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.

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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

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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

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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

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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

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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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