Measuring the masses: A series of papers

I was part of an international team that published a number of papers relating to mass gatherings. These papers focused on the need for consistency in the reporting of mass gathering events from a health perspective. These papers were published in a series in the journal Prehospital and Disaster Medicine. The various papers in this series are listed below.

REFERENCES

Lund A, Turris S, Rabb H, Munn MB, Chasmar E, Ranse J, Hutton A. (2021). Measuring the masses: mass gathering medical case reporting, conceptual modelling – The DREAM model (Paper 5). Prehospital and Disaster Medicine. Full-text article available here (PDF)

Turris S, Rabb H, Chasmar E, Munn MB, Callaghan CW, Hutton A, Ranse J, Lund A. (2021). Measuring the masses series: A proposed template for post-event medical reporting (Paper 4). Prehospital and Disaster Medicine. Full-text article available here (PDF) 

Turris S, Lund A, Munn MB, Chasmar E, Rabb H, Callaghan CW, Ranse J, Hutton A. (2021). Measuring the masses series: Domains driving data collection and analysis for the health outcomes of mass gatherings (Paper 3). Prehospital and Disaster Medicine. Full-text article available here (PDF) 

Turris S, Rabb H, Chasmar E, Callaghan CW, Ranse J, Lund A. (2021). Measuring the masses: Understanding health outcomes arising from mass gatherings, reporting gaps and recommendations (Paper 2). Prehospital and Disaster Medicine. Full-text article available here (PDF) 

Turris S, Rabb H, Munn MB, Chasmar E, Callaghan CW, Ranse J, Lund A. (2021). Measuring the masses: The current state of mass gathering medical case reporting (Paper 1). Prehospital and Disaster Medicine. Full-text article available here (PDF)

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The impact of Chemical, Biological, Radiological, Nuclear and Explosive events on Emergency Departments: An integrative review

 

I was invited to speak at the Qatar Health 2021 conference on the topic of disaster health. This presentation focused on the findings of an integrative literature review relating to Chemical, Biological, Radiological and Nuclear [CBRN] events and their impact on Emergency Departments [EDs]. The literature review aimed to identify papers relating to the impact of CBRN events on ED and to analyze these papers for lessons learnt to strengthen ED preparedness. The presentation explored the global epidemiology of disasters, the nature of CBRN events, ED preparedness, clinician education, willingness and resources. The Qatar Health 2021 conference theme related to mass gathering events. As such, this presentation discussed the intersect between ED preparedness for CBRN events in the context of mass gathering events. 

REFERENCE 

Ranse J. (2021). The impact of Chemical, Biological, Radiological, Nuclear and Explosive events on Emergency Departments: An integrative review; invited speaker for Qatar Health 2021, Doha, Qatar, 22nd January. [online]

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Recommencing mass gathering events in the context of COVID-19: Lessons from Australia

I was invited to speak at the Qatar Health 2021 conference on the topic of mass gathering events. This presentation focused on the recommencement of mass gatherings in the Australian context. In particular, this presentation focused on the Australian COVID-19 epidemiology, an overview of mass gathering events and COVID-19 in Australia, case studies from national and grass-root sports, and strategies for recommending mass gathering events during COVID-19. 

REFERENCE 

Ranse J. (2021). Recommencing mass gathering events in the context of COVID-19: Lessons from Australia; invited speaker for Qatar Health 2021, Doha, Qatar, 22nd January. [online]

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

I was invited to speak at the Qatar Health 2021 conference on the topic of mass gathering events. This presentation focused on a review of the literature regarding novel respiratory viruses in the context of mass gathering events. This presentation synthesised the literature relating to SARS-CoV-1, H1N1pdm09, and SARS-CoV-2 (COVID-19) in the context of mass gathering events.  Previously published infection prevention and control strategies were presented against a framework of pre, during, and after mass gathering event considerations. These infection preventions and control strategies o have implications for both event organisers and health officials when recommencing events in the context of COVID-19.

Ranse J. (2021). Novel respiratory viruses in the context of mass gathering events: A systematic review to inform event planning from a health perspective; invited speaker for Qatar Health 2021, Doha, Qatar, 21st January. [online]

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Rethinking mass gathering domains for understanding patient presentations: A discussion paper

Aim: The aim of this paper is to further develop an existing data model for mass-gathering health outcomes. 

Background: Mass-gathering events (MGEs) occur frequently throughout the world. Having an understanding of the complexities of MGEs is important to determine required health resources. Environmental, psychosocial, and biomedical domains may be a logical starting point to determine how data are being collected and reported in the literature; however, it may be that other factors influencing health resources are not identified within these domains. 

Method: Based on an exhaustive literature synthesis, this paper is the final paper in a series that explores the collection of variables that impact biomedical presentations associated with attendance/participation in MGEs. Findings: The authors propose further evolution of the Arbon model to include the addition of several domains, including: event environment; command, control, and communication (C3); public health; health promotion; and legacy when reporting the health outcomes of an event. 

Conclusions: Including a variety of domains that contribute to an MGE allows for formal evaluation of the event, which in turn informs future knowledge and skill development for both the event management group and the wider community.

Full-text article is available here (PDF)

Hutton A, Ranse J, Zimmerman P. (2020). Rethinking mass gathering domains for understanding patient presentations: A discussion paper. Prehospital and Disaster Medicine.

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Vulnerability: A concept synthesis and its application to the Emergency Department (ED).

Aim: The aim of this concept synthesis was to add clarity to the concept of vulnerability with application to the Emergency Department (ED) by critiquing, analysing and amalgamating published concept analyses. 

Background: The concept of vulnerability has been used widely, however it has various meanings. A clearer understanding of vulnerability and application to the ED may help healthcare professionals provide high quality care responsive to the needs of vulnerable individuals. 

Method: Nine concept analyses of vulnerability were retrieved using Medline, CINAHL, and PsycINFO databases. After extracting data on each analysis, Walker and Avant’s concept synthesis method was used to structure this synthesis, with a thematic synthesis approach used in the analysis. 

Findings: Four themes associated with vulnerability emerged from the synthesis. The first theme, vulnerability as a journey, reflected elements within an individual’s life that perpetuate and exacerbate vulnerability. The second theme, vulnerability as susceptibility and risk, highlighted intrinsic and extrinsic elements that contribute to a state of risk. The third theme, positive and negative repercussions, emphasised lessons that can be learned from experience, with the fourth theme of a shared understanding indicating the importance of understanding the concept of vulnerability for patient care. 

Conclusion: Findings from this synthesis highlight the multiple elements associated with a vulnerable state, evident in the context of the ED. With multiple ED-specific elements contributing to vulnerability, clarity of the term is important to inform ED-specific interventions designed to meet the needs of vulnerable populations.

Full-text is available here (PDF) 

Wardrop R, Crilly J, Ranse J, Chaboyer W. (2020). Vulnerability: A concept synthesis and its application to the Emergency Department (ED). International Emergency Nursing.

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The impact of disasters on emergency department resources: Review against the Sendai Framework for disaster risk reduction 2015–2030.

Free full-text article

ABSTRACT

Background: Emergency departments (EDs) are often first to feel the intra-hospital effects of disasters. Compromised care standards during disasters eventuate from increased demands on health resources; the facilities, supplies, equipment and manpower imperative for a functioning healthcare facility. Emergency departments must understand the effect of disasters on their health resources. This paper examines the impact on resources within the ED as a result of a disaster and provides a review against the United Nations Office for Disaster Risk Reduction’s Sendai Framework for Disaster Risk Reduction 2015–2030 priorities. 

Method: An integrative literature review design was utilised. Articles were extracted from databases and search engines. The Preferred Reporting Items of Systematic reviews and Meta-Analysis Guidelines for systematic literature reviews were used. 

Results: Seven papers met inclusion criteria. Disaster consumable stocking was used to mitigate disaster risk and improve resilience. Logistical challenges were exacerbated by poor building design. Ineffective human resource management, communications failure, insufficient ED space, diminished equipment and supplies and unreliable emergency power sources were described.

Conclusions: Disaster planning and preparedness strategies can address health resource deficits, increasing ED resilience. Further retrospective case studies are required to greater understand the effects of disasters on ED health resources.

REFERENCE: 

Carrington M, Hammad K, Ranse J. (2020). The impact of disasters on emergency department resources: Review against the Sendai Framework for disaster risk reduction 2015–2030. Australasian Emergency Care

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Disaster evacuation shelters in the context of COVID-19

As a consultant to the World Health Organization, Regional Office for the Western Pacific, I led the development of technical guidance regarding disaster evacuation shelters in the context of COVID-19.

Full-text guidance is free online here

ABSTRACT 

The Western Pacific is the world’s most disaster-prone region. When a disaster occurs, people may need to seek accommodation in a disaster evacuation shelter. However, it may be difficult for people in a disaster evacuation shelter to avoid confined and enclosed spaces with poor ventilation; crowded places with many people nearby; and close-contact settings, such as close-range conversations. This document outlines key considerations and strategies that should be considered for the establishment of a disaster evacuation shelter in the context of COVID-19. In particular, considerations and strategies are outlined for the preparedness, response, and recovery phases of disasters.

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Research in the context of coronavirus disease 2019: Considerations for critical care environments

Free full-text article

In this editorial, I discuss some key considerations of undertaking research in critical care environments in the context of COVID-19.

In summary, research during disasters and public health emergencies, such as COVID-19, should be carefully considered before it is commenced. First, for individual researchers, this means embarking on high-quality, collaborative, and meaningful research, resisting the temptation to quickly grasp low-hanging research, which has the potential to be expedited at the jeopardy of quality. Second, for organisations that facilitate research through funding support or access to potential participants, supporting research with high scientific rigour should be maintained and strategies implemented to facilitate collaborative research particularly when it becomes apparent that duplication of research efforts is imminent. Finally, journals must be agile so that they can quickly respond to the need for rapid dissemination of information while still maintaining established standards of good publishing practice.

REFERENCE:

Ranse J. (2020). Research in the context of coronavirus disease 2019: Considerations for critical care environments. Australian Critical Care. 33(4):309-310.

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Australian bush fire experience

I was invited by Dr Atilla Hertelendy from Georgetown University to present to the students of the Emergency Management Program. This presentation focused on the history of bush fires in Australia, with a focus on more recent events including:

• 2003 Canberra bush fires 
• 2009 Black Saturday and Victorian Bushfire 
• 2019 / 2020 Black Summer

Additionally, aspects of the healthcare professional's role, experience, and education were discussed.


Ranse J. (2020). Australian bush fire experience; online presentation [via Zoom] at the Georgetown University, Emergency Management Program, Miami, Florida, United States of America, USA, 21st April.

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

Full-text article (PDF)


ABSTRACT

Aim: This review discusses the need for consistency in mass-gathering research and evaluation from a psychosocial perspective.

Background: Mass gatherings occur frequently throughout the world. Having an understanding of the complexities of mass gatherings is important to determine required health resources. Factors within the environmental, psychosocial, and biomedical domains influence the usage of health services at mass gatherings. A standardized approach to data collection is important to identify a consistent reporting standard for the psychosocial domain.

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

Results: In total, 31 manuscripts met the inclusion criteria. The main variables identified were use of alcohol or drugs, crowd behavior, crowd mood, rationale, and length of stay.

Conclusion: Upon interrogating the literature, the authors have determined that the variables fall under the categories of alcohol or drugs; maladaptive and adaptive behaviors; crowd behavior, crowd culture, and crowd mood; reason for attending event (motivation); duration; and crowd demographics. In collecting psychosocial data from mass gatherings, an agreed-upon set of variables that can be used to collect de-identified psychosocial variables for the purpose of making comparisons across societies for mass-gathering events (MGEs) would be invaluable to researchers and event clinicians.



Hutton A, Ranse J, Grey K, Turris S, Lund A, Munn BM. (2020). Psychosocial influences on patient presentations: Considerations for research and evaluation at mass-gathering events. Prehospital and Disaster Medicine.

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The impact of mass casualty incidents on intensive care units

Full-text article (PDF)

ABSTRACT
Objectives: Mass casualty incidents occur worldwide and have the capacity to overwhelm local healthcare facilities. There has been much research into how these events are managed in the prehospital environment and in the emergency department. However, there is a paucity in research addressing the impact that mass casualty incidents have on adult intensive care units. This review seeks to identify what literature is available that addresses the impact that mass casualty incidents have on intensive care units.

Review method used: Integrative Review Data sources: Electronic databases MEDLINE, CINAHL, PubMed and Scopus.

Review Methods: Electronic databases were searched using terms such as "Intensive Care Unit" OR "Intensive Care" OR "Critical Care" OR "ICU" AND "Mass Casualty Incidents" OR "MCI" OR "Mass Casualty Event" OR "Mass Casualty Management" OR "Disaster". Articles that were published in the preceding 10 years in English as case studies or addressing real world events were included. Editorials, theoretical papers and research involving paediatrics were excluded from the results.

Results: Seven articles met the search criteria. Results identified four key areas in ICU that were impacted by mass casualty incidents. These areas include the impact on facilities, on resources, on staff and of training on the management of mass casualty incidents.

Conclusions: This review has demonstrated a paucity in research and reporting practices on the impact that mass casualty incidents have on intensive care units. The returned articles have identified four areas that were seen as influencing management of real-world mass casualty incidents. By increasing reporting and research into factors that impact mass casualty incident management in intensive care units, policy and training can be enhanced to ensure better preparedness for future incidents.




Sellers D, Ranse J. (2020). The impact of mass casualty incidents on intensive care units. Australian Critical Care.

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Impact of mass gatherings on ambulance services and emergency departments

I presented at the Qatar Health 2020 conference regarding the impact of mass gatherings on ambulance services and emergency departments. Qatar Health 2020 is a collaborative effort between Hamad Medical Corporation and the Ministry of Public Health in preparation for the FIFA World Cup 2022.

In particular, this presentation highlights:

• the host population to event population relationship
• frameworks for understanding the impacts of mass gatherings
• current literature to inform practice
• case studies relating to music festivals, and the 2018 Commonwealth Games

REFERENCES

Arbon, P., Bridgewater, F. H., & Smith, C. (2001). Mass gathering medicine: a predictive model for patient presentation and transport rates. Prehospital and Disaster Medicine, 16(3), 150-158.

Catherine Delany. Master of Emergency Nursing (Dissertation). A retrospective analysis of drug and alcohol-related patient presentations to the Gold Coast Health emergency departments during the 2018 Commonwealth Games. Supervisors: Julia Crilly, Jamie Ranse.

DeMott, J. M., Hebert, C. L., Novak, M., Mahmood, S., & Peksa, G. D. (2018). Characteristics and resource utilization of patients presenting to the ED from mass gathering events. The American Journal of Emergency Medicine, 36(6), 983-987.

Gold Coast Public Health Unit. (2019). Gold Coast 2018 Commonwealth Games Summary Report. Retrieved from: https://www.goldcoast.health.qld.gov.au/sites/default/files/GC2018%20Public%20Health%20Summary%20Report%20Final%20.pdf

Hughes, H. E., Colón-González, F. J., Fouillet, A., Elliot, A. J., Caserio-Schonemann, C., Hughes, T. C., ... & Lake, I. R. (2018). The influence of a major sporting event upon emergency department attendances; A retrospective cross-national European study. PloS one, 13(6), e0198665.

Lund A, Turris S, Bowles R, Steenkamp M, Hutton A, Ranse J, Arbon P. (2014). Mass gathering health research foundational theory: Part 1 Population models for mass gatherings. Prehospital and Disaster Medicine. 29(6):648-654.

Ranse, J., Hutton, A., Keene, T., Lenson, S., Luther, M., Bost, N., ... & Hayes, C. (2017). Health service impact from mass gatherings: a systematic literature review. Prehospital and disaster medicine, 32(1), 71-77.

Ranse, J., Lenson, S., Keene, T., Luther, M., Burke, B., Hutton, A., ... & Crilly, J. (2019). Impacts on in‐event, ambulance and emergency department services from patients presenting from a mass gathering event: A retrospective analysis. Emergency Medicine Australasia, 31(3), 423-428.

Ruest, S. M., Stephan, A. M., Masiakos, P. T., Biddinger, P. D., Camargo, C. A., & Kharasch, S. (2018). Substance use patterns and in-hospital care of adolescents and young adults attending music concerts. Addiction Science and Clinical Practice, 13(1), 1.

Shirley (Yunjing) Qiu. Bachelor of Nursing (Honours), First Class. A retrospective cohort study evaluating the impact of a mass gathering (the 2018 Commonwealth Games) on emergency department presentations with communicable diseases. Supervisors: Julia Crilly, Jamie Ranse, Peta-Anne Zimmerman

Turris S, Lund A, Hutton A, Bowles R, Ellerson E, Steenkamp M, Ranse J, Arbon P. (2014). Mass gathering health research foundational theory: Part 2 Event modelling for mass gatherings. Prehospital and Disaster Medicine. 29(6):655-663



Reference from this presentation: Ranse J. (2020). Impact of mass gatherings on ambulance services and emergency departments; invited speaker for Qatar Health 2020, Doha, Qatar, 17th January.

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

Full-text paper (PDF)

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

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

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

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



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

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The 2018 Commonwealth Games Experience

I presented at the 4th International Conference for Mass Gathering Medicine in Jeddah, Saudi Arabia. The focus of this presentation related to the impact of the 2018 Commonwealth Games on the health services (public health, ambulance, emergency departments)


Ranse J. (2019). The 2018 Commonwealth Games Experience; invited speaker for 4th International Conference for Mass Gathering Medicine, Jeddah, Saudi Arabia, 13th December.

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Impact of mass gathering events on emergency healthcare services: informing health service planning for safer communities.

I was interviewed by Gold Coast 7 News regarding funding I received from the Australian Research Council to explore the impact of mass gathering events on emergency health services.

PROJECT OVERVIEW
Mass gathering events (MGEs) occur frequently across Australia. The preparation of a MGE from an emergency healthcare service perspective is conducted with limited evidence to support decision-making. Using routinely collected data from Tourism and Events Queensland, Queensland Ambulance Service, Queensland Emergency Departments, and the Bureau of Meteorology, this research aims to determine the impact on ambulance and emergency department services in the vicinity of 750 planned MGEs over a five year period (2015 - 2019). The expected outcome includes an enhanced ability to predict the required emergency healthcare services for a MGE, therefore enhancing the planning and response, benefiting MGE attendees and the MGE host community.

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

Free full-text article is available here (PDF)

ABSTRACT

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

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

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

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



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

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Frequency and location of mass gatherings in relation to emergency departments: A descriptive study

The full-text article is available here


ABSTRACT

Introduction: As the number of mass gathering events increases, so too does the reliance on tertiary emergency healthcare services. Approximately 1% of event attendees may present to a local emergency department for clinical assessment and/or management. Often, these attendees are transported by ambulance services. The purpose of this study is to determine the frequency and location of events held in New South Wales (NSW), Australia. This information may be used by event and health service personnel to further inform event planning such as staffing, equipment and economic considerations when large events in the community occur.

Methods: This descriptive study used data scraping of an established data warehouse to identify events held in the 2017 calendar year by name, type, location (within the state of NSW) and duration. Using Google Maps, the distance and travel time between these events and the nearest emergency department (ED) was determined. Data was analysed using simple descriptive statistics.

Results: Of the 722 events in NSW analysed, 395 were single-day events. The majority of these were concerts (n=284, 39%), followed by festivals (n=259, 36%) and sporting events (n=176, 24%). The average distance and time to arrive at an ED from an event was 15.0 (±35.8) kilometres and 15.4 (±27.2) minutes, respectively. 

Conclusion: Existing literature has highlighted that event attendees are regularly transported to emergency departments from events. This research has demonstrated that events occur frequently with varying vicinity to nearest EDs, with the majority of events occurring near territory care centres. However, there is limited research on the impact on emergency healthcare services resulting from an event.



Hutton A, Ranse J, Lipscomb R, Hutton G, Rabb H, Crilly J. (2019). Frequency and location of mass gathering events in relation to emergency departments: A descriptive study. Australasian Journal of Paramedicine.

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End-of-life care content in postgraduate critical care nursing programs: Structured telephone interviews to evaluate content informing practice

Full-text article is available here

ABSTRACT
Background: The provision of end-of-life care remains a significant component of work for clinicians in critical care settings. Critical care nurses report that this area of practice receives limited attention in education and training.

Objectives: The objective of this study was to identify and describe the end-of-life care content in postgraduate critical care nursing programs in Australia.

Methods: Using a descriptive exploratory research design, an Internet search was undertaken in August 2015, identifying 17 education providers offering postgraduate critical care nursing programs. Thirteen individuals agreed to participate in a structured telephone interview regarding end-of-life content in their postgraduate program. Descriptive statistics were calculated to summarise the data obtained.

Results: Twelve participants reported that end-of-life care content was explicitly addressed in their postgraduate critical care nursing programs, yet variation in actual content areas covered was evident. The majority of programs addressed content related to organ donation (92%) and legal and ethical issues (77%). However, content least commonly identified as covered pertained to the work of the nurse in providing direct clinical care to the patient at the end of life and his or her family, including the physical changes experienced by the dying patient (31%), respiratory management encompassing withdrawal of ventilation and symptom management (23%), emotional support of family (23%), care of the body after death (23%), and the process of withdrawing life-sustaining treatment (15%). Participants (92%) agreed that end-of-life content was important in postgraduate critical care nursing programs, with 77% of participants agreeing that more time should be allocated to end-of-life content.

Conclusions: This study provides preliminary evidence of the variation in end-of-life content in postgraduate critical care nursing programs in Australia. Addressing gaps in end-of-life care content in formal education, including clinical care of the dying patient, is urgently needed to address the complexity of this phase of care that is so frequently provided in critical care units


Ranse K, Delaney L, Ranse J, Coyer F, Yates P. End-of-life care content in postgraduate critical care nursing programs: Structured telephone interviews to evaluate content informing practice. Australian Critical Care. [in-press]

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

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



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

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

ABSTRACT

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

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

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

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

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



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

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

ABSTRACT

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

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

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

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


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

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

ABSTRACT

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

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

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

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

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


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

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Proposing a minimum data set for mass gathering health

ABSTRACT

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

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

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

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

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


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

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

ABSTRACT:

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

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

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

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

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



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

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

ABSTRACT

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

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

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

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




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

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

ABSTRACT

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

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

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

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

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



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

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

ABSTRACT

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

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

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

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

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


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

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

ABSTRACT

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

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

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

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

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


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

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Core curriculum for event medical leaders

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

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

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

Core content proposed:

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

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

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

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

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

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How do you actually care during a catastrophe?

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

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

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

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

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

Free full-text article is available here (PDF)

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


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

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

Free full-text article is available here (PDF)

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

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

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

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

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

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

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Impacts on in-event, ambulance and emergency department services from patients presenting from a mass gathering event: A retrospective analysis

Free full-text article is available here (PDF) 


ABSTRACT 

Objective
The aim of this study was to describe the in‐event, ambulance and ED impacts of patient presentations from an Australian mass gathering event (MGE) including patient demographics, provision of care, length of stay and discharge disposition.

Methods
This research was set at one MGE in Australia. The MGE had one first aid post and one in‐event health team staffed by doctors, nurses and paramedics. A retrospective analysis of patient care records from providers of in‐event, ambulance and ED services was undertaken. Data analysis included descriptive and inferential statistics.

Results
Of the 20 000 MGE participants, 197 (0.99% [95% CI 0.86–1.13], 9.85/1000) presented for in‐event first aid care, with 24/197 (12.2% [95% CI 8.33–17.49], 1.2/1000) referred to in‐event health professionals. Fifteen of the referred patients (62.5% [95% CI 42.71–78.84]) returned to the MGE following administration of intravenous fluids (n = 13) and/or anti‐emetics (n = 11). Seven (29.2% [95% CI 14.92–49.17], 0.35/1000) were referred to ambulance paramedic care, requiring endotracheal intubation (n = 1) and airway adjuncts (n = 3) prior to transportation to ED; these patients had an ED median length of stay of 7 h (5.5–12.5) receiving imaging and ventilator support. Five were discharged from ED, one required an operation and another required intensive care unit admission.

Conclusions
There was an impact on in‐event, ambulance and ED services from this MGE but the in‐event model of care may have limited ambulance usage and ED visits. The ED length of stay was greater than the national median, perhaps reflecting the appropriateness of transport and nature of care requirements while in the ED.



Ranse J, Lenson S, Keene T, Luther M, Burke B, Hutton A, Johnston A, Crilly J. (2018). Impacts on in-event, ambulance and emergency department services from patients presenting from a mass gathering event: A retrospective analysis. Emergency Medicine Australasia.

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Lived-relationships: Experiences of nurses in the out-of-hospital environment following a disaster

The World Association for Disaster and Emergency Medicine launched a podcast series in 2018. I was invited to speak on the topic of 'Lived-relationships: Experiences of nurses in the out-of-hospital environment following a disaster'. The podcast relates to some of the findings from my Doctoral studies, focusing on the lived-relationships with patients and their families, colleagues, and self.

Ranse J (Interviewee), Hutton A (Producer). (2018). Lived-relationships of nurses in the out-of-hospital environment following a disaster; audio podcast for World Association for Disaster and Emergency Medicine, 17th October. Series 1, Episode 3. Retrieved from https://wadem.org/resources/podcasts/

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End-of-life care in postgraduate critical care nurse curricula: An evaluation of current content informing practice

ABSTRACT

Introduction: Despite the frequency with which critical care nurses’ engage in end-of-life care, preparation and support of nurses for this work through professional development opportunities or postgraduate education is reportedly limited.

Objectives: To identify and describe end-of-life care content in postgraduate critical care nursing courses in Australia.

Methods: A purposive sampling technique was used to invite a postgraduate course convener from each higher education institution, identified through a search of the internet as offering a postgraduate course in critical care nursing (n = 17). An individual structured telephone survey was undertaken with each participant (n = 13). Content analysis of participant responses was undertaken to identify and describe the end-of-life content and modes of content delivery.

Results: Participants agreed (92%) that end-of-life care content was important within post-graduate education, with 77% agreeing that more time should be allocated to focus on end-of-life care. The majority of courses addressed legal and ethical issues related to end-of-life care (77%), however this content was predominately covered in the context of organ donation (92%). The content least commonly addressed pertained to the work of the nurse in providing direct clinical care, including the physical changes to the dying patient (31%), the process of withdrawing life sustaining treatment (15%), withdrawal of ventilation and symptom management (23%), emotional support to the family (23%) and care of the body after death (23%).

Conclusion(s): The inclusion of end-of-life care content in critical care curricula is needed to address the complexity of this area of practice, including the care and inclusion of family, the physical care and emotional support of the patient and self-care for the nurse. It is recommended that targeted educational initiatives to improve the care that patients and their families receive and support nurses in the delivery of this care.




Ranse K, Delaney L, Ranse J, Coyer F, Yates P. (2018). End-of-life care in postgraduate critical care nurse curricula: An evaluation of current content informing practice. Poster presented at the ANZICS/ACCCN Intensive Care Annual Scientific Meeting, Adelaide, 11th - 13th October.

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Impact of patients presenting with alcohol and/or drug intoxication on in-event health care services at mass-gathering events: An integrative literature review

Free full-text article is available here (PDF)


ABSTRACT
Background
There is a growing body of literature relating to mass-gathering events. A common thread amongst this literature, particularly the literature relating to music festivals, is the incidence of patients presenting with substance and/or alcohol intoxication. However, the impact of alcohol and/or drugs on the provision of in-event health care services has not been explored in detail.

Aim
The goal of this review was to develop an understanding of the impact of alcohol and/or drugs on in-event health care services at mass-gathering events.

Method
This paper used integrative review as a methodology. The articles included in this literature review were sourced by searching databases inclusive of Medline (Ovid; US National Library of Medicine, National Institutes of Health; Bethesda, Maryland USA), Scopus (Elsevier; Amsterdam, Netherlands), PsycINFO (Ovid; American Psychological Association; Washington DC, USA), and Pub Med (National Center for Biotechnology Information, National Institutes of Health; Bethesda, Maryland USA). Identified manuscripts that met the inclusion criteria were thematically analyzed.

Results
In total, 12 manuscripts met the inclusion criteria for this review. A thematic analysis of these manuscripts identified three main themes: (i) predictive factors, (ii) patient presentation rates, and (iii) levels of care.

Conclusion
Substance use and/or intoxication can place a strain on in-event medical services at mass-gathering events. Of the various types of mass-gathering events, music festivals appear to be the most affected by substance use and intoxication.



Bulloack M, Ranse J, Hutton A. (2018). Impact of patients presenting with alcohol and/or drug intoxication on in-event health care services at mass-gathering events: An integrative literature review. Prehospital and Disaster Medicine.

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