Using Mixed Methods to Assess Pediatric Disaster Preparedness in the Hospital Setting

Major Incident Hospital Simulations in Hospital Based Health Care: A Scoping Review

Major incidents are occurring in increasing frequency, and place significant stress on existing health-care systems. Simulation is often used to evaluate and improve the capacity of health systems to respond to these incidents, although this is difficult to evaluate. A scoping review was performed, searching 2 databases (PubMed, CINAHL) following PRISMA guidelines. The eligibility criteria included studies addressing whole hospital simulation, published in English after 2000, and interventional or observational research. Exclusion criteria included studies limited to single departments or prehospital conditions, pure computer modelling and dissimilar health systems to Australia. After exclusions, 11 relevant studies were included. These studies assessed various types of simulation, from tabletop exercises to multihospital events, with various outcome measures. The studies were highly heterogenous and assessed as representing variable levels of evidence. In general, all articles had positive conclusions with respect to the use of major incidence simulations. Several benefits were identified, and areas of improvement for the future were highlighted. Benefits included improved understanding of existing Major Incident Response Plans and familiarity with the necessary paradigm shifts of resource management in such events. However, overall this scoping review was unable to make definitive conclusions due to a low level of evidence and lack of validated evaluation.

Systematic review on the current state of disaster preparation Simulation Exercises (SimEx)

INTRODUCTION

The simulation exercise (SimEx) simulates an emergency in which an elaboration or description of the response is applied. The purpose of these exercises is to validate and improve plans, procedures, and systems for responding to all hazards. The purpose of this study was to review disaster preparation exercises conducted by various national, non-government, and academic institutions.

METHODOLOGY

Several databases, including PubMed (Medline), Cumulative Index to Nursing and Allied Health Literature (CINAHL), BioMed Central, and Google Scholar, were used to review the literature. Information was retrieved using Medical Subject Headings (MeSH) and documents were selected according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). To assess the quality of the selected articles, the Newcastle-Ottawa Scale (NOS) technique was utilized.

RESULTS

A total of 29 papers were selected for final review based on PRISMA guidelines and the NOS quality assessment. Studies have shown that many forms of SimEx commonly used in disaster management including tabletop exercises, functional exercises, and full-scale exercises have their benefits and limitations. There is no doubt that SimEx is an excellent tool for improving disaster planning and response. It is still necessary to give SimEx programs a more rigorous evaluation and to standardize the processes more thoroughly.

CONCLUSIONS

Drills and training can be improved for disaster management, which will enable medical professionals to face the challenges of disaster management in the 21st century.

Learning From Simulating Mass Casualty Events: A Systematic Search and a Comprehensive Qualitative Review

Mass casualty events (MCE) strain available health-care resources requiring extraordinary measures. Simulated exercises are used to improve preparedness. We sought to identify learning points and common themes arising from such exercises in literature. Reporting of action points to improve response plans were investigated. Type of exercises, environments, and departments were also explored. We systematically searched 3 databases and applied our eligibility criteria. Inclusion criteria were in-situ MCE simulations of clinical response to traumatic MCEs, including scene management, prehospital care, and in hospital care. Exclusion criteria were nonmedical response, infectious outbreaks, training courses with self-selecting participants, simulations assessing mechanical tools, and mathematical modeling. A total of 6883 titles were identified and screened. Eighty-three studies were read in full. Twenty-two articles were included. We identified numerous learning points, which were collated and categorized into 11 themes. Fifty-nine percent of the papers reported actions that would be or had been implemented. MCE simulation exercises have been found to improve familiarity and confidence among participants. The 11 themes identified from published exercises overlap with areas of improvement from real events. MCE simulations in the literature appear to focus on carrying out the exercise itself rather than learning points possibly missing opportunities to improve response plans.

Children's Health Care in Mass-Casualty Incidents: A Systematic Literature Review

OBJECTIVES

Considering the pediatric peculiarities and the difficulty of assisting this population in mass-casualty situations, this study aims to identify the main topics regarding children's health care in mass-casualty incidents (MCIs) that are discussed in the Emergency Medicine area.

METHODS

This systematic review was performed according to the recommendations of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and registered with the PROSPERO database of systematic reviews with the number CRD42021229552. The last update of the search in the databases was on May 27, 2021 and resulted in 45 documents to be analyzed. The inclusion criteria included the peer-reviewed academic papers in English, Portuguese, Spanish, and Italian languages; the databases used were PubMed, Scopus, MEDLINE/Bireme (Virtual Library of Health - VLH), and Web of Science, which execute the query on the topic, keywords, or abstracts. Also, to be included, documents that were available with full-text access through CAPES, Google, or Google Scholar. Books, non-academic research, and content in languages other than the presented ones were represented as exclusion criteria.

RESULTS

From the resulting papers, 21 articles served as the basis for this analysis. Revealed were the year of publication, the first author's institution nationality, topic, and disaster management phase for each study, which allow other researchers to understand the main topics regarding children's health care in MCIs.

CONCLUSIONS

The topics regarding child's health care in MCIs found in the primary studies of this review, in order of frequency, were: Disaster Response (including the following sub-topics: simulation, education, quality of care, use of technological tools, and damage analysis); Triage; and Disaster Planning. The Emergency Medicine operation was focused on harm reduction after the occurrence of an MCI. Further studies focusing on the pre-disaster and post-disaster phases are needed.

Simulating a Vertical Evacuation of a NICU and PICU to Examine the Relationship Between Training and Preparedness

OBJECTIVE

The aim of this study was to implement pediatric vertical evacuation disaster training and evaluate its effectiveness by using a full-scale exercise to compare outcomes in trained and untrained participants.

METHODS

Various clinical and nonclinical staff in a tertiary care university hospital received pediatric vertical evacuation training sessions over a 6-wk period. The training consisted of disaster and evacuation didactics, hands-on training in use of evacuation equipment, and implementation of an evacuation toolkit. An unannounced full-scale simulated vertical evacuation of neonatal intensive care unit (NICU) and pediatric intensive care unit (PICU) patients was used to evaluate the effectiveness of the training. Drill participants completed a validated evaluation tool. Pearson chi-squared testing was used to analyze the data.

RESULTS

Eighty-four evaluations were received from drill participants. Forty-three (51%) of the drill participants received training and 41 (49%) did not. Staff who received pediatric evacuation training were more likely to feel prepared compared with staff who did not (odds ratio, 4.05; confidence interval: 1.05-15.62).

CONCLUSIONS

There was a statistically significant increase in perceived preparedness among those who received training. Recently trained pediatric practitioners were able to achieve exercise objectives on par with the regularly trained emergency department staff. Pediatric disaster preparedness training may mitigate the risks associated with caring for children during disasters.

The impact of disasters on emergency department resources: review against the Sendai framework for disaster risk reduction 2015-2030

BACKGROUND

Emergency departments (EDs) are often first to feel the intra-hospital effects of disasters. Compromised care standards during disasters eventuate from increased demands on health resources; the facilities, supplies, equipment and manpower imperative for a functioning healthcare facility. Emergency departments must understand the effect of disasters on their health resources. This paper examines the impact on resources within the ED as a result of a disaster and provides a review against the United Nations Office for Disaster Risk Reduction's Sendai Framework for Disaster Risk Reduction 2015-2030 priorities.

METHOD

An integrative literature review design was utilised. Articles were extracted from databases and search engines. The Preferred Reporting Items of Systematic reviews and Meta-Analysis Guidelines for systematic literature reviews were used.

RESULTS

Seven papers met inclusion criteria. Disaster consumable stocking was used to mitigate disaster risk and improve resilience. Logistical challenges were exacerbated by poor building design. Ineffective human resource management, communications failure, insufficient ED space, diminished equipment and supplies and unreliable emergency power sources were described.

CONCLUSIONS

Disaster planning and preparedness strategies can address health resource deficits, increasing ED resilience. Further retrospective case studies are required to greater understand the effects of disasters on ED health resources.

360 virtual reality pediatric mass casualty incident: A cross sectional observational study of triage and out-of-hospital intervention accuracy at a national conference

OBJECTIVE

With adolescent mass casualty incidents (MCI) on the rise, out-of-hospital readiness is critical to optimize disaster response. We sought to test the feasibility and acceptability of a 360 Virtual Reality (360 VR) platform for disaster event decisionmaking.

METHODS

This was a cross-sectional observational assessment of a subject's ability to triage and perform out-of-hospital interventions using a 360 VR MCI module. A convenience sample of attendees was recruited over 1.5 days from the American College of Emergency Physicians (ACEP) national conference in San Diego, CA.

RESULTS

Two hundred and seven (207) subjects were enrolled. Ninety-six (46%) subjects identified as attendings, 66 (32%) as residents, 13 (6%) as medical students, 4 (2%) as emergency medical technicians and 28 (14%) as other. When comparing mean scores between groups, physicians who were <40 years old had mean scores higher than physicians who were >40 years old (8.7 vs 6.5, P < 0.001). Residents achieved higher scores than attendings (8.6 vs 7.5, P = 0.005). Based on a 5-point Likert scale, participants felt the 360 VR experience was engaging (median = 5) and enjoyable (median = 5). Most felt that 360 VR was more immersive than mannequin-based simulation training (median = 5).

CONCLUSION

We conclude that 360 VR is a feasible platform for assessing triage and intervention decisionmaking for adolescent MCIs. It is well received by subjects and may have a role as a training and education tool for disaster readiness. In this era of distanced learning, 360 VR is an attractive option for future immersive educational experiences.

Disasters in Germany and France: An Analysis of the Emergency Events Database From a Pediatric Perspective

OBJECTIVE

The objective of this study was to conduct comprehensive analyses of disaster patterns for Germany and France from a pediatric perspective.

METHODS

An analysis of the Emergency Events Database (EM-DAT), epidemiological database with standard methods of descriptive and comparative statistics respecting the strengthening the reporting of observational studies in epidemiology (STROBE) criteria, was performed.

RESULTS

Between 2006 and 2016, there were 41 and 42 disasters in Germany and France claiming 259 and 4973 lives, respectively. Ages of afflicted individuals were not specified in EM-DAT. In Germany, most events were storms (37%), extreme temperatures (17%), floods (17%), and transport accidents (17%). In France, most events were storms (45%), extreme temperatures (17%), floods (19%), and transport accidents (14%). In Germany, most lives (96) were lost in transport accidents. In France, most casualties were due to the heat waves of 2006 and 2015 (1388 and 3275). Reported event types in Germany and France were similar, but heat waves struck France more significantly than Germany.

CONCLUSIONS

Pediatric data are not explicitly captured in EM-DAT, but reported disaster patterns suggest that exposures to heat and cold, storms, trauma, chemicals, water, and infectious agents are possible mechanisms of injury. Age-stratified disaster data are needed to enable a timely, transparent, coordinated, and sustained data-driven approach to pediatric disaster resilience.

The Value of Functional Exercise in Pediatric Mass- Casualty Incident Training

BACKGROUND

Hospital staff in Taiwan practice mass casualty incident (MCI) management through full-scale exercise (FSE). However, FSE is generally resource-intensive and time-consuming. As an alternative, functional exercise (FE) may be more cost-effective with a similar effect in certain aspects. Hence, we aimed to evaluate the FE value in MCI training. We investigated whether FE can increase the familiarity of pediatric MCI response and the effect in different groups.

METHODS

A new emergency operation plan (EOP) of nontraumatic pediatric MCI was developed in 2018 for our Children's Hospital. An FE was conducted to assess the plan. In addition to the emergency department staff, head nurses, supervisors, and physicians of Children's Hospital also participated in the exercise. Pre- and post-exercise questionnaires were designed, and participants were asked to evaluate their familiarity with pediatric MCI response pre- and post-exercise. Participants' reading experience of the new EOP, previous training level, occupation position, and whether they were using a computer during the exercise were also noted in the questionnaires. Data were analyzed using paired t-test and Fisher's exact test.

RESULTS

Among 49 participants, 16 participants completed the pre- and post-exercise questionnaires. The post-exercise familiarity score was found to be significantly higher than that of pre-exercise (p < 0.05). There were no significant differences among the relationships between familiarity increase and participants' reading experience of the new EOP, previous training level, occupation position, and whether they were using a computer during the exercise.

CONCLUSIONS

FE can significantly increase the familiarity of the hospital staff with pediatric MCI response and may be applied as a new training method of hospital disaster preparedness.

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.

Findings from an Assessment and Inventory of a Regional, Decentralized Stockpile

Stockpiles can aid with healthcare surge that occurs after a disaster, and experts recommend that these caches be assessed at least annually to ensure supply integrity. The purpose of this study was to assess a regional stockpile to determine its viability and readiness. An assessment was performed in the summer and fall of 2016 on a regionally funded stockpile that was decentralized through a regional network of 15 local hospitals. Each supply was assessed to determine whether the correct amount was present, if it was in a safe and usable condition (ie, deployable), and whether it had expired. Stockpiled materials were categorized by the type of supply or equipment for analysis. The percent of deployable materials was calculated for each item, each category of supplies, and for the entire cache. Almost all sites (93.3%, n = 14) reported that they inventory their cache at least once a year. On average, 60.1% of each site's cache materials were present and deployable (range: 22.1%-87.5%). The best-maintained supplies included personal protective equipment (79.4% deployable) and general medical supplies (73.5% deployable). Decontamination equipment and pediatric supplies had the lowest percentages of deployability (29.0% and 37.7%, respectively). Although almost all sites claimed to assess the stockpile annually, results from this study indicate that almost half of the supplies are either missing or in an unusable condition. This not only represents wasted resources, but it could also hinder disaster response, leading to increased morbidity and mortality. Facilities may need to invest in infrastructure to maintain stockpiled materials after purchase to ensure viability.

Using Mixed Methods to Assess Pediatric Disaster Preparedness in the Hospital Setting

Introduction

Children are particularly vulnerable during disasters and mass-casualty incidents. Coordinated multi-hospital training exercises may help health care facilities prepare for pediatric disaster victims.

Problem

The purpose of this study was to use mixed methods to assess the disaster response of three hospitals, focusing on pediatric disaster victims.

Methods

A full-functional disaster exercise involving a simulated 7.8-magnitude earthquake was conducted at three Los Angeles (California USA) hospitals, one of which is a freestanding designated Level I Pediatric Trauma Center. Exercise participants provided quantitative and qualitative feedback regarding their perceptions of pediatric disaster response during the exercise in the form of surveys and interviews. Additionally, trained observers provided qualitative feedback and recommendations regarding aspects of emergency response during the exercise, including communication, equipment and supplies, pediatric safety, security, and training.

Results

According to quantitative participant feedback, the disaster exercise enhanced respondents’ perceived preparedness to care for the pediatric population during a mass-casualty event. Further, qualitative feedback from exercise participants and observers revealed opportunities to improve multiple aspects of emergency response, such as communication, equipment availability, and physician participation. Additionally, participants and observers reported opportunities to improve safety and security of children, understanding of staff roles and responsibilities, and implementation of disaster triage exercises.

Conclusion

Consistent with previous investigations of pediatric disaster preparedness, evaluation of the exercise revealed several opportunities for all hospitals to improve their ability to respond to the needs of pediatric victims. Quantitative and qualitative feedback from both participants and observers was useful for comprehensively assessing the exercise's successes and obstacles. The present study has identified several opportunities to improve the current state of all hospitals’ pediatric disaster preparedness, through increased training on pediatric disaster triage methods and additional training on the safety and security of children. Regular assessment and evaluation of supplies, equipment, leadership assignments, and inter-hospital communication is also suggested to optimize the effectiveness and efficiency of response to pediatric victims in a disaster.

BurkeRV, KimTY, BachmanSL, IversonEI, BergBM. Using mixed methods to assess pediatric disaster preparedness in the hospital setting. Prehosp Disaster Med. 2014;29(6): 1-7.