Novel respiratory viruses in the context of mass-gathering events: A systematic review to inform event planning from a health perspective

ABSTRACT 

Background: Mass-gathering events (MGEs) occur regularly throughout the world. As people congregate at MGEs, there is an increased risk of transmission of communicable diseases. Novel respiratory viruses, such as Severe Acute Respiratory Syndrome Coronavirus-1 (SARS-CoV-1), Influenza A Virus Subtype H1N1 Strain 2009 (H1N1pdm09), Middle East Respiratory Syndrome Coronavirus (MERS-CoV), and Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), or Coronavirus Disease 2019 (COVID-19), may require specific infection prevention and control strategies to minimize the risk of transmission when planning MGEs. This literature review aimed to identify and analyze papers relating to novel respiratory viruses with pandemic potential and to inform MGE planning.

Method: This paper used a systematic literature review method. Various health care databases were searched using keywords relating to MGEs and novel respiratory viruses. Information was extracted from identified papers into various tables for analysis. The analysis identified infection prevention and control strategies used at MGEs to inform planning before, during, and following events.

Results: In total, 27 papers met the criteria for inclusion. No papers were identified regarding SARS-CoV-1, while the remainder reported on H1N1pdm09 (n = 9), MERS-CoV (n = 15), and SARS-CoV-2 (n = 3). Various before, during, and after event mitigation strategies were identified that can be implemented for future events.

Conclusions: This literature review provided an overview of the novel respiratory virus epidemiology at MGEs alongside related public health mitigation strategies that have been implemented at these events. This paper also discusses the health security of event participants and host communities in the context of cancelling, postponing, and modifying events due to a novel respiratory virus. In particular, ways to recommence events incorporating various mitigation strategies are outlined.

The full-text article is available here (PDF)

Ranse J, Beckwith D, Khan A, Yezli S, Hertelendy A, Hutton A, Zimmerman PA. (2021). Novel respiratory viruses in the context of mass gathering events: A systematic review to inform event planning from a health perspective. Prehospital and Disaster Medicine. [in-press]

Read More

Using clinical based vignettes to further develop a mass-gathering triage tool

Full-text paper (PDF)

ABSTRACT
Background: Previously published triage tools for use at mass gathering events (MGE) lack real-world validation. Non-health care professionals, such as first aiders, first responders, and advanced responders often undertake a triage role at MGEs. This research aimed to determine consistency in the decision-making of a MGE triage tool.

Method: Volunteer members of St John Ambulance Australia were recruited. Surveys included participant demographics and real-world clinical vignettes. Participants determined a triage category based on the vignettes and supplied triage tool. Demographics were analysed using descriptive statistics and responses to vignettes were analysed using Fleiss Kappa [p-bar].

Results: There were 110 participants, the majority male (60%), having completed a Bachelor or higher degree (53.6%), and were non-health care professionals (70%). Of the vignettes, there was a slightly better than moderate agreement (items: 18, p-bar: 0.55). There was an excellent level of agreeance for the resuscitation category (items: 3, b-par 0.69), and moderate level of agreeance for the urgent (items: 10, b-par 0.52) and minor (items: 5, b-par 0.52) categories.

Conclusions: This research demonstrated similar findings to that of emergency department triage tool validation. Multi-country, multi-site, multi-type, real-world testing at MGEs is the next step to progress the development of this tool.



Ranse J, Cannon M, Roitman R, Morphet J. (2020) Using clinical based vignettes to further develop a mass-gathering triage tool. Australasian Journal of Emergency Care.

Read More

Environmental influences on patient presentations: Considerations for research and evaluation at mass-gathering events

Free full-text article is available here (PDF)

ABSTRACT

Aim: This paper discusses the need for consistency in mass-gathering research and evaluation from an environmental reporting perspective.

Background: Mass gatherings occur frequently throughout the world. Having an understanding of the complexities of mass gatherings is important to inform health services about the possible required health resources. Factors within the environmental, psychosocial, and biomedical domains influence the usage of health services at mass gatherings. A minimum data set (MDS) has been proposed to standardize collection of biomedical data across various mass gatherings, and there is a need for an environmental component. The environmental domain includes factors such as the nature of the event, availability of drugs or alcohol, venue characteristics, and meteorological factors.

Method: This research used an integrative literature review design. Manuscripts were collected using keyword searches from databases and journal content pages from 2003 through 2018. Data were analyzed and categorized using the existing MDS as a framework.

Results: In total, 39 manuscripts were identified that met the inclusion criteria. Conclusion: In collecting environmental data from mass gatherings, there must be an agreed-upon MDS. A set of variables can be used to collect de-identified environmental variables for the purpose of making comparisons across societies for mass-gathering events (MGEs).



Hutton A, Ranse J, Grey K, Turris S, Lund A, Munn BM. (2019). Environmental influences on patient presentations: Considerations for research and evaluation at mass-gathering events. Prehospital and Disaster Medicine.

Read More

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.

Read More

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.

Read More

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.

Read More

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.

Read More

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).

Read More

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

Read More

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.

Read More

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]

Read More

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.

Read More

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

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

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

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

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

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

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

Our poster at #PAIC2014 Onsite health providers and ambulance paramedics at mass gatherings http://t.co/H14Z9LGzeq pic.twitter.com/e84OUXaN71

— Jamie Ranse (@jamieranse) September 19, 2014

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

Read More

Operational aspects of health care delivery at World Youth Day 2008: Lessons learnt by an emergency management organisation

Free full-text article is available from the Australasian Journal of Paramedicine


SUMMARY

Hundreds of thousands of people attended World Youth Day 2008 [WYD08] in Sydney. Pilgrims from over 170 nations attended the week-long event (15-20th July) culminating in one of the largest mass gatherings in Australia. St John Ambulance Australia was the primary health care agency chosen for the provision of health services to WYD08 participants and officials. WYD08 posed a number of challenges during the planning and deployment stages of operational activities; due to the extremely large number of participants and varying location of WYD08 events. This article provides an overview of WYD08, the involvement of an emergency management organisation with a focus on their experiences and lessons learnt. These experiences and lessons are useful for any health care agency or emergency management organisation, tasked with planning similar large-scale mass gathering events.


Moutia D, Ranse J, Banu-Lawrence H. Operational aspects of health delivery at World Youth Day 2008: Lesions learnt by an emergency management organisation. Australasian Journal of Paramedicine. 2014;11(3):[accepted]

Read More

Understanding patient presentations among young people at mass gatherings

Ranse J. (2014). Understanding patient presentations among young people at mass gatherings; presentation to Paramedics Australasia, Paramedics Australasia Student Association and St John Ambulance (ACT), Canberra, ACT, 29th April.

Read More

Understanding the characteristics of patient presentations of young people at outdoor music festivals

Free full-text article is available here (PDF)

ABSTRACT 

Outdoor music festivals are unique events given that they are, for the most part, bounded and ticketed, and alcohol is served. They frequently have a higher incidence of patient presentations when compared with similar types of mass gatherings. Often, however, single events are reported in the literature, making it difficult to generalize the findings across multiple events and limiting the understanding of the ‘‘typical’’ patient presentations at these mass gatherings. The aim of this paper was to understand the characteristics of young people who have presented as patients to on-site health care at outdoor music festivals in Australia, and the relative proportion and type of injury and illness presentations at these events. This research used a nonexperimental design, utilizing a retrospective review of patient report forms from outdoor music festivals. Data were collected from 26 outdoor music festivals across four States of Australia during the year 2010. Females presented at greater numbers than males, and over two-thirds presented with minor illnesses, such as headaches. Males presented with injuries, in particular lacerations to their face and their hands, and alcohol and substance use made up 15% of all presentations.



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.

Read More

Health considerations at major events (mass gatherings)

This presentation was delivered in 2011, 2012 and in 2013 to students at the University of Canberra who are undertaking the unit: sports as entertainment. This presentation provides an overview of some key points for event managers, when considering health care for participants and/or spectators of their event. In particular this presentation focused on event managers of sporting events.

My presentation mentions the Bradford City Football Stadium disaster. The original footage from this event can be found on YouTube (below). The disaster starts to unfold at the 30 second point.

   

Additionally, footage from the Hillsborough stadium disaster may be of interest, this is also available on YouTube:

 

Ranse J. (2013). Health considerations at major events (mass gatherings); presented to students of the University of Canberra – Undergraduate Sports Studies in the unit: Sport as entertainment, Canberra, ACT, 23rd October.

Ranse J. (2012). Health considerations at major events (mass gatherings); presented to students of the University of Canberra – Undergraduate Sports Studies in the unit: Sport as entertainment, Canberra, ACT, 22nd August.

Ranse J. (2011). Health considerations at major events (mass gatherings); presented to students of the University of Canberra – Undergraduate Sports Studies in the unit: Sport as entertainment, Canberra, ACT, 28th September.

Read More

Injury patterns and crowd behaviour at mass gathering events

This presentation was delivered to members of St John Ambulance Australia (ACT) during the symposium: Sex, Drugs, and Rock and Roll. This symposium focused on the various aspects of health care at mass gatherings.

My presentation was divided into two distinct sections. Firstly, the theory of mass gatherings was presented together with the current evidence pertaining to factors that influence patient presentation rates. Secondly, a case study was presented outlining the characteristics of ~5,000 patients who presented to Australian outdoor music festivals in 2009/2010 for clinical assessment and/or management. In particular, the patients presentations related to injury, illness, environmental factors and mental health were discussed.


Ranse J. (2013). Injury patterns and crowd behaviour at mass gathering events. Sex, Drugs, and Rock and Roll - St John Ambulance Australia (ACT), Canberra, ACT, 14th September.

Read More

Epidemiology of injuries at the Australian 24 hour mountain bike championships

Free full-text article is available here (PDF)

ABSTRACT
Introduction: To describe injury type and frequency, and the factors influencing these, in endurance mountain bike riders.

Method: This study used a cross-sectional retrospective audit of patient report forms, prospective meteorological information and race data over an eight-year period. The Australian twenty-four hour mountain bike championships is held annually in Canberra, Australia. All riders who presented to a first aid station for treatment during the race from 2000-2007, were included. Studied factors influencing injury were race time, ambient temperature and rider gender. Studied outcome measures were injury frequency, location, type and management.

Results: Of the 14,777 riders over the eight years, 596 required first aid treatment for injuries (4.03%), the majority for minor injuries to extremities. Only 0.25% of riders were referred to hospital, 0.06% by ambulance. The injury incidence was 8.4/1000 bike hours with a race-ending presentation (a patient referred to hospital) incidence of 0.5/1000 bike hours. Patient presentation rates were highest in the first eight hours of a race. Higher average temperatures per year were associated with a greater risk of injury. Females were more likely to be injured.

Conclusion: This mountain bike competition was safe with minor injuries to extremities predominating and low referral rates to hospital, as a result, first aid service organisations provided adequate clinical care at this event.



Taylor N, Ranse J. (2013). Epidemiology of injuries at the Australian 24 hour mountain bike championships, 2000 – 2007. Australasian Journal of Paramedicine. 10(1)a4:1-5

Read More

The characteristics of patient presentations from Australian outdoor music festivals

ABSTRACT
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

Read More