Bruria Adini

Recommendations for intensive care unit and hospital preparations for an influenza epidemic or mass disaster: Summary report of the European Society of Intensive Care Medicine's Task Force for intensive care unit triage during an influenza epidemic or mass disaster

PurposeTo provide recommendations and standard operating procedures for intensive care units and hospital preparedness for an influenza pandemic.MethodsBased on a literature review and expert opinion, a Delphi process was used to define the essential topics.ResultsKey recommendations include: Hospitals should increase their ICU beds to the maximal extent by expanding ICU capacity and expanding ICUs into other areas. Hospitals should have appropriate beds and monitors for these expansion areas. Establish a management system with control groups at facility, local, regional and/or national levels to exercise authority over resources. Establish a system of communication, coordination and collaboration between the ICU and key interface departments. A plan to access, coordinate and increase labor resources is required with a central inventory of all clinical and non-clinical staff. Delegate duties not within the usual scope of workers’ practice. Ensure that adequate essential medical equipment, pharmaceuticals and supplies are available. Protect patients and staff with infection control practices and supporting occupational health policies. Maintain staff confidence with reassurance plans for legal protection and assistance. Have objective, ethical, transparent triage criteria that are applied equitably and publically disclosed. ICU triage of patients should be based on the likelihood for patients to benefit most or a ‘first come, first served’ basis. Develop protocols for safe performance of high-risk procedures. Train and educate staff.ConclusionsMortality, although inevitable during a severe influenza outbreak or disaster, can be reduced by adequate preparation.

Twitter in the cross fire--the use of social media in the Westgate Mall terror attack in Kenya.

On September 2013 an attack on the Westgate mall in Kenya led to a four day siege, resulting in 67 fatalities and 175 wounded. During the crisis, Twitter became a crucial channel of communication between the government, emergency responders and the public, facilitating the emergency management of the event. The objectives of this paper are to present the main activities, use patterns and lessons learned from the use of the social media in the crisis. Using TwitterMate, a system developed to collect, store and analyze tweets, the main hashtags generated by the crowd and specific Twitter accounts of individuals, emergency responders and NGOs, were followed throughout the four day siege. A total of 67,849 tweets were collected and analyzed. Four main categories of hashtags were identified: geographical locations, terror attack, social support and organizations. The abundance of Twitter accounts providing official information made it difficult to synchronize and follow the flow of information. Many organizations posted simultaneously, by their manager and by the organization itself. Creating situational awareness was facilitated by information tweeted by the public. Threat assessment was updated through the information posted on social media. Security breaches led to the relay of sensitive data. At times, misinformation was only corrected after two days. Social media offer an accessible, widely available means for a bi-directional flow of information between the public and the authorities. In the crisis, all emergency responders used and leveraged social media networks for communicating both with the public and among themselves. A standard operating procedure should be developed to enable multiple responders to monitor, synchronize and integrate their social media feeds during emergencies. This will lead to better utilization and optimization of social media resources during crises, providing clear guidelines for communications and a hierarchy for dispersing information to the public and among responding organizations.

Assessing levels of hospital emergency preparedness

INTRODUCTION Emergency preparedness can be defined by the preparedness pyramid, which identifies planning, infrastructure, knowledge and capabilities, and training as the major components of maintaining a high level of preparedness. The aim of this article is to review the characteristics of contingency plans for mass-casualty incidents (MCIs) and models for assessing the emergency preparedness of hospitals. CHARACTERISTICS OF CONTINGENCY PLANS Emergency preparedness should focus on community preparedness, a personnel augmentation plan, and communications and public policies for funding the emergency preparedness. The capability to cope with a MCI serves as a basis for preparedness for non-conventional events. Coping with chemical casualties necessitates decontamination of casualties, treating victims with acute stress reactions, expanding surge capacities of hospitals, and integrating knowledge through drills. Risk communication also is important. ASSESSMENT OF EMERGENCY PREPAREDNESS An annual assessment of the emergency plan is required in order to assure emergency preparedness. Preparedness assessments should include: (1) elements of disaster planning; (2) emergency coordination; (3) communication; (4) training; (5) expansion of hospital surge capacity; (6) personnel; (7) availability of equipment; (8) stockpiles of medical supplies; and (9) expansion of laboratory capacities. The assessment program must be based on valid criteria that are measurable, reliable, and enable conclusions to be drawn. There are several assessment tools that can be used, including surveys, parameters, capabilities evaluation, and self-assessment tools. SUMMARY Healthcare systems are required to prepare an effective response model to cope with MCIs. Planning should be envisioned as a process rather than a production of a tangible product. Assuring emergency preparedness requires a structured methodology that will enable an objective assessment of the level of readiness.

Chapter 1. Introduction. Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster.

BackgroundIn December 2007, the European Society of Intensive Care Medicine established a Task Force to develop standard operating procedures (SOPs) for operating intensive care units (ICU) during an influenza epidemic or mass disaster.PurposeTo provide direction for health care professionals in the preparation and management of emergency ICU situations during an influenza epidemic or mass disaster, standardize activities, and promote coordination and communication among the medical teams.MethodsBased on a literature review and contributions of content experts, a list of essential categories for managing emergency situations in the ICU were identified. Based on three cycles of a modified Delphi process, consensus was achieved regarding the categories. A primary author along with an expert group drafted SOPs for each category.ResultsBased on the Delphi cycles, the following key topics were found to be important for emergency preparedness: triage, infrastructure, essential equipment, manpower, protection of staff and patients, medical procedures, hospital policy, coordination and collaboration with interface units, registration and reporting, administrative policies and education.ConclusionsThe draft SOPs serve as benchmarks for emergency preparedness and response of ICUs to emergencies or outbreak of pandemics.

The relationship between demographic/educational parameters and perceptions, knowledge and earthquake mitigation in Israel

Perceptions, knowledge and mitigation are factors that might play a role in preventing injury and loss of life during a major earthquake.(2) Little is known about the relationships between different demographic and educational parameters and these factors. A national representative sample of 495 adults was investigated in order to determine the relationship between demographic and educational parameters in terms of the perceived threat, perceived coping, knowledge and mitigation of earthquakes in Israel. Compared to females, males perceived the threat of earthquakes to be lower (t = 3.183, p = 0.002), manifested higher levels of perceived coping (t = 2.55, p = 0.011), and had higher levels of earthquake related knowledge (t = 2.047, p = 0.041). We conclude that there are gender differences in perceptions and knowledge regarding earthquakes.

Relationship Between Standards of Procedures for Pandemic Flu and Level of Hospital Performance in Simulated Drills

STUDY OBJECTIVE Standard operating procedures are the basis of a consistent response to varied threats. The aim of this study is to investigate the relationship between the quality of standard operating procedures developed by hospitals for the management of a pandemic influenza outbreak and the level of performance in a H5N1 flu drill. METHODS Standard operating procedures developed by all general hospitals in Israel for the management of pandemic influenza were evaluated with a tool developed for this purpose. The hospital standard operating procedure score was then compared with the score obtained by the hospital in a simulated drill. RESULTS Cronbachs alpha was used to determine the reliability of the standard operating procedure evaluation scores and the scores obtained on the drill. Reliability of both scores was high (>0.70). Hospital standard operating procedure scores were found to be moderately related to the scores obtained on the simulated drill. An important relationship was found between performance on the drill and the following components of the standard operating procedure: protection of staff and patients, staffing coordination and control, and infrastructure maintenance and minimizing overload. Hospital characteristics were not found to be important in determining either the hospital standard operating procedure score or performance on the simulated drill. CONCLUSION A reasonably strong relationship was found between quality of the standard operating procedures developed by hospitals to deal with a pandemic influenza and performance on a pandemic drill. Components of the standard operating procedure that dealt with areas that were relatively unfamiliar to staff or topics that were perceived by personnel as posing a risk to their well-being were found to be more important. The quality of the standard operating procedures was found to be important in relation to performance in a pandemic flu drill; therefore, we suggest investing effort in developing standard operating procedures that are comprehensive and cover relatively new domains in detail.

Factors That May Influence the Preparation of Standards of Procedures for Dealing with Mass-Casualty Incidents

INTRODUCTION General hospitals in Israel are required to develop standards of procedures (SOPs) to facilitate the management of mass-casualty incidents (MCIs). These SOPs represent the initial step in a continuous process, providing guidelines for hospitals to manage MCIs in an organized and efficient manner. Evaluation of the preparedness levels of hospitals in dealing with MCIs is required in order to promote an effective response, and to identify factors that might impact the quality of SOPs. The aim of this study was to identify the characteristics of hospitals that have an impact on the preparation of SOPs. METHODS An evaluation tool was developed to assess the SOPs from 22 hospitals during the management of a MCI. The results of the evaluations were analyzed, in relation to the size, trauma capabilities, ownership, geographic location, urban versus rural status of the hospitals, the proximity to other hospitals, participation in drills during the year prior to the evaluation, and number of actual MCIs the hospital managed in the past three years. RESULTS The evaluation scores of the SOPs of 11 of the 22 hospitals (50%) were very high, so their SOPs did not require modifications. The SOPs of four hospitals (18%) were rated highly, requiring only minor modifications. The SOPs of four hospitals (18%) received poor ratings, requiring major modifications, and three hospitals (14%) were found to have incomplete SOPs and received very poor ratings. No significant differences were found between the ratings of SOPs in relation to the different characteristics of the hospitals analyzed. A low correlation between the level of SOPs and the number of MCIs that the hospital managed was found (r = 0.266, NS). CONCLUSIONS The tool developed to evaluate the quality of the SOPs of hospitals to manage MCIs was logistically feasible and capable of differentiating between hospital SOPs. The comprehensiveness and completeness of the SOPs appears to be unrelated to the characteristics of the hospitals included in this study. Of particular note was the lack of a significant correlation between the SOP rating and the number of actual MCIs managed by a hospital.

Load index model: An advanced tool to support decision making during mass-casualty incidents.

BACKGROUND In mass-casualty events, accessing information concerning hospital congestion levels is crucial to improving patient distribution and optimizing care. The study aimed to develop a decision support tool for distributing casualties to hospitals in an emergency scenario involving multiple casualties. METHODS A comprehensive literature review and structured interviews with 20 content experts produced a shortlist of relevant criteria for inclusion in the model. A “load index model” was prepared, incorporating results of a modified Delphi survey of 100 emergency response experts. The model was tested in three simulation exercises in which an emergency scenario was presented to six groups of senior emergency managers. Information was provided regarding capacities of 11 simulated admitting hospitals in the region, and evacuation destinations were requested for 600 simulated casualties. Of the three simulation rounds, two were performed without the model and one after its presentation. Following simulation experiments and implementation during a real-life security threat, the efficacy of the model was assessed. RESULTS Variability between experts concerning casualties’ evacuation destinations decreased significantly following the model’s introduction. Most responders (92%) supported the need for standardized data, and 85% found that the model improved policy setting regarding casualty evacuation in an emergency situation. These findings were reaffirmed in a real-life emergency scenario. CONCLUSION The proposed model improved capacity to ensure evacuation of patients to less congested medical facilities in emergency situations, thereby enhancing lifesaving medical services. The model supported decision-making processes in both simulation exercises and an actual emergency situation.

Improving Hospital Mass Casualty Preparedness Through Ongoing Readiness Evaluation

The objective of this study was to investigate the effect of ongoing use of an evaluation tool on hospitals’ emergency preparedness for mass casualty events (MCEs). Two cycles of evaluation of emergency preparedness were conducted based on measurable parameters. A significant increase was found in mean total scores between the 2 cycles (from 77.1 to 88.5). An increase was found in scores for standard operating procedures, training, and equipment, but the change was significant only in the training category. Relative increase was highest for hospitals that did not experience real MCEs. This study offers a structured and practical approach for ongoing improvement of emergency preparedness, based on validated, measurable benchmarks. Ongoing assessment of emergency preparedness motivates hospitals to improve capabilities and results in a more effective emergency response mechanism. Use of predetermined and measurable benchmarks allows the institutions being assessed to improve their level of performance in the areas evaluated.

Relationship between equipment and infrastructure for pandemic influenza and performance in an avian flu drill.

Background: Effective preparedness for pandemic influenza necessitates acquisition and maintenance of vital equipment and infrastructure. The aim of this study was to investigate the relationship between the level of hospital preparedness relating to infrastructure and equipment and performance of the hospital in an avian flu drill. Methods: The levels of preparedness of the infrastructure and equipment for pandemic influenza of all 24 general hospitals were evaluated using a tool developed for this purpose. The hospital evaluation scores were then compared with the scores obtained by the hospitals in a simulated avian flu drill. Results: The overall scores of equipment and infrastructure for pandemic influenza of general hospitals ranged from 67% to 100%. Comparison of the overall level of preparedness of equipment and infrastructure for pandemic influenza with the overall scores achieved in the avian flu drill revealed a medium correlation. A medium correlation was also found between stockpiling of medications and performance in the avian flu drill. No correlations were found between operating infrastructure, availability of protective measures and medical forms and performance in the avian flu drill. Conclusions: This study has identified benchmarks of infrastructure and equipment required for managing a pandemic influenza event and evaluating the level of emergency preparedness of the hospital. The significant relationship between maintaining stockpiles of antiviral medications for patients and staff and performance in an avian flu drill emphasises its importance in the process of maintaining emergency preparedness for a pandemic influenza outbreak.