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.

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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.

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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:

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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:

• September 17, 2014: Canberra Hospital to move patients as fallback for busy wards
• September 17, 2014: Surge in demand puts Canberra Hospital emergency department under 'enormous pressure'
• September 18, 2014: Canberra Hospital grapples with 'overcapacity' 

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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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.

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What are the research needs for the field of disaster nursing in the next five years? An international Delphi study

Free full-text article is available here (PDF)

ABSTRACT

Background: Internationally there is an increasing amount of peer-reviewed literature pertaining to disaster nursing. The literature includes personal anecdotes, reflections, and accounts of single case studies. Furthermore, issues such as the willingness of nurses to assist in disasters, the role of nurses in disasters, leadership, competencies, and educational preparedness for nurses have been the focus of the literature.

Aim: The aim of this research was to determine the international research priorities for disaster nursing.

Method: This research used a three-round Delphi technique. The first round used a face-to-face workshop to generate research statements with nursing members of the World Association for Disaster and Emergency Medicine (WADEM). The second and third rounds included the ranking of statements on a 5-point Likert scale with nursing members of WADEM and the World Society of Disaster Nursing (WSDN). Statements that achieved a mean of four or greater were considered a priority and progressed.

Results: Participants were from multiple countries. Research statements were generated in the areas of: education, training, and curriculum; psychosocial; strategy, relationship, and networking; and clinical practice. Psychosocial aspects of disaster nursing ranked the highest, with five statements appearing in the top ten research areas, followed by statements relating to: education, training, and curriculum; clinical practice; and finally, strategy, relationship, and networking.

Conclusions: Future disaster nursing research should focus on the area of psychosocial aspects of disaster nursing, in particular, both the psychosocial needs of a disaster-affected community and the psychosocial well-being of nurses who assist in disaster health activities.




Ranse J, Hutton A, Jeeawody B, Wilson R. What are the research needs for the field of disaster nursing in the next five years? An international Delphi study. Prehospital Disaster Medicine. 2014

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National consistency in industrial awards for disaster release for Australian Nurses: An integrative review of enterprise agrrangements

Free full-text article is available here (PDF)

ABSTRACT
This research explores the types of provisions made available to nurses within Australian public employment agreements to respond to disasters and alternate provisions made available to provide personal property protection and personal care during a disaster. An integrative literature review methodology is used to collect, evaluate, analyse and integrate sources of evidence to inform a discussion on the current enterprise arrangements for nurses with respect to eight Australian jurisdictions. These were evaluated for the industrial provisions made available to nurses wanting to assist in responding to disasters. Only five of these agreements mentioned provisions for nurses to assist in disasters. Where these provisions exist, they vary in their consistency, terminology and the quantity of the entitlements, potentially leading to inequality and variability in the financial support frameworks for nurses involved in disaster events.



Lenson S, Ranse J, Cusack L. (2014). National consistency in industrial awards for disaster release for Australian nurses: An integrative review of enterprise arrangements. Asia Pacific Journal of Health Management. 9(2):53-58.

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Doing phenomenology and hermeneutics: Australian civilian nurses' lived experience of being in a disasters

This presentation was presented at the Higher Degrees Week - Flinders University, Faculty of Health Sciences, School of Nursing and Midwifery as a progress seminar for my PhD studies.

ABSTRACT
This presentation will focus on the theoretical underpinnings of phenomenology and hermeneutics as they are applied to a research paradigm which aims to: provide insight into the experience of being an Australian civilian nurse within the out-of-hospital environment during a disaster. A purposive sampling technique was employed to recruit participants for this research. Subsequently, data was collected from eight participants using semi-structured interviews at two points in time, one week apart. The first interview was primarily phenomenological, whilst the second was more hermeneutic in nature. Participant narrative was captured on an electronic audio recording device and transcribed. In terms of data analysis, phenomenology is neither inductive nor deductive, rather phenomenology is reductive. This research primarily used an eidetic reduction of participant narrative, returning to the experience as it is in itself; by uncover the uniqueness or ‘whatness’ of the experience. The result of the reduction is a lived experience description, a description of the experience that is recognisable by others of what it may be like being an Australian civilian nurse within the out-of-hospital environment during a disaster.




Ranse J. (2014). Doing phenomenology and hermeneutics: Australian civilian nurses' lived experience of being in a disasters; presentation at the Higher Degrees Week - Flinders University, Faculty of Health Sciences, School of Nursing and Midwifery. Adelaide, South Australia, 30th June.

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Disasters happen: the realities of being in a disaster

I was invited to the University of New England, Armidale, New South Wales to present on the topic of disaster health and to participate in some research collaboration with academic staff members.

ABSTRACT:
Disasters happen, and health professionals are involved in restoring and maintaining the health and health services of disaster-affected communities. This presentation will provide an overview of what is known about disaster health in the Australian context, such as the willingness of health professionals to assist in a disaster and their educational preparedness. In particular, this presentation will focus on the realities of what it is like to be a health professional in a disaster.

Ranse J. (2014). Disasters happen: the realities of being in a disaster; presentation to Faculty at University of New England, Armidale, NSW, 5th June.

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Enhancing the minimum data set for mass-gathering research and evaluation: An integrative literature review

Free full-text article is available here (PDF)

ABSTRACT:
Introduction: In 2012, a minimum data set (MDS) was proposed to enable the standardized collection of biomedical data across various mass gatherings. However, the existing 2012 MDS could be enhanced to allow for its uptake and usability in the international context. The 2012 MDS is arguably Australian-centric and not substantially informed by the literature. As such, an MDS with contributions from the literature and application in the international settings is required.

Methods: This research used an integrative literature review design. Manuscripts were collected using keyword searches from databases and journal content pages from 2003 through 2013. Data were analyzed and categorized using the existing 2012 MDS as a framework.

Results: In total, 19 manuscripts were identified that met the inclusion criteria. Variation in the patient presentation types was described in the literature from the mass-gathering papers reviewed. Patient presentation types identified in the literature review were compared to the 2012 MDS. As a result, 16 high-level patient presentation types were identified that were not included in the 2012 MDS.

Conclusion: Adding patient presentation types to the 2012 MDS ensures that the collection of biomedical data for mass-gathering health research and evaluation remains contemporary and comprehensive. This review proposes the addition of 16 high-level patient presentation categories to the 2012 MDS in the following broad areas: gastrointestinal, obstetrics and gynecology, minor illness, mental health, and patient outcomes. Additionally, a section for self-treatment has been added, which was previously not included in the 2012 MDS, but was widely reported in the literature.


Ranse J, Hutton A, Turris S, Lund A. (2014). Enhancing the minimum data set for mass gathering research and evaluation: An integrative literature review. Prehospital Disaster Medicine. 29(3):1-10.

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What was the role of nurses during the 2011 Great East Earthquake of Japan? An integrative review of the Japanese literature

Free full-text article is available here (PDF)

ABSTRACT

Background: An earthquake and tsunami hit the east coast of Japan on March 11, 2011. Nurses were actively involved in the health response to this disaster and, subsequently, many authors have reported on the role nurses played in these efforts in Japanese nursing professional journals.

Aim: To describe the role of nurses who assisted in the 2011 Great East Earthquake of Japan by reviewing Japanese literature and reporting the findings in English.

Method: This research used an integrative literature review methodology. Manuscripts were obtained from the Japanese database Ichushi Ver. 5 (Japan Medical Abstracts Society, Tokyo, Japan). A total of 44 manuscripts were identified and included in a thematic analysis.

Results: Three main themes were identified: (1) nursing roles, (2) specialized nursing roles, and (3) preparedness education. Nurses fulfilled different roles in the period after the disaster (ie, as a clinician, a communicator, a leader, and a provider of psychosocial support). Additionally, the specialized nurse role was identified, along with the need for preparedness education to support the nurse’s role in a disaster.

Conclusion: The understanding of the role of nurses in disasters is expanding. There is a need to further explore the roles of specialized nurses in disasters. Further disaster education opportunities should be available as a part of continuing education for all nurses. Radiation aspects of disaster assistance should be included in disaster education programs where there are radio-nuclear hazards present in the environment

Kako M, Ranse J, Yamamoto A, Arbon P. (2014). What was the role of nurses during the 2011 Great East Earthquake of Japan? An integrative review of the Japanese literature. Prehospital Disaster Medicine. 29(3):1-5.

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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]

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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.

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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.

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Nurses and Twitter: The good, the bad and the reluctant

Free full-text article is available here (PDF)

ABSTRACT
Nurses and other health professionals are adopting social media to network with health care professionals and organizations, support health education, deliver health promotion messages, enhance professional development and employment opportunities, and communicate within political forums. This paper explores the growing use of social media, and examines the current dynamics of Twitter as an example of the uptake of social media. This paper also offers practical guidance for new Twitter users who are interested in using this social media approach in clinical or educational settings, and for professional development.



Wilson RL, Ranse J, Cashin A, McNamara P. (2014). Nurses and Twitter: The good, the bad, and the reluctant. Collegian. 21(2):111-119.

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The role of Australian nurses in disasters: what ‘group’ of nurses should assist?

Free full-text article is available here (PDF)

OVERVIEW
This publication builds on the understanding of the Australian nurses role in a disaster. In particular it focuses on research conducted following the Black Saturday and Victorian Bushfires of 2009. It highlights the need for nurses from multiple disciplines to assist following a disaster.


Ranse J. (2013). The role of Australian nurses in disasters: what ‘group’ of nurses should assist? The Hive [Australian College of Nursing – newsletter publication]. (4):24-25

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Future considerations for Australian nurses and their disaster educational preparedness: a discussion

Free full-text article is available here (PDF)

ABSTRACT
Australian nurses have been active participants in disaster assistance both within the in-hospital and out-of-hospital environment. This paper discusses the current disaster education opportunities and challenges for nurses. Additionally, various educational strategies for different cohorts of nurses are discussed highlighting the need for education to be targeted at the right cohort of nurses, at the right time, using the right strategy. To enhance the educational preparedness of Australian nurses and subsequently their willingness to assist in a disaster it is suggested that the education should replicate the realities of ‘what it is like’ to assist in a disaster. Additionally, education should be positioned within a national framework for disaster health education.


Ranse J, Hammad K, Ranse K. (2013). Future considerations for Australian nurses and their disaster educational preparedness: a discussion. Australian Journal of Emergency Management. 28(4):49-53.

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Who is my leader? Lessons from a hospital disaster drill in a less developed country

Free full-text article is available here (PDF)


ABSTRACT

Introduction: A paucity of literature exists pertaining to the role of leaders during the health response to disasters. The minimal published literature regarding disaster leadership suggests that health leadership in a disaster should adopt an approach similar to that of professions such as law enforcement, military and freighting.

Aim: This paper aims to describe observations pertaining to disaster leadership during a mock disaster scenario.

Background: This case study is set in Surkhet, Nepal, a small city prone to disasters such as earthquakes and floods. This case presents a mock disaster scenario of an earthquake set at a nongovernment health facility.

Methods: Observations were made of the performance of responders in establishing triage, treatment and command centers. Results: Institutional leaders among the responders struggled to apply the disaster plans in the face of spontaneous disaster leadership.

Conclusions: Both the recognised leadership of an organisation, and those who in a disaster may step up as disaster leaders need to be confident in implementing the disaster contingency plans. Leadership in disasters must have a clear distinction between incident controller and ‘clinical leader’ roles.

Discussion and recommendations: This paper provides recommendations that may have applicability to leadership in real world disasters.


Filmer L, Ranse J. (2013). Who is my leader? Lessons from a hospital disaster drill in a less developed country. Australasian Emergency Nursing Journal. 16(4)170-174. doi:10.1016/j.aenj.2013.08.004 

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Add health needs to your emergency checklist

In October I participated in a number of media interviews that focused on the need for members of the community to be 'health prepared' for disasters. These interviews were undertaken within the context of bushfires. At the time of the interviews, a number of large bushfires were devastating regions of New South Wales.

Print media appearances:

• ‘Add health needs to your emergency checklist’; print media in Canberra Weekly, 24th October

Article above from the Canberra Weekly

Radio media appearances:

• Adding health needs to your emergency checklist; radio interview on ABC Radio Illawarra, 20th October
• News headlines regarding ‘adding health needs to your emergency checklist’, on the following: FM 104.7 (Canberra); Mix 106.3 (Canberra)

Media release:

Australians should not only prepare their house and belongings against the threat of bushfires, floods or storms this summer, but also be ready to look after their health during an emergency, advises a University of Canberra disaster response expert.

Jamie Ranse, a health academic who specialises in disasters, said that in the wake of a major incident emergency services are stretched and medicines are in short supply, so residents should be ready to look after themselves.

“When preparing for potential evacuation, people often think about sentimental items they would like to take with them, such as photo albums and computers, but they often forget to think about items that will support their health needs,” he said.

Mr Ranse said during previous disasters such as the Queensland floods, Victorian and Canberra bushfires, people were relocated to evacuation centres where they remained for days or weeks.

“Whilst in these centres, a number of people required medications of some kind. However, during a disaster, medications become increasingly hard to access, and this is made even harder if people don't know what medications they take.”

Mr Ranse said there are a few simple steps people can take to be health prepared, including preparing a list of previous medical and surgical history, as well as a list and a supply of current medication.

“This list should be placed with other items you might take in an evacuation such as blankets and warm clothes. People should also have a basic understanding of first aid and have a small first aid kit in an accessible location.

“It’s also a good idea to get to know your neighbours as you may be able to help them prepare for a disaster, or provide assistance during a disaster.

“It is important that people are as self-sufficient as possible as emergency services are stretched beyond capacity, and they will not be able to respond in a timely matter to minor injuries or ailments.”

Key points for being health prepared:

• Have a current list of medications, ailments and previous medical/surgical history. 
• Keep this list with other items you might take in an evacuation, such as photo albums or computers 
• Keep a stocked first aid kit in your car 
• Learn first aid and know basic first aid principles such as how to control bleeding, how to open an airway and how to do CPR 
• Get to know your neighbours, you might need each other’s help in an emergency

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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.

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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.

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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

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Social Media: Friend or Foe

I was invited by the Princess Alexandra Hospital to participate as a panel member of a lunchtime debate regarding social media. I was on the side of social media being a 'friend'.

My five minutes of the debate focused on three aspects of social media:

• Social / personal social media, such as ‘what I had for breakfast’. In discussing social and personal aspects of social media, I highlighted that this is one way, but not the only way to use social media.
• Professional communication and engagement, such as engaging at a conference, networking with like-minded people, and linking with professional organisations. I emphasised that this is of most benefit to health professions. It allows for the extension of our existing professional networks. Additionally, social media has significant benefits for health professionals attending (and not attending) conferences, as social media exists as an extension of the conference allowing for parallel conversations and sharing of information
• Important information delivery and public messages, such as social media in disasters. This aspect was discussed in the context of comparing Cyclone Tracy in 1974 in which it took many hours before those outside Darwin Australia knew about the event, and the Christ Church Earthquake in New Zealand, 2011 in which we knew about the event in seconds - complete with images, video and messages from those trapped.  

Ranse J. (2013). Social media: Friend or Foe; debate panel member for the Princess Alexandra Hospital Health Symposium, Brisbane, Queensland, 22nd August.

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Exploring staff willingness to attend work during a disaster: A study of nurses employed in four Australian emergency departments

Free full-text article is available here (PDF)

ABSTRACT
Background: Much of the literature about emergency nurses willingness to work during disasters has been from a non-Australian perspective. Despite the many recent disasters, little is known of Australian nurse’s willingness to participate in disaster response. This paper presents findings from a study that explored nurses willingness to attend work during a disaster and the factors that influenced this decision.

Methods: Data were collected consecutively using a combination of focus group and interview methods. Participants in this study, registered nurses from emergency departments, were recruited through convenience sampling from four hospitals in Australia. Participant narrative was electronically recorded, transcribed and thematically analysed.

Results: The participants for both the focus groups and interviews compromised a mix of ages, genders and years of experience as emergency nurses from across four jurisdictions within Australia. Three major themes that influenced willingness emerged with a number of subthemes. Theme one reflected the uncertainty of the situation such as the type of disaster. The second theme surrounded the preparedness of the workplace, emergency nurse and colleagues, and the third theme considered personal and professional choice based on home and work circumstances and responsibilities.

Conclusions: The decision to attend work or not during a disaster, includes a number of complex personal, work-related and professional factors that can change, depending on the type of disaster, preparedness of the work environment and the emergency nurses’ personal responsibilities at that time.


Arbon P, Cusack, L, Ranse J, Shaban R, Considine J, Kako M, Woodman R, Mitchell B, Bahnisch L, Hammad K. (2013). Exploring staff willingness to attend work during a disaster: a study of nurses employed in four Australian emergency departments. Australasian Emergency Nursing Journal.16(3):103-109 doi:10.1016/j.aenj.2013.05.004

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Nursing through disasters

Free full-text article is available here (HTML)

I was interviewed by Karen Keast of Style My Words for Nursing Careers Allied Health. This interview and subsequent article discussed much of my work relating to disaster nursing in Australia. In particular it focuses on the need for all nurses to have some awareness of disasters, and their potential roles in a disaster.

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Disaster content in Australian tertiary postgraduate emergency nursing courses: A survey

Free full-text article is available here (PDF)

ABSTRACT
Background: Emergency nurses play a pivotal role in disaster relief during the response to, and recovery of both in-hospital and out-of-hospital disasters. Postgraduate education is important in preparing and enhancing emergency nurses’ preparation for disaster nursing practice. The disaster nursing content of Australian tertiary postgraduate emergency nursing courses has not been compared across courses and the level of agreement about suitable content is not known.

Aim: To explore and describe the disaster content in Australian tertiary postgraduate emergency nursing courses.

Method: A retrospective, exploratory and descriptive study of the disaster content of Australian tertiary postgraduate emergency nursing courses conducted in 2009. Course convenors from 12 universities were invited to participate in a single structured telephone survey. Data was analysed using descriptive statistics. 

Results: Ten of the twelve course convenors from Australian tertiary postgraduate emergency nursing courses participated in this study. The content related to disasters was varied, both in terms of the topics covered and duration of disaster content. Seven of these courses included some content relating to disaster health, including types of disasters, hospital response, nurses’ roles in disasters and triage. The management of the dead and dying, and practical application of disaster response skills featured in only one course. Three courses had learning objectives specific to disasters.

Conclusion: The majority of courses had some disaster content but there were considerable differences in the content chosen for inclusion across courses. The incorporation of core competencies such as those from the International Council of Nurses and the World Health Organisation, may enhance content consistency in curriculum. Additionally, this content could be embedded within a proposed national education framework for disaster health.



Ranse J, Shaban R, Considine J, Hammad K, Arbon P, Mitchell B, Lenson S. (2013). Disaster content in Australian tertiary postgraduate emergency nursing courses: A survey. Australasian Emergency Nursing Journal. 16(2):58-63. doi:10.1016/j.aenj.2013.04.002

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Australasian emergency nurses’ willingness to attend work in a disaster: A survey

Free full-text article is available here (PDF)

ABSTRACT
Background: The type of disaster, individual demographic factors, family factors and workplace factors, have been identified in the international, multidisciplinary literature as factors that influence a person’s willingness to attend and assist in their workplace during a disaster. However, it is unknown if these factors are applicable to Australasian emergency nurses.

Aim: The research aims to determine the extent to which Australasian emergency nurses are willing to attend their workplace in a disaster.

Method: This research was exploratory and descriptive study design, using online and paper based surveys as a means of data collection. Australasian emergency nurses from two Australasian emergency nursing colleges and four Australian hospitals were recruited to participate. Data analysis was conducted using both descriptive and inferential statistics.

Results: In total, 451 Australasian emergency nurses participated in this research. Participants were more willing to attend their workplace during a conventional disaster (p≤0.001), if they worked full-time (p = 0.01), had received formal education pertaining to disasters (p≤0.001), had a family disaster plan (p = 0.008), did not have children (p = 0.001) and worked in an environment in which they perceived their colleagues, managers and organisation to be prepared.

Conclusions: The factors that influenced Australasian emergency nurses to attend their workplace in a disaster were similar to that described in the international multidisciplinary literature. Of particular note, improving disaster knowledge and skills, having a family disaster plan and improving the perceptions of the nurses’ workplace preparedness can enhance the nurses’ willingness to assist in a disaster.


Arbon P, Ranse J, Cusack L, Considine J, Shaban R, Woodman R, Bahnisch L, Kako M, Hammad K, Mitchell B. (2013). Australasian emergency nurses’ willingness to attend work in a disaster: A survey. Australasian Emergency Nursing Journal. 16(2):52-57. doi:10.1016/j.aenj.2013.05.004 

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Open access to Nursing journals: An audit of the 2010 ERA journal list

Free full-text article is available here (PDF)

ABSTRACT
Objective: To determine the proportion of nursing journals that are fully open access or have some elements of openness, and hence are readily accessible by nurses in clinical settings.

Design: A descriptive study, with interpretive analysis of existing data sources. Setting Access to online journals from the perspective of a nurse as a consumer.

Subjects: Nursing specific journals from the 2010 Excellence in Research for Australia (ERA) list of publications. Main outcome measure The proportion of nursing journals with unrestricted online open access as of October 2011.

Results: Of the 224 journals included in this research, 12% (27/224) had unrestricted open access to all published manuscripts, 39% (88/224) had partial or conditional access and 49% (109/224) had no elements of open access, and required the consumer to have access to a paid subscription.

Conclusion: Approximately half (51%) of nursing journals surveyed have all or some articles that are open access. This is higher than other studies of open access research articles globally. However, barriers at an institutional level may need to be addressed to ensure nurses can be informed in their care of patients.

Bail K, Ranse J, Clarke R, Rattray B. (2013) Open access to nursing journals: an audit of the 2010 ERA journal list. Australian Journal of Advanced Nursing. 30(4):5-11

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Disaster health: an Australian perspective

I was invited by the Faculty of Public Health and the Faculty of Nursing at Naresuan University, Phitsanulok, Thailand to present on the topic of disaster health from an Australian perspective. This presentation focused on the following topics:
- Willingness
- Education
- Role
- Triage

A number of clinicians and academics shared their experience of disaster assistance within the Phisanulok Province. Additionally, during this visit I had the privilege to meet with a number of public health official regarding their experience of assisting in floods and landslides that have affected their Districts.


Ranse J. (2013). Disaster health: an Australian perspective. Department of Nursing, Naresuan University, Thailand, 3rd June.

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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.

ABSTRACT
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.

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Industrial considerations for Australian nurses responding to disasters

This presentation was undertaken by Shane Lenson.


ABSTRACT
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.

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

ABSTRACT
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.

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Disaster and emergency medicine online research repository: A retrospective review

ABSTRACT
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. 

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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

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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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Phenomenology

This presentation was delivered to students of the Professional Doctorate in Nurse Practitioner (Research) at the University of Canberra. This presentation commenced with a definition of phenomenology and discussed some of the key notion in phenomenology that builds this definition. In particular, the notions of conscious awareness, intentionality, perception and being were explored. Additionally, this presentation discussed some elements of the method of ‘doing’ phenomenology, focusing on the process of data collection and data analysis.


Ranse J. (2013). Phenomenology; paper presented students of the University of Canberra – Professional Doctorate in Nurse Practitioner (Research), Canberra, ACT, 24th February

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Minimum data set for mass-gatherings health research and evaluation: The beginning of an international dialogue

I was fortunate to have someone write a letter to the editor to my original article titled: Minimum data set for mass-gatherings health research and evaluation, which was coauthored with Dr Allison Hutton. This letter to the editor was published in the journal Prehospital and Disaster Medicine. The authors make a number of suggestions to enhance our proposed minimum data set. Additionally, the authors invite us to meet and collaborate with them on future research activities.

In response to this letter to the editor, Allison Hutton and I wrote a response. This response was also published in Prehospital and Disaster Medicine.

Essentially, this response reiterated our original discussion paper regarding the need for some consistency internationally in the reporting of research and evaluations from mass gatherings. In particular, our original work focused on the need to move from author-dependent, author-varied and author-self-generated data sets to an internationally agreed set of minimum variables for collection at mass gatherings. The aim of this would be to compare events internationally, to gain a better understanding of health service requirements during a mass gathering. Additionally, we have accepted the invitation to meet with the authors who wrote the letter to the editor, and will meet with them face-to-face in May 2013 in Manchester, United Kingdom.


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

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Developing a professional presence online: using google blogger

This was an interactive workshop presented to Higher Degree Research (HDR) students at University of Canberra. The aim of this workshop was to provide students with the skills and ability to develop an online professional portfolio using Google Blogger.


Ranse J. (2013). Developing a professional presence online: Using google blogger; workshop presented to Higher Degree Research (HDR) students of the University of Canberra, University of Canberra, ACT, 31st January

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A comparison of open access in exercise science journals: 2010 to 2012

ABSTRACT:
The aim of this study was to complete an audit on the number of open access journals within the discipline of Exercise Science. Publishing in open access journals results in wide dissemination of material in a very short period of time compared with the more traditional way of publishing in a subscription journal. The 2010 ERA journal list, category Human Movement and Sport Science, was initially utilised and then compared with the openness of the same journals in 2012.

In this study journals were audited for their degree of open access, open licensing and open format. Open access relates to the free online availability of research results and hence research publications and in the discipline of exercise science relates to the concept of an idealised level playing field. Open licensing relates to the ability of the consumers to replicate and share those publications freely whilst open format relates to the use of open and transferrable format types. Open access increased (p=0.014) as did our measurement of open licensing (p=0.000) and open formats (p=0.021) between the 2010 and 2012 reviews of the journals in 1106 FOR code.

This study reveals an increase in the number of Exercise Science journals that have full or partial open access over the two year period and suggests that authors are increasingly adopting peer reviewed open access journal publications. It is evident from this study that the impact of open access journals be assessed and further research into the feasibility of such a rating is imperative.


Rattray B, Cooke J, Bail K, Ranse J. (2013). A Comparison of open access in exercise science journals: 2010 to 2012. The Open Sports Science Journal. 6:1-7.

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