Public experiences of mass casualty decontamination

In this article, we analyze feedback from simulated casualties who took part in field exercises involving mass decontamination, to gain an understanding of how responder communication can affect people’s experiences of and compliance with decontamination. We analyzed questionnaire data gathered from 402 volunteers using the framework approach, to provide an insight into the public’s experiences of decontamination and how these experiences are shaped by the actions of emergency responders. Factors that affected casualties’ experiences of the econtamination process included the need for greater practical information and better communication from responders, and the need for privacy. Results support previous findings from small-scale incidents that involved decontamination in showing that participants wanted better communication from responders during the process of decontamination, including more practical information, and that the failure of responders to communicate effectively with members of the public led to anxiety about the decontamination process. The similarity between the findings from the exercises described in this article and previous research into real incidents involving decontamination suggests that field exercises provide a useful way to examine the effect of responder communication strategies on the public’s experiences of decontamination. Future exercises should examine in more detail the effect of various communication strategies on the public’s experiences of decontamination. This will facilitate the development of evidence-based communication strategies intended to reduce anxiety about decontamination and increase compliance among members of the public during real-life incidents that involve mass decontamination

Optimization of Nonambulant Mass Casualty Decontamination Protocols as Part of an Initial or Specialist Operational Response to Chemical Incidents

© 2018 The Author(s). Published with license by Taylor & Francis.© 2018 Robert P. Chilcott, Hannah Mitchell, Hazem Matar. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-ncnd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.Objective: The UK's Initial Operational Response (IOR) is a new process for improving the survival of multiple casualties following a chemical, biological, radiological or nuclear incident. Whilst the introduction of IOR represents a patient-focused response for ambulant casualties, there is currently no provision for disrobe and dry decontamination of nonambulant casualties. Moreover, the current specialist operational response (SOR) protocol for nonambulant casualty decontamination (also referred to as “clinical decontamination”) has not been subject to rigorous evaluation or development. Therefore, the aim of this study was to confirm the effectiveness of putatively optimized dry (IOR) and wet (SOR) protocols for nonambulant decontamination in human volunteers. Methods: Dry and wet decontamination protocols were objectively evaluated using human volunteers. Decontamination effectiveness was quantified by liquid chromatography–mass spectrometry analysis of the recovery of a chemical warfare agent simulant (methylsalicylate) from skin and hair of volunteers, with whole-body fluorescence imaging to quantify the skin distribution of residual simulant. Results: Both the dry and wet decontamination processes were rapid (3 and 4 min, respectively) and were effective in removing simulant from the hair and skin of volunteers, with no observable adverse effects related to skin surface spreading of contaminant. Conclusions: Further studies are required to assess the combined effectiveness of dry and wet decontamination under more realistic conditions and to develop appropriate operational procedures that ensure the safety of first responders.Peer reviewe

Challenge Patient Dispatching in Mass Casualty Incidents

Efficient management of mass casualty incidents is complex, since regular emergency medical services struc-tures have to be switched to a temporary “disaster mode” involving additional operational and tactical struc-tures. Most of the relevant decisions have to be taken on-site in a provisional and chaotic environment. Data gathering about affected persons is one side of the coin; the other side is on-site patient dispatching requiring information exchange with the regular emergency call center and destination hospitals. In this paper we extend a previous conference contribution about the research project e-Triage to the aspect of patient data and on-site patient dispatching. Our considerations reflect the situation in Germany, which deserves from our point of view substantial harmonization

Effective responder communication improves efficiency and psychological outcomes in a mass decontamination field experiment: implications for public behaviour in the event of a chemical incident

The risk of incidents involving mass decontamination in response to a chemical, biological, radiological, or nuclear release has increased in recent years, due to technological advances, and the willingness of terrorists to use unconventional weapons. Planning for such incidents has focused on the technical issues involved, rather than on psychosocial concerns. This paper presents a novel experimental study, examining the effect of three different responder communication strategies on public experiences and behaviour during a mass decontamination field experiment. Specifically, the research examined the impact of social identity processes on the relationship between effective responder communication, and relevant outcome variables (e.g. public compliance, public anxiety, and co-operative public behaviour). All participants (N = 111) were asked to visualise that they had been involved in an incident involving mass decontamination, before undergoing the decontamination process, and receiving one of three different communication strategies: 1) Health-focused explanations about decontamination, and sufficient practical information; 2) No health-focused explanations about decontamination, sufficient practical information; 3) No health-focused explanations about decontamination, insufficient practical information. Four types of data were collected: timings of the decontamination process; observational data; and quantitative and qualitative self-report data. The communication strategy which resulted in the most efficient progression of participants through the decontamination process, as well as the fewest observations of non-compliance and confusion, was that which included both health-focused explanations about decontamination and sufficient practical information. Further, this strategy resulted in increased perceptions of responder legitimacy and increased identification with responders, which in turn resulted in higher levels of expected compliance during a real incident, and increased willingness to help other members of the public. This study shows that an understanding of the social identity approach facilitates the development of effective responder communication strategies for incidents involving mass decontamination

The Police Response to Active Shooter Incidents

There have been many active shooter incidents in the United States since Columbine, and police agencies continue to modify their policies and training to reflect the lessons that are learned from each new tragedy. This report summarizes the state of the field as of 2014. The Police Executive Research Forum conducted research on these issues and held a one-day Summit in Washington, D.C., in which an overflow crowd of more than 225 police chiefs and other officials discussed the changes that have occurred, and where they are going from here

Increasing New Orienting Emergency Department Nurses\u27 Awareness of Mass Casualty Incident Emergency Preparedness and Disaster Response Core Competencies to Improve Mass Casualty Incident Response

Mass casualty incidents (MCI) impose a substantial threat to healthcare. Despite the increasing frequency of MCIs many healthcare organizations and nursing programs do not adequately prepare nurses to be effective responders during an MCI. This evidence-based practice pilot project was purposed to increase new orienting emergency department nurses’ confidence and ability to effectively respond to an MCI. This project involved implementing an MCI educational program consisting of a disaster nursing framework to educate new orienting emergency department nurses on emergency preparedness and disaster response core competencies. The project leader utilized a quasi-experimental design to collect data pre- and post-intervention utilizing a modified Emergency Preparedness Information Questionnaire (EPIQ). The measurable outcomes for the project included improvement in awareness of competencies relate to MCI emergency preparedness, awareness of competencies related to disaster response, and level of self-reported confidence to respond to MCIs. This project revealed a statistically significant improvement in the awareness of emergency preparedness and disaster response core competencies among new orienting emergency department nurses as well as enhanced self-reported confidence to respond to an MCI. The results of this project have important implications for enhancing MCI education for nurses to develop prepared and effective responses to MCIs

The Strategy of Medical Rescue for Mass Casualty Incidents

Mass casualty incidents refer to the medical resources required in the rescue of casualties, which obviously exceed existing local medical resources in a relatively short period. In recent years, mass casualty incidents caused by various reasons happen frequently in China, which results in the serious situation of emergency medical rescue. Troops have always been an important force in the rescue of mass casualty accidents. This paper introduces the latest development of the method of triage and its principles of implementation in the on-site rescue of mass casualty incidents in foreign armies. According to National Emergency Plan for Medical and Health Rescue in Public Emergencies, the paper puts forward strategies and skills that should be adopted in the on-site rescue of mass casualty accidents, and analyzes the significance of mass casualty drills at the same time

Evaluation of medical response in disaster preparedness : with special reference to full-scale exercises

Background: Disaster exercises and simulations serves as teaching and training tool for improving medical response in disaster preparedness. Rapid and effective medical response in major incidents is known as a “key phase” to optimise resources, and this requires that management systems have an “all hazards” approach. Decision-making at all levels of management is based on available information and involves allocation of medical resources and triage decisions. Aim: The overall aim of this thesis was to increase our knowledge of the impact of quantitative evaluation of medical response on disaster preparedness. The specific aims were: to increase the ability to learn from full-scale exercises by applying quality indicators at two levels of command and control (I, II); to identify key indicators essential for initial disaster medical response registration (III); to explore ambulance staff attitudes towards practising triage tagging (IV); and to increase our knowledge of the applicability of a technical support system and its potential to provide real-time, overall situation awareness available to those overseeing the medical management of the operation. Methods: Study I, II and V were observational studies based on data collections from full-scale exercises. Templates with measurable performance indicators for evaluation of command and control were used in Study I and II and the same performance indicators combined with outcome indicators was also included in Study II. A consensus method, the Delphi technique, with 30 experts was used in Study III. Study IV used mixed methods, a pre-and post web survey answered by ambulance nurses and physicians (n=57 respectively 57) before and after a time limited strategy with triage tags and three focus groups interviews comprising 21 ambulance nurses and emergency medical technicians. Study V used major two incidents simulations to test the applicability of Radio Frequency Identification (RFID tags) technology and compare it with traditionally paper-based triage tags (n= 20 respectively 20). The quantitative data were analysed using descriptive statistics, and content analysis was used for the qualitative data. Results: The evaluation model exposed several problems occurring in the initial decision-making process that were repeatedly observed (I, II). These results in study II also demonstrated to have a major impact on patient outcome.Out of 17 severely injured patients five respectively seven were at risk for preventable death. A total of 97 statements were generated, of these 77 statements reached experts consensus, and 20 did not (III). Ambulance staffs believe in the usefulness of standardised triage methods, but the sparse application of triage tags at the scene indicates that the tags are not used frequently. Infrequent use in daily practice prevents participants from feeling confident with the triage tool (IV).The Radio Frequency Identification system improved situational awareness in disaster management. Triage information was available at least one hour earlier compared to a paper-based triage system (V). Conclusions: The presented evaluation model can be used in an objective, systematic and reproducible way to evaluate complex medical responses, which is a prerequisite for quality assurance, identification of problems, and the development of disaster preparedness

Triage Process in Emergency Departments: an Indonesian Study

Background: Triage process has rapidly developed in some countries in the last three decades in order to respond to the demand for emergency services by growing population and emergency health needs. However, this development does not appear to match in Indonesian hospitals. The triage process in Indonesia remains obscure.Purpose: This study aimed to describe triage process in Indonesia from a range of different perspectives.Methods: The research design of this study was descriptive qualitative using semistructured interviews of 12 policy makers or persons responsible from 5 different organizations which informed triage practice in Indonesia. The data were analyzed using a three step content analysis.Results: The result produced 3 themes. First, four steps of triage process ranging from receiving to prioritizing were reported as the triaging procedures in Indonesia which were almost similar to the International literature except for a re-triage step. Second,primary and secondary triage processes were also applied in all emergency departments in Indonesia. Last, no prolonged waiting time in Indonesia could be assumed whether the triage process was effective and efficient or it was only a quick process of sorting to rapidly increase the number of patients in the treatment rooms. Out of the themes, the result also indicated that the involvement of nurses in health policy development inIndonesia needed supportConclusion: Triage process in Indonesia still needs improvements. Patient\u27s re-triage and evaluating secondary triage should be given more frameworks in the future. An effective and efficient triage process in Indonesia will best manage the number of patients in the treatment rooms and therefore further observational researches on patterns and trends are needed. Moreover, including the role of nurses as policy makers in the curriculum of nursing undergraduate and post-graduate degrees would give nurses the evidence to seek out policy making positions in the futur