Disaster Planning Drills and Readiness Assessment

1. Disaster Planning Drills and Readiness Assessment Gary B. Green, MD, MPH, FACEP Associate Professor of Emergency Medicine & Pathology Johns Hopkins University School of Medicine and Johns Hopkins University Evidence-Based Practice Center President, Emergency International, Inc.

2. “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

3. 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 (growing “toolbox”)

4. 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

5. Pre-course Knowledge exam Post-course Knowledge exam Didactic education training (modular courses) Review/modify disaster plan Skills/practical training (drills) Drill evaluation: (Institutional & Individual skills assessment) (Re) Define stakeholders & goals Modification & re-engineering of training interventions Report & analysis of strengths & weaknesses Continuous Quality Improvement (CQI) Process Applied to Disaster Preparedness Capacity Building

6. Preparation for Conventional vs. Bioterrorism Event • Preparedness for biologic, chemical or radiation events is built on conventional preparedness • Additional needed preparations include: • Decontamination of victims • Protection of health care workers • Containment of infectious agents • Agent/vector specific treatments • Preparedness for “chronic” disaster

7. EMS & PUBLIC SAFETY RAD & CHEM RAD & CHEM BIO BIO Disaster Response PREHOSPITAL SCENE RESPONSE HOSPITAL DRILL RESPONSE SYSTEM INTEGRATION IN-HOSPITAL EVENT INCIDENT COMMAND SYSTEM (ICS)

8. Basic Components of Disaster Response System • Incident Command System • System integration (communications) • Logistics (materials, facilities, transportation) • Clinical operations • Human resources • Security • Public relations • Others as defined by local plan

9. Training Techniques 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

10. Training 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

11. Training Techniques • 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

12. 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?

13. 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

14. 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