Hospital Response to Acute-Onset Disasters: The State of the Science in 2005

The development and psychometric testing of a Disaster Response Self-Efficacy Scale among undergraduate nursing students

BACKGROUND

Disaster nurse education has received increasing importance in China. Knowing the abilities of disaster response in undergraduate nursing students is beneficial to promote teaching and learning. However, there are few valid and reliable tools that measure the abilities of disaster response in undergraduate nursing students.

OBJECTIVES

To develop a self-report scale of self-efficacy in disaster response for Chinese undergraduate nursing students and test its psychometric properties.

PARTICIPANTS AND SETTINGS

Nursing students (N=318) from two medical colleges were chosen by purposive sampling.

METHODS

The Disaster Response Self-Efficacy Scale (DRSES) was developed and psychometrically tested. Reliability and content validity were studied. Construct validity was tested by exploratory and confirmatory factor analysis. Reliability was tested by internal consistency and test-retest reliability.

RESULTS

The DRSES consisted of 3 factors and 19 items with a 5-point rating. The content validity was 0.91, Cronbach's alpha coefficient was 0.912, and the intraclass correlation coefficient for test-retest reliability was 0.953. The construct validity was good (χ²/df=2.440, RMSEA=0.068, NFI=0.907, CFI=0.942, IFI=0.430, p<0.001).

CONCLUSIONS

The newly developed DRSES has proven good reliability and validity. It could therefore be used as an assessment tool to evaluate self-efficacy in disaster response for Chinese undergraduate nursing students.

External factors impacting hospital evacuations caused by Hurricane Rita: the role of situational awareness

INTRODUCTION

The 2005 Gulf Coast hurricane season was one of the most costly and deadly in US history. Hurricane Rita stressed hospitals and led to multiple, simultaneous evacuations. This study systematically identified community factors associated with patient movement out of seven hospitals evacuated during Hurricane Rita.

METHODS

This study represents the second of two systematic, observational, and retrospective investigations of seven acute care hospitals that reported off-site evacuations due to Hurricane Rita. Participants from each hospital included decision makers that comprised the Incident Management Team (IMT). Investigators applied a standardized interview process designed to assess evacuation factors related to external situational awareness of community activities during facility evacuation due to hurricanes. The measured outcomes were responses to 95 questions within six sections of the survey instrument.

RESULTS

Investigators identified two factors that significantly impacted hospital IMT decision making: (1) incident characteristics affecting a facility's internal resources and challenges; and (2) incident characteristics affecting a facility's external evacuation activities. This article summarizes the latter and reports the following critical decision making points: (1) Emergency Operations Plans (EOP) were activated an average of 85 hours (3 days, 13 hours) prior to Hurricane Rita's landfall; (2) the decision to evacuate the hospital was made an average of 30 hours (1 day, 6 hours) from activation of the EOP; and (3) the implementation of the evacuation process took an average of 22 hours. Coordination of patient evacuations was most complicated by transportation deficits (the most significant of the 11 identified problem areas) and a lack of situational awareness of community response activities. All evacuation activities and subsequent evacuation times were negatively impacted by an overall lack of understanding on the part of hospital staff and the IMT regarding how to identify and coordinate with community resources.

CONCLUSION

Hospital evacuation requires coordinated processes and resources, including situational awareness that reflects the condition of the community as a result of the incident. Successful hospital evacuation decision making is influenced by community-wide situational awareness and transportation deficits. Planning with the community to create realistic EOPs that accurately reflect available resources and protocols is critical to informing hospital decision making during a crisis. Knowledge of these factors could improve decision making and evacuation practices, potentially reducing evacuation times in future hurricanes.

CCATT: a military model for civilian disaster management

When major disasters incapacitate hospitals and definitive care facilities-as Hurricane Katrina did in 2005-a crisis point is rapidly reached. Critical care services are often the first to be overwhelmed. Personal experiences and regional disaster plans were examined in the wake of Hurricane Katrina to uncover shortfalls in delivery of care and resources. A search was undertaken for a viable model for delivering critical care services in the immediate post-disaster period. Such a model already exists in the US Air Force's (USAF) Critical Care Air Transport Teams (CCATT). These teams have functioned well during recent military conflicts by providing both ground critical care and transport of high-risk, severely injured patients. The need for augmented critical care and transport resources in the face of overwhelming casualties in the civilian environment does not require a de novo construct. The USAF's CCATT model should be easily adaptable to the civilian disaster scenario.