A Full Scale Exercise In Disaster Medicine

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A full scale exercise in Disaster MedicineF. Della Corte Chair Dpt. Anesthesia, Intensive Care and Critical Emergency Medicine Novara - ItalyEmergency Medicine Education Session Sept 16 2008Which are the questions to be answered in the lecture?How could exercises improve the outcome in MCIs and disasters?How could an exercise be used as a teaching tool?Oct. 3rd, 2005h. 9,45: a bomb explodes in the Repubblica underground stationh. 9,30 A kamikaze blows himself up near the Colosseo h. 10,00: a rucksack with a bomb explodes on the number 64 bus, in Largo S.Pantaleo, next to Corso Vittorio EmanueleFrom Dr. Patis thesis (EMDM VII edition), 2007What the hell are you doing, guys?Help for an unemployed, innocent bystander !!!!The overall number of casualties is 399: 116 treated and transported by EMS and 283 self-reffered to the hospitals.From Dr. Patis thesis (EMDM VII edition), 2007Real crash atRepubblica underground stationDrill atRepubblica underground stationAFTER THE SIMULATIONThe management of the surge and the level of care improved after the MCI due to:Revision of diagnostic flow Setting and revision of clinical prioritiesBetter management of available personnel Structural changes in the Emergency DepartmentNEEDS AFTER THE MCITo create a tool for data collection and further evaluation of hospital management performances To identify a specific area close to the ED for relatives and mediaTo state criteria to monitor patients after their admittance To schedule a regular planning of drills involving all personnel responsible for emergency managementTo improve training and information of dedicated staffFrom Dr. Patis thesis (EMDM VII edition), 2007Jan 18, 2007Dec 14, 2006Feb 25,2007DUBAIFrom Dr. Zulfiqars thesis (EMDM VII edition), 2007Real size exerciseon Nov 27, 2006From Dr. Zulfiqars thesis (EMDM VII edition), 2007Simulation/ExerciseRepresentation of the operations performed in time by a real system or process Advantages- to reduce the catastrophic consequences of a mistake- to reduce the physical risk- to reduce costs- to easily "re-play"- to compress and expand timeThe didactic environmentDisaster Exercise FunctionsTo Test disaster plan procedures- Detect difficulties in executing strategies or tactics proposed in plans- Develop working relationships with personnel from responder groups and agenciesTo Constitute a type of public information- Inform and make the public aware- practice health provider with press- help press members to understand the conduction of emergency operationsTo Educate and train personnel- hands on exposure to emergency equipment, vehicles, procedures and protocols- unique experience for elected and appointed public officialsTo Evaluate the effectiveness training programsThe didactic environmentPerry RW.. Disaster Exercise Outcomes for Professional Emergency Personnel and Citizen Volunteers. Journal Of Contingencies And Crisis Management. 2004; 12(2): 64-75Exercising as Formative EvaluationThe purpose of the evaluation may be Formative(to provide ongoing feedback so that the learners core curriculum can improve)or Summative(to provide a final grade assessment of the performance of the learner or curriculum)The didactic environmentDrills Table-top Exercises Functional Unit Assessment Functional Exercises Full-scale ExercisesTypes of Disaster Medicine ExercisesThe didactic environment Drills Tabletop exercise Functional Unit Assessment Functional exercise Full-scale exerciseInformal discussion of simulated disaster situations Moderate time restraintsLower stress than functional or full-scale exercisesForms can be learned and revisedRelationships of people and positions can be explored and alteredCost-effectiveMay use computer technologiesThe didactic environmentKMC Linkoping, SwedenThe didactic environmentThe didactic environmentThe didactic environmentCreating outdoorsAn infinite variety of areas can be created.Limited scenario (Railway crash)Wider area: Province of NovaraThe didactic environmentThe didactic environmentNetworked HospitalsThe didactic environmentVitals via monitorThe didactic environment2004Agency for Healthcare Research and Quality US Department of Health and Human ServicesKey question:(1) What is the effectiveness of hospital disaster drills in training hospital staff to respond to an MCI?(2) What is the effectiveness of computer simulations in training hospital staff for an MCI? (3) What is the effectiveness of tabletop or other exercises in training hospital staff to respond to a MCI?(4) What methods or tools have been used to evaluate the effectiveness of hospital disaster drills, computer simulations, tabletop exercises, or other exercises in training hospital staff to respond to a MCI?Hsu EB et al. Training of ho