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Development and Assessment of a Disaster live drill evaluation tool for primary health care

facilities

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Summary

Background

The massive loss in life and destruction of property in Dubai just as the entire world

justifies the need to prevent these disasters from occurring if possible as well as preparing for any

disaster medically to prevent unnecessary loss of life. The primary healthcare facilities are

mandated with the role of upholding the safety of the patients in the hospital, the health workers,

and also the visitors to the facility. Upholding safety of all the parties calls the institution to make

all the necessary precautions. Performing drills a preferable method of evaluating if an institution

is prepared for disasters. Evaluation of an institution performance during a drill in Dubai is not

currently standardized. There is a need for a common ground of evaluation to recommend for

improvement after comparison to the performance by other primary healthcare facilities.

Development of a drill evaluation tool based on the existing information and observation will aid

in a customized drill evaluation tool for Dubai which is likely to serve the country better than

developed foreign tools that don’t put into consideration internal factors affecting drill

performance in Dubai.

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Problem statement

Overview

Just as many countries in the world, the United Arab Emirates there are different classes of

health care facilities. Primary health care is one of the classification well recognized by the World

Health Organization. Primary health care health facilities are immediate health facilities assessable

to the citizens that offer immediate healthcare facilities. Having the high health standards in Dubai,

the primary health care facilities are well equipped to offer most if not all of the most common

medical services (Abdellatif et al., 2017). The patient to hospital bed ration in Dubai was 1.9 per

1000 citizens which is a considerably lower ratio when compared to some highly developed

countries which have a ratio of more than eight hospital beds per 1000 people. Therefore, the

hospitals tend to be more crowded when to compare to the highly developed countries. High

population in hospitals means higher tension in case a disaster happens within the institution

Many primary health care facilities in Dubai invest much in educating both medical

professionals and the community on the management of disasters. No matter how much we invest

in preparation for disasters, it might be impossible to determine the efficiency of the investment

without experiencing circumstances or events that happen during disasters. Even if the real

circumstances of a disaster like a fire or an earthquake can be simulated, it is tough to determine

how efficient a primary health facility is efficient in managing the disaster. Evaluation of

effectiveness in managing a disaster calls for evaluation of many aspects of emergency response.

The parameters of how efficient is efficient are hard to describe. In Dubai, the question of how

efficient is efficient is hard to answer because there are no set standard parameters to describe

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emergency response. There is no known common drill evaluation tool in Dubai. Without a standard

drill evaluation tool, it is hard to quantitatively and qualitatively describe emergency response in

a health facility. There is a need to create a standard drill disaster evaluation tool which will be

used to rate how good or poor is a health facility for managing disasters. The results from the

evaluation tool will be used to make comparisons and make recommendations for better disaster

management in the Emirate.

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Hypothesis

1. Development of a Dubai drill evaluation tool will aid in assessing the preparedness of

medical professionals in case of a disaster.

Objectives

Overall Objective

1. To prevent life loss and property loss to disasters in Dubai due to disasters.

Specific Aims

1. Pinpoint the critical elements of disaster emergency response

2. To develop a drill evaluation tool that can serve in Dubai

3. An assessment of a live drill.

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Background and Significance

Disaster is a sudden and calamitous event that is likely to lead to loss of property, life or

cause injury to the people affected (Khan, Kausar, & Ghani, 2017). The damage caused by a

calamity can be either mental, socioeconomic, political, or cultural or take any other dimension,

therefore, hardly has a defined parameter of measurement (Srivastava, 2010, p. 01). Disaster can

be natural or human-caused, examples of natural disaster include hurricanes, floods volcano

eruptions, and also earthquakes. Human-caused disasters to include, a terrorist attack, plane

crashes car accidents, and many more. Disasters affect almost all parts of the world, what varies is

the kind of disasters that are common in some areas, as an example the United States of America

is sited in the Circum-Pacific Belt which predisposes it to Drought hurricane. The same Circum-

Pacific Belt is a region is described to be one of the most common regions faced by the world

earthquakes (Kinghorn, 2015). Disasters, therefore, affect the entire world.

Most of the western countries are prone to seismic activities with the Dubai being part. The

GCC is made of seven emirates which are centers for tourist and business activities. Dubai harbors

a population of 2,104,895 which is the highest populated city (“World Capital Institute,” 2013)

which is a significantly high number of people in case of a major disaster. According to the sun

news in 2017, an earthquake struck the Iraq-Iran border killing 328 and injuring scores (Adu,

2017). This was one of the most disastrous earthquakes that ever struck the country. Dubai also

has a record of human-made calamities, on September 1983, Gulf air 771 was bombed as it

approached the Abu Dhabi international airport killing a total of 112 people ("Gulf Times, Qatar,"

1983). In 2017, Dubai skyscraper explosion, a 63 storey building exploded under un-identified

caused injuring 16 and killing one ("Dubai hotel fire: Inferno at 63-storey address downtown hotel

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near New Year’s Eve fireworks display," 2016). These are many more examples of natural and

human-made disasters that face the world every day.

Preparation for Disaster

Loss of life and destruction of property on the incidence of a disaster can be minimized by

ensuring that everyone is prepared for any disaster that may attack as well as ensuring that

immediate responders act within viable time ("Preventing, preparing for, responding to, and

recovering from disasters," n.d.). Preparation for disaster response may not be as simple as it

sounds. It calls for the commitment of some stakeholders mainly because it may be an expensive

investment and it requires the commitment and involvement of almost everyone in an institution,

particularly in a primary health care facility. Once the stakeholders have passed the budget for

disaster preparation, then the management has the mandate to ensure that safety requirements are

available within the hospital. Priority should be given to disasters that are common in that specific

primary health care facility. The management also has to provide skilled safety professionals who

will adequately train everyone at the hospital how to manage disasters. Once the training has been

adequately provided and maybe, refresher courses offered as well as other steps that might be taken

to ensure that the knowledge sticks into the beneficiaries heads, a drill is always necessary.

Steps for carrying out a live Disaster Drill

Predrill planning assessment

In this phase, the intention of the drill is first identified. The critical lesson or skill to be

gained can be from past training session or from another idea that you want the beneficiaries to

gain. All the factors about the drill should be considered including chances for an accident during

the drill simulation.

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Pre-drill participant assessment

In this phase, the participants are assessed for confidence in how they should manage a

situation. The phase is crucial to access what the beneficiaries are confidently ready to practice in

a real disaster set-up.

Post-drill briefing session

A post-drill briefing session is a crucial phase in carrying out a drill. During the phase, the

outcome of the drill is discussed to the beneficiaries. The phase gives the management a chance to

pin-point flaws that might have been noted during the drill.

Follow-up assessment

The follow-up session is primarily meant to refresh knowledge to the beneficiaries. Follow-

up assessment is not necessarily one because the more exposed beneficiaries are to the knowledge

the better they are likely to understand ("Four phases of drills and exercises evaluation," n.d.).

Evaluation of Disaster live Drill

There are three known methods of evaluating preparedness for a disaster which is, using

surveys, a drill by the help of a structured evaluation tool, and video analysis of team performance

(Kaji, Langford, & Lewis, 2008). Surveys are used to collect information from the beneficiaries

either to inquire what they might have acquired from disaster management training. Surveys can

also be used to evaluate the success of a drill by inquiring questions related to the drill. Video

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analysis can be used together with a drill to view the actual response of beneficiaries in case of a

simulated disaster situation. A structured evaluation tool is used to rate the level of preparedness

of a specific group of people or institution in numbers. All the three methods can be used

simultaneously to come up with more accurate results.

Pressurized by the urge to evaluate the performance of disaster drills on the acceptable

common ground, the Johns Hopkins University Evidence-based Practice Center developed the first

evaluation tool composed of a set of evaluation modules and addendums in the year 2004 ("New

evaluation tool helps determine if hospital disaster drills are effective," 2004). In 2005, In 2005,

the Agency for Healthcare Research and Quality requested John Hopkins University to develop a

bridge evaluation tool that all hospitals should use to evaluate their preparedness for disasters

(Kaji, Langford, & Lewis, 2008). The evaluation tool composed of the most important drill

efficiency evaluation elements, the modules and addendums, and recommendations on what is

expected of an excellent evaluation tool. If used correctly, the abridged evaluation too is effective

in identifying the weaknesses and strength of a hospital disaster management strategy ("Evaluation

of hospital disaster drills," 2011). Even though the evaluation tool ranks institutional preparedness

for disasters, it is not meant to pass or fail certain institutions disaster management preparedness

rather foster further and constant development of the health institution strategies to manage

possible disasters.

It is hard to define how good is good without set standards and parameters that should

define the efficiency of a system. Evaluation of performance in a disaster live drill without

reference key parameters to consider is also likely to introduce bias in a case where one focuses

more on what he or she thinks looks good or bad, therefore, forgetting other aspects of a live

disaster performance drill.

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Research Methods and Design

Population, Sample Size, and Sample Selection Procedure

The primary population in concern for the live disaster evaluation tool will be the patients

in primary hospital facilities around Dubai, the health care providers and visitors that will be

visiting the hospital during the drill. The main challenge to evaluating the performance of the drill

evaluation tool is that the tool cannot be evaluated without subjecting it to the real disaster and

studying its credibility.

The population sample cannot be defined at this stage. The reason why it will not be defined

is that the number of patients in a primary health care facility in Dubai may vary drastically due to

many factors. Some of the factors include the location of the primary healthcare facility, the type

of services offered in the hospital as well as other external forces like outbreaks of diseases. Even

though, all the patients that will be in the hospital facility will be evaluated through different

methods as discussed in the previous chapter- video footage observation, use of questionaries’ and

by use of standard set John Hopkins Hospital evaluation tool. The evaluation tool will be subjected

to different predetermined standards of drills and tested for credibility. Two replicates of the drills

will be prepared to reduce error.

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The sample selected for the evaluation of the new tool will be random. From a total of all

Dubai outpatients, 2212371 visited the primary health care facilities in the year 2005 (Abdellatif

et al., 2017). This population that visits the primary health care facilities will serve as the subjects

for the study to develop a disaster evaluation tool. All the collected data will be considered in

evaluating the performance of the new disaster evaluation tool.

Tools and Variables

After the Dubai disaster evaluation tool has been developed, it will have to be verified for

reliability. There will be three main methods used to collect data to validate the credibility of the

newly developed disaster evaluation tool. Video footage evaluation will be the first tool to evaluate

how the tool performs. Video footage of a real-time disaster will be studied keenly and evaluated

using the new tool. Questionnaires will be the second method of data collection; they will be

offered to the subjects who will participate in the testing drills and the data collected will be

compared to the kind of data produced by the new evaluation tool. The third and final method that

will be used to collect data for verification of the new tool credibility will be the John Hopkins

already existing tool for evaluation efficiency of hospital institutions preparation for disaster. The

tool will data will be compared to whatever the tool produces.

The evaluation modules will be developed from literature reviews and evaluate the current

practices on-going in the hospitals. The following are some parameters that will be evaluated and

rated in one to five star with the matching description. Organizational preparedness for internal

communications, IT preparedness to manage the disaster, building and infrastructure preparedness,

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vendor and supplies preparedness and efficiency, the primary health employees preparedness, the

time taken to channel the information about the disaster, the correctness of the information

channeled, and many more as listed in John Hopkins model. Only the appropriate evaluation

modules from the model shall be considered.

During development of the evaluation protocol, the following has to be considered,

variation in different hospital zones risks, the flexibility of use of the evaluation tool as

environments vary, safety and security of the persons under the drill test subjects, and the culture

of the subjects under the drill study.

Sources of Data and Data Collection Procedure

Data will be collected from questionnaires, which will be administered to the drill subjects

randomly. The collected data will then be used to evaluate the preparedness of the primary health

facility using the newly prepared evaluation tool. The collected data will then be compared to the

data collected from the original John Hopkins disaster preparedness evaluation tool. All the

possible data collection sources will be considered in the evaluation Just as John Hopkins model.

Data Analysis

Data analysis in this specific work will be based on a comparison between the collected

data from the newly proposed evaluation tool and the evaluation from the John Hopkins disaster

evaluation tool. The efficiency of the new tool to determine the preparedness of the institution

against disasters will be determined by comparing the data from both sources baring error created

by human judgment.

Ethics Issues

It is against ethics to use human as test samples in research work (Kapp, 2006). In our case

where we might need more than one drill to evaluate the drill evaluation tool performance, it might

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be limited to conducting own drills. The research will have to majorly depend on the drills

organized by primary healthcare facilities which might mean longer study time and use of more

resources.

Study limitations

Since the study will be based on real-time drill studies, as mentioned before the research

on the efficacy of the drill might have to depend on the drill organized by the primary healthcare

facilities. Organizing a drill in a facility that you are not part of management will take more

convincing and external output as well as legal permissions and regulations.

The study is also likely to demand many resources, carrying out real-time drill evaluation

will call for more than a single person. In cases where there will be no drill activities of preference,

preparation and funding of own drill will be necessary.

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