Mass-gathering health research foundational theory: Part 1 - Population models for mass gatherings

Free full-text article is available here (PDF)

ABSTRACT
Background: The science underpinning the study of mass-gathering health (MGH) is developing rapidly. Current knowledge fails to adequately inform the understanding of the science of mass gatherings (MGs) because of the lack of theory development and adequate conceptual analysis. Defining populations of interest in the context of MGs is required to permit meaningful comparison and meta-analysis between events.

Process: A critique of existing definitions and descriptions of MGs was undertaken. Analyzing gaps in current knowledge, the authors sought to delineate the populations affected by MGs, employing a consensus approach to formulating a population model. The proposed conceptual model evolved through face-to-face group meetings, structured breakout sessions, asynchronous collaboration, and virtual international meetings.

Findings and Interpretation: Reporting on the incidence of health conditions at specific MGs, and comparing those rates between and across events, requires a common understanding of the denominators, or the total populations in question. There are many, nested populations to consider within a MG, such as the population of patients, the population of medical services providers, the population of attendees/audience/participants, the crew, contractors, staff, and volunteers, as well as the population of the host community affected by, but not necessarily attending, the event. A pictorial representation of a basic population model was generated, followed by a more complex representation, capturing a global-health perspective, as well as academically- and operationally-relevant divisions in MG populations.

Conclusions: Consistent definitions of MG populations will support more rigorous data collection. This, in turn, will support meta-analysis and pooling of data sources internationally, creating a foundation for risk assessment as well as illness and injury prediction modeling. Ultimately, more rigorous data collection will support methodology for evaluating health promotion, harm reduction, and clinical-response interventions at MGs. Delineating MG populations progresses the current body of knowledge of MGs and informs the understanding of the full scope of their health effects.



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 Disaster Medicine. 29(6):648-654

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Mass-gathering health research foundational theory: Part 2 - Event modelling for mass gatherings.

ABSTRACT 
Background: Current knowledge about mass-gathering health (MGH) fails to adequately inform the understanding of mass gatherings (MGs) because of a relative lack of theory development and adequate conceptual analysis. This report describes the development of a series of event lenses that serve as a beginning ‘‘MG event model,’’ complimenting the ‘‘MG population model’’ reported elsewhere.

Methods: Existing descriptions of ‘‘MGs’’ were considered. Analyzing gaps in current knowledge, the authors sought to delineate the population of events being reported. Employing a consensus approach, the authors strove to capture the diversity, range, and scope of MG events, identifying common variables that might assist researchers in determining when events are similar and might be compared. Through face-to-face group meetings, structured breakout sessions, asynchronous collaboration, and virtual international meetings, a conceptual approach to classifying and describing events evolved in an iterative fashion.

Findings: Embedded within existing literature are a variety of approaches to event classification and description. Arising from these approaches, the authors discuss the interplay between event demographics, event dynamics, and event design. Specifically, the report details current understandings about event types, geography, scale, temporarily, crowd dynamics, medical support, protective factors, and special hazards. A series of tables are presented to model the different analytic lenses that might be employed in understanding the context of MG events.

Interpretation: The development of an event model addresses a gap in the current body of knowledge vis a vis understanding and reporting the full scope of the health effects related to MGs. Consistent use of a consensus-based event model will support more rigorous data collection. This in turn will support meta-analysis, create a foundation for risk assessment, allow for the pooling of data for illness and injury prediction, and support methodology for evaluating health promotion, harm reduction, and clinical response interventions at MGs.


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 Disaster Medicine. 29(6):655-663.

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Review: The mental health imaginary vis-a`-vis its nurses and Australian environs: an essay

Free full-text article is available here (PDF)

I was invited to provide a review and response to a manuscript that was published in the 'Nursing in Crisis' special issue of the Journal of Research in Nursing. This manuscript is reviewed was:

Nicholls, D. (2014). The mental health imaginary vis-à-vis its nurses and Australian environs: an essay Journal of Research in Nursing. 19:580-589.

The work reviewed takes a unique exploration of the future of mental health nursing in the Australian environs. To do this, the author work presents an historical account of what it may have been like to be a mental health nurse in Australian in the late 1900s. This account is a philosophical view that does not necessarily aim to resolve an issue, build a theory or seek agreement, but instead is a philosophical work taking shape from the author’s lifeworld.

My review discusses the progress, challenges and complexities of the mental health context, highlighting that they are not of uniqueness or of singularity to mental health nursing. Instead, aspects of the author’s lifeworld and the mental health imaginary vis-a`-vis its nurses and Australian environs has a broader application to the discussion of changes over time related to nursing and its natural attitude, education, and culture.

Ranse, J. (2014). Review: The mental health imaginary vis-à-vis its nurses and Australian environs: An essay. Journal of Research in Nursing. 19(7-8):590-591.

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Understanding the effect of clinician dependent versus evidence-based pathway for the management of Salmonella-like symptoms in an emergency department.

ABSTRACT

Introduction: On Monday the 13th of May 2013, a surge in patients with vomiting and diarrhoea presented to an Emergency Department (ED) in Canberra. Contract tracing identified a focal point between patients, and pathology samples identified Salmonella as the responsible agent. On the following Wednesday, upon a hospital based disaster being declared, a just-in-time evidence-based pathway was introduced to ensure consistency in patient management. This research aims to describe the effect of this pathway (intervention) versus clinician dependent (control) management of such patients.

Method: This research was retrospective in design. The sample includes 110 patients who presented in May 2013 to one ED, with Salmonella-like symptoms. Data was collected from the Emergency Department Information System. Patient characteristics, such as age and gender are described using descriptive statistics. A Mann-Whitney test was used to compare continuous data and a Fisher exact test was used to compare categorical data, between the two groups. This research has ethics approval from the health care facility.

Results: Over an eight day period, 110 patients presented with salmonella-like symptoms. Of these, 47 were male and 63 were female, with a median age of 30 years (IQR: 20-42). Both age (p=0.65) and gender (p=0.84) were statistically similar between the two groups. Overall, the mean length of stay in minutes (±SD) was 735 (1112). However, the mean length of stay in minutes was statistically different between the two groups, with the control being 975 (1280) and the intervention being 230 (251) (p=0.0001).

Discussion: The length of stay for patients between the two groups was statistically significantly different, suggesting that the implementation of a just-in-time evidence-based pathway for the management of patients with Salmonella-like symptoms reduced the ED length of stay. This finding is useful in that it may assist in the future planning of similar public health emergencies or for use when patients present with Salmonella-like symptoms on a daily basis.






Ranse J, Luther M, Ranse K. (2014). Understanding the effect of clinician dependent versus evidence-based pathway for the management of Salmonella-like symptoms in an emergency department; paper presented at the 12th International Conference for Emergency Nurses, Perth, Australia, 9th October.

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

ABSTRACT:

Introduction: Health providers at mass gatherings aim to minimise the disruption to the health services of the surrounding community. The mass gathering literature focuses on patients presenting to onsite care providers at events, and scantly reports on patients presenting to prehospital care providers (ambulance paramedics) and hospital emergency departments (EDs). In 2012, an outdoor music festival with approximately 20,000 participants was held in Canberra. The festival had one first aid post, and a medical assistance team staffed by doctors, nurses and paramedics. This research describes the characteristics of patients and health service usage from this event.

Method: Data was collected retrospectively from the event onsite care provider (St John Ambulance Australia) patient records. These records were linked to both prehospital (ACT Ambulance Service) and hospital EDs (Canberra Hospital and Calvary Health Care ACT) patient records. A preexisting minimum data set was used to code patient characteristics. Data analysis included descriptive statistics, such as frequencies and means of central tendency.

Results: In total, 197 (9.86/1,000) patients presented for clinical assessment and/or management at the event. Two patients who required hospitalisation bypassed the onsite care providers and were transferred directly via the ambulance service to hospital. The onsite medical assistance team managed 22 patients (1.1/1,000), of whom two were referred to police, five transported to hospital and 15 discharged to the event. In total, seven patients were transported to hospital by ambulance (0.35/1,000). Hospital presentation rate and patient characteristics are currently being determined at the time of this abstract submission.

Discussion: This is the first research to describe patient presentations to onsite care providers, prehospital and hospitals from a mass gathering. This research provides insight into the health service usage associated with mass gathering. Strategies to minimising the disruption to the prehospital and hospital health services of the surrounding community will be discussed.

Ranse J, Lenson S, Keene T, Luther M, Burke B, Hutton A. Patient presentations to onsite health providers, ambulance paramedics and hospital emergency departments from a mass gathering: a case study. 12th International Conference for Emergency Nurses.

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Drugs, pills top emergency list for evacuation too

I was interviewed by Natasha Body from the Canberra Times. The interview focused on the health preparedness of the community in a disaster.

The full text article is available here

This article was among the most read articles for the day across Australia as demonstrated below:

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Canberra's hospitals ability to cope in a disaster

I was interviewed by Mark Parton on 1206AM Canberra 2CC regarding the ability of Canberra's health system to cope if a disaster or mass casualty incident was to occur in the region.

The interview was initiated on the background of a number of reports in The Canberra Times relating to the overcapacity of Canberra's hospitals, and in particular the Emergency Departments:

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

My interview highlighted that the health system in Canberra had coped in the past with major incidents. Additionally, I discussed the educational preparedness of nurses and the ability of the health systems to adapt based on previous events. For example, the establishment of influenza assessment clinics as adjunct to the emergency departments in communicable diseases such as H1N109 Influenza.

My interview is below:

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

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

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

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

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

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

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

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

— Jamie Ranse (@jamieranse) September 19, 2014

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

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

Free full-text article is available here (PDF)

ABSTRACT

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

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

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

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

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




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

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

Free full-text article is available here (PDF)

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



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

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

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

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




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

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Disasters happen: the realities of being in a disaster

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

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

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

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

Free full-text article is available here (PDF)

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

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

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

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


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

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

Free full-text article is available here (PDF)

ABSTRACT

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

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

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

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

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

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

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

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


SUMMARY

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


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

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Understanding patient presentations among young people at mass gatherings

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

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

Free full-text article is available here (PDF)

ABSTRACT 

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



Hutton A, Ranse J, Verdonk N, Ullah S, Arbon P. Understanding the characteristics of patient presentations of young people at outdoor music festivals. Prehospital Disaster Medicine. 2014;29(2):1-7.

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

Free full-text article is available here (PDF)

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



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

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