Virtual Poster Presentation

Introduction:

Population of Interest: Increase Hospital Emergency Preparedness and Response Related to

Mass Casualty Incidents for Front Line Staff

Emergency preparedness can often be a topic or agenda item that is forgotten about or cast aside
until the latest heartbreak and unnecessary loss of life reminds every one of its importance. Events
such as the tragedy in Las Vegas, Nevada in 2017 or Hurricane Katrina remind the masses that the
wickedness of man nor Mother Nature can be prevented, however, we can help mitigate and prepare,
building more resilient communities.

Any natural or manmade disaster can result in a sudden, unanticipated influx of patients arriving at
local hospitals. These events only intensify the necessity for hospitals needs to be proactive versus
reactive with an all-hazards approach.

Headers:

Issue of Concern

Increasing hospital emergency department staff knowledge of preparedness and response related to a
mass casualty incident (MCI)

Both local and national events have played a significant role impacting the necessity and sense of
urgency related to preparedness for front line staff for mass casualty events. East Central Wisconsin is
home to the college town of Oshkosh, home to almost 67,000 residents and The University of
Wisconsin-Oshkosh. Each summer the community is host to several large-scale, multiple day music
festivals and a weeklong international aviation event boosting the local economy and significantly
augmenting the population throughout the area. The largest event in Oshkosh is the Experimental
Aircraft Association (EAA) AirVenture. This single week event brings aircraft enthusiasts from around
the globe, boasting an attendance of almost 600,000 people. With tragedies such as the events that
occurred at the Pulse Nightclub, Sandy Hook, Las Vegas Route 91 Festival, the Boston Marathon, and
unfortunately so many others- our region feels it is not a matter of “IF” something happens in our area,
but a matter of “WHEN.”

A solid plan is needed in the regional hospitals to ensure preparedness for mass casualty incidents
with frontline staff. Through research, review of past events, and mass casualty management, this
writer is hoping to gather best practice recommendations that can be replicated as needed in order to
enhance local preparation, building resiliency among staff, benefiting the community.

5 Sub Roles of the APHN and priority interventions

• Clinician: Conduct a regional assessment of hospitals, identify current understanding of MCI

response, and current needs of staff.
• Educator: Utilize the information gathered by clinician to develop educational tools to enhance
staff understanding regarding a planned approach, goals, ethical considerations, triage plans, and
tools related to an MCI event.
• Administrator: The most valuable intervention an administrator can give is buy-in & support of
preparedness initiatives & requires active participation.
• Consultant: A neutral third party to observe/control an exercise/tabletop discussion related to an
MCI scenario. Valuable tool to gauge progress and preparation efforts, expose gaps, & celebrate
successes.
• Researcher: Review online or published sources, looking for best practices among various
disciplines, helping determine a best practice approach for MCI preparedness and response.

Elaborates on the MSN Project

Plan: Implement an educational plan to increase caregiver preparedness and exercise training
response for mass casualty incidents. The goal is to present education and a quick exercise for
frontline staff to increase muscle memory and retention for mass patient surge events.

Intervention
• Pre and Post Intervention Survey- asking role, in the event of an MCI incident role knowledge,
department and hospital readiness
• MCI Education for staff
o Triggering events- what is an MCI
o First 5 minutes priority action items based on roles
o MASS Triage
• MCI “Quick Drill”- 15 min or les, bringing in charge RN, triage, ED tech, MD and give scenario.
Then ask about activation and top priorities based on role. Enabled for real time discission

Resources
• Emergency Department Educator
• Emergency department leadership
• Hospital leadership support

Barriers/Challenges
• Real world ED census
• Physician buy in
• Staff completion of pre and post survey
 “To strengthen and sustain communities’ abilities to prevent, protect against, mitigate the
effects of, respond to, and recover from incidents with negative health effects”
~(Healthy People 2020, 2018)

Summary of Evidence
Multiple events in the last several decades have been the source of after-action type reports and
lessons learned. These tragedies have influenced healthcare perhaps in ways previously
unanticipated before September 11, 2001, with increased national attention on emergency
preparedness.
• Simulation education and evaluation tools to assess participant retention
• Evaluate current hospital disaster preparedness tools to measure the quality of outcome
• Pre and post educational evaluation via multiple-choice test

Article 1:
Miller, J. L., Rambeck, J. H., & Snyder, A. (2014). Improving emergency preparedness system
readiness through simulation and interprofessional education. Public Health Reports, 129(Suppl 4),
129–135. Retrieved from doi: 10.1177/00333549141296S417
• Simulation education and evaluation tools to assess participant retention
The participants were placed into teams of 6-12 from many aspects of medicine, from dentistry to
nursing, so the participants did have some similarities and some differences, recruited from the
university of students in relevant programs. Purpose was to assess the efficiency and effectiveness of
the educational intervention utilizing educational intervention using best practice in immersive
simulation, repetitive practice, multiple opportunities for feedback, follow up survey to assess retention.
Article 2:
Heidaranlu E, Ebadi A, Khankeh HR, Ardalan A. (2015, Sep 14.) Hospital disaster preparedness tools:
A systematic review. PLOS Currents Disasters. Edition 1. doi:
10.1371/currents.dis.7a1ab3c89e4b433292851e349533fd77.
• Evaluate current hospital disaster preparedness tools to measure the quality of outcome
This research article is a systematic review of hospital disaster preparedness tools. Healthcare
providers play a significant role in a disaster when immediate and efficient execution of plans are
imperative in decreasing loss of life, therefore a review was conducted to evaluate current hospital
disaster preparedness tools to measure the quality of outcome
Article 3:
Glow, S. D., Colucci, V. J., Allington, D. R., Noonan, C. W., & Hall, E. C. (2013). Managing Multiple-
Casualty Incidents: A Rural Medical Preparedness Training Assessment. Prehospital and Disaster
Medicine, 28(04), 334-341. doi:10.1017/s1049023x13000423
• Pre and post educational evaluation via multiple-choice test
This research project was based on educating staff that would be involved in an MCI event and
wanted to test if an educational course would prove to be effective (Glow, Colucci, Allington, Noonan,
& Hall, 2013). This study was volunteer based and a quasi-experimental in nature. The participants are
from various fields from firefighter, ED nurse, ED MD, and paramedic. The outcomes were measured,
and were able to validate improvement in scores.

Population Diagnosis and Plan of Action

Knowledge Deficit of Frontline Staff Related to Educational Training and Exercising for Mass
Casualty Incidents

“To strengthen and sustain communities’ abilities to prevent, protect against, mitigate the
effects of, respond to, and recover from incidents with negative health effects”
~(Healthy People 2020, 2018)

Future Recommendations
• Staff champions
• Provider champion
• Longer implementation period
• Need to incorporate hospital/regional specific processes