Mental wellbeing considerations in preparation for disaster healthcare: perceptions of deployed emergency staff

Researcher: Tytti Mäkinen; Supervisor: Sari Miettinen

The mental wellbeing of internationally deployed disaster relief workers has become an issue of concern. Many disaster situations to where humanitarian workers are deployed involve conflict with an ensuing threat of violence toward workers, in addition to exposure to stress, culture shock, witnessing trauma, fatigue and so on. The psychological consequences of these have been documented in research, however the role of training and preparation in supporting mental wellbeing has not received due attention, despite research indicating the need for it. Perceptions of the workers themselves of its efficacy and relevance has been researched minimally.

This qualitative study examines the perceptions of volunteers of a small international disaster relief organisation in regard to the pre-deployment preparation they have received and its appropriateness and effectiveness in supporting the volunteers' mental wellbeing.

Disaster preparedness among medical and nursing personnel

Researcher: Kossioris Aristomenis

Background:
Disasters, as regards the health sector, are considered a sudden or gradual disease of an entire community, which is impossible to confront adequately without external assistance.

Aim:
The aim of the study was to explore the disaster preparedness among medical and nursing personnel.

Methods:
The statistical sample of this study consisted of 364 health care professionals. A special questionnaire designed by Fung et al in 2007 was used. Statistical analysis was produced using SPSS 17 and the performance of the chi-square test.

Results:
By the descriptive analysis it was detected that the biggest percentage of the medical and nursing personnel (61%) considered themselves not adequately prepared for disasters. Of the study participants, 64.6% stated that if a disaster happen in their workplace they would follow the hospital disaster plan to manage the situation, while 55.7% they did not know if there is a disaster plan in their workplace. 81,8% considered as disaster the fires in Peloponnese and Evia in 2007, while 30.3% the aviation accident in Grammatiko area in 2005. 77.1% stated that the occurrence of earthquake is a very likely possibility for the Greek territory, while 77.5% stated as unlikely the possibility of a nuclear accident. By the statistical analysis it was detected that the administrative nurses perceived themselves more frequently as prepared for disaster management (p=0.002), as well those who have done postgraduate studies (p=0.047) and those who had participated in any disaster management educational activity in their workplace (p<0.001).
 
Conclusions:
Education and training affects positively the knowledge on disasters and the health-related disaster preparedness, therefore, it is necessary for the health care professionals, when in an undergraduate level, to attend more relevant courses.

Battlefield First Aid Training for Street Level Officers and Agents

Researcher: Anthony Bevers

Introduction
The purpose of this study is to explore the need for tactical medicine training for civilian law enforcement. Currently, there are gaps in the training most departments receive as basic first aid is taught in academies and may be a one hour annual class there after. The results of the Vietnam War spurred the US Army to create an updated combat first aid curriculum that would stem the numbers of killed in action on the battlefield. This was the Combat Lifesaver (CLS) Course and it has changed the way the military does medical treatments for battlefield casualties. The Tactical Lifesaver (TLS) Course is the civilian law enforcement equivalent to the CLS Course and will aid law enforcement in the fight against an ever increasing amount of ultra-violent crimes.

Problem
Law enforcement officers and agents do not receive enough combat oriented medical training to more effectively address increasing amount of ultra-violent crimes.

Hypothesis
If the training is adopted: 
1. Law enforcement agencies will see less officer fatalities in shots fired situations.
2. Capabilities will be added to law enforcement which will enhance their ability to address mass casualty scenarios as a result of shots fired scenarios and terrorism.

Method
Students will attend a two day course tailored to their department's training needs and environment. Day 1 will introduce students to tactical medicine and students will learn skills such as fashioning a improvised tourniquet and using commercially available tourniquets among other tactical medicine skills. Day 2 will see students in the field practicing the skills taught in day two. Students' knowledge and skills will be tested and an after action review will be conducted to evaluate the quality of the training.

End State
A domestic police force more capable of responding to the dynamic environment in which it operates.

Emergency Nurses and Disasters

Researchers: Karen Hammad, Paul Arbon, Kristine Gebbie, Alison Hutton

Nurses working in the emergency department play an important role in the healthcare response to disaster, yet very little is known about their experience. I am conducting a study about emergency nurses and disaster response. I would like to interview nurses who have worked in the emergency department during a response to an external disaster event about their experiences and understanding of disaster response. You will be asked to be involved in two interviews of approximately 60 minutes duration conducted via Skype.

If you would like to know more about this study or you would like to participate please don’t hesitate to contact me disaster.study@flinders.edu.au

Crisis Leadership in an Acute Clinical Setting: Christchurch Hospital ICU February 2011

Researcher: Lev Zhuravsky

Introduction
An Intensive Care Unit is a geographically distinct area of a hospital where critically ill and injured patients undergo continuous monitoring and support of failing organ systems. On Tuesday February 22, at 12:51 pm local time, a 6.3 magnitude earthquake struck Christchurch. The health response to the Christchurch earthquake was unique because this city with an urban population of about 400,000 people has only one hospital with an emergency department and Intensive Care Unit.

Problem
The main purpose of this study was to investigate if shared leadership is possible and warranted during a crisis engendered by a natural disaster, through an exploration of the nature of both specialists and nursing leadership in the Intensive Care Unit of Christchurch Hospital within the first seventy two hours of the earthquake. This qualitative study explores the Intensive Care’s staff experiences and adopted leadership approaches to manage large scale crisis resulting from the city-wide disaster.

Method
In-depth interviews were conducted with ten members of the ICU team. Thematic analysis of the verbatim transcriptions revealed three main global themes- core formal leadership competencies, a role of informal leadership in crisis and, a contribution of shared leadership approach to an overall management of a crisis. Results This research highlighted the importance of main formal leadership competencies such as decision making abilities, ability to remain calm and effective communication. A contribution of an informal leadership focussed on motivation to lead, autonomy and emotional support. Shared leadership played an important role in managing complex critical situation triggered by a natural disaster.

Conclusion
The results of this research could potentially add value to the research field of crisis leadership and contribute to the development of professional and personal capacity building programmes and interventions aiming to assist existing and future leaders in managing complex crises.

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

Researchers: Jamie Ranse, Allison Hutton

In the last two decades, the amount of literature pertaining to nurses in disasters has increased. However, whilst research and evaluation of disaster research involving nursing is increasing, it is beneficial to have a mutually agree list of research topics that would be of assistance to the larger nursing population in enhancing the theoretical understanding of disaster nursing.

This research aims to determine international research priorities for disaster nursing, over the next 5 years. 

This research consists of three rounds:
Round 1: This round will be conducted in a workshop with the researchers and nursing participants of the World Congress on Disaster and Emergency Medicine, May 2013. The aim of this round is to generate themes and statements relating to possible research questions.
Round 2: The themes and statements generated in round 1 will be complied and developed as an online survey tool for ranking.
Round 3: Those themes and statements from round 2 that reached a consensus will be complied and developed as an online survey tool for further ranking.

On the completion of the third round, a list of research priorities will be developed with an international consensus. It is anticipated that these results will be published in a peer-reviewed journal and presented at an international conference.

Identifying the Need for First Responder Training for CONUS Deployed National Guardsmen

Researcher: Anthony Bevers

The purpose of this study is to explore the need for specialized first responder type training for the National Guard. Currently, there are gaps in specialized first aid training for the National Guard's secondary mission of Defense Support of Civil Authorities (DSCA). The Army's Combat Life Saver (CLS) course is not adequate to fulfill the special circumstances the DSCA mission. This mixed methods study seeks to increase the capability of the National Guard’s response to disasters and individual aid in the community in times of need.

Questions the study will seek: Is there a need for the training? 

Review of existing related literature will be completed. A review of the number of incidents where non-medical Service Members responded will be conducted. Interviews with non-medical Soldiers and Airmen will be conducted.

 Is the training effective and relevant? 

The author has already compiled the curriculum of the CLS Supplement (CLS2) course and will seek the efficacy of relevance of the curriculum with testing on small groups of Soldiers.

 End State 

Service Members who attend the two day course will be more confident and competent to address the unique aspects of the CONUS prehospital disaster environment. The results of this study will be submitted to the Texas Army National Guard (TXARNG) for review and implementation as standard training for the TXARNG.

Future Cooperation

At this time, I am not collaborating with another researcher, but I would be happy to take on interested parties to co-author the study.

Understanding and Identifying potential risks for young people at outdoor music fesitvals

Researchers: Alison Hutton, Jamie Ranse, Paul Arbon.

The aim of this research was to understand the nature of patient presentations at music festivals around Australia. This study used a minimum data set developed by Ranse and Hutton (2012) which used four main categories of presentation type.

These being illness, injury, environmental factors and mental health. Outdoor music festivals are unique events (Gleder and Robinson, 2009), and in the mass gathering literature are espoused to have a higher incident of patient presentations than other types of mass gathering (Milsten et al, 2003). Often single events are written up, which makes it difficult to generalize to other events, therefore the aim of this research is to discuss characteristics of patient presentations of 25 outdoor music festivals across four Australian states.

The project found that more than two thirds of those who present are women. In addition males were more likely to present with injuries and women were more likely to present with illness related symptons. The environmental data includes the ingestion of drugs and alcohol. This data set showed that patients that presented to onsite care with drug and alcohol related issues had the higher rate of being transferred to hospital.

The role of on-site care in hospital avoidance at mass gathering events

Researchers: Alison Hutton, Brett Aimers, Jamie Ranse, Paul Arbon.

It is generally accepted that mass gathering events have a heightened potential to produce a higher incidence of illness, injury and therefore a subsequent increase in demand for ambulance and hospital resources. The balance between planning for mass gathering health care and maintaining adequate community resources is an emerging issue for health agencies today (Gutman, Lund & Turris, 2007).

Currently, the body of literature that examines the provision of health care at mass gatherings is under developed and may not accurately reflect the impact of on site health agencies on ‘hospital avoidance ’. St John Ambulance Australia is well positioned to contribute to this subject by exploring its role in hospital avoidance when deployed to mass gatherings.

Therefore this project aims to identify the number of patients that would have ordinarily required hospital care who were provided with end-to-end care and discharged by St John Ambulance Australia. Secondly to determine the injuries and illnesses that would ordinarily require ambulance transport from a mass gathering to hospital.

Study of Czech Republic EMS preparedness: large number of injuries and casualties - bus accident

Researcher: Ondrej Prudel

Czech Republic became an important transit country for international road transport after joining the EU. This led to an increasing traffic situation with many buses on the roads. My research forms part of a university theses analyses situation of Czech EMS, and how it is solved with large number of bus accident injuries and casualties. Aims of the research are to analyse the continous process of eduacation of paramedics, such as: drills, EMS equipment, overall preparedness, how was bus accidents solved in the past (triage, transportation, crisis preparedness), differents between drills and true situation.

Hypothesis of project are:
1) Czech EMS are prepared to solve bus accident situation, and
2) Drill trainings help to improve preparedness of local EMS