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

Information Systems for Supporting Fire Emergency Response

Despite recent work on information systems, many first responders in emergency situations are unable to develop sufficient understanding of the situation to enable them to make good decisions. The record of the UK Fire and Rescue Service (FRS) has been particularly poor in terms of providing the information systems support to the fire fighters decision-making during their work. There is very little work on identifying the specific information needs of different types of fire fighters. Consequently, this study has two main aims. The first is to identify the information requirements of several specific members of the FRS hierarchy that lead to better Situation Awareness. The second is to identify how such information should be presented. This study was based on extensive data collected in the FRS brigades of three counties and focused on large buildings having a high-risk of fire and four key fire fighter job roles: Incident Commander, Sector Commander, Breathing Apparatus Entry Control Officer and Breathing Apparatus Wearers. The requirements elicitation process was guided by a Cognitive Task Analysis (CTA) tool: Goal Directed Information Analysis (GDIA), which was developed specifically for this study. Initially appropriate scenarios were developed. Based on the scenarios, 44 semi-structured interviews were carried out in three different elicitation phases with both novice and experienced fire fighters. Together with field observations of fire simulation and training exercises, fire and rescue related documentation; a comprehensive set of information needs of fire fighters was identified. These were validated through two different stages via 34 brainstorming sessions with the participation of a number of subject-matter experts. To explore appropriate presentation methods of information, software mock-up was developed. This mock-up is made up of several human computer interfaces, which were evaluated via 19 walkthrough and workshop sessions, involving 22 potential end-users and 14 other related experts. As a result, many of the methods used in the mock-up were confirmed as useful and appropriate and several refinements proposed. The outcomes of this study include: 1) A set of GDI Diagrams showing goal related information needs for each of the job roles with the link to their decision-making needs, 2) A series of practical recommendations suitable for designing of human computer interfaces of fire emergency response information system, 3) Human computer interface mock-ups for an information system to enhance Situation Awareness of fire fighters and 4) A conceptual architecture for the underlying information system. In addition, this study also developed an enhanced cognitive task analysis tool capable of exploring the needs of emergency first responders. This thesis contributes to our understanding of how information systems could be designed to enhance the Situation Awareness of first responders in a fire emergency. These results will be of particular interest to practicing information systems designers and developers in the FRS in the UK and to the wider academic community

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

Communication in sudden-onset major incidents. Patterns and challenges. A scoping review.

Major incidents and disasters are rare occurrences that challenge society and health care systems substantially. The mobilization of extraordinary resources calls for robust preparedness plans, regular training and funding. Command & control is essential in major incident management. To achieve, maintain and execute command & control, communication within emergency medical services and between authorities involved in major incident and disaster management is paramount. The main aim of the master thesis is to explore communication between emergency medical services professionals in sudden-onset major incidents in a broader perspective. The thesis focuses on previous patterns and challenges in communication to provide policymakers with data for the improvement of future major incident preparedness. A scoping review of existing scientific and non-indexed literature describing communication in sudden-onset major incidents provides the sources of information in the thesis. Based on the included literature, this scoping review has found that the patterns in major incident communication are frequent breakdown with potential and actual consequences for patient survival, outcome and management and for the expedited return to a normal state. The challenges in major incident communication are predominantly inter-authority communication difficulties, system overload and lack of introduction and training in the use of communication devices. Cross-border incidents challenge communication substantively. The scoping review has shown that focus has been on describing the operational and tactical approach in sudden-onset major incidents and that communication challenges have not been assessed systematically. A general agreement that communication has been challenging exists; however, it remains mainly unquantified and improvised means of communication have been used extensively

Leveraging the BLAC Model for Situation Awareness in CIP

Because critical infrastructure (CI) is considered to be the backbone of a nation’s livelihood, the Critical Infrastructure Protection (CIP) program was established in 1998 by the American President as a directive to ensure the United States’ security and to keep it safe from any malicious attacks or unexpected disasters. However, protecting the critical infrastructure of this country has always been challenging, especially with the interdependencies among each sector, which increases its vulnerability. Any failure of one sector could cause a significant impact on the others. The Decision Support System (DSS) is a computer system that helps agencies make decisions based on existing situations. The decision making of the DSS has a strong relationship to situational awareness (SA), such that the quality of a decision relies on the degree of the situational awareness. Regarding CI, any decision for one sector affects other sectors. Therefore, decision makers should have insight about the consequences for all sectors when one sector changes. To avoid the complexity of interdependencies in the critical infrastructure of the United States, the healthcare sector was chosen to demonstrate the thesis hypothesis. Situational awareness is applied to healthcare, in general, but this thesis focuses on the situational awareness that is addressed during a multi-casualty incident (MCI). Bi-layer access control (BLAC) is an instrument that was proposed recently in a doctoral dissertation. BLAC uses a new concept named pseudoroles to verify the eligibility of access. For any request, BLAC checks, as a first step, against fixed attributes, then, in the next step, it matches against the associated policies. This two-step process increases the efficiency of the method. Although BLAC was introduced into the healthcare sector to protect patients’ privacy by regulating access to electronic health records, the pseudoroles concept can be implemented in any other sector. This thesis aims to utilize the concept of pseudoroles leveraged in situational awareness in the CIP program. Focusing on MCIs, this thesis proposes a model that will help ambulance personnel make decisions as to the most appropriate hospital for each patient’s care. The decision making depends on multiple factors that are related to the patient\u27s case and the policies of each hospital. Because of the importance of time, in such situations, and the need for the patient to be transported to a hospital as soon as possible, the model uses the BLAC mechanism of a two-step evaluation to exclude all impractical hospitals, at a first glance, based on the hospitals’ policies. Thus, by complex evaluation of the hospitals\u27 information, there is a higher probability that the most appropriate hospital will be chosen for the patients

Feasibility of a human performance model in consequence management

Human civilization has always encountered unpredictable disasters as a result of natural events. Now it also faces the disasters caused by terrorist attacks. Governments must have consequence management plans in place to protect public health and safety, restore essential services, and provide emergency relief to affected businesses and individuals. Human performance models predict outcomes in complex dynamic situations. Such models can simulate disaster management procedures under varying circumstances. This work applies human performance modeling in a terrorist situation and evaluates possible uses of such models by first responders in practical consequence management applications. It includes a case study of an attempted terrorist attack --Abstract, page iv

Preparedness and response to a mass casualty event resulting from terrorist use of explosives

"The purpose of this interim planning guidance is to provide valuable information and insight to help public policy and health system leaders at all levels prepare for and respond to a mass casualty event (MCE) caused by terrorist use of explosives (TUE). Medical preparations for an MCE have traditionally focused on the scene and prehospital sectors. Comprehensive mass casualty care, from a health systems perspective, has received far less attention and has evolved separately from the rest of the emergency response community. This document provides practical information to promote comprehensive mass casualty care in the event of a TUE. It is not intended to reflect U.S. Department of Health and Human Services (DHHS) policy but, rather, to provide public policy and health systems leaders with options to consider when planning their response to an MCE. This document is a collaboration between the Centers for Disease Control and Prevention (CDC) and the National Preparedness Leadership Initiative of Harvard University. CDC provides additional specific mass casualty and blast-injury related material that complements this document. These materials include "Blast Injuries: Fact Sheets for Professionals," "In a Moment's Notice: Surge Capacity for Terrorist Bombings: Challenges and Proposed Solutions," and the "Bombings: Injury Patterns and Care" course." - p. 4Executive summary -- 1. Introduction -- 2. Principles for health systems' preparedness in emergencies -- 3. Prehospital care -- 4. Patient distribution -- 5. Surge capacities and capabilities for hospitals -- Conclusion -- References -- AcknowledgementsTitle from PDF title screen (viewed on Mar. 19, 2010).Authors: Isaac Ashkenazi, MD, MPA, MSC, MNS, Richard C. Hunt, MD, FACEP, Scott M. Sasser, MD, FACEP, Sridhar V. Basavaraju, MD, Ernest E. Sullivent, MD, MPH, FACEP, Vikas Kapil, DO, MPH, FACOEM, Lisa C. McGuire, PhD, Lisa T. Garbarino, and Paula S. Peters, MPH, CHES.Mode of access: World Wide Web as an Arobat .pdf file (1.24 MB, 36 p.).Includes bibliographical references (p. 30).National Center for Injury Prevention and Control. Interim planning guidance for preparedness and response to a mass casualty event resulting from terrorist use of explosives. Atlanta, GA: Centers for Disease Control and Prevention; 2010

Preparedness and Response to a Mass Casualty Event Resulting from Terrorist Use of Explosives

No DescriptionInjury Prevention and ControlPublic Health Preparedness and ResponseCurren

A Wearable Platform for Patient Monitoring during Mass Casualty Incidents

Based on physiological data, intelligent algorithms can assist with the classification and recognition of the most severely impaired victims. This dissertation presents a new sensorbased triage platform with the main proposal to join different sensor and communications technologies into a portable device. This new device must be able to assist the rescue units along with the tactical planning of the operation. This dissertation discusses the implementation and the evaluation of the platform