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

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Title: 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

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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

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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
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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

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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

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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
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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
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