Kahjuks pole selle sisu tõlget valitud keeles. Andmed kuvatakse inglise keeles.

Full-scale regional exercises: Closing the gaps in disaster preparedness.

Authors
Klima DA ; Seiler SH ; Peterson JB ; Christmas AB ; Green JM ; Fleming G ; Thomason MH ; Sing RF

BACKGROUND: Man-made (9/11) and natural (Hurricane Katrina) disasters have enlightened the medical community regarding the importance of disaster preparedness. In response to Joint Commission requirements, medical centers should have established protocols in place to respond to such events. We examined a full-scale regional exercise (FSRE) to identify gaps in logistics and operations during a simulated mass casualty incident. METHODS: A multiagency, multijurisdictional, multidisciplinary exercise (FSRE) included 16 area hospitals and one American College of Surgeons-verified Level I trauma center (TC). The scenario simulated a train derailment and chemical spill 20 miles from the TC using 281 moulaged volunteers. Third-party contracted evaluators assessed each hospital in five areas: communications, command structure, decontamination, staffing, and patient tracking. Further analysis examined logistic and operational deficiencies. RESULTS: None of the 16 hospitals were compliant in all five areas. Mean hospital compliance was 1.9 (±0.9 SD) areas. One hospital, unable to participate because of an air conditioner outage, was deemed 0% compliant. The most common deficiency was communications (15 of 16 hospitals [94%]; State Medical Asset Resource Tracking Tool system deficiencies, lack of working knowledge of Voice Interoperability Plan for Emergency Responders radio system) followed by deficient decontamination in 12 (75%). Other deficiencies included inadequate staffing based on predetermined protocols in 10 hospitals (63%), suboptimal command structure in 9 (56%), and patient tracking deficiencies in 5 (31%). An additional 11 operational and 5 logistic failures were identified. The TC showed an appropriate command structure but was deficient in four of five categories, with understaffing and a decontamination leak into the emergency department, which required diversion of 70 patients. CONCLUSION: Communication remains a significant gap in the mass casualty scenario 10 years after 9/11. Our findings demonstrate that tabletop exercises are inadequate to expose operational and logistic gaps in disaster response. FSREs should be routinely performed to adequately prepare for catastrophic events.

Codebooks
SLR Criteria
Summary

An after-action review was performed and subsequently reviewed for deficiencies, which were broadly defined as the inability to use tools or fully execute patient care strategies in the intended format.

SLR Criteria
Summary

Multiagency, multijurisdictional, multidisciplinary full-scale regional exercise.

Summary

5 areas of preparedness:CommunicationsDecontaminationCommand structureStaffingPatient tracking

Summary

scenario simulated a train derailment and chemical spillThird-party contracted evaluators assessed each hospital in five areas: communications, command structure, decontamination, staffing, and patient tracking.

SLR Criteria
Summary

Included the 16 area hospital. These included a single Level I trauma center (TC), two Level 3 TCs, and 281 moulaged volunteers. Nine hospitals presented with less than 200 beds (range, 52Y162), whereas six presented with more than 200 beds (range, 220Y795).

SLR Criteria
Summary

Evaluate the results of a multijurisdictional, multidisciplinary, and multiorganizational, fullscale regional exercise (FSRE) simulating an MCI involving a chemical spill.

Summary

Our findings demonstrate that tabletop exercises are inadequate to expose operational and logistic gaps in disaster response

SLR Criteria
Summary

None of the 16 hospitals were compliant in all five areas. Mean hospital compliance was 1.9 (T0.9 SD) areas. The most common deficiency was communications (15 of 16 hospitals [94%].Communication remains a significant gap in the mass casualty scenario 10 years after 9/11

SLR Criteria
Summary

Our objectives for the exercise were to implement incident communications between agencies, coordinate care through the incident command center, and effectively decontaminate patients after a chemical spill.The scenario simulated a train derailment and chemical spill 20 miles from the TC using 281 moulaged volunteers.

eu Portfolio of Solutions web site has been initially developed in the scope of DRIVER+ project. Today, the service is managed by AIT Austrian Institute of Technology GmbH., for the benefit of the European Crisis Management. PoS is endorsed and supported by the Disaster Competence Network Austria (DCNA) as well as by the STAMINA and TeamAware H2020 projects.