Emergency Response Training Research Articles

Community-based first aid: a program report on the intersection of community-based participatory research and first aid education in a remote Canadian Aboriginal community

Community-based first aid training is the collaborative development of locally relevant emergency response training. The Sachigo Lake Wilderness Emergency Response Education Initiative was developed, delivered, and evaluated through two intensive 5-day first aid courses. Sachigo Lake First Nation is a remote Aboriginal community of 450 people in northern Ontario, Canada, with no local paramedical services. These courses were developed in collaboration with the community, with a goal of building community capacity to respond to medical emergencies. Most first aid training programs rely on standardized curriculum developed for urban and rural contexts with established emergency response systems. Delivering effective community-based first aid training in a remote Aboriginal community required specific adaptations to conventional first aid educational content and pedagogy. Three key lessons emerged during this program that used collaborative principles to adapt conventional first aid concepts and curriculum: (1) standardized approaches may not be relevant nor appropriate; (2) relationships between course participants and the people they help are relevant and important; (3) curriculum must be attentive to existing informal and formal emergency response systems. These lessons may be instructive for the development of other programs in similar settings.

Analysis of the resilience of team performance during a nuclear emergency response exercise

The current work presents results from a cognitive task analysis (CTA) of a nuclear disaster simulation. Audio-visual records were collected from an emergency room team composed of individuals from 26 different agencies as they responded to multiple scenarios in a simulated nuclear disaster. This simulation was part of a national emergency response training activity for a nuclear power plant located in a developing country. The objectives of this paper are to describe sources of resilience and brittleness in these activities, identify cues of potential improvements for future emergency simulations, and leveraging the resilience of the emergency response system in case of a real disaster. Multiple CTA techniques were used to gain a better understanding of the cognitive dimensions of the activity and to identify team coordination and crisis management patterns that emerged from the simulation exercises.

Disaster Medicine and Public Health Preparedness of Health Professions Students: A Multidisciplinary Assessment of Knowledge, Confidence, and Attitudes

This study assessed disaster medicine knowledge and competence and perceived self-efficacy and motivation for disaster response among medical, nursing, and dental students. Survey methodology was used to evaluate knowledge, comfort, perceived competency, and motivation. Also, a nonresponder survey was used to control for responder bias. A total of 136 responses were received across all 3 schools. A nonresponder survey showed no statistical differences with regard to age, gender, previous presence at a disaster, and previous emergency response training. In spite of good performance on many knowledge items, respondent confidence was low in knowledge and in comfort to perform in disaster situations. Knowledge was strong in areas of infection control, decontamination, and biological and chemical terrorism but weak in areas of general emergency management, role of government agencies, and radiologic events. Variations in knowledge among the different health professions were slight, but overall the students believed that they required additional education. Finally, students were motivated not only to acquire more knowledge but to respond to disaster situations. Health care students must be adequately educated to assume roles in disasters that are a required part of their professions. This education also is necessary for further disaster medicine education in either postgraduate or occupational education. As students' performance on knowledge items was better than their perceived knowledge, it appears that a majority of this education can be achieved with the use of existing curricula, with minor modification, and the addition of a few focused subjects, which may be delivered through novel educational approaches.

Simulation fidelity and contextual interference in helicopter underwater egress training: An analysis of training and retention of egress skills

In an effort to explore influencing factors related to survival, the following paper outlines an argument to incorporate more realistic simulator fidelity, contextual interference (CI), and skill acquisition during helicopter underwater egress training for the offshore oil and gas industry. Previous skill acquisition research is used to frame specific forms of training while highlighting the differences in current methodological approaches that may influence survival following a ditching. By examining distinct domains, a discussion of fidelity (physical and cognitive) and CI (i.e., making the training more memorable by increasing the difficulty and variability of tasks in a random order) is grounded in performance outcomes from real-world helicopter ditchings reports from 2000 to 2011. Based on the ditching event evidence gained from 97 accident reports, recommendations are made for increasing the level of fidelity and CI during this specialized emergency response training program. The accident reports are also used to develop a list of tasks that should be completed in three distinct phases of an event and should be considered in the preparation of offshore workers for a real-world ditching.

Evaluation of Strategic Emergency Response Training on an OLIVE Platform

Virtual worlds provide a new methodological framework for conducting emergency response exercises. The research attempts to evaluate whether the use of virtual worlds avoids recognized weaknesses of traditional emergency response exercises and facilitates further learning outcomes. The objectives of the article include, first, to examine whether the virtual worlds contribute to learning experiences for the emergency response exercises; second, to use a case study to evaluate and synthesize preliminary findings of the strategic flood response exercise; and third, to make recommendations for conducting a larger scale emergency response in an online Virtual Learning Environment. The preliminary findings suggest that the use of virtual worlds could potentially facilitate better learning outcomes and provide as an effective training methodology to the emergency communities. It also identifies the challenges of developing virtual world exercises, for instance, the need for better collaboration and communication between developers, academics, and end users.

Improvement of the Normative-Regulatory Framework Concerning Anti-Epidemic Procedures for Works with Infectious Disease Agents in Mobile Laboratories of Specialized Anti-Epidemic Teams (SAET)

Carried out is a range of investigations aimed at the improvement of the anti-epidemic procedures for works with infectious disease agents (herein biological safety provision) in mobile laboratories of specialized anti-epidemic teams (SAET). Evaluation of the operational experience of stationary and field laboratories, as well as comparative analysis of the national safety requirements for works with pathogenic biological agents and WHO international regulations in the sphere of biological safety provision in laboratories, has made it possible to outline common for all types of microbiological laboratories principles for biosafety provision. With due consideration of these principles formulated are the core requirements for the provision of biological safety of SAET activities. Based on the results of biorisk and biohazard assessment which have to do with innovative mobile laboratories, worked out is a system of anti-epidemic procedures aimed towards establishment of the conditions that offer as low as practically achievable level of risk for personnel of SAET mobile laboratories, for population and human environment too. These practices, designed for biological safety provision among the personnel of mobile laboratories (ML), have been played back in a number of standard operational procedures. With a view to establishing of the environment with acceptable level of biorisk for the personnel and population when ML are used for various purposes and in various contingencies (in full force, single unit or several modules), worked out are the algorithms of decision-making support as regards selection of modules and optional accessories. However, there is a need for emergency response plans and training programs for the personnel on the provision of biosafety in ML to ensure and maintain acceptable level of biorisk connected with ML functioning.

Nonclinical Core Competencies and Effects of Interprofessional Teamwork in Disaster and Emergency Response Training and Practice: A Pilot Study

To define and delineate the nontechnical core competencies required for disaster response, Disaster Medical Assistance Team (DMAT) members were interviewed regarding their perspectives and experiences in disaster management. Also explored was the relationship between nontechnical competencies and interprofessional collaboration. In-depth interviews were conducted with 10 Canadian DMAT members to explore how they viewed nontechnical core competencies and how their experiences influenced their perceptions toward interprofessonalism in disaster response. Data were examined using thematic analysis. Nontechnical core competencies were categorized under austere skills, interpersonal skills, and cognitive skills. Research participants defined interprofessionalism and discussed the importance of specific nontechnical core competencies to interprofessional collaboration. The findings of this study established a connection between nontechnical core competencies and interprofessional collaboration in DMAT activities. It also provided preliminary insights into the importance of context in developing an evidence base for competency training in disaster response and management. (Disaster Med Public Health Preparedness. 2013;0:1-8).

The epidemiology and surveillance response to pandemic influenza A (H1N1) among local health departments in the San Francisco Bay Area.

BackgroundPublic health surveillance and epidemiologic investigations are critical public health functions for identifying threats to the health of a community. Very little is known about how these functions are conducted at the local level. The purpose of the Epidemiology Networks in Action (EpiNet) Study was to describe the epidemiology and surveillance response to the 2009 pandemic influenza A (H1N1) by city and county health departments in the San Francisco Bay Area in California. The study also documented lessons learned from the response in order to strengthen future public health preparedness and response planning efforts in the region.MethodsIn order to characterize the epidemiology and surveillance response, we conducted key informant interviews with public health professionals from twelve local health departments in the San Francisco Bay Area. In order to contextualize aspects of organizational response and performance, we recruited two types of key informants: public health professionals who were involved with the epidemiology and surveillance response for each jurisdiction, as well as the health officer or his/her designee responsible for H1N1 response activities. Information about the organization, data sources for situation awareness, decision-making, and issues related to surge capacity, continuity of operations, and sustainability were collected during the key informant interviews. Content and interpretive analyses were conducted using ATLAS.ti software.ResultsThe study found that disease investigations were important in the first months of the pandemic, often requiring additional staff support and sometimes forcing other public health activities to be put on hold. We also found that while the Incident Command System (ICS) was used by all participating agencies to manage the response, the manner in which it was implemented and utilized varied. Each local health department (LHD) in the study collected epidemiologic data from a variety of sources, but only case reports (including hospitalized and fatal cases) and laboratory testing data were used by all organizations. While almost every LHD attempted to collect school absenteeism data, many respondents reported problems in collecting and analyzing these data. Laboratory capacity to test influenza specimens often aided an LHD’s ability to conduct disease investigations and implement control measures, but the ability to test specimens varied across the region and even well-equipped laboratories exceeded their capacity. As a whole, the health jurisdictions in the region communicated regularly about key decision-making (continued on next page) (continued from previous page) related to the response, and prior regional collaboration on pandemic influenza planning helped to prepare the region for the novel H1N1 influenza pandemic. The study did find, however, that many respondents (including the majority of epidemiologists interviewed) desired an increase in regional communication about epidemiology and surveillance issues.ConclusionThe study collected information about the epidemiology and surveillance response among LHDs in the San Francisco Bay Area that has implications for public health preparedness and emergency response training, public health best practices, regional public health collaboration, and a perceived need for information sharing.

A Focus on Fire Fundamentals Including Emergency Response Training at the National Fire Agency in Taiwan

This article reflects on process safety fundamentals of fires and explosions for the benefit of new professionals entering the field. It provides a brief review of fire fundamentals such as the fire triangle and the respect that must be paid to the unknown ignition source. Various control methods are reviewed at the elementary level, including the reminder that the ignition source is always free. After a review of fire fundamentals, an emergency response training exercise is presented for a burning propane fire witnessed at a training facility in Taiwan. The National Fire Agency of Taiwan has built the third largest emergency response‐training center in the world. The 270 acres facility is located in central Taiwan near Taichung, Taiwan. The site has 49 separate emergency response training scenarios. Scenario pads include training for fire attack on mock‐ups of chemical storage facilities, tanker trucks, power transformers, passenger airliners, and shipping vessels. Overall, this article serves as a reminder of the safe guards used in fire safety and the importance of training beforehand in the event of an emergency. © 2013 American Institute of Chemical Engineers Process Saf Prog 32: 2–7, 2013

Disaster Management in the Era of Lean Healthcare

Disaster Management in the Era of Lean Healthcare

The Virtual Emergency Response Training System of Earthquake on University Campus

In order to serve for emergency management of earthquake disaster reduction, based on the research area of University Town in Fuzhou, the paper analyzed crowd and space distribution characteristics in university campus as well as functional demand that university students perform emergency virtual walkthrough towards emergency, constructed emergency plan virtual walkthrough system for daily walkthrough and actual combat guidance; virtually deduced possible range damaged by earthquake disaster, confirmed spatial optimized layout distribution of emergency evacuation point, planned channel for emergency and evacuation to provide a scientific, simple, and vivid visible analytical means, emergency response preview education, test verification, and decision aid support for event preview, emergency rescue, treatment, and decision, which greatly improves the efficiency of emergency treatment, enriches knowledge and experience of emergency, and promotes the learning ability of emergency management.

An assessment of the emergency response among health workers involved in the 2010 cholera outbreak in northern Nigeria

The 2010 cholera outbreak in northern Nigeria affected over 40,000 people, with a case fatality rate (CFR) of ≥3.75%. We assessed the emergency response of health care workers (HCWs) involved in case management. This was a cross-sectional study with data collected through a self-administered questionnaire. Data entry and analysis were performed using Epi info software. A total of 56 HCWs were interviewed. The mean age was 31 years (SD±8.16 years). The majority of the HCWs (80%; n=45) were aged 18-39 years. Most were community health extension workers (60%), and 3.6% (n=2) were medical doctors. Many of the HCWs had less than 2 years of work experience (42%). Additionally, 82% of the respondents had <1 week of cholera emergency response training, and 50% of the HCWs managed >20 suspected cases of cholera per day. Although 78% of HCWs reported the practice of universal safety precautions, 32% (n=18) knew HCWs who developed symptoms of cholera during the epidemic, most of which was believed to be hospital acquired (78%). We also found that 77% (n=43) of HCWs had no access to the required emergency response supplies. Inadequate training, a lack of qualified HCWs and a limited supply of emergency response kits were reported. Therefore, the government and stakeholders should address the gaps noted to adequately control and prevent future epidemics.

Context‐Specific, Scenario‐Based Risk Scales

Reacting to an emergency requires quick decisions under stressful and dynamic conditions. To react effectively, responders need to know the right actions to take given the risks posed by the emergency. While existing research on risk scales focuses primarily on decision making in static environments with known risks, these scales may be inappropriate for conditions where the decision maker's time and mental resources are limited and may be infeasible if the actual risk probabilities are unknown. In this article, we propose a method to develop context-specific, scenario-based risk scales designed for emergency response training. Emergency scenarios are used as scale points, reducing our dependence on known probabilities; these are drawn from the targeted emergency context, reducing the mental resources required to interpret the scale. The scale is developed by asking trainers/trainees to rank order a range of risk scenarios and then aggregating these orderings using a Kemeny ranking. We propose measures to assess this aggregated scale's internal consistency, reliability, and validity, and we discuss how to use the scale effectively. We demonstrate our process by developing a risk scale for subsurface coal mine emergencies and test the reliability of the scale by repeating the process, with some methodological variations, several months later.

Deadly Shooting Shocks Psychiatric Hospital

Back to table of contents Next article Professional NewsFull AccessDeadly Shooting Shocks Psychiatric HospitalAaron LevinAaron LevinSearch for more papers by this authorPublished Online:6 Apr 2012https://doi.org/10.1176/pn.47.7.psychnews_47_7_1-aAbstractA man wearing two wristwatches and carrying two 9mm handguns entered the Western Psychiatric Institute and Clinic (WPIC) in Pittsburgh on March 8, killing one employee and wounding seven other people before being shot to death by university police.Police officers walk out of Western Psychiatric Institute and Clinic March 8. A gunman opened fire at the psychiatric facility at the University of Pittsburgh in a shooting that killed two people, including the gunman, and wounded seven others. AP Photo/Pittsburgh Tribune-Review, Justin MerrimanThe dead employee was identified as Michael Schaab, 25, a therapist working on the geriatric unit. Names of the other wounded individuals and their affiliation, if any, with the clinic had not been released by hospital officials at press time. Four of the injured required surgery but all were expected to survive, said Donald Yealy, M.D., a professor and chair of emergency medicine at the University of Pittsburgh Medical Center (UPMC), in a news conference.“We are all deeply saddened by the tragic events yesterday and in particular the loss of one of our dedicated staff members and the injuries to others,” said Jeffrey Romoff, UPMC president and CEO, in a statement to employees.The incident began around 1:40 p.m. when the gunman entered the building lobby and began firing. University of Pittsburgh police in the area responded and exchanged fire with the suspect before killing him.UPMC Police Chief Tim Delaney credited his department’s community emergency response training, developed in the wake of the 2007 Virginia Tech shooting, for the prompt action by his officers.After some delay, the gunman was identified as John Shick, but as of press time, his motives were still unknown.He was a 2004 graduate of Carleton College in Minnesota with a degree in chemistry and was banned from the Duquesne University graduate program in biology after harassing female students last fall, according to the Pittsburgh Post-Gazette.Other news reports said that Shick had a violent encounter with police at the Portland, Ore., airport in 2009 that resulted in several assault charges and a commitment hearing there. He was ordered into psychiatric treatment for 180 days, but how long he remained in treatment has not been revealed.A UPMC spokeswoman would not disclose whether Shick had ever been a patient at the clinic, citing privacy laws. She also would not confirm news reports that a “doctor or psychiatrist” was among the injured. APA members who were asked for comment on the event referred Psychiatric News to UPMC’s media relations office, which declined to permit interviews.“Security will be reviewed thoroughly” in light of the shooting, said WPIC President Claudia Roth, Ph.D., at a news conference. The 310-bed hospital has 2,000 clinical staff members, she said.The facility now uses a metal detector at the entrance to its emergency department but not at the general entrance, where the incident began.Some psychiatric facilities use hand-held, metal-detecting wands to check patients and visitors for weapons or other contraband, said Scott Zeller, M.D., chief of psychiatric emergency services at the Alameda County Medical Center in Oakland, Calif., and president of the American Academy for Emergency Psychiatry.“At our dedicated psychiatric campus we wand all patients on arrival to the hospital and also wand all visitors prior to entry into patient-care areas,” said Zeller in an interview.However, it is not clear if such precautions would have stopped Shick, since he started shooting almost immediately after he entered the building.Shortly after the event, WPIC began providing support for staff, patients, and families in work areas and the lobby, with other teams circulating throughout the building, said Roth in a statement.About 300 staff members took part in group support sessions in the first five days. A drop-in support center for families and visitors of WPIC patients was set up and was staffed by members of the National Alliance on Mental Illness. The Web site for Western Psychiatric Institute and Clinic is www.upmc.com/HospitalsFacilities/Hospitals/wpic/Pages/default.aspx. ISSUES NewArchived

Integrating four-dimensional geographical information and mobile techniques into radiological accident emergency response training

When radiological accidents occur, radioactive material may spread into the atmosphere, causing large-scale and long-term contamination. To diminish the effects of such accidents, researchers from many countries have investigated training programs in emergency response to radiological accidents, especially in the wake of several serious radiological accidents. Although many training programs have been proposed, this study identifies two problems: the lack of effective data representation and the lack of complete training records. Therefore, by considering various requirements for relief and evacuation work at radiological accident sites, it integrates four-dimensional geographical information and mobile techniques to construct a training platform for radiological accident emergency response. During training, groups of participants learn to respond to simulated radiological accident scenarios. Moreover, participants can use the training platform to review and discuss training details. Judging by the results, the training platform has not only increased the effectiveness of training programs, but also complied with standard operating procedures for radiological accident emergency response in Taiwan. In conclusion, this study could serve as a useful reference for similar studies and applications.

(A325) Educational and Technical Considerations of Veterinary Personnel Involved in Animal Welfare during Disasters

Training and education of healthcare and government workers has long been accepted as integral to disaster preparedness, although, up until recently, veterinarians and veterinary paraprofessionals have not participated in such practices. It is well documented that when disasters occur, there are dramatic increases in the occurrence and spread of zoonotic diseases, significant contamination of food, water and soil, and reductions in food supply for both humans and animals. These effects reflect the interdependence of humans, animals and their environment, and the importance of managing animal health and welfare after such disasters. Currently, animal welfare emergency management (AWEM) is neither evidence-based nor standardized. Most veterinary schools do not include AWEM in their curriculum, even though AWEM is an essential part of the veterinary professions obligations to both animals and humans. With this gap identified, research was undertaken to derive educational competencies and objectives in criteria-based preparedness and responses that were relevant to veterinarians and veterinary paraprofessionals involved in AWEM. The results have been used to inform the development of Animal Emergency Response training for inclusion in both veterinary and veterinary paraprofessional curriculums. A systematic evidence-based consensus building method was used to derive the educational competences and objectives. This included the following steps: (1) review of peer-reviewed literature on relevant content areas and educational theory; (2)a review of existing competences and training objectives within other sectors involved in disaster management; (3) a survey of international experts and responders which produced qualitative and (4) quantative results development of competencies and testable objectives. The qualitative results showed that veterinarians and veterinary paraprofessionals require core competencies in all three groups and the four basic components of disaster management: mitigation, preparedness, response/emergency relief and recovery. A curriculum should cover all animals, companion, production and wild.

System dynamics modeling to optimize emergency responders’ emergency and nonemergency efforts: Case study of Air Force Bioenvironmental Engineering combating weapons of mass destruction response capabilities

Objectives: The authors applied a system dynamics model to the problem of optimizing the balance of emergency response training with routine work tasks using a case study of US Air Force Bioenvironmental Engineering units.Design: A system dynamics model was constructed using available work time inputs for emergency response training and routine task execution. The model generated estimates of task proficiency for emergency and routine tasks.Setting: The study was conducted using a case study of management of US Air Force Bioenvironmental Engineering units.Main outcome measures: The model generated estimates of task proficiency (0-100 percent) for emergency and nonemergency tasks based on time allocation policy inputs.Results: The optimal balance to maintain both emergency and nonemergency task proficiency at or above 70 percent was to have an intensive 2-week period of 35 h/wk devoted to emergency response training, followed by a constant 21 h/wk (52.5 percent of available effort) to emergency response training.Conclusions: The results reinforce the popular notion that an organization with a significant amount of effort devoted to routine tasks that differ from emergency response tasks will not be able to approach 100 percent readiness task proficiency without significant degradation of routine task proficiency. Synergy of routine task selection to enhance readiness proficiency is essential to maintain emergency response capabilities.

Sudden Cardiac Death of the Young in Michigan: Development and Implementation of a Novel Mortality Review System

Advances in screening, detection and treatment make Sudden Cardiac Death of the Young (SCDY) a potentially preventable condition. Since hereditary causes account for many deaths, identification of an affected individual has implications for immediate relatives; who should receive targeted screening with the aim of preventing SCDY. To develop a mortality review process for SCDY and to identify potential unmet needs for family-based, medical system and public health interventions. The Michigan Department of Community Health and Michigan State University developed a system for investigating SCDY. Review of medical records and next-of-kin (NOK) interviews were conducted. A de-identified summary of each case was presented to an expert panel. The panel identified factors that contributed to the death and possible actions to prevent future deaths. If the case was deemed to have a likely heritable cause, NOK were notified of a possible increased risk and need for evaluation of immediate family members. Twenty-three deaths aged 1-39 years between 2006 and 2008, were selected for review. Sixteen NOK were interviewed. Several primary and secondary prevention measures were identified, including enhanced pre-participation sports screening; provider education; public awareness of risk factors, symptoms, emergency response training for coaches and the general public; and creation and dissemination of emergency response and medical examiner protocols. Seventeen NOK were notified of the potential heritable cause. Investigation of these deaths has led to identification of individual, family, public and provider needs and motivated policy makers to initiate changes to prevent future SCDY.

Emergency response training for laboratory workers

Over the last five years, laboratory safety training at the University of Vermont has evolved to focus on emergency recognition and response for new workers. This evolution has been driven by the increasingly interconnected nature of laboratory research, both between academic disciplines and physically as new laboratory buildings emphasize open laboratory settings. This article describes our current training practices and how relates it to regulatory requirements established by EPA and OSHA.

The use of virtual simulators for emergency response training in the mining industry

By its very nature, underground mining can be a hazardous activity. The history of all countries where mining has taken place unfortunately often contains major disasters. The successful initial control of such incidents is crucially dependent on the effectiveness of the mine’s immediate emergency response and the mine’s emergency preparedness arrangements, which underpin this response.Emergency response is sometimes given a low priority in training planning because catastrophic events occur infrequently. The majority of mine emergency rescue training is traditionally focused on training the rescue teams. A number of computer augmented training systems have recently been developed to perform or assist all levels of mine personnel in the process of mine rescue training.Modern simulation systems range from tactile systems that physically represent the real world to purely computer generated visualizations. In a mining context, a primary aim of developing virtual environments is to allow mine personnel to practice and experience mine processes that will be encountered in the day-to-day operations at a mine site.This article provides a review of the use of such simulators in the mining industry and details current work being undertaken in Australia and Canada to develop the next generation of this technology in the mining field. This work is based on an extensive literature review and the insight and the experience of the two authors who have each worked in this field for more than 20 years.