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

30 May, 2013

Progressing towards an international consensus on data modelling for mass gathering and mass participation events

This presentation was undertaken by Adam Lund for this research team.

There is call for increased attention to foundational theory building to support the evidence base for mass gathering medicine/health (MGM/H). There is a need for a more consistent approach to data collection, case reporting, and research methodology. Recently publications highlight the need for agreement on data points across varying MGM/H contexts.

This discussion aims to present a supportive rather than prescriptive process of building consensus that will support MGM/H researchers and clinicians to produce work with value to international events. The authors propose an ongoing, iterative, collaborative process with the goal of developing and maintaining consensus on core concepts, methodology, and reporting in MGM/H research and evaluation. Stakeholder input will be sought internationally from researchers, advocacy groups, and operational personnel who may undertake literature reviews, research collaboration, consensus meetings, as well as iterative document creation and review.

The authors propose five conceptual categories as a starting point for analysis and discussion: 1) Event & Community (prospective & retrospective) - describing events so events in different parts of the world can be compared reliably; 2) Health Team Resources - describing personnel, equipment, assets, policies, protocols and other factors that impact on-site care; 3) Patient - describing patient encounters, history, findings, treatment, response, and outcome; supporting a minimum common set of descriptors of patient factors; 4) Reporting - standardized descriptive, summative, or analytic reporting “fields” and formats that would permit a more consistent understanding of events and increase the ability to perform meta-analyses of events; and, 5) Overview of Research Methodologies – review and categorization of common methodologies in the MGM/H literature, including summarization of best practices to support future inquiry into MGM/H.

This proposed method of consensus will allow mass gathering health science to become more robust and be generalizable to other MGM/H events.

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.

Industrial considerations for Australian nurses responding to disasters

This presentation was undertaken by Shane Lenson.

Within the Australian out-of-hospital environment, nurses have been deployed from various States and Territories to assist in the response to events such as the Victorian Bushfires [2009] and the Queensland floods [2011]. Similarly, nurses have been deployed overseas to assist in events including the Christchurch earthquake [2011] and Sumatra-Andaman earthquake and tsunami [2004]. Nurses are likely to continue in the health response to a disaster. However, consideration needs to be given to the industrial agreements for nurses when released from their normal employment arrangements to assist in disastrous events.

An integrative literature review methodology was used to collect, evaluate, analyse and integrate sources of evidence to inform this discussion on the current enterprise arrangements for nurses with respect to disaster response. Nursing and midwifery public sector enterprise agreements were sourced from each of the eight Australian jurisdictions. These were evaluated for the industrial provisions made available to nurses wanting to assist in responding to disasters.

Only five enterprise agreements mentioned provisions for nurses to assist in disasters. Where these provisions exist they vary in the their consistency, terminology and the quantity of the entitlements potentially leading in inequality and variability in the financial support frameworks of nursing involved in disaster events.

There is no national approach by nursing industrial organisations to standardise provisions related to an emergency event or disaster. Those agreements that had provisions were notable in their variability in the definition of disasters and the terminology used to define the entitlements for nurses willing to respond to disasters. This variability may leads to inequity and sustainability of nurses who are willing to respond to disaster with nurses sent from some states or territories being financially supported compared to nurses from other regions possibility not being renumerated for undertaking the same role and responsibilities.

Lenson S, Ranse J, Cusack L. (2013). Industrial considerations for Australian nurses responding to disasters; paper presented at the 18th World Congress on Disaster and Emergency Medicine, Manchester, UK, May.

28 May, 2013

Biomedical data collection for mass gathering research and evaluation: A review of the literature

Internationally, planned events such as mass gatherings occur frequently. Known factors influencing the usage of health services, or patient presentations, at mass-gatherings are acknowledged within the environmental, psychosocial and biomedical domains. Health-related research and evaluation from mass gatherings commonly include biomedical information pertaining to patient presentations. The aim of this research was to review the various categorisations reported by authors to describe the patient populations at mass-gatherings, with a focus only on the biomedical domain.

This research utilised an integrative literature review methodology to identify papers from within the last ten years that included research or evaluation from a mass-gathering event in which the authors included published biomedical information.

Numerous papers were identified that included information pertaining to biomedical information from mass gathering events. It was noted that the coding and categorisation of patient-level biomedical information seems inconsistent, varied, haphazard and author dependent.

Recently, there has been literary discussion about the need for consistency and consensus in reporting on biomedical information. This literature review supports this notion. In particular, this presentation builds on a previously published minimum data set proposed by Ranse and Hutton and enhances it by including additional categorisations of biomedical information. As such, a revised minimum data set with a data dictionary is proposed in an effort to generate conversation about a possible agreed minimum amount and the type of information that should be collected consistently for research and evaluation at mass gatherings.

Ranse J, Hutton A. (2013). Biomedical data collection for mass gathering research and evaluation: A review of the literature; paper presented at the 18th World Congress on Disaster and Emergency Medicine, Manchester, UK, May.

Disaster and emergency medicine online research repository: A retrospective review

Internationally, there is an increasing amount of literature published in the disciplines of disaster and emergency medicine. However, there is a limited opportunity to openly share research progress prior to peer-reviewed publication. Having the ability to share research prior to peer-reviewed publication has many benefits. As such, an online research repository for unpublished non-peer-reviewed research summaries was originally created by the authors of this presentation for the World Association for Disaster and Emergency Medicine (WADEM) nursing section. Later, this repository was launched to the wider WADEM membership. This presentation aims to showcase the research repository and highlight its usage since its launch in August 2012.

Data regarding visitations to the WADEM research repository was obtained retrospectively from an existing application within Google Blogger, the research repository platform. Data was analysed using descriptive statistics.

The research repository was launched in August 2012 with 21 research summaries. Between August and December 2012, 6 additional summaries were submitted. Additionally, the research repository had been visited on 2734 occasions. The median visits per month are 550 (IQR: 429.5 – 663.5). The most commonly viewed research summaries related to disaster preparedness (n=158), occupational stress (n=110), emergency nurses willingness to assist in disasters (n=59), and simulation in education (n=52).

The results demonstrate that the research repository is being viewed and used. By showcasing the research repository in this presentation, it is hoped that contributions and views to this repository will be enhanced. In particular, this presentation highlights the benefits of openly submitting research summaries to the research repository, such as an opportunity for possible collaboration and sharing of research work.

Ranse J, Lenson S. (2013). Disaster and emergency medicine on-line research repository: A retrospective review; paper presented at the 18th World Congress on Disaster and Emergency Medicine, Manchester, UK, May. 

The characteristics of patient presentations from Australian outdoor music festivals

The literature pertaining to patient characteristics from outdoor music festivals is predominately reported from single descriptive events. These events demonstrate a higher incidence of patient presentations when compared to other types of mass gatherings. Outdoor music festivals rely on on-site care and clinicians to assess and manage patients. However little is known about characteristics of patient presentations across a large number of outdoor music festivals within the Australian context. As such, this research aimed to describe the characteristics of patient presentations from Australian outdoor music festivals.

The setting for this research was 25 outdoor music festivals across four Australian states in 2010. Patient information from these events was obtained from Patient Care Records from St John Ambulance Australia. The patient information from these records was entered into a de-identifiable database using the Ranse and Hutton minimum data set. Data was then analyzed using descriptive and inferential statistics in SPSS.

In total 5,000 patients presented to the 25 events for clinical assessment and management. This research found that females present in greater numbers to on-site care than males. In addition, it was found that the majority of females present with whereas males presented to on-site care with injuries. The majority of patients transferred to hospital where those who presented with alcohol and/or other drugs related concerns.

This is the first research that explored patient characteristics at multiple outdoor music festivals in Australia. The research has highlighted some key results that may inform public health policy and assist clinical providers and event managers in the planning of health services at future events.

Hutton A, Ranse J, Arbon P, Ullah, S. (2013). The characteristics of patient presentations from Australian outdoor music festivals; paper presented at the 18th World Congress on Disaster and Emergency Medicine, Manchester, UK, May

01 May, 2013

Author response — Letter to the editor: Beyond a clinical role: Nurses were psychosocial supporters, coordinators and problem solvers in the Black Saturday and Victorian bushfires in 2009.

I was fortunate to have someone write a letter to the editor to my original article titled: Beyond a clinical role: Nurses were psychosocial supporters, coordinators and problem solvers in the Black Saturday and Victorian bushfires in 2009, which was coauthored with Shane Lenson. This letter to the editor was published in the journal Australasian Emergency Nursing Journal. The author make a number of observations regarding our work. 

In response to this letter to the editor, Shane Lenson and I wrote a response. This response was also published in the Australasian Emergency Nursing Journal .

The response is available here in full text

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