Full-scale regional exercises: Closing the gaps in disaster preparedness.
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 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 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.
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.
Multiagency, multijurisdictional, multidisciplinary full-scale regional exercise.
5 areas of preparedness:CommunicationsDecontaminationCommand structureStaffingPatient tracking
simulated a train derailment and chemical spillThird-party contracted evaluators assessed each hospital in five areas: communications, command structure, decontamination, staffing, and patient tracking.
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).
Evaluate the results of a multijurisdictional, multidisciplinary, and multiorganizational, fullscale regional exercise (FSRE) simulating an MCI involving a chemical spill.
Our findings demonstrate that tabletop exercises are inadequate to expose operational and logistic gaps in disaster response
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 10 years after 9/11
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 simulated a train derailment and chemical spill 20 miles from the TC using 281 moulaged volunteers.
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