UNIFIED: Understanding New Information from Emergency Departments Involved in the San Bernardino Terrorist Attack

Abstract

Introduction: Emergency departments (ED) are on the front line for treating victims of multi-casualty incidents. The primary objective of this study was to gather and detail the common experiences from those hospital-based health professionals directly involved in the response to the San Bernardino terrorism attack on December 2, 2015. Secondary objectives included gathering information on experiences participants found were best practices. Methods: We undertook a qualitative study using Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines by performing semi-structured interviews with physicians, nurses, and incident management staff from multiple institutions responding to the San Bernardino terrorist attack. We coded transcripts using qualitative analysis techniques and we delineated and agreed upon a refined list with code definitions using a negotiated group process. Final themes were developed and analyzed. Results: A total of 26 interviews were completed; 1172 excerpts were coded and categorized into 66 initial themes. Six final categories of communication, training, unexpected help, process bypassed, personal impact/emotions, and practical advice resulted. Conclusion: Our study provides context regarding the response of healthcare personnel from multiple institutions to a singular terrorist attack in the United States. It elucidates several themes to help other institutions prepare for similar events. Understanding these common experiences provides opportunity to prepare for future incidents and develop questions to study in future events.

Case series: Point-of-Care Ultrasound Conducted by Medical Students During their First Clinical Rotation Changes Patients’ Primary Diagnosis and Management

“…POCUS is meant to accelerate the process of diagnosis and treatment and assist in the decision-making process. 18,19 As seen in the cases presented, POCUS examination conducted by the students led to faster diagnosis and treatment. When necessary, the POCUS examination was followed by a definitive gold standard test which confirmed the findings found on the POCUS examination.…”

Emotional and psychological implications for healthcare professionals in disasters or mass casualties: A systematic review

“…Conversely, some professionals also reported positive emotions, such as having felt commitment, professional satisfaction and pride in what they have done and their role in providing assistance (Brooks et al, 2019;Pourvakhshoori et al, 2017;Smith et al, 2020). The sense of pride can be strengthened by the support and gratitude of the community as well as other professionals, validating the work they do and restoring commitment to their profession (De Soir et al, 2012), as seen during the COVID-19 pandemic (Foley et al, 2020;Salopek-Žiha et al, 2020).…”

“…significant changes in jobs, and financial strains had negative psychological implications for professionals (Chan et al, 2016;Nishi et al, 2012;Smith et al, 2020). Besides this, the lack of recognition, according to the model of balance effort-reward, creates a split in the reciprocal relationship between effort (required to meet labour demands) and rewards (in terms of salary, esteem, professional opportunities or feeling valued) (Brooks et al, 2019).…”

“…This training requires, therefore the knowledge of how to protect themselves and their families, the precautions they should take, as well as the knowledge of how to manage the safety equipment needed to reduce perceived risks (Mackler et al, 2007;Verschuur et al, 2007). It also involves training in skills, expertise and confidence to work under high-stress situations (Smith et al, 2020;Waters et al, 1992), seminars or training days on emotional/ psychological well-being, stress management and relaxation strategies training, psychological first aid training, strategies to build resilience (Chan et al, 2016), as well as emotional and cognitive readiness for the realities they may face professionally (Nishi et al, 2012;Rogers & Lawhorn, 2007).…”