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The role of emergency preparedness exercises in the response to a mass casualty terrorist incident: A mixed methods study.

ABSTRACT: Simulation exercises are an important part of emergency preparedness activities for the healthcare community but evidence of their impact on the response to real major incidents is limited. This project studied the impact of health emergency preparedness exercises (HEPEs) on the response to a mass casualty terrorist incident. The mixed methods study design was adopted comprising an on-line survey and follow up individual interviews. Participants were healthcare staff who took part in responses to three major terrorist incidents in the UK in 2017. Descriptive statistics and analysis of variance were undertaken with quantitative data. Content and thematic analysis methods were used for qualitative data analysis. The online survey generated 86 responses; 79 (92%) were from the responders to the Manchester Arena bombing. Twenty-one survey respondents shared their experiences in in-depth interviews. Healthcare staff who took part in HEPEs felt better prepared to respond than those who did not attend an exercise. The most commonly reported benefits from HEPEs were awareness of major incident plans and having the opportunity to practice responding to a similar scenario in the recent exercise. Specific benefits included: improved coordination of the response through adherence to recently practiced incident plans; confidence with response roles; real-time modifications of the response and support provided to staff who did not take part in exercises. Exercise recency was highlighted as an important facilitating factor. The study provides strong objective evidence that the response to a mass casualty terrorist incident was enhanced by training and service development achieved through HEPEs.

SUBMITTER: Skryabina EA

PROVIDER: S-EPMC7709486 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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The role of emergency preparedness exercises in the response to a mass casualty terrorist incident: A mixed methods study.

Skryabina Elena A EA Betts Naomi N Reedy Gabriel G Riley Paul P Amlôt Richard R

International journal of disaster risk reduction : IJDRR 20200601

Simulation exercises are an important part of emergency preparedness activities for the healthcare community but evidence of their impact on the response to real major incidents is limited. This project studied the impact of health emergency preparedness exercises (HEPEs) on the response to a mass casualty terrorist incident. The mixed methods study design was adopted comprising an on-line survey and follow up individual interviews. Participants were healthcare staff who took part in responses t ...[more]

PMID: 33312855

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Project description:Background:Mass casualty incidents (MCI) such as train or bus crashes, explosions, collapses of buildings, or terrorist attacks result in rescue teams facing many victims and in huge challenges for hospitals. Simulations are performed to optimize preparedness for MCI. To maximize the benefits of MCI simulations, it is important to collect large amounts of information. However, a clear concept and standardization of a data-driven post-exercise evaluation and debriefing are currently lacking. Methods:GPS data loggers were used to track the trajectories of patients, medics, and paramedics in two simulated MCI scenarios using real human actors. The distribution of patients over the treatment area and their time of arrival at the hospital were estimated to provide information on the quality of triage and for debriefing purposes. Results:The results show the order in which patients have been treated and the time for the individual arrivals as an indicator for the triage performance. The distribution of patients at the accident area suggested initial confusion and unclear orders for the placement of patients with different grades of injury that can be used for post-exercise debriefing. The dynamics of movement directions allowed to detect group behavior during different phases of the MCI. Conclusions:Results indicate that GPS data loggers can be used to collect precise information about the trajectories of patients and rescue teams at an MCI simulation without interfering with the realism of the simulation. The exact sequence of the deliverance of patients of different triage categories to their appropriate destinations can be used to evaluate team performance for post-exercise debriefing. Future MCI simulations are planned to validate the use of GPS loggers by providing "hot-debrief" immediately after the MCI simulation and to explore ways in which group detection can provide relevant information for post-exercise evaluations. Trial registration:Not applicable.

Project description:BACKGROUND:Over the past several decades, naturally occurring and man-made mass casualty incidents (MCIs) have increased in frequency and number worldwide. To test the impact of such events on medical resources, simulations can provide a safe, controlled setting while replicating the chaotic environment typical of an actual disaster. A standardized method to collect and analyze data from mass casualty exercises is needed to assess preparedness and performance of the health care staff involved. OBJECTIVE:In this study, we aimed to assess the feasibility of using wearable proximity sensors to measure proximity events during an MCI simulation. In the first instance, our objective was to demonstrate how proximity sensors can collect spatial and temporal information about the interactions between medical staff and patients during an MCI exercise in a quasi-autonomous way. In addition, we assessed how the deployment of this technology could help improve future simulations by analyzing the flow of patients in the hospital. METHODS:Data were obtained and collected through the deployment of wearable proximity sensors during an MCI functional exercise. The scenario included 2 areas: the accident site and the Advanced Medical Post, and the exercise lasted 3 hours. A total of 238 participants were involved in the exercise and classified in categories according to their role: 14 medical doctors, 16 nurses, 134 victims, 47 Emergency Medical Services staff members, and 27 health care assistants and other hospital support staff. Each victim was assigned a score related to the severity of his/her injury. Each participant wore a proximity sensor, and in addition, 30 fixed devices were placed in the field hospital. RESULTS:The contact networks show a heterogeneous distribution of the cumulative time spent in proximity by the participants. We obtained contact matrices based on the cumulative time spent in proximity between the victims and rescuers. Our results showed that the time spent in proximity by the health care teams with the victims is related to the severity of the patient's injury. The analysis of patients' flow showed that the presence of patients in the rooms of the hospital is consistent with the triage code and diagnosis, and no obvious bottlenecks were found. CONCLUSIONS:Our study shows the feasibility of the use of wearable sensors for tracking close contacts among individuals during an MCI simulation. It represents, to our knowledge, the first example of unsupervised data collection-ie, without the need for the involvement of observers, which could compromise the realism of the exercise-of face-to-face contacts during an MCI exercise. Moreover, by permitting detailed data collection about the simulation, such as data related to the flow of patients in the hospital, such deployment provides highly relevant input for the improvement of MCI resource allocation and management.

Dataset Information

The role of emergency preparedness exercises in the response to a mass casualty terrorist incident: A mixed methods study.

Publications

The role of emergency preparedness exercises in the response to a mass casualty terrorist incident: A mixed methods study.

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