Assessing and Improving Hospital Mass-Casualty Preparedness: A No-Notice Exercise

Abstract

In recent years, mass-casualty incidents (MCIs) have become more frequent and deadly, while emergency department (ED) crowding has grown steadily worse and widespread. The ability of hospitals to implement an effective mass-casualty surge plan, immediately and expertly, has therefore never been more important. Yet, mass-casualty exercises tend to be highly choreographed, pre-scheduled events that provide limited insight into hospitals' true capacity to respond to a no-notice event under real-world conditions. To address this gap, the US Department of Health and Human Services (Washington, DC USA), Office of the Assistant Secretary for Preparedness and Response (ASPR), sponsored development of a set of tools meant to allow any hospital to run a real-time, no-notice exercise, focusing on the first hour and 15 minutes of a hospital's response to a sudden MCI, with the goals of minimizing burden, maximizing realism, and providing meaningful, outcome-oriented metrics to facilitate self-assessment. The resulting exercise, which was iteratively developed, piloted at nine hospitals nationwide, and completed in 2015, is now freely available for anyone to use or adapt. This report demonstrates the feasibility of implementing a no-notice exercise in the hospital setting and describes insights gained during the development process that might be helpful to future exercise developers. It also introduces the use of ED "immediate bed availability (IBA)" as an objective, dynamic measure of an ED's physical capacity for new arrivals. Waxman DA , Chan EW , Pillemer F , Smith TWJ , Abir M , Nelson C . Assessing and improving hospital mass-casualty preparedness: a no-notice exercise. Prehosp Disaster Med. 2017;32(6):662-666.

Overestimated, still less than competent: A cross-sectional study concerning emergency department registered nurses’ disaster preparedness

“…Major incidents (MI) threaten to overwhelm the health care system by causing a sudden surge of patients in need of health care, [1][2][3][4][5]. Hospitals play critical roles in providing care during MIs [6,7].…”

Tömeges sérültellátás aspektusai és lehetőségei a lőtt és robbantásos merényletek esetén

“…Az Egyesült Államokban több kórház által kidolgozott, előzetes bejelentés nélküli gyakorlat a kórház tömeges sérüléssel járó esemény bekövetkezését követő első 75 percben nyújtott intézkedéseire koncentrál. Az értékelés legfontosabb szempontja, hogy a gyakorlat teljes időtartama alatt menynyire képes a kórház fenntartani sürgősségi ellátó kapacitását az újonnan érkező sérültek azonnali triage-olása és ellátása érdekében [19].…”

Implementation of emergency preparedness in long term care and Rogers' diffusion of innovation theory.

“…In these events, individual long term care facilities and local/state responders rely even more so on good planning (Waxman et al, 2017;Bolton & Zimmerman, 2007). Emergency responses need to be based on sound plans that are pre-tested using exercises organized and facilitated by community partners that include first responders.…”

“…In addition, his example and support created an environment that challenged ways to look at ideas and theories that give credence to our work together and this study. In these events, individual long term care facilities and local/state responders rely even more so on good planning (Bolton & Zimmerman, 2007;Waxman et al, 2017).Emergency responses need to be based on sound plans that are pre-tested using exercises organized and facilitated by community partners that include first responders. The lessons learned by the research about solid decision-making for shelter-in-place or evacuation decisions are just as important in no-notice events as hurricane emergencies.…”

“…In addition, his example and support created an environment that challenged ways to look at ideas and theories that give credence to our work together and this study. In these events, individual long term care facilities and local/state responders rely even more so on good planning (Bolton & Zimmerman, 2007;Waxman et al, 2017).…”