Simulation Applications in Emergency Medical Services

Mass-Casualty Training Exercise Using High-Fidelity Computerized Simulators and Involving Time and Resource Limitation

PURPOSE

Training emergency department (ED) personnel in the care of victims of mass-casualty incidents (MCIs) is a highly challenging task requiring unique and innovative approaches. The purpose of this study was to retrospectively explore the value of high-fidelity simulators in an exercise that incorporates time and resource limitation as an optimal method of training health care personnel in mass-casualty care.

METHODS

Mass-casualty injury patterns from an explosive blast event were simulated for 12 victims using high-fidelity computerized simulators (HFCS). Programmed outcomes, based on the nature of injuries and conduct of participants, ranged from successful resuscitation and survival to death. The training exercise was conducted five times with different teams of health care personnel (n = 42). The exercise involved limited time and resources such as blood, ventilators, and imaging capability. Medical team performance was observed and recorded. Following the exercise, participants completed a survey regarding their training satisfaction, quality of the exercise, and their prior experiences with MCI simulations. The Likert scale responses from the survey were evaluated using mean with 95% confidence interval, as well as median and inter-quartile range. For the categorical responses, the frequency, proportions, and associated 95% confidence interval were calculated.

RESULTS

The mean rating on the quality of experiences related trainee survey questions (n = 42) was between 4.1 and 4.6 on a scale of 5.0. The mean ratings on a scale of 10.0 for quality, usefulness, and pertinence of the program were 9.2, 9.5, and 9.5, respectfully. One hundred percent of respondents believed that this type of exercise should be required for MCI training and would recommend this exercise to colleagues. The five medical team (n = 5) performances resulted in the number of deaths ranging from two (including the expectant victims) to six. Eighty percent of medical teams attempted to resuscitate the "expectant" infant and exhausted the O- blood supply. Sixty percent of medical teams depleted the supply of ventilators. Forty percent of medical teams treated "delayed" victims too early.

CONCLUSION

A training exercise using HFCS for mass casualties and employing limited time and resources is described. This exercise is a preferred method of training among participating health care personnel.

Does Tabletop Exercise Enhance Knowledge and Attitude in Preparing Disaster Drills?

Background: Tabletop Exercise (TTE) is a specific learning method through a simulation designed to test the competency and the ability of a group to respond to disasters. Using the map of disaster events is considered effective to prepare disaster drills rather than other methods. TTE method has been carried out annually to train the students, however no studies reported the effect of this method.Purpose: The study aimed to evaluate the effect of TTE on enhancing nursing students’ knowledge and attitude in a disaster drill. Methods: This study was conducted with one-group pre and post-test of a quasi-experimental design. The total samplings were 80 nursing students of the fourth year who undertook the disaster nursing course. The intervention of the study was started using the scenario of an earthquake disaster simulation using TTE media divided into four groups. The instruments consisted of two questionnaires: Students’ Knowledge on Tabletop Exercise (SKTE), and Students' Attitude on Tabletop Exercise (SATE) which were tested for their validity and reliability. The data were analyzed using a dependent paired t-test. Results: The study showed that TTE had a positive effect in enhancing the knowledge (p=0.001) and the attitude of nursing students in disaster drills (p=0.001) (df=79). Conclusion: TTE intervention was an effective direct learning method to improve students’ competencies in disaster response. TTE might be considered as a learning method in improving students' competencies in preparing disaster drills.

A fit for purpose training programme for the decontamination of personnel

Contingency plans are a crucial part of operating any nuclear facility. The success of a contingency plan depends on the efficacy of the plan and the confidence and understanding of those who must enact it. This project focused on both of these aspects, clarifying technique and then designing and delivering a training programme for decontamination. The design of the training was based on the IAEA Systematic Approach to Training (SAT). The delivery focused on ways of increasing retention including use of practical examples and assessment, peer assessment and visual contingency plans. A quantitative survey of the trainees was conducted using a questionnaire before and after the training programme delivery. The results clearly demonstrate an improvement across all elements of skills and knowledge required to undertake decontamination. Effective training is fundamental to the development of a good safety culture and the methodology used in this work has led to a clear improvement in radiation protection culture at the Devonport site.

Improving Emergency Response Systems Through the Use of Intelligent Information Systems

The shifts experienced in the environment of disaster operations and emergency response are reshaping the context of information acquisition and utilization in hospitals. In addition to the formulation of emergency response plans, healthcare organizations (especially hospitals) are being challenged by the growing need to maintain and share real time information necessary for the improvement of emergency response processes. Such information-related attention originates from many emergency-specific concerns including the limited focus of current emergency response information systems, decision limitations that challenge the formulation of decision support applications and the characterization of user requirements, the heterogeneity of emergency response information and the difficulty of integrating spatially distributed information sources. The increased attention in emergency response information also emerges from the recent technological developments (in terms of hardware, software functionalities, databases and telecommunication, among others) which significantly affected the processing, storage and retrieval of real time information. This paper focuses on the examination of the context of emergency response in Al Ahsaa area of Saudi Arabia and the applicability of multi-agent information systems through the proposal of an integrated architecture. Then it sheds light on the implementation concerns to ensure the contribution of the proposed architecture towards the engagement of stakeholders, the improvement of the availability and accessibility of emergency management information and the harmonization of emergency response operations. .