Bouncing back : the role of design and making in understanding and dealing with adversity

The Bouncing Back Project, which began after the Queensland flood event in January 2011, has organically grown through a number of reiterations as per the diagram above. In the August 2011 it resulted in the physical construction of an Emergency Shelter [designed by GreenLeaf Engineers] in Sydney at the Customs House in Circular Quay and a conference paper publication at the AASA conference. To date this research has progressed without any research grant funding and has resulted in significant media interest. During the construction of the Emergency Shelter we collected a wide range of multimedia data which is being compilled into a documentary focusing on the architecture students’ experience throughout the iterations of Bouncing Back.

Bouncing Back : Recovery through Design + Making

Architectural education is beginning to recognise the potential of a more intensive relationship between the tasks of designing and building (Erdman et al., 2002) within a work integrated learning environment. The Bouncing Back Project, began after the Queensland, Australia floods in January 2011, and has organically grown through a number of architectural student exhibitions, initially displaying flood responsive designs. In September 2011, 10 Queensland University of Technology architecture students travelled to Sydney to work together in helping to construct a shelter in the Emergency Shelter Exhibition, at Customs House in Circular Quay. The construction and making of the shelter, was filmed. This film documents the student experience, of making, working with industry professionals, community engagement and it reveals how this activity promotes informal work integrated learning in a real world context.

Collaboration to improve evacuation centre operations in Queensland

Purpose The purpose of this paper is to provide a case study of two organisations working in evacuation centres which overcame challenges to develop a constructive relationship, resulting in improved outcomes for disaster-affected people. A wide range of services for disaster-affected communities are provided as part of emergency sheltering. Collaboration between agencies providing services is essential, but sometimes challenging. Design/methodology/approach A wide range of services for disaster-affected communities are provided as part of emergency sheltering. Collaboration between agencies providing services is essential, but sometimes challenging. The purpose of this paper is to provide a case study of two organisations working in evacuation centres which overcame challenges to develop a constructive relationship, resulting in improved outcomes for disaster-affected people. Findings The Preferred Sheltering Practices provides an ongoing anchor for Australian Red Cross and Environmental Health Australia (EHA) (Queensland) Inc.’s relationship and has led to other tangible benefits such as involvement in each other’s events and trainings. The relationship has become embedded in each organisation’s day-to-day business ensuring the relationship’s sustainability beyond individual staff movements. Originality/value This case study provides an example of how collaboration can be achieved between two organisations with seemingly different mandates to improve the response for disaster-affected communities.

Bouncing back : Students learning through real-world experiences

The Bouncing Back research study, which began after the Queensland flooding in January 2011, has organically expanded through a number of architectural student design projects and exhibitions, which have sought to respond to catastrophic flooding events. In September 2011, 10 Queensland University of Technology architecture students travelled to Sydney to help construct a 1:1 true-to-life scale shelter, for the Emergency Shelter Exhibition at Customs House in Circular Quay. During the construction of the shelter, data were collected in situ, through dynamic interviews with the students. Using a grounded theory methodology, data were coded and then thematically analysed, to reveal three influential factors that positively impacted the students’ learning in this informal context. These were the student experience, the process of learning through physical making/fabrication, and development of empathy with the community. Analysis of these three factors demonstrated how this informal situated learning activity promoted vitally important learning in a real-world context, which is difficult to replicate in a physical on-campus environment.

Paramedic knowledge of infectious disease aetiology and transmission in an Australian Emergency Medical System

Introduction: Paramedics and other emergency health workers are exposed to infectious disease particularly when undertaking exposure-prone procedures as a component of their everyday practice. This study examined paramedic knowledge of infectious disease aetiology and transmission in the pre-hospital care environment.--------- Methods: A mail survey of paramedics from an Australian ambulance service (n=2274) was conducted.--------- Results: With a response rate of 55.3% (1258/2274), the study demonstrated that paramedic knowledge of infectious disease aetiology and modes of transmission was poor. Of the 25 infectious diseases included in the survey, only three aetiological agents were correctly identified by at least 80% of respondents. The most accurate responses for aetiology of individual infectious diseases were for HIV/AIDS (91.4%), influenza (87.4%), and hepatitis B (85.7%). Poorest results were observed for pertussis, infectious mononucleosis, leprosy, dengue fever, Japanese B encephalitis and vancomycin resistant enterococcus (VRE), all with less than half the sample providing a correct response. Modes of transmission of significant infectious diseases were also assessed. Most accurate responses were found for HIV/AIDS (85.8%), salmonella (81.9%) and influenza (80.1%). Poorest results were observed for infectious mononucleosis, diphtheria, shigella, Japanese B encephalitis, vancomycin resistant enterococcus, meningococcal meningitis, rubella and infectious mononucleosis, with less than a third of the sample providing a correct response.--------- Conclusions: Results suggest that knowledge of aetiology and transmission of infectious disease is generally poor amongst paramedics. A comprehensive in-service education infection control programs for paramedics with emphasis on infectious disease aetiology and transmission is recommended.

Determinants of pre-hospital care non-usage for patients with emergency care needs [including commentary by Snooks H.]

Objective-To establish the demographic, health status and insurance determinants of pre-hospital ambulance non-usage for patients with emergency medical needs. Methods-Triage category, date of birth, sex, marital status, country of origin, method and time of arrival, ambulance insurance status, diagnosis, and disposal were collected for all patients who presented over a four month period (n=10 229) to the emergency department of a major provincial hospital. Data for patients with urgent (n=678) or critical care needs (n=332) who did not use pre-hospital care were analysed using Poisson regression. Results-Only a small percentage (6.6%) of the total sample were triaged as having urgent medical needs or critical care needs (3.2%). Predictors of usage for those with urgent care needs included age greater than 65 years (prevalence ratio (PR)=0.54; 95% confidence interval (CI)= 0.35 to 0.83), being admitted to intensive care or transferred to another hospital (PR=0.62; 95% CI=0.44 to 0.89) or ward (PR=0.72; 95% CI=0.56 to 0.93) and ambulance insurance status (PR=0.67; 95% CI=052 to 0.86). Sex, marital status, time of day and country of origin were not predictive of usage and non-usage. Predictors of usage for those with critical care needs included age 65 years or greater (PR=0.45; 95% CI=0.25 to 0.81) and a diagnosis of trauma (PR=0.49; 95% CI=0.26 to 0.92). A non-English speaking background was predictive of non-usage (PR=1.98; 95% CI=1.06 to 3.70). Sex, marital status, time of day, triage and ambulance insurance status were not predictive of non-usage. Conclusions-Socioeconomic and medical factors variously influence ambulance usage depending on the severity or urgency of the medical condition. Ambulance insurance status was less of an influence as severity of condition increased suggesting that, at a critical level of urgency, patients without insurance are willing to pay for a pre-hospital ambulance service.

On feasibility of regional frequency-based emergency control plans

Decentralized and regional load-frequency control of power systems operating in normal and near-normal conditions has been well studied; and several analysis/synthesis approaches have been developed during the last few decades. However in contingency and off-normal conditions, the existing emergency control plans, such as under-frequency load shedding, are usually applied in a centralized structure using a different analysis model. This paper discusses the feasibility of using frequency-based emergency control schemes based on tie-line measurements and local information available within a control area. The conventional load-frequency control model is generalized by considering the dynamics of emergency control/protection schemes and an analytic approach to analyze the regional frequency response under normal and emergency conditions is presented.

Growing demand for emergency health services in Queensland, Australia

Introduction: The demand for emergency health services (EHS), both in the prehospital (ambulance) and hospital (emergency departments) settings, is growing rapidly in Australia. Broader health system changes have reduced available health infrastructure, particularly hospital beds, resulting in reduced access to and congestion of the EHS as demonstrated by longer waiting times and ambulance “ramping”. Ambulance ramping occurring when patients have a prolonged wait on the emergency vehicle due to the unavailability of hospital beds. This presentation will outline the trends in EHS demand in Queensland compared with the rest of Australia and factors that appear to be contributing to the growth in demand. Methods: Secondary analysis was conducted using data from publicly available sources. Data from the Queensland Ambulance Service and Queensland Health Emergency Department Information System (EDIS) also were analyzed. Results: The demand for ambulance services and emergency departments has been increasing at 8% and 4% per year over the last decade, respectively; while accessible hospital beds have reduced by almost 10% contributing to the emergency department congestion and possibly contributing to the prehospital demand. While the increase in the proportion of the elderly population seems to explain a great deal of the demand for EHS, other factors also influence this growth including patient characteristics, institutional and societal factors, economic, EHS arrangements, and clinical factors. Conclusions: Overcrowding of facilities that provide EHS are causing considerable community concern. This overcrowding is caused by the growing demand and reduced access. The causes of this growing demand are complex, and require further detailed analysis in order to quantify and qualify these causes in order to provide a resilient foundation of evidence for future policy direction.

Queensland Emergency Medical System : a structural and organizational model for the emergency medical system in Australia

Objective: The emergency medical system (EMS) can be defined as a comprehensive, coordinated and integrated system of care for patients suffering acute illness and injury. The aim of the present paper is to describe the evolution of the Queensland Emergency Medical System (QEMS) and to recommend a strategic national approach to EMS development. Methods: Following the formation of the Queensland Ambulance Service in 1991, a state EMS committee was formed. This committee led the development and approval of the cross portfolio QEMS policy framework that has resulted in dynamic policy development, system monitoring and evaluation. This framework is led by the Queensland Emergency Medical Services Advisory Committee. Results: There has been considerable progress in the development of all aspects of the EMS in Queensland. These developments have derived from the improved coordination and leadership that QEMS provides and has resulted in widespread satisfaction by both patients and stakeholders. Conclusions: The strategic approach outlined in the present paper offers a model for EMS arrangements throughout Australia. We propose that the Council of Australian Governments should require each state and Territory to maintain an EMS committee. These state EMS committees should have a broad portfolio of responsibilities. They should provide leadership and direction to the development of the EMS and ensure coordination and quality of outcomes. A national EMS committee with broad representation and broad scope should be established to coordinate the national development of Australia's EMS.

How does ambulance service utilisation impact demand for Emergency Departments in Queensland, Australia?

Background: There are indications that pre-hospital emergency care and management of patients can help reduce the demand for hospital emergency departments (EDs). Ambulance services play a significant role at this stage of care. In 2003, the Queensland Government introduced a Community Ambulance Cover (CAC) levy in return for a free ambulance service at the point of access to all Queenslanders. This may have led to the impression in consumers of an entitlement to free ambulance services under any circumstances regardless of the urgency of the matter which may have in turn contributed to the crowding of EDs in Queensland. Objectives: This paper aims to answer the following questions: - How many patients arrive at hospital EDs by ambulance in Queensland, compared to other modes of arrival? - How has this changed over time, particularly after the CAC introduction in 2003? What percentage of ambulance arrivals are urgent ED patients? - Has the perceived free ambulance services created extra demand for EDs in Queensland, compared with other Australian jurisdictions that charge patients for ambulance services? Methods: We will secondary analyse the data from sources such as Queensland Ambulance Services, Department of Health and Australian Bureau of Statistics to answer the research questions. Findings and Conclusions Queensland has the highest utilization rate of ambulance services (about 18% in 2007-08) and the highest annual growth rate in demand for these services (7.7% on average since 2000-01), well above the population growth. On the other hand, the proportion of ED patients arriving by ambulance in Queensland has increased by about 4% annually. However, when compared with other states and territories with charge at the point of access, it seems that the growth in demand for EDs cannot be explained solely or mainly by CAC or ambulance utilisation in Queensland.