Bioterrorism training in U.S. emergency medicine residencies: has it changed since 9/11?

Anesthesiologists and Disaster Medicine: A Needs Assessment for Education and Training and Reported Willingness to Respond

BACKGROUND

Anesthesiologists provide comprehensive health care across the emergency department, operating room, and intensive care unit. To date, anesthesiologists' perspectives regarding disaster medicine and public health preparedness have not been described.

METHODS

Anesthesiologists' thoughts and attitudes were assessed via a Web-based survey at 3 major academic institutions. Frequencies, percentages, and odds ratios (ORs) were used to assess self-reported perceptions of knowledge and skills, as well as attitudes and beliefs regarding education and training, employee development, professional obligation, safety, psychological readiness, efficacy, personal preparedness, and willingness to respond (WTR). Three representative disaster scenarios (natural disaster [ND], radiological event [RE], and pandemic influenza [PI]) were investigated. Results are reported as percent or OR (95% confidence interval).

RESULTS

Participants included 175 anesthesiology attendings (attendings) and 95 anesthesiology residents (residents) representing a 47% and 51% response rate, respectively. A minority of attendings indicated that their hospital provides adequate pre-event preparation and training (31% [23-38] ND, 14% [9-21] RE, and 40% [31-49] PI). Few residents felt that their residency program provided them with adequate preparation and training (22% [14-33] ND, 16% [8-27] RE, and 17% [9-29] PI). Greater than 85% of attendings (89% [84-94] ND, 88% [81-92] RE, and 87% [80-92] PI) and 70% of residents (81% [71-89] ND, 71% [58-81] RE, and 82% [70-90] PI) believe that their hospital or residency program, respectively, should provide them with preparation and training. Approximately one-half of attendings and residents are confident that they would be safe at work during response to a ND or PI (55% [47-64] and 58% [49-67] of attendings; 59% [48-70] and 48% [35-61] of residents, respectively), whereas approximately one-third responded the same regarding a RE (31% [24-40] of attendings and 28% [18-41] of residents). Fewer than 40% of attendings (34% [26-43]) and residents (38% [27-51]) designated who would take care of their family obligations in the event they were called into work during a disaster. Regardless of severity, 79% (71-85) of attendings and 73% (62-82) of residents indicated WTR to a ND, whereas 81% (73-87) of attendings and 70% (58-81) of residents indicated WTR to PI. Fewer were willing to respond to a RE (63% [55-71] of attendings and 52% [39-64] of residents). In adjusted logistic regression analyses, those anesthesiologists who reported knowing one's role in response to a ND (OR, 15.8 [4.5-55.3]) or feeling psychologically prepared to respond to a ND (OR, 6.9 [2.5-19.0]) were found to be more willing to respond. Similar results were found for RE and PI constructs. Both attendings and residents were willing to respond in whatever capacity needed, not specifically to provide anesthesia.

CONCLUSIONS

Few anesthesiologists reported receiving sufficient education and training in disaster medicine and public health preparedness. Providing education and training and enhancing related employee services may further bolster WTR and help to build a more capable and effective medical workforce for disaster response.

Identifying weaknesses in national health emergency response skills and techniques with emergency responders: A cross-sectional study from China

BACKGROUND

To identify the weakest skill areas perceived by participants among key skills highly demanded during emergencies and to explore factors influencing the self-rated overall skill proficiency of public health emergency responders.

METHODS

The participants were selected by a multistage, stratified cluster sampling method in Heilongjiang CDC to complete questionnaires that assessed their perceptions of health emergency response skills and techniques. A final sample of 1,740 staff members was obtained and analyzed.

RESULTS

The 5 top skill deficiency areas perceived by participants were field epidemiologic investigation, personal protection, effective nuclear and radioactive response as well as psychological interventio (for these two areas gain the equal score), and risk assessment. The logistic regression revealed personal protective skills as the most important factor contributing to the self-rated overall skill proficiency of public health emergency responders, followed by field epidemiologic investigation skills.

CONCLUSIONS

More attention should be given to emergency response skill training and education programs. Major obstacles hindering the promotion of key skills and techniques among front-line emergency responders should be addressed urgently. Continuous efforts should be made to remove the financial, technical, and resource obstacles to improve public health emergency response capacity.

Reporting for duty during mass casualty events: a survey of factors influencing emergency medicine physicians

BACKGROUND

Academic medical centers play a major role in disaster response, and residents frequently serve as key resources in these situations. Studies examining health care professionals' willingness to report for duty in mass casualty situations have varying response rates, and studies of emergency medicine (EM) residents' willingness to report for duty in disaster events and factors that affect these responses are lacking.

OBJECTIVE

We sought to determine EM resident and faculty willingness to report for duty during 4 disaster scenarios (natural, explosive, nuclear, and communicable), to identify factors that affect willingness to work, and to assess opinions regarding disciplinary action for physicians unwilling to work in a disaster situation.

METHODS

We surveyed residents and faculty at 7 US teaching institutions with accredited EM residency programs between April and November 2010.

RESULTS

A total of 229 faculty and 259 residents responded (overall response rate, 75.4%). Willingness to report for duty ranged from 54.1% for faculty in a natural disaster to 94.2% for residents in a nonnuclear explosive disaster. The 3 most important factors influencing disaster response were concern for the safety of the family, belief in the physician's duty to provide care, and availability of protective equipment. Faculty and residents recommended minimal or no disciplinary action for individuals unwilling to work, except in the infectious disease scenario.

CONCLUSIONS

Most EM residents and faculty indicated they would report for duty. Residents and faculty responses were similar in all but 1 scenario. Disciplinary action for individuals unwilling to work generally was not recommended.

Pediatric emergency preparedness training: are we on a path toward national dissemination?

BACKGROUND

Emergency preparedness training is crucial for all health professionals, but the physiologic, anatomic, and psychologic differences between children and adults necessitates that health professionals receive training specific to pediatric emergencies. Before a standardized, nationally disseminated pediatric curriculum can be developed or endorsed, evidence-based evaluations of short- and long-term outcomes need to be conducted.

METHODS

A review of literature was conducted to identify developed courses and any evaluation of these courses.

RESULTS

Much has been published that supports the need for pediatric emergency preparedness, and many resources have been developed. However, very little literature presents evaluations of training courses.

DISCUSSION

To achieve evidence-based pediatric emergency preparedness training, existing training programs must be evaluated, standardized training guidelines need to be developed, and critical components of pediatric disaster response need to be captured in the academic literature.

Impact of an educational intervention on residents' knowledge of pediatric disaster medicine

BACKGROUND

Globally, natural and created events have underscored the vulnerability of children in disasters. There is an unmet need for a standardized pediatric disaster medicine (PDM) curriculum.

OBJECTIVE

To create and implement a PDM course, measure course efficacy, and assess residents' attitudes toward and experience in disaster medicine.

DESIGN/METHODS

An educational intervention was conducted for pediatric and emergency medicine residents at a tertiary care teaching hospital. Participants completed a precourse survey of PDM attitudes and experience. Paired t tests were used to compare pretest, immediate posttest, and delayed posttest scores. Test performance was assessed by resident type and postgraduate year. A postcourse survey gauged reaction to the course and interest in further PDM training.

RESULTS

Among the participants, 11 residents (9.4%) have treated disaster victims, and 5 (4.3%) had formal disaster medicine education. Most (83%) felt PDM is an important part of their training. Seventy-five eligible residents (64.6%) completed the intervention. Pairwise comparison of scores showed a mean improvement in scores of 24.5% immediately after taking the course (95% confidence interval, 22.9%-30.1%; P < 0.001). Two months later, residents scored a mean of 69.0% for the delayed posttest, with a retained improvement in scores (18.3%; 95% confidence interval, 14.3%-22.3%; P < 0.001). Residents preferred future PDM exercises to additional didactic training (72.0% vs. 32.7%; P < 0.001%).

CONCLUSIONS

Residents who complete this curriculum increase their knowledge of PDM with moderate retention of information. Most residents lack PDM training, believe it is important, and request disaster-training exercises.

Bioterrorism: Evaluating the preparedness of pediatricians in Michigan

OBJECTIVE

There is a paucity of literature in the United States regarding preparedness for a bioterrorist attack on children. The main objective of this study was to assess the self-reported level of bioterrorism preparedness of pediatricians practicing in Michigan.

METHODS

We conducted a survey that was mailed to 1000 pediatricians practicing in Michigan from July through December 2006. Survey questions were designed to evaluate the overall level of preparedness, as defined by the American Academy of Pediatrics, in dealing with a possible biological event and to describe key demographic variables.

RESULTS

Of the 590 pediatricians who responded (59%), a majority (80%) were general pediatricians, whereas 20% were pediatric subspecialists. Sixty percent of responders believe terrorism is a threat, with biological agents (52%; 95% confidence interval (CI), 48.00-56.12) as the most likely cause of an event. Half of the pediatricians who responded had a workplace disaster plan, but only 12% feel their preparedness for a biological attack/event was good. Sixty-six percent (392/590) were not currently Pediatric Advanced Life Support certified, 38% (95% CI,34.63-42.51) have never attended a lecture based on bioterrorism, 85% (95% CI, 82.00-87.78) have never participated in a bioterrorism training exercise, and 89% (95% CI, 87.00-91.95) do not provide disaster-oriented anticipatory guidance to their patients. Seventy-six percent (95% CI, 73.10-79.98) of all responders indicated their desire for more bioterrorism training, with 42% preferring diagnostic algorithms and 37% (95% CI, 32.79-40.59) preferring a prepared lecture on video format.

CONCLUSIONS

Surveyed pediatricians in Michigan consider bioterrorism a significant threat but are overwhelmingly underprepared to deal with an event. There is a perceived need for a coordinated educational program to improve level of preparedness.

Pediatric disaster preparedness: best planning for the worst-case scenario

Natural and man-made disasters are unpredictable but certainly will include children as victims. Increasingly, knowledge of pediatric disaster preparedness is required of emergency and primary care practitioners. A complete pediatric disaster plan comprises the following elements: appropriate personnel and equipment, disaster- and venue-specific training, and family preparedness. Disaster preparedness exercises are crucial for training plan implementation and response evaluation. Exercise content depends on local hazard vulnerabilities and learner training needs. Postexercise evaluations follow a stepwise process that culminates in improved disaster plans. This article will review disaster planning and the design, implementation, and evaluation of pediatric disaster exercises.