Development of an Evacuation Tool to Facilitate Disaster Preparedness: Use in a Planned Evacuation to Support a Hospital Move

Use of simulation models when developing and testing hospital evacuation plans: a tool for improving emergency preparedness

BACKGROUND

In recent decades, analyses of hospitals evacuations have generated valuable knowledge. Unfortunately, these evacuation case studies often lack crucial details and policies that would be helpful in evacuation preparedness. The aim of this study was to use a simulation model to illustrate how it can aid emergency planners in the development, testing, and revising of hospitals evacuation plans. This study includes evacuation exercises at two emergency hospitals in Region Stockholm, Sweden.

METHODS

A scientifically validated simulation system for "table top" exercises was used for interactive training of hospital medical staff, prehospital staff and collaborating agencies. All participants acted in their usual professionals' roles. The exercises were run in real-time and mirrored actual hospital resources with the aid of moveable magnetic symbols illustrating patients, staff and transport, presented on whiteboards. During the exercises, observers and independent instructors documented actions taken and post-exercise surveys were conducted to obtain reactions and compare results.

RESULTS

The simulation system allowed the emergency planner to test the whole evacuation process, making it possible to train and evaluate the important functions of management, coordination, and communication. Post-exercise surveys explored participants perception of the exercises. Analysis of open-ended questions included areas for improvement and resulted in five main categories: (1) management and liaison; (2) communication; (3) logistics; (4) medical care and patient prioritisation; and (5) resource utilisation.

CONCLUSIONS

This study has shown that "table top" exercises using a validated simulation system can serve to guide emergency planners when developing evacuation plans, procedures, and protocols as well in training of all medical staff. The system also served to train adaptive thinking, leadership, communication, and clarification of critical functions.

Factors Influencing Hospital Emergency Evacuation during Fire: A Systematic Literature Review

BACKGROUND

Although the hospital is known as a safe place for treating patients, due to various reasons, it is prone to several internal hazards, including fire. This study aimed to identify the factors affecting hospital emergency evacuation during fire.

METHODS

This was a systematic review conducted according to the PRISMA guideline. Thematic Content analysis was utilized to analyze and extract results. We found the studies investigating the factors affecting hospital emergency evacuation during fire through a comprehensive search in various data resources (MEDLINE, Web of Science, Google Scholar, Embase, ProQuest, Scopus, IRANMEDEX, SID, ISC, and Magiran) and other sources from the beginning of January 2000 to the end of December 2019. Thematic Content analysis was also employed to analyze.

RESULTS

At first and based on the initial search, 4484 studies were identified, and 48 articles were finally included in the study. Based on the results; five main themes along with 10 sub-themes were identified. The themes included the incident's characteristics, response measures, hospital preparedness, hospital residents, and hospital building, and the sub-themes were emergency evacuation features, fire characteristics, command, operation, patients' and staff's characteristics, planning, logistics, and structure and design hospital.

CONCLUSIONS

Based on the results of the present study, hospital preparedness as one of the most important factors can reduce the hospital evacuation time. Therefore, hospitals can ensure a timely and more effective response in emergency evacuation during fire by improving their preparedness.

Using risk analysis to ensure patients' medication safety during hospital relocations and evacuations

OBJECTIVES

To ensure patient safety and the preparedness of medication processes during hospital relocations and evacuations by using Failure Modes, Effects, and Criticality Analysis (FMECA).

METHODS

The relocation of six regional hospitals to a single building, resulting in 400 beds being moved, could be compared with an emergency evacuation. An FMECA was performed on the hospital group's internal medicine and intensive care units (IMU and ICU), examining how medication processes would be affected by a hospital relocation or evacuation.

RESULTS

We identified 59 hospital relocation and 68 evacuation failure modes. Failure modes were ranked based on their criticality index (CI; range 1-810). The higher the CI, the greater the patient-related risk. Average initial IMU and ICU hospital relocation CI scores were 160 (range 105-294) and 201 (range 125-343), respectively, subsequently reduced to 32 (-80%) and 49 (-76%) after mitigation measures. Average initial IMU and ICU evacuation CI scores were 319 (range 245-504) and 592 (range 441-810), respectively, subsequently reduced to 194 (-39%) and 282 (-52%). Most mitigation measures (17/22), such as for example checklists, could be implemented in both situations. Due to their unpredictable nature, five measures were specific to evacuation situations.

CONCLUSIONS

This study highlights the value of using an FMECA on medication processes to anticipate potential negative impacts on patient safety during hospital relocations or evacuations. Preparation for a hospital relocation can provide useful knowledge and an opportunity to test mitigation measures that might prove useful in evacuations.

Development of Patient Evacuation Resource Classification System (PERC) Using Systems Engineering to Assist Hospital Evacuations in a Disaster

The aim of this study was the development of a decision-support tool capable of identifying the most appropriate transportation and local area coalition bed space (resources) for patient evacuations during a crisis. Introduction of the new concept of dichotomous tables and how they are incorporated into the Patient Evacuation Resource Classification (PERC) system. The methods used were Systems Engineering fundamentals to conduct a requirements analysis of the process, develop a new construct guided by functional analysis, design an evidence-based model that accurately identifies patient resource requirements translatable to resource capabilities, and create a prototype for a proof of concept. Research resulted in the PERC system prototype. The PERC system prototype created by this research allows for system testing under a Solomon four-group design simulation with the participation of leading medical, emergency response, academic, consulting industry, and logistics professionals from the Washington, DC, metropolitan area.

Intensive Care Role in Disaster Management Critical Care Clinics

The "daily disasters" within the ebb and flow of routine critical care provide a foundation of preparedness for the less-frequent, larger events that affect most health care organizations at some time. Although large disasters can overwhelm, those who strengthen processes and habits through daily practice will be the best prepared to manage them.

Pediatric disaster preparedness: identifying challenges and opportunities for emergency department planning

PURPOSE OF REVIEW

To review the current literature on best practices for pediatric disaster preparedness in an emergency department (ED).

RECENT FINDINGS

Children have unique anatomical, physiologic, immunologic, and psychosocial needs that impact their vulnerability to and resilience in a disaster, yet they have been historically underrepresented in disaster planning at local and national levels. Lessons learned from recent disaster events, disaster research, and disaster experts provide guidance on pediatric disaster preparedness for ED.

SUMMARY

All EDs should include children in their disaster plans and exercises. ED staff should be knowledgeable about their role in institutional disaster operations and familiar with standard disaster management principles.