The EDIT Survey: Identifying Emergency Department Information Technology Knowledge and Training Gaps.

OBJECTIVE: To review Emergency Department internet connectivity, cyber risk factors, perception of risks and preparedness, security policies, training and mitigation strategies. METHODS: A validated targeted survey was sent to Canadian ED physicians and nurses between March 5, 2019 and April 28, 2019. RESULTS: There were 349 responses, with physicians making up 84% of the respondents (59% urban teaching, 35% community teaching, 6% community non-teaching hospitals). All had multiple passwords, 93% had more than 1 user account, over 90% had to log repeatedly each workday, 52% had to change their passwords every 3 months, 75% had multiple methods of authentication and 53% reported using a terminal where someone else was already logged in. Passwords were used to review laboratory and radiology data, access medical records and manage patient flow. Majority of the respondents (51%) did not know if they worked with internet linked devices. Only 7% identified an 'air gapped' computer in their facility and 76% used personal devices for patient care, with less than a third of those allowing the IT department to review their device. A total of 26 respondents received no cyber security training. CONCLUSION: This paper revealed significant computer-human interface dysfunctionality and readiness gaps in the event of an IT failure. These stemmed from poor system design, poor planning and lack of training. The paper identified areas with technical or training solutions and suggested mitigation strategies.

Hospital Emergency Readiness Overview study.

In 2001, a survey of Canadian emergency departments indicated significant deficiencies in disaster preparedness. Since then, there have been efforts on the part of Provincial governments to remedy this situation. This survey repeats the original study with minor modifications to determine if there has been improvement. The Hospital Emergency Readiness Overview study demonstrates that despite improvements, there remain gaps in Canadian healthcare facility readiness for disaster, specifically one involving contaminated patients. It also highlights the lack of any standardized assessment of healthcare facilities' chemical, biological, radiological, or nuclear readiness.

Response of a community hospital and its emergency department to the H1N1 pandemic influenza.

Hospital's faced with surges in patient visits during the H1N1 pandemic and who were unable to redirect patients to community influenza clinics had a variety of response options. This article reviews the implementation and impact of an "in-hospital" Emergency Department based influenza clinic.

Canadian operational and emotional prehospital readiness for a tactical violence event.

Providing prehospital care poses unique risks. Paramedics are essentially the only medical personnel who are routinely at the scene of violent episodes, and they are more likely to be assaulted than are other prehospital personnel. In addition to individual acts of violence, emergency medical services (EMS) providers now need to cope with tactical violence, defined as the deployment of extreme violence in a non-random fashion to achieve tactical or strategic goals. This study reviewed two topics; the readiness of EMS crews for violence in their environment and the impact of violence on the EMS crew member. This latter also evaluated the access and effectiveness of emotional support available to caregivers exposed to violent episodes. The results of the survey indicate a significant lack of preparedness for situations involving tactical violence. A total of 89% of respondents either had never had such training or had been trained more than one year ago. Thirty-six percent of respondents had never engaged in a field exercise with other responding agencies, and 4.5% of respondents were not aware of who would be in charge in such an event. In addition, this study indicates that EMS crews are exposed to events with significant emotional impacts without access to appropriate training and adequate support.

Chemical, biological, radiological and nuclear preparedness training for emergency medical services provider.

OBJECTIVE: We assessed the self-reported theoretical and practical preparedness training of Canadian emergency medical services (EMS) providers in chemical, biological, radiological and nuclear (CBRN) events. METHODS: We designed an online survey to address the theoretical and practical CBRN training level of prehospital providers. Emergency medical services staff in British Columbia and Ontario were invited to participate. RESULTS: Of the 1028 respondents, 75% were male, and the largest demographic groups were front-line personnel with more than 15 years of experience. Only 63% of respondents indicated they had received either theoretical or practical training to work in a contaminated environment, leaving 37% who indicated they had received neither type of training. Of those that had received any training, 61% indicated they had received "hands-on" or practical training and 82% indicated they had received some training in identification of a possibly contaminated scene. Only 42% had received training for symptoms of nerve agents, 37% had received training for symptoms of blister agents and 46% had received training for symptoms of asphyxiants. Thirty-two percent had received training for the treatment of patients exposed to nerve agents, and 30% had received training for the treatment of patients exposed to blister agents. Only 31% of all respondents had received training for detecting radiation. CONCLUSION: CBRN events involve unique hazards and require specific education and training for EMS providers. A large proportion of Canadian EMS providers report not having received the training to identify and work in contaminated environments.

Populations at risk--paediatrics.

Disasters affect all segments of the population. Many subsets of the general adult population have specific needs and vulnerabilities. One group with specific needs and which is always at high risk in disasters is children. The physiological, anatomical, developmental and psychological requirements in children differ from those of adults. Disaster planning must recognise and adapt to this. For the past 3 years, the Centre of Excellence in Emergency Preparedness (CEEP) has been developing a document that will outline specific paediatric issues in disasters and provide general (and, where possible, specific) guidelines for Canadian health-care providers and disaster planners. This paper discusses special issues of emergency preparedness for children and reviews the content of the document being developed at CEEP.

Emergency preparedness: what every health care worker needs to know.

Canada is moving forward quickly with plans to ensure that it is prepared to deal with emergencies. The National Framework for Health Emergency Management, released Nov. 26, 2004, recommends that a National Health Incident Management System (IMS) be developed. However, although most communities have successfully implemented IMS in the emergency services sector, many are still struggling with the integration of IMS into their health care systems. It is essential that all health care workers, regardless of profession or position, understand at least the basic concepts of emergency preparedness because of the wide variety of roles they may be asked to fulfill in an emergency situation. This article will review the basic concepts in emergency preparedness and management with a specific focus on IMS in health care.

Canadian emergency department preparedness for a nuclear, biological or chemical event.

Since the terror attacks of September 11th, emergency departments across North America have become more aware of the need to be prepared to deal with a mass casualty terror event, particularly one involving nuclear, biological or chemical contaminants. The effects of such an attack could also be mimicked by accidental release of toxic chemicals, radioactive substances or biological agents unrelated to terrorist activity. The purpose of this study was to review the risks and characteristics of these events and to assess the preparedness of Canadian emergency departments to respond. This was done by means of a survey, which showed a significant risk of a mass casualty event (most likely chemical) coupled with a deficiency in preparedness -- most notably in the availability of appropriate equipment, antidotal therapy and decontamination capability. There were also significant deficiencies in the ability to respond to a major biologic or nuclear event.

Terrorism in Canada.

This paper reviews terrorism in Canada, assessing the incidence and nature of terrorist activity, the potential targets of terrorist attacks, risk factors to Canadian nationals and institutions, and the responses of the Canadian government in dealing with the threat and the effectiveness of those responses. Despite the fact that there have been no recent high-profile terrorist events in Canada, this country has a serious terrorism problem, the key manifestation of which is the multitude of terrorist organizations that have designated Canada as a base of operations. In addition, Canadians have been attacked overseas and Canadian organizations, both local and abroad, are potential targets of terrorist activity. Canadian attempts to deal with terrorism through foreign and domestic policy have been ineffective, primarily because the policies have been poorly enforced. Until recently, terrorist organizations legally could raise funds in Canada, in direct contravention of international treaties signed by Canada. It is possible that the ineffectiveness in enforcing the anti-terrorism legislation stems from hope that placating terrorist organizations, and the countries that support them, will prevent Canada from becoming a target. Unfortunately evidence from other countries has shown this strategy to be ineffective.