Emergencies and Public Health Crisis Management- Current Perspectives on Risks and Multiagency Collaboration

The successful management of emergencies and public health crises depends on adequate measures being implemented at all levels of the emergency chain of action, from policy makers to the general population. It starts with appropriate risk assessment, prevention, and mitigation and continues to prehospital and hospital care, recovery, and evaluation. All levels of action require well-thought out emergency management plans and routines based on established command and control, identified safety issues, functional communication, well-documented triage and treatment policies, and available logistics. All these characteristics are capabilities that should be developed and trained, particularly when diverse agencies are involved. In addition to institutional responses, a robust, community-based disaster response system can effectively mitigate and respond to all emergencies. A well-balanced response is largely dependent on local resources and regional responding agencies that all too often train and operate within “silos”, with an absence of interagency cooperation. The importance of this book issue is its commitment to all parts of emergency and public health crisis management from a multiagency perspective. It aims to discuss lessons learned and emerging risks, introduce new ideas about flexible surge capacity, and show the way it can practice multiagency collaboration

Pre-hospital pain management in children: A mixed methods study

Background Pain is a highly complex sensory and emotional experience; the biological, psychological and social aspects must each be considered. The intersection between the phenomenon of pain, the unpredictable pre-hospital environment and children is highly convoluted. Studies have shown that pre-hospital pain management in children is poor, despite access to pain management being considered a fundamental human right. Without effective pain treatment, children may suffer long-term psychological changes (e.g. altered pain perception) and are at risk of developing post-traumatic stress disorder. The aim of this thesis was to identify predictors, barriers and facilitators associated with effective pre-hospital pain management in children suffering acute pain and to identify ways to improve the quality of care. Methods A postpositivist paradigm was adopted for the study, with a critical realist ontology and a modified objectivist epistemology. A mixed methods sequential explanatory design was adopted, informed by a systematic mixed studies review. The initial quantitative study employed a multivariable logistic regression analysis using routinely collected clinical data to identify predictors of effective pain management. The final qualitative study used face-to-face semi-structured interviews with ambulance clinicians to help explain the identified predictors, identify barriers and facilitators and explore ways to improve the quality of care. Interviews were audio recorded and transcribed verbatim with thematic analysis used to analyse the data. Results The systematic mixed studies review included 13 studies (8 quantitative and 5 qualitative) and highlighted the importance of analgesic administration. The initial quantitative study included 2312 clinical records; only 39% of children suffering acute pain achieved effective pain management. Predictors of effective pain management included children who were younger, administered analgesics, attended by a paramedic or living in an area of low or medium deprivation. The final qualitative study included 12 ambulance clinicians (9 paramedics and 3 emergency medical technicians) who provided possible explanations for these disparities. Novel barriers and facilitators were also identified along with ways to improve pain management. Meta-inferences were developed which provided a more comprehensive understanding of this complex phenomenon. To improve pre-hospital pain management in children, the following recommendations were made; 1) explore methods to increase rates of analgesic administration, perhaps by utilising the intranasal and inhaled route; 2) reduce fear and anxiety in children, perhaps by using child friendly uniform, non-pharmacological techniques and more public interaction and 3) reduce fear and anxiety in clinicians, by enhancing training, optimising crew mix and developing a more pragmatic pain assessment tool. A theoretical model of pre-hospital pain management in children was developed as part of this thesis. Conclusion Pre-hospital pain management in children may be improved by increasing rates of analgesic administration and reducing the fear and anxiety experienced by children and clinicians. Future research should explore the experience of the child and determine the most important outcome measures. Robust clinical trials are needed to determine the efficacy and safety of intranasal (fentanyl/ketamine) and inhaled (methoxyflurane) analgesics in the pre-hospital setting. Investment in future research and intervention development is imperative; we need to make children’s pain in the pre-hospital setting matter

Undergraduate nursing students’ team communication skills within a simulated emergency setting : a grounded theory study

Recognising and managing clinical deterioration is considered a high priority in health care with ineffective communication being a significant contributing factor to poor clinical outcomes for patients. Nurses are in a unique position to make a difference in influencing improvements in team communication. In Australia, nurse education has become more complicated and demanding with nursing students focus on behaviour skills, such as communication, becoming more difficult in a saturated curriculum. Simulation-based education has provided an experiential way to learn these complex skills. Although there has been much work in the healthcare literature on clinical teamwork, including communication and its intersection with patient safety, there is still a gap in explaining how individuals within the team contribute to communication. The purpose of this study was to explore and explain how nursing students communicate in simulated emergency settings and how factors, such as culture, language, gender, age and power, affect nursing students’ team communication. This study investigated how transitioning nursing students are prepared with the necessary skills to achieve effective team communication at the point of transition to clinical practice as registered nurses. In order to address the aims of the study, a constructivist grounded theory methodology, informed by Kathy Charmaz (2006), was employed. Using purposive sampling, third year nursing students were recruited from one Australian university, to undertake a structured team simulation experience. Participants worked in teams of three or four to experience the team communication whilst working together to care for a deteriorating patient in the form of a mannequin. Simulations were video recorded after which individual, in-depth, semi-structured interviews were conducted with 21 participants. In line with a grounded theory approach, data collection and analysis were conducted concurrently until theoretical saturation was achieved. In response to the central problem of how nursing students communicate in simulated emergency settings, a core process was established that explained the factors that affect team communication. This problem is conceptualised as Navigating uncertainty: Explaining communication of nursing students within an emergency setting. This theoretical construct helps to explain nursing students’ actions and insights into factors that influence their communication within emergency teams. The core process is represented in three transitional stages of the theory comprising: Finding a place in the team, Understanding and working out differences and Looking to the future: Developing strategies to improve communication. This process was mediated by contextual conditions of the student, the simulation and the team. The phases are reinforced by the three main categories of Having a place in the team, Knowing yourself, and Transitioning from student to registered nurse. These categories represent the key activities that nursing students were engaged with that led to the development of the core category and process. The generated findings and theory offer valuable insights into factors that influence team communication skills within emergency settings. The theory raises awareness of social processes undertaken by nursing students during team communication, and highlights obstacles that can assist educators and academics to structure team communication education to better meet the needs of nursing students transitioning to practice settings.Doctor of Philosoph

Challenges for engineering students working with authentic complex problems

Engineers are important participants in solving societal, environmental and technical problems. However, due to an increasing complexity in relation to these problems new interdisciplinary competences are needed in engineering. Instead of students working with monodisciplinary problems, a situation where students work with authentic complex problems in interdisciplinary teams together with a company may scaffold development of new competences. The question is: What are the challenges for students structuring the work on authentic interdisciplinary problems? This study explores a three-day event where 7 students from Aalborg University (AAU) from four different faculties and one student from University College North Denmark (UCN), (6th-10th semester), worked in two groups at a large Danish company, solving authentic complex problems. The event was structured as a Hackathon where the students for three days worked with problem identification, problem analysis and finalizing with a pitch competition presenting their findings. During the event the students had workshops to support the work and they had the opportunity to use employees from the company as facilitators. It was an extracurricular activity during the summer holiday season. The methodology used for data collection was qualitative both in terms of observations and participants’ reflection reports. The students were observed during the whole event. Findings from this part of a larger study indicated, that students experience inability to transfer and transform project competences from their previous disciplinary experiences to an interdisciplinary setting

Exploring the practical use of a collaborative robot for academic purposes

This article presents a set of experiences related to the setup and exploration of potential educational uses of a collaborative robot (cobot). The basic principles that have guided the work carried out have been three. First and foremost, study of all the functionalities offered by the robot and exploration of its potential academic uses both in subjects focused on industrial robotics and in subjects of related disciplines (automation, communications, computer vision). Second, achieve the total integration of the cobot at the laboratory, seeking not only independent uses of it but also seeking for applications (laboratory practices) in which the cobot interacts with some of the other devices already existing at the laboratory (other industrial robots and a flexible manufacturing system). Third, reuse of some available components and minimization of the number and associated cost of required new components. The experiences, carried out following a project-based learning methodology under the framework of bachelor and master subjects and thesis, have focused on the integration of mechanical, electronic and programming aspects in new design solutions (end effector, cooperative workspace, artificial vision system integration) and case studies (advanced task programming, cybersecure communication, remote access). These experiences have consolidated the students' acquisition of skills in the transition to professional life by having the close collaboration of the university faculty with the experts of the robotics company.Postprint (published version