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.

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.

World Youth Day patient presentation characteristics

Researchers: Paul Arbon, Jamie Ranse

This project aims to establish a databases of patient presentations and mass gathering event profiles across all events during the four days of World Youth Day in Sydney in 2008, to analyze quantitative data from the event and compare findings across the WYD events and with existing predictive modeling data to provide a more sophisticated understanding of the key factors that affect patient presentations at mass gatherings.

Understanding the willingness of emergency nurses to respond to a health care disaster

Researchers: Paul Arbon, Jamie Ranse, Lynette Cusack

Disaster response is an emergency nursing responsibility. However responding to disasters is becoming more hazardous as terrorism, pandemics and chemical industrial accidents challenge the safety of nurse responders and their families. International experience has shown that nurses can become victims of disasters and that fear of contaminating family and friends may prevent nurses from attending work or returning home during a disaster response.

This research contributes to disaster planning by providing insight into the factors that affect the willingness of Australian emergency nurses to respond to disasters. This research will facilitate disaster planning and policy development at national and health agency levels that better supports the personal needs of emergency nurses during disaster response.

Exploring the disaster content of postgraduate emergency nursing programs in Australia

Researcher: Jamie Ranse, Paul Arbon, Ramon Shaban, Julie Considine, Belinda Mitchell, Shane Lenson

This research will describe and explore the disaster content of postgraduate emergency nursing courses as a means to better understand the disaster preparedness of emergency nurses.

Black Saturday and the Victorian Bushfires of February 2009: A descriptive survey of nurses who assisted in the pre-hospital setting

Researchers: Jamie Ranse, Shane Lenson, Brett Aimers

Background: In February 2009, bushfires devastated the state of Victoria, Australia, resulting in the loss of property and life – this event was named ‘Black Saturday’. Pre, during and post the impact of this event, health care professionals, such as nursing members of St John Ambulance Australia, provided clinical care in the pre-hospital environment. There is a paucity of literature regarding the clinical and disaster background, education and preparedness of those health care professionals who assist in similar emergencies, as such the characteristics of responders are not well understood.

Method: This research used a retrospective descriptive postal survey design, to survey nursing members of St John Ambulance Australia regarding their nursing experience; pre-hospital experience; disaster education, training and experience; and their role during the response to the 2009 Victorian bushfires.

Results: A total of 53 nurses were approached for inclusion in this research, of which 24 (45%) voluntarily participated. Males represented 46% and females represented 54% of participants. Participants had more combined years of nursing experience in the medical and surgical environments, then other areas of practice. Post-graduate critical care nursing was the primary area of completed post-graduate education. The previous disaster experience of participants was principally related to bushfire emergency response. Most participants had undertaken disaster related education, however this varied in type and duration. Similarly, most had participated in training or mock disasters; however this was commonly not related to bushfire emergencies. During the response to the Victorian bushfires, those nurses who undertook a clinical role did so at a staging area, caring for fire fighters and working with other members of their organisation. Half of the participants undertook an administrative role.

Conclusions: This research has provided insight into the characteristics and level of preparedness, of nurses who responded to the 2009 Victorian bushfires. Previously, such information has not been available in the literature. In this research, males were overrepresented when compared to the national average of nurses. The most amount of nursing experience was in the medical and surgical environment, this is consistent with national nursing workforce trends. Whilst most had clinical experience in bushfires, no training or mock scenarios focused specifically to bushfires. There is a need to explore further, the various roles undertaken by nurses during response, as this research has focused on one event – the 2009 Victorian bushfires.

Outputs:

Publication (Collegian)

Chain of survival at mass gatherings: A case series of resuscitation events

Researchers: Jamie Ranse, Kathryn Zeitz

At a large public event, or mass gathering, various factors influence patient presentations, which bring challenges to patient care. The chain of survival has been investigated in the prehospital setting; however this has not explicitly included the mass-gathering environment. This study sought to determine the facilitators and barriers to the chain of survival at mass gatherings.

This case series research was exploratory and descriptive, using the analysis of personal experiences of resuscitation. Participants were members of St John Ambulance Australia who had participated actively in a resuscitation event in 2007. Telephone interviews were used as a means of data collection. Participant narrative was recorded electronically, transcribed verbatim, and analyzed thematically using a well established human science approach.

The thematic analysis revealed five main themes and a number of sub-themes. Four of the main themes were aligned easily with the four chain of survival links. The remaining main theme outlined a new link in the chain of survival of specific importance to mass gatherings, ‘early planning’. Additionally, a number of sub-themes were identified, which exemplified various facilitators and barriers to the chain of survival in this environment.

This research highlights various barriers and facilitators to the chain of survival in the mass-gathering environment. Additionally, the unique “early planning” link in the chain of survival as described in this research highlights the importance of a preparatory phase for responders at mass gatherings.

Outputs:

	Publication (Prehospital Disaster Medicine)
	Summary (Jamie Ranse Website)