The effectiveness of health interventions in cardiovascular risk reduction among emergency service personnel

Purpose
The physical demands and hazards associated with emergency service work place particular stress on responders’ cardiovascular systems. Indeed, cardiovascular disease (CVD) is a significant problem for emergency service personnel. Although it may be difficult to alter the cardiovascular health hazards associated with the work environment, it is possible for personnel to control their modifiable CVD risk factors, cardiovascular fitness levels and subsequently, reduce their CVD risk. This review aimed to determine the effectiveness and methodological quality of health interventions designed to mitigate CVD risk in emergency service personnel.

Methods
A literature search of electronic journal databases was performed. Sixteen relevant studies were assessed for methodological quality using a standardised assessment tool. Data regarding the effectiveness of each intervention were extracted and synthesised in a narrative format.

Results
Fifteen studies were rated ‘Weak’ and one study was rated ‘Strong’. Interventions which combined behavioural counselling, exercise and nutrition were more effective in improving cardiovascular health than nutrition, exercise or CVD risk factor assessment-based interventions alone. Further, CVD risk factor assessment in isolation proved to be an ineffective intervention type to reduce CVD risk.

Conclusion
Combined interventions appear most effective in improving the cardiovascular health of emergency service personnel. Accordingly, fire and emergency service agencies should consider trialling multifaceted interventions to improve the cardiovascular health of personnel and avoid interventions focused only on one of nutrition, exercise or CVD risk factor assessment. However, as most studies were methodologically weak, further studies of a higher methodological quality are needed.

Effects of work-related sleep restriction on acute physiological and psychological stress responses and their interactions: A review among emergency service personnel

Emergency work can expose personnel to sleep restriction. Inadequate amounts of sleep can negatively affect physiological and psychological stress responses. This review critiqued the emergency service literature (e.g., firefighting, police/law enforcement, defense forces, ambulance/paramedic personnel) that has investigated the effect of sleep restriction on hormonal, inflammatory and psychological responses. Furthermore, it investigated if a psycho-physiological approach can help contextualize the significance of such responses to assist emergency service agencies monitor the health of their personnel. The available literature suggests that sleep restriction across multiple work days can disrupt cytokine and cortisol levels, deteriorate mood and elicit simultaneous physiological and psychological responses. However, research concerning the interaction between such responses is limited and inconclusive. Therefore, it is unknown if a psycho-physiological relationship exists and as a result, it is currently not feasible for agencies to monitor sleep restriction related stress based on psycho- physiological interactions. Sleep restriction does however, appear to be a major stressor contributing to physiological and psychological responses and thus, warrants further investigation.

Losing innocence : finding the line between emotional bonds and boundaries in protective service work

This paper builds on existing literature on the notion of emotional labour by investigating work in a child protective service environment. Notable characteristics of formal organisations, such as child protective services, are that they operate within a legal framework and that workers' professional duties have great influence on clients. This paper examines the intricacies of the worker-client relationship and the emotional dynamics of the service interactions by interviewing a group of workers in a public hospital in Victoria, Australia. This research extricates the complexities in the client-worker relationship by examining a range of work characteristics including their roles as professional caregivers, the emotional bonds and boundaries in the workers-client relationship, the intensity and magnitude of felt and displayed emotions, as well as the self-management of emotions and clients' emotions. This study adds to existing knowledge on the emotional expressions, experiences and regulation of emotions of the professional work lives in a child protective service work environment.
This paper is divided into the following sections. The first section details protective service work within the larger framework of human service work, and how the worker-client interface is different from other front-line service work. This is followed the need to examine the emotional dynamics of work in a child protective service organisation. Next, a study of these emotional dynamics in a child protective service organisation is reported. The paper concludes with a consideration of the wider implications for the sociology of protective service work, and how affective issues differ other service work roles.

Enterprise social networking in knowledge-intensive work practices : a case study in a professional service firm

Social media technologies are making fast inroads into organisations. In the context of knowledge-intensive work the propositions of improved communication, information sharing and user involvement seem particularly promising. We study the phenomenon of Enterprise Social Networking (ESN) in the context of Professional Service Firms (PSF). Our case study investigates emerging knowledge work practices on the ESN platform Yammer within Deloitte Australia. We perform a genre analysis of communication data and uncover a set of emerging practices. We reflect on our results in the context of the knowledge-intensive nature of professional service work. We find that Yammer in the case company has become 1) an information-sharing channel, 2) a space for crowdsourcing ideas, 3) a place for finding expertise and solving problems and 4) a conversation medium for context and relationship building. We conclude by positioning ESN in the well-known 3-C model for classifying collaborative ICT.

Extending social marketing to emergency services organisations

Social marketing theory is examined in relation to an organisational context which has received little attention. This paper examines the development of an integrated social marketing campaign for a State Emergency Service, and focusses on a particularly serious scenario where the penalty for miscommunication may be death, widespead injury or substantial property damage. The researchers take an action research approach, identifying community perceptions of risk to determine appropriate communication message development. The study identifies the factors contributing to risk perception beyond traditional concepts of involvement which are common in studies of consumer behaviour. Additionally, this paper provides an investigation of some of the issues that affect communication effectiveness, such as the influence of stakeholders, the poor performance of traditional communications methods, the utility of social marketing principles, and segmentation requirements, as well as influential ideas from the general risk communication literature.

Sculpting fog: attempting to define "acceptable risk" in emergency services.

There is currently no consensus as to how “acceptable risk” should be defined in emergency service response. Attempts to address this have relied upon the assumption that a probabilistic model of risk can be calculated and that acceptable levels of risk can be determined. Examples of this process can be seen in a number of emergency services, e.g. dynamic risk assessment utilised by a number of fire services.

Small rural emergency departments are not simply cut-down large urban emergency departments

 It is important to understand how small rural emergency departments work. They are a significant fraction of a state’s medical system. Although they each see only a few thousand patients a year, as a group they are likely to treat more emergency patients than the largest city hospital. It is a myth that they only deal with minor ailments. 

Examination of the "all hazards" approach to disaster management as applied to field disaster management and pre-hospital care in Australia

Disasters, emergencies, incidents, and major incidents - they all come back to the same thing regardless of what they are called. The common denominator is that there is loss of life, injury to people and animals and damage and destruction of property. The management of such events relies on four phases: 1. Prevention 2. Preparation 3. Response 4. Recovery Each of these phases is managed in a different way and often by different teams. Here, concentration has been given to phases 2 and 3, with particular emphasis on phase 3, Response. The words used to describe such events are often related to legislation. The terminology is detailed later. However, whatever the description, whenever prevention is not possible, or fails, then the need is to respond. Response is always better when the responders are prepared. Training is a major part of response preparation and this book is designed to assist those in the health industry who need to be ready when something happens. One of the training packages for responders is the Major Incident Medical Management and Support (MIMMS) Course and this work was designed to supplement the manual prepared by Hodgetts and Macway-Jones(87) in the UK. Included is what the health services responder, who may be sent to an event in which the main concern is trauma, should know. Concentration is on the initial response and does not deal in any detail with hospital reaction, the public health aspects, or the mental health support that provides psychological help to victims and responders, and which are also essential parts of disaster management. People, in times of disaster, have always been quick to offer assistance. It is now well recognised however, that the 'enthusiastic amateur', whilst being a well meaning volunteer, isn't always what is needed. All too often such people have made things worse and have sometimes ended up as victims themselves. There is a place now for volunteers and there probably always will be. The big difference is that these people must be well informed, well trained and well practiced if they are to be effective. Fortunately such people and organisations do exist. Without the work of the St John Ambulance, the State Emergency Service, the Rural Fire Service the Red Cross and the Volunteer Rescue Association, to mention only a few, our response to disasters would be far less effective. There is a strong history of individuals being available to help the community in times of crisis. Mostly these people were volunteers but there has also always been the need for a core of professional support. In the recent past, professional support mechanisms have been developed from lessons learned, particularly to situations that need a rapid and well organised response. As lessons are learned from an analysis of events, philosophy and methods have changed. Our present system is not perfect and perhaps never will be. The need for an 'all-hazards approach' makes detailed planning very difficult and so there will probably always be criticisms about the way an event was handled. Hindsight is a wonderful thing, provided we learn from it. That means that this text is certainly not the 'last word' and revisions as we learn from experience will be inevitable. Because the author works primarily in New South Wales, many of the explanations and examples are specific to that state. In Australia disaster response is a State, rather than a Commonwealth, responsibility and consequently, and inevitably, there are differences in management between the states and territories within Australia. With the influence of Emergency Management Australia, these differences are being reduced. This means that across state and territory boundaries, assistance is common and interstate teams can be deployed and assimilated into the response rapidly, safely, effectively and with minimum explanation. This text sets out to increase the understanding of what is required, what is in place and how the processes of response are managed. By way of introduction and background, examples are given of those situations that have occurred, or could happen. Man Made Disasters has been divided into two distinct sections. Those which are related to structures or transport and those related directly to people. The first section, Chapter 3, includes: • Transport accidents involving land, rail, sea or air vehicles. • Collapse of buildings for reasons other than earthquakes or storms. • Industrial accidents, including the release of hazardous substances and nuclear events. A second section dealing with the consequences of the direct actions of people is separated as Chapter 4, entitled 'People Disasters'. Included are: • Crowd incidents involving sports and entertainment venues. • Terrorism From Chapter 4 on, the emphasis is on the Response phase and deals with organisation and response techniques in detail. Finally there is a section on terminology and abbreviations. An appendix details a typical disaster pack content. War, the greatest of all man made disasters is not considered in this text.

Social media in disaster response : Queensland Police Service - public engagement during the 2011 floods

Social Media, particularly Microblogging services, are now being adopted as an additional tool for emergency service agencies to be able to interact with the community at all stages of a disaster. Unfortunately, no standard framework for Social Media adoption for disaster management exists and emergency service agencies are adopting Social Media in an ad-hoc fashion. This paper seeks to provide a general understanding of how Social Media is being used by emergency service agencies during disasters, to better understand how we might develop a standardised framework of adoption. In this study of the 2010/11 Queensland Flood event, Facebook broadcast messages from the Queensland Police Service to the general public, were analysed by genre. Findings show that these Microblogging activities were mostly about information distribution and warning broadcasts and that the strength of Social Media for two-way communication and collaboration with the general public, was under-utilised during this event.

'Hands-on' assessment: a useful strategy for improving patient safety in emergency departments

BACKGROUND: Patient assessment is an essential nursing intervention that reduces the incidence and impact of errors and preventable adverse events in emergency departments (EDs). This paper reports on a key finding of the ED nurse component of a larger study investigating how registered nurses manage 'discontinuities' or 'gaps' in patient care. METHODS: The larger study was undertaken as a naturalistic inquiry using a qualitative exploratory descriptive approach. Data were collected from a criterion-based purposeful sample of 71 nurses, of which 19 were ED nurses, and analysed using content and thematic analysis strategies. RESULTS: The component of the study reported here revealed that ED nurses used 'hands-on', head-to-toe assessment to manage gaps in patient care. Examination of the data revealed three key dimensions of patient assessment in the ED: (i) assessment is the 'bread and butter' of emergency nursing; (ii) 'hands-on' assessment techniques are irreplaceable and, (iii) patient assessment is undervalued in EDs. CONCLUSIONS: The findings of this study reaffirm the role of 'hands-on' observation and assessment in creating safety in EDs. Further research and inquiry is needed to determine how health care systems can provide the conditions for ensuring that 'hands-on' assessment occurs.

Impact of automated dispensing cabinets on medication selection and preparation error rates in an emergency department: a prospective and direct observational before-and-after study

RATIONALE, AIMS AND OBJECTIVES: The implementation of automated dispensing cabinets (ADCs) in healthcare facilities appears to be increasing, in particular within Australian hospital emergency departments (EDs). While the investment in ADCs is on the increase, no studies have specifically investigated the impacts of ADCs on medication selection and preparation error rates in EDs. Our aim was to assess the impact of ADCs on medication selection and preparation error rates in an ED of a tertiary teaching hospital. METHODS: Pre intervention and post intervention study involving direct observations of nurses completing medication selection and preparation activities before and after the implementation of ADCs in the original and new emergency departments within a 377-bed tertiary teaching hospital in Australia. Medication selection and preparation error rates were calculated and compared between these two periods. Secondary end points included the impact on medication error type and severity. RESULTS: A total of 2087 medication selection and preparations were observed among 808 patients pre and post intervention. Implementation of ADCs in the new ED resulted in a 64.7% (1.96% versus 0.69%, respectively, P = 0.017) reduction in medication selection and preparation errors. All medication error types were reduced in the post intervention study period. There was an insignificant impact on medication error severity as all errors detected were categorised as minor. CONCLUSION: The implementation of ADCs could reduce medication selection and preparation errors and improve medication safety in an ED setting.

A structured framework improves clinical patient assessment and nontechnical skills of early career emergency nurses: a pre-post study using full immersion simulation

AIMS AND OBJECTIVES: The aim of this study was to evaluate the effect of the new evidence-informed nursing assessment framework HIRAID (History, Identify Red flags, Assessment, Interventions, Diagnostics, reassessment and communication) on the quality of patient assessment and fundamental nontechnical skills including communication, decision making, task management and situational awareness. BACKGROUND: Assessment is a core component of nursing practice and underpins clinical decisions and the safe delivery of patient care. Yet there is no universal or validated system used to teach emergency nurses how to comprehensively assess and care for patients. DESIGN: A pre-post design was used. METHODS: The performance of thirty eight emergency nurses from five Australian hospitals was evaluated before and after undertaking education in the application of the HIRAID assessment framework. Video recordings of participant performance in immersive simulations of common presentations to the emergency department were evaluated, as well as participant documentation during the simulations. Paired parametric and nonparametric tests were used to compare changes from pre to postintervention. RESULTS: From pre to postintervention, participant performance increases were observed in the percentage of patient history elements collected, critical indicators of urgency collected and reported to medical officers, and patient reassessments performed. Participants also demonstrated improvement in each of the four nontechnical skills categories: communication, decision making, task management and situational awareness. CONCLUSION: The HIRAID assessment framework improves clinical patient assessments performed by emergency nurses and has the potential to enhance patient care. RELEVANCE TO CLINICAL PRACTICE: HIRAID should be considered for integration into clinical practice to provide nurses with a systematic approach to patient assessment and potentially improve the delivery of safe patient care.

Anxiety is more common in children with asthma

Objective There are a variety of reasons why there may be an association between asthma and anxiety in children. Research into the relation between asthma and anxiety has been limited by the sole use of parent-reported or self-reported asthma symptoms to define asthma status. The objective of this study was to determine if children with physician-defined asthma are more likely to suffer anxiety than children without asthma.

Design A population-based, cross-sectional assessment, of self-reported anxiety symptoms.

Setting and participants Children aged 5–13 years from Barwon region of Victoria, Australia. Asthma status was determined by review with a paediatrician. Controls were a sample of children without asthma symptoms (matched for age, gender and school).

Outcome measure The Spence Children's Anxiety Scale (SCAS) written questionnaire. The authors compared the mean SCAS score, and the proportion of children with an SCAS score in the clinical range, between the groups.

Results Questionnaires were issued to 205 children with asthma (158 returned, response rate 77%), and 410 controls (319 returned, response rate 78%). The SCAS scores were higher in asthmatics than controls (p<0.001); and were more likely to be in the clinical range (OR=2.5, 95% CI 1.1 to 5.8, p=0.036). There was no evidence that these associations could be explained by known confounding factors.

Conclusions Children with asthma are substantially more likely to suffer anxiety than children without asthma. Future studies are required to determine the sequence of events that leads to this comorbidity, and to test strategies to prevent and treat anxiety among children with asthma.