Management of major accidents - Communication challenges and solutions in the preparedness and response phases for both authorities and companies

siirretty Doriast

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

Disaster response and preparedness : focus on hospital incident command groups and emergency department registered nurses

Background: While disasters per definition are rare, incidents that cause mass casualties that threaten to overwhelm its limited resources are an ever-present risk. Disaster medicine is a specific discipline of medicine dedicated to providing adequate health care to patients of major incidents through the development of preventive-, preparedness-, response and recovery interventions. Emergency department registered nurses are among the first to receive, assess and treat patients of a major incident, highlighting the importance of their preparedness and disaster medicine competencies. However, when an incident threatens to overwhelm health care’s resources, a specific type of management group may be required to aid and guide hospital response. The hospital incident command group aids in hospital response through timely decision-making and allocation of resources. Despite these two groups being recognized as vital components of disaster response, little has been known concerning the disaster preparedness of these two groups. emergency department registered nurses’ disaster preparedness. The overall aim of the thesis was to assess disaster medicine preparedness in Stockholm, Sweden through the evaluation of hospital incident command groups and emergency department registered nurses. The aim of study I was to identify the essential disaster nursing competencies. Sixty-nine specific disaster medicine competencies were identified through a modified Delphi method in which experts within the field of emergency- or disaster medicine reached consensus concerning necessary disaster medicine competencies for emergency department registered nurses. The aim of study II was to assess emergency department registered nurses’ self-perceived disaster preparedness using the results in study one as the basis of a questionnaire. A cross- sectional method was used to assess the preparedness of nurses in the study setting. The results of this study indicate that emergency department registered nurses may be less than competent and overestimate their preparedness. The aim of study III was to assess hospital incident command groups’ preparedness. This was done through an observational study in which measurable indicators were used to evaluate hospital incident command groups during simulations. The results in this study indicate that proactive decision-making correlates with overall command group response. Shortly after the simulations in study III, an antagonistic incident occurred in Stockholm, Sweden. This provided a unique opportunity to compare planned preparedness with actual preparedness. through exploration of disaster preparedness coordinators' experiences of hospital response during a major incident. Thus, the aim of study IV was to explore registered nurses’ experiences as disaster preparedness coordinators (DPC) of hospital incident command groups during an MI. This was done through one focus group discussion with six disaster preparedness coordinators and six follow-up interviews with the same coordinators were conducted. Data were analyzed using inductive content analysis. One main category, Expectations, prior experiences, and uncertainty affect HICG response during a major incident and three categories. Gaining situational awareness, transitioning to management, and actions taken during uncertainty were identified. The thesis concludes that disaster medicine preparedness in the study setting may be adequate but that response may be dependent upon several factors including the type and timing of the incident, frequency and type of training, education, experience, and the ability to reduce uncertainty in order to make timely and relevant decisions

Beitrag des Medizinstudiums

Einführung: Ärztinnen und Ärzte fühlen sich zu Beginn ihrer Weiterbildung unsicher, was zu Verzögerungen und Fehlern in Diagnose und Behandlung führen und so das Patientenwohl gefährden kann. Die Stärkung einer zu niedrigen Selbstsicherheit könnte dies verbessern. Die Inzidenz medizinischer Fehler, u.a. durch mangelhafte Teamarbeit und Kommunikation verursacht, wird auf ca. 9% eingeschätzt. Das Training der Teamarbeit mittels Simulation kann Fehler verringern und wird bereits in der Weiterbildung eingesetzt. Um Medizinstudierende bestmöglich auf ihre spätere Arbeit vorzubereiten, werden Rahmenlehrpläne konzipiert, die die zu erlernenden Kompetenzen während des Studiums festlegen. Ein zukunftssicheres Curriculum gäbe dabei die Möglichkeit, Studierende besser vorzubereiten und so ebenfalls die Selbstsicherheit zu stärken. Die Dissertation untersucht, ob sich mittels Notfallsimulationen Selbstsicherheit steigern lässt, entwickelt Hilfsmittel zum Training der Teamarbeit und untersucht die Delphi-Methode als eine Möglichkeit einen Rahmenlehrplan auf Zukunftssicherheit zu untersuchen. Methodik: Es wurde ein simulierter Nachtdienst für Studierende konzipiert, in dem diese Notfallsituationen trainieren und Feedback erhalten. Die Änderung der Selbstsicherheit wurde mittels Fragebögen erfasst. Zudem wurde ein Feedbackinstrument zur Teamarbeit entwickelt und ein Assessmentinstrument zum Erfassen der Teamarbeit adaptiert. Darüber hinaus wurde das „Konsensusstatement praktische Fertigkeiten“ der Gesellschaft für medizinische Ausbildung mit der Delphi-Methode auf Zukunftssicherheit überprüft und versucht, neue Trends in der Ausbildung zu antizipieren. Ergebnisse: Vor Beginn der Notfallsimulation waren Studierende eher unsicher, danach fühlten sich Studierende deutlich sicherer. Der Effekt ist unabhängig von der Rolle, die Studierende während der Simulation inne haben. Zur Verbesserung des Feedbacks der Teamarbeit wurde der „TeamTAG“ entwickelt, der die Beobachtung der Teamarbeit vereinfacht und gut anwendbar ist. Das Assessmentinstrument „TEAM“ zur Beobachtung der Teamarbeit wurde übersetzt und als valide und reliabel bewertet. Mittels Delphi-Methode konnten 288 Lernziele des Konsensusstatement untersucht werden, 147 davon werden als relevant angesehen. Es wurden außerdem elf Thesen zur zukünftigen Entwicklung der medizinischen Praxis untersucht, von denen 7 als eher wahrscheinlich eintreffend bewertet worden sind. Schlussfolgerung: Simulation ist als Methode der Stärkung der Selbstsicherheit geeignet. TeamTAG und TEAM funktionieren als Instrumente zur Untersuchung der Teamarbeit in Simulationen, mögliche Effekte des TeamTAG auf die Teamarbeit der Studierenden werden aktuell untersucht. Die Delphi-Methode kann genutzt werden, um Rahmenlehrpläne auf ihre Zukunftssicherheit zu untersuchen, die Bewertung von Thesen kann zudem helfen, zukünftige Trends zu antizipieren um Medizinstudierende besser auf Ihre Arbeit vorzubereiten.Introduction: Junior doctors feel unsafe when starting into postgraduate training. This might lead to delayed diagnosis, treatment, errors and endanger patient safety. Strengthening self- efficacy might improve these problems. Incidence of medical errors e.g. insufficient teamwork and communication is estimated with about 9%. Training of teamwork might reduce these errors and is already applied in postgraduate training. To prepare medical students as well as possible, outcome frameworks are conceptualized to determine required competences during studies. A future-proofed outcome framework would give the possibility to improve students’ postgraduate preparedness and – as consequence – their self-efficacy. This thesis examines the use of emergency simulations to strengthen self-efficacy, develops tools for training teamwork and investigates the Delphi method as a possibility to check an outcome framework for future reliability. Methods: A simulated nightshift for medical students was conceived in which students trained emergency scenarios and underwent feedback. Changes in self-efficacy were measured with questionnaires. Furthermore, a feedback tool for teamwork was developed and a tool for assessing teamwork adapted. At last, the “consensus statement on practical skills” by German Association for Medical Education was examined for future reliability and to anticipate new trends in education. Results: Before emergency simulations, students were rather unsafe, afterwards students felt way more secure. This effect is independent of the role students have during simulation. For fostering teamwork feedback, the TeamTAG was developed, which is feasible and simplifies observing teamwork. The Assessment tool “TEAM” for observing teamwork was translated and proofed as valid and reliable. With Delphi methods, 288 learning goals of the consensus statement were checked with judging 147 as relevant. Eleven assumptions for future developments in medical practice were examined – seven were judged as possibly occurring. Take-home points: Simulation is able to improve self-efficacy. TeamTAG and TEAM work as tools for examining teamwork in simulation. Possible effects of the use of TeamTAG on students’ teamwork are currently examined. The Delphi method can be used to check outcome frameworks for future reliability. Judging of assumptions might further help to anticipate trends and prepare students better for postgraduate training

How Do Communities Use a Participatory Public Health Approach to Build Resilience? The Los Angeles County Community Disaster Resilience Project.

Community resilience is a key concept in the National Health Security Strategy that emphasizes development of multi-sector partnerships and equity through community engagement. Here, we describe the advancement of CR principles through community participatory methods in the Los Angeles County Community Disaster Resilience (LACCDR) initiative. LACCDR, an initiative led by the Los Angeles County Department of Public Health with academic partners, randomized 16 community coalitions to implement either an Enhanced Standard Preparedness or Community Resilience approach over 24 months. Facilitated by a public health nurse or community educator, coalitions comprised government agencies, community-focused organizations and community members. We used thematic analysis of data from focus groups (n = 5) and interviews (n = 6 coalition members; n = 16 facilitators) to compare coalitions' strategies for operationalizing community resilience levers of change (engagement, partnership, self-sufficiency, education). We find that strategies that included bidirectional learning helped coalitions understand and adopt resilience principles. Strategies that operationalized community resilience levers in mutually reinforcing ways (e.g., disseminating information while strengthening partnerships) also secured commitment to resilience principles. We review additional challenges and successes in achieving cross-sector collaboration and engaging at-risk groups in the resilience versus preparedness coalitions. The LACCDR example can inform strategies for uptake and implementation of community resilience and uptake of the resilience concept and methods

Disaster Preparedness Education and Resource Needs for Pregnant and Post-Partum Families

Hurricane Katrina in 2005 heightened awareness of the need to educate vulnerable populations on disaster preparedness. However, little has been written specifically on the preparedness needs of the pregnant and post-partum families. Only one article explores disaster preparedness education for this population. To fill this gap. An interprofessional sample (n=115) rated the relevance of the educational topics and birthing kit items proposed by the panel from the previous Delphi study. The education topics were reduced to four themes that explained 66.80% of the variance and the birthing kit items were reduced to six themes that explained 70.99% of the variance

Considering the Perspective of Emergency Management Professionals Regarding Radiological Response and School Resiliency

The purpose of the study is to consider the perspective of emergency management professionals regarding need for a radiological response plan and its implications to school resiliency. This study utilizes a three-round, Modified Delphi Method to provide structure for the group process, elicit experts’ opinions, and build consensus regarding radiological response and school resiliency. The experts’ opinions are analyzed at the conclusion of each round and synthesized to create considerations for school systems for a school-system-based radiological-specific response plan. The recommendations align existing school system’s capabilities, roles and responsibilities with required emergency response actions necessary to protect the health and safety of faculty, staff, and students during a disaster such as the release of radioactive substances. Emergent themes surfacing during this study include: (1) training, (2) all-hazard planning, (3) communication, (4) collaboration, (5) medical response, and (6) protective actions. The results and recommendations from this study have generalizability for future practice and implementation of emergency management in a school setting, business and industry and for other local, state federal and tribal organizations. The major finding from this study indicates that an all-hazards plan is sufficient for response to a radiological-specific emergency event

Towards a resilient community: A decision support framework for prioritizing stakeholders' interaction areas

Interactions among community stakeholders act as a buffer against disasters and present a way to build community resilience. Several decision support frameworks have been proposed in the literature to improve community resilience, but none focus on interactions among stakeholders. This paper presents a decision support framework to guide decision-makers in prioritizing areas of interaction based on their mutual impact. The framework is built on three components. The first involved conducting a literature review to identify areas of interaction among community stakeholders; resulting in identifying 27 factors that reflect the various interaction areas. The second was to implement a Delphi study to capture the dependency among the different areas. The third was to prioritize the identified areas of interaction through network analysis techniques to understand the propagating impacts of a change in one area on the others. The framework was applied to Spain, utilizing data provided by Spanish resilience experts. Our findings indicate a high degree of interdependence among all areas of interaction. Decentralization of the decision-making process and effective leading capabilities of emergency organizations have been identified as top priority areas. By utilizing this framework, decision-makers can systematically enhance interactions among diverse stakeholders, creating a roadmap to improve community resilience