Computer simulation as a tool for assessing decision-making in pandemic influenza response training.

INTRODUCTION: We sought to develop and test a computer-based, interactive simulation of a hypothetical pandemic influenza outbreak. Fidelity was enhanced with integrated video and branching decision trees, built upon the 2007 federal planning assumptions. We conducted a before-and-after study of the simulation effectiveness to assess the simulations' ability to assess participants' beliefs regarding their own hospitals' mass casualty incident preparedness. DEVELOPMENT: Using a Delphi process, we finalized a simulation that serves up a minimum of over 50 key decisions to 6 role-players on networked laptops in a conference area. The simulation played out an 8-week scenario, beginning with pre-incident decisions. TESTING: Role-players and trainees (N=155) were facilitated to make decisions during the pandemic. Because decision responses vary, the simulation plays out differently, and a casualty counter quantifies hypothetical losses. The facilitator reviews and critiques key factors for casualty control, including effective communications, working with external organizations, development of internal policies and procedures, maintaining supplies and services, technical infrastructure support, public relations and training. Pre- and post-survey data were compared on trainees. RESULTS: Post-simulation trainees indicated a greater likelihood of needing to improve their organization in terms of communications, mass casualty incident planning, public information and training. Participants also recognized which key factors required immediate attention at their own home facilities. CONCLUSION: The use of a computer-simulation was effective in providing a facilitated environment for determining the perception of preparedness, evaluating general preparedness concepts and introduced participants to critical decisions involved in handling a regional pandemic influenza surge.

Hospital-based coalition to improve regional surge capacity.

INTRODUCTION: Surge capacity for optimization of access to hospital beds is a limiting factor in response to catastrophic events. Medical facilities, communication tools, manpower, and resource reserves exist to respond to these events. However, these factors may not be optimally functioning to generate an effective and efficient surge response. The objective was to improve the function of these factors. METHODS: Regional healthcare facilities and supporting local emergency response agencies developed a coalition (the Healthcare Facilities Partnership of South Central Pennsylvania; HCFP-SCPA) to increase regional surge capacity and emergency preparedness for healthcare facilities. The coalition focused on 6 objectives: (1) increase awareness of capabilities and assets, (2) develop and pilot test advanced planning and exercising of plans in the region, (3) augment written medical mutual aid agreements, (4) develop and strengthen partnership relationships, (5) ensure National Incident Management System compliance, and (6) develop and test a plan for effective utilization of volunteer healthcare professionals. RESULTS: In comparison to baseline measurements, the coalition improved existing areas covered under all 6 objectives documented during a 24-month evaluation period. Enhanced communications between the hospital coalition, and real-time exercises, were used to provide evidence of improved preparedness for putative mass casualty incidents. CONCLUSION: The HCFP-SCPA successfully increased preparedness and surge capacity through a partnership of regional healthcare facilities and emergency response agencies.

Radiological preparedness-awareness and attitudes: a cross-sectional survey of emergency medicine residents and physicians at three academic institutions in the United States.

CONTEXT: Emergency preparedness has been increasingly recognized as important. Research shows many medical personnel feel unprepared to respond to radiation incidents. Knowledge and attitudes of emergency medicine residents and faculty are largely unstudied, regarding their abilities to provide care for radiation disaster victims. It is unknown whether receiving training in radiological emergency preparedness improves knowledge and attitudes. OBJECTIVES: (1) Assess the attitudes of emergency medicine residents and faculty toward a radiological disaster; (2) Assess knowledge gaps of emergency medicine residents and faculty regarding radiological emergency preparedness; (3) Assess the attitudes of emergency medicine residents and faculty toward different educational strategies. METHODS: An electronic survey was sent to 309 emergency medicine residents and faculty at three U.S. academic institutions. Analyses were performed using SAS 9.0 software. RESULTS: The survey response rate was 36.6%. Only 37% and 28% of respondents had attended radiological preparedness training in the preceding 5 years or any training in radiation detection, respectively. Higher proportions of trained physicians were: (1) more familiar with DTPA and Prussian blue; (2) more comfortable assessing, decontaminating, and managing victims of radiation incidents; and (3) more comfortable using radiation detectors than their untrained counterparts. Many respondents were unable to differentiate between contamination with and exposure to radiological material. Classroom teaching at the workplace and prepackaged educational materials were most frequently rated as the preferred educational method for radiation preparedness training. DISCUSSION AND CONCLUSION: Our results suggest a need for additional radiological-nuclear preparedness training for emergency medicine residents and faculty. Training should include radiation detection, decontamination, explaining differences between radiation exposure and contamination, and teaching patient management, including DTPA and Prussian blue.

HIV service provision for people with severe mental illness in outpatient mental health care settings in New York.

People with severe mental illness evidence significantly higher rates of HIV infection than the general population in the United States. Frequently, the only access to health care for this population is through their outpatient mental health care providers. In order to determine how these providers were dealing with the increased risk of HIV infection among this group, a survey of all licensed and certified outpatient mental health care centers in New York State was conducted. The data were compared to a similar previous survey conducted in 1997.