Using a Logic Model to Enable and Evaluate Long-Term Outcomes of a Mass Casualty Training Program: A Single Center Case Study

Purpose: Global health disasters are on the rise and can occur at any time with little advance warning, necessitating preparation. The authors created a comprehensive evidence-based Emergency Preparedness Training Program focused on long-term retention and sustained learner engagement. Method: A prospective observational study was conducted of a simulation-based mass casualty event training program designed using an outcomes-based logic model. A total of 25 frontline healthcare workers from multiple hospital sites in the New York metropolitan area participated in an 8-hour immersive workshop. Data was collected from assessments, and surveys provided to participants 3 weeks prior to the workshop, immediately following the workshop, and 3 months after completion of the workshop. Results: The mean percentage of total knowledge scores improved across pre-workshop, post-workshop and retention (3 months post-workshop) assessments (53.2% vs. 64.8% vs. 67.6%, P < 0.05). Average comfort scores in the core MCI competencies increased across pre-workshop, post-workshop and retention self-assessments (P < 0.01). Of the participants assessed at 3 months retention (n = 14, 56%), 50.0% (n = 7) assisted in updating their hospital’s emergency operations plan and 50.0% (n = 7) pursued further self-directed learning in disaster preparedness medicine. Conclusions: The use of the logic model provided a transparent framework for the design, implementation, and evaluation of a competency-based EPT program at a single academic center.

Why Does Israel Lead the World in COVID-19 Vaccinations? Applying Mass Casualty Event Principles to COVID-19 Vaccination Programs

The article examines Israel’s experience in managing the COVID-19 vaccination program beginning in December 2020. Utilizing principles of mass casualty event management, such as triaging, flow of casualty care, and flexibility (among others), we analyze Israel’s vaccination program. The successful Israeli experience was found to be based on timely coordinated and adaptive health system logistics and operations, as well as cooperative population behaviors.

Salty Crackers as Fortuitous Dosimeters: A Novel PSL Method for Rapid Radiation Triage

When a radiological and nuclear (R/N) emergency occurs, the categorization of individuals into those who are unaffected and those requiring medical intervention is a high priority. At times, a professional dosimeter is not available and therefore some common belongings may be used as fortuitous dosimeters. The preparation of these objects for the measurement should be such as to give the most accurate and precise results. This paper focused on the Photo-Stimulated Luminescence (PSL) response of salty crackers confronts the problem of sample preparation (mass, grain size), dose response and signal stability. The dose response was determined for doses up to 5 Gy, which allowed the calculation of the limit of detection. Additionally, the signal stability was investigated for samples irradiated with 0.3 and 3 Gy. The observed decrease of the signal does not prevent the detection in the dose range typical for R/N emergency. The main dosimetric characteristics were investigated by using two different models of PSL readers equipped with single (infrared) or double (infrared, blue light) stimulation. The results indicated that the limit of detection can be improved by applying blue light stimulation. Moreover, strong correlation of the measurements performed in the two different instruments, as well as the rapidity of the analysis and the simplicity of the operations, suggest that this method can be suitable for a rapid radiation triage of a large number of civilians in a mass casualty event. The study was simultaneously conducted by two laboratories (Ruder Bošković Institute, RBI, Croatia and Istituto Superiore di Sanità, ISS, Italy) involved in the BioPhyMeTRE project (grant No. G5684) supported by NATO Science for Peace and Security Programme.

562 Burn Bed Availability in the Northeast Region During the COVID-19 Pandemic

Introduction The coronavirus disease pandemic has placed enormous strain on all medical services with ICU capabilities throughout the Northeast region. The surge in ICU beds might severely limit burn centers to accept burn patients in a regional mass casualty incident. Methods Burn bed data was collected by a regional burn disaster consortium. Open burn bed census was collected via telephone from each burn center in the consortium on April 15th, May 7th, May 21st, June 4th and June 18th of 2020. This data was compared to published data from 2009 to 2016. Results The results are listed in Table 1. Lowest available burn bed was 35 beds on April 15th, 2020. Conclusions Although a disaster may impact surrounding local and state hospitals, it does not always impact a burn center’s ability to transfer patients from a local trauma center or nearby burn center. A pandemic however affects a larger region and impacts all hospitals within that region. Peak ICU utilization in the Northeast was between the second and third week of April. During the peak utilization time, burn bed census was about 50% of the historical average. Burn bed census did not return to historical average until May 7, 2020. If a mass casualty event occurred in the pandemic region, the Northeast region would have to reach out to other ABA designated regions for assistance. Historically, burn mass casualty plans are based on the capacity to move burn patients to other burn centers in order to relieve surge capacity at the affected center. This data illustrates that, in a pandemic, burn beds are being utilized for non-burn patients. The ability to follow these plans will be greatly impacted.

Non-Pediatric Nurses’ Willingness to Provide Care to Pediatric Patients during a Disaster: An Assessment of Pediatric Surge Capacity in Four Midwestern Hospitals

Objective: To assess non-pediatric nurses’ willingness to provide care to pediatric patients during a mass casualty event (MCE). Methods: Nurses from 4 non-pediatric hospitals in a major metropolitan Midwestern region were surveyed in the fall of 2018. Participants were asked about their willingness to provide MCE pediatric care. Hierarchical logistical regression was used to describe factors associated with nurses’ willingness to provide MCE pediatric care. Results: In total, 313 nurses were approached and 289 completed a survey (response rate = 92%). A quarter (25.3%, n = 73) would be willing to provide MCE care to a child of any age; 12% (n = 35) would provide care only to newborns in the labor and delivery area, and 16.6% (n = 48) would only provide care to adults. Predictors of willingness to provide care to a patient of any age during an MCE included providing care to the youngest-age children during routine duties, reporting confidence in calculating doses and administering pediatric medications, working in the emergency department, being currently or previously certified in PALS, and having access to pediatric-sized equipment in the unit or hospital. Conclusion: Pediatric surge capacity is lacking among nurses. Increasing nurses’ pediatric care self-efficacy could improve pediatric surge capacity and minimize morbidity and mortality during MCEs.

Strategies for General Surgery Training Programs During the COVID-19 Pandemic

The COVID-19 pandemic presented a unique challenge for Medical systems worldwide. Initial response to the crisis situation for the pandemic closely mirrored plans for a mass casualty event. By leveraging resources including human and physical, and by dividing our surgeon workforce into micro teams we were able to create a flexible and responsive infrastructure to address the crisis as it unfolded. By adoption of virtual platforms and equal division of labor, surgical resident education was continued. Specific adjustments to the schedule and curriculum for medical students allowed them to continue their studies safely and on schedule. Our model serves as an example by which hospital systems of similar size may utilize principles of mass casualty preparedness to craft their own plan for a future contagion response strategy.