Outcome-based approach in development of a disaster management course for healthcare workers.
INTRODUCTION: The Faculty of Medicine, University of Colombo, Sri Lanka provided voluntary healthcare services during the aftermath of the 2004 tsunami. At that time the faculty recognised the need to prepare the healthcare system for future disasters by enhancing the capability of healthcare workers. The development and implementation of a disaster management course for healthcare workers was identified as a priority. METHOD: An outcome-based approach was used to develop the curriculum. Qualitative and quantitative methods were used to identify the core competencies and outcomes that healthcare workers need to achieve at the end of the course. The content, teaching learning methods and assessments were aligned with the course outcomes. The course consists of 9 core modules and an elective research module. Formative and summative assessment methods were included. CONCLUSION: Training is an important component of disaster management. The outcome-based approach provides a useful framework for developing such training programmes and ensures that needs are addressed. (+info)
Developing an international health area of concentration in a family medicine residency.
BACKGROUND AND OBJECTIVES: We sought to develop an Area of Concentration (AOC) in international health to inspire and better prepare interested residents for such experiences during residency and in the future. METHODS: The curriculum has three phases: pre-experience preparation, the international experience, and post-experience debriefing. In the last 2 years, residents and faculty have worked in Sri Lanka, Pakistan, Mexico, and Tanzania. The three main types of experiences have been disaster relief, clinical care, and community-based primary health care. RESULTS: Compared to only two or fewer residents participating annually prior to the establishment of the AOC, more than 30 residents and faculty have participated in an international experience in the last 2 years. Our department now has at least two established annual international experiences and has developed educational and process manuals. CONCLUSIONS: An AOC curriculum can nurture interest and provide relevant skills that can be used in the care of vulnerable populations in the United States and abroad. (+info)
SMART--an integrated wireless system for monitoring unattended patients.
Monitoring vital signs and locations of certain classes of ambulatory patients can be useful in overcrowded emergency departments and at disaster scenes, both on-site and during transportation. To be useful, such monitoring needs to be portable and low cost, and have minimal adverse impact on emergency personnel, e.g., by not raising an excessive number of alarms. The SMART (Scalable Medical Alert Response Technology) system integrates wireless patient monitoring (ECG, SpO(2)), geo-positioning, signal processing, targeted alerting, and a wireless interface for caregivers. A prototype implementation of SMART was piloted in the waiting area of an emergency department and evaluated with 145 post-triage patients. System deployment aspects were also evaluated during a small-scale disaster-drill exercise. (+info)
Mechanical ventilation in mass casualty scenarios. Augmenting staff: project XTREME.
Disaster preparedness typically includes plans that address the need for surge capacity to manage mass-casualty events. A major concern of disaster preparedness in respiratory therapy focuses on responding to a sudden increase in the volume of patients who require mechanical ventilation. Plans for such disasters must include contingencies to address surge capacity in ventilator inventories and the respiratory therapy staff who will manage the ventilators. Tactics to address these situations include efforts to lower demand by transferring patients to other institutions as well as efforts to augment staffing levels. Staff can be augmented by mobilization of deployable teams of volunteers from outside the region and through exploitation of local resources. The latter includes strategies to recruit local respiratory therapists who are currently in either non-clinical or non-hospital-based positions and policies that optimize existing respiratory therapy resources within an institution by canceling elective surgeries, altering shift structure, and postponing vacations. An alternative approach would employ non-respiratory-therapy staff to assist in the management of patients with respiratory failure. Project XTREME (Cross-Training Respiratory Extenders for Medical Emergencies) is a cross-training program developed to facilitate training of non-respiratory-therapy health professionals to assist in the management of patients who require mechanical ventilation. It includes an interactive digital video disc as well as a competency validation laboratory and is designed to be performed at the time of an emergency. Pilot testing of the program suggests it is effective. (+info)
Ethical issues in resource triage.
Mass-care events, such as pandemic influenza, could reach such devastating proportions that there will be the need to make difficult triage decisions that will ultimately result in the deaths or severe disability of patients in large numbers. The method by which we determine how triage of scarce health care resources will be performed must be clearly defined prior to a disaster event. This paper will discuss several of the ethical principles that must be weighed in developing a mass-care triage plan, as well as steps to facilitate its implementation. Development of triage policies in such an event should be developed in an open and transparent manner, be reasonable in design, include the views of the critical stakeholders, and be responsive to and provide a mechanism for accountability, with a clearly defined goal of the just triage of limited health care resources. Planning failure will result in increased deaths from poor triage processes and substantial mistrust of the health care system and its practitioners. (+info)
Health care worker protection in mass casualty respiratory failure: infection control, decontamination, and personal protective equipment.
Maintenance of a safe and stable health care infrastructure is critical to an effective mass casualty disaster response. Both secondary contamination during chemical disasters and hospital-associated infections during epidemic illness can pose substantial threats to achieving this goal. Understanding basic principles of decontamination and infection control during responses to chemical and biologic disasters can help minimize the risks to patients and health care workers. Effective decontamination following toxic chemical exposure should include both removal of contaminated clothing and decontamination of the victim's skin. Wet decontamination is the most feasible strategy in a mass casualty situation and should be performed promptly by trained personnel. In the event of an epidemic, infection prevention and control measures are based on essential principles of hand hygiene and standard precautions. Expanded precautions should be instituted as needed to target contact, droplet, and airborne routes of infectious disease transmission. Specific equipment and measures for critical care delivery may serve to decrease risk to health care workers in the event of an epidemic. Their use should be considered in developing comprehensive disaster response plans. (+info)
Oxygen supplies during a mass casualty situation.
Mass casualty and pandemic events pose a substantial challenge to the resources available in our current health care system. The ability to provide adequate oxygen therapy is one of the systems that could be out-stripped in certain conditions. Natural disasters can disrupt manufacturing or delivery, and pandemic events can increase consumption beyond the available supply. Patients may require manual resuscitation, basic oxygen therapy, or positive-pressure ventilation during these scenarios. Available sources of oxygen include bulk liquid oxygen systems, compressed gas cylinders, portable liquid oxygen (LOX) systems, and oxygen concentrators. The last two are available in a variety of configurations, which include personal and home systems that are suitable for individual patients, and larger systems that can provide oxygen to multiple patients or entire institutions. Bulk oxygen systems are robust and are probably sustainable during periods of high consumption, but are at risk if manufacturing or delivery is disrupted. Compressed gas cylinders offer support during temporary periods of need but are not a solution for extended periods of therapy. Personal oxygen concentrators and LOX systems are limited in their application during mass casualty scenarios. Large-capacity oxygen concentrators and LOX systems may effectively provide support to alternative care sites or larger institutions. They may also be appropriate selections for governmental emergency-response scenarios. Careful consideration of the strengths and limitations of each of these options can reduce the impact of a mass casualty event. (+info)
Information management during mass casualty events.
Preparing for a mass casualty event starts long before the event. Being able to provide care during an event requires collecting information about processes, equipment, supplies, and personnel to anticipate different situations. Planning should include an impact analysis to identify and prioritize critical services that need to be maintained. Impact analysis is carried out in concert with the entire health care delivery organization, not by individual departments. Planning may include addressing inadequate staffing, disrupted supply chains, and loss of information systems. Care may need to be provided in alternate locations, without access to the usual information resources. Mass casualty events also depend on the availability of communications to inform others on the emergency response teams, as well as to inform patients and the public. (+info)