Thomas Terndrup, MD Professor and Chair, Department of Emergency Medicine Director, Center for Emerg

1
Weapons of Mass Destruction Hospital Leadership
Course Evaluation of Participant Response
Capabilities Emily Heck, BA1, Thomas Terndrup,
MD1, James E. Black, MD1, Erica Pryor, PhD, RN2,
Carrie Barton, MD1, Rick Mathews, MS3, Betsy
Weiner, PhD, RN4, and the National Health
Professions Preparedness Consortium (NHPPC)
1University of Alabama at
Birmingham, Center for Emergency Care and
Disaster Preparedness, Birmingham, AL, USA 2
University of Alabama at Birmingham, School of
Nursing, Birmingham, Alabama, USA 3Louisiana
State University, National Center for Biomedical
Research and Training, Baton Rouge, Louisiana,
USA 4Vanderbilt University, International
Nursing Coalition for Mass Casualty Education,
Nashville, Tennessee, USA

• Thomas Terndrup, MD
  Professor
  and Chair, Department of Emergency Medicine
  Director, Center for Emergency Care and
  Disaster Preparedness University of Alabama at
  Birmingham

2

National Health Professions Preparedness
Consortium (NHPPC)
3
NHPPC Purpose

• Address the preparedness of the nations response
  to incidents involving weapons of mass
  destruction (WMD)
• Facilitate the development of a long-term,
  focused, threat-responsive national capability
• Work with local, state and federal agencies to
  achieve these goals
• Tasked by the Department of Homeland Security
  (originally by the Office of Public Health
  Emergency Preparedness of DHHS)

4
NHPPC Capabilities

• Leadership in the development of curricula
• Structure to facilitate collaborative efforts
• Ability to design, test, standardize, and
  implement WMD curricula
• Production of course materials and instructional
  aids

5
Objectives

• 4-day tabletop and live exercise course at the
  Noble Training Center
• Course designed to train hospital
  administrators, physicians, nurses, EMS, and
  public health officials to effectively respond to
  WMD incidents
• 26 contact hours
• 13 faculty/student ratio

6
Noble Training Center Facility

• Former 100 bed U.S. Army hospital
• Functional
• Maintained by full-time, dedicated staff
• Provides realistic environment without disrupting
  an actual hospital
• Other teaching aids available
• Orientation to facility and pre-course assessments

7
(No Transcript)
8
(No Transcript)
9
Exercise One

• Table-top exercise
• Participants divided into mixed-functional groups
• Emergency Department, Hospital Administration,
  EMS Management, Public Health, Nurse Managers
• Chemical explosion scenario which overwhelms
  communitys resources
• Scenario paused for faculty-lead discussions
• Groups assembled for integrated discussion

10
(No Transcript)
11
Exercise Two

• Real-time exercise that continues scenario from
  Exercise One
• Increased intensity and pace
• Participants report to functional areas
• Emergency Department, Hospital Administration,
  EMS Management, Public Health, Nurse Managers
• Manage WMD event by initiating incident command
  system
• Coordination of functional groups in hospital
  control room
• Faculty-lead discussions

12
(No Transcript)
13
Exercise Three

• Ten-hour, real-time exercise
• Participants report to functional areas
• Recognize WMD event as biological attack
• Address issues regarding a more covert event and
  the associated problems
• Integrated decisions on communications with
  various response agencies, hospital security and
  isolation, staffing augmentation, transfers, etc
• Faculty-lead discussions

14
(No Transcript)
15
(No Transcript)
16
Final Day

• Extensive debriefing sessions
• Additional lectures from various experts
• Faculty feedback
• Course participant discussion
• Distribution of take-home materials
• Post-course assessment

17
Exercise Summary

• Exercises provided course participants with an
  opportunity to engage in administrative
  decision-making activities within their
  functional areas
• Course faculty from the NHPPC acted as
  facilitators
• Participants also took part in facilitated
  discussions in interdisciplinary groups
  received classroom instruction on selected topics

18
Methods

• Number of courses held
• Pilot courses held, courses refined,
• 8/02 to 1/03
• 8 courses between 3/03-8/03

19
Methods

• Course Participants
• A total of 414 participants completed the course
• The number of participants ranged from 32 to 40
  for the first four courses and from 54 to 77 for
  the last four courses
• Participants included hospital administrators
  and executive officers, Emergency Medicine
  physicians and nurses, EMS administrators and
  personnel, and public health officials
• Paired pre and post-course responses were
  available from 82 of the 414 participants

20
Methods

• Instrument
• Participants were asked to rate their abilities
  in specific performance areas related to disaster
  preparedness and response at the beginning and at
  the completion of each course.
• A total of 21 performance statements were
  rated, 19 of which were evaluated for all 8
  courses.
• Each item was rated on a 5-point scale, coded
  from 1poor to 5excellent, with 3adequate.
• Office of Emergency Preparedness-American
  College of Emergency Physicians April 2001 Final
  Report (Ann Emerg Med 200137587-601)

21
Methods

• Statistical Analysis
• SAS 8.0 and SPSS 11.5 were used for data
  analyses
• Mean pre and post-ratings were calculated for
  each item and compared across courses
• Difference scores between pre and post-ratings
  were analyzed with Sign tests
• a level was set at 0.005 to control the overall
  Type I error rate

22
21 performance statement competencies focusing on
5 areas

• Recognition
• Communication
• Effective decision-making
• Integration/management of resources
• Response/recovery roles

23
(No Transcript)
24
Competency Area 1 Recognition

• Differentiate between the public health role and
  medical communitys role in emergency response to
  WMD events
• Describe the various roles, responsibilities,
  capabilities and alternative resources of the
  entities that may respond to a WMD or mass
  casualty incident
• Recognize healthcare facility infra-structural
  issues that could confront managers in the event
  of a community WMD event
• Describe the types of resources available to the
  local community from State, Regional, and Federal
  agencies
• Compare and contrast the differences between the
  crisis and the consequence phases of the
  Federal Response Plan

25
Competency Area 2 Communication

• Relate the fundamentals of an incident command
  system, including HEICS, and its importance to a
  successful response to a WMD event
• Outline effective communications and
  information-sharing strategies that are useful in
  managing the healthcare/medical community
  response to WMD events
• Construct process to request resources from
  State, Regional and Federal agencies
• Initiate effective communications and
  information-sharing processes among various
  response entities during a WMD event

26
Competency Area 3 Effective decision-making

• Construct a plan for decontamination of
  ambulatory and non-ambulatory patients
• Develop a plan to address the long-term needs
  that should be anticipated in a large scale,
  community disaster resulting from a WMD incident
• Generate a plan to effectively manage the
  deceased and their remains resulting from a WMD
  event
• Revise the facility EOP for response to a WMD
  event

27
Competency Area 4 Integration Management of
Resources

• Design effective leadership and administrative
  strategies to manage situations and related
  extraordinary complications of WMD events
• Adapt facility infra-structure and resources to
  meet the challenges of the WMD events situation
• Explain the Federal consequence management
  resources available to the local community
• Integrate the role of the volunteers and
  pastoral services in the organizations plans for
  WMD response

28
Competency Area 5 Response/Recovery roles

• Effectively respond to a scenario that poses
  multiple attacks and agents
• Differentiate between the Federal crisis and
  consequence responses
• Implement effective stress management strategies
  for healthcare institutions related to WMD events
  
• Outline potential issues and barriers that the
  healthcare community may face as they begin the
  process of returning-to-normal in a WMD event

29
Results

• Mean pre-course statement ratings (range 1.99 to
  2.91), indicated a less-than-adequate performance
  ability
• Mean post-course ratings (range 3.32 to 4.13),
  indicated a greater-than-adequate ability
• All post-course ratings were significantly
  higher than the pre-course ratings (all p lt
  0.001)
• Variability in participant ratings between
  courses was assessed, and no significant
  difference was found for 16 of the 21 performance
  competencies

30
(No Transcript)
31
Conclusions

• Results suggest a substantial improvement in
  perceived performance competency by participants
  upon completion of the course
• Further research is planned to examine the
  sustainability and translation of participant
  post-course performance levels over time

32
Funding Department of Health and Human Services
Contract 282-99-0043 Acknowledgement
s NHPPC Course Faculty  Noble Training Center
Staff  Auburn University, Auburn, Alabama