1
|
Investigating Organizational Learning and Adaptations for Improved Disaster Response Towards "Resilient Hospitals:" An Integrative Literature Review. Prehosp Disaster Med 2022; 37:665-673. [PMID: 35924715 PMCID: PMC9470520 DOI: 10.1017/s1049023x2200108x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: For hospitals, learning from disaster response efforts and adapting organizational practices can improve resilience in dealing with future disruptions. However, amidst global disruptions by climate change, the coronavirus disease 2019 (COVID-19) pandemic, and other disasters, hospitals’ ability to cope continues to be highly variable. Hence, there are increasing calls to improve hospitals’ capabilities to grow and adapt towards enhanced resilience. Aim: This study aims two-fold: (1) to characterize the current state of knowledge about how hospitals are gaining knowledge from their responses to disasters, and (2) to explore how this knowledge can be applied to inform organizational practices for hospital resilience. Method: This study used Preferred Reporting Items of Systematic Reviews and Meta-Analysis (PRISMA) guidelines for data collection and framework for data analysis, Covidence software, and Medical Subject Headings (MeSH) terms and keywords relevant to “hospitals,” “learn,” “disaster response,” and “resilience.” The quality appraisal used an adapted version of the Mixed Methods Assessment Tool (MMAT). Results: After applying inclusion and exclusion criteria and quality appraisal, out of the 420 articles retrieved, 22 articles remained for thematic and content analysis. The thematic analysis included the hospital’s functional (operational) and physical (structural and non-structural) sections. The content analysis followed nine learning areas (Governance and Leadership, Planning and Risk Assessment, Surveillance and Monitoring, Communication and Network Engagement, Staff Practices and Safety, Equipment and Resources, Facilities and Infrastructure, Novelty and Innovation, and Learning and Evaluation). On applying the Deming cycle, only four studies described a completed learning cycle wherein hospitals adapted their organizational structures using the prior experience and evaluation gained in responding to disaster(s). Conclusions: There is a gap between hospitals’ organizational learning and institutionalized practice. The conceptualized Hybrid Resilience Learning Framework (HRLF) aims to guide the hospitals’ decision makers in evaluating organizational resilience and knowledge. In the face of disasters, both the stressful factors and the coping strategies that affect the health care workers (HCWs) should be substantially considered.
Collapse
|
2
|
Tušer I, Bekešienė S, Navrátil J. Emergency management and internal audit of emergency preparedness of pre-hospital emergency care. QUALITY & QUANTITY 2020; 57:1-13. [PMID: 33020672 PMCID: PMC7528452 DOI: 10.1007/s11135-020-01039-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/11/2020] [Indexed: 12/01/2022]
Abstract
One of the negative components of international travel is the higher likelihood of emergencies that affect a large number of people (mass negative impact on health), for example the transmission of infectious diseases, as e.g. SARS CoV-2 pandemic. The frequency and sources of mass-casualty incidents are currently changing dynamically, especially with the onset of terrorist attacks and large-scale natural disasters. Health services and emergency medical service (EMS) take part in addressing these emergencies. For this reason, this paper deals with the EMS emergency preparedness in the Czech Republic for an emergency events with a large number of affected people. EMS in the Czech Republic are not provided by the state but by individual regions. EMS in the Czech Republic do not have central management, nor do they use uniform data documentation. The investigation of the current situation has shown that the attitudes of EMS in individual regions of the Czech Republic to the tasks of emergency preparedness for mass casualty incidents are not identical. The current method of evaluating improvements in the quality of EMS emergency preparedness lacks consistency and is not comprehensively supervised. To tackle this, the paper presents an internal audit methodology for assessing the level of emergency preparedness of the emergency medical services. The authors therefore defined the decisive criteria and indicators assessing the quality level of EMS emergency preparedness at major disaster with multiple victim incident. When developing the methodological procedure of the preparedness evaluation, an algorithm was chosen, based on the gradual verification of the evaluation criteria and indicators by an expert group. Some findings and recommendations based on a research carried out in EMS in individual regions of the Czech Republic are presented.
Collapse
Affiliation(s)
- Irena Tušer
- Department of Security and Law, AMBIS College, Prague, Czech Republic
| | - Svajonė Bekešienė
- Department of Defense Technologies, General Jonas Žemaitis Military Academy of Lithuania, Šilo Str. 5A, 10322 Vilnius, Lithuania
| | - Josef Navrátil
- Department of Security and Law, AMBIS College, Prague, Czech Republic
| |
Collapse
|
3
|
Sonawane DV, Garg BK, Chandanwale A, Mathesul AA, Shinde OR, Singh S. 26/11 Mumbai terrorist attack revisited: Lessons learnt and novel disaster model for future. JÀMBÁ: JOURNAL OF DISASTER RISK STUDIES 2020; 12:915. [PMID: 32934783 PMCID: PMC7479386 DOI: 10.4102/jamba.v12i1.915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 04/28/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Dhiraj V Sonawane
- Department of Orthopaedics, Grant Medical College and Sir J.J. Group of Hospitals, Mumbai, India
| | - Bipul K Garg
- Department of Orthopaedics, Grant Medical College and Sir J.J. Group of Hospitals, Mumbai, India
| | - Ajay Chandanwale
- Department of Orthopaedics, Grant Medical College and Sir J.J. Group of Hospitals, Mumbai, India
| | - Ambarish A Mathesul
- Department of Orthopaedics, Sassoon General Hospital and Byramjee Jeejeebhoy Medical College, Pune, India
| | - Omkar R Shinde
- Department of Orthopaedics, Grant Medical College and Sir J.J. Group of Hospitals, Mumbai, India
| | - Shravan Singh
- Department of Orthopaedics, Grant Medical College and Sir J.J. Group of Hospitals, Mumbai, India
| |
Collapse
|
4
|
Abstract
INTRODUCTION Terror attacks have increased in frequency, and tactics utilized have evolved. This creates significant challenges for first responders providing life-saving medical care in their immediate aftermath. The use of coordinated and multi-site attack modalities exacerbates these challenges. The use of triage is not well-validated in mass-casualty settings, and in the setting of intentional mass violence, new and innovative approaches are needed. METHODS Literature sourced from gray and peer-reviewed sources was used to perform a comparative analysis on the application of triage during the 2011 Oslo/Utoya Island (Norway), 2015 Paris (France), and 2015 San Bernardino (California USA) terrorist attacks. A thematic narrative identifies strengths and weaknesses of current triage systems in the setting of complex, coordinated terrorist attacks (CCTAs). DISCUSSION Triage systems were either not utilized, not available, or adapted and improvised to the tactical setting. The complexity of working with large numbers of patients, sensory deprived environments, high physiological stress, and dynamic threat profiles created significant barriers to the implementation of triage systems designed around flow charts, physiological variables, and the use of tags. Issues were identified around patient movement and "tactical triage." CONCLUSION Current triage tools are inadequate for use in insecure environments, such as the response to CCTAs. Further research and validation are required for novel approaches that simplify tactical triage and support its effective application. Simple solutions exist in tactical triage, patient movement, and tag use, and should be considered as part of an overall triage system.
Collapse
|
5
|
Ashkenazi I, Hunt RC. You're It-You've Got to Save Someone: Immediate Responders, Not Bystanders. Front Public Health 2019; 7:361. [PMID: 31867300 PMCID: PMC6907095 DOI: 10.3389/fpubh.2019.00361] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 11/14/2019] [Indexed: 11/21/2022] Open
Abstract
Recurring disasters and life-threatening emergencies mandate that communities across the world be adequately prepared to prevent, respond, and recover from these events. Experiences throughout the world with mass casualty incidents and other disasters have increasingly highlighted the vital role that “active bystanders”—persons at the scene of an event who step forward to help—can play in preventing, containing, reporting, saving lives, decreasing morbidity, and increasing resilience. This paper seeks to emphasize the importance of the public in response to emergencies. No longer should we use the passive word “bystanders.” Rather immediate responders fill a critical silent gap before trained professionals arrive. In support of immediate responders this paper will identify the barriers to bystander action, and provide next steps to increase the number of individuals who take action at times of emergency. Immediate responders can and do play a valuable and unique role in reducing mortality, morbidity, and suffering from emergency events. While some cultures and countries have a long history of engaging the public as critical in an emergency response, others do not. The challenge is how best to increase the number of individuals who are motivated, prepared and ready to respond appropriately when they find themselves at the scene of an active shooter, bombing, hurricane, earthquake, tornado, fire, vehicle crash, or other life-threatening emergency.
Collapse
Affiliation(s)
- Isaac Ashkenazi
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Richard C Hunt
- United States Department of Health and Human Services, Washington, DC, United States
| |
Collapse
|
6
|
Abstract
Anthropogenic disasters may be defined as any disaster caused by human action or inaction. Natural disasters occur without human interference. Injuries caused by terrorists and related criminal activities may be broadly grouped into 3 categories: blunt, blast, and penetrating trauma. Most terrorist and criminal activities that create a mass-casualty situation are performed using the weapons most readily available, such as firearms or explosives. A consistent pattern, comparing terrorism with interpersonal violence, is the greater severity of impact on the victim.
Collapse
|
7
|
Khorram-Manesh A. Facilitators and constrainers of civilian-military collaboration: the Swedish perspectives. Eur J Trauma Emerg Surg 2018; 46:649-656. [PMID: 30542745 PMCID: PMC7280332 DOI: 10.1007/s00068-018-1058-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 12/04/2018] [Indexed: 11/17/2022]
Abstract
Purpose An increasing number of international and domestic armed conflicts, including terror attacks on civilians, along with constrained healthcare finance and resource limitation, has made a civilian–military collaboration (CMC) crucial. The purpose of this study was to identify facilitators and constrainers in CMC in a national perspective with a specific focus on medical aspects. Method A literature review of recently published papers about civilian–military collaboration, along with a short survey, was conducted. For the review, major search engines were used. Results The results indicated many facilitators, but few important constrainers with a high impact on the outcome. The conducted survey indicated discrepancies between the needs and resources. Conclusion The current global and domestic security threats and challenges, make CMC critical and inevitable. However, there is a need for careful analysis of its consequences, impact, possibilities, and limitations to differentiate between our expectations and the current reality.
Collapse
Affiliation(s)
- Amir Khorram-Manesh
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
| |
Collapse
|
8
|
Carli P, Telion C. Paris City Disaster: Response to the Recent Terror Attacks and Lessons Learned. CURRENT TRAUMA REPORTS 2018. [DOI: 10.1007/s40719-018-0119-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
9
|
Bobko JP, Sinha M, Chen D, Patterson S, Baldridge T, Eby M, Harris W, Starling R, Lichtman O. A Tactical Medicine After-action Report of the San Bernardino Terrorist Incident. West J Emerg Med 2018; 19:287-293. [PMID: 29560056 PMCID: PMC5851501 DOI: 10.5811/westjem.2017.10.31374] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 08/25/2017] [Accepted: 10/09/2017] [Indexed: 11/11/2022] Open
Affiliation(s)
- Joshua P Bobko
- Loma Linda University, Department of Emergency Medicine, Loma Linda, California.,West County Special Weapons and Tactical Team, Orange County, California
| | - Mrinal Sinha
- First Care Provider Foundation, Research Associate
| | - David Chen
- Huntington Beach Special Weapons and Tactical Team, Huntington Beach, California
| | - Stephen Patterson
- San Bernardino Sheriff Aviation Department, Division of Aviation, San Bernardino, California
| | | | - Michael Eby
- San Bernardino Police Department, San Bernardino, California
| | | | - Ryan Starling
- San Bernardino Police Department, San Bernardino, California
| | - Ofer Lichtman
- Rancho Cucamonga Fire District, Rancho Cucamonga, California
| |
Collapse
|
10
|
Solomon H. Shifting Gears: Triage and Traffic in Urban India. Med Anthropol Q 2017; 31:349-364. [DOI: 10.1111/maq.12367] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 09/24/2016] [Accepted: 02/08/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Harris Solomon
- Department of Cultural Anthropology and the Duke Global Health Institute Duke University
| |
Collapse
|
11
|
Boddaert G, Mordant P, Le Pimpec-Barthes F, Martinod E, Aguir S, Leprince P, Raux M, Couëtil JP, Fiore A, Lescot T, Malgras B, Pons F, Castier Y. Surgical management of penetrating thoracic injuries during the Paris attacks on 13 November 2015. Eur J Cardiothorac Surg 2017; 51:1195-1202. [DOI: 10.1093/ejcts/ezx036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 01/17/2017] [Indexed: 11/14/2022] Open
|
12
|
|
13
|
Turner CDA, Lockey DJ, Rehn M. Pre-hospital management of mass casualty civilian shootings: a systematic literature review. Crit Care 2016; 20:362. [PMID: 27825363 PMCID: PMC5101656 DOI: 10.1186/s13054-016-1543-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 10/25/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mass casualty civilian shootings present an uncommon but recurring challenge to emergency services around the world and produce unique management demands. On the background of a rising threat of transnational terrorism worldwide, emergency response strategies are of critical importance. This study aims to systematically identify, describe and appraise the quality of indexed and non-indexed literature on the pre-hospital management of modern civilian mass shootings to guide future practice. METHODS Systematic literature searches of PubMed, Cochrane Database of Systematic Reviews and Scopus were conducted in conjunction with simple searches of non-indexed databases; Web of Science, OpenDOAR and Evidence Search. The searches were last carried out on 20 April 2016 and only identified those papers published after the 1 January 1980. Included documents had to contain descriptions, discussions or experiences of the pre-hospital management of civilian mass shootings. RESULTS From the 494 identified manuscripts, 73 were selected on abstract and title and after full text reading 47 were selected for inclusion in analysis. The search yielded reports of 17 mass shooting events, the majority from the USA with additions from France, Norway, the UK and Kenya. Between 1994 and 2015 the shooting of 1649 people with 578 deaths at 17 separate events are described. Quality appraisal demonstrated considerable heterogeneity in reporting and revealed limited data on mass shootings globally. CONCLUSION Key themes were identified to improve future practice: tactical emergency medical support may harmonise inner cordon interventions, a need for inter-service education on effective haemorrhage control, the value of senior triage operators and the need for regular mass casualty incident simulation.
Collapse
Affiliation(s)
- Conor D. A. Turner
- Barts and The London School of Medicine and Dentistry, Queen Mary University London, Garrod Building, Turner Street, Whitechapel, London, E1 2AD UK
| | - David J. Lockey
- Barts and The London School of Medicine and Dentistry, Queen Mary University London, Garrod Building, Turner Street, Whitechapel, London, E1 2AD UK
- London’s Air Ambulance, Barts Health Trust, London, UK
- The Norwegian Air Ambulance Foundation, Drøbak, Norway
| | - Marius Rehn
- London’s Air Ambulance, Barts Health Trust, London, UK
- The Norwegian Air Ambulance Foundation, Drøbak, Norway
- Department of Health Studies, University of Stavanger, Stavanger, Norway
| |
Collapse
|
14
|
Thompson J, Rehn M, Lossius HM, Lockey D. Risks to emergency medical responders at terrorist incidents: a narrative review of the medical literature. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:521. [PMID: 25323086 PMCID: PMC4422304 DOI: 10.1186/s13054-014-0521-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
As the threat of international terrorism rises, there is an increasing requirement to provide evidence-based information and training for the emergency personnel who will respond to terrorist incidents. Current major incident training advises that emergency responders prioritize their own personal safety above that of the 'scene and survivors'. However, there is limited information available on the nature of these threats and how they may be accurately evaluated. This study reviews the published medical literature to identify the hazards experienced by emergency responders who have attended previous terrorist incidents. A PubMed literature search identified 10,894 articles on the subject of 'terrorism', and there was a dramatic increase in publications after the 9/11 attacks in 2001. There is heterogeneity in the focus and quality of this literature, and 307 articles addressing the subject of scene safety were assessed for information regarding the threats encountered at terrorist incidents. These articles demonstrate that emergency responders have been exposed to both direct terrorist threats and environmental scene hazards, including airborne particles, structural collapse, fire, and psychological stress. The emphasis of training and preparedness for terrorist incidents has been primarily on the direct threats, but the published literature suggests that the dominant causes of mortality and morbidity in responders after such incidents are the indirect environmental hazards. If the medical response to terrorist incidents is to be based on evidence rather than anecdote, analysis of the current literature should be incorporated into major incident training, and consistent collection of key data from future incidents is required.
Collapse
Affiliation(s)
- Julian Thompson
- London's Air Ambulance, The Helipad, Royal London Hospital, Whitechapel Road, Whitechapel, London, E1 1BB, UK.
| | - Marius Rehn
- Department of Research and Development, Norwegian Air Ambulance Foundation, Holterveien 24, 1448, Drøbak, Norway. .,Field of Pre-hospital Critical Care, Network of Medical Sciences, University of Stavanger, Kjel Aarholmsgate 41, 4036, Stavanger, Norway.
| | - Hans Morten Lossius
- Department of Research and Development, Norwegian Air Ambulance Foundation, Holterveien 24, 1448, Drøbak, Norway. .,Field of Pre-hospital Critical Care, Network of Medical Sciences, University of Stavanger, Kjel Aarholmsgate 41, 4036, Stavanger, Norway.
| | - David Lockey
- London's Air Ambulance, The Helipad, Royal London Hospital, Whitechapel Road, Whitechapel, London, E1 1BB, UK. .,School of Clinical Sciences, University of Bristol, 69 St Michael's Hill, Bristol, BS2 8DZ, UK.
| |
Collapse
|
15
|
|