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

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.

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.

Impact of a Two-step Emergency Department Triage Model with START, then CTAS, on Patient Flow During a Simulated Mass-casualty Incident

2015 ◽  
Vol 30 (4) ◽  
pp. 390-396 ◽  
Author(s):  
James S. Lee ◽  
Jeffrey M. Franc
Keyword(s):  
Emergency Department ◽  
Patient Flow ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Mean Difference ◽  
Time Intervals ◽  
Simulation Exercise ◽  
Physician Assessment ◽  
Emergency Department Triage ◽  
The Difference

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.

scholarly journals (A145) Simulation for the Assessment and Optimization of Medical Disaster Management

2011 ◽  
Vol 26 (S1) ◽  
pp. s41-s42
Author(s):  
E.L. Dhondt ◽  
F. Van utterbeek ◽  
C. Ullrich ◽  
M. Debacker
Keyword(s):  
Decision Making ◽  
Disaster Management ◽  
Disaster Response ◽  
Large Scale ◽  
Simulation Optimization ◽  
Mass Casualty ◽  
Optimization Techniques ◽  
Evidence Based ◽  
Outcome Indicators ◽  
Medical Response

BackgroundThe ultimate goal of medical disaster management must be to predictably orchestrate transition from “standard of care” to “sufficiency of care” using evidence-based methods. However, neither descriptive reports of disaster responses nor epidemiological studies investigating disaster risk factors have been able to provide validated outcome measures as to what constitutes a “good” disaster response. Moreover, it either has been considered impossible, ethically inappropriate, or both, to identify experimental and control groups essential for hypothesis testing for the conduct of scientific randomized controlled clinical trials.ObjectiveThe aim of this study was to identify a number of performance and outcome indicators and define optimal disaster response and management decision-making for various disaster scenarios using simulation optimization.Methods and ResultsA system model of medical disaster management was designed, and victim models and performance and outcome indicators were developed. Various mass-casualty and large-scale disaster scenarios were developed, including: (1) a hospital emergency incident/disaster; (2) a CBRNE incident; (3) an airplane crash and airport disaster; (4) a mass gathering; and (5) a military battlefield mass casualty. Using “Discrete Event Driven Simulation”, multiple replications were made for different decision-making modalities, different resource allocations, and different disaster response procedures. Statistical analysis and optimization techniques were applied to achieve the best available setting of parameters of the simulation model. In such a way, the “Medical Disaster Management Simulator” runs the “missing experimental studies” in a simplified artificial simulated disaster environment.ConclusionsSimulation optimization is an adequate tool for judging and evaluating the effectiveness and adequacy of health and relief services provided during disaster medical response. Evidence-based recommendations and codes of best practice were formulated for optimal medical disaster and military battlefield management in different large-scale event scenarios as well as for teaching, training, and research in medical disaster management.

Development of evaluation modules for use in hospital disaster drills

2007 ◽  
Vol 2 (2) ◽  
pp. 87-95 ◽  
Author(s):  
Mollie W. Jenckes, MHSc, BSN ◽  
Christina L. Catlett, MD ◽  
Edbert B. Hsu, MD, MPH ◽  
Karen Kohri ◽  
Gary B. Green, MD, MPH ◽  
...  
Keyword(s):  
Disaster Response ◽  
Healthcare Providers ◽  
Physical Space ◽  
Mass Casualty ◽  
Lessons Learned ◽  
Evaluation Tool ◽  
General Observation ◽  
Incident Command ◽  
Structure Communication ◽  
Command Center

Introduction: Disaster drills are a valuable means of training healthcare providers to respond to mass casualty incidents resulting from acts of terrorism or public health crises. We present here a proposed hospital-based disaster drill evaluation tool that is designed to identify strengths and weaknesses of hospital disaster drill response, provide a learning opportunity for disaster drill participants, and promote integration of lessons learned into future responses. Methods: Clinical specialists, experienced disaster drill coordinators and evaluators, and experts in questionnaire design developed the evaluation mod-ules based upon a comprehensive review of the litera-ture, including evaluations of disaster drills. The tool comprises six evaluation modules designed to capture strengths and weaknesses of different aspects of hospital disaster response. The Predrill Module is completed by the hospital during drill planning and is used to define the scope of the exercise. The Incident Command Center Module assesses command structure, communication between response areas and the command center, and communication to outside agencies. The Triage Zone Module captures the effect of a physical space on triage activities, efficiency of triage operations, and victim flow. The Treatment Zone Module assesses the relation of the zone’s physical characteristics to treatment activities, efficacy of treatment operations, adequacy of supplies, and victim flow. A Decontamination Zone Module is available for evaluating decontamination operations and the use of decontamination and/or personal protective equipment in drills that involve biological or radiological hazardous materials. The Group Debriefing Module provides sample discussion points for drill participants in all types of drills. The tool also has addenda to evaluate specifics for 1) general observation and documentation, 2) victim tracking, 3) biological incidents, and 4) radiological incidents. Conclusion: This evaluation tool will help meet the need for standardized evaluation of disaster drills. The modular approach offers flexibility and could be used by hospitals to evaluate staff training on response to natural or man-made disasters.

Truth Matters: Cognitive Integrity as an Intervention for Self-Deception

2017 ◽  
Author(s):  
Eugenia Isabel Gorlin ◽  
Michael W. Otto
Keyword(s):  
Decision Making ◽  
Problem Solving ◽  
Autonomous Agents ◽  
Therapeutic Interventions ◽  
Empirical Validation ◽  
The Past ◽  
Adaptive Problem

To live well in the present, we take direction from the past. Yet, individuals may engage in a variety of behaviors that distort their past and current circumstances, reducing the likelihood of adaptive problem solving and decision making. In this article, we attend to self-deception as one such class of behaviors. Drawing upon research showing both the maladaptive consequences and self-perpetuating nature of self-deception, we propose that self-deception is an understudied risk and maintaining factor for psychopathology, and we introduce a “cognitive-integrity”-based approach that may hold promise for increasing the reach and effectiveness of our existing therapeutic interventions. Pending empirical validation of this theoretically-informed approach, we posit that patients may become more informed and autonomous agents in their own therapeutic growth by becoming more honest with themselves.

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