Health Emergency Preparedness Exercises Research Articles

UK healthcare staff experiences and perceptions of a mass casualty terrorist incident response: a mixed-methods study

IntroductionSystem learning from major incidents is a crucial element of improving preparedness for response to any future incidents. Sharing good practice and limitations stimulates further actions to improve preparedness and...

The role of emergency preparedness exercises in the response to a mass casualty terrorist incident: A mixed methods study

Simulation exercises are an important part of emergency preparedness activities for the healthcare community but evidence of their impact on the response to real major incidents is limited. This project studied the impact of health emergency preparedness exercises (HEPEs) on the response to a mass casualty terrorist incident. The mixed methods study design was adopted comprising an on-line survey and follow up individual interviews. Participants were healthcare staff who took part in responses to three major terrorist incidents in the UK in 2017. Descriptive statistics and analysis of variance were undertaken with quantitative data. Content and thematic analysis methods were used for qualitative data analysis.The online survey generated 86 responses; 79 (92%) were from the responders to the Manchester Arena bombing. Twenty-one survey respondents shared their experiences in in-depth interviews. Healthcare staff who took part in HEPEs felt better prepared to respond than those who did not attend an exercise. The most commonly reported benefits from HEPEs were awareness of major incident plans and having the opportunity to practice responding to a similar scenario in the recent exercise. Specific benefits included: improved coordination of the response through adherence to recently practiced incident plans; confidence with response roles; real-time modifications of the response and support provided to staff who did not take part in exercises. Exercise recency was highlighted as an important facilitating factor.The study provides strong objective evidence that the response to a mass casualty terrorist incident was enhanced by training and service development achieved through HEPEs.

Coordination, Communication, and Clade X: Challenges and Lessons Learned from Health Emergency Exercise After-Action Reports and How They Can Help Guide Future Efforts to Improve Information Sharing

Abstract Clade X is only the latest in a series of high profile health emergency preparedness exercises intended to better equip government officials and responders at different levels of government and in different sectors for the challenges they are likely to face during a pandemic or bioterrorism event. A key issue in regard to emergency preparedness response is information sharing. This study examines previous literature on the importance of information sharing to emergency response, particularly in regard to public health emergencies. A content and correspondence analysis of data collected from exercise after-action reports is then conducted to examine the prominence of information sharing as a theme in those reports. The relationship between information sharing and other themes is also considered. Specific passages regarding information sharing are examined to consider how the theme is discussed in the context of the report. The findings of the analyses above are then compared to a recent tabletop exercise conducted by the Nuclear Threat Initiative regarding a biological attack. The comparison of this recent exercise to previous exercises is used to highlight key policy considerations. Recommendations are provided regarding how policy makers could help to address these considerations prior to a real world emergency. While technology is consistently evolving to improve the means by which we can share information, issues of coordination, including between the public health and health care sectors, continue to remain an obstacle.

Evaluation of emergency preparedness exercises: the design of a questionnaire to measure staff perceptions

Evaluation is an essential part of health emergency preparedness exercises (HEPE) that allows identification of limitations in performance. Addressing limitations enhances preparedness. However, th...

Evaluating the Effectiveness of a Full-Scale Exercise of Epidemiologic Capacity for Bioterrorism Response

Abstract Introduction In May 2016, the Texas Department of State Health Services Public Health Region 7, in partnership with the local health departments in their region, designed and conducted a full-scale exercise (FSE) with a real-time epidemiologic phase leading to full-scale medical countermeasures distribution. Methods The exercise was designed to be a plausible scenario with a biologic agent that occurs naturally in Texas, Bacillus anthracis, and align with the Homeland Security Exercise and Evaluation Program (HSEEP) recommendations. After Action Reports (AAR) were reviewed and key informant interviews were conducted and content analyzed for themes through inductive coding. Results Themes identified include: benefits to exercising epidemiology’s role in public health preparedness; identification of gaps in real-time communication between public health and epidemiology; need to incorporate epidemiology into future exercises; importance of exercising realistic epidemiology scenarios in real-time; and identification of strengths and weakness in exercise coordination and logistics. Conclusion There is value in exercising epidemiology capabilities in real-time and in an operational full-scale context. Fully incorporating epidemiology into public health emergency preparedness exercises is one way to strengthen the relationship between these two disciplines and ensure well-coordinated rapid responses to public health threats.

A scoping review of evaluation methods for health emergency preparedness exercises.

To review and analyze evaluation methods currently utilized in health emergency preparedness exercises (HEPE). This study, part of a larger scoping review that systematically collected and reviewed published evidence related to the benefits of HEPE, provides a further analysis of the evaluation methods utilized in such exercises. We separately analyzed discussion-based and operation-based exercises according to their purpose. This addresses a methodological limitation related to the poorly understood relationship between the purpose and context in which a specific evaluation method is selected to be used. In the reviewed 64 studies, a variety of evaluation methods were utilized for HEPE including observations, participants' survey, and post-exercise debriefs. At present, the selection and use of these methods is not guided by any methodology, but seems rather arbitrary. No specific evaluation methods were isolated for any exercise type. The purpose of evaluation should guide the selection of evaluation methods for HEPE, and these are not context specific. If evaluation is for accountability purposes, such as to test organizational capability to respond, participant feedback should be collected in addition to objective data on performance in an exercise. Advantages of routinely collecting data from exercise participants to study their reactions (exercise feedback, perceptions, satisfaction with the exercise) and routinely conducting post-exercise debriefs (both hot debrief and cold debrief), are discussed to support evaluation for development or learning purposes in any context.

What is the value of health emergency preparedness exercises? A scoping review study

Emergency exercises involving the health community are considered an important and integral part of emergency preparedness activities. However, little is known about whether these exercises are effective at improving individual and/or organisational preparedness for responding to emergencies. This paper reviews and summarises published evidence on the effectiveness and benefits of exercises to prepare health emergency professionals for responding to emergencies and disasters. A literature search strategy was designed to identify the relevant publications from four major medical databases (Medline, Embase, Global Health and CINAHL). Studies meeting our inclusion criteria were analysed in detail (N=86). Both qualitative and quantitative data were reviewed. Data analysis involved a descriptive summary and a thematic analysis.Health emergency preparedness exercises were found to be effective (post exercise) at improving participants’ knowledge of emergency activities, policies and procedures and improving overall competence and confidence. Other immediate individual benefits included improved perceptions of preparedness and improved understanding of individual roles and roles of partners. Whether these improvements persist over time and translate into improved emergency response is not clear. The most commonly reported post-exercise organisational benefits were: identifying gaps or limitations in plans, protocols or procedures and providing opportunities to share lessons. Only a few identified studies reported the long-term impact of exercises on job practices and on real emergency response. Published evidence of exercises impact on individual and organisational levels of emergency preparedness and response over the long term is very limited. The majority of the studies included (n=65, 76%) were US-based.

Public Health Emergency Preparedness Exercises: Lessons Learned

The Harvard School of Public Health Center for Public Health Preparedness exercise program has two aims: (1) educating the public health workforce on key public health system emergency preparedness issues, and (2) identifying specific systems-level challenges in the public health response to large-scale events. Rigorous evaluation of 38 public health emergency preparedness (PHEP) exercises employing realistic scenarios and reliable and accurate outcome measures has demonstrated the usefulness of PHEP exercises in clarifying public health workers' roles and responsibilities, facilitating knowledge transfer among these individuals and organizations, and identifying specific public health systems-level challenges.