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Ten (+1) lessons from conducting a mass casualty in situ simulation exercise in a Canadian academic hospital setting

Jeffrey T. Tochkin, MA, CEM, Hung Tan, MSc, Caroline Nolan, Harrison Carmichael, MD, Andrew Willmore, MD, George Mastoras, MD

Abstract


Providing care in a twenty-first century urban emergency department (ED) and trauma center is a complex high-pressure practice environment. The pressure is intensified during patient surge scenarios commonly seen during mass casualty incidents, such that response must be practiced regularly. Beyond clinical mastery of individual patient trauma care, a coordinated system-level response is essential to optimize patient care during these relatively infrequent events. This paper highlights the need to perform exercises in hospitals while providing practical advice on how to utilize in situ simulation for mass casualty testing. Eleven lessons are presented to assist other emergency management professionals, hospital administrators, or clinical staff to achieve success with in situ simulation. Based upon our experience designing and executing an in situ mass casualty simulation within an ED, we offer lessons applicable to any type of disaster exercise. Simulation offers a powerful tool for the conduct of disaster preparedness exercises for staff across multiple hospital departments and professions.


Keywords


Mass casualty, hospital exercise, simulation, hospital preparedness

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References


Guha-Sapir D, Hoyois P, Below R: Annual Disaster Statistical Review 2014: The Numbers and Trends. Brussels: CRED; 2015.

Waxman D, Chan E, Pillemer F, Smith T, et al.: Assessing and improving hospital mass-casualty preparedness: A no-notice exercise. Prehospital and Disaster Medicine, 2017; 32(6): 662-666. DOI: 10.1017/S1049023X17006793.

Edwards D, Williams LH, Scott MA, et al.: When disaster strikes: Maintaining operational readiness. Nurse Manager. 2007; 38(9): 64-66.

Kobayashi L, Overly FL, Fairbanks RJ, et al.: Advanced medical simulation applications for emergency medicine microsystems evaluation and training. Acad Emerg Med. 2008; 15: 1058-1070.DOI:10.1111/j.1553-2712.2008.00247.x.

Mastoras G, Poulin C, Norman L, et al.: LO044: Stress-testing the resuscitation room: Latent threats to patient safety identified during interprofessional in-situ simulation in the emergency department. CJEM. 2016; 18(S1): S45-S45. DOI:10.1017/cem.2016.81.

Dunn W, Deutsch E, Maxworthy J, et al.: Systems integration. In Levine AI, DeMaria SJ, Schwartz AD, Sim AJ (eds.): The Comprehensive Textbook of Healthcare Simulation. New York: Springer; 2013: 121-134.

Gowing JR, Walker KN, Elmer SL, et al.: Disaster preparedness among health professionals and support staff: What is effective? An integrative literature reviews. Prehospital Disaster Med. 2017; 32(3): 321-328.

Carmichael H, Mastoras G, Nolan C, et al.: Integration of in situ sim into an emergency department code orange exercise in a tertiary care trauma referral centre. The University of Ottawa; 2019 (Unpublished).

Jung D, Carman M, Aga R, et al.: Disaster preparedness in the emergency department using in situ simulation. Adv Emerg Nurs J. 2016; 38(1): 56-68.

Norman G, Dore K, Grierson L: The minimal relationship between simulation fidelity and transfer of learning. Med Educ. 2012; 46: 636-647.

Ministry of the Solicitor General: Incident management system. 2017. Available at https://www.emergencymanagementontario.ca/english/emcommunity/ProvincialPrograms/IMS/ims_main.html.

Spurr J, Gatward J, Joshi N, et al.: Top 10 (+1) tips to get started with in situ simulation in emergency and critical care departments. Emerg Med J. 2016; 33: 514-516.

Hsu EB, Jenckes MW, Catlett CL, et al.: Effectiveness of hospital staff mass-casualty incident training methods: A systematic literature review. Prehospital Disaster Med. 2014; 19(3): 191-199.

Aghera A, Emery M, Bounds R, et al.: A randomized trial of SMART goal enhanced debriefing after simulation to promote educational actions. Western J Emerg Med. 2018; 19(1): 112-120. DOI:10.5811/westjem.2017.11.36524.

Rudolph JW, Raemer DB, Simon R: Establishing a safe container for learning in simulation. Simul Healthc. 2014; 9: 339-349.

Petrie M: Homeland security exercise and evaluation program: Quick reference guide. University of California, Berkley, School of Public Health Center for Infectious Diseases and Emergency Readiness. n.d. Available at https://www.calhospitalprepare.org/sites/main/files/file-attachments/cider_hseep_refgdv3.pdf?1376949630.

Canadian Standards Association: Z1600-17: Emergency and continuity management program. 2017. Available at https://store.csagroup.org/. Accessed August 14, 2019.

Brooks SK, Dunn R, Amlot R, et al.: Training and post-disaster interventions for the psychological impacts on disaster-exposed employees: A systematic review. J Ment Health. 2018; 1-25. DOI:10.1080/09638237.2018.1437610.

Adini B, Aharonson-Daniel L, Israeli A: Load index model: An advanced tool to support decision making during mass-casualty incidents. J Trauma Acute Care Surg. 2015; 78(3): 622-627. DOI:10.1097/TA.0000000000000535.

Canadian Institute for Health Information: Emergency department wait times in Canada continuing to rise. 2019. Available at https://www.cihi.ca/en/emergency-department-wait-times-in-canada-continuing-to-rise. Accessed August 20, 2019.




DOI: https://doi.org/10.5055/jem.0581

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