South African General Surgeon Preparedness for Humanitarian Disasters.

BACKGROUND: Humanitarian medical organizations provide surgical care for a broad range of conditions including general surgical (GS), obstetric and gynecologic (OBGYN), orthopedic (ORTHO), and urologic (URO) conditions in unstable contexts. The most common humanitarian operation is cesarean section. The objective of this study was to identify the proportion of South African general surgeons who had operative experience and current competency in GS, OBGYN, ORTHO, and URO humanitarian operations in order to evaluate their potential for working in humanitarian disasters. METHODS: This was a cross-sectional online survey of South African general surgeons administered from November 2017-July 2018. Rotations in OBGYN, ORTHO, and URO were quantified. Experience and competency in eighteen humanitarian operations were queried. RESULTS: There were 154 SA general surgeon participants. Prior to starting general surgery (GS) residency, 129 (83%) had OBGYN, 125 (81%) ORTHO, and 84 (54%) URO experience. Experience and competency in humanitarian procedures by specialty included: 96% experience and 95% competency for GS, 71% experience and 51% competency for OBGYN, 77% experience and 66% competency for ORTHO, and 86% experience and 81% competency for URO. 82% reported training, and 51% competency in cesarean section. CONCLUSIONS: SA general surgeons are potentially well suited for humanitarian surgery. This study has shown that most SA general surgeons received training in OBGYN, ORTHO, and URO prior to residency and many maintain competence in the corresponding humanitarian operations. Other low- to middle-income countries may also have broad-based surgery training, and the potential for their surgeons to offer humanitarian assistance should be further investigated.

BUILDING RISK COMMUNICATION CAPABILITIES AMONG PROFESSIONALS: SEVEN ESSENTIAL CHARACTERISTICS OF RISK COMMUNICATION.

Since the Fukushima disaster, medical professionals have been involved in risk communication with residents affected. This is an urgent issue, and an important aspect of global disaster preparedness is defining the essential characteristics of professional risk communication, and training medical professionals and students to conduct effective risk communication. Using a narrative of risk trade-offs between radionuclides in the diet and traffic accidents as an example, we introduce the seven essential characteristics required by medical professionals and authorities involved in risk communication: (1) risk assessment, (2) differentiating between risk acceptance and risk trade-offs, (3) understanding differences in risk quality, (4) understanding how to frame information given residents' values, (5) giving attention to coping with too-high risk, (6) building trust and (7) fully considering how information is provided. Furthermore, we introduce an example of lectures at which participants can voluntarily learn the seven essential characteristics of risk communication through group discussions.

Evaluation of the association between disaster training and confidence in disaster response among graduate medical trainees: A cross-sectional study.

OBJECTIVE: Disasters by definition overwhelm the resources of a hospital and may require a response from a range of practitioners. Disaster training is part of emergency medicine (EM) resident curricula, but less emphasized in other training programs. This study aimed to compare disaster educational training and confidence levels among resident trainees from multiple specialties. DESIGN: A structured questionnaire assessed graduate medical training in disaster education and self-perceived confidence in disaster situations. Cross-sectional sampling of resident trainees from the departments of surgery, pediatrics, internal medicine, and EM was performed. SETTING: The study took place at a large urban academic medical center during March 2013. PARTICIPANTS: Among 331 available residents, a convenience sample of 157 (47.4 percent) was obtained. MAIN OUTCOME MEASURES: Outcomes investigated include resident confidence in various disaster scenarios, volume of disaster training currently received, and preferred education modality. RESULTS: EM trainees reported 7.3 hours of disaster instruction compared to 1.3 hours in non-EM trainees (p < 0.001). EM residents reported significantly more confidence in disaster scenarios compared to non-EM residents except for overall low confidence levels for mega mass casualty incidents. The preferred education modality for both EM and non-EM residents was simulation exercises followed by lecture. CONCLUSIONS: This study demonstrated relatively lower confidence among non-EM residents in disaster response as well as lower number of disaster education time. These data report a learner preference for simulation training.

Adaptando o currículo para atender a necessidades de profissionais de saúde em um desastre: uma proposta para enfermeiras brasileiras / Adaptando el currículo para atender a necesidades de profesionales de salud en un desastre: una propuesta para enfermeras brasileñas / Tailoring curricula to fit health professionals needs in a disaster: a proposal for Brazilian nurses

RESUMO Introdução Educação e capacitação são os pilares da preparação para os desastres e melhores currículos e programas de treinamento são baseados em competências. Objetivo Este artigo apresenta uma proposta para ser aplicada ao currículo de enfermagem no Brasil, baseada nas Diretrizes Curriculares Nacionais e nas recomendações para a integração de habilidades e competências no currículo de graduação propostas pela Organização Mundial da Saúde. Resultados Foi realizada uma comparação de referenciais de competências para indicar as competências específicas essenciais para enfermeiras brasileiras. Níveis de proficiência foram indicados para o estabelecimento de objetivos educacionais e experiências de aprendizado e instrumentos de avaliação recomendados da literatura. Conclusões As competências constituem o início da discussão que deverá ocorrer em cada escola de enfermagem para que todas as enfermeiras brasileiras estejam preparadas para o caso de um desastre ocorrer.

RESÚMEN Introducción Educación y capacidad son los pilares de la preparación para los desastres y mejores currículos y programas de entrenamiento son basados en competencias. Objetivo Este artículo presenta una propuesta para ser aplicada al currículo de enfermería en Brasil, basada en las Directrices Curriculares Nacionales y en las recomendaciones para la integración de habilidades y competencias en el currículo de grado propuestas por la Organización Mundial de la Salud. Resultados Se realizó una comparación de referenciales de competencias para indicar aquellas específicas esenciales para enfermeras brasileñas. Niveles de competencia fueran indicados para el establecimiento de objetivos educacionales e experiencias de aprendizaje e instrumentos de evaluación recomendados por la literatura. Conclusiones Las competencias constituyen el inicio de la discusión que deberá ocurrir en cada escuela de enfermería para que todas las enfermeras brasileñas estén preparadas para el caso de un desastre ocurrir.

ABSTRACT Introduction Education and training are the cornerstones of disaster preparedness and best curricula and training programs are competency-based. Objective This paper presents a proposal to be applied in nursing curricula in Brazil, based on the National Curriculum Guidelines and the recommendations for integrating skills and competencies into undergraduate curricula proposed by the World Health Organization. Results Comparison of competencies sets was conducted to indicate the specific competencies to be included as essential for Brazilian nurses. Levels of proficiency were indicated for the establishment of learning objectives and learning experiences and evaluation tools recommended from the literature. Conclusions The competencies provided are the beginning of the discussion that will have to take place in every nursing school, if all Brazilian nurses are to graduate ready to participate should a disaster occur.

Assessment of the accuracy of the Medical Response to Major Incidents (MRMI) course for interactive training of the response to major incidents and disasters.

BACKGROUND AND AIMS: The benefit of simulation models for interactive training of the response to major incidents and disasters has been increasingly recognized during recent years and a variety of such models have been reported. However, reviews of this literature show that the majority of these reports have been characterized by significant limitations regarding validation of the accuracy of the training related to given objectives. In this study, precourse and postcourse self-assessment surveys related to the specific training objectives, as an established method for curriculum validation, were used to validate the accuracy of a course in Medical Response to Major Incidents (MRMI) developed and organized by an international group of experts under the auspices of the European Society for Trauma and Emergency Surgery. METHODS: The studied course was an interactive course, where all trainees acted in their normal roles during two full-day simulation exercises with real time and with simultaneous training of the whole chain of response: scene, transport, the different functions in the hospital, communication, coordination, and command. The key component of the system was a bank of magnetized casualty cards, giving all information normally available as a base for decisions on triage and primary management. All treatments were indicated with attachments on the cards and consumed time and resources as in reality. The trainees' performance was recorded according to prepared protocols and a measurable result of the response could be registered. This study was based on five MRMI courses in four different countries with altogether 235 participants from 23 different countries. In addition to conventional course evaluations and recording of the performance during the 2 exercise days, the trainees' perceived competencies related to the specific objectives of the training for different categories of staff were registered on a floating scale 1-10 in self-assessment protocols immediately before and after the course. The results were compared as an indicator of to which extent the training fulfilled the given objectives. These objectives were set by an experienced international faculty and based on experiences from recent major incident and disasters. RESULTS: Comparison of precourse and postcourse self-assessments of the trainees' perceived knowledge and skills related to the given objectives for the training showed a significant increase in all the registered parameters for all categories of participating staff. The average increase was for prehospital staff 74 percent (p<0.001), hospital staff 65 percent (p<0.001), and staff in coordinating/administrative functions 81 percent (p<0.001). CONCLUSIONS: The significant differences in the trainees' self-assessment of perceived competencies between the precourse and postcourse surveys indicated that the methodology in the studied course model accurately responded to the specific objectives for the different categories of staff.

Virtual-world hospital simulation for real-world disaster response: Design and validation of a virtual reality simulator for mass casualty incident management.

BACKGROUND: Mass casualty incidents are unfortunately becoming more common. The coordination of mass casualty incident response is highly complex. Currently available options for training, however, are limited by either lack of realism or prohibitive expense and by a lack of assessment tools. Virtual worlds represent a potentially cost-effective, immersive, and easily accessible platform for training and assessment. The aim of this study was to assess feasibility of a novel virtual-worlds-based system for assessment and training in major incident response. METHODS: Clinical areas were modeled within a virtual, online hospital. A major incident, incorporating virtual casualties, allowed multiple clinicians to simultaneously respond with appropriate in-world management and transfer plans within limits of the hospital's available resources. Errors, delays, and completed actions were recorded, as well as Trauma-NOnTECHnical Skills (T-NOTECHS) score. Performance was compared between novice and expert clinician groups. RESULTS: Twenty-one subjects participated in three simulations: pilot (n = 7), novice (n = 8), and expert groups (n = 6). The novices committed more critical events than the experts, 11 versus 3, p = 0.006; took longer to treat patients, 560 (299) seconds versus 339 (321) seconds, p = 0.026; and achieved poorer T-NOTECHS scores, 14 (2) versus 21.5 (3.7), p = 0.003, and technical skill, 2.29 (0.34) versus 3.96 (0.69), p = 0.001. One hundred percent of the subjects thought that the simulation was realistic and superior to existing training options. CONCLUSION: A virtual-worlds-based model for the training and assessment of major incident response has been designed and validated. The advantages of customizability, reproducibility, and recordability combined with the low cost of implementation suggest that this potentially represents a powerful adjunct to existing training methods and may be applicable to further areas of surgery as well.

[Current organization of disaster medicine]. / Organisation actuelle de la médecine de catastrophe.

The concept of disaster medicine, derivedfrom medical management of casualties caused by terrorist attacks or earthquakes, began to be taught in medical school in 1982. It adapts military intervention tactics to civilian practices, and differentiates major disasters (in which preformed teams are sent to the scene) from disasters with limited effects (predefined plans form the backbone of the rescue organization). Management of blast and crush syndromes, triage, care of numerous burn victims, on-site amputation, necrotomy, medicopsychological support, mass decontamination, and rescue management are some of the aspects with which physicians should be familiar. Predefined intervention teams and ad hoc materials have been created to provide autonomous logistic support. Regulations, ethical aspects and managerial methods still need to be refined, and research and teaching must be given a new impetus.

Disaster preparedness among medical students: a survey assessment.

OBJECTIVE: To describe the level of preparedness in performing medical procedures of medical students at one allopathic medical school and to determine the level of willingness to perform these procedures in the event of a disaster. DESIGN: Cross-sectional survey. SETTING: US allopathic medical school associated with a county hospital. PARTICIPANTS: All third- and fourth-year medical students (344) in the 2007-2008 academic year were invited to participate. One hundred ninety-five students participated in this study (response rate = 57.6 percent). MAIN OUTCOME MEASURES: Information on demographic characteristics, personal disaster experience, personal disaster preparedness, and overall preparedness level and willingness to perform various medical procedures was collected. Multiple regression analysis was used to identify the factors predicting procedural willingness during a disaster. RESULTS: Demographics and personal disaster preparedness were not statistically significant between third-year medical students (M3) and fourth-year medical students (M4). Although procedural preparedness was significantly higher in M4 than M3, willingness to perform these procedures in a disaster was not different. Fourth-year students, first receivers (students' anticipated field is in emergency medicine or surgery), not having had a personal disaster experience, and increased procedural preparedness independently impact procedural willingness in a disaster However, when controlled for the covariate effects in the regression model, only first receivers, no past personal disaster experience, and increased procedural preparedness predicted willingness to perform medical procedures during a disaster. CONCLUSIONS: Third- and fourth-year students possess skills that may prove useful in a disaster response. Further investigations are necessary to determine how medical students may be utilized during these events.

Simulation for team training and assessment: case studies of online training with virtual worlds.

Individuals in clinical training programs concerned with critical medical care must learn to manage clinical cases effectively as a member of a team. However, practice on live patients is often unpredictable and frequently repetitive. The widely substituted alternative for real patients-high-fidelity, manikin-based simulators (human patient simulator)-are expensive and require trainees to be in the same place at the same time, whereas online computer-based simulations, or virtual worlds, allow simultaneous participation from different locations. Here we present three virtual world studies for team training and assessment in acute-care medicine: (1) training emergency department (ED) teams to manage individual trauma cases; (2) prehospital and in-hospital disaster preparedness training; (3) training ED and hospital staff to manage mass casualties after chemical, biological, radiological, nuclear, or explosive incidents. The research team created realistic virtual victims of trauma (6 cases), nerve toxin exposure (10 cases), and blast trauma (10 cases); the latter two groups were supported by rules-based, pathophysiologic models of asphyxia and hypovolemia. Evaluation of these virtual world simulation exercises shows that trainees find them to be adequately realistic to "suspend disbelief," and they quickly learn to use Internet voice communication and user interface to navigate their online character/avatar to work effectively in a critical care team. Our findings demonstrate that these virtual ED environments fulfill their promise of providing repeated practice opportunities in dispersed locations with uncommon, life-threatening trauma cases in a safe, reproducible, flexible setting.