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Emergency Medical Services (EMS) workers are critical to effective disaster response. Therefore, it is important to understand their knowledge, skills, and preparedness for disasters. This study investigated factors influencing EMS workers' disaster knowledge, skills, and preparedness in the Saudi Arabian context. The study also sought to identify challenges to disaster preparedness among Saudi Arabian EMS workers. A descriptive cross-sectional survey using was distributed to EMS workers in military and government hospitals across 3 Saudi Arabian cities. Responses were recorded on a 6-point Likert scale where higher scores indicated higher knowledge, skills, or preparedness. The results were analysed using descriptive and inferential statistical analysis. 272EMS workers participated in this study. EMS workers reported a moderate level of knowledge (3.56), skills (3.44), and preparedness (3.73) for disasters. Despite this, EMS workers reported a high level of involvement in regular disaster drills ( = 4.24, = 1.274) and a strong interest in further disaster education opportunities ( = 5.43, = 1.121). Participants also reported a high skill level with the triage principles used in their workplace during a disaster ( = 4.06, = 1.218). The study findings revealed a significant positive correlation between disaster preparedness levels and age, years of experience, education level, and the facility worked in. EMS workers have moderate disaster knowledge, skills, and preparedness levels. Knowledge, skill, and preparedness have a significant relationship on the EMS workers' demographics. These findings demonstrate the need to invest in preparing Saudi Arabian EMS workers to effectively respond to bioterrorism disasters.

Background Stunting, a condition in which children fail to achieve their expected height for age, is a significant public health problem, particularly in low- and middle-income countries. The nutrition and caring practices of mothers and children during the first 1000 days of life determine the ability of a child to develop, learn, and thrive; however, mothers who work may not be able to ensure that their child is receiving adequate nutrition in the early stages of life. This study aimed to identify the determinants of working mothers’ stunting prevention behavior, including individual factors, work-related stress, well-being, knowledge, and attitudes toward the behavior of working mothers in supporting the prevention of stunting in West Java Province, Indonesia. Methods This study used a cross-sectional design with a total sample of 225 working mothers in 78 offices mapped in Bandung city, Bekasi city, Bekasi Regency, Karawang Regency, West Bandung Regency, and Sumedang Regency in West Java Province, Indonesia. The inclusion criteria were as follows: working mothers aged 18 and above who reside and work in 6 cities/regencies of the study, have at least one child under the age of 5 years, and have consented to participate. The questionnaire consisted of demographic data and health characteristics, as well as questionnaires on knowledge, attitudes, work-related stress, well-being, and stunting prevention behavior. The data were analyzed using chi-square tests and logistic regression. Results Among the 19 variables, two determinant factors influence stunting prevention behavior among working mothers in West Java Province, Indonesia. These factors are working mothers’ well-being (OR 3.30, P  < 0.001) and knowledge about stunting prevention (OR 2.79, P  < 0.001). A low level of well-being among working mothers increases the risk of poor stunting prevention behavior by 3.30 times. Similarly, insufficient knowledge about stunting prevention increases this risk by 2.79 times. The interplay between well-being and knowledge may improve mothers’ stunting prevention behavior. Conclusions Working mothers’ well-being and knowledge of stunting prevention affect their stunting prevention behavior. This study is the first in Indonesia to explore the determinant factors of stunting prevention behavior among working mothers. Working mothers should receive special attention from the government regarding their rights to improve their well-being and knowledge related to their health. Further research should adopt longitudinal and intervention-based designs, include other caregivers, and explore diverse geographic and employment settings. Research on workplace and policy-level support systems is also recommended to inform more comprehensive strategies for improving child health outcomes.

The International Council of Nurses (ICN; Geneva, Switzerland) and the World Association for Disaster and Emergency Medicine (WADEM; Madison, Wisconsin USA) joined together in 2014 to review the use of the ICN Framework of Disaster Nursing Competencies. The existing ICN Framework (version 1.10; dated 2009) formed the starting point for this review. The key target audiences for this process were members of the disaster nursing community concerned with pre-service education for professional nursing and the continuing education of practicing professional nurses. To minimize risk in the disaster nursing practice, competencies have been identified as the foundation of evidence-based practice and standard development. A Steering Committee was established by the WADEM Nursing Section to discuss how to initiate a review of the ICN Framework of Disaster Nursing Competencies. The Steering Committee then worked via email to develop a survey to send out to disaster/emergency groups that may have nurse members who work/respond in disasters. Thirty-five invitations were sent out with 20 responses (57%) received. Ninety-five percent of respondents knew of the ICN Framework of Disaster Nursing Competencies, with the majority accessing these competencies via the Internet. The majority of those who responded said that they make use of the ICN Framework of Disaster Nursing Competencies with the most common use being for educational purposes. Education was done at a local, national, and international level. The competencies were held in high esteem and valued by these organizations as the cornerstone of their disaster education, and also were used for the continued professional development of disaster nursing. However, respondents stated that five years on from their development, the competencies also should include the psychosocial elements of nurses caring for themselves and their colleagues. Additionally, further studies should explore if there are other areas related to the disaster nursing practice (in addition to psychosocial concerns) that may be missing or not fully developed. Finally, the authors of this report recommend that future research explore how the ICN Framework of Disaster Nursing Competencies do or do not assist in maintaining best practices in this field and improve outcomes for victims of disaster. Hutton A , Veenema TG , Gebbie K . Review of the International Council of Nurses (ICN) Framework of Disaster Nursing Competencies. Prehosp Disaster Med. 2016;31(6):680–683.

Introduction:As the largest body of health professionals, nurses are looked upon during a disaster for leadership, clinical assistance, and support during these events. Nurses are at the forefront of managing disasters in their communities, yet their complex role as advanced nurse practitioners, clinicians, managers, and leaders is not always fully understood and/or recognized. The aim of this paper is to explore the level of Advanced Nursing Practice (ANP) in Australia that takes place in a disasterMethod:This scoping review was guided by Arksey and O’Malley’s framework. The review searched five relevant databases. A scoping review design was chosen as the authors expected that evidence in the field would be produced using a wide variety of methodologies.Results:Nurses work long hours during a disaster with hospitals and nurses becoming the center of events and the \"go to\" place during a disaster. During disasters nurses often have little sleep, have limited time to meet their individual/personal needs, and frequently put others needs before themselves. Nurses mentioned in these studies were reported to have worked while they were worried for themselves and their families. These nurses reported feeling capable and reported that all their experience and skills came to the fore during these challenging situations.Conclusion:During disasters, most nurses are found to be flexible and adaptable, with many taking on a variety of roles. Nurses are quick to find solutions with problem-solving keys and their ability to respond to disasters \"just what you do.\" The nurses in these studies demonstrated fundamental expertise and had the agility to pivot when the occasion demanded. As a result of this study, it is evident, and not surprising, that these Australian nurses work beyond conventional limits during a disaster.

Australia is a significant hotspot for heatwaves due to its geographical location and pronounced climatic variability, and heatwave exposure is expected to further increase in the future with anthropogenic climate change. With the intent to support United Nations Sustainable Development Goals 3 (Good health and well-being) and 13 (Climate action), in this study we identified key challenges and opportunities for adapting to heatwaves, focusing on the most vulnerable members of our community—older adults. A naturalistic, qualitative approach was selected for this study. Data were collected via semistructured interviews. Key insights were captured through a series of semistructured interviews with key informants from local government agencies and community groups that provide care for older adults in New South Wales, Australia. Questions centered around current preventative measures adopted by the organization regarding heatwaves, level of heatwave knowledge of local residents, and common effects of heatwaves in the local community. The findings highlight four primary challenges: (1) increasing duration and intensity of heatwaves; (2) lack of knowledge among older adults regarding symptoms and the effect on the body; (3) the financial and social impacts of heatwaves; and (4) inadequate urban planning practices and building codes including the need for the creation of cool and green spaces. This study provides important insights for protecting our most vulnerable populations from the growing threat of heatwaves.

Introduction: Rural and remote nurses are often involved in disaster response. These nurses are faced with unique challenges in their daily practice due to geographical isolation and reduced resources. Nurses' roles and experiences in times of disaster have been discussed in the past; however, in the setting of rural and remote areas it remains largely underreported. The aim of this article is to provide an overview of the literature regarding the experiences of rural and remote nurses during and following disasters. Disasters affect all areas of the world. Methods: This scoping review was guided by Arksey and O'Malley's methodological framework for scoping reviews. Electronic databases CINAHL, MEDLINE, Scopus, Cochrane, Joanna Briggs Institute and Embase were searched. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist was used to guide the reporting of this review. Key concepts and themes were identified using Braun and Clarke's six-step framework for thematic analysis. Results: Eight articles met the inclusion criteria for this review. Themes that were identified included disaster roles, pre-disaster preparations, psychological and emotional states, and community involvement and relationships. Conclusion: Minimal literature exists that explores what rural and remote nurses experience in times of disaster. In this review, the experience of rural and remote nurses included the relationships between their personal and professional obligations and their influence on nurses' ability to respond to disasters. Further research is required in this domain to better understand the phenomena and address knowledge gaps that exist in the existing literature.

Objective Patients commonly show signs and symptoms of deterioration for hours or days before cardiorespiratory arrest. Rapid response teams (RRT) were created to improve recognition and response to patient deterioration in these situations. Activation criteria include vital signs or 'general concern' by a clinician or family member. The general concern criterion for RRT activation accounts for nearly one-third of all RRT activity, and although it is well established that communication deficits between staff can contribute to poorer outcomes for patients, there is little evidence pertaining to communication and its effects on the general concern RRT activation. Thus, the aim of the present study was to develop a substantive grounded theory related to the communication process between clinicians that preceded the activation of an RRT when general concern criterion was used. Methods Qualitative grounded theory involved collection of three types of data details namely personal notes from participants in focus groups with white board notes from discussions and audio recordings of the focus groups sessions. Focus groups were conducted with participants exploring issues associated with clinician communication and how it related to the activation of an RRT using the general concern criterion. Results The three main phases of coding (i.e. open, axial and selective coding) analysis identified 322 separate open codes. The strongest theme contributed to a theory of ineffective communication and decreased psychological safety, namely that 'In the absence of effective communication there is a subsequent increase in anxiety, fear or concern that can be directly attributed to the activation of an RRT using the 'general concern' criterion'. The RRT filled cultural and process deficiencies in the compliance with an escalation protocol. Issues such as 'not for resuscitation documentation' and 'inability to establish communication with and between medical or nursing personnel' rated highly and contributed to the debate. Conclusions This study highlighted that in the surveillance and management of the deteriorating patient and in the absence of effective communication there is a subsequent increase in anxiety, fear or concern that can be directly attributed to the activation of an RRT for the 'general concern' calling criteria. What is known about the topic? Deficiencies in collaboration and communication between healthcare professionals (HCPs) increase the stress and anxiety of healthcare staff and correspond to poorer outcomes for patients. The RRT can be activated as a 'general concern RRT' without observation of physiological derangements if staff are concerned about a patient's condition, allowing for assistance from a skilled critical care team at the patient's bedside. There are limited data on how poor communication affects the frequency of activation of general concern RRTs. What does this paper add? This study shows that poor communication between health professionals increases staff levels of anxiety and concern. In addition, the RRT system is being used to fill deficiencies in many other hospital processes, including end-of-life discussions. The deficiencies in hospital processes contribute to poor communication and increased levels of concern with this study demonstrating a direct link between a clinician's level of anxiety/concern and the 'general concern' activation category for the RRT system. What are the implications for practitioners? The present study highlights the importance of effective communication strategies between HCPs to improve patient safety and quality of care. The study also highlights the expanding role of the RRT in hospitals, which has implications for hospital policy makers with regard to future funding and resource allocation. Finally, many of the concerns raised in the present study by the focus groups have been addressed by recent measures introduced through the Australian Commission on Safety and Quality in Health Care (e.g. rapid detection and response observation charts and Introduction, Situation, Background, Assessment and Recommendation [ISBAR] style of communication) with these measures supported by the findings of the present study.

With outdoor music festivals becoming increasingly popular, the combination of sun, large crowds and alcohol can have disastrous effects. Researchers at Flinders University School of Nursing and Midwifery have found that young adults between 18-25 years old are the group most often transferred to hospital with drug and alcohol related illnesses.

Introduction The science underpinning mass-gathering health (MGH) is developing rapidly. However, MGH terminology and concepts are not yet well defined or used consistently. These variations can complicate comparisons across settings. There is, therefore, a need to develop consensus and standardize concepts and data points to support the development of a robust MGH evidence-base for governments, event planners, responders, and researchers. This project explored the views and sought consensus of international MGH experts on previously published concepts around MGH to inform the development of a transnational minimum data set (MDS) with an accompanying data dictionary (DD). Report A two-round Delphi process was undertaken involving volunteers from the World Health Organization (WHO) Virtual Interdisciplinary Advisory Group (VIAG) on Mass Gatherings (MGs) and the MG section of the World Association for Disaster and Emergency Medicine (WADEM). The first online survey tested agreement on six key concepts: (1) using the term \"MG HEALTH;\" (2) purposes of the proposed MDS and DD; (3) event phases; (4) two MG population models; (5) a MGH conceptual diagram; and (6) a data matrix for organizing MGH data elements. Consensus was defined as ≥80% agreement. Round 2 presented five refined MGH principles based on Round 1 input that was analyzed using descriptive statistics and content analysis. Thirty-eight participants started Round 1 with 36 completing the survey and 24 (65% of 36) completing Round 2. Agreement was reached on: the term \"MGH\" (n=35/38; 92%); the stated purposes for the MDS (n=38/38; 100%); the two MG population models (n=31/36; 86% and n=30/36; 83%, respectively); and the event phases (n=34/36; 94%). Consensus was not achieved on the overall conceptual MGH diagram (n=25/37; 67%) and the proposed matrix to organize data elements (n=28/37; 77%). In Round 2, agreement was reached on all the proposed principles and revisions, except on the MGH diagram (n=18/24; 75%). Discussion/Conclusions Event health stakeholders require sound data upon which to build a robust MGH evidence-base. The move towards standardization of data points and/or reporting items of interest will strengthen the development of such an evidence-base from which governments, researchers, clinicians, and event planners could benefit. There is substantial agreement on some broad concepts underlying MGH amongst an international group of MG experts. Refinement is needed regarding an overall conceptual diagram and proposed matrix for organizing data elements. Steenkamp M , Hutton AE , Ranse JC , Lund A , Turris SA , Bowles R , Arbuthnott K , Arbon PA . Exploring international views on key concepts for mass-gathering health through a Delphi process. Prehosp Disaster Med. 2016;31(4):443-453.

Aim: To review research evidence on the adults with type 1 diabetes mellitus (T1DM)'s ability to continue self management in the hospital setting. Background: A person with T1DM requires a daily management routine to control glycaemia levels known as self management. On admission to hospital anecdotal evidence suggests people with T1DM are managed by health professionals and self management is difficult. A review of the literature is required to explore the anecdotal evidence. Design: A literature review of available primary peer-reviewed research on self management of T1DM in hospital. Method: A systematic search of the literature published between 1998 and 2008 was undertaken to identify research available on self management of T1DM in hospital. The mixed methods review was conducted using critique tools for randomised control trials, qualitative and quantitative studies. Four main themes were identified; Glycaemic control, development of self management, the expert patient and T1DM management in hospital. Results: Sixteen related publications were identified. In the context of their daily life adults with T1DM perceive their ability to self manage as important and view themselves as 'experts' in their self management. However, there is a recognised conflict about T1DM management between the 'expert' and health professional. Furthermore, management of T1DM by health professionals in the hospital setting has been identified as having a biomedical focus and being poorly managed. Conclusion: People with T1DM have knowledge and skills to self manage. Whilst there is support for adults to actively self manage their illness to maintain glycaemic control, there is no support in the literature regarding a continuation of self management in thehospital setting.