Disaster Exercises Research Articles

National survey of institutional pediatric disaster preparedness.

Describe institutional disaster preparations focusing upon the strategies to address pediatric patients in disaster preparedness. Descriptive study using survey methodology. Hospitals that provide emergency care to pediatric patients throughout the United States. Survey responses were solicited from hospital personnel that are familiar with the disaster preparedness plan at their institution. None. Describe how pediatric patients are included in institutional disaster preparedness plans. The presence of a pediatric-specific lead, policies and procedures, and geographic/demographic patterns are also a focus. The survey was distributed to 120 hospitals throughout the United States and responses were received from 29 states. Overall response rate was 58 percent, with 53 percent of the surveys fully completed. Sixty-three percent of hospitals had an individual responsible for pediatric-specific disaster planning and 78 percent specifically addressed the care of pediatric patients (<16 yo) in their disaster plan. The hospitals with an individual designated for pediatric disaster planning were more likely to have a disaster plan that specifically addresses the care of pediatric patients (90 percent vs 56 percent; p = 0.015), to represent children with special healthcare needs as simulated patients in disaster exercises (73 percent vs 22 percent; p = 0.003), and to include pediatric decontamination procedures in disaster exercises (78 percent vs 35 percent; p = 0.008) than hospitals without a designated pediatric disaster planner. The majority of hospitals surveyed incorporate pediatric patients into their disaster preparedness plan. Those hospitals with an individual designated for pediatric disaster planning were more likely to specifically address the care of pediatric patients in their institutional disaster plan.

Exploring communication media options in an inter-organizational disaster response coordination network using agent-based simulation

Large-scale disasters require rapid, well-coordinated responses from many organizations. This coordination involves extensive communication about specific needs, resource availability, optimal sizes and packaging of goods, and location and timing of deliveries. Faster, more accurate communication within the disaster response network translates to more effective response at the disaster site. This article presents a modeling project that assessed the effects of distinct communication media on response times within a centralized network. In the United States, the Federal Emergency Management Agency (FEMA) provides support and coordination among numerous responding agencies. An initial agent-based simulation model incorporated data from participant interviews and FEMA documentation about communication processes among response organization representatives. This model tracked effects of meetings, meeting scheduling, and bulletins on time required to complete the processing of requests. Following a second round of interviews and detailed observations during a national disaster exercise, we built a second agent-based simulation model that varied usage of email, phone, and face-to-face communications alongside a centralized information system and tracked the processing of anticipated, standard, and non-standard resource requests. Results show significant effects of different combinations of communication media on response times. Recommendations based on the study include: resist the temptation to schedule more than one meeting per day; use bulletins to disseminate information updates; supplement the centralized information system with direct interpersonal communication media such as email; and for unusual or difficult requests enable representatives to have in-person conversations or the closest alternative such as video teleconferencing with screen-sharing.

Construct A Disaster Resilience Measuring Framework for Hospital Buildings

As described by the Delhi Medical School, hospital catastrophe resilience is " hospital resilience is its capacity to withstand, absorb, and react to calamities while keeping and expanding lifesaving services, and then recover or adapt to its previous form." The purpose of this article is to provide a method by which the disaster preparedness of hospitals may be evaluated as a whole. Following a comprehensive literature search and Modified-Delphi consultation, A suggested assessment approach was established to quantify hospital resilience. Emergency services and surge capacity; recovery and adaptation procedures; emergency preparedness; command, communication, and cooperation system; disaster plan; resource stockpile; staff capabilities; disaster training and exercises; hospital security; these are the eight critical areas mentioned. Using a specialized questionnaire, data were gathered from 41 tertiary hospitals in India Shandong Province for this research. The framework's fundamental structure was determined using factor analysis.

Meta-evaluation of published studies on evaluation of health disaster preparedness exercises through a systematic review.

OBJECTIVE:Exercise evaluation is one of the most important steps and sometimes neglected in designing and taking exercises, in this stage of exercise, it systematically identifying, gathering, and interpreting related information to indicate how an exercise has fulfilled its objectives. The present study aimed to assess the most important evaluation techniques applied in evaluating health exercises for emergencies and disasters.METHODS:This was meta-evaluation study through a systematic review. In this research, we searched papers based on specific and relevant keywords in research databases including ISI web of science, PubMed, Scopus, Science Direct, Ovid, ProQuest, Wiley, Google Scholar, and Persian database such as ISC and SID. The search keywords and strategies are followed; “simulation,” “practice,” “drill,” “exercise,” “instrument,” “tool,” “questionnaire,” “ measurement,” “checklist,” “scale,” “test,” “inventory,” “battery,” “evaluation,” “assessment,” “appraisal,” “emergency,” “disaster,” “cricise,” “hazard,” “catastrophe,: “hospital”, “prehospital,” “health centers,” “treatment centers,” were used in combination with Boolean operators OR and AND.RESULTS:The research findings indicate that there are different techniques and methods for data collection to evaluate performance exercises of health centers and affiliated organizations in disasters and emergencies including debriefing inventories, self-report, questionnaire, interview, observation, shooting video, and photographing, electronic equipment which can be individually or collectively used depending on exercise objectives or purposes.CONCLUSION:Taking exercise in the health sector is one of the important steps in preparation and implementation of disaster risk management programs. This study can be thus utilized to improve preparedness of different sectors of health system according to the latest available evaluation techniques and methods for better implementation of disaster exercise evaluation stages.

Implementing a Disaster Preparedness Curriculum for Medical Students.

Training in disaster medicine and preparedness is minimal or absent in the curricula of many medical schools in the United States. Despite a 2003 joint recommendation by the Association of American Medical Colleges and the Centers for Disease Control and Prevention, few medical schools require disaster training for medical students. The challenges of including disaster training in an already rigorous medical school curriculum are significant. We evaluated medical students' experiences with mandatory disaster training during a 2-year period in a medical university setting. Disaster training has been mandatory at Thomas Jefferson University since 2002 and requires all first-year medical students to attend lectures, undergo practical skills simulation training, and participate in the hospital's interdisciplinary disaster exercise. Medical students were encouraged to complete a survey after each component of the required training. Twenty-three survey questions focused on assessing students' experiences and opinions of the training, including evaluation of the disaster exercise. Students provided ratings on a 5-point Likert scale (5 = strongly agree, 1 = strongly disagree). A total of 503 medical students participated in the disaster preparedness curriculum during the course of 2 years. Survey response rates were high for each portion of the training: lectures (91%), skills sessions (84%), and disaster exercise (100%). Students believed that disaster preparedness should remain part of the medical school curriculum (rating 4.58/5). The disaster lectures were considered valuable (rating 4.26/5) and practical skills sessions should continue to be part of the first-year curriculum (4.97/5). Students also believed that participation in the disaster exercise allowed them to better understand the difficulties faced in a real disaster situation (4.2/5). Our mandatory disaster preparedness training course was successfully integrated into the first-year curriculum >10 years ago and has been well received by students without compromising the existing university curriculum. Integrating interdisciplinary teams and course components important to other education stakeholders may help other schools overcome obstacles to implementing disaster medicine training. Future education research should focus on developing interdisciplinary education to help disseminate disaster medicine topics across all 4 years of medical school.

Twenty Challenges in Incident Planning

AbstractDisasters create overwhelming demands to affected communities and pose unique problems that complicate efforts of orchestrating the response. It is in such environments of uncertainty, operational friction, time-constraints and the need for interagency coordination that disaster and crisis managers are required to develop incident plans to address multiple demands. Based on observations from 50 disaster exercises, we have identified twenty critical points in incident planning, that is, those incident planning activities which are most challenging for emergency managers, are poorly implemented or otherwise constitute an area for improvement. The most challenging components of the incident planning process were information gathering from the field, running estimates of the situation, response-generated demands, resource capabilities and mobilization time, course of action development and analysis, and decision-making under uncertainty. In addition, this study identified three good practices in incident planning. First, the process is iterative and planners revisit several steps in a back-and-forth fashion. Second, both rational and intuitive decision-making processes are likely to be used during the course of any one incident, based on the time available for planning. Third, better plans are produced when flexibility is built into courses of action to address expected developments of situation or when decision-making is decentralized.

Disaster preparedness among nurses: a systematic review of literature.

This review explored peer-reviewed publications that measure nurses' preparedness for disaster response. The increasing frequency of disasters worldwide necessitates nurses to adequately prepare to respond to disasters to mitigate the negative consequences of the event on the affected population. Despite growing initiatives to prepare nurses for any disasters, evidence suggests they are under prepared for disaster response. This is a systematic review of scientific articles conducted from 2006 to 2016 on nurses' preparedness for disasters. SCOPUS, MEDLINE, PubMed, CINAHL and PsychINFO were the primary databases utilized for search of literature. Keywords used in this review were as follows: 'emergency', 'disaster', 'disaster preparedness', 'disaster competencies', 'disaster nursing', 'disaster role' and 'nurse'. Seventeen (17) articles were selected for this review. Factors that increase preparedness for disaster response include previous disaster response experience and disaster-related training. However, it is widely reported that nurses are insufficiently prepared and do not feel confident responding effectively to disasters. The findings of this review contribute to a growing body of knowledge regarding disaster preparedness in nurses and have implications for academia, hospital administration and nursing educators. The findings of this review provide evidence that could be used by nurse educators and nurse administrators to better prepare nurses for disaster response. The findings from this review place an emphasis on hospitals to implement policies to address lack of preparedness among their employees. Furthermore, this review highlights the benefit of further research and provision of well-grounded disaster exercises that mimic actual events to enhance the preparedness of the nursing workforce.

K116) An Objective Comparison of the START Triage Protocols and the Sacco Triage Method

objective:The objective of this study was to compare the operational viability and performance of the Sacco Triage Method (STM) to that of the Simple Triage and Rapid Treatment (START) protocol.Methods:Following a 20-minute review of the mandated START protocol and a 20-minute training session of STM, parallel disaster exercises were conducted. Emergency responded used START in the morning and STM in the afternoon on a simulated building collapse involving 99 victims. Data were collected on the accuracy of patient assessment (START) and scoring (STM), the timeliness in clearing the scene, and me prioritization of patients leaving the scene.Results:The STM scoring was more accurate than START assessments at 91.7% and 71.0%, respectively. The time to clear the scene was 16% less using STM than START (53 minutes and 63 minutes, respectively). The 13 most seriously injured patients left the scene in the first seven ambulances using STM; while only two of the 13 most seriously injured patients left the scene in the first 13 ambulances under START, and the three most serious patients were transported by bus. Surveyed providers preferred START to STM and believed it to be more accurate, faster, and better able to identify the most serious patients.Conclusions:Emergency responders did not implement START successfully Despite refresher training and 12 years of using START as their statewide protocol, tagging was inaccurate and patient prioritization was poor. In comparison, STM was implemented after 20 minutes of introductory training, was shown to be operationally viable, and outperformed START in all objectives.

Utilization of Functional Exercises to Build Regional Emergency Preparedness among Rural Health Organizations in the US.

Rural communities face barriers to disaster preparedness and considerable risk of disasters. Emergency preparedness among rural communities has improved with funding from federal programs and implementation of a National Incident Management System. The objective of this project was to design and implement disaster exercises to test decision making by rural response partners to improve regional planning, collaboration, and readiness. Six functional exercises were developed and conducted among three rural Nebraska (USA) regions by the Center for Preparedness Education (CPE) at the University of Nebraska Medical Center (Omaha, Nebraska USA). A total of 83 command centers participated. Six functional exercises were designed to test regional response and command-level decision making, and each 3-hour exercise was followed by a 3-hour regional after action conference. Participant feedback, single agency debriefing feedback, and regional After Action Reports were analyzed. Functional exercises were able to test command-level decision making and operations at multiple agencies simultaneously with limited funding. Observations included emergency management jurisdiction barriers to utilization of unified command and establishment of joint information centers, limited utilization of documentation necessary for reimbursement, and the need to develop coordinated public messaging. Functional exercises are a key tool for testing command-level decision making and response at a higher level than what is typically achieved in tabletop or short, full-scale exercises. Functional exercises enable evaluation of command staff, identification of areas for improvement, and advancing regional collaboration among diverse response partners. Obaid JM , Bailey G , Wheeler H , Meyers L , Medcalf SJ , Hansen KF , Sanger KK , Lowe JJ . Utilization of functional exercises to build regional emergency preparedness among rural health organizations in the US. Prehosp Disaster Med. 2017;32(2):224-230.

Liberia national disaster preparedness coordination exercise: Implementing lessons learned from the West African disaster preparedness initiative.

In light of the recent Ebola outbreak, there is a critical need for effective disaster management systems in Liberia and other West African nations. To this end, the West Africa Disaster Preparedness Initiative held a disaster management exercise in conjunction with the Liberian national government on November 24-25, 2015. During this tabletop exercise (TTX), interactions within and between the 15 counties and the Liberian national government were conducted and observed to refine and validate the county and national standard operating procedures (SOPs). The exercise took place in three regional locations throughout Liberia: Monrovia, Buchanan, and Bong. The TTX format allowed counties to collaborate utilizing open-source software platforms including Ushahidi, Sahana, QGIS, and KoBoCollect. Four hundred sixty-seven individuals (representing all 15 counties of Liberia) identified as key actors involved with emergency operations and disaster preparedness participated in the exercise. A qualitative survey with open-ended questions was administered to exercise participants to determine needed improvements in the disaster management system in Liberia. Key findings from the exercise and survey include the need for emergency management infrastructure to extend to the community level, establishment of a national disaster management agency and emergency operations center, customized local SOPs, ongoing surveillance, a disaster exercise program, and the need for effective data sharing and hazard maps. These regional exercises initiated the process of validating and refining Liberia's national and county-level SOPs. Liberia's participation in this exercise has provided a foundation for advancing its preparedness, response, and recovery capacities and could provide a template for other countries to use.

Transmission of dental data on a microdotted paper-based dental chart from a digital pen – trial operations at disaster exercise sites and at a landslide disaster at Hiroshima City

ABSTRACTIn Japan, dental charting following a disaster is performed by handwriting the information on a paper-based dental chart before manual input into a computer database. Even if available, radiographic facial or intraoral images, regardless of whether they are analogue or digital, must be stored separately from the dental chart. To create a comprehensive and more permanent database accessible worldwide, we developed a system employing digital pens with image microprocessors. This system digitizes and records characters and drawings as they are being handwritten on a microdotted-paper-based post-mortem dental chart. Data stored in the built-in memory of the digital pen are transferred to a computer or tablet via Bluetooth. Using a cognitive wireless router, the information is relayed to a remote data centre. Radiographic and other images are also transferred into the same folder under a unique ID number. After several practical field tests, the system was employed at a landslide disaster in Hiroshima City. Data transfer was excellent, confirming the efficacy of the new system. This system enables data in any language to be quickly stored in the database, facilitating worldwide searches for missing persons by matching with ante-mortem dental records. The new system saves labour, helps prevent misidentification, and significantly expedites identification processes following a mass disaster.

If Only We Knew What We Know: Factors for Mobilizing Citizen Participation in Community-based Emergency Preparedness

Emergency management typically consists of four phases: mitigation, preparedness, response, and recovery. Citizen participation is recognized as key to these four phases, and local governments are responsible for promoting authentic citizen participation in all phases. Many studies have asserted the importance of citizen participation in improving the capabilities of community-based emergency response and recovery, yet studies on citizen activities and participation in the pre-disaster process are relatively limited. In practice, increasing citizen preparedness for disasters has presented a challenge to local emergency management agencies. In Taiwan, the approaches employed by local emergency management agencies for mobilizing citizens to participate in emergency management activities are often considered in isolation from their other administrative duties. To fill this gap, this study examines factors for mobilizing citizens in disaster exercises from the perspective of local fire branch heads. Using survey data collected from Southern Taiwan in 2013, we found that the capacity of local fire branches to provide emergency communications and information delivery, as well as pre-disaster risk assessment and alert systems, is critical for enhancing citizen participation in the local emergency preparedness process.

Low Compliance of Urgent Care Centers in the United States With Recommendations for Office-Based Disaster Preparedness

The aim of the study was to determine the compliance of urgent care centers in the United States with published recommendations for office-based disaster preparedness. An electronic questionnaire was distributed to urgent care center administrators as identified by the American Academy of Urgent Care Medicine directory. One hundred twenty-two questionnaires of the 872 distributed were available for analysis (14% usable response rate). Twenty-seven percent of centers have an established disaster plan for events that involve their establishment and surrounding community; 49% practice the plan at least once a year, 19% less frequent than once a year, and 32% never practice. Forty-seven percent of centers are familiar with designated emergency shelters and community evacuation plans. Seventeen percent of centers function as part of a surveillance system to provide early detection of any biologic/chemical/nuclear agents. Twenty-two percent of centers take part in local community and hospital disaster planning, exercises, and drills through emergency medical services and public health systems. Five percent of centers aid schools, child care centers, camps, and other child congregate facilities in disaster planning. Twenty-eight percent of centers have an assembled emergency/disaster kit, containing such items as water, first aid supplies, radios, flashlights, batteries, heavy-duty gloves, food, and sanitation supplies. Areas for improvement in urgent care center disaster preparedness were identified, such as developing an office disaster plan that is practiced at least yearly, becoming familiar with designated emergency shelters and community evacuation plans, providing surveillance to detect potential acts of terrorism, assisting community organizations (hospitals, schools, child care centers, etc) in disaster planning, and assembling office emergency/disaster kits.

Disaster Olympics: A Model for Resident Education.

The aim of this study was to describe an educational method teaching Disaster Medicine to American Emergency Medicine (EM) physicians and to evaluate knowledge attainment using this method. This was an observational study using a pre-test and a post-test. A full-scale disaster exercise (FSE) was conducted at a large academic center with two hospitals in Brooklyn, New York (USA). Eighty-two EM residents (physicians in training, post medical school) participated in the study. Inclusion criteria for study participation was all EM residents training at the State University of New York (SUNY) Downstate at the time of the study. There were no exclusion criteria. The exercise was a disaster drill designed as "Olympic Games." Participants in the exercise took a pre-test and a post-test. The primary outcome of the study was the mean difference between pre-test and post-test scores of the study participants using independent sample t-tests. Secondary outcomes of the study were percent of critical actions met by the residents and the hospitals as measured by direct observation of trained study personnel during the exercise. Mean resident post-test scores were higher than pre-test scores to a degree that was statistically significant (62% versus 53%; P =.002). The residents' performances ranged from 48% to 63% of objectives met. The hospitals' performances met 50% to 100% of their objectives. The use of an Olympic Games format was an effective model for disaster education for physicians. The model allowed for evaluation of performance and protocols of participants and hospital systems, respectively, and may be used objectively to evaluate for areas of improvement. The Disaster Olympics drill was found to improve emergency preparedness knowledge in the population studied and may constitute a novel and efficacious methodology in disaster training. Daniel P , Gist R , Grock A , Kohlhoff S , Roblin P , Arquilla B . Disaster Olympics: a model for resident education. Prehosp Disaster Med. 2016;31(3):237-241.

Use of Medical Reserve Corps Volunteers in a Hospital-based Disaster Exercise.

Introduction The Medical Reserve Corps (MRC) is a national network of community-based volunteer groups created in 2002 by the Office of the United States Surgeon General (Rockville, Maryland USA) to augment the nation's ability to respond to medical and public health emergencies. However, there is little evidence-based literature available to guide hospitals on the optimal use of medical volunteers and hesitancy on the part of hospitals to use them. Hypothesis/Problem This study sought to determine how MRC volunteers can be used in hospital-based disasters through their participation in a full-scale exercise. A full-scale exercise was designed as a "Disaster Olympics," in which the Emergency Medicine residents were divided into teams tasked with completing one of the following five challenges: victim decontamination, mass casualty/decontamination tent assembly, patient triage and registration during a disaster, point of distribution (POD) site set-up and operation, and infection control management. A surge of patients potentially exposed to avian influenza was the scenario created for the latter three challenges. Some MRC volunteers were assigned clinical roles. These roles included serving as members of the suit support team for victim decontamination, distributing medications at the POD, and managing infection control. Other MRC volunteers functioned as "victim evaluators," who portrayed the potential avian influenza victims while simultaneously evaluating various aspects of the disaster response. The MRC volunteers provided feedback on their experience and evaluators provided feedback on the performance of the MRC volunteers using evaluation tools. Twenty-eight (90%) MRC volunteers reported that they worked well with the residents and hospital staff, felt the exercise was useful, and were assigned clearly defined roles. However, only 21 (67%) reported that their qualifications were assessed prior to role assignment. For those MRC members who functioned as "victim evaluators," nine identified errors in aspects of the care they received and the disaster response. Of those who evaluated the MRC, nine (90%) felt that the MRC worked well with the residents and hospital staff. Ten (100%) of these evaluators recommended that MRC volunteers participate in future disaster exercises. Through use of a full-scale exercise, this study was able to identify roles for MRC volunteers in a hospital-based disaster. This study also found MRC volunteers to be uniquely qualified to serve as "victim evaluators" in a hospital-based disaster exercise. Gist R , Daniel P , Grock A , Lin C , Bryant C , Kohlhoff S , Roblin P , Arquilla B . Use of Medical Reserve Corps volunteers in a hospital-based disaster exercise. Prehosp Disaster Med. 2016;31(3):259-262.

Evacuation performance evaluation tool.

Hospitals conduct evacuation exercises to improve performance during emergency events. An essential aspect in this process is the creation of reliable and valid evaluation tools. The objective of this article is to describe the development and implications of a disaster evacuation performance tool that measures one portion of the very complex process of evacuation. Through the application of the Delphi technique and DeVellis's framework, disaster and neonatal experts provided input in developing this performance evaluation tool. Following development, content validity and reliability of this tool were assessed. Large pediatric hospital and medical center in the Midwest. The tool was pilot tested with an administrative, medical, and nursing leadership group and then implemented with a group of 68 healthcare workers during a disaster exercise of a neonatal intensive care unit (NICU). The tool has demonstrated high content validity with a scale validity index of 0.979 and inter-rater reliability G coefficient (0.984, 95% CI: 0.948-0.9952). The Delphi process based on the conceptual framework of DeVellis yielded a psychometrically sound evacuation performance evaluation tool for a NICU.

Evaluation of Disaster Preparedness Based on Simulation Exercises: A Comparison of Two Models.

The objective of this study was to highlight 2 models, the Hospital Incident Command System (HICS) and the Disaster Management Indicator model (DiMI), for evaluating the in-hospital management of a disaster situation through simulation exercises. Two disaster exercises, A and B, with similar scenarios were performed. Both exercises were evaluated with regard to actions, processes, and structures. After the exercises, the results were calculated and compared. In exercise A the HICS model indicated that 32% of the required positions for the immediate phase were taken under consideration with an average performance of 70%. For exercise B, the corresponding scores were 42% and 68%, respectively. According to the DiMI model, the results for exercise A were a score of 68% for management processes and 63% for management structure (staff skills). In B the results were 77% and 86%, respectively. Both models demonstrated acceptable results in relation to previous studies. More research in this area is needed to validate which of these methods best evaluates disaster preparedness based on simulation exercises or whether the methods are complementary and should therefore be used together. (Disaster Med Public Health Preparedness. 2016;10:544-548).

Enhancing disaster preparedness of specialty nurses on a national scale

Purpose – The number of disasters has increased by 30 per cent worldwide in the past 30 years. Nurses constitute the largest clinical group within a hospital and their ability to respond to disasters is crucial to the provision of quality patient care. The purpose of this paper is to evaluate a four-year disaster preparedness partnership between two tertiary hospitals from the perspective of executive staff, senior clinical managers and specialist nurses. The national disaster response centre was situated in one hospital and the other hospital was located 3,500 km away. Design/methodology/approach – The intervention involved selected nurses working at the partner hospital to enable familiarisation with policies, procedures and layout in the event of a request for back-up in the event of a national disaster. A mixed-methods design was used to elicit the strengths and limitations of the partnership. Surveys, in-depth interviews and focus groups were used. Findings – In total, 67 participants provided evaluations including ten executive staff, 17 clinical management nurses and 38 nurses from the disaster response team. Improvements in some aspects of communication were recommended. The successful recruitment of highly skilled and committed nurses was a strength. A disaster exercise resulted in 79 per cent of nurses, able and willing to go immediately to the partner hospital for up to 14 days. Research limitations/implications – During the four year partnership, no actual disaster occurred that required support. This limited the ability to fully trial the partnership in an authentic manner. The disaster exercise, although helpful in trialling the processes and assessing nurse availability, it has some limitations. Originality/value – This innovative partnership successfully prepared specialist nurses from geographically distant hospitals for a disaster response. This together with a willingness to be deployed enhanced Australia’s capacity in the event of a disaster.

Examining Coordination in Disaster Response Using Simulation Methods

Abstract Purpose of the research is to examine coordination in disaster response by computer simulation using Petri net. We addressed issues on coordination in disaster response by focusing on interorganizational processes. Defining the processes according to disaster exercise, we developed the model based on Stochastic Petri Net. Index items, including average delay time and busyness probability, were introduced to facilitate discussion. Simulation demonstrated utilization of process analysis in performance assessment of collaborative disaster response. Since fragmentation is critical factor hindering efficient response, its remedy or elimination should be focused for system optimization.

Development of a disaster preparedness curriculum for medical students: a pilot study of incorporating local events into training opportunities.

Contemporary disasters, like the outbreak of Ebola in West Africa, have piqued the interest of medical students in disaster preparedness. The topic is also a requirement of undergraduate medical education.(1) Yet current literature suggests that disaster preparedness education is lacking. Our objective was to pilot a curriculum to augment medical students' disaster preparedness education by marshalling local resources to provide practical hands-on experiences. This pilot curriculum consisted of lectures; simulations; asynchronous learning materials; a large-scale, regional disaster exercise; and preparation for and participation in a real-time mass gathering. Outcomes were measured by student performance on written tests and evaluations of each activity. Academic Health Center with associated medical school. Fifty-two medical students participated in at least one of the six activities during this voluntary pilot program. Premedical students and residents (n=57) participated in some activities. Forty-one medical students took either the pretest or the post-test over the curriculum. Only eight students took both. A paired t test comparing pretest to post-test scores using imputed missing data (t=-11.72, df=40, p≤0.001) was consistent with an analysis using only complete data (t=-2.35, df=7, p=0.05), implying that student scores improved significantly over time. Evaluations indicated a student preference for hands-on over didactic or independent learning activities. This pilot curriculum was designed to capitalize on practical hands-on training opportunities for our medical students, including participation in a disaster exercise and a mass-gathering event. These opportunities provided effective and engaging disaster preparedness education.