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.

Habit retraining for the management of urinary incontinence in adults (review)

Background
Habit retraining is toileting assistance given by a caregiver to adults with urinary incontinence. It involves the identification of an incontinent person's natural voiding pattern and the development of an individualised toileting schedule which pre-empts involuntary bladder emptying.

Objectives
To assess the effects of habit retraining for the management of urinary incontinence in adults.

Search strategy
We searched the Cochrane Incontinence Group specialised register (9 May 2002), MEDLINE (January 1966 to February 2004), EMBASE (January 1980 to Week 18-2002), CINAHL (January 1982 to February 2001), PsychINFO (January 1972 to August 2002), Biological Abstracts (January 1980 to December 2000), Current Contents (January 1993 to December 2001) and the reference lists of relevant articles. We also contacted experts in the field, searched relevant websites and hand searched journals and conference
proceedings.

Selection criteria
All randomised or quasi-randomised controlled trials comparing habit retraining delivered either alone or in conjunction with another intervention for urinary incontinence in adults.

Data collection and analysis
Data extraction and quality assessment were undertaken by at least two people working independendy of each other. Any differences were resolved by discussion. The relative risks for dichotomous data were calculated with 95% confidence intervals. Where data were insufficient for a quantitative analysis, a narrative overview was undertaken.

Main results
Three trials with a total of 337 participants met the inclusion criteria, describing habit retraining combined with other approaches compared with usual care. Participants were primarily care-dependent elderly women with concurrent cognitive and/or physical impairment, residing in either a residential aged-care facility or in their own home. Outcomes included incidence and/or severity of urinary incontinence, the prevalences of urinary tract infection, skin rash and skin breakdown, cost and caregiver preparedness, role strain and burden. Caregivers found it difficult to maintain voiding records and to implement the toileting program. A 61% compliance rate was reported in one trial .

There were no statistically significant differences in the incidence and in the volume of incontinence between groups. Within group analyses did however show improvements on these measures. Reductions were also reported for the intervention group in one study for skin rash, skin breakdown and in caregivers' perceptions of their level of stress. Descriptive data on the. intervention suggests that habit retraining is a labour-intense activity. Electronic loggers, used as an adjunct to caregiver-delivered wet/dry checks, were reported as providing more accurate data than that from caregiver conducted wet/dry checks. To date, no analysis of the time and resources associated with these comparisons is available.

Reviewers' conclusions
Data on habit retraining are few and of insufficient quality to provide a firm basis for practice.

The conceptualisation of operational risk management models

Operational risk is evolving as a specialist field of risk management that must be practiced within all organisations, but currently has a particular relevance to banks. The Basel Committee on Banking Supervision has circulated a consultative paper which, if adopted by nation-state bank supervisors, will impose an operational risk capital charge on banks as part of a new Capital Accord. The definition of operational risk is wide-ranging and creates some unique issues related to the development of appropriate risk management models. This paper conceptualises two distinct operational risk management models; being a predictive model that will result in a known outcome upon its implementation, and a pre-emptive operational risk management model which prepares an organisation in the event that a future risk occurrence results in a disruption to critical business operations.

Marketing readiness of websites and organisational performance in Australia and New Zealand: a discussion of pre-test findings

The Web played a role in the burst of economic activity that occurred in the late 1990s that saw company values dramatically rise and fall, business and government processes reshaped, traditional marketing media challenged, and much written concerning the benefits to customers from the adoption of what was initially termed e-commerce. Initial empirical studies of Australian and New Zealand business and government use of the Web found that while the Web was used for marketing communication, it was not as favoured as trade press reports suggested as a marketing transaction channel, nor for relationship management. This paper, which reports the findings of a pre-test of the self-administered online questionnaire stage of a three-phase study, suggests that little has changed in organisational use of the Web in Australia and New Zealand since the late 1990s, even among high network traffic organisations. The pre-test findings reported do not present a clear picture concerning the influence of strategic use of traditional and online marketing mix elements on organisational performance. Analysis employing a Marketing Readiness of Website Indicator (MRWI) content analysis tool is shown not to predict organisational performance as hypothesised.

Evaluation of a stress management course in adult education centres in rural Australia

Objective: To investigate whether attending a six-week stress management course in a rural adult education centre is effective in reducing participants' levels of stress, anxiety and depression.

Design: Repeated measures design using self-report measures of stress, anxiety and depression at commencement and completion of a six-week stress management course, and six months post-completion follow up.

Setting and participants: One hundred and thirty-two adults (age range 18–73 years) living in a rural community who self-enrolled in the stress management course at adult education centres.

Intervention: The course consisted of six weekly group sessions. Each two-hour session conducted by mental health professionals, included teaching cognitive behavioural strategies targeted at reducing individual symptoms of stress.

Main outcome measures: Comparative analysis of pre- and post-test and six-month follow up on measures of stress (Stress Symptom Checklist), anxiety and depression (Hospital Anxiety and Depression Scale).

Results: Results indicated a significant reduction in stress symptoms (F(7,90) = 34.92, P < 0.001), anxiety and depression (F(3,95) = 87.92, P < 0.001) from course commencement to course completion. These improvements were sustained six months after course completion for stress symptoms (F(11,65) = 22.40, P < 0.001), anxiety and depression (F(5,73) = 41.78, P < 0.001).

Conclusion: Findings demonstrate the stress management course is an effective community intervention in a rural community. Challenges for future implementation of the program are discussed.

Criticisms of auditors and earnings management during the Asian economic crisis

Auditors were criticised during and after the Asian economic crisis for supplying variable quality across global audit markets. This study examines
the level of earnings management as measured by discretionary accruals in the pre-crisis compared to the post-crisis periods as they impacted Malaysia. Both the Jones (1991) and earnings per share frequency distribution methods are used to examine earnings management behaviour. As hypothesised, the pre-crisis period is associated with significantly higher levels of absolute discretionary accruals and increased propensity to meet or beat the prior year earnings per share, whereas the post-crisis period is not. This finding is consistent with auditors responding to the criticisms that were made. However, the propensity to avoid losses is found to be higher in the post-crisis period, indicating that earnings management is not fully constrained.

Workplace strategies and facilities management

This book provides comprehensive coverage of issues that facility managers in the property industry need to understand and apply in the pursuit of value for money over the life span of built facilities. The authors introduce the fast-growing discipline of facility management, examine the core competencies that facility managers should possess and study different contemporary drivers of change. The book emphasises the need to consider facilities management issues at the pre-design stage of the construction process, rather than only when the building is completed, in order to maximise value for money.

The conceptualisation of operational risk management models

Operational risk is evolving as a specialist field of risk management that must be practiced within all organisations, but currently has a particular relevance to banks. The Basel Committee on Banking Supervision has circulated a consultative paper which, if adopted by nation-state bank supervisors, will impose an operational risk capital charge on banks as part of a new Capital Accord. The definition of operational risk is wide-ranging and creates some unique issues related to the development of appropriate risk management models. This paper conceptualises two distinct operational risk management models; being a predictive model that will result in a known outcome upon its implementation, and a pre-emptive operational risk management model which prepares an organisation in the event that a future risk occurrence results in a disruption to critical business operations.

The assessment of formal management development : a method, a baseline and the need to incorporate learning styles

Purpose – To assess the impact of a course on the development of management competencies for students over the duration of the course, by examining changes in the competencies of the students. The potential impact of student learning styles was also examined in the study.

Design/methodology/approach – A “Pre, Post, Then” design and a combination of paired sample t-tests, and alpha and beta change statistics were used to examine the change in competencies over time.

Findings – This study found that even a standard subject design had a significant and substantial impact on the management competence development of the students.

Practical implications – From the perspective of students-as-products, the base line provided here allows for the testing of alternative designs of educational systems, whereby alternative designs have to prove a benefit above and beyond that of a basic teaching system. Therefore, the present study should assist the field of management development to create a range of design options.

Originality/value – This study applies a powerful and under-utilised research method to provide a base line of the amount of management development that can occur in a typical formal management course, but is unique in that it includes the impact of the students’ learning styles.

Brief anger management programs with offenders : outcomes and predictors of change

Anger management interventions with offenders, particularly violent offenders, are a common form of rehabilitative activity. The rationale for addressing anger problems is clear-cut and there is good evidence that anger management can be effective with some client populations. Information relating to effectiveness with serious offenders, however, is sparse. An intervention study is reported in which offenders receiving anger management were compared with waiting list controls on a range of dependent measures. In general, the degree of pre-treatment/post-treatment change was small and experimental versus control differences were not statistically significant. The degree of improvement was found to be predictable from pre-treatment measures of anger and treatment readiness. Explanations of the low impact of anger management on violent offenders are discussed and recommendations made for improving outcomes.

Aerobic exercise and resistance training for the management of type 2 diabetes mellitus

BACKGROUND
Implementation of a structured physical exercise program can improve glycemic control in patients with type 2 diabetes mellitus.

OBJECTIVE
To evaluate the efficacy of aerobic exercise and resistance training (either alone or in combination) in the management of type 2 diabetes mellitus.

DESIGN AND INTERVENTION
DARE (Diabetes Aerobic and Resistance Exercise) was a 26-week, single-center, parallel-group, randomized, controlled trial of patients with type 2 diabetes mellitus of >6 months' duration. Participants were aged 39-70 years with a baseline [HbA.sub.1c] level 6.6-9.9%. Exclusion criteria included current insulin therapy, regular exercise regime and blood pressure >160/95 mmHg. All participants underwent a 4-week run-in period that comprised 12 sessions of combined aerobic exercise and resistance training; participants who attended [greater than or equal to] 10 sessions were eligible to enter the study. Eligible participants were randomly allocated to one of four groups: aerobic exercise alone; resistance training alone; combined aerobic exercise and resistance training; and no intervention (control group). Exercise was performed three times weekly. The aerobic exercise group progressed from 15-20 min on a treadmill or bicycle ergometer per session at 60% of the maximum heart rate to 45 min per session at 75% of the maximum heart rate. The resistance training group performed 7 different exercises on weight machines per 45 min session, and progressed to 2-3 sets of each exercise at the maximum weight that could be lifted 7-9 times. The combined exercise group performed the full aerobic exercise program plus the full resistance training program. Participants in the control group reverted to their pre-study exercise levels.

OUTCOME MEASURES
The primary outcome measure was the change in [HbA.sub.1c] from baseline. Secondary outcome measures included changes in blood pressure, lipid profile, and body composition.

RESULTS
A total of 251 participants were eligible for intervention. The median session attendance was 80% (aerobic exercise), 85% (resistance training) and 86% (combined exercise). When compared with the control group, the HbA1c levels were reduced by 0.50% in the aerobic exercise group (P = 0.007) and by 0.38% in the resistance training group (P = 0.038). The combined exercise group had an additional reduction of 0.46% when compared with the aerobic exercise group (P = 0.014) and of 0.59% when compared with the resistance training group (P = 0.001). Decreases in [HbA.sub.1c] levels were greatest for participants with a baseline [HbA.sub.1c] level = 7.5% (P <0.001). For participants with a baseline level [HbA.sub.1c] <7.5%, significant improvements in glycemic control were observed in the combined exercise group only (P = 0.002). Changes in blood pressure and lipid profiles did not differ between the groups. By contrast, participation in a structured exercise program improved body composition.

CONCLUSION
Although aerobic exercise or resistance training alone improved glycemic control, additional improvements were observed with the combined exercise regimen.