Pier Luigi Ingrassia

Utstein-Style Template for Uniform Data Reporting of Acute Medical Response in Disasters

Background: In 2003, the Task Force on Quality Control of Disaster Management (WADEM) published guidelines for evaluation and research on health disaster management and recommended the development of a uniform data reporting tool. Standardized and complete reporting of data related to disaster medical response activities will facilitate the interpretation of results, comparisons between medical response systems and quality improvement in the management of disaster victims. Methods: Over a two-year period, a group of 16 experts in the fields of research, education, ethics and operational aspects of disaster medical management from 8 countries carried out a consensus process based on a modified Delphi method and Utstein-style technique. Results: The EMDM Academy Consensus Group produced an Utstein-style template for uniform data reporting of acute disaster medical response, including 15 data elements with indicators, that can be used for both research and quality improvement. Conclusion: It is anticipated that the Utstein-style template will enable better and more accurate completion of reports on disaster medical response and contribute to further scientific evidence and knowledge related to disaster medical management in order to optimize medical response system interventions and to improve outcomes of disaster victims.

Education and training initiatives for crisis management in the European Union: a web-based analysis of available programs.

INTRODUCTION Education and training are key elements of disaster management. Despite national and international educational programs in disaster management, there is no standardized curriculum available to guide the European Union (EU) member states. European- based Disaster Training Curriculum (DITAC), a multiple university-based project financially supported by the EU, is charged with developing a holistic and highly-structured curriculum and courses for responders and crisis managers at a strategic and tactical level. The purpose of this study is to qualitatively assess the prevailing preferences and characteristics of disaster management educational and training initiatives (ETIs) at a postgraduate level that currently exist in the EU countries. METHODS An Internet-based qualitative search was conducted in 2012 to identify and analyze the current training programs in disaster management. The course characteristics were evaluated for curriculum, teaching methods, modality of delivery, target groups, and funding. RESULTS The literature search identified 140 ETIs, the majority (78%) located in United Kingdom, France, and Germany. Master level degrees were the primary certificates granted to graduates. Face-to-face education was the most common teaching method (84%). Approximately 80% of the training initiatives offered multi- and cross-disciplinary disaster management content. A competency-based approach to curriculum content was present in 61% of the programs. Emergency responders at the tactical level were the main target group. Almost all programs were self-funded. CONCLUSION Although ETIs currently exist, they are not broadly available in all 27 EU countries. Also, the curricula do not cover all key elements of disaster management in a standardized and competency-based structure. This study has identified the need to develop a standardized competency-based educational and training program for all European countries that will ensure the practice and policies that meet both the standards of care and the broader expectations for professionalization of the disaster and crisis workforce.

Evaluation of Medical Management During a Mass Casualty Incident Exercise: An Objective Assessment Tool to Enhance Direct Observation

BACKGROUND Functional exercises represent an important link between disaster planning and disaster response. Although these exercises are widely performed, no standardized method exists for their evaluation. STUDY OBJECTIVES To describe a simple and objective method to assess medical performance during functional exercise events. METHODS An evaluation tool comprising three data fields (triage, clinical maneuvers, and radio usage), accompanied by direct anecdotal observational methods, was used to evaluate a large functional mass casualty incident exercise. RESULTS Seventeen medical responders managed 112 victims of a simulated building explosion. Although 81% of the patients were assigned the appropriate triage codes, evacuation from the site did not follow in priority. Required maneuvers were performed correctly in 85.2% of airway maneuvers and 78.7% of breathing maneuvers, however, significant under-treatment occurred, possibly due to equipment shortages. Extensive use of radio communication was documented. In evaluating this tool, the structured markers were informative, but further information provided by direct observation was invaluable. CONCLUSION A three-part tool (triage, medical maneuvers, and radio usage) can provide a method to evaluate functional mass casualty incident exercises, and is easily implemented. For the best results, it should be used in conjunction with direct observation. The evaluation tool has great potential as a reproducible and internationally recognized tool for evaluating disaster management exercises.

Core Competencies in Disaster Management and Humanitarian Assistance: A Systematic Review

Disaster response demands a large workforce covering diverse professional sectors. Throughout this article, we illustrate the results of a systematic review of peer-reviewed studies to identify existing competency sets for disaster management and humanitarian assistance that would serve as guidance for the development of a common disaster curriculum. A systematic review of English-language articles was performed on PubMed, Google Scholar, Scopus, ERIC, and Cochrane Library. Studies were included if reporting competency domains, abilities, knowledge, skills, or attitudes for professionals involved disaster relief or humanitarian assistance. Exclusion criteria included abstracts, citations, case studies, and studies not dealing with disasters or humanitarian assistance. Thirty-eight papers were analyzed. Target audience was defined in all articles. Five references (13%) reported cross-sectorial competencies. Most of the articles (81.6%) were specific to health care. Eighteen (47%) papers included competencies for at least 2 different disciplines and 18 (47%) for different professional groups. Nursing was the most widely represented cadre. Eighteen papers (47%) defined competency domains and 36 (94%) reported list of competencies. Nineteen articles (50%) adopted consensus-building to define competencies, and 12 (31%) included competencies adapted to different professional responsibility levels. This systematic review revealed that the largest number of papers were mainly focused on the health care sector and presented a lack of agreement on the terminology used for competency-based definition.

Art of disaster preparedness in European union: a survey on the health systems.

Introduction: Naturally occurring and man-made disasters have been increasing in the world, including Europe, over the past several decades. Health systems are a key part of any community disaster management system. The success of preparedness and prevention depends on the success of activities such as disaster planning, organization and training. The aim of this study is to evaluate health system preparedness for disasters in the 27 European Union member countries. Method: A cross-sectional analysis study was completed between June-September 2012. The checklist used for this survey was a modified from the World Health Organization toolkit for assessing health-system capacity for crisis management. Three specialists from each of the 27 European Union countries were included in the survey. Responses to each survey question were scored and the range of preparedness level was defined as 0-100%, categorized in three levels as follows: Acceptable; Transitional; or Insufficient. Results: Response rate was 79.1%. The average level of disaster management preparedness in the health systems of 27 European Union member states was 68% (Acceptable). The highest level of preparedness was seen in the United Kingdom, Luxemburg, and Lithuania. Considering the elements of disaster management system, the highest level of preparedness score was at health information elements (86%), and the lowest level was for hospitals, and educational elements (54%). Conclusion: This survey study suggests that preparedness level of European Union countries in 2012 is at an acceptable level but could be improved. Elements such as hospitals and education and training suffer from insufficient levels of preparedness. The European Union health systems need a collective strategic plan, as well as enough resources, to establish a comprehensive and standardized disaster management strategy plan. A competency based training curriculum for managers and first responders is basic to accomplishing this goal. Keywords: Disaster medicine; Disaster preparedness; Disaster epidemiology; Health systems; European Union

A simple graphical method for quantification of disaster management surge capacity using computer simulation and process-control tools

INTRODUCTION Surge capacity, or the ability to manage an extraordinary volume of patients, is fundamental for hospital management of mass-casualty incidents. However, quantification of surge capacity is difficult and no universal standard for its measurement has emerged, nor has a standardized statistical method been advocated. As mass-casualty incidents are rare, simulation may represent a viable alternative to measure surge capacity. Hypothesis/Problem The objective of the current study was to develop a statistical method for the quantification of surge capacity using a combination of computer simulation and simple process-control statistical tools. Length-of-stay (LOS) and patient volume (PV) were used as metrics. The use of this method was then demonstrated on a subsequent computer simulation of an emergency department (ED) response to a mass-casualty incident. METHODS In the derivation phase, 357 participants in five countries performed 62 computer simulations of an ED response to a mass-casualty incident. Benchmarks for ED response were derived from these simulations, including LOS and PV metrics for triage, bed assignment, physician assessment, and disposition. In the application phase, 13 students of the European Master in Disaster Medicine (EMDM) program completed the same simulation scenario, and the results were compared to the standards obtained in the derivation phase. RESULTS Patient-volume metrics included number of patients to be triaged, assigned to rooms, assessed by a physician, and disposed. Length-of-stay metrics included median time to triage, room assignment, physician assessment, and disposition. Simple graphical methods were used to compare the application phase group to the derived benchmarks using process-control statistical tools. The group in the application phase failed to meet the indicated standard for LOS from admission to disposition decision. CONCLUSIONS This study demonstrates how simulation software can be used to derive values for objective benchmarks of ED surge capacity using PV and LOS metrics. These objective metrics can then be applied to other simulation groups using simple graphical process-control tools to provide a numeric measure of surge capacity. Repeated use in simulations of actual EDs may represent a potential means of objectively quantifying disaster management surge capacity. It is hoped that the described statistical method, which is simple and reusable, will be useful for investigators in this field to apply to their own research.

Data collection in a live mass casualty incident simulation: automated RFID technology versus manually recorded system.

Objectives To demonstrate the applicability and the reliability of a radio frequency identification (RFID) system to collect data during a live exercise. Methods A rooftop collapse of a crowded building was simulated. Fifty-three volunteers were trained to perform as smart victims, simulating clinical conditions, using dynamic data cards, and capturing delay times and triage codes. Every victim was also equipped with a RFID tag. RFID antenna was placed at the entrance of the advanced medical post (AMP) and emergency department (ED) and recorded casualties entering the hospital. Results A total of 12 victims entered AMP and 31 victims were directly transferred to the ED. 100% (12 of 12 and 31 of 31) of the time cards reported a manually written hospital admission time. No failures occurred in tag reading or data transfers. A correlation analysis was performed between the two methods plotting the paired RFID and manual times and resulted in a r=0.977 for the AMP and r=0.986 for the ED with a P value of less than 0.001. Conclusion We confirmed the applicability of RFID system to the collection of time delays. Its use should be investigated in every aspect of data collection (triage, treatments) during a disaster exercise.

Virtual Reality Simulation Training for Ebola Deployment

Both virtual and hybrid simulation training offer a realistic and effective educational framework and opportunity to provide virtual exposure to operational public health skills that are essential for infection control and Ebola treatment management. This training is designed to increase staff safety and create a safe and realistic environment where trainees can gain essential basic and advanced skills.

Combining Dedicated Online Training and Apprenticeships in the Field to Assist in Professionalization of Humanitarian Aid Workers: a 2-year Pilot Project for Anesthesia and Intensive Care Residents Working in Resource Constrained and Low-income Countries.

Introduction: As a result of the gaps in humanitarian response highlighted by several reports, the international community called for an increased professionalization of humanitarian aid workers. This paper describes a pilot project by an Italian university and a non-profit, non-governmental organization to implement a medical apprenticeship in low-income countries during Anesthesia and Intensive Care Medicine residencies. Methods: Before deployment, participants were required to complete a dedicated online training course about safety and security in the field, principles of anesthesia at the district hospital level, emergency and essential surgical care, essentials of medical treatment in resource-constrained environments and psychological support in emergencies. Results: At the end of the program, a qualitative self-evaluation questionnaire administered to participants highlighted how the project allowed the participants to advance their professional skills when working in a low-resource environment, while also mastering their adapting skills and the ability to interact and cooperate with local healthcare personnel. The project also proved to be a means for personal growth, making these experiences a recommendation for all residents as a necessary step for the professionalization of healthcare personnel involved in humanitarian aid.

TIER competency-based training course for the first receivers of CBRN casualties: a European perspective.

Introduction Education and training are key elements of health system preparedness vis-à-vis chemical, biological, radiological and nuclear (CBRN) emergencies. Medical respondents need sufficient knowledge and skills to manage the human impact of CBRN events. Objective The current study was designed to determine which competencies are needed by hospital staff when responding to CBRN emergencies, define educational needs to develop these competencies, and implement a suitable delivery method. Methods This study was carried out from September 2014 to February 2015, using a three-step modified Delphi method. On the basis of international experiences, publications, and experts’ consensus, core competencies for hospital staff – as CBRN casualty receivers – were determined, and training curricula and delivery methods were defined. Results The course consists of 10 domains. These are as follows: threat identification; health effects of CBRN agents; planning; hospital incident command system; information management; safety, personal protective equipment and decontamination; medical management; essential resources; psychological support; and ethical considerations. Expected competencies for each domain were defined. A blended approach was chosen. Conclusion By identifying a set of core competencies, this study aimed to provide the specific knowledge and skills required by medical staff to respond to CRBN emergencies. A blended approach may be a suitable delivery method, allowing medical staff to attend the same training sessions despite different time zones and locations. The study output provides a CBRN training scheme that may be adapted and used at the European Union level.