Regional approach to competency-based patient care provider disaster training: the Center for Health Professional Training and Emergency Response.

OBJECTIVES: This article details the development of the Center for Health Professional Training and Emergency Response (CHPTER), including its innovative, competency-based emergency preparedness training (EPT) curriculum, and the results of a regional preparedness workforce assessment. METHODS: CHPTER was established in 2009 with the goal of enhancing regional health security and patient surge competency by offering patient care providers, including clinicians and volunteers, hands-on lessons that will protect and save lives during a disaster. A 1-day emergency preparedness training (EPT) course that includes a loud, chaotic clinical disaster scenario was developed. A two-part workforce assessment survey to further refine regional EPT needs was administered. RESULTS: The 1-day EPT course enhanced patient care providers' knowledge, comfort level, and skills required to save lives during a disaster. Twenty-one emergency department directors and 400 patient care providers responded to the surveys. The majority of emergency department directors surveyed believe that one in five of their provider workforce would fail to properly perform their expected duties in a disaster. More than half of the patient care providers reported fewer than 2 hours of annual EPT training and 40% of employers required no annual training. The most significant barriers to widespread dissemination of EPT were financial constraints and time availability of providers. CONCLUSIONS: Patient care providers in our region (North and South Carolina) are not prepared for a disaster. The CHPTER 1-day competency-based EPT curricula improved trainee knowledge, comfort level, and disaster care skills. CHPTER may serve as a model for other regions seeking to improve care provider EPT programs.

Individual variability in the locus of prefrontal craving for nicotine: implications for brain stimulation studies and treatments.

BACKGROUND: Attenuation of cue-elicited craving with brain stimulation techniques is a growing area of attention in addiction research. This investigation aims to guide these studies by assessing individual variability in the location of peak cortical activity during cue-elicited craving. METHOD: Twenty-six nicotine-dependent individuals performed a cue-elicited craving task in a 3T MRI scanner while BOLD signal data was collected. The task included epochs of smoking cues, neutral cues, and rest. The location of peak activity during smoking cues relative to neutral cues ('hot spot') was isolated for each individual. The spatial dispersion of the 26 cue-elicited hot spots (1 per participant) was quantified via hierarchical clustering. RESULTS: When viewing nicotine cues all 26 participants had at least one cluster of significant prefrontal cortex activity (p<0.05, cluster corrected). Only 62% had peak activity in the medial prefrontal cortex cluster (including 100% of the men). In 15% of the participants peak activity was located in either the left lateral prefrontal cortex or left insula cluster. Peak activity in the remaining 23% was dispersed throughout the prefrontal cortex. CONCLUSION: There is considerable individual variability in the location of the cue-elicited 'hot spot' as measured by BOLD activity. Men appear to have a more uniform location of peak BOLD response to cues than women. Consequently, acquiring individual functional imaging data may be advantageous for either tailoring treatment to the individual or filtering participants before enrollment in treatment.