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Objective: The aim of this study was to describe the in-event, ambulance and ED impacts of patient presentations from an Australian mass gathering event (MGE) including patient demographics, provision of care, length of stay and discharge disposition., Methods: This research was set at one MGE in Australia. The MGE had one first aid post and one in-event health team staffed by doctors, nurses and paramedics. A retrospective analysis of patient care records from providers of in-event, ambulance and ED services was undertaken. Data analysis included descriptive and inferential statistics., Results: Of the 20 000 MGE participants, 197 (0.99% [95% CI 0.86-1.13], 9.85/1000) presented for in-event first aid care, with 24/197 (12.2% [95% CI 8.33-17.49], 1.2/1000) referred to in-event health professionals. Fifteen of the referred patients (62.5% [95% CI 42.71-78.84]) returned to the MGE following administration of intravenous fluids (n = 13) and/or anti-emetics (n = 11). Seven (29.2% [95% CI 14.92-49.17], 0.35/1000) were referred to ambulance paramedic care, requiring endotracheal intubation (n = 1) and airway adjuncts (n = 3) prior to transportation to ED; these patients had an ED median length of stay of 7 h (5.5-12.5) receiving imaging and ventilator support. Five were discharged from ED, one required an operation and another required intensive care unit admission., Conclusions: There was an impact on in-event, ambulance and ED services from this MGE but the in-event model of care may have limited ambulance usage and ED visits. The ED length of stay was greater than the national median, perhaps reflecting the appropriateness of transport and nature of care requirements while in the ED., (© 2018 Australasian College for Emergency Medicine.)

Specific Event Identifiers a. Event type: Outdoor music festival. b. Event onset date: December 3, 2016. c. Location of event: Regatta Point, Commonwealth Park. d. Geographical coordinates: Canberra, Australian Capital Territory (ACT), Australia (-35.289002, 149.131957, 600m). e. Dates and times of observation in latitude, longitude, and elevation: December 3, 2016, 11:00-23:00. f. Response type: Event medical support. Abstract Introduction Young adult patrons are vulnerable to risk-taking behavior, including drug taking, at outdoor music festivals. Therefore, the aim of this field report is to discuss the on-site medical response during a music festival, and subsequently highlight observed strategies aimed at minimizing substance abuse harm., Method: The observed outdoor music festival was held in Canberra (Australian Capital Territory [ACT], Australia) during the early summer of 2016, with an attendance of 23,008 patrons. First aid and on-site medical treatment data were gained from the relevant treatment area and service., Results: The integrated first aid service provided support to 292 patients. Final analysis consisted of 286 patients' records, with 119 (41.6%) males and 167 (58.4%) females. Results from this report indicated that drug intoxication was an observed event issue, with 15 (5.1%) treated on site and 13 emergency department (ED) presentations, primarily related to trauma or medical conditions requiring further diagnostics., Conclusion: This report details an important public health need, which could be met by providing a coordinated approach, including a robust on-site medical service, accepting intrinsic risk-taking behavior. This may include on-site drug-checking, providing reliable information on drug content with associated education. Luther M , Gardiner F , Lenson S , Caldicott D , Harris R , Sabet R , Malloy M , Perkins J . An effective risk minimization strategy applied to an outdoor music festival: a multi-agency approach. Prehosp Disaster Med. 2018;33(2):220-224.

The clinical education of paramedic students is an international concern. In Australia, student placements are commonly undertaken with local district ambulance services, however these placements are increasingly limited. Clinical placements within inter-professional settings represent an innovative yet underdeveloped area of investigation. This paper addresses that gap by reporting a pilot evaluation of paramedic student clinical placements in a specialised obstetrics setting. Using a case study approach, the evaluation aimed to identify paramedic psychomotor skills that could be practised in this setting, and understand the nature of key learning events. A purposive sample of paramedic students was recruited following completion of the obstetrics placement. A combination of student reflection and assessed psychomotor skills data were collected from clinical placement logs. Content analysis of all data was conducted inductively and deductively, as appropriate. Findings indicated a comprehensive range of psychomotor skills can be practised in this setting, with over thirty psychomotor skills identified directly related to the paramedic curriculum; and seven psychomotor skills indirectly related. The themes finding confidence in maternity care, watching the experts, and putting theory into practice provide narrative insight into the clinical learning experience of paramedic students in this setting. Further research is recommended to build upon this pilot., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: During a mass gathering, some participants may receive health care for injuries or illnesses that occur during the event. In-event first responders provide initial assessment and management at the event. However, when further definitive care is required, municipal ambulance services provide additional assessment, treatment, and transport of participants to acute care settings, such as hospitals. The impact on both ambulance services and hospitals from mass-gathering events is the focus of this literature review. Aim This literature review aimed to develop an understanding of the impact of mass gatherings on local health services, specifically pertaining to in-event and external health services., Method: This research used a systematic literature review methodology. Electronic databases were searched to find articles related to the aim of the review. Articles focused on mass-gathering health, provision of in-event health services, ambulance service transportation, and hospital utilization., Results: Twenty-four studies were identified for inclusion in this review. These studies were all case-study-based and retrospective in design. The majority of studies (n=23) provided details of in-event first responder services. There was variation noted in reporting of the number and type of in-event health professional services at mass gatherings. All articles reported that patients were transported to hospital by the ambulance service. Only nine articles reported on patients presenting to hospital. However, details pertaining to the impact on ambulance and hospital services were not reported., Conclusions: There is minimal research focusing on the impact of mass gatherings on in-event and external health services, such as ambulance services and hospitals. A recommendation for future mass-gathering research and evaluation is to link patient-level data from in-event mass gatherings to external health services. This type of study design would provide information regarding the impact on health services from a mass gathering to more accurately inform future health planning for mass gatherings across the health care continuum. Ranse J , Hutton A , Keene T , Lenson S , Luther M , Bost N , Johnston ANB , Crilly J , Cannon M , Jones N , Hayes C , Burke B . Health service impact from mass gatherings: a systematic literature review. Prehosp Disaster Med. 2017;32(1):71-77.

Background: Emergency nurses play a pivotal role in disaster relief during the response to, and recovery of both in-hospital and out-of-hospital disasters. Postgraduate education is important in preparing and enhancing emergency nurses' preparation for disaster nursing practice. The disaster nursing content of Australian tertiary postgraduate emergency nursing courses has not been compared across courses and the level of agreement about suitable content is not known., Aim: To explore and describe the disaster content in Australian tertiary postgraduate emergency nursing courses., Method: A retrospective, exploratory and descriptive study of the disaster content of Australian tertiary postgraduate emergency nursing courses conducted in 2009. Course convenors from 12 universities were invited to participate in a single structured telephone survey. Data was analysed using descriptive statistics., Results: Ten of the twelve course convenors from Australian tertiary postgraduate emergency nursing courses participated in this study. The content related to disasters was varied, both in terms of the topics covered and duration of disaster content. Seven of these courses included some content relating to disaster health, including types of disasters, hospital response, nurses' roles in disasters and triage. The management of the dead and dying, and practical application of disaster response skills featured in only one course. Three courses had learning objectives specific to disasters., Conclusion: The majority of courses had some disaster content but there were considerable differences in the content chosen for inclusion across courses. The incorporation of core competencies such as those from the International Council of Nurses and the World Health Organisation, may enhance content consistency in curriculum. Additionally, this content could be embedded within a proposed national education framework for disaster health., (Copyright © 2013 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.)

Aim: This research explores the roles of nurses that participated in the Black Saturday and Victorian bushfires in February 2009, including aspects that influence nurses' roles, such as prior education, training and availability of resources., Background: It is acknowledged that nurses play an important role in disaster response and recovery. However, our understanding of nurses' roles is superficial and commonly based on descriptions of events in which specifics relating to the nurses' roles are embedded within other topics or issues. Similarly, aspects that support nurses in the disaster environment, including previous experience, education and the provision of resources, are not well understood., Method: Single, semi-structured telephone interviews were conducted with 11 volunteer nursing members of St John Ambulance Australia. These interviews were electronically recorded, transcribed verbatim and thematically analysed using a well-recognised human science approach., Findings: The thematic analysis identified two broad themes: being prepared and having an expansive role. Participants indicated that they were educationally prepared and had adequate clinical experience. They outlined that they took many resources with them; however, they were used very little, as their role consisted of minimal clinical care. Additionally, nurses performed roles including a psychosocial supporter, a coordinator of care and resources, and problem solvers., Conclusions: The nurses' role in providing health care during and/or following a disaster is more than a clinical care role. This understanding should be applied to the development of education programs, competencies and policies, with a particular focus on contextualising the education to the realities of possible disastrous scenarios that incorporates elements of coordination, problem solving and psychosocial care within a national framework. Additionally, this awareness education should be used to inform nurses about the realities of working in disaster environments., (Copyright © 2012 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.)

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.