Pandemic (H1N1) 2009 Influenza Outbreak in Australia: Impact on Emergency Departments.

Executive summary Objective: The aims of this study were to identify the impact of Pandemic (H1N1) 2009 Influenza on Australian Emergency Departments (EDs) and their staff, and to inform planning, preparedness, and response management arrangements for future pandemics, as well as managing infectious patients presenting to EDs in everyday practice. Methods This study involved three elements: 1. The first element of the study was an examination of published material including published statistics. Standard literature research methods were used to identify relevant published articles. In addition, data about ED demand was obtained from Australian Government Department of Health and Ageing (DoHA) publications, with several state health departments providing more detailed data. 2. The second element of the study was a survey of Directors of Emergency Medicine identified with the assistance of the Australasian College for Emergency Medicine (ACEM). This survey retrieved data about demand for ED services and elicited qualitative comments on the impact of the pandemic on ED management. 3. The third element of the study was a survey of ED staff. A questionnaire was emailed to members of three professional colleges—the ACEM; the Australian College of Emergency Nursing (ACEN); and the College of Emergency Nursing Australasia (CENA). The overall response rate for the survey was 18.4%, with 618 usable responses from 3355 distributed questionnaires. Topics covered by the survey included ED conditions during the (H1N1) 2009 influenza pandemic; information received about Pandemic (H1N1) 2009 Influenza; pandemic plans; the impact of the pandemic on ED staff with respect to stress; illness prevention measures; support received from others in work role; staff and others’ illness during the pandemic; other factors causing ED staff to miss work during the pandemic; and vaccination against Pandemic (H1N1) 2009 Influenza. Both qualitative and quantitative data were collected and analysed. Results: The results obtained from Directors of Emergency Medicine quantifying the impact of the pandemic were too limited for interpretation. Data sourced from health departments and published sources demonstrated an increase in influenza-like illness (ILI) presentations of between one and a half and three times the normal level of presentations of ILIs. Directors of Emergency Medicine reported a reasonable level of preparation for the pandemic, with most reporting the use of pandemic plans that translated into relatively effective operational infection control responses. Directors reported a highly significant impact on EDs and their staff from the pandemic. Growth in demand and related ED congestion were highly significant factors causing distress within the departments. Most (64%) respondents established a ‘flu clinic’ either as part of Pandemic (H1N1) 2009 Influenza Outbreak in Australia: Impact on Emergency Departments. the ED operations or external to it. They did not note a significantly higher rate of sick leave than usual. Responses relating to the impact on staff were proportional to the size of the colleges. Most respondents felt strongly that Pandemic (H1N1) 2009 Influenza had a significant impact on demand in their ED, with most patients having low levels of clinical urgency. Most respondents felt that the pandemic had a negative impact on the care of other patients, and 94% revealed some increase in stress due to lack of space for patients, increased demand, and filling staff deficits. Levels of concern about themselves or their family members contracting the illness were less significant than expected. Nurses displayed significantly higher levels of stress overall, particularly in relation to skill-mix requirements, lack of supplies and equipment, and patient and patients’ family aggression. More than one-third of respondents became ill with an ILI. Whilst respondents themselves reported taking low levels of sick leave, respondents cited difficulties with replacing absent staff. Ranked from highest to lowest, respondents gained useful support from ED colleagues, ED administration, their hospital occupational health department, hospital administration, professional colleges, state health department, and their unions. Respondents were generally positive about the information they received overall; however, the volume of information was considered excessive and sometimes inconsistent. The media was criticised as scaremongering and sensationalist and as being the cause of many unnecessary presentations to EDs. Of concern to the investigators was that a large proportion (43%) of respondents did not know whether a pandemic plan existed for their department or hospital. A small number of staff reported being redeployed from their usual workplace for personal risk factors or operational reasons. As at the time of survey (29 October –18 December 2009), 26% of ED staff reported being vaccinated against Pandemic (H1N1) 2009 Influenza. Of those not vaccinated, half indicated they would ‘definitely’ or ‘probably’ not get vaccinated, with the main reasons being the vaccine was ‘rushed into production’, ‘not properly tested’, ‘came out too late’, or not needed due to prior infection or exposure, or due to the mildness of the disease. Conclusion: Pandemic (H1N1) 2009 Influenza had a significant impact on Australian Emergency Departments. The pandemic exposed problems in existing plans, particularly a lack of guidelines, general information overload, and confusion due to the lack of a single authoritative information source. Of concern was the high proportion of respondents who did not know if their hospital or department had a pandemic plan. Nationally, the pandemic communication strategy needs a detailed review, with more engagement with media networks to encourage responsible and consistent reporting. Also of concern was the low level of immunisation, and the low level of intention to accept vaccination. This is a problem seen in many previous studies relating to seasonal influenza and health care workers. The design of EDs needs to be addressed to better manage infectious patients. Significant workforce issues were confronted in this pandemic, including maintaining appropriate staffing levels; staff exposure to illness; access to, and appropriate use of, personal protective equipment (PPE); and the difficulties associated with working in PPE for prolonged periods. An administrative issue of note was the reporting requirement, which created considerable additional stress for staff within EDs. Peer and local support strategies helped ensure staff felt their needs were provided for, creating resilience, dependability, and stability in the ED workforce. Policies regarding the establishment of flu clinics need to be reviewed. The ability to create surge capacity within EDs by considering staffing, equipment, physical space, and stores is of primary importance for future pandemics.

A regulatory on-board mass monitoring application for heavy vehicles in Australia

This paper reports on the development of specifications for an on-board mass monitoring (OBM) application for regulatory requirements in Australia. An earlier paper reported on feasibility study and pilot testing program prior to the specification development [1]. Learnings from the pilot were used to refine this testing process and a full scale testing program was conducted from July to October 2008. The results from the full scale test and evidentiary implications are presented in this report. The draft specification for an evidentiary on-board mass monitoring application is currently under development.

Mapping social enterprise in Australia : conceptual debates and their operational implications

In the last ten years, there has been growing interest in social enterprise by governments, the not for profit sector and philanthropy in Australia The drivers of this interest have been variously understood to be: increasing demands for innovative responses to social and environmental problems; pressures on non-profit organisations to diversify their income sources; and increasing emphases by government on the role of civil society actors in partnering around social policy agendas. Whatever its genesis, very little is known about the scale and scope of the emerging social enterprise sector. In order to research the scope of the sector, an important first step involves understanding just what social enterprise is, and how it may be operationalised. This paper presents the findings from the first stage of a national research project conducted by the authors in conjunction with a new social enterprise development company. The purpose of the project was to provide a comprehensive snapshot of the social enterprise sector in Australia. In this paper, we focus on the definitional debates arising from our workshop discussions, what these mean for understanding contemporary discourses of social enterprise, and their implications for research, policy and practice.

Reduction of environmental effects of civil aircraft through multi-objective flight plan optimisation

With rising environmental alarm, the reduction of critical aircraft emissions including carbon dioxides (CO2) and nitrogen oxides (NOx) is one of most important aeronautical problems. There can be many possible attempts to solve such problem by designing new wing/aircraft shape, new efficient engine, etc. The paper rather provides a set of acceptable flight plans as a first step besides replacing current aircrafts. The paper investigates a green aircraft design optimisation in terms of aircraft range, mission fuel weight (CO2) and NOx using advanced Evolutionary Algorithms coupled to flight optimisation system software. Two multi-objective design optimisations are conducted to find the best set of flight plans for current aircrafts considering discretised altitude and Mach numbers without designing aircraft shape and engine types. The objectives of first optimisation are to maximise range of aircraft while minimising NOx with constant mission fuel weight. The second optimisation considers minimisation of mission fuel weight and NOx with fixed aircraft range. Numerical results show that the method is able to capture a set of useful trade-offs that reduce NOx and CO2 (minimum mission fuel weight).

Social infrastructure planning and sustainable community : example from south east Queensland, Australia

Social infrastructure and sustainable development represent two distinct but interlinked concepts bounded by a geographic location. For those involved in the planning of a residential development, the notion of social infrastructure is crucial to the building of a healthy community and sustainable environment. This is because social infrastructure is provided in response to the basic needs of communities and to enhance the quality of life, equity, stability and social well being. It also acts as the building block to the enhancement of human and social capital. While acknowledging the different levels of social infrastructure provision from neighbourhood, local, district and sub-regional levels, past evidence has shown that the provision at neighbourhood and local level and are affecting well-being of residents and the community sustainability. With intense physical development taking place in Australia's South East Queensland (SEQ) region, local councils are under immense pressure to provide adequate social and community facilities for their residents. This paper shows how participation-oriented, need-sensitive Integrated Social Infrastructure Planning Guideline is used to offer a solution for the efficient planning and provision of multi-level social infrastructure for the SEQ region. The paper points out to the successful implementation of the guideline for social infrastructure planning in multiple levels of spatial jurisdictions of Australia's fastest growing region.

Occupational mobility in Queensland’s aged care, automotive and civil construction sectors

Current trends in workforce development indicate the movement of workers within and across occupations to be the norm. In 2009, only one in three vocational education and training (VET) graduates in Australia ended up working in an occupation for which they were trained. This implies that VET enhances the employability of its graduates by equipping them with the knowledge and competencies to work in different occupations and sectors. This paper presents findings from a Government-funded study that examined the occupational mobility of selected associate professional and trades occupations within the Aged Care, Automotive and Civil Construction sectors in Queensland. The study surveyed enrolled nurses and related workers, motor mechanics and civil construction workers to analyse their patterns of occupational mobility, future work intentions, reasons for taking and leaving work, and the factors influencing them to leave or remain in their occupations. This paper also discusses the implications of findings for the training of workers in these sectors and more generally.

Mental harm, rescuers and the Civil Liability Act 2002 (NSW)

At common law, a duty of care may be owed to a claimant who suffers nervous shock or pure mental harm due to witnessing, or hearing about, physical injury caused to another due to a defendant’s negligence. “Pure mental harm” is the ‘impairment of a person’s mental condition’ that is not suffered as a consequence of any other kind of personal injury to them. However, as many accidents have the potential to create a wide circle of mental suffering to bystanders, family members or others not physically injured themselves, it has traditionally been ‘thought impolitic that everybody so affected should be able to recover damages from the tortfeasor.’ ‘To allow such extended recovery would stretch liability too far.’ Nevertheless, whilst adopting a restrictive approach to liability, the common law courts have recognised that a defendant might owe a duty in relation to the pure mental harm suffered by one who foreseeably attends an accident scene to rescue another from a situation created by the defendant’s negligence.

Project alliancing at National Museum of Australia : the collaborative process

Project alliancing is a new alternative to traditional project delivery systems, especially in the commercial building sector. The Collaborative Process is a theoretical model of people and systems characteristics that are required to reduce the adversarial nature of most construction projects. Although developed separately, both are responses to the same pressures. Project alliancing was just used successfully to complete the National Museum of Australia. This project was analyzed as a case study to determine the extent to which it could be classified as a “collaborative project”. Five key elements of The Collaborative Process were reviewed and numerous examples from the management of this project were cited that support the theoretical recommendations of this model. In the case of this project, significant added value was delivered to the client and many innovations resulted from the collective work of the parties to the contract. It was concluded that project alliances for commercial buildings offer many advantages over traditional project delivery systems, which are related to increasing the levels of collaboration among a project management team.

Educational policy for citizenship in the early years in Australia

This paper explores how young children are constructed in educational policy for citizenship in Australia, investigating tensions between early childhood educational discourses that construct young children as active citizens and the broader discourses of citizenship in Australian educational policy. There is a widespread discourse within early childhood education that regards young children as citizens and democratic participants in their own lives. This view is a reflection of the oft cited Article 12 in the UN Convention on the Rights of the Child (UNCRC 1989). However, educational policy and curriculum for citizenship in Australia, by and large, adheres to age and stage understandings of children, implicitly deeming young children unable to conceptualise abstract ideas of what it means to ‘be a good citizen’. This paper is located in the borders and intersections between discourses of early childhood education, young children as active participants in their own lives and what it means to be an active citizen in Australia. We are concerned with the interweaving of these ideas and how they are played out in educational policy making. This is an important perspective to take for governing and policy making are exercises in harnessing existing ideas and discourses, thereby rendering strategies and tactics for managing populations thinkable and sayable (Rose 1999). The ‘views from the margins’ (Burman 2008, p. 7) can provide alternative perspectives on policymaking, illuminating discursive tactics and strategies.

Challenging the assumptions of positivism : an analysis of the concept of society in Sampi on behalf of the Bardi and Jawi people v Western Australia [2010] and Bodney v Bennell [2008]

The requirement to prove a society united by a body of law and customs to establish native title rights has been identified as a major hurdle to achieving native title recognition. The recent appeal decision of the Federal Court in Sampi on behalf of the Bardi and Jawi People v Western Australia [2010] opens the potential for a new judicial interpretation of society based on the internal view of native title claimants. The decision draws on defining features of legal positivism to inform the court’s findings as to the existence of a single Bardi Jawi society of ‘one people’ living under ‘one law’. The case of Bodney v Bennell [2008] is analysed through comparitive study of how the application of the received positivist framework may limit native title recognition. This paper argues that the framing of Indigenous law by reference to Western legal norms is problematic due to the assumptions of legal positivism and that an internal view based on Indigenous worldviews, which see law as intrinsically linked to the spiritual and ancestral connection to country, is more appropriate to determine proof in native title claims.

Water rights and water governance : a cautionary tale and the case for interdisciplinary governance

Although Australia is the world’s driest continent without the complication of international borders and a generally good governance reputation, its record of water governance is very poor. This chapter considers some of the potentially general lessons that might be derived for water governance. These include: the difficulties of delineatingwater rights; the apparent preference for creating property rights in unsustainable uses of water while failing to deliver basic water rights; the inter twining of carbon and water crises; the dangers of privatising networks that form natural monopolies; the dangers of disciplinary hubris where interdisciplinary understanding is critical. It concludes by starting to address some of the water governance issues raised by globalisation.

Modernising charity law : recent developments and future directions

In recent years the pressure for charity law reform has swept across the common law jurisdictions with differing results. Modernising Charity Law examines how the UK jurisdictions have enacted significant statutory reforms after many years of debate, whilst the federations of Canada and Australia seem merely to have intentions of reform. New Zealand and Singapore have begun their own reform journeys. This highly insightful book brings together perspectives from academics, regulators and practitioners from across the common law jurisdictions. The expert contributors consider the array of reforms to charity law and assess their relative successes. Particular attention is given to the controversial issues of expanded heads of charity, public benefit, religion, competition with business, government participation and regulation. The book concludes by challenging the very notion of charity as a foundation for societies which, faced by an array of global threats and the rising tide of human rights, must now also embrace the expanding notions of social capital, social entrepreneurism and civil society. This original and highly topical work will be a valuable resource for academics, regulators and legal practitioners as well as advanced and postgraduate students in law and public policy. Specialists in charity law, comparative law, and law and public policy should also not be without this important book.