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Slide Presentation by Gary B. Green, M.D.
On April 15, 2003, Gary B. Green, M.D., made a presentation in the Web-Assisted Audioconference entitled Disaster Planning Drills and Readiness Assessment.
The is the text version of Dr. Green's slide presentation. Select to access the PowerPoint® slides (125 KB).
Disaster Planning Drills and Readiness Assessment
Gary B. Green, M.D., M.P.H.
Associate Professor of Emergency Medicine and Pathology
Department of Emergency Medicine
The Johns Hopkins University School of Medicine
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.
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
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.
Continuous Quality Improvement (CQI) Process Applied to Disaster Preparedness Capacity Building
Slide provides a diagram of the Continuous Quality Improvement (CQI)
process. The process includes a series of text boxes connected to each
other by arrows which flow in a clockwise direction. The process begins with a pre-course
knowledge exam that's conducted prior to didactic education and training (modular
courses). A post-course knowledge exam follows. The second step includes the
development of skills through practical training (drills) and a drill evaluation,
which assesses institution and individual skills. A report and analysis of
strengths and weaknesses are included in the third step. In the fourth step
modification and re-engineering of the training intervention is conducted,
taking into account stakeholders goals (some of which may have to be redefined).
Finally the disaster plan is reviewed and modified. The last step then flows
back into the first step – pre-course exam and didactic education/training
and the entire process repeats on a continuous basis.
Preparation for Conventional vs. Bioterrorism Event
- Preparedness for biologic, chemical or radiation events is built on
- Additional needed preparations include:
- Decontamination of victims.
- Protection of health care workers.
- Containment of infectious agents.
- Agent/vector specific treatments.
- Preparedness for "chronic" disaster.
Slide contains a diagram of the interaction of different components of
a disaster response. A circle, representing the "pre-hospital scene response" appears
on the left-hand side of the slide and an oval, representing the "Hospital
Drill Response," is on the right. Within the hospital drills response
oval is a smaller oval depicting a "in-hospital event."
The circle and oval are encircled with two sets of dotted lines, forming a
bulls eye figure on each side of the page. The outermost dotted ring around
each includes biological events. The middle (inner) dotted ring includes radiological
or chemical events.
Connecting the circle and oval is a double-headed arrow, which represents
systems integration." At the top of the diagram is a text box that reads "EMS & Public
Safety." Two straight arrows radiate from the text box connecting it
to the Pre-hospital scene circle and systems integration, respectively. A
dotted arrow also extends from the same text box to the hospital drill response
At the bottom of the diagram is another text box that reads "Incident
Command System." This box also has three arrows, one linking it to
the Pre-hospital scene circle, another to systems integration and another
to the Hospital drill response oval.
Basic Components of Disaster Response System
- Incident Command System.
- System integration (communications).
- Logistics (materials, facilities, transportation).
- Clinical operations.
- Human resources.
- Public relations.
- Others as defined by local plan.
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.
- "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.
- 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.
Drill Evaluation: Define Goals & Boundaries
- Define specific goals for the drill
- Don't 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?
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.
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.
Current as of July 2003
Disaster Planning Drills and Readiness Assessment. Text Version of a Slide Presentation at a Web-assisted Audioconference. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/ulp/disastertele/greentxt.htm
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