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While there is increasing interest in implementing drug checking within overdose prevention, we must also consider how to scale-up these responses so that they have significant reach and impact for people navigating the unpredictable and increasingly complex drug supplies linked to overdose. The purpose of this paper is to present a distributed model of community drug checking that addresses multiple barriers to increasing the reach of drug checking as a response to the illicit drug overdose crisis.

A detailed description of the key components of a distributed model of community drug checking is provided. This includes an integrated software platform that links a multi-instrument, multi-site service design with online service options, a foundational database that provides storage and reporting functions and a community of practice to facilitate engagement and capacity building.

The distributed model diminishes the need for technicians at multiple sites while still providing point-of-care results with local harm reduction engagement and access to confirmatory testing online and in localized reporting. It also reduces the need for training in the technical components of drug checking (e.g. interpreting spectra) for harm reduction workers. Moreover, its real-time reporting capability keeps communities informed about the crisis. Sites are additionally supported by a community of practice.

This paper presents innovations in drug checking technologies and service design that attempt to overcome current financial and technical barriers towards scaling-up services to a more equitable and impactful level and effectively linking multiple urban and rural communities to report concentration levels for substances most linked to overdose.

Although it is widely acknowledged that health care delivery systems are complex adaptive systems, there are gaps in understanding the application of systems engineering approaches to systems analysis and redesign in the health care domain. Commonly employed methods, such as statistical analysis of risk factors and outcomes, are simply not adequate to robustly characterize all system requirements and facilitate reliable design of complex care delivery systems. This is especially apparent in institutional-level systems, such as patient safety programs that must mitigate the risk of infections and other complications that can occur in virtually any setting providing direct and indirect patient care. The case example presented here illustrates the application of various system engineering methods to identify requirements and intervention candidates for a critical patient safety problem known as failure to rescue. Detailed descriptions of the analysis methods and their application are presented along with specific analysis artifacts related to the failure to rescue case study. Given the prevalence of complex systems in health care, this practical and effective approach provides an important example of how systems engineering methods can effectively address the shortcomings in current health care analysis and design, where complex systems are increasingly prevalent.

The purpose of this paper is to propose a practice framework for disaster resilience education (DRE) with homeless communities.

A survey with 163 homeless service providers together with 45 interviews with people with a lived experience of homelessness, homeless service providers and emergency services.

Key principles for DRE with the homeless community were: safe relationships, collaboration, strengths-based, empowerment, providing essential resources, and inclusivity. Recommendations for the design of DRE foregrounded partnerships and knowledge sharing between the homeless community and emergency services. Locally relevant risk information and material supports, together with sharing stories and eliciting values were important considerations for developing DRE content. Preferred delivery methods were outreach to build on trusted relationships and existing services, together with written material in large font emphasising images for distribution through drop in centres, food vans and new tenancy packages.

The key principles, together with the detailed suggestions outlining ways to translate the principles into actions, can be used by emergency and homeless services to develop effective DRE materials and programmes.

The proposed DRE framework aims to not only enhance disaster risk knowledge, but also address the exclusion, isolation and disempowerment experienced by people who are homeless. By building on an effective intervention models within homeless services (Trauma-Informed Care) DRE can enhance the social connection, self-confidence and well-being goals of homeless services and clients.

The DRE framework is based on the first comprehensive Australian research with homeless services, clients and emergency managers on best practice for improving extreme weather preparedness in the homeless community.