Disaster Drills Research Articles

Generic evaluation methods for disaster drills in developing countries: (Green GB, Modi S, Lunney K, Thomas TL. Generic evaluation methods for disaster drills in developing countries. Ann Emerg Med 2003;41:689-99.)

Generic evaluation methods for disaster drills in developing countries: (Green GB, Modi S, Lunney K, Thomas TL. Generic evaluation methods for disaster drills in developing countries. Ann Emerg Med 2003;41:689-99.)

Disaster medicine and the emergency medicine resident

Disaster medicine and the emergency medicine resident

Generic evaluation methods for disaster drills in developing countries

Disaster simulations (drills) are widely used throughout the world and are considered a fundamental tool for evaluation and improvement of local disaster response capacity. Despite this, no generally accepted methodology exists for quantitative evaluation of the medical response to a disaster drill. We therefore set out to develop and prospectively test a comprehensive method to assess both medical provider and organizational performance during a disaster simulation. Because disasters disproportionately affect the populations of developing countries, we designed these methods to be sufficiently flexible to be applicable in both the developed and the developing world. Objective outcome measures were identified for each component of disaster medical response and were incorporated into 3 data collection instruments. The derived methods were applied to a multiagency disaster simulation in Guatemala City, Guatemala. On the basis of this pilot study, suggested modifications and recommendations were made. The ability to objectively identify the specific strengths and weaknesses of an emergency medical services systems' medical response to a disaster is an important step toward optimizing system performance. On the basis of our experience, we recommend the incorporation of objective evaluation methods such as these into every disaster simulation. [Ann Emerg Med. 2003;41:689-699.]

Development of Risk-Adaptive Information Managemant System for Local Government and its Application to Disaster Drill in Nagata Ward, Kobe City

Development of Risk-Adaptive Information Managemant System for Local Government and its Application to Disaster Drill in Nagata Ward, Kobe City

Comparison of Effectiveness of Disaster Drill Methodologies: Table Top vs. Simulation Exercise

Comparison of Effectiveness of Disaster Drill Methodologies: Table Top vs. Simulation Exercise

Emergency preparedness and disaster management in Hawaii

The research is an administrative case study based on an extensive review of Hawaii government documents and interviews with key personnel of the Hawaii Emergency Preparedness Committee, civil defense and other relevant officials. Describes the interagency coordination at the federal, state, county, and community level to improve capability. Also described and critically evaluated are the roles of interagency emergency preparedness training, disaster drills, and coordination and partnership with the private sector, such as medical centers and the Federal Emergency Management Agency’s designated “disaster resistant communities” in Maui and Hawaii County. Recommends that more frequent interagency drills, increased funding for family emergency preparedness and local community response teams, and continuous training by emergency response coordinators could improve state and county disaster preparedness and concludes that, overall, Hawaii is adequately prepared in emergency response capability, particularly in the areas of medical services and interagency coordination.

The Good, The Bad, and The Ugly

This article discusses how the proximity of a treatment plant to an elementary school, response problems identified during a disaster drill, and the safety of customers prompted the Northern Kentucky Water District (District) to change its disinfection chemical from chlorine gas to its liquid alternative, sodium hypochlorite. Although the conversion process wasn't easy, the District's ultimate goal of a safer system was achieved.

Hospital trauma care in multiple-casualty incidents: A critical view

During a multiple-casualty incident, a large casualty caseload adversely affects the quality of trauma care given to individual patients. From a trauma care perspective, the goal of the hospital emergency plan is to provide severely injured patients with a level of care that approximates the care given to similar patients under normal conditions. Therefore, the realistic admitting capacity of the hospital is determined primarily by the number of trauma teams that the hospital can recruit. Effective triage of these casualties is often not straightforward, with high overtriage rates. Simplified triage algorithms may be a practical alternative to more elaborate schemes. The concept of minimal acceptable care is the key to a staged management approach during a mass-casualty incident. Discrete-event computer simulation and war game tabletop exercises for key personnel are 2 new modalities that are supplementing the traditional mock disaster drill as effective planning and training tools. [Hirshberg A, Holcomb JB, Mattox KL. Hospital trauma care in multiple-casualty incidents: a critical review. Ann Emerg Med. June 2001;37:647-652.]

The World Trade Center Attack Disaster preparedness: health care is ready, but is the bureaucracy?

When a disaster occurs, it is for governments to provide the leadership, civil defense, security, evacuation, and public welfare. The medical aspects of a disaster account for less than 10% of resource and personnel expenditure. Hospitals and health care provider teams respond to unexpected occurrences such as explosions, earthquakes, floods, fires, war, or the outbreak of an infectious epidemic. In some geographic locations where natural disasters are common, such as earthquakes in Japan, such disaster practice drills are common. In other locations, disaster drills become pro forma and have no similarity to real or even projected and predicted disasters. The World Trade Center disaster on 11 September 2001 provides new information, and points out new threats, new information systems, new communication opportunities, and new detection methodologies. It is time for leaders of medicine to re-examine their approaches to disaster preparedness.

What We Have Learned from a Disaster Drill: A Questionnaire Study for Simulated Victims and Hospital Personnel

What We Have Learned from a Disaster Drill: A Questionnaire Study for Simulated Victims and Hospital Personnel

The Medical Management of Civil Disasters in Hong Kong

Civil Disasters (major incidents) are events which place stress on the emergency services, both in the pre-hospital and hospital phases. There is often intense media interest, and staff must cope with additional pressures while trying to create order from chaos. The need for special arrangements to cope with the large number or severity of casualties defines disasters and distinguishes them from the normal peaks of Accident and Emergency workload. Good organisation of the medical response at the scene requires an efficient medical manager, the medical control officer (MCO), and also the presence of trained staff, who are commonly provided by the Hospital Authority and Auxiliary Medical Services. The need for training and the value of full-scale disaster drills as well as regular table-top exercises is emphasized.

Radiation safety role in institutional disaster planning.

United States Nuclear Regulatory Commission (NRC) materials license applicants (non-nuclear power) must submit spill procedures with their application. While our counterparts in the nuclear power industry historically have concerned themselves with disaster drills and evacuation plans as a result of fire, explosion, or an act of terrorism, other licensees are looking only at minor spills of unsealed radioactive material and only at tile radiation hazard. Beyond NRC regulations, various oversight and accrediting organizations require, or at a minimum encourage, a written disaster plan outlining actions to be taken for events likely to occur in the region of the institution. Some of these organizations require drills to practice implementation of the written plan. On 5 May 1999, Mayo Clinic performed a wide-scale disaster drill involving Rochester City and Olmsted County response organizations, and several Mayo Clinic departments. Planning took several months; the drill took approximately three hours. Participants gathered at several meetings post-drill for "debriefing" sessions to discuss successes, areas for improvement, and lessons learned. There were three overriding lessons learned: critical responders need special identification to allow access to the disaster site; initial victim surveys are for gross contamination only; and access to the potentially contaminated disaster site might take weeks or months following a real event.

A S TATEWIDE S TUDY OF EMS O VERSIGHT : M EDICAL D IRECTOR C HARACTERISTICS AND I NVOLVEMENT C OMPARED WITH N ATIONAL G UIDELINES

Introduction. From their inception, advanced life support (ALS) programs have had oversight by emergency medical services (EMS) medical directors. Position statements about medical direction have been published in the medical literature, initially by the American College of Emergency Physicians (ACEP). Most recently, the National Association of EMS Physicians (NAEMSP) published a position paper to serve as a guideline for the medical directors' tasks, describing qualifications and areas of involvement. Objective. To study the baseline status of EMS oversight in Maryland as the position paper was disseminated, to view how local directors meet the published guidelines. Methods. Twenty-two of the 23 (96%) jurisdictional EMS medical directors (JMDs) in Maryland were interviewed in face-to-face meetings. Information was collected about their qualifications and their regular involvement in activities within various EMS subsystems. Results. Sixteen (73%) JMDs are members of ACEP and four (18%) are members of NAEMSP. Six (27%) received EMS medical director training. Three (14%) went through a formal application process for their positions. Activities of relatively high involvement were investigations of variance from protocols (100% of JMDs involved), runsheet review (15 [68%]), liaison duties (20 [91%]), and disaster drills (15 [68%]). Most other subsystems, including dispatch, public health, administration, system evaluation, and quality programs, showed relatively low regular involvement (0–59%). Conclusion. In Maryland, significant increases in active physician involvement in EMS are necessary to meet the national job description. These data provide supportive evidence of the need for further commitment by state and local agencies, as well as trained EMS physicians in national societies, to enable all JMDs to reach the goals set forth for their important degs in EMS systems.

Disaster Drills and Continuous Medical Education using Satellite-based Internet

We designed and evaluated a satellite-based Internet system for use in medical applications. Many experimental telemedicine projects use satellites, but we combined digital satellite communication with an ordinary telephone network to realize an economical countrywide network for emergency medicine and continuous medical education. The system appears to be a useful and practical technology for daily clinical activities.

Triage Tags and Disaster Drills—Analysis of Tags Used in Two Disaster Drills

Triage Tags and Disaster Drills—Analysis of Tags Used in Two Disaster Drills

Assessment of U.S. helicopter emergency medical services' planning and preparedness for disaster response

Introduction: Helicopter emergency medical services (HEMS) roles in disaster response vary significantly from routine operation, and as reported in the literature, such responses have not been without difficulty. We identified nine criteria (written policy, triage and incident command training, disaster drill participation, ground and air communications plan, critical incident stress management, annual review, policy sharing) that may significantly affect an air medical program's disaster preparedness, response, and recovery. Of these criteria, a written policy is considered of primary importance. Methods: A written survey was developed and mailed in July 1995 to 187 U.S. rotor-wing members of the Association of Air Medical Services. The survey was designed to identify the programs that had a written policy and fulfilled the guideline criteria, had a written policy and partially fulfilled the criteria, or did not have a written policy. Results: Surveys were returned from 104 (56%) programs. Of the 103 qualifying respondents, 16 (16%) meet the criteria, 55 (53%) partially met the criteria, and 32 (31%) did not have written policies. Conclusion: Most U.S. HEMS programs have not fully addressed disaster preparedness, response, and recovery. HEMS disaster response guidelines should be established, and these criteria should be incorporated.

The Tokyo subway sarin attack: disaster management, Part 1: Community emergency response.

The Tokyo subway sarin attack was the second documented incident of nerve gas poisoning in Japan. Prior to the Tokyo subway sarin attack, there had never been such a large-scale disaster caused by nerve gas in peacetime history. This article provides details related to how the community emergency medical services (EMS) system responded from the viewpoint of disaster management, the problems encountered, and how they were addressed. The authors' assessment was that if EMTs, under Japanese law, had been allowed to maintain an airway with an endotracheal tube or use a laryngeal mask airway without physician oversight, more patients might have been saved during this chemical exposure disaster. Given current legal restrictions, advanced airway control at the scene will require that doctors become more actively involved in out-of-hospital treatment. Other recommendations are: 1) that integration and cooperation of concerned organizations be established through disaster drills; 2) that poison information centers act as regional mediators of all toxicologic information; 3) that a real-time, multidirectional communication system be established; 4) that multiple channels of communication be available for disaster care; 5) that public organizations have access to mobile decontamination facilities; and 6) that respiratory protection and chemical-resistant suits with gloves and boots be available for out-of-hospital providers during chemical disasters.

Systems and Problems of Disaster Drills in the National Hospitals of Japan

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Experience and Problems of Disaster Drills and Education for Medical Teams Using a Disaster Manual

Experience and Problems of Disaster Drills and Education for Medical Teams Using a Disaster Manual

The Efficacy of Integrating “Smart Simulated Casualties” in Hospital Disaster Drills

Full-scale disaster drills are complex, expensive, and may involve hundreds or thousands of people. However, even when carefully planned, they often fail to manifest the details of medical care given to the casualties during the drill. To assess the feasibility of integrating physicians among the simulated casualties of a hospital disaster drill. A total of 178 physicians graduating an Advanced Trauma Life Support (ATLS) course participated in eight hospital disaster drills during 1994 as "Smart Victims." The participants were given cards with descriptions of their injury and detailed instructions on how to manipulate their medical condition according to the medical care provided in the hospital. They also were given coded questionnaires to fill out during the process of the drill. Conclusions were drawn from analysis of the questionnaires and from a roundtable discussion following each drill. The "smart casualties" made comments on the following topics: 1) triage (over-triage in 9%, and under-triage in 4%); 2) treatment sites; 3) medical equipment usage (i.e., shortage of ventilators and splinting devices); 4) medical knowledge and care rendered by the hospital staff; 5) evacuation and escorting of the wounded; 6) management of patients with post-traumatic stress disorder; and 7) medical documentation. Their comments contributed valuable information on the quality of medical care and organization, and identified obstacles that otherwise would have been overlooked. The "smart casualties" were very cooperative and indicated that their participation in the drill contributed to their understanding of disaster situations in hospitals. Integrating physicians among the simulated casualties in a hospital disaster drill may contribute to achieving the objectives of hospital disaster drills and add to disaster management education of the simulated casualty physicians.