The Standardization of the Emergency Department Response to Chemical, Biological, Radiological, and Nuclear (CBRN) Events: Human Factors/Ergonomics Approach.

OBJECTIVE: To provide standardized recommendations for the emergency department (ED) response to chemical, biological, radiological, and nuclear (CBRN) events by combining the human factors/ergonomics method of hierarchical task analysis with the theoretical framework for Work as Imagined versus Work as Done. METHODS: Document analyses were used to represent CBRN response operational procedures. Semi-structured interviews using scenario cards were carried out with 57 first receivers (ED staff) to represent CBRN practice at 2 acute hospitals in England. RESULTS: Variability existed in general organizational responsibilities associated with the CBRN response. Variability was further evident in top level CBRN tasks and CBRN phases at both EDs. Operational procedures focused on tasks such as documentation, checking, and timing. CBRN practice focused on patient needs through assessment, treatment, and diagnosis. CONCLUSION: The findings provide top-down and bottom-up insights to enhance the ED CBRN response through standardization. The standardized CBRN action card template embeds the choice approach to standardization. The standardized CBRN framework implements the streamlined categorization of CBRN phases. Work as Imagined versus Work as Done is a useful theoretical framework to unpack a complex sociotechnical system, and hierarchical task analysis is an effective system mapping tool in health care.

Post-trip safety interventions: State-of-the-art, challenges, and practical implications.

INTRODUCTION: Currently, risky driving behaviour is a major contributor to road crashes and as a result, wide array of tools have been developed in order to record and improve driving behaviour. Within that group of tools, interventions have been indicated to significantly enhance driving behaviour and road safety. This study critically reviews monitoring technologies that provide post-trip interventions, such as retrospective visual feedback, gamification, rewards or penalties, in order to inform an appropriate driver mentoring strategy delivered after each trip. METHOD: The work presented here is part of the European Commission H2020 i-DREAMS project. The reviewed platform characteristics were obtained through commercially available solutions as well as a comprehensive literature search in popular scientific databases, such as Scopus and Google Scholar. Focus was given on state-of-the-art-technologies for post-trip interventions utilized in four different transport modes (i.e. car, truck, bus and rail) associated with risk prevention and mitigation. RESULTS: The synthesized results revealed that smartphone applications and web-based platforms are the most accepted, frequently and easiest to use tools in cars, buses and trucks across all papers considered, while limited evidence of post-trip interventions in -rail was found. The majority of smartphone applications detected mobile phone use and harsh events and provided individual performance scores, while in-vehicle systems provided delayed visual reports through a web-based platform. CONCLUSIONS: Gamification and appropriate rewards appeared to be effective solutions, as it was found that they keep drivers motivated in improving their driving skills, but it was clear that these cannot be performed in isolation and a combination with other strategies (i.e. driver coaching and support) might be beneficial. Nevertheless, as there is no holistic and cross-modal post-trip intervention solution developed in real-world environments, challenges associated with post-trip feedback provision and suggestions on practical implementation are also provided.