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

07 May, 2019

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



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



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


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

ABSTRACT

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

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

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

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

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



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

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

ABSTRACT

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

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

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

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


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

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

ABSTRACT

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

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

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

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

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


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

Proposing a minimum data set for mass gathering health

ABSTRACT

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

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

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

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

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


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

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


ABSTRACT:

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

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

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

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

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



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

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

ABSTRACT

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

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

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

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




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

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

ABSTRACT

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

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

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

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

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



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

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

ABSTRACT

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

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

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

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

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


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

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

ABSTRACT

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

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

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

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

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


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

Core curriculum for event medical leaders

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

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

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

Core content proposed:

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

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

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

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


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

30 April, 2019

How do you actually care during a catastrophe?




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


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

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

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

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





17 April, 2019

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


Free full-text article is available here (PDF)

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


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

11 January, 2019

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


Free full-text article is available here (PDF)

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

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

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

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

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



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

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