Mass Gathering Health / Mass Gathering Medicine

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

Bushfires

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

Public Health Emergencies

Various publications and presentations relating to H1N1 2009 influenza outbreak and Salmonella outbreaks

In the media

Latest interviews and articles from the media

Invited Speaker

Various presentations given as an invited and keynote speaker.

11 May, 2015

Disaster health: what emergency nursing students need to know








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

Mass-gathering health research foundational theory: Part 2 - Event modelling for mass gatherings.


ABSTRACT 
Background: Current knowledge about mass-gathering health (MGH) fails to adequately inform the understanding of mass gatherings (MGs) because of a relative lack of theory development and adequate conceptual analysis. This report describes the development of a series of event lenses that serve as a beginning ‘‘MG event model,’’ complimenting the ‘‘MG population model’’ reported elsewhere.

Methods: Existing descriptions of ‘‘MGs’’ were considered. Analyzing gaps in current knowledge, the authors sought to delineate the population of events being reported. Employing a consensus approach, the authors strove to capture the diversity, range, and scope of MG events, identifying common variables that might assist researchers in determining when events are similar and might be compared. Through face-to-face group meetings, structured breakout sessions, asynchronous collaboration, and virtual international meetings, a conceptual approach to classifying and describing events evolved in an iterative fashion.

Findings: Embedded within existing literature are a variety of approaches to event classification and description. Arising from these approaches, the authors discuss the interplay between event demographics, event dynamics, and event design. Specifically, the report details current understandings about event types, geography, scale, temporarily, crowd dynamics, medical support, protective factors, and special hazards. A series of tables are presented to model the different analytic lenses that might be employed in understanding the context of MG events.

Interpretation: The development of an event model addresses a gap in the current body of knowledge vis a vis understanding and reporting the full scope of the health effects related to MGs. Consistent use of a consensus-based event model will support more rigorous data collection. This in turn will support meta-analysis, create a foundation for risk assessment, allow for the pooling of data for illness and injury prediction, and support methodology for evaluating health promotion, harm reduction, and clinical response interventions at MGs.


Turris S, Lund A, Hutton A, Bowles R, Ellerson E, Steenkamp M, Ranse J, Arbon P. (2014). Mass gathering health research foundational theory: Part 2 Event modelling for mass gatherings. Prehospital Disaster Medicine. 29(6):655-663.

14 December, 2014

Review: The mental health imaginary vis-a`-vis its nurses and Australian environs: an essay


Free full-text article is available here (PDF)

I was invited to provide a review and response to a manuscript that was published in the 'Nursing in Crisis' special issue of the Journal of Research in Nursing. This manuscript is reviewed was:

Nicholls, D. (2014). The mental health imaginary vis-à-vis its nurses and Australian environs: an essay Journal of Research in Nursing. 19:580-589.

The work reviewed takes a unique exploration of the future of mental health nursing in the Australian environs. To do this, the author work presents an historical account of what it may have been like to be a mental health nurse in Australian in the late 1900s. This account is a philosophical view that does not necessarily aim to resolve an issue, build a theory or seek agreement, but instead is a philosophical work taking shape from the author’s lifeworld.

My review discusses the progress, challenges and complexities of the mental health context, highlighting that they are not of uniqueness or of singularity to mental health nursing. Instead, aspects of the author’s lifeworld and the mental health imaginary vis-a`-vis its nurses and Australian environs has a broader application to the discussion of changes over time related to nursing and its natural attitude, education, and culture.

Ranse, J. (2014). Review: The mental health imaginary vis-à-vis its nurses and Australian environs: An essay. Journal of Research in Nursing. 19(7-8):590-591.

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

This article was among the most read articles for the day across Australia as demonstrated below:


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:







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