health services.

Method: 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 utilisation.

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.

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. (2016) Health service impact from mass-gatherings: A systematic literature review; paper presented at the 14th International Conference for Emergency Nurses. Alice Springs, Australia. 20th October.





14 October, 2016

The impact of mass gatherings on ambulance services and hospitals


This presentation was delivered as a webinar to members of the World Association of Disaster and Emergency Medicine.


ABSTRACT
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 in-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 presentation. In particular, a case study of one outdoor music festival in 2012 in the Australian Capital Territory with approximately 20,000 participants will be analysed. This festival had one first aid post and a health team staffed by doctors, nurses and paramedics.


Ranse J. (2016). The impact of mass gatherings on ambulance services and hospitals; webinar presentation to members of the Mass Gathering Section of the World Association for Disaster and Emergency Medicine, 14th October.



30 June, 2016

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



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
Disasters disrupt the normal functioning of a community resulting in an increased demand for health services. The literature pertaining to the experience of Australian nurses assisting in the out-of-hospital disaster environment is primarily descriptive of single events and does not include a phenomenological perspective. The aim of this research was to gain insight into what it may be like Being an Australian civilian in-hospital nurse working in the out-of-hospital disaster environment. Phenomenology as a method was used in this research, which is concerned with the essence of things as they are appearing in the conscious awareness of the first person. Narrative was obtained from eight participants using semi-structured interviews at two points in time. From the participant narrative, moments of their lived experience included; on the way to the disaster, prior to starting work, working the shift, end of the shift and returning home. From the lived experience description a reflection was undertaken against the phenomenological existentials of spatiality, corporeality, communality, and temporality. The existential theme of temporality emerged strongly. The lived experience description and existential reflection provide insight into what it may be like Being an Australian civilian in-hospital nurse working in the out-of-hospital disaster environment. This in turn, may inform future education, research, clinical practice and health policy related to nurses in the out-of-hospital disaster environment.

Ranse J. (2016). Australian civilian hospital nurses’ lived experience of an out-of-hospital disaster; presentation at the Higher Degrees Week - Flinders University, Faculty of Health Sciences, School of Nursing and Midwifery. Adelaide, South Australia, 30th June.

23 May, 2016

Exploring international views on key concepts for mass gathering health through a Delphi process

Introduction: The science underpinning mass-gathering health (MGH) is developing rapidly. However, MGH terminology and concepts are not yet well defined or used consistently. These variations can complicate comparisons across settings. There is, therefore, a need to develop consensus and standardize concepts and data points to support the development of a robust MGH evidence-base for governments, event planners, responders, and researchers. This project explored the views and sought consensus of international MGH experts on previously published concepts around MGH to inform the development of a transnational minimum data set (MDS) with an accompanying data dictionary (DD).

Report: A two-round Delphi process was undertaken involving volunteers from the World Health Organization (WHO) Virtual Interdisciplinary Advisory Group (VIAG) on Mass Gatherings (MGs) and the MG section of the World Association for Disaster and Emergency Medicine (WADEM). The first online survey tested agreement on six key concepts: (1) using the term “MG HEALTH;” (2) purposes of the proposed MDS and DD; (3) event phases; (4) two MG population models; (5) a MGH conceptual diagram; and (6) a data matrix for organizing MGH data elements. Consensus was defined as ≥80% agreement. Round 2 presented five refined MGH principles based on Round 1 input that was analyzed using descriptive statistics and content analysis. Thirty-eight participants started Round 1 with 36 completing the survey and 24 (65% of 36) completing Round 2. Agreement was reached on: the term “MGH” (n = 35/38; 92%); the stated purposes for the MDS (n = 38/38; 100%); the two MG population models (n = 31/36; 86% and n = 30/36; 83%, respectively); and the event phases (n = 34/36; 94%). Consensus was not achieved on the overall conceptual MGH diagram (n = 25/37; 67%) and the proposed matrix to organize data elements (n = 28/37; 77%). In Round 2, agreement was reached on all the proposed principles and revisions, except on the MGH diagram (n = 18/24; 75%).

Discussion/Conclusions: Event health stakeholders require sound data upon which to build a robust MGH evidence-base. The move towards standardization of data points and/ or reporting items of interest will strengthen the development of such an evidence-base from which governments, researchers, clinicians, and event planners could benefit. There is substantial agreement on some broad concepts underlying MGH amongst an international group of MG experts. Refinement is needed regarding an overall conceptual diagram and proposed matrix for organizing data elements.



Steenkamp M, Hutton A, Ranse J, Arbon P, Lund A, Turris S, Bowles R. (2016). Exploring international views on key concepts for mass gathering health through a Delphi process. Prehospital Disaster Medicine.

14 March, 2016

International consensus on key concepts and data definitions for mass gathering health: Process and progress


Free full-text article is available here (PDF)

ABSTRACT
Mass gatherings (MGs) occur worldwide on any given day, yet mass-gathering health (MGH) is a relatively new field of scientific inquiry. As the science underpinning, the study of MGH continues to develop, there will be increasing opportunities to improve health and safety of those attending events. The emerging body of MG literature demonstrates considerable variation in the collection and reporting of data. This complicates comparison across settings and limits the value and utility of these reported data. Standardization of data points and/or reporting in relation to events would aid in creating a robust evidence base from which governments, researchers, clinicians, and event planners could benefit.Moving towards international consensus on any topic is a complex undertaking. This report describes a collaborative initiative to develop consensus on key concepts and data definitions for a MGH “Minimum Data Set.” This report makes transparent the process undertaken, demonstrates a pragmatic way of managing international collaboration, and proposes a number of steps for progressing international consensus. The process included correspondence through a journal, face-to-face meetings at a conference, then a four-day working meeting; virtual meetings over a two-year period supported by online project management tools; consultation with an international group of MGH researchers via an online Delphi process; and a workshop delivered at the 19thWorld Congress on Disaster and Emergency Medicine held in Cape Town, South Africa in April 2015. This resulted in an agreement by workshop participants that there is a need for international consensus on key concepts and data definitions.


Turris S, Steenkamp M, Lund A, Hutton A, Ranse J, Bowles R, Aruthnott K, Anikeeva O, Arbon P. (2016). International consensus on key concepts and data definitions for mass gathering health: Process and progress. Prehospital Disaster Medicine. 31(2):1-4.

17 November, 2015

Impact of a pilot pathway for the management of gastroenteritis-like symptoms in an emergency department: A case study following a Salmonella outbreak



Free full-text article is available here (PDF)


ABSTRACT

Objective: This research aims to describe the effect of standard care (control) versus a clinical management pathway (intervention) on patient length of stay and admission rates during a public health emergency at one Australian Emergency Department.

Method: A retrospective audit of hospital records for patients who presented in May 2013 with gastroenteritis-like symptoms was undertaken following a surge in patient presentations from a Salmonella outbreak. Patients who presented with gastroenteritis-like symptoms between 15th and 19th May 2013 received care according to a clinical management pathway (intervention). The focus of the intervention was based on symptom management, including a standardised approach to analgesia, anti-emetics and rehydration. 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.

Results: Over an eight-day period, 110 patients presented with gastroenteritis-like symptoms. The median length of stay was statistically different between the two groups (P< 0.001). More patients were admitted to hospital from the control group (n = 5) when compared with the intervention group (n = 0); however, given the small number of patients in these groups, inferential statistical analysis was not a reasonable consideration.

Conclusion: The length of stay for patients between the two groups was statistically different, suggesting that the implementation of a clinical management pathway for patients with gastroenteritis-like symptoms reduced the ED length of stay. This finding is useful in future planning for similar public health emergency responses and/or for use when patients present with gastroenteritis-like symptoms on a daily basis.



Ranse J, Luther M, Ranse K. (2015). Impact of a pilot pathway for the management of gastroenteritis-like symptoms in an emergency department: A case study following a Salmonella outbreak. Emergency Medicine Australasia. [in-press].

29 September, 2015

A stethoscope, a patient and me



The anecdote in this manuscript is taken directly from my thesis. The anecdote provides insight into the phenomenological natural attitude of the stethoscope and what it may be like to experience a stethoscope as a nurse or as a patient.


Ranse J. (2015). A stethoscope, a patient and me. Journal of Advanced Nursing Interactive. [http://journalofadvancednursing.blogspot.com.au/2015/09/the-stethoscope-patient-and-me.html]

15 September, 2015

Pandemics and environmental emergencies



This chapter has a primary focus on environmental emergencies, such as heat-related emergencies, cold-related emergencies, drowning, and atmospheric-pressure-related emergencies. Each section within this chapter provides a good overview of anatomy, physiology, patient assessment and interventions, with an emphasis on both the pre-hospital and in-hospital care of the patient.

 My contribution to this chapter was particularly in the areas of

  • Pandemics, and 
  • Mass gathering health 


 The pandemic section highlights the historical background to pandemics. However, much of this section focuses on the challenges for health professionals, drawing on recent literature and examples from H1N1 2009 influenza. Mass gathering health presents unique challenges for the health system and health professionals. This section of the chapter highlights these challenges. Additionally, this section outlines the characteristics of mass gatherings that influence the demand for health services (such as temperature, crowd mood, venue type). In particular, this section outlines the public health considerations for mass gatherings.


Mateer J, Cusack L, Ranse J. (2015). Chapter 28: Pandemics and environmental emergencies in Curtis K, Ramsden C (eds). Emergency and trauma care: For nurses and paramedics 2nd ed. Elsevier Australia.

23 July, 2015

Planning Healthcare for a Mass Gathering

 

I had a conversation with Craig Hooper from Operational Health about mass gathering health. To listen to the podcast, visit http://www.operationalhealth.com/#!204-planning-mass-gathering-healthcare/c1srl


The following is taken directly from the Operational Health website.

----START----
Craig chats with Assistant Professor Jamie Ranse about the clinical and operational planning that sits behind mass gatherings. Using World Youth Day 2008 as a case study, Jamie discusses the need to engage a cross section of health and healthcare providers. International perspectives are also discussed with the underlying messaging being that progress toward improved health planning at mass gathers relies on shared definitions and data points and moving away from purely descriptive journal articles to articles.

About my guest:
Assistant Professor Jamie Ranse of the University of Canberra has a keen professional and personal interest in the area of disaster and mass gathering health. He is currently undertaking a PhD exploring the experience of nurses who participate in disasters. He is an Associate Editor for the Australasian Emergency Nursing Journal, holding the disaster portfolio and peer-reviews a number of national and international journals relating to disaster and primary health care. Jamie remains engaged in the clinical setting as a casual RN at the Emergency Department of Calvary Health Care ACT.

About the Podcast Host:
Craig is a health and emergency service management specialist with more than 30 years experience in operational management, emergency planning, health service delivery and service redevelopment. More information can be found at www.cahooper.com

Academic Publications
Jamie Ranse has a large number of publications and presentations relating to Mass Gathering and Major Event health on his website, www.jamieranse.com Some of those discussed on this episode include;

Data Sets
  • Ranse J, Hutton A. (2012). Minimum data set for mass gathering health research and evaluation: A discussion paper. Prehospital and Disaster Medicine. 27(6):1-8. doi:10.1017/S1049023X12001288 (Direct Link)
  • Ranse J, Hutton A. (2013). Minimum data set for mass-gatherings health research and evaluation: The beginning of an international dialogue. Prehospital and Disaster Medicine. [author reply]. 28(2):3 (Direct Link)
  • Lund A, Turris S, Bowles R, Gutman S, Hutton A, Ranse J, Arbon P. (2013). Progressing towards an international consensus on data modelling for mass gathering and mass participation events; paper presented at the 18th World Congress on Disaster and Emergency Medicine, Manchester, UK, May. (Direct Link)
Hutton A*, Ranse J, Arbon P. (2012). Understanding and identifying potential risks for participants at music festivals; paper presented at the St John Ambulance Australia Member Convention, Sydney, New South Wales, Australia, 19th May. (Direct link)

Hutton A, Ranse J, Verdonk N, Ullah S, Arbon P. Understanding the characteristics of patient presentations of young people at outdoor music festivals. Prehospital Disaster Medicine. 2014;29(2):1-7. (Direct Link)

Ranse J, Arbon P. Evaluating the influential factors in mass gathering casualty presentation characteristics – World Youth Day, Sydney, Australia, 2008; paper presented at the 7th International Conference for Emergency Nurses, Gold Coast, Australia, 8th October 2009. (Direct link)

----FINISH-----

Ranse J (Interviewee), Hooper C (Producer). (2015). Mass gathering health; audio podcast for Operational Health, 23rd July. Series 2, Episode 4. Retrieved from http://www.operationalhealth.com/#!204-planning-mass-gathering-healthcare/c1srl

21 June, 2015

Leadership opportunities for Mental Health Nurses in the field of disaster preparation, response, and recovery.


Free full-text article is available here (PDF)


ABSTRACT

Disasters occur internationally and are nondiscriminatory. The loss resulting from the destruction associated with disasters leads to the development of various levels of psychological trauma in survivors. Health teams provide assistance to survivors before, during and after disasters, and mental health nurses make an important contribution to these teams. However, the leadership role of mental health nurses in disaster situations has not been extensively explored in the literature. This article discusses aspects of mental health nursing leadership in preparation for, response to and recovery from disasters. In particular, recommendations are made to enhance the leadership of mental health nurses in the context of disasters.



Ranse J, Hutton A, Wilson R, Usher K. (2015). Leadership opportunities for Mental Health Nurses in the field of disaster preparation, response and recovery. Issues in Mental Health Nursing.36(5):391-394.

03 June, 2015

The realities of assisting in a disaster: An Australian perspective



I presented on the topic of disaster health, with a particular focus on an Australian perspective, to students and faculty staff of the University of Santo Tomas, Philippines.

The focus of this presentation included:

  • Disaster health arrangements,
  • Willingness of nurses to assist in a disaster,
  • Educational preparedness of nurses,
  • Role of nurses in a disaster,
  • Leadership and teamwork,
  • Hospital surge capacity,
  • Disaster triage,
  • Nursing student role in a disaster, and
  • Future research priorities 


Ranse J. (2015). The realities of assisting in a disaster: An Australian perspective; presentation to Student and Faculty staff of the University of Santo Tomas, Philippines, Canberra, ACT, 3rd June.





11 May, 2015

Disaster health: what emergency nursing students need to know




I was invited by the Canberra Emergency Nursing Student Society to discuss aspects of disaster health, particularly as it relates the the realities of nursing in a disaster and the role of student nurses.

This presentation discussed research related to:

  • Willingness,
  • Education,
  • Nursing roles,
  • Leadership and teamwork,
  • Hospital surge capacity,
  • Triage,
  • Disaster tourism, and
  • Future research priorities.




Ranse J. (2015). Disaster health: what emergency nursing students need to know; presentation to Canberra Emergency Nursing Student Society, Canberra, ACT, 12th May.

27 February, 2015

The use of Haddon’s matrix to plan for injury and illness prevention at Outdoor Music Festivals


Free full-text article is available here (PDF)


ABSTRACT

Introduction: Mass-gathering music events, such as outdoor music festivals (OMFs), increase the risk of injuries and illnesses among attendees. This increased risk is associated with access to alcohol and other drugs by young people and an environment that places many people in close contact with each other.

Aim: The purpose of this report was to demonstrate how Haddon’s matrix was used to examine the factors that contributed to injuries and illnesses that occurred at 26 OMFs using data from the Ranse and Hutton’s minimum data set.

Methods: To help understand the kinds of injuries and illnesses experienced, Hutton et al identified previous patterns of patient presentations at 26 OMFs in Australia. To develop effective prevention strategies, the next logical step was to examine the risk factors associated with each illness/injury event. The Haddon matrix allows event practitioners to formulate anticipatory planning for celebratory-type events.

Results: What was evident from this work was that the host, the agent, and the physical and social environments contributed to the development of injuries and illness at an event. The physical environment could be controlled, to a certain extent, through event design, safety guidelines, and legislation. However, balancing cultural norms, such as the importance placed on celebratory events, with the social environment is more difficult.

Discussion: The use of the Haddon matrix demonstrates that interventions need to be targeted at all stages of the event, particularly both pre-event and during the event. The opportunity to promote health is lost by the time of post event. The matrix provided vital information on what factors may contribute to injury at OMFs; form this information, event planners can strategize possible interventions.


COMMENTS:

The publication of this work has generated international interest in applying the Haddon's matrix to other mass gathering events, such as the Hajj.



Hutton A, Savage C, Ranse J, Finnell D, Kub J. (2015). The use of Haddon’s matrix to plan for injury and illness prevention at Outdoor Music Festivals. Prehospital Disaster Medicine.

31 January, 2015

Patient presentations and health service impact: A case study from a mass gathering.




This is a preliminary report relating to research undertaken with an aim to enhance the understanding of the health service requirements at an outdoor music festival by describing the health service usage in one Australian jurisdiction. In particular, this research aims to describe the patient characteristics for the following patient populations:

  1. Those patients who presented for onsite care at the event, provided by St John Ambulance Australia (ACT), 
  2. Those patients whose care was escalated to onsite doctors, nurses and paramedics volunteering at the event with St John Ambulance Australia (ACT), 
  3. Those patients whose care was escalated to the care of ACT Ambulance Service, and 
  4. Those patients who had care provided at either the Canberra Hospital or Calvary Hospital in the ACT.

Ranse, J., Lenson, S., Keene, T., Luther, M., Burke, B., Hutton, A., & Jones, N. 2015.Patient presentations and health service impact: A case study from a mass gathering.[Report]


31 December, 2014

Mass-gathering health research foundational theory: Part 1 - Population models for mass gatherings


Free full-text article is available here (PDF)

ABSTRACT
Background: The science underpinning the study of mass-gathering health (MGH) is developing rapidly. Current knowledge fails to adequately inform the understanding of the science of mass gatherings (MGs) because of the lack of theory development and adequate conceptual analysis. Defining populations of interest in the context of MGs is required to permit meaningful comparison and meta-analysis between events.

Process: A critique of existing definitions and descriptions of MGs was undertaken. Analyzing gaps in current knowledge, the authors sought to delineate the populations affected by MGs, employing a consensus approach to formulating a population model. The proposed conceptual model evolved through face-to-face group meetings, structured breakout sessions, asynchronous collaboration, and virtual international meetings.

Findings and Interpretation: Reporting on the incidence of health conditions at specific MGs, and comparing those rates between and across events, requires a common understanding of the denominators, or the total populations in question. There are many, nested populations to consider within a MG, such as the population of patients, the population of medical services providers, the population of attendees/audience/participants, the crew, contractors, staff, and volunteers, as well as the population of the host community affected by, but not necessarily attending, the event. A pictorial representation of a basic population model was generated, followed by a more complex representation, capturing a global-health perspective, as well as academically- and operationally-relevant divisions in MG populations.

Conclusions: Consistent definitions of MG populations will support more rigorous data collection. This, in turn, will support meta-analysis and pooling of data sources internationally, creating a foundation for risk assessment as well as illness and injury prediction modeling. Ultimately, more rigorous data collection will support methodology for evaluating health promotion, harm reduction, and clinical-response interventions at MGs. Delineating MG populations progresses the current body of knowledge of MGs and informs the understanding of the full scope of their health effects.



Lund A, Turris S, Bowles R, Steenkamp M, Hutton A, Ranse J, Arbon P. (2014). Mass gathering health research foundational theory: Part 1 Population models for mass gatherings. Prehospital Disaster Medicine. 29(6):648-654

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