1
|
Baikmohammadi S, Amirheidari B, Dehesh T, Moghadam MN, Yazdi-Feyzabadi V, Hassani E, Habibzadeh H. A qualitative study on barriers and strategies to hospital preparedness against chemical, biological, radiological, and nuclear incidents. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2024; 13:3. [PMID: 38525212 PMCID: PMC10959262 DOI: 10.4103/jehp.jehp_1827_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 01/29/2023] [Indexed: 03/26/2024]
Abstract
BACKGROUND The effects of chemical, biological, radiological, and nuclear (CBRN) incidents on human society can be irreparable. Preparing the health system for these incidents is essential. This study aims to identify obstacles to hospital preparedness against CBRN incidents and provide solutions. MATERIALS AND METHODS This qualitative study was conducted using semi-structured interview method in 2022. The research community included experts in the fields of CBRN, and 17 persons were included in the study through purposive sampling. The interviews were collected by interview guide and recorded face-to-face and online and were analyzed using thematic content analysis method in MS Word 2016. RESULTS The interviews' analysis was classified into two main categories and 34 sub-categories. Some of the most important obstacles to the hospital preparedness against CBRN incidents were the lack of proper crisis management, the lack of specialist staff, the stress of employees, the lack of turnover and sufficient rest for employees, legal gaps, and so on. The main strategies were determining the type and extent of the risk factor, strong crisis management, the lack of parallelism, continuous monitoring, having a protocol and road map, appropriate training programs, having skilled personnel, rapid response of personnel, positive attitude of the staff, and the favorable condition of the building. CONCLUSION The appointment of an expert in the field of CBRN and having a specialized unit, the existence of specialized and trained staff along with access to the required facilities, clear instructions, and intra-departmental and inter-departmental cooperation affect the readiness of hospitals against CBRN incidents.
Collapse
Affiliation(s)
- Saeid Baikmohammadi
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Bagher Amirheidari
- Department of Pharmaceutical Biotechnology, Faculty of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran
| | - Tania Dehesh
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahmood Nekoei Moghadam
- Health in Disasters and Emergencies Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Vahid Yazdi-Feyzabadi
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ebrahim Hassani
- Department of Anesthesiology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Hossein Habibzadeh
- Department of Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
| |
Collapse
|
2
|
Yari A, Yousefi Khoshsabegheh H, Zarezadeh Y, Amraei M, Soufi Boubakran M, Motlagh ME. Iranian primary healthcare system's response to the COVID-19 pandemic using the healthcare incident command system. PLoS One 2023; 18:e0290273. [PMID: 37607162 PMCID: PMC10443878 DOI: 10.1371/journal.pone.0290273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 07/28/2023] [Indexed: 08/24/2023] Open
Abstract
The present study aimed to evaluate the effects of the healthcare incident command system (HICS) on the district health networks (DHNs) covered by provincial Medical Universities (PMU) in terms of the management and commanding of the COVID-19 pandemic in Iran. This study was a cross-sectional survey. The study was performed in Iran in June 2020 in 60 DHNs, 41 of which had an active HICS. Data were collected on eight HCIS dimensions from all 60 DHNs by trained crisis management experts to evaluate the effects of HICS use on management of the COVID-19 pandemic. For all the 60 DHNs, the mean score of the COVID-19 incident command and management was 78.79 ± 11.90 (range 20-100); with mean scores highest for organizational support and coordination and lowest for logistic and planning. Significant differences were observed between the DHNs with active HICS and DHNs with inactive or no HICS in terms of the mean scores of incident management and command and their associated dimensions. According to the results, the HICS use had a positive impact on the improvement of incident management and command and all the related dimensions. Therefore, the HICS could be conducted and implemented in primary healthcare for the systematic and proper management of crises caused by infectious diseases and increasing primary healthcare system efficiency in response to these crises.
Collapse
Affiliation(s)
- Arezoo Yari
- Department of Health in Emergencies and Disasters, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Homa Yousefi Khoshsabegheh
- Department of Health in Emergencies and Disasters, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Disaster Risk Management Office, Ministry of Health and Medical Education, Tehran, Iran
| | - Yadolah Zarezadeh
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Majid Amraei
- Disaster Risk Management Office, Ministry of Health and Medical Education, Tehran, Iran
| | | | | |
Collapse
|
3
|
De Rouck R, Benhassine M, Debacker M, Dugauquier C, Dhondt E, Van Utterbeeck F, Hubloue I. Creating realistic nerve agent victim profiles for computer simulation of medical CBRN disaster response. Front Public Health 2023; 11:1167706. [PMID: 37457279 PMCID: PMC10347399 DOI: 10.3389/fpubh.2023.1167706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/09/2023] [Indexed: 07/18/2023] Open
Abstract
In the last decades, Chemical, Biological, Radiological and Nuclear (CBRN) threats have become serious risks prompting countries to prioritize preparedness for such incidents. As CBRN scenarios are very difficult and expensive to recreate in real life, computer simulation is particularly suited for assessing the effectiveness of contingency plans and identifying areas of improvement. These computer simulation exercises require realistic and dynamic victim profiles, which are unavailable in a civilian context. In this paper we present a set of civilian nerve agent injury profiles consisting of clinical parameters and their evolution, as well as the methodology used to create them. These injury profiles are based on military injury profiles and adapted to the civilian population, using sarin for the purpose of illustration. They include commonly measured parameters in the prehospital setting. We demonstrate that information found in military sources can easily be adjusted for a civilian population using a few simple assumptions and validated methods. This methodology can easily be expanded to other chemical warfare agents as well as different ways of exposure. The resulting injury profiles are generic so they can also be used in tabletop and live simulation exercises. Modeling and simulation, if used correctly and in conjunction with empirical data gathered from lessons learned, can assist in providing the evidence practices for effective and efficient response decisions and interventions, considering the contextual factors of the affected area and the specific disaster scenario.
Collapse
Affiliation(s)
- Ruben De Rouck
- Research Group on Emergency and Disaster Medicine, Vrije Universiteit Brussel, Brussels, Belgium
| | - Mehdi Benhassine
- Department of Mathematics, Royal Military Academy, Brussels, Belgium
| | - Michel Debacker
- Research Group on Emergency and Disaster Medicine, Vrije Universiteit Brussel, Brussels, Belgium
| | - Christian Dugauquier
- Twenty-third Medical Battalion, Belgian Defence, Tournai, Belgium
- Belgian Delegate in The NATO Biological Medical Panel, Brussels, Belgium
| | | | | | - Ives Hubloue
- Research Group on Emergency and Disaster Medicine, Vrije Universiteit Brussel, Brussels, Belgium
| |
Collapse
|
4
|
Farhat H, Alinier G, Gangaram P, El Aifa K, Khenissi MC, Bounouh S, Khadhraoui M, Gargouri I, Laughton J. Exploring pre‐hospital healthcare workers' readiness for chemical, biological, radiological, and nuclear threats in the State of Qatar: A cross‐sectional study. Health Sci Rep 2022; 5:e803. [PMID: 36090624 PMCID: PMC9428763 DOI: 10.1002/hsr2.803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/01/2022] [Accepted: 08/11/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
- Hassan Farhat
- Hamad Medical Corporation Ambulance Service Doha Qatar
- Faculty of Sciences University of Sfax Sfax Tunisia
- Faculty of Medicine “Ibn El Jazzar” University of Sousse Sousse Tunisia
| | - Guillaume Alinier
- Hamad Medical Corporation Ambulance Service Doha Qatar
- School of Health and Social Work University of Hertfordshire Hatfield UK
- Weill Cornell Medicine College Doha Qatar
- Faculty of Health and Life Sciences Northumbria University Newcastle upon Tyne UK
| | - Padarath Gangaram
- Hamad Medical Corporation Ambulance Service Doha Qatar
- Faculty of Health Sciences Durban University of Technology Durban South Africa
| | | | | | - Sonia Bounouh
- Hamad Medical Corporation Ambulance Service Doha Qatar
| | - Moncef Khadhraoui
- Departement of Analytical Chemistry and Environmental Pollution, Higher Institute of Biotechnology University of Sfax Sfax Tunisia
| | | | | |
Collapse
|
5
|
Bajow N, Alkhalil S, Maghraby N, Alesa S, Najjar AA, Aloraifi S. Assessment of the effectiveness of a course in major chemical incidents for front line health care providers: a pilot study from Saudi Arabia. BMC MEDICAL EDUCATION 2022; 22:350. [PMID: 35534890 PMCID: PMC9082960 DOI: 10.1186/s12909-022-03427-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 05/03/2022] [Indexed: 05/30/2023]
Abstract
BACKGROUND Mass chemical exposure emergencies are infrequent but can cause injury, illness, or loss of life for large numbers of victims. These emergencies can stretch and challenge the available resources of healthcare systems within the community. Political unrest in the Middle East, including chemical terrorist attacks against civilians in Syria and increasing chemical industry accidents, have highlighted the lack of hospital preparedness for chemical incidents in the region. This study aimed to evaluate the effectiveness of a course designed to empower frontline healthcare providers involved in mass casualty incidents with the basic knowledge and essential operational skills for mass chemical exposure incidents in Saudi Arabia. METHODS A mixed-methods approach was used to develop a blended learning, simulation enhanced, competency-based course for major chemical incidents for front line healthcare providers. The course was designed by experts from different disciplines (disaster medicine, poisoning / toxicology, and Hazard Material Threat - HAZMAT team) in four stages. The course was piloted over five days at the Officers Club of the Ministry of Interior (Riyadh, Saudi Arabia). The 41 participants were from different government health discipline sectors in the country. Pre- and post-tests were used to assess learner knowledge while debriefing sessions after the decontamination triage session and simulation-enhanced exercises were used for team performance assessment. RESULTS The overall knowledge scores were significantly higher in the post-test (69.47%) than the pre-test (46.3%). All four knowledge domains also had significant differences between pre- and post-test results. There were no differences in the pre and post-test scores for healthcare providers from the different health disciplines. A one-year post-event survey demonstrated that participants were satisfied with their knowledge retention. Interestingly, 38.3% had the opportunity to put this knowledge into practice in relation to mass chemical exposure incidents. CONCLUSION Delivering a foundation level competency-based blended learning course with enhanced simulation training in major chemical incidents for front line healthcare providers may improve their knowledge and skills in response to such incidents. This in turn can improve the level of national preparedness and staff availability and make a crucial difference in reducing the health impacts among victims.
Collapse
Affiliation(s)
- Nidaa Bajow
- Security Forces Hospital Program, P O Box 89489, Riyadh, 11682, Kingdom of Saudi Arabia.
| | - Shahnaz Alkhalil
- Faculty of Engineering and Technology, Alzaytoonah University, Amman, Jordan
| | - Nisreen Maghraby
- King Fahad University Hospital Collage of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Saleh Alesa
- General Directorate of Medical Services Special Security Forces, Riyadh, Kingdom of Saudi Arabia
| | - Amal Al Najjar
- Security Forces Hospital Program, P O Box 89489, Riyadh, 11682, Kingdom of Saudi Arabia
| | - Samer Aloraifi
- Hail Health Cluster Ministry of Health, Hail, Kingdom of Saudi Arabia
| |
Collapse
|
6
|
Farhat H, Laughton J, Gangaram P, El Aifa K, Khenissi MC, Zaghouani O, Khadhraoui M, Gargouri I, Alinier G. Hazardous material and chemical, biological, radiological, and nuclear incident readiness among prehospital care professionals in the State of Qatar. GLOBAL SECURITY: HEALTH, SCIENCE AND POLICY 2022. [DOI: 10.1080/23779497.2022.2069142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Hassan Farhat
- Hamad Medical Corporation Ambulance Service Group
- PhD (c) in Health Sciences, Faculty of Medicine of Sousse “Ibn El Jazzar”, University of Sousse, Tunisia
- PhD (c) candidate in Biology, Faculty of Sciences, University of Sfax, Tunisia
| | | | - Padarath Gangaram
- Hamad Medical Corporation Ambulance Service Group
- Honorary Research Fellow, Faculty of Health Sciences, Durban University of Technology, Durban, South Africa
| | - Kawther El Aifa
- Hamad Medical Corporation Ambulance Service Group
- Master of Sciences (c) in Project Management, Lincoln University of Business and Management, Sharjah, the United Arab Emirates in partnership with the University of the West of Scotland, Technology Ave, Blantyre, Glasgow G72 0LH, United Kingdom
| | | | | | - Moncef Khadhraoui
- University of Sfax, Higher Institute of Biotechnology, Sfax-Tunisia, Analytical Chemistry and Environmental Pollution department
| | - Imed Gargouri
- University of Sfax, Faculty of Medicine, Sfax-Tunisia, Occupational Health department
| | - Guillaume Alinier
- Hamad Medical Corporation Ambulance Service Group
- University of Sfax, Higher Institute of Biotechnology, Sfax-Tunisia, Analytical Chemistry and Environmental Pollution department
- University of Hertfordshire, School of Health and Social Work, Hatfield-UK
- Weill Cornell Medicine-Qatar, Doha, Qatar
- Northumbria University, Faculty of Health and Life Sciences, Newcastle upon Tyne, UK
| |
Collapse
|
7
|
The Current State of Infectious Disasters Preparedness Around the World: A Qualitative Systematic Review (2007-2019). Disaster Med Public Health Prep 2020; 16:753-762. [PMID: 33371908 DOI: 10.1017/dmp.2020.258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Infectious disasters have specific features which require special approaches and facilities. The main challenge is the rate of spread, and their ability to traverse the Earth in a short time. The preparedness of hospitals to face these events is therefore of the utmost importance. This study was designed to assess the preparedness of countries facing biological events worldwide. A qualitative systematic review was done from PubMed (National Library of Medicine, Bethesda, MD), Scopus (Elsevier, Amsterdam, Netherlands), Web of Science (Thomson Reuters, New York, NY), ProQuest (Ann Arbor, MI), and Google Scholar (Google Inc, Mountain View, CA). Two journals were searched as key journals. The search period was from January 1, 2007 to December 30, 2018. Twenty-one (21) documents were selected including 7 (33%) from Asia, 7 (33%) from Europe, 4 (19%) from USA, 2 (10%) from Africa, and 1 (5%) multi-continental. Forty-six (46) common sub-themes were obtained and categorized into 13 themes (infection prevention control, risk perception, planning, essential support services, surveillance, laboratory, vulnerable groups, education and exercise and evaluation, human resource, clinical management of patients, risk communication, budget, and coordination). Not all articles discussed all the identified categories. There is an extended process required to reach complete preparedness for confronting biological events, including adequate and well-managed budget. Medical centers may have trouble dealing with such events, at least in some respects, but most developed countries seem to be more prepared in this regard.
Collapse
|
8
|
Patel SS, Grace RM, Chellew P, Prodanchuk M, Romaniuk O, Skrebets Y, Ryzhenko SA, Erickson TB. "Emerging Technologies and Medical Countermeasures to Chemical, Biological, Radiological, and Nuclear (CBRN) Agents in East Ukraine". Confl Health 2020; 14:24. [PMID: 32411293 PMCID: PMC7206701 DOI: 10.1186/s13031-020-00279-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/30/2020] [Indexed: 11/22/2022] Open
Abstract
Since 2014, Ukraine has been beset by an armed conflict with international and internal dimensions. The nature of this conflict is multidimensional, and disaster preparedness and response in this context must be as well. Health experts from Ukraine, the United States of America, United Kingdom, Czech Republic, and Norway convened for an educational event in Dnipro, East Ukraine on November 11-15, 2019. At the event, "Emerging Technologies and Countermeasures to CBRN Agents: Advanced Training Response to Conflict and Security Challenges in East Ukraine," over 1,000 participants participated in panel discussions, didactic lectures, and an advanced training on various dimensions of disaster response. This report provides an overview of the key discussions and outcomes of the event.
Collapse
Affiliation(s)
- Sonny S. Patel
- Fellow, NIH Fogarty Global Health Humanitarian Scholar, Harvard University, Cambridge, USA
| | - Robert M. Grace
- USIP-Minerva Peace Scholar, United States Institute of Peace, Graduate Research Fellow, Program on Negotiation, Harvard Law School, Cambridge, MA USA
| | | | - Mykola Prodanchuk
- L.I. Medved’s Research Center of Preventive Toxicology, Food, and Chemical Safety, Ministry of Health of Ukraine, Kyiv, Ukraine
| | | | - Yuriy Skrebets
- Regional Clinical Hospital, I.I. Mechnikov, Dnipro, Ukraine
| | | | - Timothy B. Erickson
- Brigham Health, Harvard Medical School, Harvard Humanitarian Initiative, Boston, USA
| |
Collapse
|
9
|
Sharififar S, Jahangiri K, Zareiyan A, Khoshvaghti A. Factors affecting hospital response in biological disasters: A qualitative study. Med J Islam Repub Iran 2020; 34:21. [PMID: 32551310 PMCID: PMC7293813 DOI: 10.34171/mjiri.34.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Indexed: 11/05/2022] Open
Abstract
Background: The fatal pandemics of infectious diseases and the possibility of using microorganisms as biological weapons are both rising worldwide. Hospitals are vital organizations in response to biological disasters and have a crucial role in the treatment of patients. Despite the advances in studies about hospital planning and performance during crises, there are no internationally accepted standards for hospital preparedness and disaster response. Thus, this study was designed to explain the effective factors in hospital performance during biological disasters. Methods: Qualitative content analysis with conventional approach was used in the present study. The setting was Ministry of Health and related hospitals, and other relevant ministries responsible at the time of biologic events in Islamic Republic of Iran (IR of Iran) in 2018. Participants were experts, experienced individuals providing service in the field of biological disaster planning and response, policymakers in the Ministry of Health, and other related organizations and authorities responsible for the accreditation of hospitals in IR of Iran. Data were collected using 12 semi-structured interviews in Persian language. Analysis was performed according to Graneheim method. Results: After analyzing 12 interviews, extraction resulted in 76 common codes, 28 subcategories, and 8 categories, which are as follow: detection; treatment and infection control; coordination, Resources; training and exercises; communication and information system; construction; and planning and assessment. Conclusion: Hospital management in outbreaks of infectious diseases (intentional or unintentional) is complex and requires different actions than during natural disasters. In such disasters, readiness to respond and appropriate action is a multifaceted operation. In IR of Iran, there have been few researches in the field of hospital preparation in biologic events, and the possibility of standardized assessment has be reduced due to lack of key skills in confronting biological events. It is hoped that the aggregated factors in the 8 groups of this study can evaluate hospital performance more coherently.
Collapse
Affiliation(s)
- Simintaj Sharififar
- Department of Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,School of Nursing, Aja University of Medical Sciences, Tehran, Iran
| | - Katayoun Jahangiri
- Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Armin Zareiyan
- Department of Health in Disasters and Emergencies, School of Nursing, Aja University of Medical Sciences, Tehran, Iran
| | - Amir Khoshvaghti
- Infectious Diseases Research Center, Aerospace and Subaquatic Medicine Faculty, Aja University of Medical Sciences, Tehran, Iran
| |
Collapse
|
10
|
Singh SK, Kuhn JH. Clinical Management of Patients Infected with Highly Pathogenic Microorganisms. DEFENSE AGAINST BIOLOGICAL ATTACKS 2019. [PMCID: PMC7123672 DOI: 10.1007/978-3-030-03053-7_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The clinical management of high consequence infectious diseases (HCID) poses an immense challenge, seen largely varying standards in terms of infection prevention control (IPC) as well as in quality of clinical care. This chapter gives an overview of possible treatment as well as IPC options. Lessons learned within the German Permanent Working Group of Competence and Treatment Centres for highly infectious, life-threatening diseases (STAKOB) are taken into account.
Collapse
Affiliation(s)
- Sunit K. Singh
- Molecular Biology Unit, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Jens H. Kuhn
- NIH/NIAID, Division of Clinical Research, Integrated Research Facility at Fort Detrick, Frederick, MD USA
| |
Collapse
|
11
|
Emergency Department Response to Chemical, Biological, Radiological, Nuclear, and Explosive Events: A Systematic Review. Prehosp Disaster Med 2018; 33:543-549. [DOI: 10.1017/s1049023x18000900] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractIntroductionA Chemical, Biological, Radiological, Nuclear, and explosive (CBRNe) event is an emergency which can result in injury, illness, or loss of life. The emergency department (ED) as a health system is at the forefront of the CBRNe response with staff acting as first receivers. Emergency departments are under-prepared to respond to CBRNe events - recognizing key factors which underlie the ED CBRNe response is crucial to provide evidence-based knowledge to inform policies and, most importantly, clinical practice.ProblemChallenges in detection, decontamination, and diagnosis are associated with the ED CBRNe response when faced with self-presenting patients.MethodsA systematic review was carried out in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). An in-depth search strategy was devised to identify studies which focused on the ED and CBRNe events. The inclusion criteria were stringent in terms of the environment (ED), participants (first receivers), situation (CBRNe response), and actions (detection, decontamination, and diagnosis). Fifteen databases and topic-specific journals were searched. Studies were critically appraised using the Mixed Methods Appraisal Tool (MMAT). Papers were thematically coded and synthesized using NVivo 10 (QSR International Ltd, Melbourne, Australia).ResultsSixty-seven full-text papers were critically appraised using the MMAT; 70% were included (n = 60) as medium- or high-quality studies. Data were grouped into four themes: preparedness, response, decontamination, and personal protective equipment (PPE) problems.DiscussionThis study has recognized the ED as a system which depends on four key factors - preparedness, response, decontamination, and PPE problems - which highlight challenges, uncertainties, inconsistencies, and obstacles associated with the ED CBRNe response. This review suggests that response planning and preparation should be considered at three levels: organizational (policies and procedures); technological (decontamination, communication, security, clinical care, and treatment); and individual (willingness to respond, PPE, knowledge, and competence). Finally, this study highlighted that there was a void specific to detection and diagnosis of CBRNe exposure on self-presenting patients in the ED.Conclusion:The review identified concerns for both knowledge and behaviors which suggests that a systems approach would help understand the ED response to CBRNe events more effectively. The four themes provide an evidence-based summary for the state of science in ED CBRNe response, which can be used to inform future policies and clinical procedures.RazakS,HignettS,BarnesJ.Emergency department response to chemical, biological, radiological, nuclear, and explosive events: a systematic review.Prehosp Disaster Med.2018;33(5):543–549.
Collapse
|
12
|
Fernandez-Pacheco AN, Rodriguez LJ, Price MF, Perez ABG, Alonso NP, Rios MP. Drones at the service for training on mass casualty incident: A simulation study. Medicine (Baltimore) 2017; 96:e7159. [PMID: 28658106 PMCID: PMC5500028 DOI: 10.1097/md.0000000000007159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Mass casualty incidents (MCI) are characterized by a large number of victims with respect to the resources available. In this study, we aimed to analyze the changes produced in the self-perception of students who were able to visualize aerial views of a simulation of a MCI. A simulation study, mixed method, was performed to compare the results from an ad hoc questionnaire. The 35 students from the Emergency Nursing Master from the UCAM completed a questionnaire before and after watching an MCI video with 40 victims in which they had participated. The main variable measured was the change in self-perception (CSP). The CSP occurred in 80% (28/35) of the students (P = .001). Students improved their individual (P = .001) and group (P = .006) scores. They also described that their personal performance had better results than the group performance (P = .047). The main conclusion of this study is that drones could lead to CSP and appraisal of the MCI simulation participants.
Collapse
Affiliation(s)
| | | | - Mariana Ferrandini Price
- Health Sciences, Catholic University of Murcia (UCAM) and Nurse at the Emergency Services, Murcia, Spain
| | | | | | | |
Collapse
|