Disaster Preparedness in the Emergency Department With the Use of Insitu Simulation

Aims/Objectives: The project examined whether insitu simulation would increase emergency healthcare providers’ knowledge of how to perform during a disaster, improve competency in skills related to those actions, and improve communication regarding the special circumstances inherent to a disaster in the ED. Outcome measures of interest included changes in providers’ knowledge, skill levels, and communication following on-site disaster preparedness training with the use of simulation.

Background: High influxes of patients during disasters have led to increased incidence of medical errors in EDs ultimately leading to poor patient outcomes. Nearly 30% of errors committed in the EDs are due to deficiencies in knowledge and skills, and between 60%-70% of errors occur due in part from communication breakdowns.

Research Methods: Trained observers recorded results from observation of the drill on a validated observation tool. Pretest-posttest questionnaires were used to determine changes in providers’ knowledge, skills, and communication across three time points: 1 month presimulation, 1 week postsimulation, and a retention measure at 4 months postsimulation. Sample: n= 55 ED providers. Setting: Academic Level 1 Trauma Center and designated Homeland Security Radiological Site in upper Midwest region of the U.S.

Instrument Reliability and Validity: Johns Hopkins Disaster Tool (JHDT) measured changes in providers’ knowledge, skills, and communications demonstrated during a disaster simulation by two independent observers at designated areas during the insitu simulation. The JHDT has been found to have a high degree of internal reliability suggesting the constructs to be valid. The knowledge-based pretest/posttest was adapted from the FEMA Orientation to Hazardous Materials for Medical Personnel Self Study Guide IS 346 and contained 29 items on pretest and 30 items on posttest and retention surveys and was found to have face validity after being piloted at three hospitals across the U.S.

Research Findings: One-way ANOVA comparing the average percent of items correct for these three domains at three different time points was not found to be significant. Skill scores of providers did not significantly change from pre to postsimulation; communication significantly increased from post to retention; knowledge improved across all time points. Post hoc comparisons revealed significant differences between post and retention for communication. Kappa values of observers were moderate for the treatment and triage zones and fair for the decontamination zone.

Implications or Significance of Findings: Insitu simulation markedly improved knowledge and significantly increased communication amongst emergency healthcare providers during a disaster drill. Future research is needed to develop quantifiable benchmarks for emergency healthcare providers’ knowledge, skills, and communication during disaster preparedness drills.