Evaluation of Mass Casualty Incident Education to Guide Disaster Responder Preparedness

Transcription

1 Evaluation of Mass Casualty Incident Education to Guide Disaster Responder Preparedness Lin-Ti Chang, DNP, RN-BC, ANP-BC, CCRN Honor Society of Nursing, Sigma Theta Tau International 24th International Nursing Research Congress Prague, Czech Republic July 25, 2013

2 Acknowledgement: Susan M. Briggs, MD, MPH, FACS Associate Professor of Surgery, Harvard Medical School Director, International Trauma and Disaster Institute (ITDI), MGH

3 Background Disasters are the ultimate test of interprofessional responders and communities capability to provide care to those in need. Nurses play an essential role in disaster response and are often the single largest group of responders in any major disaster.

4 Background While the response of interprofessional responders can be a strength, it can also potentially overwhelm a disaster response system due to the lack of communication between professionals from different organizations and variation of knowledge in disaster response in a disaster. Mass Casualty Incident (MCI) management Understanding of the common features and response expertise required for all disasters, regardless of etiology. Primary goal of reducing the mortality and morbidity caused by the disaster.

5 Purpose Evaluate an educational program - Advanced Disaster Medical Response (ADMR) Course for interprofessional responders in Hong Kong that was created based on existing literature on the critical elements of mass casualty management. 1. Radioactive agents 2. Biological agents 3. Chemical agents 4. Explosive agents 5. Natural disaster 6. Principles of disaster response

6 Theoretical Framework Bridge between theory and practice from global perspective Bandura s Self-efficacy Theory conceptualizes personbehavior-environment interaction as triadic reciprocality, a foundation for reciprocal determinism (Bandura, 1982). Bandura s (1997) concept of self-efficacy beliefs are derived from four sources: 1. Enactive attainment 3. Verbal persuasion 2. Vicarious experiences 4. Physiological state

7 Methods Pretest/posttest descriptive design Sample Alice Ho Miu Ling Nethersole Hospital, Hong Kong n =70 15 Physicians (21.4%) 33 Registered Nurses (47.1%) 22 Other disciplines (31.4%) Emergency Medical Technicians, Paramedics, Educator, Police, Firefighter, Hospital Administrator

8 Sample 79% first time exposure to ADMR training 21% participated in other disaster management courses: Basic Life Support (BLS) Major Incident Medical Management and Support (MIMMS) Hospital Incident Command Advanced Hazmat Life Support (AHLS) Health Emergencies in Larger Population (HELP)

9 Sample 81% never participated in a real life disaster event 19% had participated in varied roles in disaster events: Severe Acute Respiratory Syndrome (SARS) Banda Aceh tsunami Bali bombing Sichuan earthquake Fukushima Daiichi nuclear disaster

10 Methods Procedure Partners Human Research Committee Internal Review Board & International Trauma Disaster Institute, Massachusetts General Hospital Lecture, demonstration and skills stations Participants were allocated equally to four-groups in two demonstration and two skills stations in separate classrooms Two faculty instructors assigned to each group used cultural and site appropriate scenarios for demonstration and skill stations Pretest/Posttest Course evaluation

11 Sample Course Agenda Day One Welcome Address Pre-test Mass Casualty Response Incident Command Response ABD s of Disaster Response Decontamination Chemical Agents Blast Injuries Crush Injuries ICS (Demo) ICS (Skill Station) Day Two Extremity Injuries Radioactive Agents Biological Agents Heat Injuries Psychological Response Field Triage (Skill Station) Pelvic Immobilization (Demo) Combat Application Tourniquet (Demo) Decontamination (Demo) Post-test Conclusion, Awarding of Certificate ICS = Incident Command System

12 Sample Pretest / Posttest Not to be reproduced: Pretest/posttest is the property of ITDI, MGH.

13 Sample Course Evaluation Not to be reproduced: Course content is the property of ITDI, MGH.

14 Findings

15 Findings Estimated marginal means of measure of pretest and posttest scores for each element: 1. Radioactive agents 2. Biological agents 3. Chemical agents 4. Explosive agents 5. Natural disaster 6. Principles of natural disaster response

16 Findings (p =.245, partial eta squared =.09)

17 Findings ADMR course incorporates the four sources necessary to support self-efficacy. Pretest & posttest scores and course summative evaluation showed the extent to which participants perceive, rapidly learn, and apply basic principles of mass casualty management.

18 Limitations Generalizability Use of a convenience sample to those self-selected to attend the ADMR course and the geographical location of the course. Educational preparation of each professional differs from those in other global settings.

19 Discussion Validate the ADMR course provides education on the key principles of mass casualty management for disaster responders. Provide evidence that the ADMR course may guide any professional including nursing in disaster preparedness and respond to a disaster. Provides data specific to roles and critical elements to improve future mass casualty management educational offerings and support national guidelines for interprofessional disaster responders especially for nursing.

20 Discussion Course evaluation summaries reinforce the importance of incorporating didactic with demonstration and skills stations to enhance communication and teamwork among interprofessional participants. The ADMR course faculties have extensive global experience in disaster response that promotes broad exchange of knowledge with course participants. Selfefficacy is enhanced in education when the trainees have confidence in the source of new knowledge.

21 Conclusion Educating interprofessional disaster responders on the key principles of disaster management and understanding of misconception and evidence-based reports in disaster response will improve our response to disaster effectively and in term ensure reducing the mortality and morbidity caused by the disaster. Nurses comprise the largest single group in the disaster responder team, therefore it is essential that nurses receive education in key principles of the mass casualty management and training in disaster preparedness and response.

22 Implications Education Academic and hospital leaders to influence development of educational programs on mass casualty management across interprofessional disaster responders. Team approach with layering of professionals with varying skills will promote a coordinated response, which is vital to responding to disasters locally or anywhere in the world.

23 Implications Practice Educational investment can result in positive system outcomes, such as responder safety and health, and improve the delivery of safe quality patient care. Research Future studies to evaluating these education programs for validity and role specific educational strengths, assess geographical differences in knowledge, and provide opportunities for improvement and practice will advance the science of disaster response management.

24 Future Direction Continue expand the data base and extend analysis of additional data. Incorporate findings into future educational programs. Disseminate findings of the study to other scholars.

25 Questions / Comments Thank you!