Improvised Neonatal Care–Realizing the Gaps in a Disaster Zone

Evacuation of Vulnerable and Critical Patients: Multimodal Simulation for Nurse-Led Patient Evacuation

INTRODUCTION

Virtual simulation (VS) is an adaptable medium for teaching critical disaster management skills such as efficient hospital evacuation. We aimed to compare VS and prerecorded narrated multimedia lecture-based training of pediatric nurses for evacuation of a sick newborn in the neonatal intensive care unit and pediatric emergency department (ED) using live evacuation simulations.

METHODS

Thirty neonatal intensive care unit and 30 ED nurses enrolled with 30 randomized to multimedia lecture and 30 randomized to VS, with equal block distribution of nurses from each unit. Pretraining/posttraining surveys were administered, and live evacuation simulations were scored for time to evacuation, items collected, and communication.

RESULTS

Overall, disaster preparation and communication improved within the VS group as compared with the multimedia lecture group. Virtual simulation rated more immersive (P < 0.001), better at safety threat identification (P < 0.05), and better at evacuation preparation compared with multimedia lecture (P < 0.01). Virtual simulation participants felt more prepared in disaster response (P < 0.001) and patient evacuation (P < 0.001). Both groups packed equal essential items, but VS participants packed more equipment (mean, 19 vs. 15, P < 0.01) with no significant evacuation time difference between the VS group (145 ± 58 seconds) and multimedia lecture group (152 ± 59 seconds, P = not significant). Virtual simulation participants had better communication ratings with the charge nurse (P < 0.05) and family (P < 0.001).

CONCLUSIONS

Virtual simulation was well received by nurses compared with multimedia lecture and may be an effective adjunct for training nurses on infant patient evacuation during a disaster.

Identifying Crucial Equipment and Skills Needed to Evacuate Critically Ill Infants During Disasters: Using Nursing Expertise to Guide Training Targets

INTRODUCTION

Unexpected disasters, such as earthquakes or fires, require preparation to address knowledge gaps that may negatively affect vulnerable patients. Training programs can promote natural disaster readiness to respond and evacuate patients safely, but also require evidence-based information to guide learning objectives.

PROBLEM

There is limited evidence on what skills and bedside equipment are most important to include in disaster training and evacuation programs for critically ill infants.

METHODS

An expert panel was used to create a 13-item mastery checklist of skills for bedside registered nurses (RNs) required to successfully evacuate a critically ill infant. Expert nurses were surveyed, and the Angoff method was used to determine which of the mastery checklist skills a newly graduated nurse (ie, the "minimally competent" nurse) should be able to do. Participants then rated the importance of 26 commonly available pieces of bedside equipment for use in evacuating a hemodynamically unstable, intubated infant during a disaster.

RESULTS

Twenty-three emergency department (ED) and neonatal intensive care unit (NICU) charge RNs responded to the survey with a mean of 19 (SD = 9) years of experience and 30% reporting personal experience with evacuating patients. The skills list scores showed an emphasis on the newly graduated nurse having more complete mastery of skills surrounding thermoregulation, documentation, infection control, respiratory support, and monitoring. Skills for communication, decision making, and anticipating future needs were assessed as less likely for a new nurse to have mastered. On a scale of one (not important) to seven (critically important), the perceived necessity of equipment ranged from a low of 1.6 (breast pump) to a high of 6.9 (face mask). The individual intraclass correlation coefficient (ICC) of 0.55 showed moderate reliability between raters and the average team ICC of 0.97 showed excellent agreement as a group.

CONCLUSION

Experts rated the ability to manage physiological issues, such as thermoregulation and respiratory support, as skills that every nurse should master. Disaster preparedness activities for nurses in training may benefit from checklists of essential equipment and skills to ensure all nurses can independently manage patients' physiologic needs when they enter the workforce. Advanced nursing training should include education on decision making, communication during emergencies, and anticipation of future issues to ensure that charge and resource nurses can support bedside nurses during evacuation events.

Improvised Neonatal Care–Realizing the Gaps in a Disaster Zone

The treatment of newborns in a disaster zone can be extremely challenging. The effects of the disaster combine with local health care disparity to give these neonates little chance of survival in the event of even minor complications. Rescue teams arriving at such locations must be prepared to handle and to aid these difficult situations using improvisation and ingenuity to overcome many of the unexpected hurdles. A discussion of the difficulties faced in the Philippines following a typhoon and recommendations for future teams are presented.

MendlovicJ, AlbukrekD, DaganD, MerinO, WeiserG. Improvised neonatal care‒realizing the gaps in a disaster zone. Prehosp Disaster Med. 2016;31(1):111–113.