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Saadatmand V, Ahmadi Marzaleh M, Shokrpour N, Abbasi HR, Peyravi MR. Designing a model of emergency medical services preparedness in response to mass casualty incidents: a mixed-method study. BMC Emerg Med 2024; 24:127. [PMID: 39048983 PMCID: PMC11267821 DOI: 10.1186/s12873-024-01055-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Emergency medical services preparedness in mass casualty incidents is one of the most important concerns in emergency systems. A mass casualty incident is a sudden event with several injured individuals that overwhelms the local health care system. This study aimed to identify and validate the components of emergency medical services readiness in mass casualty incidents which ultimately led to designing a conceptual model. METHODS This research was an explanatory mixed-method study conducted in five consecutive stages in Iran between November 2021 and September 2023. First, a systematic review was carried out to extract the components of emergency medical services preparedness in mass casualty incidents based on the PRISMA guideline. Second, a qualitative study was designed to explore the preparedness components through in-depth semi-structured interviews and analyzed using the content analysis approach. Third, the integration of the components extracted from the two stages of the systematic review and qualitative study was done by an expert panel. Fourth, the obtained components were validated using the Delphi technique. Two rounds were done in the Delphi phase. Finally, the conceptual model of emergency medical services preparedness in mass casualty incidents was designed by a panel of experts. RESULTS 10 articles were included in the systematic review stage and sixteen main components were extracted and classified into four categories. In the second stage, thirteen components were extracted from the qualitative study and classified into five categories. Then, the components of the previous two phases were integrated into the panel of experts and 23 components were identified. After validation with the Delphi technique, 22 components were extracted. Lastly, the final components were examined by the panel of experts, and the conceptual schematic of the model was drawn. CONCLUSIONS It is necessary to have an integrated framework and model of emergency medical service readiness in the planning and management of mass casualty incidents. The components and the final model of this research were obtained after the systematic scientific steps, which can be used as a scheme to improve emergency medical service preparedness in response to mass casualty incidents.
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Affiliation(s)
- Vahid Saadatmand
- Department of Medical Emergencies, School of Paramedicine, Faculty of Jahrom University of Medical Science, Jahrom, Iran
| | - Milad Ahmadi Marzaleh
- Department of Health in Disasters and Emergencies, School of Health Management and Medical Information Sciences, Faculty of Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nasrin Shokrpour
- English Department, Faculty of Paramedical Sciences, Shiraz, Iran
| | - Hamid Reza Abbasi
- Department of Surgery, School of Medicine, Faculty of Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahmoud Reza Peyravi
- Department of Health in Disasters and Emergencies, School of Health Management and Medical Information Sciences, Faculty of Shiraz University of Medical Sciences, Alley 29, Qasrodasht Ave, Shiraz, 71336-54361, Iran.
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Beyrami Jam M, Aminizadeh M, Akbari-Shahrestanaki Y, Khankeh HR. Evaluating the disaster preparedness of emergency medical services (EMS) facilities: a cross-sectional investigation in Iran. BMC Emerg Med 2024; 24:48. [PMID: 38523286 PMCID: PMC10962146 DOI: 10.1186/s12873-024-00932-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/11/2024] [Indexed: 03/26/2024] Open
Abstract
INTRODUCTION The preparedness of Emergency Medical Services (EMS) plays a crucial role in managing health disaster risks. This study was conducted to assess the disaster preparedness of EMS facilities in Iran, using a nationally reliable tool. METHODS A cross-sectional study was conducted in May 2021 to evaluate the disaster preparedness of EMS facilities in Iran using a national standard tool. The census sampling approach was utilized to select the samples, and descriptive statistics, as well as analytical statistics like the independent t-test and Pearson's correlation test, were used to analyze the data using SPSS-18 software. RESULTS The findings of this study revealed that the majority of EMS facilities in Iran possess a moderate level of preparedness in dealing with disasters. Also, the results indicate that EMS facilities have an average level of preparedness against disasters in all dimensions except for "coordination and cooperation" and "surge capacity". CONCLUSION According to this study, the majority of EMS facilities in Iran are exposed to different disasters. Furthermore, the findings indicate that while EMS facilities are generally prepared to respond to disasters at an average level, there are some important preparedness gaps in dimensions like response capacities, coordination, and cooperation. Thus, specific strategies, standards, and procedures must be developed and disseminated by the National Medical Emergency Organization.
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Affiliation(s)
- Mehdi Beyrami Jam
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
| | - Mohsen Aminizadeh
- Health in Disasters and Emergencies Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Yousof Akbari-Shahrestanaki
- Department of Pre-Hospital Medical Emergencies, School of Paramedical, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Hamid Reza Khankeh
- Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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A Scoping Review of the Essential Components of Emergency Medical Response Systems for Mass Casualty Incidents. Disaster Med Public Health Prep 2023; 17:e274. [PMID: 36597790 DOI: 10.1017/dmp.2022.235] [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: 01/05/2023]
Abstract
OBJECTIVE Emergency medical (EM) response systems require extensive coordination, particularly during mass casualty incidents (MCIs). The recognition of preparedness gaps and contextual priorities to MCI response capacity in low- and middle-income countries (LMICs) can be better understood through the components of EM reponse systems. This study aims to delineate essential components and provide a framework for effective emergency medical response to MCIs. METHODS A scoping review was conducted using 4 databases. Title and abstract screening was followed by full-text review. Thematic analysis was conducted to identify themes pertaining to the essential components and integration of EM response systems. RESULTS Of 20,456 screened citations, 181 articles were included in the analysis. Seven major and 40 sub-themes emerged from the content analysis as the essential components and supportive elements of MCI medical response. The essential components of MCI response were integrated into a framework demonstrating interrelated connections between essential and supportive elements. CONCLUSIONS Definitions of essential components of EM response to MCIs vary considerably. Most literature pertaining to MCI response originates from high income countries with far fewer reports from LMICs. Integration of essential components is needed in different geopolitical and economic contexts to ensure an effective MCI emergency medical response.
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Khilji FUR, Zil-e-Huma, Baloch NS, Shoaib M, Iqbal Z, Raziq A, Sadaf N, Ainuddin S, Haider S, Saleem F, Iqbal Q, Hussain T, Ayaz A, Ishaq R. Physicians' Response and Preparedness of Terrorism-Related Disaster Events in Quetta City, Pakistan: A Qualitative Inquiry. Front Public Health 2022; 10:912762. [PMID: 35832271 PMCID: PMC9271701 DOI: 10.3389/fpubh.2022.912762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background Besides catastrophes, infrastructural damages, and psychosocial distress, terrorism also imposes an unexpected burden on healthcare services. Considerably, adequately-prepared and responsive healthcare professionals affirms effective management of terrorism-related incidences. Accordingly, the present study aimed to evaluate physicians' preparedness and response toward terrorism-related disaster events in Quetta city, Pakistan. Methods A qualitative design was adopted. Physicians practicing at the Trauma Center of Sandeman Provincial Hospital (SPH), Quetta, were approached for the study. We conducted in-depth interviews; all interviews were audio-taped, transcribed verbatim, and analyzed for thematic contents by a standard content analysis framework. Results Fifteen physicians were interviewed. The saturation was achieved at the 13th interview however we conducted another two to validate the saturation. The thematic content analysis revealed five themes and 11 subthemes. All physicians have experienced, responded to, and managed terrorism-related disaster events. They were prepared professionally and psychologically in dealing with a terrorism-related disaster. Physicians identified lack of disaster-related curricula and training, absence of a standardized protocol, recurrence of the disaster, and hostile behavior of victim's attendants during an emergency as critical barriers to effective terrorism-related disaster management. Among limitations, all respondents mentioned workspace, and resources as a foremost constraint while managing a terrorism-related disaster event. Conclusion Although physicians understood the abilities and had the required competencies to mitigate a terrorism-related disaster, lack of workspace and resources were identified as a potential barrier to effective disaster management. Based on the results, we propose reconsideration and integration of the medical curriculum, particularly for terrorism-related disaster management, collaboration, and communication among various stakeholders to manage terrorism-related disaster events competently.
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Affiliation(s)
| | - Zil-e-Huma
- Department of Zoology, Sardar Bahadur Khan Women's University, Quetta, Pakistan
| | | | - Maryam Shoaib
- Department of Gynecology and Obstetrics, Sandeman Provincial Hospital, Quetta, Pakistan
| | - Zaffar Iqbal
- Health Department Government of Balochistan, Quetta, Pakistan
| | - Abdul Raziq
- Department of Statistics, University of Balochistan Quetta, Quetta, Pakistan
| | - Nabila Sadaf
- Department of Pharmacy, Sardar Bahadur Khan Womens' University, Quetta, Pakistan
| | - Syed Ainuddin
- Department of Disaster Management and Development Studies, University of Balochistan, Quetta, Pakistan
| | - Sajjad Haider
- Faculty of Pharmacy and Health Sciences, University of Baluchistan, Quetta, Pakistan
| | - Fahad Saleem
- Faculty of Pharmacy and Health Sciences, University of Baluchistan, Quetta, Pakistan
| | - Qaiser Iqbal
- Faculty of Pharmacy and Health Sciences, University of Baluchistan, Quetta, Pakistan
| | - Tanveer Hussain
- Department of Disaster Management and Development Studies, University of Balochistan, Quetta, Pakistan
| | - Asfandyar Ayaz
- Department of Disaster Management and Development Studies, University of Balochistan, Quetta, Pakistan
| | - Rabia Ishaq
- Faculty of Pharmacy and Health Sciences, University of Baluchistan, Quetta, Pakistan
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Glober N, Hamilton J, Montelauro N, Ulintz A, Arkins T, Supples M, Liao M, O'Donnell D, Faris G. Safety of an Alternative Care Protocol for EMS non-transport in the COVID-19 Pandemic. PREHOSP EMERG CARE 2022; 27:315-320. [PMID: 35666266 DOI: 10.1080/10903127.2022.2086652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIM Our primary goal was to evaluate safety of a new emergency medical services (EMS) protocol directing non-transport of low-acuity patients during the COVID-19 pandemic. METHODS We performed a retrospective cohort analysis of all patients in Marion County, Indiana, from March 23, 2020 to May 25, 2020 for whom a novel non-transport protocol was used by EMS for patients with low-acuity COVID-19 symptoms. We assessed paramedic compliance with the protocol to determine numbers and types of deviations. We further reviewed a statewide health information exchange database to identify any patients with emergency department (ED) visits, hospital admissions, or death within 30 days of the EMS non-transport. For ED and hospital visits, we collected ED or admission diagnoses to determine if the etiologies were COVID-related. RESULTS Between March 24, 2020 and May 25, 2020, 222 patients were documented as "Treated, Released (per protocol)." The protocol was correctly applied 144 times (64.8%). The other 78 times, although the EMS clinicians documented use of the protocol, it was not actually used (e.g., another protocol such as "no medical emergency" was used). Of the 144 patients for whom the protocol was used, in 55 cases (38.2%), the clinicians documented patient factors that should have contraindicated use of the protocol (e.g., chest pain, past medical history of asthma). The protocol was applied 5 times (3.5%) in pediatric patients. Two patients were admitted to the hospital within 72 hours of incorrect application of the protocol; both were for COVID-related complaints. Two patients were admitted to the hospital within 72 hours of correct protocol use; one was for a COVID-related complaint. CONCLUSION In this case series, paramedics demonstrated large deviations from the novel non-transport protocol. Several patients were admitted to the hospital within 72 hours of non-transport both when the protocol was used correctly, and when it was used incorrectly.
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Affiliation(s)
- Nancy Glober
- Department of Emergency Medicine, Indiana University, Indianapolis, USA
| | | | | | - Alex Ulintz
- Department of Emergency Medicine, Indiana University, Indianapolis, USA
| | - Thomas Arkins
- Indianapolis Emergency Medical Services, Indianapolis, USA
| | - Michael Supples
- Department of Emergency Medicine, Indiana University, Indianapolis, USA
| | - Mark Liao
- Department of Emergency Medicine, Indiana University, Indianapolis, USA
| | - Daniel O'Donnell
- Department of Emergency Medicine, Indiana University, Indianapolis, USA
| | - Greg Faris
- Department of Emergency Medicine, Indiana University, Indianapolis, USA
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A Region-Wide All-Hazard Training Program for Prehospital Mass Casualty Incident Management: A Real-World Case Study. Disaster Med Public Health Prep 2022; 17:e184. [PMID: 35361292 DOI: 10.1017/dmp.2022.84] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE We report the development, implementation, and results of a sustainable region-wide mass-casualty management prehospital training program implemented by the Regione Lombardia emergency medical services (EMS) agency AREU in Italy. METHODS The educational program learning objectives are: (1) command and control, communications, and resource management; (2) mass casualty triage and the START triage protocol; (3) on-scene management; (4) Regione Lombardia and AREU Mass Casualty standard operating procedures; and (5) inter-agency communications and relations. For each course edition data on participants' summative assessment, participants' feedback and costs were collected. RESULTS Between June 26, 2013, and December 31, 2020, a total of 84 editions of the provider training event were delivered, training an overall 1329 prehospital providers; 1239 (93%) passed the summative assessment and were qualified as being operationally "ready." Regarding participant feedback, the overall program was rated 4.4 ± 0.7 out of 5. The overall cost of running the provider program during the study period was €321 510 (circa US $382 000). The average cost per edition was €3828 and €242 per participant. CONCLUSIONS We have described a simple yet interactive simulation and blended-learning approach, which has yielded good pass rates, good participant satisfaction, and contained costs to systematically train emergency medical service personnel.
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Neely R, Haynes K, Miller G. Development of a Mobile Hospital for Disaster Relief. J Nurs Adm 2021; 51:33-37. [PMID: 33278199 DOI: 10.1097/nna.0000000000000963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Mobile supplemental hospitals were an important asset to community response in preparing for the recent pandemic. MED-1 is a Mobile Emergency Department that has adapted and evolved to the changing needs of communities in times of disaster and nondisaster. An overview of the asset (MED-1), the operations, and use is provided to demonstrate how mobile supplemental hospitals can effectively meet a range of healthcare needs. Innovative utilization of MED-1 has secured its future as an effective resource averaging 100 days of deployment per year.
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Affiliation(s)
- Robyn Neely
- Author Affiliations: Associate Vice President/Chief Nurse Executive (Ms Neely), Atrium Health; Manager of Operations (Ms Haynes); and Director of Clinical Services (Mr Miller), Mobile Medicine, Charlotte, North Carolina
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Alanazy ARM, Wark S, Fraser J, Nagle A. Nontransported Cases after Emergency Medical Service Callout in the Rural and Urban Areas of the Riyadh Region. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2020; 9:38-44. [PMID: 33519342 PMCID: PMC7839576 DOI: 10.4103/sjmms.sjmms_560_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/13/2020] [Accepted: 11/22/2020] [Indexed: 11/04/2022]
Abstract
Background Callouts resulting in patient nontransportation can impact the overall quality of prehospital Emergency Medical Service (EMS), as resources in health care are finite. While some studies have investigated the causes of nontransportation, few have examined whether there are differences between urban and rural patients. Similarly, there has been limited research focused on rural EMS in locations such as the Middle East. Objectives This study investigated EMS cases that resulted in nontransportation in the urban and rural areas of the Riyadh region in the Kingdom of Saudi Arabia. Methods A cross-sectional study of 800 (400 rural and 400 urban) patient records was undertaken, using 12 months (January 1 to December 31, 2017) of data from the Saudi Red Crescent EMS. A random sampling method was used to select ambulance records from the 78 urban and rural EMS stations in the Riyadh region, with demographic data and reasons for patient nontransport analyzed comparatively. Results A total of 310 cases were nontransported (39%) (rural: 146; urban = 164). The highest rates of nontransportation cases were of medical and trauma callouts (44.6% and 39.6%, respectively), which was consistent in both areas. The most common reason for nontransportation in both urban and rural areas was refusal of treatment and transportation (66.5% and 59.9%, respectively). Further, 10 patients were treated on-scene and released by rural EMS, while no urban patients were treated and released. Overall, the case presentations of nontransported patients did not differ significantly between both areas, and it was found that gender, age, and geographic location were not predictors for nontransportation. Conclusions The high rate of nontransportation, particularly in medical and trauma callouts, indicates that a review of current EMS protocols may be required, along with consideration of relevant community education programs.
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Affiliation(s)
- Ahmed Ramdan M Alanazy
- School of Rural Medicine, Faculty of Medicine and Health, University of New England, Armidale, New South Wales, Australia
| | - Stuart Wark
- School of Rural Medicine, Faculty of Medicine and Health, University of New England, Armidale, New South Wales, Australia
| | - John Fraser
- School of Rural Medicine, Faculty of Medicine and Health, University of New England, Armidale, New South Wales, Australia
| | - Amanda Nagle
- School of Rural Medicine, Faculty of Medicine and Health, University of New England, Armidale, New South Wales, Australia
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Qualitative Study of Health System Preparedness for Successful Implementation of Disaster Exercises in the Iranian Context. Disaster Med Public Health Prep 2020; 16:500-509. [PMID: 33023696 DOI: 10.1017/dmp.2020.257] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Implementing disaster exercises in different parts of the health system is one of the important steps in providing and developing disaster risk management plans. Considering the importance of promoting health system preparedness through exercise, the present study aimed to identify and explain necessary and original components for successful implementation of preparedness exercises of the health-care system in disaster. METHODS The study was a qualitative content analysis. Data were collected by purposeful sampling through in-depth and semi-structured individual interviews with 25 health professionals in disaster. Directed content analysis was used to analyze the data, which extracted the initial codes after performing the recorded interviews on paper and immersing them in the data analysis. RESULTS The data analysis resulted in the production of 100 initial codes, 14 subcategories, 6 main categories of "coordination and information management," "standards and indicators," "conduction and control of the process," "logistic management and supplies," "management of treatment operation," and "management of health operation," under the original theme of "implementation of exercise." CONCLUSIONS The findings of this study can greatly increase the attention of senior managers to preparedness in all areas of the health system, especially managers of prehospitals and hospitals who are the forefront of the response to the disaster. The findings of this study can be considered as a guideline for the implementation of principle and standardized health system preparedness exercises.
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Optimizing Routine and Disaster Prehospital Care Through Improved Emergency Medical Services Oversight. Disaster Med Public Health Prep 2020; 15:595-607. [PMID: 32476635 DOI: 10.1017/dmp.2020.71] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To identify modifiers of emergency medical services (EMS) oversight quality, including facilitators and barriers, and inform best practices and policy related to EMS oversight and system performance. METHODS We used a qualitative design, including 4 focus groups and 10 in-depth, 1-on-1 interviews. Primary data were collected from EMS stakeholders in Michigan from June to July 2016. Qualitative data were analyzed using the rapid assessment technique. RESULTS Emergent themes included organizational structure, oversight and stakeholder leadership, interorganizational communication and relationships, competition or collaboration among MCA stakeholders, quality improvement practices, resources, and needs specific to rural communities. CONCLUSIONS EMS is a critical component of disaster response. This study revealed salient themes and modifiers, including facilitators and barriers, of EMS oversight quality. These findings were evaluated in the context of current evidence and informed state policy to improve the quality of EMS oversight and prehospital care for both routine and disaster settings. Some were particular to geographic regions and communities, whereas others were generalizable.
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Alwidyan MT, Trainor JE, Bissell RA. Responding to natural disasters vs. disease outbreaks: Do emergency medical service providers have different views? INTERNATIONAL JOURNAL OF DISASTER RISK REDUCTION : IJDRR 2020; 44:101440. [PMID: 32363141 PMCID: PMC7185370 DOI: 10.1016/j.ijdrr.2019.101440] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 12/02/2019] [Accepted: 12/04/2019] [Indexed: 05/24/2023]
Abstract
INTRODUCTION Our planet has been experiencing a huge burden of natural disasters and public health emergencies in the last three decades. Emergency medical service providers are expected to be in the frontlines during such emergencies. Yet, this system is badly understudied when it comes to its roles and performance during disasters and public health emergencies. This study is designed to enhance understanding by assessing a sample U.S EMS providers' views about working during natural disasters and disease outbreaks and explores whether they are coming to work during such conditions. METHODS This study utilized a qualitative approach using face-to-face interviews with EMS workers from the State of Delaware, USA. Participants were asked about their views, insights, and potential behavior of working during natural disasters and disease outbreaks. Data collected were transcribed and coded using ATLAS.ti software to develop themes of the study using an inductive approach. RESULTS Three themes were emerged from interviews regarding working during natural disasters; respondents expressed excitement, concern, or no real differences. For disease outbreaks, however, the two themes were concerned and no additional risk. While participants expressed varying concerns about working during disasters and pandemic conditions, everyone felt willing and obligated to come to work despite the perceived high risk for some of them to work in some conditions. CONCLUSION This study helps to provide the base upon which EMS, public health, and emergency management agencies can formulate actions that emerged from the views of EMS providers concerning work during disasters and public health emergencies.
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Affiliation(s)
- Mahmoud T. Alwidyan
- Department of Allied Medical Science, Jordan University of Science and Technology, Irbid, Jordan
| | - Joseph E. Trainor
- Biden School of Public Policy & Administration, University of Delaware, Newark, United States
| | - Richard A. Bissell
- Department of Emergency Health Services, University of Maryland, Baltimore County, Baltimore, United States
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Madrigano J, Chandra A, Costigan T, Acosta JD. Beyond Disaster Preparedness: Building a Resilience-Oriented Workforce for the Future. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14121563. [PMID: 29236028 PMCID: PMC5750981 DOI: 10.3390/ijerph14121563] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 12/05/2017] [Accepted: 12/09/2017] [Indexed: 10/25/2022]
Abstract
Enhancing citizens' and communities' resilience is critical to adapt successfully to ongoing challenges faced by communities, as well as acute shocks resulting from disasters. While significant progress has been made in this area, several research and practice gaps remain. A crucial next step to advance resilience is the development of a resilience-oriented workforce. This narrative review examines existing literature to determine key components of a resilience-oriented workforce, with a focus on organizational structures, training and education, and leadership models. Reviewed articles spanned a variety of study types, including needs assessments of existing workforce, program evaluations, and reviews/commentaries. A resilience-oriented workforce spans many disciplines and training programs will need to reflect that. It requires a collaborative organizational model that promotes information sharing structures. Leadership models should foster a balance between workforce autonomy and operation as a collective entity. Optimal strategies to develop a resilience-oriented workforce have yet to be realized and future research will need to collect and synthesize data to promote and evaluate the growth of this field.
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Affiliation(s)
- Jaime Madrigano
- RAND Corporation, 1200 South Hayes Street, Arlington, VA 22202, USA.
| | - Anita Chandra
- RAND Corporation, 1200 South Hayes Street, Arlington, VA 22202, USA.
| | - Tracy Costigan
- Robert Wood Johnson Foundation, 50 College Road East, Princeton, NJ 08540, USA.
| | - Joie D Acosta
- RAND Corporation, 1200 South Hayes Street, Arlington, VA 22202, USA.
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Willoughby M, Kipsaina C, Ferrah N, Blau S, Bugeja L, Ranson D, Ibrahim JE. Mortality in Nursing Homes Following Emergency Evacuation: A Systematic Review. J Am Med Dir Assoc 2017; 18:664-670. [PMID: 28412167 DOI: 10.1016/j.jamda.2017.02.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 02/08/2017] [Accepted: 02/08/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To determine the risk associated with mortality among nursing home residents within 6 months following an evacuation because of man-made or natural disasters. DESIGN A systematic review conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Statement. SETTING All peer-reviewed studies published in English, French, German, or Spanish between January 1, 2000 and December 31, 2015, examining mortality within 6 months of disaster evacuation from a nursing home. MEASUREMENTS Extracted information included study and population characteristics, mortality measures, and risk factors. Studies were examined using the disaster management cycle that considers preparedness, response, recovery, and mitigation. RESULTS The 10 included studies were published between 2010 and 2015 with one-half conducted in the United States. Only 3 studies detailed the preparedness stage, and 4 detailed the response stage of the disaster management cycle. Mortality was measured as an indicator of recovery and was found to be elevated at 1 month [from 0.03% (n = 1088) to 10.5% (n = 75)] 3 months [from 0.08% (n = 3091) to 15.2% (n = 197)], and 6 months [from 14.9% (n = 263) and 16.8% (n = 22)] postevacuation compared with pre-evacuation and sheltering-in-place. Studies identified vulnerable residents as being over 80 years of age, frail, dependent, male residents with multiple comorbidities and, made recommendations on disaster preparedness. CONCLUSIONS There is little research on the effects of evacuation on nursing home residents, which is surprising considering the elevated risk of mortality postevacuation. Evacuation seems to have a negative effect on the survival of nursing home residents independent of the effect of the disaster. Standard evacuation procedures may be less applicable to this vulnerable population because of extra challenges they face in disasters.
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Affiliation(s)
- Melissa Willoughby
- Health Law and Aging Research Unit, Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia.
| | - Chebiwot Kipsaina
- Health Law and Aging Research Unit, Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia
| | - Noha Ferrah
- Health Law and Aging Research Unit, Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia
| | - Soren Blau
- Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia
| | - Lyndal Bugeja
- Health Law and Aging Research Unit, Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia
| | - David Ranson
- Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia
| | - Joseph Elias Ibrahim
- Health Law and Aging Research Unit, Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia
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Legal Considerations for Health Care Practitioners After Superstorm Sandy. Disaster Med Public Health Prep 2016; 10:518-24. [DOI: 10.1017/dmp.2016.33] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractDuring disaster response and recovery, legal issues often arise related to the provision of health care services to affected residents. Superstorm Sandy led to the evacuation of many hospitals and other health care facilities and compromised the ability of health care practitioners to provide necessary primary care. This article highlights the challenges and legal concerns faced by health care practitioners in the aftermath of Sandy, which included limitations in scope of practice, difficulties with credentialing, lack of portability of practitioner licenses, and concerns regarding volunteer immunity and liability. Governmental and nongovernmental entities employed various strategies to address these concerns; however, legal barriers remained that posed challenges throughout the Superstorm Sandy response and recovery period. We suggest future approaches to address these legal considerations, including policies and legislation, additional waivers of law, and planning and coordination among multiple levels of governmental and nongovernmental organizations. (Disaster Med Public Health Preparedness. 2016;10:518–524)
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The State of Leadership Education in Emergency Medical Services: A Multi-national Qualitative Study. Prehosp Disaster Med 2014; 29:478-83. [DOI: 10.1017/s1049023x14000867] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveThis study investigated how leadership is learned in Emergency Medical Services (EMS) from a multi-national perspective by interviewing EMS providers from multiple nations working in Riyadh, Kingdom of Saudi Arabia.MethodsA phenomenological, qualitative methodology was developed and 19 EMS providers from multiple nations were interviewed in June 2013. Interview questions focused on how participants learned EMS leadership as an EMS student and throughout their careers as providers. Data were analyzed to identify themes, patterns, and codes to be used for final analysis to describe findings.ResultsEmergency Medical Services leadership is primarily learned from informal mentoring and on-the-job training in less than supportive environments. Participants described learning EMS leadership during their EMS education. A triangulation of EMS educational resources yielded limited results beyond being a leader of patient care. The only course that yielded results from triangulation was EMS Management. The need to develop EMS leadership courses was supported by the findings. Findings also supported the need to include leadership education as part of continuing medical education and training.ConclusionEmergency Medical Services leadership education that prepares students for the complexities of the profession is needed. Likewise, the need for EMS leadership education and training to be part of continuing education is supported. Both are viewed as a way to advance the EMS profession. A need for further research on the topic of EMS leadership is recognized, and supported, with a call for action on suggested topics identified within the study.LeggioWJJr. The state of leadership education in Emergency Medical Services: a multi-national qualitative study. Prehosp Disaster Med. 2014;29(5):1-6.
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Abstract
INTRODUCTION For effective responses to emergencies, individuals must have the ability to respond and also be willing to participate in the response. A growing body of research points to gaps in response willingness among several occupational cohorts with response duties, including the Emergency Medical Services (EMS) workforce. Willingness to respond is particularly important during an influenza or other pandemic, due to increased demands on EMS workers and the potential for workforces to be depleted if responders contract influenza or stay home to care for sick dependents. State emergency preparedness laws are one possible avenue to improve willingness to respond. Hypothesis Presence of certain state-level emergency preparedness laws (ie, ability to declare a public health emergency; requirement to create a public health emergency plan; priority access to health resources for responders) is associated with willingness to respond among EMS workers. METHODS Four hundred twenty-one EMS workers from the National Registry of Emergency Medical Technicians' (NREMT's) mid-year Longitudinal EMT Attributes and Demographics Study (LEADS) were studied. The survey, which included questions about willingness to respond during an influenza pandemic, was fielded from May through June 2009. Survey data were merged with data about the presence or absence of the three emergency preparedness laws of interest in each of the 50 US states. Unadjusted logistic regression analyses were performed with the presence/absence of each law and were adjusted for respondents' demographic/locale characteristics. RESULTS Compared to EMS workers in states that did not allow the government to declare a public health emergency, those in states that permitted such declarations were more likely to report that they were willing to respond during an influenza pandemic. In adjusted and unadjusted analyses, this difference was not statistically significant. Similar results were found for the other state-level emergency preparedness laws of interest. CONCLUSION While state-level emergency preparedness laws are not associated with willingness to respond, recent research suggests that inconsistencies between the perceived and objective legal environments for EMS workers could be an alternative explanation for this study's findings. Educational efforts within the EMS workforce and more prominent state-level implementation of emergency preparedness laws should be considered as a means to raise awareness of these laws. These types of actions are important steps toward determining whether state-level emergency preparedness laws have the potential to promote response willingness among EMS workers.
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Carron PN, Reigner P, Vallotton L, Clouet JG, Danzeisen C, Zürcher M, Yersin B. Implementation of a medical command and control team in Switzerland. DISASTERS 2014; 38:434-450. [PMID: 24601925 DOI: 10.1111/disa.12043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In case of a major incident or disaster, the advance medical rescue command needs to manage several essential tasks simultaneously. These include the rapid deployment of ambulance, police, fire and evacuation services, and their coordinated activity, as well as triage and emergency medical care on site. The structure of such a medical rescue command is crucial for the successful outcome of medical evacuation at major incidents. However, little data has been published on the nature and structure of the command itself. This study presents a flexible approach to command structure, with two command heads: one emergency physician and one experienced paramedic. This approach is especially suitable for Switzerland, whose federal system allows for different structures in each canton. This article examines the development of these structures and their efficiency, adaptability and limitations with respect to major incident response in the French-speaking part of the country.
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Affiliation(s)
- Pierre-Nicolas Carron
- Emergency physicians at the Service of Emergency Medicine and Learning Centre for Disaster Medicine, University Hospital, Lausanne, Switzerland
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Adini B, Peleg K. On Constant Alert: Lessons To Be Learned From Israel’s Emergency Response To Mass-Casualty Terrorism Incidents. Health Aff (Millwood) 2013; 32:2179-85. [DOI: 10.1377/hlthaff.2013.0956] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Bruria Adini
- Bruria Adini is head of the master’s program in the Emergency Medicine Department, Recanati School of Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; a member of the PREPARED Research Center at the university; and a senior consultant on emergency management to the Israeli Ministry of Health
| | - Kobi Peleg
- Kobi Peleg (
) is director of the National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, in Tel Hashomer, Israel, and head of the Department of Disaster Medicine and head of the multidisciplinary programs for Emergency and Disasters Management, School of Public Health, Tel Aviv University
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Peyravi M, Örtenwal P, Djalali A, Khorram-Manesh A. An overview of shiraz emergency medical services, dispatch to treatment. IRANIAN RED CRESCENT MEDICAL JOURNAL 2013; 15:823-8. [PMID: 24616794 PMCID: PMC3929819 DOI: 10.5812/ircmj.10982] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 06/09/2013] [Accepted: 08/04/2013] [Indexed: 11/21/2022]
Abstract
Background Advanced ambulance service (Emergency Medical Services/EMS) is considered to be an integral part of emergency medical care as the first assets responding to emergencies and disasters in the prehospital setting in most developed countries. Objectives The aim of this study was to evaluate the current situation of Shiraz’s EMS by comparing data obtained during two different time periods. Materials and Methods This is a retrospective analytic and comparative study in which data obtained from Shiraz EMS during two one-year periods (21st of March 2011 to 20th of March 2012 and 22nd of September 1999 to 21st of September 2000) were compared. Furthermore, these data were also compared with available data from Gothenburg’s EMS (2010). Results Of 84084 missions performed by Shiraz EMS during one year trauma cases were the most common [39282 (46.7%)]. The most common cause of trauma was road traffic accidents (RTA) (27257; 76.5%). Near 56% of all patients were transported to hospitals; some 47% by ambulances and 8.8% by private cars. Around 36.2% of patients received definitive medical treatment at the scene. While there was an increase in response and evacuation times, the number of deaths at scene before ambulance arrival decreased. Conclusions Although Shiraz’s EMS has expanded during last decade and the mortality rate at scene has decreased, the number of RTA-related trauma cases, along with the response and evacuation time, has increased. More than one third of the patients received definitive treatment and could be dismissed directly from the scene. Standardized triage and treatment protocols are needed to improve the EMS activity.
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Affiliation(s)
- Mahmoudreza Peyravi
- Prehospital and Disaster Medicine Centre, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Medical Schools, Shiraz University of Medical Sciences, Shiraz, IR Iran
- Corresponding author: Mahmoudreza Peyravi, Prehospital and Disaster Medicine Centre, Regionens HUS SE-40544, Gothenburg, Sweden, Tel: +46-704005074, E-mail:
| | - Per Örtenwal
- Prehospital and Disaster Medicine Centre, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Ahmadreza Djalali
- Center for Research and Education in Emergency and Disaster Medicine, Università degli Studi del Piemonte Orientale Novara, Italy
| | - Amir Khorram-Manesh
- Prehospital and Disaster Medicine Centre, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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Resource Utilization in the Emergency Department of a Tertiary Care University-Based Hospital in Tokyo Before and After the 2011 Great East Japan Earthquake and Tsunami. Prehosp Disaster Med 2012; 27:515-8. [DOI: 10.1017/s1049023x12001318] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractIntroductionThe objective of this study was to determine the resource utilization of a tertiary care Japanese emergency department (ED) that was not immediately adjacent to the area of the 2011 Great East Japan earthquake and tsunami.MethodsA retrospective chart review was performed at a tertiary care university-based urban ED located approximately 290 km from the primary site of destruction secondary to an earthquake measuring 9.0 on the Richter Scale and the resulting tsunami. All patients who presented for a period of twelve days before and twelve days after the disaster were included. Data were collected using preformed data collection sheets, and stored in an Excel file. Abstracted data included gender, time in the ED, intravenous fluid administration, blood transfusion, oxygen, laboratories, electrocardiograms (ECGs), radiographs, ultrasound, diagnoses, surgical and medical referrals, and prescriptions written. Ten percent of the charts were reviewed for accuracy, and an error rate reported. Data were analyzed using 2-tailed t-tests, Fisher's exact tests or rank sum tests. Bonferroni correction was used to adjust P values for multiple comparisons.ResultsCharts for 1193 patients were evaluated. The error rate for the abstracted data was 3.2% (95% CI, 2.4%-4.1%). Six hundred fifty-seven patients (53% male) were evaluated in the ED after the earthquake, representing a 23% increase in patient volume. Mean patient time spent in the ED decreased from 61 minutes to 52 minutes (median decrease from 35 minutes to 32 minutes; P = .005). Laboratory utilization decreased from 51% to 43% (P = .006). The percentage of patients receiving prescriptions increased from 48% to 54% (P = .002). There was no change in the number of patients evaluated for surgical complaints, but there was an increase in the number treated for medical or psychiatric complaints.ConclusionThere was a significant increase in the number of people utilizing the ED in Tokyo after the Great East Japan earthquake and tsunami. Time spent in the ED was decreased along with laboratory utilization, possibly reflecting decreased patient acuity. This information may help in the allocation of national resources when planning for disasters.ShimadaM, TanabeA, GunshinM, RiffenburghRH, TanenDA. Resource utilization in the emergency department of a tertiary care university-based hospital in Tokyo before and after the 2011 Great East Japan Earthquake and tsunami. Prehosp Disaster Med. 2012;27(6):1-4.
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