Improving Pediatric Administrative Disaster Preparedness Through Simulated Disaster Huddles

2020 ◽  
pp. 1-6 ◽  
Author(s):  
Isabel T. Gross ◽  
Scott A. Goldberg ◽  
Travis Whitfill ◽  
Storm Liebling ◽  
Angelica Garcia ◽  
...  
Keyword(s):  
Emergency Department ◽  
Patient Outcomes ◽  
Disaster Preparedness ◽  
Mass Casualty ◽  
Mass Casualty Incidents ◽  
Time Commitment ◽  
Potential Impact

ABSTRACT Members of an emergency department (ED) staff need to be prepared for mass casualty incidents (MCIs) at all times. Didactic sessions, drills, and functional exercises have shown to be effective, but it is challenging to find time and resources for appropriate training. We conducted brief, task-specific drills (deemed “disaster huddles”) in a pediatric ED (PED) to examine if such an approach could be an alternative or supplement to traditional MCI training paradigms. Over the course of the study, we observed an improving trend in the overall score for administrative disaster preparedness. Disaster huddles may be an effective way to improve administrative disaster preparedness in the PED. Low-effort, low-time commitment education could be an attractive way for further disaster preparedness efforts. Further studies are indicated to show a potential impact on lasting behavior and patient outcomes.

scholarly journals The Role of the Nurse Disaster Preparedness Coordinator at a Large Suburban Teaching Hospital

2019 ◽  
Vol 34 (s1) ◽  
pp. s165-s166
Author(s):  
Beth Weeks
Keyword(s):  
Emergency Department ◽  
Emergency Management ◽  
Disaster Preparedness ◽  
Nursing Practice ◽  
The United States ◽  
Mass Casualty ◽  
Mass Casualty Incidents ◽  
Hospital Emergency ◽  
Emergency Manager

Introduction:Mass casualty incidents, whether man-made or natural, are occurring with increasing frequency and severity. Hospitals and health systems across the United States are striving to be more rigorously prepared more such incidents. Following a mass shooting in 2012 and significant growth and expansion of our hospital and health system in the following years, a need was identified for more staff to support preparedness efforts.Aim:To discuss the roles and responsibilities of Nurse Disaster Preparedness Coordinator (NDPC), a dedicated position in the Emergency Department (ED).Methods:The role of Nurse Disaster Preparedness Coordinator was implemented in 2016, is a part-time position in the Emergency Department and reports to the ED Manager while working closely with the ED Director of Emergency Preparedness and the hospital Emergency Manager. The role addresses all areas of the emergency management continuum, from planning and mitigation to response and recovery.Results:The NDPC’s responsibilities fall into the categories of all-hazards preparedness, chemical, biological, radioactive, nuclear and explosive (CBRNE) response, and general nursing practice. All-hazards preparedness includes ED staff training, policy and procedure development, and liaising with hospital emergency manager to coordinate hospital-wide efforts. CBRNE response includes the training and maintenance of a patient decontamination team, a high-risk infectious disease team, and their equipment. General nursing practice addresses research, nursing indicators as they apply to disasters, promoting evidence-based practice, and community outreach.Discussion:A dedicated Nurse Disaster Preparedness Coordinator has allowed transition from intermittent larger exercises to a regular and frequent exercise schedule and better application of full-scale exercises. Overall, the creation of the role has strengthened hospital readiness for mass casualty incidents while alleviating the vast scope of emergency management responsibilities for a large suburban hospital.

scholarly journals MP26: Development and evaluation of a novel emergency physician fan-out mechanism at an urban centre for use in mass casualty incidents

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S51
Author(s):  
J. Melegrito ◽  
B. Granberg ◽  
K. Hanrahan
Keyword(s):  
Emergency Department ◽  
Emergency Physician ◽  
Large Scale ◽  
Response Rate ◽  
Text Message ◽  
Mass Casualty ◽  
Mass Casualty Incidents ◽  
Process Mapping ◽  
Emergency Physicians ◽  
Physician Response

Background: Understaffing in mass casualty incidents limits flow in the overwhelmed emergency department, which is further compounded by inefficient use of those same human resources. Process mapping analysis of a “Code Orange” exercise at a tertiary academic hospital exposed the failures of telephone-based emergency physician fan-out protocols to address these issues. As such, a quality improvement and patient safety initiative was undertaken to design, implement, and evaluate a new mass casualty incident fan-out mechanism. Aim Statement: By February 2019, emergency physician fan-out will be accomplished within 1 hour of Code Orange declaration, with a response rate greater than 20%. Measures & Design: Process mapping of a Code Orange simulation highlighted telephone fan-out to be ineffective in mobilizing emergency physicians to provide care in mass casualty incidents: available staff were pulled from their usual duties to help unit clerks unsuccessfully reach off-duty physicians by telephone for hours. Stakeholders subsequently identified automation and computerization as a compelling change idea. A de-novo automated bidirectional text-messaging system was thus developed. Early trials were analyzed for process measures including fan-out speed, unit clerk involvement, and physician response rate, with further large-scale tests planned for early 2019. Evaluation/Results: Only 50% of telephone fan-out was completed after a 2-hour exercise despite 3 staff supplementing the 2 on-shift unit clerks, with a 4% physician response rate. In contrast, data from initial trials of the automated system suggest that full fan-out can be performed within 1 hour of Code Orange declaration and require only 1 unit clerk, with text-messages projected to yield higher physician response rates than telephone calls. Early findings have thus far affirmed stakeholder sentiments that automating fan-out can improve speed, unit clerk efficiency, and physician response rate. Discussion/Impact: Automated text-message systems can expedite fan-out protocol in mass casualty incidents, relieve allied health staff strain, and more reliably recruit emergency physicians. Large-scale trials of the novel system are therefore planned for early 2019, with future expansion of the protocol to other medical personnel under consideration. Thus, automated text-message systems can be implemented in urban centres to improve fan-out efficiency and aid overall emergency department flow in mass casualty incidents.

scholarly journals (P1-38) Emergency Department Preparedness for Training Management Plan towards Mass Casualty Incidents

2011 ◽  
Vol 26 (S1) ◽  
pp. s110-s111
Author(s):  
W.L. Chan
Keyword(s):  
Emergency Department ◽  
Food Poisoning ◽  
Management Plan ◽  
Mass Casualty ◽  
Mass Casualty Incidents ◽  
Working Relationships ◽  
Work Processes ◽  
Hospital Emergency ◽  
New Information ◽  
Planning Department

It is important to equip emergency department (ED) staff with skills to manage mass casualty incidents (MCI) as disasters strike without warning. Our hospital, Tan Tock Seng Hospital, has been the national screening centre for severe acute respiratory distress syndrome (SARS) and H1N1 outbreaks in 2003 and 2009. Furthermore, our ED has managed casualties from mass food poisoning in the community. We would like to share our experiences in training our staff for MCI. For the ED to operate smoothly in a MCI, comprehensive training of staff during “peace” time is essential. We have a selected team of doctors and nurses as the department disaster workgroup. This team, together with the hospital emergency planning department, prepare the disaster protocols using an “all hazard approach concept” and aim to minimise variations between different protocols (Conventional, Infectious disease, Hazmat, Radioactive MCI). These protocols are updated regularly, with new information disseminated to all staff. Next, all staff must be well-versed in the protocols. New staffs undergo orientation programmes to familiarize them with the work processes. Regular audits are conducted to ensure that the quality is well-maintained. Additionally, training also occurs at the inter-departmental and national levels. There are regular activation exercises to test inter-departmental response to MCI and collaborations with Ministry of Health to conduct disaster exercises e.g. the biennial Kingfisher Exercise in preparation for radiation-related MCI. Such exercises improve communication and working relationships within the ED and with other departments. The camaraderie developed can act as a pillar of support during stressful times of MCI. Lastly, the ED staffs attend local and international courses and conferences to update ourselves on the latest training and knowledge in the handling of MCI. This allows us to share our ideas and to learn from our local and international counterparts, and helps better prepare ourselves.

scholarly journals Training Emergency Department Charge Nurses Through Tabletop Exercises

2019 ◽  
Vol 34 (s1) ◽  
pp. s19-s19
Author(s):  
Beth Weeks
Keyword(s):  
Decision Making ◽  
Emergency Department ◽  
Training Program ◽  
Disaster Response ◽  
Mass Casualty ◽  
Full Scale ◽  
Leadership Role ◽  
Mass Casualty Incidents ◽  
Charge Nurses ◽  
Incident Command

Introduction:In a disaster or mass casualty incident, the Emergency Department (ED) charge nurse is thrust into an expanded leadership role, expected to not only manage the department but also organize a disaster response. Hospital emergency preparedness training programs typically focus on high-level leadership, while frontline decision-making staff get experience only through online training and infrequent full-scale exercises. Financial and time limitations of full-scale exercises have been identified as major barriers to frontline training.Aim:To discuss a cost-effective approach to training ED charge nurses and informal leaders in disaster response.Methods:A formal training program was implemented in the ED. All permanent and relief charge nurses are required to attend one four-hour Hospital ICS course within their first year in their position, as well as participate in a minimum of one two-hour ED-based tabletop exercise per year. The tabletop exercises are offered bimonthly, covering various mass casualty scenarios such as apartment complex fires, riots, and a tornado strike. Full-scale exercises involving the ED occur annually.Results:ED permanent and relief charge nurses expressed increased skills and knowledge in areas such as initiation of disaster processes, implementation of hospital incident command, and familiarization with protocols and available resources. Furthermore, ED charge nurses have demonstrated strong leadership, decision-making, and improved response to actual mass casualty incidents since implementing ICS training and tabletop exercises.Discussion:Limitations of relying on full-scale disaster exercises to provide experience to frontline leaders can be overcome by the inclusion of ICS training and tabletop exercises for ED charge nurses in a hospital training and exercise plan. Implementing a structured training program for ED charge nurses focusing on leadership in mass casualty incidents is one step to building a more resilient and prepared ED, hospital, and community.

Developing a Hospital Disaster Preparedness Plan for Mass Casualty Incidents: Lessons Learned From the Downtown Beirut Bombing

2017 ◽  
Vol 12 (3) ◽  
pp. 379-385 ◽  
Author(s):  
Mazen El Sayed ◽  
Ali F. Chami ◽  
Eveline Hitti
Keyword(s):  
Disaster Preparedness ◽  
Disaster Response ◽  
Hospital Staff ◽  
Mass Casualty ◽  
Lessons Learned ◽  
Mass Casualty Incidents ◽  
Preparedness Plan ◽  
Security Issues ◽  
Response System ◽  
General Response

AbstractMass casualty incidents (MCIs) are becoming more frequent worldwide, especially in the Middle East where violence in Syria has spilled over to many neighboring countries. Lebanon lacks a coordinated prehospital response system to deal with MCIs; therefore, hospital preparedness plans are essential to deal with the surge of casualties. This report describes our experience in dealing with an MCI involving a car bomb in an urban area of downtown Beirut, Lebanon. It uses general response principles to propose a simplified response model for hospitals to use during MCIs. A summary of the debriefings following the event was developed and an analysis was performed with the aim of modifying our hospital’s existing disaster preparedness plan. Casualties’ arrival to our emergency department (ED), the performance of our hospital staff during the event, communication, and the coordination of resources, in addition to the response of the different departments, were examined. In dealing with MCIs, hospital plans should focus on triage area, patient registration and tracking, communication, resource coordination, essential staff functions, as well as on security issues and crowd control. Hospitals in other countries that lack a coordinated prehospital disaster response system can use the principles described here to improve their hospital’s resilience and response to MCIs. (Disaster Med Public Health Preparedness. 2018; 12: 379–385)

scholarly journals Mass Casualty Management in the Emergency Department – Lessons Learned in Beirut, Lebanon - Part II

2020 ◽  
Keyword(s):  
Emergency Department ◽  
Emergency Departments ◽  
Mass Casualty ◽  
Lessons Learned ◽  
Mass Casualty Incidents ◽  
The Past ◽  
To Receive

The first article in this series (Part I) discussed the abundant exposure of our emergency department (ED) to mass casualty incidents (MCIs), particularly over the past 14 years. This experience led us to define practical strategies that emergency departments can use to develop their own MCI response plans. In the first part, our main focus was to highlight the abrupt nature of MCIs and the subsequent need to use disaster drills. Additionally, we discussed the importance of having a tiered response and activation as well as other lessons learned from our experience to maximize the preparedness of the emergency department to receive mass casualty.In this article, we discuss the optimal way to triage patients. In addition, we will tackle the best methods for documentation and communication, which are vital yet overlooked during mass casualty incidents. We will also elaborate on what we learned from dealing with outbursts of anger and violence in the ED during MCIs and how to ensure the safety of the ED staff.

Casualty Collection in Mass-Casualty Incidents: A Better Method for Finding Proverbial Needles in a Haystack

2006 ◽  
Vol 21 (6) ◽  
pp. 459-464 ◽  
Author(s):  
Kristina E. Knotts ◽  
Stuart Etengoff ◽  
Kimberly Barber ◽  
Ina J. Golden
Keyword(s):  
Patient Outcomes ◽  
Mass Casualty ◽  
Time Of Day ◽  
Mass Casualty Incidents ◽  
Ambient Light ◽  
Inclement Weather ◽  
Treatment Start ◽  
Number Of Patients ◽  
Poor Lighting ◽  
Rapid Treatment

AbstractIntroduction:Mass-casualty incidents (MCIs) are on the rise. The ability to locate, identify, and triage patients quickly and efficiently results in better patient outcomes. Poor lighting due to time of day, inclement weather, and power outages can make locating patients difficult. Efficient methods of locating patients allow for quicker transport to definitive care.Objective:The objective of this study was to evaluate the methods currently used in mass-casualty collection, and to determine whether the use of the Simple Triage and Rapid Treatment (START) triage tag system can be improved by using easily discernable tags (glow sticks) in conjunction with the standard triage tags.Methods:Numerous drills were performed utilizing the START triage method. In Trial A, patients were identified with the triage tags only. In Trial B, patients were identified using triage tags and glow sticks. Four rounds of triage drills were performed in low ambient light for each Trial, and the differences in casualty collection times were compared.Results:Casualty relocation and collection times were considerably shorter in the trials that utilized both the glow sticks and triage tags. An average of 2.58 minutes (31.75%) were saved during the casualty collections. In addition, fewer patient errors occurred during the trials in which the glow sticks were used. Between the four rounds, an average of four patient errors occurred during the trials that utilized the triage tags. However, there was an average of only one patient error for the drills when participants utilized both the triage tags and the glow sticks.Conclusions:The use of the highly visible glow sticks, in conjunction with the START triage tags, allowed for more rapid and accurate casualty collection in suboptimal lighting. The use of the glow sticks made it easier to relocate previously triaged patients and arrange for expeditious transport to definitive care. In addition, the glow sticks reduced the number of patient errors. Most importantly, there was a significant reduction in the number of patients that initially were triaged via the START method, but were overlooked during casualty collection and transport.

scholarly journals Designing and executing a functional exercise to test a novel informatics tool for mass casualty triage

2019 ◽  
Vol 26 (10) ◽  
pp. 1091-1098
Author(s):  
Sara B Donevant ◽  
Erik R Svendsen ◽  
Jane V Richter ◽  
Abbas S Tavakoli ◽  
Jean B r Craig ◽  
...  
Keyword(s):  
Emergency Department ◽  
Research Team ◽  
Planning Process ◽  
Time Frame ◽  
Mass Casualty ◽  
Mass Casualty Incidents ◽  
Unique Problem ◽  
Functional Exercise ◽  
Irritant Gas ◽  
Informatics Tools

Abstract Objective The testing of informatics tools designed for use during mass casualty incidents presents a unique problem as there is no readily available population of victims or identical exposure setting. The purpose of this article is to describe the process of designing, planning, and executing a functional exercise to accomplish the research objective of validating an informatics tool specifically designed to identify and triage victims of irritant gas syndrome agents. Materials and Methods During a 3-year time frame, the research team and partners developed the Emergency Department Informatics Computational Tool and planned a functional exercise to test it using medical records data from 298 patients seen in 1 emergency department following a chlorine gas exposure in 2005. Results The research team learned valuable lessons throughout the planning process that will assist future researchers with developing a functional exercise to test informatics tools. Key considerations for a functional exercise include contributors, venue, and information technology needs (ie, hardware, software, and data collection methods). Discussion Due to the nature of mass casualty incidents, testing informatics tools and technology for these incidents is challenging. Previous studies have shown a functional exercise as a viable option to test informatics tools developed for use during mass casualty incidents. Conclusion Utilizing a functional exercise to test new mass casualty management technology and informatics tools involves a painstaking and complex planning process; however, it does allow researchers to address issues inherent in studying informatics tools for mas casualty incidents.

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