Playing Sick and Injured: The Experiences of Undergraduate Nurses as Casualty Actors in a Mass Casualty Simulation Exercise

AbstractIntroductionA high influx of patients during a mass-casualty incident (MCI) may disrupt patient flow in an already overcrowded emergency department (ED) that is functioning beyond its operating capacity. This pilot study examined the impact of a two-step ED triage model using Simple Triage and Rapid Treatment (START) for pre-triage, followed by triage with the Canadian Triage and Acuity Scale (CTAS), on patient flow during a MCI simulation exercise.Hypothesis/ProblemIt was hypothesized that there would be no difference in time intervals nor patient volumes at each patient-flow milestone.MethodsPhysicians and nurses participated in a computer-based tabletop disaster simulation exercise. Physicians were randomized into the intervention group using START, then CTAS, or the control group using START alone. Patient-flow milestones including time intervals and patient volumes from ED arrival to triage, ED arrival to bed assignment, ED arrival to physician assessment, and ED arrival to disposition decision were compared. Triage accuracy was compared for secondary purposes.ResultsThere were no significant differences in the time interval from ED arrival to triage (mean difference 108 seconds; 95% CI, -353 to 596 seconds; P=1.0), ED arrival to bed assignment (mean difference 362 seconds; 95% CI, -1,269 to 545 seconds; P=1.0), ED arrival to physician assessment (mean difference 31 seconds; 95% CI, -1,104 to 348 seconds; P=0.92), and ED arrival to disposition decision (mean difference 175 seconds; 95% CI, -1,650 to 1,300 seconds; P=1.0) between the two groups. There were no significant differences in the volume of patients to be triaged (32% vs 34%; 95% CI for the difference -16% to 21%; P=1.0), assigned a bed (16% vs 21%; 95% CI for the difference -11% to 20%; P=1.0), assessed by a physician (20% vs 22%; 95% CI for the difference -14% to 19%; P=1.0), and with a disposition decision (20% vs 9%; 95% CI for the difference -25% to 4%; P=.34) between the two groups. The accuracy of triage was similar in both groups (57% vs 70%; 95% CI for the difference -15% to 41%; P=.46).ConclusionExperienced triage nurses were able to apply CTAS effectively during a MCI simulation exercise. A two-step ED triage model using START, then CTAS, had similar patient flow and triage accuracy when compared to START alone.LeeJS, FrancJM. Impact of a two-step emergency department triage model with START, then CTAS, on patient flow during a simulated mass-casualty incident. Prehosp Disaster Med. 2015;30(4):1–7.

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Managing Surge Capacity—Lessons Learned from a National, Mass-Casualty Simulation Exercise

Prehospital and Disaster Medicine ◽

10.1017/s1049023x0002241x ◽

2010 ◽

Vol 25 (S1) ◽

pp. S28-S29

Author(s):

G.P.H. Choa ◽

M.K.F. Leong

Keyword(s):

Mass Casualty ◽

Lessons Learned ◽

Surge Capacity ◽

Simulation Exercise

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A hospital mass casualty exercise using city buses and a tent as a hybrid system for patient decontamination

American Journal of Disaster Medicine ◽

10.5055/ajdm.2017.0273 ◽

2017 ◽

Vol 12 (3) ◽

pp. 189-196 ◽

Cited By ~ 1

Author(s):

Isabelle Imamedjian. MDCM, CCFP ◽

Nisreen Hamza M. Maghraby, MBBS, FRCPC (EM), MM ◽

Valérie Homier, MD, FRCPC

Keyword(s):

Hybrid System ◽

Weather Conditions ◽

Mass Casualty ◽

Fine Tuning ◽

Simulated Patients ◽

Simulation Exercise ◽

Ambulatory Patients ◽

Single Entry ◽

Single Mass ◽

Level 1 Trauma Center

Objective: A hospital mass casualty simulation exercise testing feasibility of two city buses and a tent as a hybrid system for patient decontamination.Design: Observational study of a single mass casualty simulation exercise involving patient decontaminationSetting: Held on May 26, 2016 at the Montreal General Hospital, a Level 1 Trauma center without a garage.Patients, participants: Twenty-one medical staff including nurses, doctors, and patient attendants, and 30 volunteer-simulated patients.Interventions: The foregrounds of the hospital were cordoned off to create a single-entry point for the simulated patients that were identified as contaminated (C) by staff wearing personal protective equipment. Non-contaminated patients were directed to a separate hospital entrance. C patients were triaged in Bus 1 to determine priority for decontamination. Bus 2 served as a holding area for stable patients awaiting decontamination. Patients were decontaminated in appropriate tent sections (non-ambulatory, ambulatory male or female) and then directed to the emergency department.Results: Direct observation and participant feedback suggested that buses may provide adequate shelter for C patients. However, buses had limited capacity for non-ambulatory patients, who were not easily transported inside. Furthermore, areas of improvement were identified in communication, staffing, equipment, and coordination of operations.Conclusions: The use of city buses as triage and waiting zones prior to decontamination appears feasible for centers without a garage and facing unpredictable weather conditions. Further simulations are required for fine-tuning and testing real-time unfolding of tasks, ideally during an unannounced exercise.

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Experience of pharmacy involvement in a disaster simulation exercise within a pediatric hospital emergency department: A pilot project

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxab483 ◽

2021 ◽

Author(s):

Kayla Marks ◽

Sarita Chung ◽

Joyce Li ◽

Mark Waltzman ◽

Shannon Manzi ◽

...

Keyword(s):

Decision Making ◽

Emergency Department ◽

Problem Solving ◽

Disaster Response ◽

Rating Scale ◽

Mass Casualty ◽

Evaluation Tool ◽

Perceived Knowledge ◽

Simulation Exercise ◽

Simulation Exercises

Abstract Disclaimer AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose In this descriptive report, we describe a unique trial of pharmacist participation in a multidisciplinary pediatric emergency department disaster simulation exercise. With the number of disasters increasing worldwide, the role of pharmacists in disaster response is of particular interest to the profession. Summary This observational study describes pharmacist participation in a disaster simulation exercise. An evaluation tool was developed to assess participants’ performance in the following domains: communication, pharmacotherapy, problem solving/decision making, and teamwork/organization. The observers used a rating scale of “concise/prompt,” “needs improvement,” or “not done” to evaluate performance on each objective. The participants’ self-perceived knowledge of disaster response was assessed with pre- and postsimulation surveys using Likert scales. Five simulation exercises were held from June to October 2019, with 2 pharmacists participating in each simulation. Within the problem solving/decision making and communication domains, pharmacists were concise/prompt 66% of the time, while they were concise/prompt for 88.8% and 92.5% of tasks in the teamwork/organization and pharmacotherapy domains, respectively. Surveys of self-perceived knowledge revealed that while only 10% of pharmacists felt “moderately prepared” prior to the simulation exercise, 80% of pharmacists felt moderately prepared to care for patients during a disaster event after the simulation exercise. Conclusion This report describes a unique approach of including emergency department–trained pharmacists in disaster simulation exercises to enhance their professional development, improve team dynamics in a mass casualty scenario, and increase their own reported level of preparedness to effectively manage a surge in critically ill pediatric patients.

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