Assessment of disaster preparedness among emergency departments in Italian hospitals: a cautious warning for disaster risk reduction and management capacity

Development and Validation of a New Tool to Improve the Accuracy of the Hospital Mass-Casualty Incident Response Plan Activation: The PEMAAF Score

INTRODUCTION

Effective response to a mass-casualty incident (MCI) entails the activation of hospital MCI plans. Unfortunately, there are no tools available in the literature to support hospital responders in predicting the proper level of MCI plan activation. This manuscript describes the scientific-based approach used to develop, test, and validate the PEMAAF score (Proximity, Event, Multitude, Overcrowding, Temporary Ward Reduction Capacity, Time Shift Slot [Prossimità, Evento, Moltitudine, Affollamento, Accorpamento, Fascia Oraria], a tool able to predict the required level of hospital MCI plan activation and to facilitate a coordinated activation of a multi-hospital network.

METHODS

Three study phases were performed within the Metropolitan City of Milan, Italy: (1) retrospective analysis of past MCI after action reports (AARs); (2) PEMAAF score development; and (3) PEMAAF score validation. The validation phase entailed a multi-step process including two retrospective analyses of past MCIs using the score, a focus group discussion (FGD), and a prospective simulation-based study. Sensitivity and specificity of the score were analyzed using a regression model, Spearman's Rho test, and receiver operating characteristic/ROC analysis curves.

RESULTS

Results of the retrospective analysis and FGD were used to refine the PEMAAF score, which included six items-Proximity, Event, Multitude, Emergency Department (ED) Overcrowding, Temporary Ward Reduction Capacity, and Time Shift Slot-allowing for the identification of three priority levels (score of 5-6: green alert; score of 7-9: yellow alert; and score of 10-12: red alert). When prospectively analyzed, the PEMAAF score determined most frequent hospital MCI plan activation (>10) during night and holiday shifts, with a score of 11 being associated with a higher sensitivity system and a score of 12 with higher specificity.

CONCLUSIONS

The PEMAAF score allowed for a balanced and adequately distributed response in case of MCI, prompting hospital MCI plan activation according to real needs, taking into consideration the whole hospital response network.

Factors Affecting the Functional Preparedness of Hospitals in Response to Disasters: A Systematic Review

Objective

This study aimed to comprehensively determine the factors that affect the hospitals' functional preparedness in response to disasters.

Methods

A systematic review of studies published in English and Persian up to the end of 2022 was performed by searching PubMed Central, Web of Science, Scopus, ProQuest, SID, and Elmnet databases. Articles that assessed hospitals' functional preparedness were searched by using a combination of medical subject heading terms and keywords including disaster, emergency, preparedness, hospital preparedness, health care facilities preparedness, hospital functional preparedness, health care facilities functional preparedness, readiness, and effective factors. Additionally, journals and gray literature were manually searched. Two independent reviewers screened the eligible papers. The inclusion criteria were the full text should be published up to the end of 2022, in both Persian and English, and focus on hospital preparedness. The extracted data were manually analyzed, summarized, and reported using the content analysis method.

Results

Of the 3465 articles, 105 studies were eventually included in the final analysis. Eighty-two influential factors were identified and classified into seven categories: government, coordination, control, and commanding (7 factors), existing guidelines and preparedness plans (12 factors), regulations (6 factors), supplying of resources (37 factors), education and training (8 factors), multi-layered information management and communication systems (8 factors), and contextual factors (4 factors).

Conclusion

There are different dimensions of hospital preparedness for disasters, each of which is influenced by several independent factors. Addressing these factors will enhance the actual functional preparedness of hospitals encountering disasters.

Practice, disaster preparation training needs, and associated factors in nursing staffs operating at Amhara regional state referral hospitals in Ethiopia

Background

Natural & human-made disasters are occurring at alarming rates around the world, necessitating more training and preparing frontline emergency department nurses.

Methods

The findings were derived from a hospital-based cross-sectional study. The study included all emergency department working nurses from the region's referral institutions. Self-administered written questionnaires were used to collect disaster information from respondents. Epidata software manager v4.6.0.2 was used to enter and code data, which was then exported to spss version 26 for additional analysis.

Result

The majority of our participants were 68-year-old men (66.7 percent). Furthermore, the average age of data respondents was 31.2 ± 5.7. It is discovered that 25 (24.5%) of participants have adequate experience, while 75 (75.5%) of responders have insufficient practice. In addition, 40.9% of responders require training in first aid and treatment concepts, 37.3% require disaster preparedness training, and 31.4% require basic disaster response principles training. In multivariate analysis, training in a hospital setting (P value = 0.047, OR: 0.282, 95 percent CI: (0.081–0.985) and simulation in a hospital setting (P value = 0.002, OR: 0.071, 95 percent CI: (0.055–0.530) were significantly linked with disaster preparedness practice.

Discussion

Levels of disaster practice, training, and their respective associated factors are discussed, along with other findings in the subject.

Conclusions

Because emergency department nurses' disaster preparedness skills are insufficient, training involving drills and simulations, as well as teaching, is required.

Implications for Nursing and Health policy

It aids in effective victim care, rehabilitative services, and emergency and disaster prevention. It may also aid in the priority of care. This will ultimately increase the effectiveness of emergency department care. The research findings may also aid in the establishment of a formal emergency and disaster preparedness framework in emergency departments.

Disaster risk management challenges in military hospitals: A qualitative study

BACKGROUND

Disaster can pose significant challenges to the health infrastructure in the community. Hospitals are the central unit for providing health services in the disaster response plan. With regard to the vital role of military hospitals in health response to disaster, this study was carried out with the aim of investigating the disaster risk management (DRM) challenges in military hospitals in Iran.

MATERIALS AND METHODS

The current study was qualitative research performed in 2020 in military hospitals in Iran. Participants consisted of 12 managers and staff of the military hospitals in Tehran and professionals in health in emergencies and disasters who were included in the study by the purposive sampling technique. Semistructured individual interviews based on the interview guide were exploited for the data collection, and a content analysis method was used to analyze them.

RESULTS

DRM challenges in military hospitals were explained in the form of six categories: "management and leadership, planning, prevention and mitigation, preparedness, response, and recovery" and 22 subcategories.

CONCLUSION

Managers' awareness of DRM challenges in hospitals, particularly military hospitals, and the design and implementation of solutions can lead to the promotion of hospital DRM and hospital preparedness to deal with disasters.

Hospitals as disaster victims: Lessons not learned?

OBJECTIVE

Hospitals are a key component to disaster response but are susceptible to the effects of disasters as well, including infrastructure damage that disrupts patient care. These events offer an opportunity for evaluation and improvement of preparedness and response efforts when hospitals are affected directly by a disaster. The objective of this structured review was to evaluate the existing literature on hospitals as disaster victims.

METHODS

A structured and scoping review of peer-reviewed literature, gray literature, and news reports related to hospitals as disaster victims was completed to identify and analyze themes and lessons observed from disasters in which hospitals are victims, to aid in future emergency operations planning and disaster response.

RESULTS

The literature search and secondary search of referenes identified 366 records in English. A variety of common barriers to successful disaster response include loss of power, water, heating and ventilation, communications, health information technology, staffing, supplies, safety and security, and structural and non-structural damage.

CONCLUSIONS

There are common weaknesses in disaster preparedness that we can learn from and account for in future planning with the aim of improving resilience in the face of future disasters.

Challenges of Hospital Disaster Risk Management: A Systematic Review Study

OBJECTIVE

This study aimed to investigate the challenges of hospital disaster risk management so that it can take a step to provide strategies and interventions to remove these barriers and improve the hospital disaster risk management (HDRM) through identifying and introducing them to disaster experts.

METHODS

This is a systematic qualitative review study. Data sources included Persian and international databases, which were searched using the keywords of hospital, disaster, risk management, risk reduction, disaster and challenge, and the combination of them. The search period ranged from January 2010 to January 2020. Data were extracted by 2 independent examiners for qualitative thematic analysis.

RESULTS

A total of 762 articles and documents were recovered. Finally, 12 articles entered the study, including 7 studies from Asia, 2 articles from Europe, 2 articles from the United States, and 1 article about Africa. After thematic analysis, 17 sub-themes were achieved and were classified into 4 subjects of technical-physical barriers, organizational-managerial barriers, financial barriers, and human barriers. All articles have not discussed on all categories.

CONCLUSIONS

The results of evaluating the challenges of hospital disaster risk management gained from this study can be beneficial in developing a roadmap to improve the status of HDRM.

Hospital preparedness for mass gathering events and mass casualty incidents in Matera, Italy, European Capital of Culture 2019

INTRODUCTION

Mass Casualty Incidents (MCI) may occur during Mass Gathering Events (MGE). A failure to prepare and train the health care system for potential MCI, can cause chaos and delays in the response, leading to an increased morbidity and mortality. Education and training of staff are crucial for preparedness. In Italy, hospital Emergency Plans for Massive Influx of Injured (in Italian designated with the acronym PEMAF) are mandatory since the '90's. However, when available, they are usually poorly known by the staff, rarely reviewed and validated. In 2014, Matera, a city in Southern Italy, was designated as the European Capital of Culture for 2019. As a result, we took this opportunity to revise the "Madonna delle Grazie" PEMAF and to start a program for increasing the awareness of the plan among the medical staff and provide specific training for MCI management.

MATERIAL & METHODS

The PEMAF was reviewed through simulations that involved the entire staff. A partnership with the International Association for Medical Response to Major Incidents & Disasters (MRMI) led to the support of experts and to the organization of residential courses based on the MAss Casualty SIMulation tool (MACSIM®). In total, six residential educational events of MACSIM-PEMAF were organized. Individual capacity was tested before and after the education through self-administered semi-quantitative questionnaires.

RESULTS

All the available resources were mapped and the functional areas identified. Alert, coordination and command sequences were defined. The communication network was improved. Documentation and registration systems were developed. Standard operational procedures (action cards) were created for the key positions. The knowledge and capacity to function in active roles during a MCI was improved among the participants in the educational program.

CONCLUSIONS

MGE are great opportunities for the development of the hosting community but also represent an increased risk of MCI. Preparedness is mandatory for health care systems. The educational format MACSIM-PEMAF seems to be adequate to review and improve the existing plans and transfer specific skills to attendants.

Acquisition of skills in Critical Emergency Medicine: an experimental study on the SIAARTI Academy CREM experience

BACKGROUND

In 2019 the SIAARTI developed a seven-days course for residents, focused on critical emergency medicine (CREM) in a hostile environment, that grounds on simulation-based education and training with hands-on simulation, high-fidelity simulators and part-task trainers. This project aimed to evaluate the efficacy of this course in comparison to traditional learning programs in term of technical (TS) and non-technical (NTS) skills. We assessed the improvement in TS and NTS over time, and the ability to involve trainees in corporate activities.

METHODS

Three-hundred and twenty-seven trainees completed the study. Trainees were allocated into 3 groups: those who joined the SIAARTI-Academy-CREM course and received a study kit (SAKit, n=124), those who received only a study kit (Kit, n=108), and Control (n=95). Eighty-five tests were administered to investigate skills at 3 timepoints: T0=baseline, T1=post-training/kit, and T2=4-months later.

RESULTS

TS differed among groups (p<0.0001), with the highest points in the SA-Kit group at T1 (post-hoc comparison, p<0.0001 vs Kit; p<0.0001 vs Control), and T2 (post-hoc comparison, p<0.0001 vs Kit; p<0.0001 vs Control). NTS differed among groups (p=0.0406), with the highest points in the SA-Kit group at T1 (post-hoc comparison, p=0.0337 vs Kit; p=0.0416 vs Control), and T2 (post-hoc comparison, p=0.0073 vs Kit; p=0.3308 vs Control). SA-Kit group significantly improved TS (p<0.0001) and NTS (p=0.0006) over time. Involvement in corporate activities of SAkit was significantly higher than Kit and Control (p=0.0012).

CONCLUSIONS

SA-Kit improvement in TS and NTS was higher than Kit and Control and was maintained over time. Participation in this course implemented participation in corporate activities among attendees.

Emergency and Disaster Handling Preparedness Among Front Line Health Service Providing Nurses and Associated Factors at Emergency Department, at Amhara Regional State Referral Hospitals, Ethiopia

Introduction

Globally around 1.6 million individuals have died as a result of disasters per year. These disruptive events that happen in the world each day result in damage to individuals, families, and communities.

Methods

An institution-based cross-sectional study was conducted. All frontline health-care providers at the emergency departments of Amhara Regional State Referral Hospitals during the study period were considered as studied subjects. Data were collected through a self-administered technique. Once all essential data were collected, data were coded and entered into epidata manager (v4.6.0.2) statistical software. SPSS version 26 was used to analyze the findings of this paper.

Results

The result of this research study showed that 66.7% were males and 33.3% were females with mean age of respondents being 31.2 ± 5.8. Among respondents, 54% (52.9) % did not have an understanding of disaster preparedness. As a result, the majority of participants, 52 (51%), have inadequate knowledge. Most respondents have adequate attitude (57.8%) and only a few, 12 (11.8%), of respondents were very familiar with regard to disaster and disaster handling preparedness. In multivariate logistic regression, receiving training on the subject (P = 0.000, AOR: 15.109. 95% CI: 3.525–64.769), respondents receiving simulation in the subject of disaster (P = 0.015, AOR: 4.855, 95% CI: 1.366–17.260) and having a direct personal/professional experience of disaster (P = 0.003, AOR: 5.703, 95% CI: 1.825–17.823) were significantly associated.

Conclusion and Recommendation

Disaster handling preparedness, knowledge and familiarity levels were below those expected for emergency department nurses. Capacity building through training, education and simulation is essential.

Developing Hospital Emergency and Disaster Management Index Using TOPSIS Method

Indonesia is a country prone to experiencing natural hazards and disasters, which have frequently damaged public infrastructure, including hospitals. The role of hospitals is crucial to alleviate the impact of disasters. However, there is still a lack of study that analyzes the factors that influence the readiness of hospitals in emergency situations. Filling in this gap, the aim of this paper is to analyze and rank hospitals across West Java and Yogyakarta, Indonesia by the resilience of their emergency management approaches. This research seeks to measure hospital resiliency during emergencies and disasters. Results indicate that the emergency and disaster management coordination, response and disaster recovery planning, communication and information management, logistics and evacuation, human resources, finance, patient care and support services, decontamination and security are key attributes for the decision-making matrix. Based on the Hospital Safety Index tool, this research proposes the Hospital Emergency and Disaster Management (HEDM) index by combining the key attributes and sub-attributes using the Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) as a multi-attribute decision-making technique. The paper concludes that the anticipated benefits of analyzing the resilience of hospitals by using HEDM is the identification of the most susceptible hospitals based on their levels of readiness and resiliency in areas which are prone to experiencing disasters. This prioritization is important for resource allocation and budget planning.

Influential factors affecting the generation of kitchen solid waste in Shanghai, China

The influential factors of the generation of kitchen solid waste (KSW) are vital to design policies that target effective KSW reductions and achieve sustainable KSW management, but has not been extensively studied. The study aims at the first step of KSW management only, i.e., generation, which is the first KSW analysis survey in Shanghai to comprehensively investigate the characteristics and influential factors of KSW generation (KSWG). The data were collected from August to October 2019, which resulted in a total of 433 usable questionnaires regarding KSWG in Shanghai, China. The average rate of KSWG is 6.038 kg/household/week or 0.265 kg/person/day. The average per-person number of KSWG bags is 0.295. The regression results show that the characteristics of KSWG are related to household size, household income, the habit of ordering takeout, district of residence, and meticulous consumption culture. Some interesting findings are observed in the present study. Firstly, there is a nonlinear relationship between KSWG and household size, which can be explained by "common consumption". Secondly, there is a nonlinear relationship between KSWG and household income, which can be explained by the Engel coefficient, which also provides supporting evidence for the environmental Kuznets curve (EKC) hypothesis. Finally, the habit of ordering takeout, district of residence, and meticulous consumption culture are all influential factors of KSWG. The results of the study can improve public awareness and knowledge of KSWG, and suggestions on the minimization of KSWG are put forward, thus will serve as a new reference for the sustainable KSW management of other cities, especially cities in developing countries.Implications: In the practice of sustainable waste management, KSWG is a complex issue that requires a broad analytic approach that considers several factors simultaneously. From a practical perspective, policy decision-makers should pay attention to at least four important actions to reduce KSWG: Firstly, compared with urban areas, rural areas are important areas for reducing KSWG, which should be given sufficient attention. Secondly, compared with low-income households, high-income households are the focus of KSWG reduction and should be considered. Thirdly, meticulous consumption culture plays an important role in promoting the reduction of KSWG, and this culture should be promoted and cultivated in the formulation of actual waste management policies. This is also an important way to reduce KSWG and should be fully considered. Finally, in the pilot process of domestic waste separation in Chinese cities, 3 R (Reduce, Reuse, and Recycle) waste management concept and method in circular economy can be applied to KSW treatment, and adequate financial support is necessary. Through strengthening the management of KSW, the potential value of KSW can be further developed, so as to realize KSWG reduction and resource utilization.

The Current State of Infectious Disasters Preparedness Around the World: A Qualitative Systematic Review (2007-2019)

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.

Evaluating the disaster preparedness of emergency medical service agencies in the world: A systematic literature review protocol

INTRODUCTION

Disasters occur almost everywhere in the world, and preparation is essential. Preparedness is an effective approach for disaster management, and it is crucial for the health systems, especially the Emergency Medical Service (EMS) agencies. This systematic review will be conducted to assess the preparedness levels of EMS agencies in the world for the response to disasters and explore the key dimensions and strategies to enhance it.

METHODOLOGY

This systematic literature review will be conducted to search comprehensively the articles published between 2000 and 2019 to explore the disaster preparedness of EMS Agencies. To this end, PubMed, Scopus, Web of Science, and Google Scholar will be thoroughly assessed. The following terms and expression will be used for searching the databases: "EMS" and other keywords "Disaster Preparedness," "Mass Casualty Incident," "Mass Gathering," "Terrorist incident," "Weapons of Mass Destruction," and CBRNE, Disaster, included: 'Emergency Preparedness, Preparedness, Readiness.

DISCUSSION

To the best of our knowledge, no systematic review study has been conducted on disaster preparedness of EMS agencies in the world. This is the first study to address this gape. It will also explore the key dimensions of disaster preparedness in EMS services and the strategies to enhance their preparedness.

CONCLUSION

Identifying the key dimensions of disaster preparedness is the first step in designing valid assessment tools to evaluate disaster preparedness of EMS service. This study will provide valuable guides for EMS administrators and researchers in an attempt to enhance of preparedness of EMS systems in disasters.

Mass Casualty Incident (MCI) training in a metropolitan university hospital: short-term experience with MAss Casualty SIMulation system MACSIM®

AIM

The aim of this study was to test and validate a new hospital Mass Casualty Incident (MCI) training using MACSIM^® (MAss Casualty SIMulation) system adapted to the specifications and MCI plan of a single hospital.

METHODS

The original MCI training format called MACSIM-PEMAF (Piano di Emergenza per il Massiccio Afflusso di Feriti, i.e., hospital disaster plan for massive influx of casualties) was developed for the Italian Society for Trauma and Emergency Surgery (SICUT) in 2016. It uses MACSIM^®, a simulation tool for the training and assessment of healthcare professionals in MCI management. Between 2016 and 2018 the course was held several times at a university hospital in the Milan metropolitan area. The MACSIM^® tool was used to reproduce different MCI scenarios with actual hospital resources. During the simulations, participants acted in their usual professional functions, testing both the local MCI plan as well as the individuals' knowledge and skills. Course effectiveness was validated by a pre- and post-curse self-assessment questionnaire.

RESULTS

MACSIM-PEMAF was tested over 7 courses, with a total of 258 participants. Pre- and post-course questionnaires showed a significant improvement for hospital staff in self-reported perceptions of knowledge and skills in MCI management. In total, on a 1-10 scale, all the staff increased their competencies from a value of 4.4 ± 2.5 to 7.5 ± 1.9 (p < 0.001).

CONCLUSION

MACSIM-PEMAF demonstrated efficacy in fulfilling the requirements of Italian law for PEMAF implementation, testing local resources and resilience, as well as increasing the self-reported perception of the hospital staff ability to respond to a MCI.

Preparing for the Maximum Emergency with a Simulation: A Table-Top Test to Evaluate Bed Surge Capacity and Staff Compliance with Training

Introduction

The sudden increase in the number of critically ill patients following a disaster can be overwhelming.

Study Objective

The main objective of this study was to assess the real number of available and readily freeable beds (“bed surge capacity”) and the availability of emergency operating rooms (OR) in a maximum emergency using a theoretical simulation.

Patients and Methods

The proportion of dismissible patients in four areas (Medical Area, Surgical Area, Sub-intensive Care Units, Intensive Care Units) and three emergency OR was assessed at 2 and 24 hours after a simulated maximum emergency. Four scenarios were modeled. Hospitalization and surgical capacities were assessed on weekdays and holidays. The creation of new beds was presumed by the possibility of moving patients to a lower level of care than that provided at the time of detection, of dislocation of patients to a discharge room, with care transferred to lower-intensity hospitals, rehabilitation, or discharge facilities. The Phase 1 table-top simulations were conducted during the weekday morning hours. In particular, the 24-hour table-top simulations of a hypothetical event lasted about 150 minutes compared to those conducted at 2 hours, which were found to be longer (about 195 minutes). Phase 2 was conducted on two public holidays and a quick response time was observed within the first 40 minutes of the start of the test (about 45% of departments).

Results

The availability of simulated beds was greater than that indicated in the maximum emergency plans (which was based solely on the census of beds). Patients admitted to Intensive Care and The Sub-Intensive Area may be more difficult to move than those in low-intensity care. The availability of emergency OR was not problematic. Age influenced the possibility of remitting/transferring patients.

Conclusion

Simulation in advance of a maximum emergency is helpful in designing an efficient response plan.

The Impact of Experience, Length of Service, and Workplace Preparedness in Physicians' Readiness in the Response to Disasters

With an increasing number of natural and man-made disasters, the need for preparedness in all levels of management is obvious. Among healthcare professionals responding to these emergencies, physicians are of particular importance due to their significant roles as leaders and frontline workers in minimizing morbidity and mortality of the affected population. This study analyses the preparedness of 549 physicians from all medical centers in Lublin, Poland to formulate their observations, suggestions, and recommendations concerning the improvement of the chain of response in disaster management. The results of this study show that the perceived preparedness of physicians for disaster management and response is not as high as it should be, and the majority of the respondents perceived their disaster preparedness insufficient. Training of physicians in disaster management and principles of disaster medicine is needed, by focusing on the specificity of rescue response to emergencies following disasters, and medical and non-medical aspects of the response with particular emphasis on a management approach covering all hazards.

Hospital Disaster Preparedness in Iran: A Systematic Review and Meta-Analysis

BACKGROUND

Disasters are increasing all over the world. Iran, is one of the high-risk countries in this regard; so it is unavoidable to prepare hospitals as vital centers when disasters happen. This study aimed to evaluation the hospital preparedness based on previous studies in Iran.

METHODS

A systematic review and meta-analysis by browsing through all articles published since 2006 to 2017, in English and Persian both languages were designed. Databases that we searched to, include Google Scholar, PubMed, Web of Science, Scopus, Medlib, Cochrane Library, Science Direct, Internationally and SID, Irandoc and Magiran, domestically. Two expert researchers investigated separately. Researchers used random and fixed effect models in the meta-analysis. Moreover, random and fixed effects model and meta-regression tests were applied by using STATA ver. 11. The P<0.05 was considered statistically significant.

RESULTS

Twenty-five studies with a sample size of 181 hospitals were introduced to the process of meta-analysis. Iranian hospital preparedness is 53%, totally, that is moderate. Preparedness in different categories is as follows: emergency services 62%, communication 57%, security 54%, education 57%, logistic 65%, human resources 52%, Management and command 64%, reception 43%, transfer and evacuation 44%, traffic 47%, non-structural safety 57%, and structural safety 49%.

CONCLUSION

Hospital preparedness is moderate in Iran. Optimal management of existing resources and the use of Update technologies in the field of hospital services be directed towards improving the preparedness of hospitals for disasters.

How to Surge to Face the SARS-CoV-2 Outbreak: Lessons Learned From Lombardy, Italy

Italy is fighting against one of the worst medical emergency since the 1918 Spanish Flu. Pressure on the hospitals is tremendous. As for official data on March 14th: 8372 admitted in hospitals, 1518 in intensive care units, 1441 deaths (175 more than the day before). Unfortunately, hospitals are not prepared: even where a plan for massive influx of patients is present, it usually focuses on sudden onset disaster trauma victims (the most probable case scenario), and it has not been tested, validated, or propagated to the staff. Despite this, the All Hazards Approach for management of major incidents and disasters is still valid and the "4S" theory (staff, stuff, structure, systems) for surge capacity can be guidance to respond to this disaster.

Survey of major trauma centre preparedness for mass casualty incidents in Australia, Canada, England and New Zealand

BACKGROUND

Mass casualty incidents (MCIs) are increasing. Trauma centres play a key role in MCIs due to their readiness and expansive multidisciplinary expertise for injury management. Previous studies have shown deficiencies in trauma centre disaster preparedness. The aim of this study was to describe the current disaster preparedness of Major Trauma Centres (MTCs) in Australia, Canada, England and New Zealand.

METHODS

A cross-sectional survey of all (n = 82) MTCs was undertaken. The anonymous survey collected data about disaster preparedness in nine key areas. Respondents were encouraged to consult appropriately at their centre to provide an accurate representation of their centre's preparedness.

FINDINGS

Responses were received from 69 (84%) centres; 61 completed all questions. 91% had a disaster preparedness committee and 80% had an all-hazards emergency plan. 79% had held an MCI drill in the past 2 years. 54% reported a system in place to calculate maximum capacity, but testing of surge capacity was uncommon. 55% reported the presence of stored resources for an MCI and 58% had a database of staff trained in Emergency Management. 74% had a training and education plan available for staff involved in an MCI and a plan for professional debriefing of staff post-MCI, while 62% had a post-disaster employee assistance programme. Most centres had appropriate back-up communication, safety and security plans.

INTERPRETATION

The disaster preparedness of MTCs was high for communication, safety and security but there was clear need for improvement in other areas including surge capacity, human resources and post-disaster recovery.

Factors affecting hospital response in biological disasters: A qualitative study

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.

Swedish emergency hospital surgical surge capacity to mass casualty incidents

Background

In Sweden the surgical surge capacity for mass casualty incidents (MCI) is managed by county councils within their dedicated budget. It is unclear whether healthcare budget constraints have affected the regional MCI preparedness. This study was designed to investigate the current surgical MCI preparedness at Swedish emergency hospitals.

Methods

Surveys were distributed in 2015 to department heads of intensive care units (ICU) and surgery at 54 Swedish emergency hospitals. The survey contained quantitative measures as the number of (1) surgical trauma teams in hospital and available after activating the disaster plan, (2) surgical theatres suitable for multi-trauma care, and (3) surgical ICU beds. The survey was also distributed to the Armed Forces Centre for Defence Medicine.

Results

53 hospitals responded to the survey (98%). Included were 10 university hospitals (19%), 42 county hospitals (79%), and 1 private hospital (2%). Within 8 h the surgical capacity could be increased from 105 to 399 surgical teams, while 433 surgical theatres and 480 ICU beds were made available. The surgical surge capacity differed between university hospitals and county hospitals, and regional differences were identified regarding the availability of surgical theatres and ICU beds.

Conclusions

The MCI preparedness of Swedish emergency care hospitals needs further attention. To improve Swedish surgical MCI preparedness a national strategy for trauma care in disaster management is necessary.

Defining and Operationalizing Disaster Preparedness in Hospitals: A Systematic Literature Review

INTRODUCTION

Societies invest substantial amounts of resources on disaster preparedness of hospitals. However, the concept is not clearly defined nor operationalized in the international literature.

AIM

This review aims to systematically assess definitions and operationalizations of disaster preparedness in hospitals, and to develop an all-encompassing model, incorporating different perspectives on the subject.

METHODS

A systematic search was conducted in five databases: Scopus, PubMed, Web of Science, Disaster Information Management Research Centre, and SafetyLit. Peer-reviewed articles containing definitions and operationalizations of disaster preparedness in hospitals were included. Articles published in languages other than English, or without available full-text, were excluded, as were articles on prehospital care. The findings from literature were used to build a model for hospital disaster preparedness.

RESULTS

In the included publications, 13 unique definitions of disaster preparedness in hospitals and 22 different operationalizations of the concept were found. Although the definitions differed in emphasis and width, they also reflected similar elements. Based on an analysis of the operationalizations, nine different components could be identified that generally were not studied in relation to each other. Moreover, publications primarily focused on structure and process aspects of disaster preparedness. The aim of preparedness was described in seven articles.

DISCUSSION/CONCLUSION

This review points at an absence of consensus on the definition and operationalization of disaster preparedness in hospitals. By combining elements of definitions and components operationalized, disaster preparedness could be conceptualized in a more comprehensive and complete way than before. The model presented can guide future disaster preparedness activities and research.

Disaster preparedness among Thai elderly emergency department patients: a survey of patients' perspective

BACKGROUND

In disaster situations, the elderly are considered to be a particularly vulnerable population. Preparedness is the key to reduce post-disaster damage. There is limited research in middle-income countries on how well elderly emergency department (ED) patients are prepared for disaster situations. The objective of this study was to determine the attitudes and behavior of elderly ED patients toward disaster preparedness.

METHODS

This study was a cross-sectional face-to-face survey at one urban teaching hospital in Bangkok, Thailand between August 1st and September 30th, 2016. Patients aged 60 and older who presented to the ED were included to this study. We excluded patients who had severe dementia [defined as Short Portable Mental State Questionnaires (SPMSQ) > 8], were unable to speak Thai, had severe trauma and/or needed immediate resuscitation. The survey instruction was adapted from previous disaster surveys. This study was approved by the Vajira Institutional Review Board (IRB).

RESULTS

A total of 243 patients were enrolled. Most of them were female [154 patients (63.4%)]. The median age was 72 [Interquartile range (IQR) 66-81] years and the most common underlying diseases were hypertension [148 patients (60.9%)] and diabetes [108 patients (44.4%)]. The majority of patients [172 patients (72.4%)] reported that they had had some teaching about disaster knowledge from a healthcare provider and had experienced a disaster [138 patients (56.8%)]. While 175/197 (81.8%) patients who had underlying diseases reported that they had a medication supply for disaster situations, only 61 (25.1%) patients had an emergency toolbox for disasters. Most patients (159, 65.4%) did not know the emergency telephone number, and 133 (54.7%) patients reported transportation limitations.

CONCLUSIONS

While most Thai elderly ED patients reported having a medication supply for disaster situations, many lacked comprehensive plans for a disaster situation. Work needs to be done to improve the quality of preparedness in disaster situations among elderly patients. Future research should focus on preparedness knowledge regarding evacuation, and shelter/residence for older patients.

The Preparedness of Hospital Emergency Departments for Responding to Disasters in Iran; a Systematic Review and Meta-Analysis

INTRODUCTION

Hospitals are the most important infrastructures of any society. The hospital emergency department is one of the most important wards of hospitals in response to disasters. The purpose of this study was to evaluate the preparedness of hospital emergency departments in response to disasters in Iran via a systematic review and meta-analysis.

METHODS

This study was a systematic review and meta-analysis. The literature search was conducted in the national and international databases including SID, Magiran, Irandoc, Google scholar, Medline, Scopus, and ISI. Valid Persian and English keywords were used to extract articles related to the preparedness of hospital emergency departments in response to disasters. The STROBE checklist was used to evaluate the quality of the articles, and the I2 index was used to assess heterogeneity among the studies. Statistical analyses were conducted using STATA14 software.

RESULTS

In this study, 185 articles were initially recruited. Meta-analysis was finally performed on 4 articles selected based on inclusion criteria. The analysis included a total of 51 hospitals in Iran. According to our results, the mean preparedness of hospital emergency departments in response to disasters was calculated as 54.64% (95% CI = 41.15-68.13, I2 = 0.0%; p = 0.727).

CONCLUSION

The results of this study showed that the average level of preparedness of hospital emergency departments in Iran to respond to disasters was moderate to high. Therefore, planning and actions should be considered based on the guidelines and accreditation standards to enhance the preparedness of hospital emergency departments in response to disasters.

The August 24, 2016, Central Italy Earthquake: Validation of the "Modified Utstein Template for Hospital Disaster Response Reporting" As a New Tool for Reporting Hospitals' Response to Disasters

BACKGROUND

After-action reports analyze events and improve knowledge about how to prevent and react to unexpected situations. Anyway, there is no consensus among the templates developed for disaster events reporting, and there is not a specific model for reporting hospital disaster response.

OBJECTIVE

The study was aimed to pilot the use of a new assessment tool for hospital response to natural disasters.

METHODS

A data collection tool, focused on hospital disaster response to natural disasters, was created modifying the "Utstein-Style Template for Uniform Data Reporting of Acute Medical Response in Disasters" and tested the reaction of the nearest hospitals to the epicenter after the August 24, 2016, Central Italy earthquake.

RESULTS

Four hospitals were included. The completion rate of the tool was 97.10%. A total of 613 patients accessed the 4 emergency departments, most of them in Rieti Hospital (178; 29.04%). Three hundred thirty-six (54.81%) patients were classified as earthquake-related, most with trauma injuries (260; 77.38%).

CONCLUSIONS

This template seemed to be a valid instrument for hospital disaster management reporting and could be used for better comprehension of hospital disaster reaction, debriefing activities, and hospital disaster plan revisions.

Development, implementation, and evaluation of a lay responder disaster training package among school teachers in Angeles City, Philippines: using Witte's behavioral model

OBJECTIVES

The aim of this study was to develop and implement a lay responder disaster training (LRDT) package with the intention to alter the perceived efficacy, perceived threat, and levels of fear among school teachers.

STUDY DESIGN

The study used an intervention-based design, wherein we intervened by conducting an LRDT which aimed to affect the participants' responses as defined by Witte's behavioral model (WBM).

METHODS

The LRDT package incorporated the usual disaster preparedness information but included the unexplored area of disaster first aid, which is lacking in most training currently being given. The entire LRDT was carried out for two consecutive days by an emergency medical services-accredited competency assessor. Preintervention and postintervention knowledge, level of fear, attitude, intentions, behavior, and a Risk Behavior Diagnosis Scale was assessed using a structured questionnaire based on the WBM.

RESULTS

After conducting the LRDT as an intervention, the results show that there was a significant change in the knowledge, behavior, perceived threat, and level of fear among the participants. Other constructs, such as attitude, intentions, and perceived efficacy, were not statistically significant after the intervention.

CONCLUSION

In conclusion, knowledge, behavior, and the perceived threat of the school teachers were significantly higher after the LRDT, and their level of fear was significantly lower. Based on these results, we can conclude that both the WBM questionnaire and the LRDT package showed potential in improving disaster risk reduction and management among school teachers in Angeles City, Philippines.

Ranking Hospitals Based on the Disasters Preparedness Using the TOPSIS Technique in Western Iran

BACKGROUND

Considering the uncontrollable occurrence of unexpected events and disasters around the world and Iran, paying attention to the readiness of hospitals, as the most important place to provide health care services, before occurring disasters is necessary and the identification of hospitals with low preparedness is very important. The present study aimed to rank hospitals based on the level of their preparedness for disasters using the TOPSIS technique.

MATERIALS AND METHODS

This was a cross-sectional and descriptive study conducted in the first half of 2018 to assess the preparedness of hospitals in Ahwaz for unexpected events. In this study, all hospitals affiliated to Ahwaz University of Medical Sciences (8 hospitals) were reviewed. The required data were collected using a standard questionnaire assessing the level of hospital preparedness in terms of structural preparedness (3 indicators), nonstructural preparedness (2 indicators), functional preparedness (13 indicators) and human resources (3 indicators) dimensions. The collected data were analyzed using the TOPSIS technique.

RESULTS

The results showed that the structural (W = 0.4) and functional (W = 0.1) preparedness dimensions had the highest and lowest weights, respectively. Also, Hospital D (CL = 0.778) and Hospital A (CL = 0.224) had, respectively, obtained the first and last ranks.

CONCLUSION

Hospital managers need to get required information about disaster management and train their personnel in the emergencies and first aid by developing educational plans and ensure their active participation at the time of disasters through increasing their knowledge about and skills in different fields of work. In the case of structural and nonstructural preparedness, the hospital buildings should be retrofitted by the technical office of the university and the safe places considered for evacuations should be visited and evaluated every 6 months. It is also necessary to have all the hospitals equipped with the Emergency Operations Center (EOC) and to review its functions and activities regularly.

Video-Based Learning vs Traditional Lecture for Instructing Emergency Medicine Residents in Disaster Medicine Principles of Mass Triage, Decontamination, and Personal Protective Equipment

Introduction Great demands have been placed on disaster medicine educators. There is a need to develop innovative methods to educate Emergency Physicians in the ever-expanding body of disaster medicine knowledge. The authors sought to demonstrate that video-based learning (VBL) could be a promising alternative to traditional learning methods for teaching disaster medicine core competencies. Hypothesis/Problem The objective was to compare VBL to traditional lecture (TL) for instructing Emergency Medicine residents in the American College of Emergency Physicians (ACEP; Irving, Texas USA) disaster medicine core competencies of patient triage and decontamination.

METHODS

A randomized, controlled pilot study compared two methods of instruction for mass triage, decontamination, and personal protective equipment (PPE). Emergency Medicine resident learning was measured with a knowledge quiz, a Likert scale measuring comfort, and a practical exercise. An independent samples t-test compared the scoring of the VBL with the TL group.

RESULTS

Twenty-six residents were randomized to VBL (n=13) or TL (n=13). Knowledge score improvement following video (14.9%) versus lecture (14.1%) did not differ significantly between the groups (P=.74). Comfort score improvement also did not differ (P=.64) between video (18.3%) and lecture groups (15.8%). In the practical skills assessment, the VBL group outperformed the TL group overall (70.4% vs 55.5%; P<.0001), with significantly better performance in donning PPE and decontamination. Although not part of the original study design, a three-month post-hoc analysis was performed. When comparing the pre-intervention and three-month post-hoc performances, there were no significant differences in knowledge increases between VBL versus TL (P=.41) or in comfort (P=.39).

CONCLUSION

Video modules can be as effective as TL when utilized to train Emergency Medicine residents in the ACEP disaster medicine core competencies of patient triage and decontamination. Curtis HA , Trang K , Chason KW , Biddinger PD . Video-based learning vs traditional lecture for instructing emergency medicine residents in disaster medicine principles of mass triage, decontamination, and personal protective equipment. Prehosp Disaster Med. 2018;33(1):7-12.