Hospital Emergency Preparedness Research Articles

Emergency preparedness capacity of a university hospital in Ghana: a cross-sectional study.

The health and safety of people are often endangered during emergencies and disasters. Efficient emergency management systems ensure that mitigation, preparedness, response, and recovery actions exist to preserve the health, safety, and welfare of the public. Failure to carry out appropriate responses can have adverse consequences for both emergency responders and casualties; hence, the need for emergency preparedness. This study sought to assess the state of emergency preparedness capacity of the Kwame Nkrumah University of Science and Technology hospital in Ghana. A facility-based cross-sectional study was conducted between December 2018 and February 2019 using three guidelines developed respectively by the World Health Organization, the Ministry of Health-Ghana, and the Ghana Health Service. The hospital's emergency preparedness was assessed regarding the emergency policies, plan, protocol, equipment, and medications. Overall, the hospital's emergency preparedness level was weak (57.36%). Findings revealed that the hospital had inadequate emergency equipment, and supplies for emergency care delivery, especially during upsurge. It also did not have an emergency planning committee. There were noticeable deficiencies in some emergency resources such as chest tubes, basic airway supplies, and many emergency drugs. Other vital emergency tools such as pulse oximeter, thermometer, and emergency medications were inadequate. The hospital had a strong emergency plan and policies on assessment (77.8% and 78%) respectively. The Kwame Nkrumah University of Science and Technology hospital is not prepared sufficiently for an emergency surge, and this poses a major health challenge. Emergency items must be made available, and the organization and planning of emergency service provisions must be improved to avoid preventable deaths during an emergency surge.

Resilienz deutscher Kliniken in Amok- und Terrorlagen

ZusammenfassungHintergrundKrankenhäuser müssen sich als kritische Infrastruktur (KRITIS) auf terroristische Anschläge sowie Amoklagen einstellen und mögliche Schadensabwehrmaßnahmen vorbereiten, da sie leicht zu treffende Ziele mit hoher Symbolkraft darstellen.MethodeIn der vorliegenden Arbeit wurde die terroristische Bedrohungslage anhand einer Auswertung der Terrorist Event Database (TED) für den Zeitraum 1970–2017 quantifiziert. Darüber hinaus wurden die Bedrohungsperzeption sowie die getroffenen Vorbereitungen mittels einer Online-Umfrage unter den Leitenden deutscher Notaufnahmen erfasst.ErgebnisseDie Auswertung der TED zeigt international einen Anstieg der terroristischen Angriffe auf medizinische Einrichtungen mit Schwerpunkt in Ländern im (Bürger‑)Kriegszustand sowie in den USA. Der Einsatz von Explosivstoffen führte im untersuchten Zeitraum zu einer hohen Anzahl an Verletzten und Toten. Die Online-Befragten empfanden eine Vorbereitung der Klinik auf terroristische Szenarien in ihren Krankenhausalarm- und -einsatzplänen (KAEP) überwiegend als wichtig. In den bestehenden KAEP waren entsprechende Maßnahmen dennoch häufig nicht etabliert. Nur in 59,4 % wurde die Verletztenversorgung im Rahmen eines terroristischen Angriffs und nur in 34 % die Sicherung der Infrastruktur behandelt.SchlussfolgerungDeutsche Kliniken sollten sich als kritische Infrastruktur sowie als mögliches Ziel terroristischer Anschläge verstehen und sich auf terroristische Bedrohungen vorbereiten. Viele günstig umzusetzende Maßnahmen sind in den Kliniken nicht ausgeschöpft und sollten zeitnah sowohl in den KAEP als auch in den Alltag integriert werden.

Emergency Preparedness: Training Outcome in Hospital Staff

Introduction:A widely acknowledged aspect of emergency preparedness is hospital-wide staff education. Maintaining interest in hospital emergency preparedness among hospital staff is challenging. A hospital-wide education process involving a robust lecture and hands on donning and doffing sessions followed by periodic disaster drills has been recently undertaken as a quality improvement process.Method:A prospective pre- and post-test study of 256 hospital staff were given a six-hour training course in comprehensive Hospital Incident Command Systems (HICS), Hazmat (Hazardous Materials), and CBRNE (Chemical, Biological, Radiation, Nuclear, and Explosive) events. The same pre and post-test were given to all participants that contained questions to assess emergency preparedness knowledge.Results:256 registrars within seven months (two classes per month) completed training with pre and post-tests. The average class size was 18.3 (range= 14 to 26 registrars). 3 of 256 (1.1 % 95% confidence interval) registrars achieved the pass mark of 70% in the pre-test survey and 230 (89.8 %) registrars achieved the pass mark in the post-test (χ2-test P < 0.001) with an absolute increase in the pass rate of 84%.Conclusion:This finding justifies Emergency Preparedness Training at our institution, showing a marked improvement in staff knowledge of HICS and CBRNE management. This study should encourage continuous widespread use of Emergency Preparedness training in hospital Emergency Preparedness.

Survey Evaluation of Nursing Emergency Preparedness Training

Introduction:An effective response to CBRNE requires that frontline staff, such as nurses, are adequately trained in Emergency Preparedness (EP). Understanding the current gaps in nursing knowledge of CBRNE is the first step in creating an effective training program. This study assessed EP training gaps and needs among nursing staff.Method:A web-based survey was distributed to all hospital nursing staff. The survey evaluated the CBRNE training that nurses received. Staff listed the types of training they had received and were asked to rate their confidence in performing various disaster-related competencies or capabilities. Competency confidence levels were also surveyed as those who feel; not at all confident or not very confident.Results:The survey assessed previous EP training. 572/763 Nursing Staff had completed the survey, for a response rate of 75%. Of the nurses who responded, areas in which they have been trained included: preparedness for radiological and nuclear agents (17.66% trained), preparedness for biological agents (22.20% trained), preparedness for chemical agents (27.45% trained), hazardous materials and patient decontamination (25% trained), and their own role within the hospital's ICS (31.29% trained), Patient evacuation (63.61% trained) and the hospital's EP plan (54.55% trained). The survey also assessed respondents' confidence in performing EP activities. The respondents reported lacking confidence in treating patients exposed to a radioactive material (59.9%), treating patients exposed to a biological agent (57.17%), and performing decontamination procedures (54.71%). The respondents reported having confidence in evacuating patients from units, departments, or hospitals (69.1%). The top incentives for participating in “nonrequired” training were no costs to complete the training (83.1%) and receiving continuing education credits (79.2%).Conclusion:A majority of nurses reported inadequate training in CBRNE events with a self-reported lack of confidence in responding to these events. A targeted and educational CBRNE curriculum and materials to enhance EP among nursing professionals are clearly indicated.

Upholding Quality and Patient Safety during COVID-19 Pandemic-A Jordanian Case Study.

The advent of the COVID-19 pandemic caused a rapid increase in demand for healthcare services over a prolonged period, and the hospital emergency preparedness system has been essential. Therefore, this study aimed to explore Jordanian hospitals' response to emergency situations and examine the underlying role and effect of accreditation programs as a "Quality and Patient Safety" tool to deal with emergency situations during the pandemic. An online survey for a cross-sectional study was conducted in Jordan between 1 March and 30 May 2022, to examine the opinions of hospitals' top, senior, and middle managers using a validated questionnaire. A total of 200 healthcare providers from 30 hospitals participated in the study. From the areas within accreditation standards that were investigated, capacity building on emergency preparedness and communication abilities received the least scores (2.46 and 2.48, respectively). Additionally, hospitals with mature quality and patient safety culture (>3 accreditation cycles) demonstrated a statistically significant difference in score in two domains-emergency preparedness (p = 0.027) and infection prevention and control (p = 0.024). During outbreaks, hospitals that are required to comply with accreditation standards that address all emergency preparedness aspects will fare better in quality performance.

ОЦЕНКА ГОТОВНОСТИ СТАЦИОНАРОВ К РАБОТЕ В УСЛОВИЯХ ЧРЕЗВЫЧАЙНЫХ СИТУАЦИЙ

Significance. The COVID-19 pandemic has led to a crisis in society and seriously challenged healthcare capabilities around the world. The industry's lack of preparedness for such a large-scale and rapid spread of the virus around the world was one of the major factors in the fight against the pandemic faced by medical organizations and health services around the world. During the pandemic, the Russian Federation (hereinafter referred to as the RF) has radically restructured activities of medical organizations, re-equipped them with modern medical equipment, and intensively developed digitalization, making it possible to prevent the collapse of the industry and ultimately successfully cope with the pandemic. Analysis of the results and consequences of the restructuring the entire industry, medical organizations providing medical care of various types and in different conditions, allows us to assess emergency preparedness of hospitals and develop recommendations for the future. The purpose of the study was to assess hospital emergency preparedness in the Russian Federation based on the analysis of dynamics in bed capacity, structure of beds and utilization indicators in 2019-2022. Material and methods: comparative analysis of the number of beds, its structure and utilization indicators in the pre-COVID period, the pandemic period and the early post-COVID period based on the federal statistical observation form No. 30 “Information about medical organization” in the Russian Federation and in the constituent entities of the Russian Federation. Methods included descriptive statistics, comparative analysis and analytics. Results. A long-term trend towards reducing bed capacity and availability of beds was once interrupted in 2020, with the trend towards reducing the number of beds in rural areas remaining interrupted. In general, during the observation period, the total number beds decreased by more than 30 thousand, the population-to-bed ratio decreased by 3%, and the hospitalization rate dropped by 7%. The shortage of adult infectious disease beds at the beginning of the pandemic associated with the prior reduction of bed capacity against the background of the network restructuring was met by repurposing other beds to serve as infectious disease ones, and deploying additional infectious disease beds in and outside medical organizations to treat patients with COVID-19. The number of adult infectious disease beds increased 7.5-fold by the end of 2020. However, the number of adult infectious disease beds then started to decrease reaching a 59,4% increase by 2022 compared to 2019, but their share in rural areas decreased from 14% to 8%. The number of pediatric disease beds increased against the background of competing dynamics. Overall, during the period, the total number of pediatric and adult infectious disease beds increased by 27%. In the structure of adult infectious disease beds, the share of COVID-19 beds varied from 92% in 2020 to 34% in 2022; additionally deployed COVID-19 beds were also in operation. Over the observation period, the average bed length of stay and average bed occupancy decreased, while hospital mortality increased. Significant variability in hospital performance indicators across regions was registered. Conclusion In 2021-2022, hospital facilities in the Russian Federation were prepared to meet the increased incidence of infectious diseases. However, the renewed processes of bed capacity reduction necessitated forecasting sustainability of hospitals in emergency situations. The undertaken analysis shows that a cut in the number of round-the-clock beds should not be guided by the mere process of reduction. The decision to change the bed capacity and structure should be preceded by a thorough preliminary analysis of specialized care availability by each specialty planned to be reduced. Reducing planned hospitalizations and postponing treatment of patients with chronic non-communicable diseases turned out to be not fully justified, which was confirmed by other studies. Infectious disease beds must function in optimal numbers to cope with the increased flow of patients in early stages of an emergency. The areas where infectious disease beds are deployed must be sufficient to realize the possibility of quickly increasing the capacity of an infectious disease hospital to the required level. Planning a network of hospitals should ensure a comprehensive specialized care delivery to patients with chronic non-communicable diseases during emergencies including planned care. Scope of application: Hospital capacity and structure planning.

Assessment and development of hospital emergency preparedness plan in response to COVID-19 pandemic in Alexandria University Hospitals

ABSTRACT Background The COVID-19 ongoing pandemic is one of the deadliest pandemics in history. It has put a significant strain on healthcare systems and frontline healthcare workers. This study attempted to assess and develop the emergency preparedness of hospitals affiliated to Alexandria University. Methods A quasi-Aquasi-experimental design was conducted in three phases; the pre-intervention assessment using ahospital emergency response checklist, then awareness intervention was implemented to provide information on emergency preparedness followed by post-intervention assessment after asix-month period following the first phase using the same checklist. Results The pre-intervention assessment showed that four hospitals had a good overall preparedness level (75% or more preparedness level), while the rest of the hospitals (7 hospitals) demonstrated a fair overall preparedness level (50%- <75%). All the individual domains have demonstrated a good or fair to good preparedness levels except the recovery domain, which was fair, and the command and control domain, which was poor in the majority of the studied hospitals. The intervention awareness program has led to a significant statistical change in the command and control as well as human resources domain. However, the post-intervention scores of command and control domain remained poor in the majority of the studied hospitals.

Beirut Explosion: Challenge of Hospital Emergency Preparedness.

On August 4, 2020, a major explosion took place in Beirut, the capital of Lebanon. Some hospitals in Beirut were destroyed and became nonfunctional, and others were overwhelmed with casualties, with 8643 casualties admitted to emergency departments on that night. The Lebanese American University Medical Center-Rizk Hospital, 2.8 km away from the blast, received an unexpected number of casualties. While a disaster plan was conceived earlier, this hospital's emergency department faced many challenges on that night, and major flaws in their preparedness plan were seen.

Level of emergency and disaster preparedness of public hospitals in Northwest Ethiopia: A cross-sectional study.

From time to time, the magnitude and type of health emergencies and disasters are increasing. Hospital emergency and disaster preparedness, on the other hand, is still in its early stages in many low- and middle-income countries. In Ethiopia, research on hospital disaster preparedness is severely limited. As a result, the purpose of this study was to determine the level of hospital emergency and disaster preparedness at public hospitals in the east Gojjam zone of Northwest Ethiopia. A census method was used to include ten hospitals in the East Gojjam zone in a cross-sectional descriptive study. An adopted World Health Organization observation checklist was used to assess disaster and emergency preparedness. Each question was assigned a score out of three points, with one indicating low readiness and three indicating the highest level of preparation. Finally, the level of preparedness was classified as "low" if the average percentage score ranged from 33.3% to 66.6 %, and as "high" if the percentage score ranged from 66.7 % to 100 %. The results were then presented in the form of texts, tables, and percentages. The evaluated hospitals' overall level of emergency and disaster preparedness falls into the low category, with an average calculated preparedness score of 54.75 %. The domain with the lowest preparedness is logistics and finance (43.33 %), while the domain with the highest preparedness is patient care and support services (60 %). According to the findings of this study, the level of emergency and disaster preparedness in the hospitals studied is low. It is therefore recommended that the ministry of health, regional health bureaus, and hospital administrators collaborate to develop an appropriate intervention strategy to address this issue.

Moving Forward from COVID-19: Organizational Dimensions of Effective Hospital Emergency Management.

Federal investment in emergency preparedness has increased notably since the 9/11 attacks, yet it is unclear if and how US hospital readiness has changed in the 20 years since then. In particular, understanding effective aspects of hospital emergency management programs is essential to improve healthcare systems' readiness for future disasters. The authors of this article examined the state of US hospital emergency management, focusing on the following question: During the COVID-19 pandemic, what aspects of hospital emergency management, including program components and organizational characteristics, were most effective in supporting and improving emergency preparedness and response? We conducted semistructured interviews of emergency managers and leaders at 12 urban and rural hospitals across the country. Through qualitative analysis of content derived from examination of transcripts from our interviews, we identified 7 dimensions of effective healthcare emergency management: (1) identify capable leaders; (2) assure robust institutional support; (3) design effective, tiered communications systems; (4) embrace the hospital incident command system to delineate roles and responsibilities; (5) actively promote collaboration and team building; (6) appreciate the necessity of training and exercises; and (7) balance structure and flexibility. These dimensions represent the unique and critical intersection of organizational factors and emergency management program characteristics at the core of hospital emergency preparedness and response. Extending these findings, we provide several recommendations for hospitals to better develop and sustain what we call a response culture in supporting effective emergency management.

Hospital Emergency Preparedness During COVID-19 Pandemic

Hospital Emergency Preparedness During COVID-19 Pandemic

Exploring Peaks in Hospital Blood Component Utilization: A 10-Year Retrospective Study at a Large Multisite Academic Centre.

Peak demand analysis is common in industries such as the energy sector, but can also be applied to the field of transfusion to characterize the nature and timing of peak days in hospital blood utilization. This information can be used to forecast future peak days or to inform hospital emergency preparedness plans. The aims of this study are to characterize peak days in red blood cell (RBC) utilization over the past 10 years at our hospital, and to compare RBC peaks with peaks in platelet, plasma, and cryoprecipitate utilization. This was a retrospective cohort study of RBC, platelet, plasma, and cryoprecipitate transfusions in the inpatient and emergency department setting between May 2009 and April 2019 at a large academic hospital, containing regional trauma and cardiovascular surgery centers. For each blood product, a peak in utilization was defined as a day with a ≥50% increase in the number of units transfused compared to the previous 90-day average. Descriptive and inferential analyses were performed to characterize peak days. There were on average 20,501 RBCs transfused per year and 56 RBCs transfused per day over the 10-year period. A total of 134 peaks in RBC utilization occurred over the study period, with an average of 14 peaks per year. RBC peak days required on average 69% more RBC units compared to nonpeak days (P< .0001). 77% of RBC peaks were caused either solely or in part by surgical bleeding, 34% were caused entirely or in part by trauma, and other causes were infrequent. RBC peaks occurred most often on Fridays and least often on weekends (P< .0001). While there were 134 RBC peaks over the study period, there was a larger number of platelet (n=292), plasma (n=467), and cryoprecipitate peaks (n=579). RBC peak days often coincided with plasma peak days, but less frequently with platelet and cryoprecipitate peaks. More studies are needed to determine whether analysis of peak usage will be of value to hospital blood banks for emergency planning and blood inventory management.

The Crosscutting Benefits of Hospital Emergency Preparedness Investments to Daily Operations: A Hospital Senior Leadership Perspective.

Hospitals are an integral part of community resiliency during and after a disaster or emergency event. In addition to community-level planning through healthcare coalitions, hospitals are required to test and update emergency plans to comply with accreditation standards at their own expense. Justifying costs related to investments in emergency preparedness can be a barrier, as these events are relatively rare. Little is known about the crosscutting benefits of investments in daily operations including patient care. This study investigated whether hospital investments in emergency preparedness had a perceived impact on daily operations from a senior leadership perspective. Using a cross-sectional study design, a 39-item survey was emailed and mailed to chief executive officers of all 105 Nebraska hospitals. Most respondents indicated that drills and exercises, staff training, and updating emergency plans had a positive impact on daily operations. A relatively small proportion (≤11%) of respondents indicated that costs of buying decontamination equipment, personal protective equipment, and costs associated with staff training and drills/exercises had a negative impact on daily operations. No differences were noted between rural and urban locations or between hospitals that allocate funds in the budget versus those that do not. The majority of hospitals in our study are likely to continue to invest over the next 3 years, inferring a sincere commitment by hospital senior leadership to continue to invest in emergency preparedness. Future research using longitudinal design and objective measures of investments and daily benefits is needed to support a business case for hospital preparedness.

Hospital disaster and emergency preparedness (HDEP) in Lebanon: A national comprehensive assessment

BackgroundHospital disaster and emergency preparedness are critical for country-specific readiness level to withstand disasters. Lebanon has consistently experienced man-made and natural disasters. This study sought to perform a comprehensive assessment of the country's level of hospital disaster and emergency preparedness. MethodA 3-step methodology was designed. We first developed a Hospital Disaster and Emergency Preparedness (HDEP) tool following a comprehensive literature review. Second, we conducted a modified Delphi process with local experts to tailor the HDEP tool to the Lebanese context. Third, we administered the tool to directors of hospitals with at least a 100 bed capacity across all governates in Lebanon. ResultsTwenty four hospitals were included. All (100%) had a disaster and emergency response plan, but only 83% of hospital plans included a recovery phase, and 62% included a formal surge capacity plan. Most hospitals were equipped with basic medical/pharmaceutical supplies, onsite laboratories, blood banks and imaging facilities. Disaster-only medical carts and disaster-only supplies were available in only 33% and 42% of the hospitals, respectively. The majority of hospitals (71%) had a medical ICU, but only 25% had a surgery-specific ICU. A backup communication system was reported in only 66.7% of hospitals. Only 79% of hospitals routinely perform disaster drills. Post-disaster mental health services were present in 15% of surveyed hospitals. ConclusionA formal HDEP plan was common to Lebanese hospitals however gaps in disaster preparedness were identified. Future initiatives should focus on building upon existing resources and capacities to strengthen readiness and improve coordination.

Emergency preparedness: Interviews with senior leadership in Nebraska hospitals.

The objective of this study was to explore perceptions of senior leadership in hospitals on the motivations, cost, benefits, barriers, and facilitators of investment in emergency preparedness. This is a qualitative study which used a grounded theory approach to develop a theory of hospital emergency preparedness. A purposive sample of hospital leaders (n = 11) in the US state of Nebraska were interviewed. Results showed that the environmental risk associated with the hospital location, the hospital's position in the community, and the preparedness requirements of the Centers for Medicare and Medicaid Services contribute to investment decisions. Rural hospitals face unique challenges in preparing for disasters, for example, lack of trained personnel. Facilitators of disaster preparedness include the availability of federal funds, the commitment of leadership, and an organizational mission aligned toward emergency preparedness. Hospitals invest in hazard vulnerability assessments; partnerships with other organizations in the community; staff trainings and infrastructure. The authors concluded that hospitals in Nebraska are committed toward investing in preparedness activities. The theory of hospital emergency preparedness developed will be used in a subsequent study to develop a decision-support framework for hospital investment in preparedness.

Preparing Hospitals in India for Covid-19 Pandemic

Hospitals have important part in the human health organization toprovide necessary treatmentfor public, mainly in a calamity. During the current outbreak of COVID-19, and is in giving important needs and supplies will possibly interrupt the providing critical treatment due to not organized health-care capacity. Along with, a greater amount of personnelabsence can be predictable. A lack of important kits and materials can lead to restricted supplies to desirable care and have a direct impact on healthcare delivery. Anxiety can lead to possibly hamper recognized operational practices. Also in hospitals dealing with COVID 19 pandemic can be a difficulty. In spite of the challenging difficulties and problems expected, the positive and organized execution of important basic and definite arrangements can aid successful hospital-based organization for the period of a speedily progressing epidemic. Hospital emergency preparedness is a constant progression that association to the complete preparedness platform. Several principles and suggestions drawn in this article are general and appropriate to other incidents. The article gives checklist which is proposed to manage current situationby hospital emergency preparation platforms.

Emergency Physician Involvement in Hospital Preparedness: A National Survey of Academic Medical Centers.

The aim of this study was to determine the involvement of emergency medicine physicians at academic medical centers across the United States as well as their background training, roles in the hospital, and compensation if applicable for time dedicated to preparedness. A structured survey was delivered by means of email to 109 Chairs of Emergency Medicine across the United States at academic medical centers. Unique email links were provided to track response rate and entered into REDCap database. Descriptive statistics were obtained, including roles in emergency preparedness, training, and compensation. Forty-four of the 109 participants responded, resulting in a response rate of 40.4%. The majority held an administrative role in emergency preparedness. Formal training for the position (participants could select more than 1) included various avenues of education such as emergency medical services fellowship or in-person or online courses. Of the participants, most (93.18%) strongly agreed that it was important to have a physician with expertise in disaster medicine assisting with preparedness. The majority of responding academic medical center participants have taken an active role in hospital emergency preparedness. Education for the roles varied though, often consisted of courses from emergency management agencies. Volunteering their time for compensation was noted by 27.5%.

From silos to coalitions: The evolution of the US Hospital Preparedness Program.

The objective of this article is to trace the hospital emergency preparedness movement in the United States, strengthen the case for hospital investments in emergency preparedness, and make recommendations to ensure sustainability of the program. Design/Approach: This article is a narrative review. Main themes from the literature about the US Hospital Preparedness Program (HPP) are discussed, beginning with the trends in funding levels of the HPP, the rise of regional healthcare coalitions, preparedness performance measures, and the challenges faced over the past 15 years of HPP activities. Finally, recommendations are made about ways to sustain the program. The HPP was established in 2002 and funding for the program has seen a 56 percent decrease over the last 16 years. Beyond the initial investment in supplies and equipment, hospitals have received very little of the healthcare preparedness funding. Disaster drills and exercises to test emergency plans in hospitals are perceived as a costly distraction from daily work. The biggest challenge is the lack of engagement and support from hospital leadership. To ensure the sustainability of the HPP, the positive impact of preparedness activities on the hospital's day-to-day operations must be demonstrated.

Training Emergency Department Charge Nurses Through Tabletop Exercises

Introduction:In a disaster or mass casualty incident, the Emergency Department (ED) charge nurse is thrust into an expanded leadership role, expected to not only manage the department but also organize a disaster response. Hospital emergency preparedness training programs typically focus on high-level leadership, while frontline decision-making staff get experience only through online training and infrequent full-scale exercises. Financial and time limitations of full-scale exercises have been identified as major barriers to frontline training.Aim:To discuss a cost-effective approach to training ED charge nurses and informal leaders in disaster response.Methods:A formal training program was implemented in the ED. All permanent and relief charge nurses are required to attend one four-hour Hospital ICS course within their first year in their position, as well as participate in a minimum of one two-hour ED-based tabletop exercise per year. The tabletop exercises are offered bimonthly, covering various mass casualty scenarios such as apartment complex fires, riots, and a tornado strike. Full-scale exercises involving the ED occur annually.Results:ED permanent and relief charge nurses expressed increased skills and knowledge in areas such as initiation of disaster processes, implementation of hospital incident command, and familiarization with protocols and available resources. Furthermore, ED charge nurses have demonstrated strong leadership, decision-making, and improved response to actual mass casualty incidents since implementing ICS training and tabletop exercises.Discussion:Limitations of relying on full-scale disaster exercises to provide experience to frontline leaders can be overcome by the inclusion of ICS training and tabletop exercises for ED charge nurses in a hospital training and exercise plan. Implementing a structured training program for ED charge nurses focusing on leadership in mass casualty incidents is one step to building a more resilient and prepared ED, hospital, and community.

Hospitals preparedness using WHO guideline: A systematic review and meta-analysis

Background: Hospitals play a critical role in providing communities with essential medical care during disasters. Objectives: In this article, the key components and recommended actions of WHO (World Health Organization) Hospital emergency response checklist have been considered to identify current practices in disaster/emergency hospital preparedness in actual or potential incidents. Methods: Articles were obtained through bibliographic databases, including ISI Web of Science, PubMed, Science Direct, Scopus, Google Scholar, and SID: Scientific information database. Keywords were “Disaster,” “Preparedness,” “Emergency Preparedness,” “Disaster Planning,” “Mass Casualty Incidents,” “Hospital Emergency Preparedness,” “Health Emergency Preparedness,” “Preparedness Response,” and “Emergency Readiness.” Independent reviewers (F.R. and M.H.Y.) screened abstracts and titles for eligibility. STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) checklist was used to qualifying the studies for this review. Results: Of 1545 identified studies, 26 articles were implied inclusion criteria. They accounted for nine key components and 92 recommended actions. The majority of principles that had been rigorously recommended at any level of the hospital emergency preparedness were command and control and post-disaster recovery. Surge capacity was considered less frequently. Conclusion: We recommend considering the proposed disaster categories by FEMA (Federal Emergency Management Agency). In this framework, different weights for nine components can be considered based on disaster categories. Thus, a more valid and reliable preparedness checklist could be developed.