Securing the second front: achieving first receiver safety and security through competency-based tools.

INTRODUCTION: Limited research has focused on the safety and security of First Responders and Receivers, including clinicians, hospital workers, public safety officials, community volunteers, and other lay personnel, during public health emergencies. These providers are, in some cases, at greater peril during large-scale disasters due to their lack of training and inadequate resources to handle major influxes of patients. Exemplified in the 1995 Tokyo sarin gas attacks and the 2008 Wenchuan earthquakes, lack of training results in poor outcomes for both patients and First Receivers. OBJECTIVE: The improvement of knowledge and comfort level of First Receivers preparing for a medical disaster via an affordable, repeatable emergency preparedness training (EPT) curriculum. METHODS: A 5-hour EPT curriculum was developed including nine learning objectives, 18 competencies, and 34 performance objectives. Following brief didactic and small group sessions, interprofessional teams of four to six trainees were observed in a large patient simulator designed to recreate environmentally challenging (ie, flood evacuation), multi-patient scenarios using a novel technique developed to utilize trainees as actors. Trained observers assessed successful completion of 16 individual and 18 team performance objectives. Prior to training, team members completed a 24-question knowledge assessment, a demographic survey, and a comfort level self-assessment. Following training, trainees repeated the 24 questions, self-assessment, and course assessment. RESULTS: One hundred ninety-five participants completed the course between November 2012 and August 2013. One hundred ninety-one (98.5%), 150 (76.9%), and 66 (33.8%) participants completed the pretest, post-test, and course assessment, respectively. The mean (SD) percentage of correct answers between the pretest and post-test increased from 46.3 (13.4) to 75.3 (12.2), P < .0001. Thirty-eight participants (19.5%) reported more than three hours of disaster EPT each year while 157 participants (80.5%) reported three hours or less of yearly EPT. Sixty-six (100%) reported the course relevant to care providers and 61 (92.4%) highly recommended the course. Comfort level increased from 37.0/100 (n = 192) before training to 76.3/100 (n = 145) after training. CONCLUSION: The Center for Health Professional Training and Emergency Response's (CHPTER's) 5-hour EPT curriculum for patient care providers recreates simultaneous multi-actor disasters, measures EPT performance, and improves trainee knowledge and comfort level to save patient and provider lives during a disaster, via an affordable, repeatable EPT curriculum. A larger-scale study, or preferably a multi-center trial, is needed to further study the impact of this curriculum and its potential to enhance the safety and security of the "Second Front.

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.