A pilot assessment of hospital preparedness for bioterrorism events

OBJECTIVE: Lessons on question content and refinement of a 2003 Agency for Healthcare Research and Quality-Health Resources Services Administration (AHRQ-HRSA) pilot hospital preparedness assessment tool designed to capture activities in more detail than previous studies are reported in this study. METHODS: Responses from fixed-choice questions, including organizational and geographical differences, were analyzed using the chi-square test. Open-ended questions were evaluated qualitatively. RESULTS: Of the respondents, 91% had developed plans and 97% designated a bio-event coordinator, but only 47% had allocated funds. Urban hospitals were more likely to participate in regional infectious disease monitoring. Hospitals that participated in a network were more likely to fund preparedness, share bio-event coordinators and medical directors, and provide advanced training. CONCLUSIONS: Several issues deserve further study: (1) hospital networks may provide the structure to promote preparedness; (2) specific procedures (e.g., expanding outpatient treatment capacity) have not been tested; and (3) special attention should be directed towards integrating non-urban hospitals into regional surveillance systems to ensure early identification of infectious disease outbreaks.     

Public health nursing competencies for public health surge events

OBJECTIVE: To develop consensus regarding public health nursing competencies in the event of a public health surge event related to disaster. DESIGN AND METHODS: Using a 3-round Delphi approach, public health nurses (PHNs) and directors of nursing from local health departments, state nursing leaders, and national nursing preparedness experts reviewed and commented on 49 draft competencies derived from existing documents. RESULTS: The final 25 competencies were categorized into Preparedness (n=9), Response (n=8), and Recovery (n=7). The Preparedness competencies focus on personal preparedness; comprehending disaster preparedness terms, concepts, and roles; becoming familiar with the health department's disaster plan, communication equipment suitable for disaster situations; and the role of the PHN in a surge event. Conducting a rapid needs assessment, outbreak investigation and surveillance, public health triage, risk communication, and technical skills such as mass dispensing are Response phase competencies. Recovery competencies include participating in the debriefing process, contributing to disaster plan modifications, and coordinating efforts to address the psychosocial and public health impact of the event. CONCLUSIONS: Identification of competencies for surge events that are specific to public health nursing is critical to assure that PHNs are able to respond to these events in an effective and efficient manner.     

Bioterrorism preparedness for local health departments

Bioterrorism preparedness has not traditionally been an everyday concern of local public health departments. The likely first responders to a biological bioterrorism event will be local public health personnel. The events of September 11, 2001, and the anthrax crisis that followed tested the capabilities of the public health system and demonstrated its fragility. Little federal funding has trickled down to local health departments, and they have not been included in planning or training for bioterrorism preparedness. Now local health departments must develop detailed bioterrorism response plans. Effective plans will involve internal assessment of strengths and weaknesses and strategizing with other local community agencies. Our health department is a suburban county agency that serves a population of over 250,000. We have started this self-assessment and planning process. This bioterrorism guide has provided some structure for us and may be helpful for other local health departments as they begin this process.     

Physician preparedness for bioterrorism recognition and response: a Utah-based needs assessment.

The medical community accepts that they have a need to be prepared to recognize and respond to bioterrorism events. A needs assessment conducted among physicians throughout the state of Utah provided insights into their perceived training needs and preferred methods of learning. Physicians have many competing demands on their time and tailored educational offering can increase the intended audience's acceptance and learning.     

Criteria for the assessment of disaster preparedness

The assessment of disaster preparedness of certain areas is to a large extent liable to subjectivity. For a modern society, however, objectivity is a prerequisite. A methodology is presented calculating the disaster preparednes of municipalities, counties, provinces, states, or even countries. Standardization of this methodology could allow comparison of disaster preparedness between these areas.     

Enhancing public health preparedness for a terrorist attack involving cyanide

The US government considers cyanide to be among the most likely agents of chemical terrorism. Cyanide differs from many other biological or chemical agents for which little or no defense is available because its individual and public health effects are largely remediable through appropriate preparedness and response. Because the toxicity of the cyanide antidote currently available in the United States renders it ill-suited for use in terrorist incidents and other situations requiring rapid out-of-hospital treatment, hydroxocobalamin--an effective and safe cyanide antidote being used in other countries--has been introduced in the United States. Unlike the other available cyanide antidote, hydroxocobalamin can be administered at the scene of a cyanide disaster, and it need not be reserved for cases of confirmed cyanide poisoning but can be administered in cases of suspected poisoning. Both of these attributes facilitate the rapid intervention necessary for saving lives. To realize the potential benefits of hydroxocobalamin, progress also needs to be realized in other aspects of readiness, including but not limited to developing plans for ensuring local and regional availability of antidote, educating emergency responders and health care professionals in the recognition and management of cyanide poisoning, and raising public awareness of the potential for a chemical weapons attack and of how to respond.     

Emergency department staff preparedness for mass casualty events involving children.

BACKGROUND: In recent years, the World Health Organization in general, and Israel in particular, have dealt with mass casualty events (MCEs) resulting from terrorism. Children are the casualties in many of these events-a reality that forces hospitals to prepare to deal with such a scenario. A literature review designed to identify unique recommendations regarding pediatric MCEs highlights both a lack of existing training programs and uncertainty on the part of health care staff when dealing with these events. OBJECTIVES: The purpose of the study was to examine the preparedness level of emergency department staff to deal with MCEs involving pediatric casualties. The study included 104 physicians and nurses working in, or responding to, the emergency department at a hospital in Israel. METHOD: The study included a 41-item questionnaire examining perception, approaches, and staff knowledge regarding dealing with pediatric MCEs versus those involving adults. The reliability of all sections of the questionnaire ranged between Chronbach's alpha coefficient 0.6 alpha-0.94. RESULTS: The preparedness levels for MCEs involving children were found to be low. Study participants ranked the likelihood of a pediatric MCE lower than one involving adults, while ranking significantly higher (P = .000) their ability to cope mentally and the knowledge and skills required when treating adults involved in MCEs. While nurses ranked higher than physicians regarding their knowledge and skills in dealing with pediatric MCE casualties, the level of knowledge for MCEs involving children was low in all subjects. Staff agreement for the parent of an MCE victim to be present during treatment was medium-low. IMPLICATIONS: On the basis of these findings, additional research involving a larger number of individuals and hospitals is indicated to determine if these results are consistent throughout the region.     

Casualty collection in mass-casualty incidents: a better method for finding proverbial needles in a haystack

INTRODUCTION: Mass-casualty incidents (MCIs) are on the rise. The ability to locate, identify, and triage patients quickly and efficiently results in better patient outcomes. Poor lighting due to time of day, inclement weather, and power outages can make locating patients difficult. Efficient methods of locating patients allow for quicker transport to definitive care. OBJECTIVE: The objective of this study was to evaluate the methods currently used in mass-casualty collection, and to determine whether the use of the Simple Triage and Rapid Treatment (START) triage tag system can be improved by using easily discernable tags (glow sticks) in conjunction with the standard triage tags. METHODS: Numerous drills were performed utilizing the START triage method. In Trial A, patients were identified with the triage tags only. In Trial B, patients were identified using triage tags and glow sticks. Four rounds of triage drills were performed in low ambient light for each Trial, and the differences in casualty collection times were compared. RESULTS: Casualty relocation and collection times were considerably shorter in the trials that utilized both the glow sticks and triage tags. An average of 2.58 minutes (31.75%) were saved during the casualty collections. In addition, fewer patient errors occurred during the trials in which the glow sticks were used. Between the four rounds, an average of four patient errors occurred during the trials that utilized the triage tags. However, there was an average of only one patient error for the drills when participants utilized both the triage tags and the glow sticks. CONCLUSIONS: The use of the highly visible glow sticks, in conjunction with the START triage tags, allowed for more rapid and accurate casualty collection in suboptimal lighting. The use of the glow sticks made it easier to relocate previously triaged patients and arrange for expeditious transport to definitive care. In addition, the glow sticks reduced the number of patient errors. Most importantly, there was a significant reduction in the number of patients that initially were triaged via the START method, but were overlooked during casualty collection and transport.     

Public health: a new nursing role for community practitioners

This article discusses the six key activities identified by the Royal College of Nursing (1994) as essential ingredients for public health nursing. Examples of public health practice and community nurse involvement are given to illustrate each activity. Public health skills such as health profiling, building healthy alliances and policy development are outlined. Current barriers to community nurses participating in these activities are identified and models of public health practice are reviewed. The potential for a radical transformation of community nursing practice is discussed in the context of an expanding public health role of community nurses in Scotland. Options for future practice are presented and discussed.     

Assessment of physician preparedness and response capacity to bioterrorism or other public health emergency events in a major metropolitan area.

BACKGROUND: The role of physicians in the detection, reporting, and response to infectious disease outbreaks, anomalous biologic events, or other public health emergencies is critical to the community's safety. OBJECTIVE/METHOD: In an effort to assess the level of preparedness of local physicians to respond to such events, the City of Fort Worth Public Health Department, the Fort Worth/Tarrant County Health Authority, and the Tarrant County Medical Society collaborated in designing and administering a cross-sectional study in spring 2006. RESULTS: The results serve as a baseline of the local clinical community's preparedness, with 91% of local physicians reporting their knowledge as "fair-poor," 80% desiring more information, and 83% favoring more training opportunities. CONCLUSION: Information obtained through this assessment is used to help cultivate educational interventions that will enhance the participation, integration, and mobilization of clinicians in the event of a community emergency.     

Disaster preparedness for nurses: a teaching guide

As one of the largest groups of health care providers in the United States, nurses are trained to attend to the physical, psychological, and spiritual needs of their patients, making them highly qualified to influence the outcomes of victims of an emergency situation. Unfortunately, nursing programs offer limited content on delivering care under extreme conditions, and few continuing education programs are available to practicing nurses. This article provides a brief educational presentation that can be used without an extensive time commitment or in-depth instructor knowledge of the subject. The course content has been presented to nurses at the American Red Cross, at local chapter meetings of professional nursing organizations, and to both graduate and undergraduate nursing students. This presentation is not designed to be a comprehensive study of disaster nursing, but serves as a starting point that might lead to further study and encourage active participation in preparedness education and planning.     

Public accountability for health: new standards for health system performance

This article reviews the failure of contemporary quality oversight organizations to respond to the changing health care environment and suggests an overhaul of quality measurement and assurance functions. The authors examine the factors that have limited public accountability for health care, emphasizing the limited agreement that exists on the purpose of American health care, standards for evaluating care, or the appropriate locus of responsibility for quality of care. A five-part quality oversight system is proposed including development of quality measures, promulgation of national standards, validation and accreditation, use of data for purchasing and provider selection, and use of data for quality improvement.     

Adverse events in health care: a literature review

Aim  This paper aims to develop understanding of the nature, costs and strategies to reduce or prevent a range of adverse events experienced by people within the healthcare system.
Background  Care interventions are not always based on safe practice and adverse events can and do occur that cause or place at risk patients lives and well-being. The nature of adverse events is diverse and can be attributed to a multitude of individual and system contributory factors and causes.
Evaluation  A review of the literature was undertaken in 2006 and 2007 using the following databases: Pubmed, CINAHL, Biomed Ovid, Synergy and the British Nursing Index. This paper evaluates the literature that pertains to adverse events and seeks understanding of this complex issue.
Key issues  Published statistics confirm that globally, professional errors in clinical practice and care delivery occur at an unacceptably high level and result in considerable human and financial consequences.
Conclusion  Reaching understanding of the multiple factors that contribute to unsafe clinical practice situations requires a cultural shift in organizations.
Implication for Nursing Management  Reasons for adverse events are complex and require healthcare managers to evaluate the system issues which impact on the delivery and organization of care.