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 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.

Does Self-reporting Facilitate History Taking in Food Poisoning Mass-casualty Incidents?

2014 ◽  
Vol 29 (4) ◽  
pp. 417-420 ◽  
Author(s):  
Ya-I Hsu ◽  
Ying C. Huang
Keyword(s):  
Health Care ◽  
Medical History ◽  
Food Poisoning ◽  
Mass Casualty ◽  
Mass Casualty Incidents ◽  
Control Group ◽  
History Taking ◽  
Care Providers ◽  
Time Required ◽  
Experimental Group

AbstractIntroductionMedical history is an important contributor to diagnosis and patient management. In mass-casualty incidents (MCIs), health care providers are often overwhelmed by large numbers of casualties. An efficient, reliable, and affordable method of information collection is essential for effective health care response.Hypothesis/ProblemIn some MCIs, self-reporting of symptoms can decrease the time required for history taking, without sacrificing the completeness of triage information.MethodsTwo resident doctors and a number of seventh graders who had previous experience of abdominal discomfort were invited to join this study. A questionnaire was developed to collect information on common symptoms in food poisoning. Each question was scored, and enrolled students were randomly divided into two groups. The experimental group students answered the questionnaire first and then were interviewed to complete the medical history. The control group students were interviewed in the traditional way to collect medical history. Time of all interviews was measured and recorded. The time needed to complete the history taking and completeness of obtained information were compared with students’ t tests, or Mann-Whitney U tests, based on the normality of data. Comprehensibility of each question, scored by enrolled students, was reported by descriptive statistics.ResultsThere were 41 students enrolled: 22 in the experimental group and 19 in the control group. Time to complete history taking in the experimental group (163.0 seconds, SD=52.3) was shorter than that in the control group (198.7 seconds, SD=40.9) (P=.010). There was no difference in the completeness of history obtained between the experimental group and the control group (94.8%, SD=5.0 vs 94.2%, SD=6.1; P=.747). Between the two doctors, no significant difference was found in the time required for history taking (185.2 seconds, SD=42.2 vs 173.1 seconds, SD=58.6; P=.449), or the completeness of information (94.1%, SD=5.9 vs 95.0%, SD=5.0; P=.601). Most of the questions were scored “good” in comprehensibility.ConclusionSelf-reporting of symptoms can shorten the time of history taking during a food poisoning mass-casualty event without sacrificing the completeness of information.HsuY, HuangYC. Does self-reporting facilitate history taking in food poisoning mass-casualty incidents?Prehosp Disaster Med. 2014;29(4):1-4.

Mass-Casualty, Terrorist Bombings: Implications for Emergency Department and Hospital Emergency Response (Part II)

2003 ◽  
Vol 18 (3) ◽  
pp. 235-241 ◽  
Author(s):  
Pinchas Halpern ◽  
Ming-Che Tsai ◽  
Jeffrey L. Arnold ◽  
Edita Stok ◽  
Gurkan Ersoy
Keyword(s):  
Emergency Department ◽  
Emergency Response ◽  
Patient Flow ◽  
Mass Casualty ◽  
Hospital Emergency ◽  
Material Resources ◽  
Patient Disposition ◽  
Flow Through ◽  
And Performance

AbstractThis article reviews the implications of mass-casualty, terrorist bombings for emergency department (ED) and hospital emergency responses. Several practical issues are considered, including the performance of a preliminary needs assessment, the mobilization of human and material resources, the use of personal protective equipment, the organization and performance of triage, the management of explosion-specific injuries, the organization of patient flow through the ED, and the efficient determination of patient disposition. As long as terrorists use explosions to achieve their goals, mass-casualty, terrorist bombings remain a required focus for hospital emergency planning and preparedness.

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.

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 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.

scholarly journals Baseline Well-being, Perceptions of Critical Incidents, and Openness to Debriefing in Community Hospital Emergency Department Clinical Staff Before COVID-19, A Cross-Sectional Study

2020 ◽  
Author(s):  
Laura Ashley Cantu ◽  
Listy Thomas
Keyword(s):  
Emergency Department ◽  
Traumatic Stress ◽  
Critical Incidents ◽  
Well Being ◽  
Cross Sectional Study ◽  
Mass Casualty ◽  
Critically Ill Children ◽  
Hospital Emergency ◽  
Cross Sectional ◽  
Mass Casualty Events

Abstract Background: Emergency department personnel routinely bear witness to traumatic experiences and critical incidents that can affect their own well-being. Peer support through debriefing has demonstrated positive impacts on clinicians’ well-being following critical incidents. This study explored community hospital emergency department staff’s perceptions of critical incidents, assessed openness to debriefing and measured baseline well-being. Our analysis provides a baseline of provider well-being immediately prior to the local onset of COVID-19. The potential need for additional resources to support frontline providers during the pandemic can be evaluated. Method: We conducted a cross-sectional study for 4-weeks prior to the first COVID-19 case in Connecticut using a survey offered to an interprofessional group of emergency department clinical staff. The main outcome measures were the Hospital Anxiety and Depression Scale (HADS) and the Professional Quality of Life (ProQOL) scale. Pearson’s chi-square test was used to identify significant differences in perceptions of critical incidents and debriefings between professional categories. One-way ANOVA and Tukey’s test were used to analyze significant differences in well-being between professional categories. Results: Thirty-nine clinical personnel from St. Vincent’s Emergency Department responded to the survey. Events frequently selected as critical incidents were caring for critically ill children (89.7%), mass casualty events (84.6%), and death of a patient (69.2%). Critical incidents were commonly reported (81.6%) as occurring once per week. Additionally, 76.2% of participants reported wanting to discuss a critical incident with their team. Across all respondents, 45.7% scored borderline or abnormal for anxiety, 55.9% scored moderate for burnout, and 55.8% scored moderate to high for secondary traumatic stress.Conclusions: At baseline, providers reported caring for critically ill children, mass casualty events, and death of a patient as critical incidents, which typically occurred once per week. Death of a patient occurs at increased frequency during the protracted mass casualty experience of COVID-19 and threatens provider well-being. Receptiveness to post-event debriefing is high but the method is still underutilized. With nearly half of staff scoring borderline or abnormal for anxiety, burnout, and secondary traumatic stress at baseline, peer support measures should be implemented to protect frontline providers’ well-being during and after the pandemic.

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