Black Saturday and the Victorian Bushfires of February 2009: A descriptive survey of nurses who assisted in the pre-hospital setting

 

Background: In February 2009, bushfires devastated the state of Victoria, Australia, resulting in the loss of property and life — this event was named ‘Black Saturday’. Pre, during and post the impact of this event, health care professionals, such as nursing members of St John Ambulance Australia, provided clinical care in the pre-hospital environment. There is a paucity of literature regarding the clinical and disaster background, education and preparedness of those health care professionals who assist in similar emergencies, as such the characteristics of responders are not well understood.

Method: This research used a retrospective descriptive postal survey design, to survey nursing members of St John Ambulance Australia regarding their nursing experience; pre-hospital experience; disaster education, training and experience; and their role during the response to the 2009 Victorian bushfires.

Results: A total of 53 nurses were approached for inclusion in this research, of which 24 (45%) voluntarily participated. Males represented 46% and females represented 54% of participants. Participants had more combined years of nursing experience in the medical and surgical environments, then other areas of practice. Post-graduate critical care nursing was the primary area of completed post-graduate education. The previous disaster experience of participants was principally related to bushfire emergency response. Most participants had undertaken disaster related education, however this varied in type and duration. Similarly, most had participated in training or mock disasters; however this was commonly not related to bushfire emergencies. During the response to the Victorian bushfires, those nurses who undertook a clinical role did so at a staging area, caring for fire fighters and working with other members of their organisation. Half of the participants undertook an administrative role.

Conclusions: This research has provided insight into the characteristics and level of preparedness, of nurses who responded to the 2009 Victorian bushfires. Previously, such information has not been available in the literature. In this research, males were overrepresented when compared to the national average of nurses. The most amount of nursing experience was in the medical and surgical environment, this is consistent with national nursing workforce trends. Whilst most had clinical experience in bushfires, no training or mock scenarios focused specifically to bushfires. There is a need to explore further, the various roles undertaken by nurses during response, as this research has focused on one event — the 2009 Victorian bushfires.

Reference: Ranse J, Lenson S, Aimers B. (2010). Black Saturday and the Victorian Bushfires of February 2009: A descriptive survey of nurses who assisted in the pre-hospital setting. Collegian. 17(4):153-159

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Changes to Australian nursing and midwifery registration: implications for interstate disaster response

This editorial discusses the recent changes to Australian nursing and midwifery registration and the subsequent implications for interstate disaster response.

Reference: Ranse J, Cusack L. (2010) Changes to Australian nursing and midwifery registration: implications for interstate disaster response. Collegian. [editorial]. 17(4):207-208

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What is the role of nursing students and faculties of nursing during disasters and emergencies? A discussion paper

Full-text article (PDF)

During times of disaster, the front-line nursing workforce and the health services in which they work may be overwhelmed by a surge in patient demand. As a result, assistance will be required to bolster the nursing workforce. Commonly, discussions regarding workforce supply and sustainability during disasters are isolated within particular health service institutions. The aims of this discussion paper are to; firstly, consider the potential contribution of nursing students and schools of nursing within Australian universities to increase the health workforce during a disaster, and secondly, to present a number of recommendations that universities and schools of nursing could consider in developing their own emergency and disaster plans.

Reference: Cusack L, Arbon P, Ranse J. (2010). What is the role of nursing students and faculties What is the role of nursing students and of nursing during disasters and emergencies? A discussion paper. Collegian. 17(4):193-197

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The pre-hospital and emergency department interface during disasters: workforce, education and other contemporary issues

This presentation explored the nexus between the pre-hospital and hospital issues in delivering disaster healthcare. In particular, issues such as triage differences, workforce pressures, and educational preparedness were discussed. This presentation was delivered to the ACT Ambulance Service and ACT Branch of the Australasian Paramedics.

Reference: Ranse J. The pre-hospital and emergency department interface during disasters: workforce, education and other contemporary issues; presentation to the ACT Ambulance Service Continuing Medical Education, 25th November 2010.

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Exploring the disaster content in Australian postgraduate emergency nursing programs

This presentation outlined recent research regarding the type and amount of disaster content in post-graduate tertiary emergency nursing programs in Australasia.

Reference: Ranse J, Arbon P, Shaban R, Considine J, Mitchell B, Lenson S. Exploring the disaster content in Australian postgraduate emergency nursing programs; paper presented at the 8th International Conference for Emergency Nurses, Canberra, Australia, 16th October 2010.

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H1N1 2009 influenza (human swine influenza): A descriptive study of the response of an influenza assessment clinic collaborating with an emergency department in Australia

This presentation highlighted the collaboration of an Australian Emergency Department and Influence Assessment Clinic. In particular this presentation explored the demographics, acuity and disposition of patients presenting to these services with influenza-like symptoms. This presentation makes recommendations for future practice in the event of another influenza-like outbreak.

Reference: Ranse J, Lenson S, Luther M, Xiao L. H1N1 2009 influenza (human swine influenza): A descriptive study of the response of an influenza assessment clinic collaborating with an emergency department in Australia; paper presented at the 8th International Conference for Emergency Nurses, Canberra, Australia, 16th October 2010.

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Understanding the willingness of Australian emergency nurses to respond to a health care disaster

This presentation outlined the findings from the first phase of a national project exploring the willingness of emergency nurses to attend their workplace during a disaster.

Ranse J, Arbon P, Shaban R, Considine J, Mitchell B, Hammond K, Cusack L, Kako M, Bahnisch L. Understanding the Willingness of Australian Emergency Nurses to Respond to a Health Care Disaster; paper presented at the 8th International Conference for Emergency Nurses, Canberra, Australia, 14th October 2010.

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A cultural perspective in the health response to an offshore disaster

This article was submitted within the Transcultural National Network section of the Royal College of Nursing, Australia publication ‘Connections’. The article outlined the importance of disaster response agencies to consider the inclusion of health care professionals who are linguistically diverse and culturally aware, of the country they are responding to.

Reference: Ranse J. (2010). A cultural perspective in the health response to an offshore disaster. Connections [Royal College of Nursing, Australia – newsletter publication]. 13(3):42-43

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Chain of survival at mass gatherings: A case series of resuscitation events

Background: At a large public event, or mass gathering, various factors influence patient presentations, which bring challenges to patient care. The chain of survival has been investigated in the prehospital setting; however this has not explicitly included the mass-gathering environment.

Objective: This study sought to determine the facilitators and barriers to the chain of survival at mass gatherings.

Methods: This case series research was exploratory and descriptive, using the analysis of personal experiences of resuscitation. Participants were members of St John Ambulance Australia who had participated actively in a resuscitation event in 2007. Telephone interviews were used as a means of data collection. Participant narrative was recorded electronically, transcribed verbatim, and analyzed thematically using a well established human science approach.

Results: The thematic analysis revealed five main themes and a number of sub-themes. Four of the main themes were aligned easily with the four chain of survival links. The remaining main theme outlined a new link in the chain of survival of specific importance to mass gatherings, ‘early planning’. Additionally, a number of sub-themes were identified, which exemplified various facilitators and barriers to the chain of survival in this environment.

Conclusions: This research highlights various barriers and facilitators to the chain of survival in the mass-gathering environment. Additionally, the unique “early planning” link in the chain of survival as described in this research highlights the importance of a preparatory phase for responders at mass gatherings.

Reference: Ranse J, Zeitz K: Chain of survival at mass gatherings: A case series of resuscitation events. Prehospital Disaster Medicine. 2010;25(5):465–471.

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Oration: Inspiring, progressing and promoting the profession of nursing in disaster health

Oration title ‘Inspiring, progressing and promoting the profession of nursing in disaster health’, delivered to the Royal College of Nursing, Australia 2010 Nursing Summit – Canberra, ACT, 26th May 2010.

Orator Biography

Throughout his nursing career, Jamie has held various clinical, education, research and management roles, primarily within the critical care environment. Jamie is currently employed as a Clinical Manager of the Emergency Department at Calvary Health Care ACT. In this role Jamie contributes to elements of clinical leadership and research facilitation. Jamie guides and mentors staff in research design and writing for publication. Additionally, Jamie is employed as a Research Associate at the Flinders University Research Centre for Disaster Resilience and Health. His research interests are in the areas of disaster and mass gathering health. To date, his work has been supported by competitive research grants, published in peer-reviewed journals and presented at national and international conferences.

Jamie volunteers with St John Ambulance Australia, holding the high-level strategic position of Chief Nurse. In this role, Jamie develops nursing policy and guidelines, and provides strategic advice on clinical and professional topics to the organisation. Additionally, Jamie promotes internally and externally, to professional nursing organisations and government, the variety of roles and activities nurses undertake in the pre-hospital environment.

Jamie is an Associate Editor for the Australasian Emergency Nursing Journal, holding the pre-hospital portfolio, and peer-reviews for a number of national and international journals relating to disaster, emergency and primary health care. Additionally, Jamie has a close affiliation with the University of Canberra where he holds an adjunct position.

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Disaster Triage

This disaster triage chapter is now published in the text 'International Disaster Nursing'. This chapter provides an overview of triage categories, systems and processes, as they relate to triage in both the pre-hospital and in-hospital settings during normal activities and during a disaster.

Reference: Ranse J, Zeitz K. Chapter 5: Disaster Triage in Power R, Daily E (eds). International Disaster Nursing. 2010. World Association of Disaster and Emergency Medicine with Cambridge Press. pp:57-79.

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Pre-hospital clinical management of heat stress

The purpose of this clinical update is to firstly, increase the awareness of nurses and midwives to the clinical dangers of heat stress, and secondly, provide the best evidence in the first aid and emergency nursing response related to the management of people with the range of heat stress illnesses.

Reference: Cusack L, Arbon P, Ranse J. Pre-hospital clinical management of heat stress. Australian Nursing Journal. 2010;17(8):30-33.

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H1N1 2009 influenza (human swine influenza): A descriptive study of the response of an influenza assessment clinic collaborating with an emergency department in Australia

Background: In June 2009, the World Health Organisation elevated their pandemic index indicating that the spread H1N1 2009 influenza was global. Many emergency departments (EDs) implemented strategies to divert patients with influenza-like symptoms, such as having separate triage and treatment areas. The establishment of influenza assessment clinics (IAC), also known as fever clinics, was a common strategy to achieve this diversion and separation. Calvary Health Care ACT (Calvary Hospital) established an IAC, supported predominately by ED nursing staff, as a strategy to enhance the health response capacity to H1N1 2009 influenza.

Aim: This study described the profile of patients presenting to the IAC and ED with influenza-like symptoms, and tested the relationships that influenced the collaboration between the IAC and ED.

Method: This was a retrospective, descriptive study using the existing patient information system to collect data. The sample for this study included all patients that presented with influenza-like symptoms to the IAC or ED during the IAC operational period; 3 June 2009—3 July 2009.

Results: 1106 patients presented with influenza-like symptoms during the study period, 967 (87.4%) presented during the operational times of the IAC (0900—1700). Patients who presented to the ED were younger than those who presented to the IAC (p = 0.001). A significantly higher proportion of patients presented in the morning period (0900—1300) in comparison to any other time (p<0.0005). Proportionately, the ED admitted more patients to hospital than the IAC (p< 0.0005). However, there were a significantly higher proportion of discharges from the ED than expected (p<0.0005).

Conclusions: Most patients with influenza-like symptoms presented during the operational hours of the IAC. Commonly, this was during the morning period which has staffing and resource implications in order to enhance the ED response capacity. A large proportion of patients were aged less than 65 years of age. Triage processes and guidelines should be enhanced to stream patients according to their likely disposition. A sustainable IAC like model should be implemented to support situations where increased ED patient presentations are experienced or expected. An evaluation of such a model should occur outside pandemic or increased patient presentation periods as this is the first study to provide an understanding of the relationship between an ED and IAC during the H1N1 2009 influenza pandemic. The results have staffing and resource implications, in order to enhance the ED response capacity.

Reference: Ranse J, Lenson S, Luther M, Xiao L. H1N1 2009 influenza (human swine influenza): A descriptive study of the response of an influenza assessment clinic collaborating with an emergency department in Australia. Australasian Emergency Nursing Journal. 2010;13(3):46-52.

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Medical response to mass gatherings

This presentation highlights what we currently know about the health response to mass gatherings. In particular, it focuses models for predicting ‘patient presentation rates’ and ‘transport to hospital’ rates from mass gathering events. Additionally, this presentation explored the factors that influence patient presentation rates, such as; the weather, crowd mood and time of day. This presentation focused on a number of case studies to highlight the varied approaches to predicting workload.

Ranse J. Medical response to mass gatherings; presentation to the ACT Ambulance Service Continuing Medical Education, 25th March 2010.

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Engaging volunteers in an emergency management organisation

Free full-text article is available here (PDF) 

ABSTRACT

The recruitment and retention of volunteers is a perennial and significant concern for emergency management organisations. This research aimed to identify factors associated with the successful engagement and retention of volunteers in an emergency management organisation. Six focus groups were undertaken with participants from both rural and metropolitan areas of one Australian jurisdiction. A number of themes were identified for the volunteer’s reasons to join, leave and stay in a volunteer emergency management organisation. The notion of retention should not be a focus for organisations; rather volunteer emergency management organisations should implement and enhance strategies to engage volunteers.

Reference: Ranse J, Carter S. Engaging volunteers in an emergency management organisation. Australian Journal of Emergency Management. 2010;25(1):36-41.

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Evaluating the influential factors in mass gathering casualty presentation characteristics – World Youth Day, Sydney, Australia, 2008

We currently have an understanding of the factors that influence ‘patient presentation rates’ and ‘transport to hospital’ rates from mass gathering events. To date these factors have been used in models to predict workload for those providing clinical care in the pre-hospital mass gathering environment. One factor that has not been explored in great detail, however is understood to have some influence on the ‘patient presentation rates’ and ‘transport to hospital’ rates, is whether the population attending the mass gathering is ‘bounded’ (or within a given fenced perimeter) or ‘unbounded’ (not fenced within a given perimeter). World Youth Day provided a unique opportunity to explore this factor in more detail as a similar population (pilgrims) attended events which were both bounded and unbounded.

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.

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The pre-hospital role of nurses during the Victorian Bushfires

This presentation illustrated the preliminary findings from a research project that explored the role of nurses who assisted in the response and/or recovery during the 2009 Victorian Bushfires. Whilst the focus was on the role of nurses during this event, this research highlighted other interesting findings, such as; nurses often trained for disaster using mock scenarios such as, aviation accidents or CBR incidents, however, in the Australian context they are more likely to participant in a bushfire or flood event.

Ranse J, Aimers B, Lenson S. The pre-hospital role of nurses during the Victorian Bushfires; paper presented at the 7th International Conference for Emergency Nurses, Gold Coast, Australia, 8th October 2009.

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R-on-T resulting in ventricular fibrillation post elective cardioversion: A case study

Elective cardioversion is a common and effective therapy for many atrial arrhythmias, however the procedure is not without risk. One risk from cardioversion is the R-on-T phenomenon. This article provides an overview of anatomy and physiology relating to R-on-T, a case of R-on-T following elective cardioversion for atrial fibrillation and important considerations for elective cardioversion in the emergency department environment.

Ranse J, Luther M, Sargent L. R-on-T resulting in ventricular fibrillation post elective cardioversion: A case study. Australasian Emergency Nursing Journal. 2009;12(3):120-122.

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A novice's guide to preparing and presenting an oral presentation at a scientific conference

This article focuses on information to assist the novice presenter with preparation of an oral presentation - from submitting the abstract to closing the presentation.

Ranse J, Hayes C. A novice’s guide to preparing and presenting an oral presentation at a Scientific Conference. Journal of Emergency Primary Health Care. 2009;7(1):1-8. [available free in full-text].

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Public health care emergencies: the role of nurses volunteering

This paper provides discussion regarding the response of nurses to public health care emergencies and disasters in Australia.

Ranse J. Public health care emergencies: the role of nurses volunteering. Connections [Royal College of Nursing, Australia – newsletter publication]. 2008;11(2):15-16.

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Mountain biking events: presentation characteristics and medical needs

This presentation provides an overview of a research project that aimed to describe injury type and frequency, and the factors influencing these, in Australian mountain bike riders. This research used a cross-sectional retrospective audit of patient records, prospective meteorological information and race data from the world’s largest twenty-four hour mountain bike race over an eight year period. Of the 14777 riders over the eight years, 675 required first aid treatment (4.6%), 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 are highest in the first eight hours of a race, and higher average temperatures per year were associated with a greater risk of injury. 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 such events.

Ranse J, Taylor N. (2008). Mountain biking events: presentation characteristics and medical needs; paper presented at the 8th Rural Critical Care Conference, Batemans Bay, Australia, 23rd August

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The reality of multiple casualty triage: putting triage theory into practice at the scene of multiple casualty vehicular accidents

Objectives: The project investigated the experiences of ambulance paramedics in applying the principles and protocols of prehospital multiple casualty triage at the scene of motor vehicle accidents. Key objectives included investigation of the situational cues and other contextual factors influencing triage practice and the development of recommendations for the future education of ambulance paramedics.

Methods: A triangulated approach was used incorporating demographic data, the use of focus groups and in-depth interviews. A thematic analysis was undertaken following the well established practices of human science research.

Results and conclusions: The research describes an extended and broadened triage process returning to a more authentic definition of triage as the practice of sorting of casualties to determine priority. The findings highlight the need to consider triage as an extended and complex process that incorporates evidence based physiological cues to assist decision making and the management of the process of triage from call out to conclusion including assessment of contextual and situational variables.

Arbon P, Zeitz K, Ranse J, Wren H, Driscoll K, Elliott R. The reality of multiple casualty triage: putting triage theory into practice at the scene of multiple casualty vehicular accidents. Emergency Medicine Journal. 2008;25(4):230-234.

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Impact of a pandemic triage tool on intensive care admissions

Bailey A, Ranse J, Leditschke A, Grove K. Impact of a pandemic triage tool on intensive care admissions; poster presented at the Asia Pacific Critical Care Congress. Sydney, Australia, 30th October – 2nd November 2008.

Bailey A, Leditschke A, Ranse J, Grove K. Impact of a pandemic triage tool on intensive care admissions; poster presented at the 28th International Symposium on Intensive Care and Emergency Medicine. Brussels, Belgium, 18th – 21st March 2008.

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Graduate nurses’ lived experience of in-hospital resuscitation: A hermeneutic phenomenological approach

Free full-text article is available here (PDF) 

Aim: The purpose of this research was to explore, describe and interpret the lived experience of graduate [junior] Registered Nurses who have participated in an inhospital resuscitation event within the non-critical care environment.

Method: Using a hermeneutic phenomenological design, a convenience sample was recruited from a population of graduate Registered Nurses with less than 12 months experience. Focus groups were employed as a means of data collection. Thematic analysis of the focus group narrative was undertaken using a well-established human science approach.

Findings: Responses from participants were analysed and grouped into four main themes: needing to decide, having to act, feeling connected and being supported. The findings illustrate a decision-making process resulting in participants seeking assistance from a medical emergency team based on previous experience, education and the perceived needs of the patient. Following this decision, participants are indecisive, questioning their decision. Participants view themselves as learners of the resuscitation process being educationally prepared to undertake basic life support, but not prepared for roles in a resuscitation event expected of the Registered Nurse, such as scribe. With minimal direction participants identified, implemented and evaluated their own coping strategies. Participants desire an environment that promotes a team approach, fostering involvement in the ongoing management of the patient within a ‘safe zone’.

Conclusion: Similarities are identifiable between the graduate nurses’ experience and the experience of bystanders and other healthcare professional cohorts, such as the chaotic resuscitation environment, having too many or not enough participants involved in a resuscitation event, being publicly tested, having a decreased physical and emotional reaction with increased resuscitation exposure and having a lack of an opportunity to participate in debriefing sessions. Strategies should be implemented to provide non-critical care nurses with the confidence and competence to remain involved in the resuscitation process, firstly to provide support for less experienced staff and secondly to participate in the ongoing management of the patient. Additionally, the need for education to be contextualised and mimic the realities of a resuscitation event was emphasised.

Ranse J, Arbon P. Graduate nurses’ lived experience of in-hospital resuscitation – a hermeneutic phenomenological approach. Australian Critical Care. 2008;21(1):38-47

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Preparing and presenting a successful poster at a scientific conference

This article provides guidance for those considering a poster presentation, by discussing the advantages of this method of information dissemination and the process of submitting an abstract to a scientific conference. Additionally this article outlines poster content inclusions, design and layout suggestions. An evaluation tool commonly used to assess a poster is included, together with some useful information regarding setting up your poster and what to do during the conference.

Ranse J, Aitken C. Preparing and presenting a successful poster at a scientific conference. Journal of Emergency Primary Health Care. 2008;6(1):9p. [available free in full-text].

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Medical emergency teams: graduate nurses interactions, attitudes and perceptions during resuscitation events in the non-critical care environment

Ranse J. Medical emergency teams: graduate nurses interactions, attitudes and perceptions during resuscitation events in the non-critical care environment; paper presented at the ANZICS/ACCCN Intensive Care Annual Scientific Meeting, Rotorua, New Zealand, 26th October 2007.

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Graduate nurses’ lived experience of in-hospital resuscitation – a hermeneutic phenomenological approach

This poster presents a summary of my research work undertaken as part of the Master of Critical Care Nursing. This poster received the 'Best poster presentation' prize at the 6th International Conference for Emergency Nurses, Melbourne, Australia.

Ranse J. Graduate nurses’ lived experience of in-hospital resuscitation – a hermeneutic phenomenological approach, poster presented at the 6th International Conference for Emergency Nurses, Melbourne, Australia, 12th October 2007.

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Mock News Broadcast - Disaster in Canberra

This mock news broadcast was used in the opening scene for the St John Ambulance Australia National Adult Competitions, held in Canberra 2007. Competitors came from all states and territories in Australia, and also included a team from New Zealand. Competitors were required to gather intelligence from the news broadcast. This intelligence was then used by the competitors to gather equipment, that was perceived to be required at a mock evacuation centre where casualties from the disaster would present with various injuries and illnesses.

The competitions were held as in conjunction with a Volunteer Emergency Management open day. The open day showcased the capabilities of various local volunteer emergency management agencies.

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Putting triage theory into practice at the scene of multiple casualty vehicular accidents: the reality of multiple casualty triage

This presentation highlights the findings of a project that explored the nexus between theoretical understandings of the triage process, and how triage is actually performed. This presentation was delivered at a number of national and international forums. For the project, information was collected from ambulance Paramedics from South Australia and the Australian Capital Territory, through focus groups and interviews. This project was supported by a grant from the ACT NRMA Road Safety Trust.






Reference: Arbon P, Zeitz K, Ranse J, Wren H, Driscoll K, Elliott R. The realities of triage; paper presented at the 6th International Conference for Emergency Nurses, Melbourne, Australia, 12th October 2007.

Reference: Arbon P, Zeitz K, Ranse J, Wren H, Driscoll K, Elliott R. Multi-casualty triage – putting triage theory into practice at the scene of multiple casualty vehicular accidents; paper presented at the15th World Congress on Disaster and Emergency Medicine, Amsterdam, the Netherlands, 14th May 2007.

Reference: Arbon P, Zeitz K, Ranse J, Wren H, Driscoll K, Elliott R. Putting triage theory into practice at the scene of multiple casualty vehicular accidents: the reality of multiple casualty triage; paper presented at the ACT Public Health Forum, Canberra, Australia, 16th November 2006.

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Thesis: In-hospital resuscitation: Graduate nurses’ lived experience in the non-critical care environment – a hermeneutic phenomenological approach

In resuscitation teachings to newly Registered Nurses, we place an emphasis on process of Airway, Breathing and Circulation - in reality this is not their role. In a resuscitation, the newly Registered Nurse will be scribing, drawing-up medications and scouting for equipment. As such, the in-hospital training of such cohorts needs to be addressed to meet the realities of the newly Registered Nurses role. This example is one of a number of findings related to my thesis, which was completed in partial fulfilment for the award: Master of Critical Care Nursing.

Reference: Ranse J. In-hospital resuscitation: graduate nurses’ lived experience in the non-critical care environment – a hermeneutic phenomenological approach [thesis]. University of Canberra. 2006.

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Putting triage theory into practice at the scene of multiple casualty vehicular accidents: the reality of multiple casualty triage

This research report highlights the findings of a project that explored the nexus between theoretical understandings of the triage process, and how triage is actually performed. Data was collected from ambulance Paramedics from South Australia and the Australian Capital Territory. This project was supported by a grant from the ACT NRMA Road Safety Trust. 

Reference: Arbon P, Zeitz K, Ranse J, Wren H, Driscoll K, Elliott R. Putting triage theory into practice at the scene of multiple casualty vehicular accidents: the reality of multiple casualty triage. [research report - available free in full-text].

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Exploring the volunteer first aiders’ experience post-resuscitation

Objectives: This study aims to identify themes associated with St John volunteer first aiders’ post-resuscitation experience following an out-of-hospital sudden cardiac arrest, and to make suggestions for future practice in education and research.

Methods: This study was exploratory and descriptive in design, utilising a single focus group as a means of data collection. All five participants from a single resuscitation event participated in the focus group. The focus group was electronically recorded and transcribed verbatim. The results were then thematically analysed.

Findings: The focus group participants described four themes associated with successful resuscitation of a casualty following sudden cardiac arrest. These themes were: postresuscitation casualty management; interactions with health care professionals; critical incident stress management and learning about the casualty’s outcome.

Discussion: Education of first aid service providers should include post-resuscitation casualty management, this could be achieved by including the chain of survival in its entirety rather than the DRABCD (danger, response, airway, breathing, circulation and defibrillation) resuscitation action plan only. Similarly, ambulance paramedics require an understanding of semi-automatic external defibrillators as used by first aid service providers. In particular, the limitations of semi-automatic external defibrillators should be included in education programs for ambulance paramedics and emergency department staff. Finally, first aid service providers should implement formal mechanisms to provide feedback to participants regarding casualty outcomes following a critical event.

Reference: Ranse J, Burke B. Exploring the volunteer first aiders’ experience post-resuscitation. Journal of Emergency Primary Health Care. 2006;4(3):10p

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Cardiac arrest: can the in-hospital chain of survival be improved?

Survival from cardiac arrest decreases between 7 and 10% each minute defibrillation is delayed. Within the pre-hospital care environment, public access defibrillation programs and first-responders utilise semi-automatic external defibrillators to effectively increase survival following cardiac arrest from approximately 10% to approximately 60%. However, survival from an in-hospital cardiac arrest remains at approximately 10% despite the introduction of medical emergency teams. This discussion paper examines various methods to increase the in-hospital survival rate following a cardiac arrest, such as the implementation of first-responder semi-automatic external defibrillator programs and increasing education standards in basic and advanced cardiac life support.

Reference: Ranse J. Cardiac arrest: can the in-hospital chain of survival be improved? Australasian Emergency Nursing Journal. 2006;9(1):23-27.

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