Ten (+1) lessons from conducting a mass casualty in situ simulation exercise in a Canadian academic hospital setting

2021 ◽  
Vol 19 (3) ◽  
pp. 253-265
Author(s):  
Jeffrey T. Tochkin, MA, CEM ◽  
Hung Tan, MSc ◽  
Caroline Nolan ◽  
Harrison Carmichael, MD ◽  
Andrew Willmore, MD ◽  
...  
Keyword(s):  
Disaster Preparedness ◽  
Hospital Setting ◽  
Mass Casualty ◽  
First Century ◽  
System Level ◽  
In Situ Simulation ◽  
Hospital Administrators ◽  
Simulation Based ◽  
Disaster Exercise

Providing care in a twenty-first century urban emergency department (ED) and trauma center is a complex high-pressure practice environment. The pressure is intensified during patient surge scenarios commonly seen during mass casualty incidents, such that response must be practiced regularly. Beyond clinical mastery of individual patient trauma care, a coordinated system-level response is essential to optimize patient care during these relatively infrequent events. This paper highlights the need to perform exercises in hospitals while providing practical advice on how to utilize in situ simulation for mass casualty testing. Eleven lessons are presented to assist other emergency management professionals, hospital administrators, or clinical staff to achieve success with in situ simulation. Based upon our experience designing and executing an in situ mass casualty simulation within an ED, we offer lessons applicable to any type of disaster exercise. Simulation offers a powerful tool for the conduct of disaster preparedness exercises for staff across multiple hospital departments and professions.

Using Mixed Methods to Assess Pediatric Disaster Preparedness in the Hospital Setting

2014 ◽  
Vol 29 (6) ◽  
pp. 569-575 ◽  
Author(s):  
Rita V. Burke ◽  
Tae Y. Kim ◽  
Shelby L. Bachman ◽  
Ellen I. Iverson ◽  
Bridget M. Berg
Keyword(s):  
Mixed Methods ◽  
Emergency Response ◽  
Disaster Preparedness ◽  
Disaster Response ◽  
Hospital Setting ◽  
Mass Casualty ◽  
Disaster Victims ◽  
Qualitative Feedback ◽  
Disaster Exercise ◽  
Communication Equipment

AbstractIntroductionChildren are particularly vulnerable during disasters and mass-casualty incidents. Coordinated multi-hospital training exercises may help health care facilities prepare for pediatric disaster victims.ProblemThe purpose of this study was to use mixed methods to assess the disaster response of three hospitals, focusing on pediatric disaster victims.MethodsA full-functional disaster exercise involving a simulated 7.8-magnitude earthquake was conducted at three Los Angeles (California USA) hospitals, one of which is a freestanding designated Level I Pediatric Trauma Center. Exercise participants provided quantitative and qualitative feedback regarding their perceptions of pediatric disaster response during the exercise in the form of surveys and interviews. Additionally, trained observers provided qualitative feedback and recommendations regarding aspects of emergency response during the exercise, including communication, equipment and supplies, pediatric safety, security, and training.ResultsAccording to quantitative participant feedback, the disaster exercise enhanced respondents’ perceived preparedness to care for the pediatric population during a mass-casualty event. Further, qualitative feedback from exercise participants and observers revealed opportunities to improve multiple aspects of emergency response, such as communication, equipment availability, and physician participation. Additionally, participants and observers reported opportunities to improve safety and security of children, understanding of staff roles and responsibilities, and implementation of disaster triage exercises.ConclusionConsistent with previous investigations of pediatric disaster preparedness, evaluation of the exercise revealed several opportunities for all hospitals to improve their ability to respond to the needs of pediatric victims. Quantitative and qualitative feedback from both participants and observers was useful for comprehensively assessing the exercise's successes and obstacles. The present study has identified several opportunities to improve the current state of all hospitals’ pediatric disaster preparedness, through increased training on pediatric disaster triage methods and additional training on the safety and security of children. Regular assessment and evaluation of supplies, equipment, leadership assignments, and inter-hospital communication is also suggested to optimize the effectiveness and efficiency of response to pediatric victims in a disaster.BurkeRV, KimTY, BachmanSL, IversonEI, BergBM. Using mixed methods to assess pediatric disaster preparedness in the hospital setting. Prehosp Disaster Med. 2014;29(6): 1-7.

scholarly journals Disaster Day: A Simulation-Based Disaster Medicine Curriculum for Novice Learners

2021 ◽  
Vol 8 ◽  
pp. 238212052110207
Author(s):  
Brad D Gable ◽  
Asit Misra ◽  
Devin M Doos ◽  
Patrick G Hughes ◽  
Lisa M Clayton ◽  
...  
Keyword(s):  
Medical Students ◽  
Disaster Management ◽  
Disaster Preparedness ◽  
Real Life ◽  
Mass Casualty ◽  
Disaster Medicine ◽  
Incident Command ◽  
Management Concepts ◽  
Simulation Based ◽  
Second Year

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.

scholarly journals Making the invisible visible: a place for utilizing activity theory within in situ simulation to drive healthcare organizational development?

2020 ◽  
Vol 5 (1) ◽  
Author(s):  
Gerard J. Gormley ◽  
Anu Kajamaa ◽  
Richard L. Conn ◽  
Sarah O’Hare
Keyword(s):  
Organizational Development ◽  
Activity Theory ◽  
Health Care Systems ◽  
System Level ◽  
Main Body ◽  
Healthcare Provision ◽  
In Situ Simulation ◽  
Healthcare Needs ◽  
Care Systems

Abstract Background The healthcare needs of our societies are continual changing and evolving. In order to meet these needs, healthcare provision has to be dynamic and reactive to provide the highest standards of safe care. Therefore, there is a continual need to generate new evidence and implement it within healthcare contexts. In recent times, in situ simulation has proven to have been an important educational modality to accelerate individuals’ and teams’ skills and adaptability to deliver care in local contexts. However, due to the increasing complexity of healthcare, including in community settings, an expanded theoretical informed view of in situ simulation is needed as a form of education that can drive organizational as well as individual learning. Main body Cultural-historical activity theory (CHAT) provides us with analytical tools to recognize and analyse complex health care systems. Making visible the key elements of an in situ simulation process and their interconnections, CHAT facilitates development of a system-level view of needs of change. Conclusion In this paper, we theorize how CHAT could help guide in situ simulation processes—to generate greater insights beyond the specific simulation context and bring about meaningful transformation of an organizational activity.

scholarly journals Adherence to Pediatric Cardiac Arrest Guidelines Across a Spectrum of Fifty Emergency Departments: A Prospective, In Situ, Simulation‐based Study

2018 ◽  
Vol 25 (12) ◽  
pp. 1396-1408 ◽  
Author(s):  
Marc Auerbach ◽  
Linda Brown ◽  
Travis Whitfill ◽  
Janette Baird ◽  
Kamal Abulebda ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Emergency Departments ◽  
In Situ Simulation ◽  
Simulation Based

scholarly journals Improving safety and reducing error in endoscopy: simulation training in human factors

2019 ◽  
Vol 10 (2) ◽  
pp. 160-166 ◽  
Author(s):  
Srivathsan Ravindran ◽  
Siwan Thomas-Gibson ◽  
Sam Murray ◽  
Eleanor Wood
Keyword(s):  
Human Factors ◽  
Simulation Training ◽  
Working Environment ◽  
Advisory Group ◽  
In Situ Simulation ◽  
Simulation Based ◽  
The Uk ◽  
Endoscopy Simulation ◽  
Patient Safety Incidents

Patient safety incidents occur throughout healthcare and early reports have exposed how deficiencies in ‘human factors’ have contributed to mortality in endoscopy. Recognising this, in the UK, the Joint Advisory Group for Gastrointestinal Endoscopy have implemented a number of initiatives including the ‘Improving Safety and Reducing Error in Endoscopy’ (ISREE) strategy. Within this, simulation training in human factors and Endoscopic Non-Technical Skills (ENTS) is being developed. Across healthcare, simulation training has been shown to improve team skills and patient outcomes. Although the literature is sparse, integrated and in situ simulation modalities have shown promise in endoscopy. Outcomes demonstrate improved individual and team performance and development of skills that aid clinical practice. Additionally, the use of simulation training to detect latent errors in the working environment is of significant value in reducing error and preventing harm. Implementation of simulation training at local and regional levels can be successfully achieved with collaboration between organisational, educational and clinical leads. Nationally, simulation strategies are a key aspect of the ISREE strategy to improve ENTS training. These may include integration of simulation into current training or development of novel simulation-based curricula. However used, it is evident that simulation training is an important tool in developing safer endoscopy.

scholarly journals A Collaborative In Situ Simulation-based Pediatric Readiness Improvement Program for Community Emergency Departments

2017 ◽  
Vol 25 (2) ◽  
pp. 177-185 ◽  
Author(s):  
Kamal Abulebda ◽  
Riad Lutfi ◽  
Travis Whitfill ◽  
Samer Abu-Sultaneh ◽  
Kellie J. Leeper ◽  
...  
Keyword(s):  
Emergency Departments ◽  
Improvement Program ◽  
In Situ Simulation ◽  
Simulation Based

1115: Improvement in Pediatric Airway Management in Community EDs After In Situ Simulation-Based Program

2020 ◽  
Vol 49 (1) ◽  
pp. 559-559
Author(s):  
Manahil Mustafa ◽  
Kamal Abulebda ◽  
Riad Lutfi ◽  
Hani Alsaedi ◽  
Samer Abu-Sultaneh
Keyword(s):  
Airway Management ◽  
Pediatric Airway ◽  
In Situ Simulation ◽  
Simulation Based

scholarly journals In-situ Simulation-Based Module to Train Interns in Resuscitation Skills During Cardiac Arrest

2020 ◽  
Vol Volume 11 ◽  
pp. 271-285 ◽  
Author(s):  
Roshana Shrestha ◽  
Dinesh Badyal ◽  
Anmol Purna Shrestha ◽  
Abha Shrestha
Keyword(s):  
Cardiac Arrest ◽  
In Situ Simulation ◽  
Simulation Based

scholarly journals Reducing door-to-needle times in stroke thrombolysis to 13 min through protocol revision and simulation training: a quality improvement project in a Norwegian stroke centre

2019 ◽  
Vol 28 (11) ◽  
pp. 939-948 ◽  
Author(s):  
Soffien Chadli Ajmi ◽  
Rajiv Advani ◽  
Lars Fjetland ◽  
Kathinka Dehli Kurz ◽  
Thomas Lindner ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Patient Outcomes ◽  
Treatment Protocol ◽  
Team Training ◽  
Quality Improvement Project ◽  
Improvement Project ◽  
In Situ Simulation ◽  
Simulation Based ◽  
Stroke Thrombolysis

BackgroundIn eligible patients with acute ischaemic stroke, rapid revascularisation is crucial for good outcome. At our treatment centre, we had achieved and sustained a median door-to-needle time of under 30 min. We hypothesised that further improvement could be achieved through implementing a revised treatment protocol and in situ simulation-based team training sessions. This report describes a quality improvement project aiming to reduce door-to-needle times in stroke thrombolysis.MethodsAll members of the acute stroke treatment team were surveyed to tailor the interventions to local conditions. Through a review of responses and available literature, the improvement team suggested changes to streamline the protocol and designed in situ simulation-based team training sessions. Implementation of interventions started in February 2017. We completed 14 simulation sessions from February to June 2017 and an additional 12 sessions from November 2017 to March 2018. Applying Kirkpatrick’s four-level training evaluation model, participant reactions, clinical behaviour and patient outcomes were measured. Statistical process control charts were used to demonstrate changes in treatment times and patient outcomes.ResultsA total of 650 consecutive patients, including a 3-year baseline, treated with intravenous thrombolysis were assessed. Median door to needle times were significantly reduced from 27 to 13 min and remained consistent after 13 months. Risk-adjusted cumulative sum charts indicate a reduced proportion of patients deceased or bedridden after 90 days. There was no significant change in balancing measures (stroke mimics, fatal intracranial haemorrhage and prehospital times).ConclusionsImplementing a revised treatment protocol in combination with in situ simulation-based team training sessions for stroke thrombolysis was followed by a considerable reduction in door-to-needle times and improved patient outcomes. Additional work is needed to assess sustainability and generalisability of the interventions.

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