Emergency department presentations during the COVID-19 pandemic in Queensland (to June 2021): Interrupted time series analysis

 

Full-text avaibale here

ABSTRACT

Objectives: To assess emergency department (ED) presentation numbers in Queensland during the coronavirus disease 2019 (COVID-19) pandemic to mid-2021, a period of relatively low COVID-19 case numbers. Design Interrupted time series analysis. 

Setting: All 105 Queensland public hospital EDs. 

Main outcome measures: Numbers of ED presentations during the COVID-19 lockdown period (11 March 2020 – 30 June 2020) and the period of easing restrictions (1 July 2020 – 30 June 2021), compared with pre-pandemic period (1 January 2018 – 10 March 2020), overall (daily numbers) and by Australasian Triage Scale (ATS; daily numbers) and selected diagnostic categories (cardiac, respiratory, mental health, injury-related conditions) and conditions (stroke, sepsis) (weekly numbers). 

Results: During the lockdown period, the mean number of ED presentations was 19.4% lower (95% confidence interval, –20.9% to –17.9%) than during the pre-pandemic period (predicted mean number: 5935; actual number: 4786 presentations). The magnitudes of the decline and the time to return to predicted levels varied by ATS category and diagnostic group; changes in presentation numbers were least marked for ATS 1 and 2 (most urgent) presentations, and for presentations with cardiac conditions or stroke. Numbers remained below predicted levels during the 12-month post-lockdown period for ATS 5 (least urgent) presentations and presentations with mental health problems, respiratory conditions, or sepsis. 

Conclusions: The COVID-19 pandemic and related public restrictions were associated with profound changes in health care use. Pandemic plans should include advice about continuing to seek care for serious health conditions and health emergencies, and support alternative sources of care for less urgent health care needs.

REFERENCE

Sweeny A, Keijzers G, Marshall A, Hall E, Ranse J, Zhang P, Grant G, Huang YL, Palipana D, Teng YD, Gerhardy B, Greenslade J, Jones P, Crilly J. Emergency department presentations during the COVID-19 pandemic in Queensland (to June 2021): Interrupted time series analysis. Medical Journal of Australia.

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Experiences of rural and remote nurses during and following disasters: a scoping review

ABSTRACT 

Introduction: Rural and remote nurses are often involved in disaster response. These nurses are faced with unique challenges in their daily practice due to geographical isolation and reduced resources. Nurses’ roles and experiences in times of disaster have been discussed in the past; however, in the setting of rural and remote areas it remains largely underreported. The aim of this article is to provide an overview of the literature regarding the experiences of rural and remote nurses during and following disasters. Disasters affect all areas of the world. 

Methods: This scoping review was guided by Arksey and O’Malley’s methodological framework for scoping reviews. Electronic databases CINAHL, MEDLINE, Scopus, Cochrane, Joanna Briggs Institute and Embase were searched. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist was used to guide the reporting of this review. Key concepts and themes were identified using Braun and Clarke’s six-step framework for thematic analysis. 

Results: Eight articles met the inclusion criteria for this review. Themes that were identified included disaster roles, pre-disaster preparations, psychological and emotional states, and community involvement and relationships. 

Conclusion: Minimal literature exists that explores what rural and remote nurses experience in times of disaster. In this review, the experience of rural and remote nurses included the relationships between their personal and professional obligations and their influence on nurses’ ability to respond to disasters. Further research is required in this domain to better understand the phenomena and address knowledge gaps that exist in the existing literature. 

REFERENCE

Brewer C, Hutton A, Hammad K, Ranse J. Experiences of rural and remote nurses during and following disasters: a scoping review. Rural and Remote Health. 22(4), 7230-7230.

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Expression of ethical principles in Australia's disaster plans

 

ABSTRACT 

Objective: This qualitative study explores whether Australian mass casualty and disaster plans explicitly acknowledge or implicitly draw upon ethical principles. 

Methods: Federal, state and territory governmental websites were searched to identify mass casualty incident and/or disaster plans. The authors examined the documents to identify whether ethical principles were overtly stated or implied, and what those values or principles were. 

Results: Ten governmental documents were identified – two federal and one for each of the eight States and Territories. One of the documents had an explicit statement of the ethical values that informed the mass casualty and disaster planning decisions which were present. Utilitarianism was the dominant ethical principle informing the document in another seven documents. 

Conclusion: In Australian government documents for mass casualty and disaster management, although ethics is definitely considered, the ethical principles on which decisions are made are rarely explicit. Mass casualty and disaster decision-making could be improved by making the ethical basis for decision-making clear, transparent and comprehensively reasoned. 

REFERENCE: 

Coco A, Patel B, Jensen M, Ranse J. The Expression of Ethical Principles in Australia's Disaster Plans. Emergency Medicine Australasia. 34(6):989-994.

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Psychosocial problems and support for disaster medical assistance team members in the preparedness, response and recovery phases of natural hazards resulting in disasters: A scoping review

ABSTRACT 

Background: Clinicians responding to disasters are at risk of experiencing psychosocial problems that can negatively impact them during, upon their return and years after the deployment. Clinicians often respond to disasters as members of organised Disaster Medical Assistance Teams (DMATs). The aim of this paper was to review and synthesise the literature regarding psychosocial problems and support provided to medical personnel in the preparedness, response, and recovery phases of a disaster. 

Methods: A comprehensive search for literature was conducted using four databases: EMBASE; CINAHL; MEDLINE; and PsychInfo. Medical Subject Heading and key terms used in the search included: Disasters; First Responder; Disaster Medical Assistance Team (DMAT); Post-Traumatic Stress Disorder. 

Results: Psychosocial problems were identified amongst DMAT members in all phases (preparedness, response and recovery) of disaster assistance. These ranged from pre-existing stress and anxiety to Post-Traumatic Stress Disorder. Psychosocial support was mostly reported in the recovery phase of the disaster deployment. 

Conclusion: A range of strategies exist to support psychosocial problems DMAT members experience, however, these tend to focus on the recovery phase of deployment with limited focus on preparedness and response phases. Further research is required to identify, implement, and evaluate short and long term psychosocial support needs and strategies for DMAT members in all phases of a disaster deployment. 

REFERENCE 

Zahos H, Crilly J, Ranse J. Psychosocial problems and support for Disaster Medical Assistance Team members in the preparedness, response and recovery phases of a disaster: A scoping review of the literature. Australasian Emergency Care

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Disaster education in undergraduate nursing curriculum: A Delphi study to prioritise content for nursing students

ABSTRACT 

Background: When a disaster occurs, a health response must adapt to meet the needs of the community. Nursing students may be able to assist in supporting the nursing workforce to meet the community’s health needs during and/or following a disaster. However, there is a paucity of literature regarding the educational needs of nursing students regarding disaster preparedness. Further, the disaster-related content that is important to be included in undergraduate nursing curricula is poorly understood. 

Methods: This study used a modified three-round Delphi design guided by the principles of the Guidance on Conducting and REporting DElphi Studies. Data was collected from Australian clinical and academic nurses via online surveys. Analysis was undertaken using descriptive statistics including means of central tendency, with disaster content topic areas and statements considered a priority if they obtained a mean score of four out of five, or greater. 

Results: A total of 38 nurses participated in this study. Across the three rounds, eight topic areas and 37 different statements were included. High priority statements for topic inclusions in undergraduate curricula were “disaster knowledge,” “assessment and triage,” “critical thinking,” and “technical skills.” Additionally, statements relating to “mental wellbeing” and “teamwork in stressful situations” were ranked as the highest. 

Conclusions: Disaster-related content should be included in undergraduate nursing curricula. This content could be embedded within existing units of study and/or delivered as a standalone unit of study. The educational method for delivering disaster content could vary from a didactic approach to simulation exercises depending on the content and local context.

REFERENCE: 

Ranse J, Ituma W, Bail K, Hutton A. Disaster education in undergraduate nursing curriculum: A Delphi study to prioritise content for nursing students. Collegian. 29(5):590-597

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Phenomenology of Australian civilian hospital nurses’ lived experiences of the out-of-hospital environment following a disaster

ABSTRACT 

Background: Disasters disrupt the fabric of communities. This includes disruption to the healthcare system that supports a disaster-affected community. Nurses are important members of disaster response teams. However, there is limited literature that describes nurses’ roles or experience in responding to disasters. 

Aim: This paper employs a phenomenological approach to uncover moments of being an Australian civilian hospital nurse in the out-of-hospital environment following a disaster. 

Method: This study uncovers moments of what it is like being an Australian civilian hospital nurse deployed to the out-of-hospital environment following a disaster. Individual interviews were undertaken at two points in time with each participant. Audio-recorded interviews were transcribed to textual narratives, which was then analysed. Several activities were undertaken to uncover moments and provide exemplars of moments, from the narrative. 

Findings: Eight hospital nurses participated in this study. Five moments were uncovered: ‘on the way to a disaster’, ‘prior to starting work’, ‘working a shift in a disaster’, ‘end of a shift’, and ‘returning home’. Each moment has its uniqueness and singularity exemplifying an experience of nurses in the out-of-hospital disaster environment. 

Discussion: When compared to a hospital context, assisting during and/or following a disaster in the out-of-hospital environment is challenging. For example, nurses may need to do more with less resources, provide more frequent psychosocial support for more extenuating circumstances, and experience an unsettling return home at the end of the deployment. 

Conclusions: This paper has provided new insights into what it may be like being an Australian civilian hospital nurse in the out-of-hospital disaster environment as part of a disaster medical assistance teams. Strategies to support nurses who assist during and/or following a disaster are important, so nurses can in turn provide care to people in disaster-affected communities.

The full-text article is available here (PDF) 

Ranse J, Arbon P, Shaban R, Cusack L. Phenomenology of Australian civilian hospital nurses’ lived experience of the out-of-hospital environment following a disaster. Collegian

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Disaster preparedness: A concept analysis and its application to the intensive care unit

Objectives: The aim of the study is to understand the concept of disaster preparedness in relation to the intensive care unit through the review and critique of the peer-reviewed literature. 

Review method used: Rodgers' method of evolutionary concept analysis was used in the study. Data sources: Healthcare databases included in the review were Cumulative Index to Nursing and Allied Health Literature, Public MEDLINE, Scopus, and ProQuest. Review methods: Electronic data bases were searched using terms such as “intensive care unit” OR “critical care” AND prep* OR readiness OR plan* AND disaster* OR “mass casualty incidents” OR “natural disaster” OR “disaster planning” NOT paed* OR ped* OR neonat*. Peer-reviewed articles published in English between January 2000 and April 2020 that focused on intensive care unit disaster preparedness or included intensive care unit disaster preparedness as part of a facility-wide strategy were included in the analysis. 

Results: Eighteen articles were included in the concept analysis. Fourteen different terms were used to describe disaster preparedness in intensive care. Space, physical resources, and human resources were attributes that relied on each other and were required in sufficient quantities to generate an adequate response to patient surges from disasters. When one attribute is extended beyond normal operational capacities, the effectiveness and capacity of the other attributes will likely be limited. 

Conclusion: This concept analysis has shown the varied language used when referring to disaster preparedness relating to the intensive care unit within the research literature. Attributes including space, physical resources, and human resources were all found to be integral to a disaster response. Future research into what is required of these attributes to generate an all-hazards approach in disaster preparedness in intensive care units will contribute to optimising standards of care. 

Full-text article is available here (PDF)

REFERENCE 

Sellers D, Crilly J, Ranse J. Disaster preparedness: A concept analysis and its application to the intensive care unit. Australian Critical Care. [in-press]

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Disaster education for Australian nursing students: An integrative review of published literature to inform curricula

ABSTRACT

Background: Globally, families and communities are impacted by disasters every day. Nurses are integral to assisting in disasters, in the support and enablement of individuals and communities. However, some studies indicate that nurses feel ill-equipped to assist, partially because disaster content is not thoroughly addressed in the undergraduate curriculum. Therefore, nursing schools need to equip undergraduate nursing students with the knowledge and preparation required to assist effectively during and/or following a disaster. 

Aim: To explore priority disaster topic areas aimed at preparing Australian undergraduate nursing students to assist in caring for survivors in the aftermath of disasters. 

Method: This study used an integrative review methodology. Various databases and platforms were searched for literature published between 2000 and 2018 using Medical Subject Heading terms and keywords relating to the undergraduate nursing curriculum. A thematic analysis of the included papers was conducted. 

Results: A total of 10 articles were identified that meet the inclusion criteria. The reviewed studies highlighted that the areas of disaster knowledge, assessment and triage, critical thinking, teamwork, technical skills, mental wellbeing, legal and ethical consideration, and socio-cultural contexts, are relevant for the undergraduate curriculum. 

Discussion: This review highlights disaster education and training topic areas that could be considered for inclusion in Australian undergraduate nursing curricula. The content relating to disaster assistance must be incorporated into nursing schools’ curriculum. Conclusion The incorporation of disaster-related content in the undergraduate nursing curriculum may enhance the disaster preparedness of nursing students and the nursing workforce more broadly.

The full-text article is available here (PDF)

Ituma W, Ranse J, Bail K, Hutton A. Disaster education for Australian nursing students: An integrative review of published literature to inform curricula. Collegian

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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

ABSTRACT 

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

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

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

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

The full-text article is available here (PDF)

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

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Planning and assessment approaches towards disaster resilient hospitals: A systematic literature review

Background: Hospitals play a critical role as a frontline agency in disasters, with staff often working within extraordinary circumstances in these facilities to deliver care. This study was inspired by the authors’ interdisciplinary experiences in health and resilience engineering. Observing increasing dialogue about how hospitals could improve their resilience to disasters we sought to understand the construct of ‘hospital resilience during disasters’ and how it could be improved. 

Method: The study involved a systematic literature review of publications related to hospital resilience during disasters, conducted at the end of January 2020. Of the 553 articles found initially, 49 remained after applying inclusion and exclusion criteria. Quality appraisal tools designed for different types of research were used. 

Results: The findings are described using language and constructs drawn from the Plan-Prepare-Respond-Recover (PPRR) discourse and Resilience Engineering Theory. The review found broad consensus that staff awareness, education, and training about disaster-related plans needs to be improved. The articles documented a wide variety of approaches to evaluating hospital resilience to disasters, wherein the importance of infrastructure and organisational resilience is clear. This included insightful guidance for developing, disseminating, communicating, and implementing disaster plans. 

Conclusion: Through distilling the literature review findings, we propose a ‘Decision-Support Model for Disaster Resilient Hospitals’ to foster proactive and systemic improvements, from anticipating to managing and monitoring organisational performance during disasters. We also propose a hybrid of two methods towards a more holistic evaluation of hospital disaster resilience. The findings have immediate implications for supporting hospital leadership strategically and operationally. 

Full-text article available here.

REFERENCE

Ali HM, Desha C, Ranse J, Roiko A. Planning and assessment approaches towards disaster resilient hospitals: A systematic literature review. International Journal of Disaster Risk Reduction. [in-press]

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Drug- and alcohol-related emergency department patient presentations during the 2018 Commonwealth Games: A multi-site retrospective analysis

Objective: To examine the impact of the 2018 Commonwealth Games on ED patient presentations related to drug(s) and/or alcohol. 

Methods: Retrospective observational study comparing ED patient presentations made pre, during and post the 2018 Commonwealth Games with either an International Classification of Diseases-10 diagnosis or presenting complaint related to drug and or alcohol misuse. 

Results: Drug- and alcohol related presentations accounted for 5% (n = 890) of all ED presentations across the 36-day study period with no significant difference between pre (n = 312), during (n = 301) and post (n = 277) periods (P = 0.2). Overall, drug- and alcohol-related patient presentations made to the EDs tended to be young (median age 35 years, interquartile range 24–48), Australian (n = 820, 92%) and male (n = 493, 55%). The majority arrived by ambulance (n = 650, 73%), were allocated an Australasian Triage Scale category of 3 (n = 505, 57%), and arrived between 15.00 and 22.59 hours (n = 365, 41%). No demographic characteristics, ED characteristics or outcomes differed significantly over time. 

Conclusions: During the 2018 Commonwealth Games, minimal impact on the ED was noted pertaining to drug and alcohol misuse. Further research is required to understand whether this held true for other types of ED presentations and during other types and locations of mass gathering events.

Full-text article available here (PDF)

Delany C, Crilly J, Ranse J. (2021). Drug- and alcohol-related emergency department patient presentations during the 2018 Commonwealth Games: A multi-site retrospective analysis. Emergency Medicine Australasia.

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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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