Organization of a Hospital-based Victim Decontamination Plan Using the Incident Command Structure

Background: Mass casualty and multi-victim incidents have increased in recent years due to a number of factors including natural disasters and terrorism. The Association of American Medical Colleges (AAMC) recommends that medical students be trained in disaster preparedness and response. However, a majority of United States medical students are not provided such education. Objective: The goal of this study was to evaluate the effectiveness of a 1 day, immersive, simulation-based Disaster Day curriculum. Settings and Design: Learners were first and second year medical students from a single institution. Materials and Methods: Our education provided learners with information on disaster management, allowed for application of this knowledge with hands-on skill stations, and culminated in near full-scale simulation where learners could evaluate the knowledge and skills they had acquired. Statistical analysis used: To study the effectiveness of our Disaster Day curriculum, we conducted a single-group pretest-posttest and paired analysis of self-reported confidence data. Results: A total of 40 first and second year medical students participated in Disaster Day as learners. Learners strongly agreed that this course provided new information or provided clarity on previous training, and they intended to use what they learned, 97.6% and 88.4%, respectively. Conclusions: Medical students’ self-reported confidence of key disaster management concepts including victim triage, tourniquet application, and incident command improved after a simulation-based disaster curriculum. This Disaster Day curriculum provides students the ability to apply concepts learned in the classroom and better understand the real-life difficulties experienced in a resource limited environment.

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Using Interprofessional Simulation to Enhance Student Knowledge and Promote Collaborative Practice in Disaster Management

Pedagogy in Health Promotion ◽

10.1177/2373379920987576 ◽

2021 ◽

pp. 237337992098757

Author(s):

Matthew Fifolt ◽

Michelle Brown ◽

Elena Kidd ◽

Meena Nabavi ◽

Heather Lee ◽

...

Keyword(s):

Experiential Learning ◽

Student Learning ◽

Disaster Management ◽

Interprofessional Education ◽

Collaborative Practice ◽

Theory And Practice ◽

Knowledge Gain ◽

Student Knowledge ◽

Complex Situation ◽

Incident Command

Introduction. Experiential learning activities, such as simulations, strengthen student learning by allowing students to apply didactic knowledge to real-world settings. Moreover, simulation-based interprofessional education supports teamwork and skill development as outlined in accreditation standards for many health and health-related academic programs. The purpose of this article is to describe the role of interprofessional simulation in enhancing student knowledge and promoting collaborative practice for disaster management. Method. Multiple data sources were used to assess a simulated EF-5 tornado disaster event including an observational protocol, a disaster simulation survey, and a survey from the Office of Interprofessional Simulation for Innovative Clinical Practice. Results. Students reported increased satisfaction and knowledge with applying skills associated with interprofessional practice, including communication, teamwork, and collaboration. Additionally, students identified skills that could be broadly applied to a range of work settings on graduation such as seeking role clarity, utilizing job action sheets, and responding to a complex situation. Notably, students reported increased levels of knowledge gain of the incident command structure after applying knowledge from didactic sessions to the simulation. Conclusion. Simulation is an innovative strategy for integrating theory and practice to best prepare graduates for the dynamic world in which they live and work. Experiential learning opportunities appeal to the assumptions of adult learning, promote the skills that employers value, and bridge the competencies of multiple academic disciplines that frequently operate in silos. Institutional leaders should view experiential learning as a critical component of student learning and an investment in workforce development.

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Use of a Multidisciplinary Incident Command System in Response to Measles Outbreak in Maryland

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1184 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s502-s504

Author(s):

Taylor McIlquham ◽

Anna Sick-Samuels ◽

Carrie Billman ◽

Jennifer Andonian ◽

Melissa Dudley ◽

...

Keyword(s):

The United States ◽

Johns Hopkins Hospital ◽

Occupational Health Services ◽

Becton Dickinson ◽

Distributed Resources ◽

Incident Command System ◽

Secondary Transmission ◽

Incident Command ◽

Measles Outbreak ◽

Triage Algorithm

Background: Measles is a highly contagious virus that reemerged in 2019 with the highest number of reported cases in the United States since 1992. Beginning in March 2019, The Johns Hopkins Hospital (JHH) responded to an influx of patients with concern for measles as a result of outbreaks in Maryland and the surrounding states. We report the JHH Department of Infection Control and Hospital Epidemiology (HEIC) response to this measles outbreak using a multidisciplinary measles incident command system (ICS). Methods: The JHH HEIC and the Johns Hopkins Office of Emergency Management established the HEIC Clinical Incident Command Center and coordinated a multipronged response to the measles outbreak with partners from occupational health services, microbiology, the adult and pediatric emergency departments, marketing and communication and local and state public health departments. The multidisciplinary structure rapidly developed, approved, and disseminated tools to improve the ability of frontline providers to quickly identify, isolate, and determine testing needs for patients suspected to have measles infection and reduce the risk of secondary transmission. The tools included a triage algorithm, visitor signage, staff and patient vaccination guidance and clinics, and standard operating procedures for measles evaluation and testing. The triage algorithms were developed for phone or in-person and assessed measles exposure history, immune status, and symptoms, and provided guidance regarding isolation and the need for testing. The algorithms were distributed to frontline providers in clinics and emergency rooms across the Johns Hopkins Health System. The incident command team also distributed resources to community providers to reduce patient influx to JHH and staged an outdoor measles evaluation and testing site in the event of a case influx that would exceed emergency department resources. Results: From March 2019 through June 2019, 37 patients presented with symptoms or concern for measles. Using the ICS tools and algorithms, JHH rapidly identified, isolated, and tested 11 patients with high suspicion for measles, 4 of whom were confirmed positive. Of the other 26 patients not tested, none developed measles infection. Exposures were minimized, and there were no secondary measles transmissions among patients. Conclusions: Using the ICS and development of tools and resources to prevent measles transmission, including a patient triage algorithm, the JHH team successfully identified, isolated, and evaluated patients with high suspicion for measles while minimizing exposures and secondary transmission. These strategies may be useful to other institutions and locales in the event of an emerging or reemerging infectious disease outbreak.Funding: NoneDisclosures: Aaron Milstone reports consulting for Becton Dickinson.

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Optimizing Scarce Resource Allocation During COVID-19: Rapid Creation of a Regional Health-Care Coalition and Triage Teams in San Diego County, California

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2020.344 ◽

2020 ◽

pp. 1-7

Author(s):

Asha Devereaux ◽

Holly Yang ◽

Gilbert Seda ◽

Viji Sankar ◽

Ryan C. Maves ◽

...

Keyword(s):

Public Health ◽

Health Care ◽

Resource Allocation ◽

San Diego ◽

Scarce Resource ◽

Successful Implementation ◽

Regional Health ◽

Incident Command ◽

Regional Health Care ◽

Crisis Care

ABSTRACT Successful management of an event where health-care needs exceed regional health-care capacity requires coordinated strategies for scarce resource allocation. Publications for rapid development, training, and coordination of regional hospital triage teams to manage the allocation of scarce resources during coronavirus disease 2019 (COVID-19) are lacking. Over a period of 3 weeks, over 100 clinicians, ethicists, leaders, and public health authorities convened virtually to achieve consensus on how best to save the most lives possible and share resources. This is referred to as population-based crisis management. The rapid regionalization of 22 acute care hospitals across 4500 square miles in the midst of a pandemic with a shifting regulatory landscape was challenging, but overcome by mutual trust, transparency, and confidence in the public health authority. Because many cities are facing COVID-19 surges, we share a process for successful rapid formation of health-care care coalitions, Crisis Standard of Care, and training of Triage Teams. Incorporation of continuous process improvement and methods for communication is essential for successful implementation. Use of our regional health-care coalition communications, incident command system, and the crisis care committee helped mitigate crisis care in the San Diego and Imperial County region as COVID-19 cases surged and scarce resource collaborative decisions were required.

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Planning for Resilience in Hospital Internal Disaster

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00001230 ◽

2003 ◽

Vol 18 (4) ◽

pp. 291-299 ◽

Cited By ~ 22

Author(s):

Ernest Sternberg

Keyword(s):

Resource Management ◽

Mobility Management ◽

Information Acquisition ◽

Communication Systems ◽

Hospital Setting ◽

High Likelihood ◽

Incident Command ◽

Informational Uncertainty ◽

Organizational Uncertainty

AbstractThis article seeks to clarify the terminology and methods of planning to avert hospital internal disaster. It differentiates “crisis” from “disaster” in the in-hospital setting. Preparedness, as contrasted with mitigation, is meant to reduce the likelihood that a crisis will turn into a disaster. Though there are some recurring features of crises, allowing for preparedness through the identification of a few high-likelihood contingencies, crises are subject to numerous, overwhelming uncertainties. These include hazard uncertainty, incident uncertainty, sequential uncertainty, informational uncertainty, consequential uncertainty, cascade uncertainty, organizational uncertainty, and background uncertainty. In view of the uncertainties, the primary aim of planners should not be to try to create plans for ever more contingencies, since contingencies are far too numerous and perhapsapproach infinity, but rather to create capabilities (through proper preparedness) for resilience during crisis. Resilience can be cultivated through improvements in information acquisition and dissemination, communication systems, resource management, mobility management, design for resilience, incident command, and staff versatility.

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