Disaster Planning Drills and Readiness Assessment

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Disaster Planning Drills and Readiness Assessment

• Gary B. Green, MD, MPH, FACEP
• Associate Professor of Emergency Medicine
  Pathology
  
• Johns Hopkins University School of Medicine and
• Johns Hopkins University Evidence-Based Practice
  Center
  
• President, Emergency International, Inc.

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Training of Clinicians for Public Health Events
Relevant to Bioterrorism Preparedness(AHRQ
Evidence Report/Technology Assessment 51)

• First evidence based report on this topic
• Work sponsored by AHRQ, done by JHU EPC
• Structured review evaluation of literature
• Released January 2002
• Available on Web at www.ahrq.gov

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Current Evidence About Hospital Disaster
Preparedness Training

• Very few high quality/scientifically based
  publications
  
• Basic building blocks of response system
  established
  
• Variety of training, assessment techniques
  reported
  
• Drills shown to be effective training tools
• Drills are dual purpose, also provide opportunity
  for system evaluation
  
• Terminology not yet standardized
• Best practices not yet defined
• Rapid development and dissemination of training
  and evaluation techniques (growing toolbox)

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Basic Steps Toward Hospital Disaster Preparedness

• Assemble key stakeholders into interdisciplinary
  team
  
• Review current resources, strengths, weaknesses
• Develop detailed, written response plan
• Disseminate and practice plan
• Evaluate adequacy of knowledge, skills and
  resources
  
• Review and re-engineer plan based on data
• Modify training as needed to target weaknesses
• Continuously repeat cycle

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Continuous Quality Improvement (CQI) Process
Applied to Disaster Preparedness Capacity
Building
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Preparation for Conventional vs. Bioterrorism
Event

• Preparedness for biologic, chemical or radiation
  events is built on conventional preparedness
  
• Additional needed preparations include
• Decontamination of victims
• Protection of health care workers
• Containment of infectious agents
• Agent/vector specific treatments
• Preparedness for chronic disaster

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Disaster Response
PREHOSPITAL SCENE RESPONSE
HOSPITAL DRILL RESPONSE
SYSTEM INTEGRATION
IN-HOSPITAL EVENT
INCIDENT COMMAND SYSTEM (ICS)
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Basic Components of Disaster Response System

• Incident Command System
• System integration (communications)
• Logistics (materials, facilities,
  transportation)
  
• Clinical operations
• Human resources
• Security
• Public relations
• Others as defined by local plan

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Training Techniques

• Results of AHRQ-sponsored EPC report
• Traditional educational techniques
• Lectures, discussions, AV aids, written material
• Standardized (smart) patients
• Accepted by physicians
• Effective for one-on-one training
• Usefulness for training of large numbers?
• Cost prohibitive?
• Teleconferencing or satellite broadcasting
• Simultaneously reaches large numbers
• Seems as effective as traditional techniques

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Training Techniques

• Tabletop exercises
• Theoretical drill with limited/no physical
  operations
  
• Usually focuses on ICS, system integration
• Successfully applied to physician training for
  bioterrorism preparedness
  
• Best as part of comprehensive training plan?
• Computer simulations
• May replace expensive drills, allow
  identification of weaknesses in disaster plan and
  implementation
  
• Very limited data available

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Training Techniques

• Disaster Drills
• Cornerstone of disaster preparedness efforts
• Significant collective experience
• High variability in methods used
• Limited data concerning objective evaluation
• Shown to improve knowledge of disaster plan
• Successful in identifying problems in plan
  execution

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Drill Evaluation Define Goals Boundaries

• Define specific goals for the drill
• Dont be ambitious beyond resources!!
• Clinical response training?
• ICS effectiveness evaluation?
• Chem, Bio, Rads included?
• Define borders of drill activities
• Interface with outside agencies?
• ED only, entire hospital, selected departments?
• Moulaged patients, smart victims, no victims?
• Security, pharmacy, radiology also involved?
• Resources available
• Adequate time before drill?
• Buy-in by key stakeholders?
• Separate evaluation team?

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Drill Evaluation Methods and Instruments from
Available Tool Box

• Clinical care evaluation
• Trained observers
• Providers recording events (triage tags, etc.)
• Smart patients
• ICS, system integration
• Direct observation difficult
• Self-assessment cross-evaluation
• Drill flow
• Movement of patients, staff, supplies, etc.
• Entrance/exit observers
• Qualitative evaluation
• Evaluators narrative comments
• Videotape review
• Debriefing comments
• Surveys, structured interviews of drill
  participants

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Evaluation of ICS

• Lack of gold standard
• Limitations of direct observation
• Difficult to capture communications among many
  key personnel
  
• Nearly impossible to monitor content of
  communications
  
• Evaluation may disrupt flow of events
• Focus on result vs. occurrence of communication
• Post-drill survey or interview of key personnel
• Clear understanding of roles?
• Knowledge of command structure?
• Communication frequency and adequacy?
• Narrative comments, critique