Lessons from media reporting of natural disasters : a case study of the 2011 flash floods in Toowoomba and the Lockyer Valley

Practice-led journalism research techniques were used in this study to produce a ‘first draft of history’ recording the human experience of survivors and rescuers during the January 2011 flash flood disaster in Toowoomba and the Lockyer Valley in Queensland, Australia. The study aimed to discover what can be learnt from engaging in journalistic reporting of natural disasters. This exegesis demonstrates that journalism can be both a creative practice and a research methodology. About 120 survivors, rescuers and family members of victims participated in extended interviews about what happened to them and how they survived. Their stories are the basis for two creative outputs of the study: a radio documentary and a non-fiction book, that document how and why people died, or survived, or were rescued. Listeners and readers are taken "into the flood" where they feel anxious for those in peril, relief when people are saved, and devastated when babies, children and adults are swept away to their deaths. In undertaking reporting about the human experience of the floods, several significant elements about journalistic reportage of disasters were exposed. The first related to the vital role that the online social media played during the disaster for individuals, citizen reporters, journalists and emergency services organisations. Online social media offer reporters powerful new reporting tools for both gathering and disseminating news. The second related to the performance of journalists in covering events involving traumatic experiences. Journalists are often required to cover trauma and are often amongst the first-responders to disasters. This study found that almost all of the disaster survivors who were approached were willing to talk in detail about their traumatic experiences. A finding of this project is that journalists who interview trauma survivors can develop techniques for improving their ability to interview people who have experienced traumatic events. These include being flexible with interview timing and selecting a location; empowering interviewees to understand they don’t have to answer every question they are asked; providing emotional security for interviewees; and by being committed to accuracy. Survivors may exhibit posttraumatic stress symptoms but some exhibit and report posttraumatic growth. The willingness of a high proportion of the flood survivors to participate in the flood research made it possible to document a relatively unstudied question within the literature about journalism and trauma – when and why disaster survivors will want to speak to reporters. The study sheds light on the reasons why a group of traumatised people chose to speak about their experiences. Their reasons fell into six categories: lessons need to be learned from the disaster; a desire for the public to know what had happened; a sense of duty to make sure warning systems and disaster responses to be improved in future; personal recovery; the financial disinterest of reporters in listening to survivors; and the timing of the request for an interview. Feedback to the creative-practice component of this thesis - the book and radio documentary - shows that these issues are not purely matters of ethics. By following appropriate protocols, it is possible to produce stories that engender strong audience responses such as that the program was "amazing and deeply emotional" and "community storytelling at its most important". Participants reported that the experience of the interview process was "healing" and that the creative outcome resulted in "a very precious record of an afternoon of tragedy and triumph and the bitter-sweetness of survival".

Changing work design in disaster response : the potential for innovation

Work design operates as the system of arrangements and procedures for organizing work to achieve organizational goals. These systems are commonly established in periods of environmental and organizational stability and formulated to achieve efficiencies in resources, employee and team configuration. However, organizations charged with responding to disasters need to be prepared to respond to unexpected events on a large scale, and disaster response planning needs to accommodate a broad range of possible disasters. When the disaster state occurs, enactment of the specific organizational response is devolved to group or individual level managers. While this enactment presents a range of risks, it also provides a potential avenue for innovation. Employees ultimately are the foundation of change and innovation, as it is people who develop, respond, change and implement new ideas. This study analyzes motivational characteristics of work design at an Australian humanitarian organization encompassing normal operations and periods of disaster activation. The study will identify the paradox of dual work designs and the implications for organizational innovation.

Emergency healthcare of the future

Emergency healthcare is a high profile component of modern healthcare systems, which over the past three decades has fundamentally transformed in many countries. However, despite this rapid development, and associated investments in service standards, there is a high level of concern with the performance of emergency health services relating principally to system wide congestion. The factors driving this problem are complex but relate largely to the combined impact of growing demand, expanded scope of care and blocked access to inpatient beds. These factors are unlikely to disappear in the medium term despite the National Emergency Access Target. The aim of this article is to stimulate a conversation about the future design and functioning of emergency healthcare systems; examining what we understand about the problem and proposing a rationale that may underpin future strategic approaches. This is also an invitation to join the conversation.

Disaster resilience in tertiary hospitals : a cross-sectional survey in Shandong Province, China

Background: Hospital disaster resilience can be defined as a hospital’s ability to resist, absorb, and respond to the shock of disasters while maintaining critical functions, and then to recover to its original state or adapt to a new one. This study aims to explore the status of resilience among tertiary hospitals in Shandong Province, China. Methods: A stratified random sample (n = 50) was derived from tertiary A, tertiary B, and tertiary C hospitals in Shandong Province, and was surveyed by questionnaire. Data on hospital characteristics and 8 key domains of hospital resilience were collected and analysed. Variables were binary, and analysed using descriptive statistics such as frequencies. Results: A response rate of 82% (n = 41) was attained. Factor analysis identified four key factors from eight domains which appear to reflect the overall level of disaster resilience. These were hospital safety, disaster management mechanisms, disaster resources and disaster medical care capability. The survey demonstrated that in regard to hospital safety, 93% had syndromic surveillance systems for infectious diseases and 68% had evaluated their safety standards. In regard to disaster management mechanisms, all had general plans, while only 20% had specific plans for individual hazards. 49% had a public communication protocol and 43.9% attended the local coordination meetings. In regard to disaster resources, 75.6% and 87.5% stockpiled emergency drugs and materials respectively, while less than a third (30%) had a signed Memorandum of Understanding with other hospitals to share these resources. Finally in regard to medical care, 66% could dispatch an on-site medical rescue team, but only 5% had a ‘portable hospital’ function and 36.6% and 12% of the hospitals could surge their beds and staff capacity respectively. The average beds surge capacity within 1 day was 13%. Conclusions: This study validated the broad utility of a framework for understanding and measuring the level of hospital resilience. The survey demonstrated considerable variability in disaster resilience arrangements of tertiary hospitals in Shandong province, and the difference between tertiary A hospitals and tertiary B hospitals was also identified in essential areas.

An interpretative phenomenological analysis of stress and well-being in Emergency Medical Dispatchers

This study explored the stress and wellbeing of Emergency Medical Dispatchers (EMD) who remotely provide crisis intervention to medical emergencies through telehealth support. Semi-structured interviews with 16 EMDs were conducted and Interpretative Phenomenological Analysis was used to identify themes in the data. These results indicated that despite their physical distance from the crisis scene, EMDs can experience vicarious trauma through acute and cumulative exposure to traumatic incidents and their perceived lack of control which can expound feelings of helplessness. Three superordinate themes of operational stress and trauma, organisational stress, and posttraumatic growth were identified. Practical implications are suggested to enable emergency services organisations to counteract this job related stress and promote more positive mental health outcomes.

Proposing and developing the definition and conceptual framework for healthcare resilience to cope with disasters

Building healthcare resilience is an important step towards creating more resilient communities to better cope with future disasters. To date, however, there appears to be little literature on how the concept of healthcare resilience should be defined and operationalized with a conceptual framework. This article aims to build a comprehensive healthcare disaster management approach guided by the concept of resilience. Methods: Google and major health electronic databases were searched to retrieve critical relevant publications. A total of 61 related publications were included, to provide a comprehensive overview of theories and definitions relevant to disaster resilience. Results and Discussions: Resilience is an inherent and adaptive capacity to cope with future uncertainty, through multiple strategies with all hazards approaches, in an attempt to achieve a positive outcome with linkage and cooperation. Healthcare resilience can be defined as the capability of healthcare organisations to resist, absorb, and respond to the shock of disasters while maintaining the most essential functions, then recover to their original state or adapt to a new state. It can be assessed by criteria, namely: robustness, redundancy, resourcefulness; and a complex of key dimensions, namely: vulnerability and safety, disaster resources and preparedness, continuity of essential health services, recovery and adaptation. Conclusions: This new concept places healthcare organisations’ disaster capabilities, management tasks, activities and disaster outcomes together into a comprehensive whole view, using an integrated approach and establishing achievable goals.

Collaboration to improve evacuation centre operations in disaster-affected communities

Emergency sheltering is a temporary source of safety and support for people affected by disasters. People access emergency sheltering just prior to or soon after a disaster; therefore they are often scared, stressed, and/or experiencing loss/grief. The gathering of people in shelters also increases several environmental health risks. Therefore ensuring emergency shelters contain adequate facilities (permanent or temporary) and are well managed is essential in providing immediate support to disaster-affected communities and providing a level of assurance that the agencies involved are capable of supporting them through the recovery process. This paper will be presented by representatives of Australian Red Cross and Environmental Health Australia (Queensland), which both have an interest in emergency sheltering in Queensland. The paper will cover the development, content and application of the ‘Preferred Sheltering Practices for Emergency Sheltering in Australia’ and the roles of various organisations in relation to emergency sheltering. The importance of or- ganisational collaboration will also be discussed, with a focus on the experience of the two organisations fol- lowing the 2011 floods in Queensland and how they are collaborating to improve future operations in evacu- ation centres, which are a common form of emergency sheltering in Queensland. The organisations are con- tinuing to work together with the ultimate goal of improving services to disaster-affected communities and supporting such communities to start the recovery process.

Ethical values in emergency medical services: A pilot study

Background Ambulance professionals often address conflicts between ethical values. As individuals’ values represent basic convictions of what is right or good and motivate behaviour, research is needed to understand their value profiles. Objectives To translate and adapt the Managerial Values Profile to Spanish and Swedish, and measure the presence of utilitarianism, moral rights and/or social justice in ambulance professionals’ value profiles in Spain and Sweden. Methods The instrument was translated and culturally adapted. A content validity index was calculated. Pilot tests were carried out with 46 participants. Ethical considerations This study conforms to the ethical principles for research involving human subjects and adheres to national laws and regulations concerning informed consent and confidentiality. Findings Spanish professionals favoured justice and Swedish professionals’ rights in their ambulance organizations. Both countries favoured utilitarianism least. Gender differences across countries showed that males favoured rights. Spanish female professionals favoured justice most strongly of all. Discussion Swedes favour rights while Spaniards favour justice. Both contexts scored low on utilitarianism focusing on total population effect, preferring the opposite, individualized approach of the rights and justice perspectives. Organizational investment in a utilitarian perspective might jeopardize ambulance professionals’ moral right to make individual assessments based on the needs of the patient at hand. Utilitarianism and a caring ethos appear as stark opposites. However, a caring ethos in its turn might well involve unreasonable demands on the individual carer’s professional role. Since both the justice and rights perspectives portrayed in the survey mainly concern relationship to the organization and peers within the organization, this relationship might at worst be given priority over the equal treatment and moral rights of the patient. Conclusion A balanced view on ethical perspectives is needed to make professionals observant and ready to act optimally – especially if these perspectives are used in patient care. Research is needed to clarify how justice and rights are prioritized by ambulance services and whether or not these organization-related values are also implemented in patient care.

Building the safety case for UAS operations in support of natural disaster response

A framework supporting the systematic development of safety cases for Unmanned Aircraft System (UAS) operations in a broad range of civil and commercial applications is presented. The case study application is the use of UAS for disaster response. In those States where regulations do not preclude UAS operations altogether, approvals for UAS operations can be granted on a case-by-case basis contingent on the provision of a safety case acceptable to the relevant National Airworthiness Authority (NAA). A safety case for UAS operations must show how the risks associated with the hazards have been managed to an acceptable level. The foundational components necessary for structuring and assessing these safety cases have not yet been proposed. Barrier-bow-tie models are used in this paper to structure the safety case for the two primary hazards of 1) a ground impact, and 2) a Mid-Air Collision (MAC). The models establish the set of Risk Control Variables (RCVs) available to reduce the risk. For the ground-impact risk model, seven RCVs are identified which in combination govern the probability of an accident. Similarly, ten RCVs are identified within the MAC model. The effectiveness of the RCVs and how they can implemented in terms of processes, policies, devices, practices, or other actions for each of the case-study applications are discussed. The framework presented can provide for the more systematic and consistent regulation of UAS through a "safety target" approach.

Burden of decompensated cirrhosis and ascites on hospital services in a tertiary care facility: time for change?

Background Ascites, the most frequent complication of cirrhosis, is associated with poor prognosis and reduced quality of life. Recurrent hospital admissions are common and often unplanned, resulting in increased use of hospital services. Aims To examine use of hospital services by patients with cirrhosis and ascites requiring paracentesis, and to investigate factors associated with early unplanned readmission. Methods A retrospective review of the medical chart and clinical databases was performed for patients who underwent paracentesis between October 2011 and October 2012. Clinical parameters at index admission were compared between patients with and without early unplanned hospital readmissions. Results The 41 patients requiring paracentesis had 127 hospital admissions, 1164 occupied bed days and 733 medical imaging services. Most admissions (80.3%) were for management of ascites, of which 41.2% were unplanned. Of those eligible, 69.7% were readmitted and 42.4% had an early unplanned readmission. Twelve patients died and nine developed spontaneous bacterial peritonitis. Of those eligible for readmission, more patients died (P = 0.008) and/or developed spontaneous bacterial peritonitis (P = 0.027) if they had an early unplanned readmission during the study period. Markers of liver disease, as well as haemoglobin (P = 0.029), haematocrit (P = 0.024) and previous heavy alcohol use (P = 0.021) at index admission, were associated with early unplanned readmission. Conclusion Patients with cirrhosis and ascites comprise a small population who account for substantial use of hospital services. Markers of disease severity may identify patients at increased risk of early readmission. Alternative models of care should be considered to reduce unplanned hospital admissions, healthcare costs and pressure on emergency services.

Emergency department models of care in the context of care quality and cost: A systematic review

To identify current ED models of care and their impact on care quality, care effectiveness, and cost. A systematic search of key health databases (Medline, CINAHL, Cochrane, EMbase) was conducted to identify literature on ED models of care. Additionally, a focused review of the contents of 11 international and national emergency medicine, nursing and health economic journals (published between 2010 and 2013) was undertaken with snowball identification of references of the most recent and relevant papers. Articles published between 1998 and 2013 in the English language were included for initial review by three of the authors. Studies in underdeveloped countries and not addressing the objectives of the present study were excluded. Relevant details were extracted from the retrieved literature, and analysed for relevance and impact. The literature was synthesised around the study's main themes. Models described within the literature mainly focused on addressing issues at the input, throughput or output stages of ED care delivery. Models often varied to account for site specific characteristics (e.g. onsite inpatient units) or to suit staffing profiles (e.g. extended scope physiotherapist), ED geographical location (e.g. metropolitan or rural site), and patient demographic profile (e.g. paediatrics, older persons, ethnicity). Only a few studies conducted cost-effectiveness analysis of service models. Although various models of delivering emergency healthcare exist, further research is required in order to make accurate and reliable assessments of their safety, clinical effectiveness and cost-effectiveness.

Effective emergency messaging during natural disasters: An application of message compliance theories

Study/Objective This research examines the types of emergency messages used in Australia during the response and early recovery phases of a natural disaster. The aim of the research is to develop theory-driven emergency messages that increase individual behavioural compliance during a disaster. Background There is growing evidence of non-compliant behaviour in Australia, such as refusing to evacuate and travelling through hazardous areas. This can result in personal injury, loss of life, and damage to (or loss of) property. Moreover, non-compliance can place emergency services personnel in life-threatening situations when trying to save non-compliant individuals. Drawing on message compliance research in psychology and sociology, a taxonomy of message types was developed to ascertain how emergency messaging can be improved to produce compliant behaviour. Method A review of message compliance literature was conducted to develop the taxonomy of message types previously found to achieve compliance. Seven categories were identified: direct-rational, manipulation, negative phrasing, positive phrasing, exchange appeals, normative appeals, and appeals to self. A content analysis was then conducted to assess the emergency messages evident in the Australian emergency management context. The existing messages were aligned with the literature to identify opportunities to improve emergency messaging. Results & Conclusion The results suggest there is an opportunity to improve the effectiveness of emergency messaging to increase compliance during the response and early recovery phases of a natural disaster. While some message types cannot legally or ethically be used in emergency communication (e.g. manipulative messaging), there is an opportunity to create more persuasive messages (e.g. appeals to self) that personalise the individual’s perception of risk, triggering them to comply with the message.

Why do Queenslanders seek care in emergency departments? A population study

Objective This study aims to identify the main reasons for which first time and multiple users seek medical care through Queensland emergency departments (ED). Methods A cross-sectional survey was conducted at eight public EDs among presenting patients (n = 911). The questions measured the socio-demographic characteristics of patients, their beliefs and attitudes towards EDs services, and perceptions of health status. Bivariate and binary logistic regression analyses were performed to examine the differences between first time and multiple users of EDs. Results First time and multiple users accounted for 55.5% and 44.5%, respectively. Multiple users themselves believed to be sicker, have poorer health status, and additional and/or chronic health conditions. Multiple users more strongly believed that their condition required treatment at an ED and perceived their condition as being very serious. Multiple users reported weekly household incomes below $600, and half of the multiple users were not working as compared to 35% first time users. Multivariate analysis showed that multiple use was significantly associated with the existence of additional health problems, having chronic condition, lower self-efficacy, and need for ED treatment. Conclusions Patients who sought care for multiple times at EDs more often than first time users suffered from additional and chronic conditions. Their opinion of an ED as the most suitable place to address their current health problem was stronger than first time users. Any proposed demand management strategies need to address these beliefs together with the reasoning of patients to provide effective and appropriate care outside or within ED services.

Building resilient communities: Creating effective multi-channel communication during disaster response and recovery

Our aim is to examine evidence-based strategies to motivate appropriate action and increase informed decision-making during the response and recovery phases of disasters. We combine expertise in communication, consumer psychology and marketing, disaster and emergency management, and law. This poster presents findings from a social media work package, and preliminary findings from the focus group work package on emergency warning message comprehension.

Factors influencing sustainability of health service innovation: Emergency nurse practitioner services

Introduction: Emergency department nurse practitioner services are one of the most frequently implemented service delivery models in Australian hospitals. This research examined factors influencing sustainability of this innovative service delivery model and offers some recommendations for future service integration. Background Many health service innovations have been implemented in an attempt to meet the growing demand for efficient, cost effective health care however, sustainability of many of these innovations has not been evaluated and is poorly understood. Aim The aim of the research was to identify factors that influence sustainability of emergency department nurse practitioner services and to operationalise a theoretical framework for evaluating innovation sustainability. Methodology The research used case study methodology. The case was emergency nurse practitioner services, and units of analysis were emergency department staff, emergency nurse practitioners and documents relating to nurse practitioner services. The data collection methods included, survey, one-on-one interviews, document analysis and telephone survey. Results This research shows that emergency nurse practitioner services partially comply with the factors of sustainability as described in the Sustainability of Innovation theoretical framework: Political, Organisational, Workforce, Financial and Innovation specific factors. Where services do not entirely meet the factors the existing benefits of the service may outweigh the barriers and other means of working around shortfalls are also implemented by staff to ensure patient safety. Conclusion The rapidly expanding emergency nurse practitioner service has been examined using case study methodology to find that certain factors may be threatening the sustainability of this health service innovation. Potentially an innovation may be sustained when only some factors are met in the short term, however, long term sustainability may be challenged if factors are not addressed and supported.