Creating a hazard-based training and assessment tool for emergency response drivers.

Emergency response drivers (ERDs) are often required to engage in high-risk driving manoeuvres on their way to a reported incident. Such risk requires that these drivers receive a high-level of training and continued development. The aim of this paper was to investigate an innovative format for a new potential tool that could support the training and assessment of these drivers: a single-clip Holistic Hazard Test, containing multiple hazards in a single route. In study one, we created a proof-of-concept 15-minute clip containing hazards, multiple-choice questions and probes to collect self-reported safety ratings. ERDs were more accurate on the multiple-choice questions (MCQs) than a control group, though response time scores to hazards did not reach the threshold for significance. In study two, we refined the development process and created a series of new holistic hazard tests across four counties of the East Midlands, UK. Each test contained many hazards and MCQs that assessed situation awareness and decision-making, based on the results of study 1. Participants were recruited across the four counties and were presented with both the test that was specific to their county and one of the unfamiliar-location tests, in order to assess the generalisability of the tests across different locales. The results showed no differences regarding location familiarity, suggesting that tests filmed in one area of the country can be viewed by drivers elsewhere without detriment to performance. ERDs once again responded to MCQs more accurately, and also scored more hazard points on the basis of faster responses to hazards compared to control participants. These results suggest such tests can successfully tap into ERD-specific skills with regard to spotting, predicting and responding to hazards on the road. We recommend refinement of this tool for assessment of emergency response drivers, and further development to extend the materials to create a training tool.

Assessment on CPR Knowledge and AED Availability in Saudi Malls by Security Personnel: Public Safety Perspective.

Security personnel are the first ones who attend the scene in the case of out-of-hospital cardiac arrest (OHCA) at malls. Cardiopulmonary resuscitation (CPR) is not enough for those patients; they need an automated external defibrillator (AED) to bring the heart to function normally. This study aimed to assess the current status of CPR and AED knowledge and availability in Saudi malls by security personnel. Using a descriptive design, a study was conducted at seven malls located in the Eastern Province of Saudi Arabia. Two hundred and fifty participants were surveyed using the American Heart Association (AHA) 2015 guidelines to assess CPR and AED knowledge and availability in Saudi malls. The sample mean age was 32.60 years (SD = 10.02), and 87% of participants were working as security personnel. The majority of the participants had not received training about CPR and AED (75.8% and 95.2%, respectively). Common misconceptions are fallen into all categories of CPR and AED knowledge. Correctly answered statements ranged from 7.2% in the compression rate to 24.2% in hand placement. The study results indicated a poor training knowledge of CPR and AED in public settings. Integrating high-quality CPR and AED knowledge within the school and college curricula is a vital need. However, in order to maximize the survival rate, it is important to set laws and legislation adopted by stakeholders and decision makers to advocate the people who try to help, mandate AED installation in crowded places, and mandate teaching hands-only CPR and AED together as a package.

Preliminary Dose Assessment for Emergency Response Exercise Using Unsealed Radioactive Contamination.

A preliminary dose assessment for an emergency response exercise using unsealed radioactive sources was performed based on conservative calculation methods. The assessment was broken into four parts: activation, distribution, exercise participation, and post-exercise monitoring. The computer code MicroShield was used to determine external exposure from the source during and after distribution. Internal exposure via inhalation and ingestion was estimated by assuming fractional intakes of activity and converting to dose using annual limits on intake and dose coefficients. It was determined from the dose assessment that a radionuclide-dependent range of 37 MBq to 1.5 GBq can be used to achieve detectable dose rates during the exercise without exceeding assumed administrative dose limits. Of the identified radionuclides, Tc results in the lowest dose and is recommended from a radiological safety standpoint. However, the choice of which radionuclide and what activity to use for an exercise should be made based on budget and the logistics of the actual exercise.

Triage in Complex, Coordinated Terrorist Attacks.

INTRODUCTION: Terror attacks have increased in frequency, and tactics utilized have evolved. This creates significant challenges for first responders providing life-saving medical care in their immediate aftermath. The use of coordinated and multi-site attack modalities exacerbates these challenges. The use of triage is not well-validated in mass-casualty settings, and in the setting of intentional mass violence, new and innovative approaches are needed. METHODS: Literature sourced from gray and peer-reviewed sources was used to perform a comparative analysis on the application of triage during the 2011 Oslo/Utoya Island (Norway), 2015 Paris (France), and 2015 San Bernardino (California USA) terrorist attacks. A thematic narrative identifies strengths and weaknesses of current triage systems in the setting of complex, coordinated terrorist attacks (CCTAs). DISCUSSION: Triage systems were either not utilized, not available, or adapted and improvised to the tactical setting. The complexity of working with large numbers of patients, sensory deprived environments, high physiological stress, and dynamic threat profiles created significant barriers to the implementation of triage systems designed around flow charts, physiological variables, and the use of tags. Issues were identified around patient movement and "tactical triage." CONCLUSION: Current triage tools are inadequate for use in insecure environments, such as the response to CCTAs. Further research and validation are required for novel approaches that simplify tactical triage and support its effective application. Simple solutions exist in tactical triage, patient movement, and tag use, and should be considered as part of an overall triage system.

The evolution of response and management training at the FEMA Center for Domestic Preparedness.

The Federal Emergency Management Agency (FEMA) Center for Domestic Preparedness (CDP) was established in 1998 and is now 20 years old. In its short history, the CDP has significantly evolved the relevance and responsiveness of its courses and its capability to provide high-fidelity, hands-on training, and exercises to meet the demanding needs of today's responders. This article discusses the basis of need for a competent, responder training program; the genesis of the CDP as a no-cost provider of responder training for state, local, tribal, and territorial responders; describes the current training opportunities available to responders; previews emerging training opportunities that are under development or envisioned in the very near future; and provides insight to the future progression of the CDP as it continues to expand and evolve its role as FEMA's premiere, responder focused, hands-on training provider.

Assessment of confined space entry and rescue training for aircraft rescue and fire fighting (ARFF) members in the United States.

INTRODUCTION: Fire and emergency service workers, including Aircraft Rescue and Fire Fighting members, may be called on to perform confined space entry and rescue operations. The purpose of the present study was to develop a comprehensive and valid understanding of the present state of confined space entry and rescue training effectiveness and resultant compliance or use of best practices among trained Aircraft Rescue and Fire Fighting personnel. METHOD: The study used a convergent, parallel mixed-methods approach. Qualitative data (n = 20) were collected via semi-structured interviews at four locations. Data were coded, analyzed and super-ordinate and sub-ordinate themes were derived. Quantitative data (n = 158) from Aircraft Rescue and Fire Fighting members were analyzed. RESULTS: Interviewees believed there is a lack of standardization in training, but believed training should not be completed in the same format every time. Several participants (50%) desired more realistic training. Other concerns were associated with staffing, personal readiness, and resource adequacy. With regard to survey outcomes, most respondents reported that their organizations completed confined space training (69.8%), but only 55.3% indicated this training was conducted as a full-scale exercise and nearly 40% indicated that rescue practice was not performed despite standards mandating annual rescue practice. Following training, 55.4% indicated training evaluation information was not presented. CONCLUSIONS: Participants mostly agreed their training effectively addressed OSHA requirements, such as how to test the atmosphere, the need for and use of personal protective equipment, how to identify pertinent permit information and methods to retrieve victims in limited space. Some gaps exist between current training practices and established training requirements and standards. PRACTICAL APPLICATIONS: Aircraft Rescue and Fire Fighting organizations need to bolster aspects of their training, particularly with regard to standardizing training efforts, practicing rescues, providing evaluation feedback and written materials and providing adequate resources.

Simplified Method for Rapid Field Assessment of Visual Acuity by First Responders After Ocular Injury.

Objective: Initial visual acuity after ocular injury is an important measure, as it is an accurate predictor of final visual outcome and gives a rapid estimation of the overall severity of the injury, thereby aiding evacuation prioritization. We devised a simple method for rapidly assessing visual acuity in the field without having to rely on formal screening cards. Methods: Using common objects, icons, and text found in the injury zone - for example, common military name tapes, rank insignias, patches, emblems, and helmet camouflage bands, which will be known collectively as the Army Combat Optotypes (ACOs) - a Snellen-equivalent method of assessing visual acuity was devised and correlated to the ocular trauma score (OTS). Results: Ability to read the ACOs at 2, 3, and 5 ft correlates with acuities in the range from 20/20 to 20/400. Identification of ACOs with visual acuity of 20/50 and 20/200 approximates important inflection points of severity for the OTS. Conclusion: Accurately assessing visual acuity in the field after ocular injury provides essential information but does not require sophisticated screening equipment. Pertinent and accurate acuities can be rapidly estimated using commonly available text or graphical icons such as standard name tapes, patches, and rank insignias.

Prehospital care training in a rapidly developing economy: a multi-institutional study.

BACKGROUND: The trauma pandemic is one of the leading causes of death worldwide but especially in rapidly developing economies. Perhaps, a common cause of trauma-related mortality in these settings comes from the rapid expansion of motor vehicle ownership without the corresponding expansion of national prehospital training in developed countries. The resulting road traffic injuries often never make it to the hospital in time for effective treatment, resulting in preventable disability and death. The current article examines the development of a medical first responder training program that has the potential to reduce this unnecessary morbidity and mortality. METHODS: An intensive training workshop has been differentiated into two progressive tiers: acute trauma training (ATT) and broad trauma training (BTT) protocols. These four-hour and two-day protocols, respectively, allow for the mass education of laypersons-such as police officials, fire brigade, and taxi and/or ambulance drivers-who are most likely to interact first with prehospital victims. Over 750 ATT participants and 168 BTT participants were trained across three Indian educational institutions at Jodhpur and Jaipur. Trainees were given didactic and hands-on education in a series of critical trauma topics, in addition to pretraining and post-training self-assessments to rate clinical confidence across curricular topics. Two-sample t-test statistical analyses were performed to compare pretraining and post-training confidence levels. RESULTS: Program development resulted in recruitment of a variety of career backgrounds for enrollment in both our ATT and BTT workshops. The workshops were run by local physicians from a wide spectrum of medical specialties and previously ATT-trained police officials. Statistically significant improvements in clinical confidence across all curricular topics for ATT and BTT protocols were identified (P < 0.0001). In addition, improvement in confidence after BTT training was similar in Jodhpur compared with Jaipur. CONCLUSIONS: These results suggest a promising level of reliability and reproducibility across different geographic areas in rapidly developing settings. Program expansion can offer an exponential growth in the training rate of medical first responders, which can help curb the trauma-related mortality in rapidly developing economies. Future directions will include clinical competency assessments and further progressive differentiation into higher tiers of trauma expertise.

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.

Building health care system capacity: training health care professionals in disaster preparedness health care coalitions.

INTRODUCTION: This study aimed to learn from the experiences of well-established, disaster preparedness-focused health care coalition (HCC) leaders for the purpose of identifying opportunities for improved delivery of disaster-health principles to health professionals involved in HCCs. This report describes current HCC education and training needs, challenges, and promising practices. METHODS: A semi-structured interview was conducted with a sample of leaders of nine preparedness-focused HCCs identified through a 3-stage purposive strategy. Transcripts were analyzed qualitatively. RESULTS: Training needs included: stakeholder engagement; economic sustainability; communication; coroner and mortuary services; chemical, biological, radiological, nuclear, and explosives (CBRNE); mass-casualty incidents; and exercise design. Of these identified training needs, stakeholder engagement, economic sustainability, and exercise design were relevant to leaders within HCCs, as opposed to general HCC membership. Challenges to education and training included a lack of time, little-to-no staff devoted to training, and difficulty getting coalition members to prioritize training. Promising practices to these challenges are also presented. CONCLUSIONS: The success of mature coalitions in improving situational awareness, promoting planning, and enabling staff- and resource-sharing suggest the strengths and opportunities that are inherent within these organizations. However, offering effective education and training opportunities is a challenge in the absence of ubiquitous support, incentives, or requirements among health care professions. Notably, an online resource repository would help reduce the burden on individual coalitions by eliminating the need to continually develop learning opportunities.

Police on the front line of community geriatric health care: challenges and opportunities.

As the population ages, police increasingly serve as first responders to incidents involving older adults in which aging-related health plays a critical role. The goals of this study were to assess police officers' knowledge of aging-related health, to identify challenges police experience in their encounters with older adults, and to describe their recommendations for how to address those challenges. This was a mixed-methods study of 141 San Francisco police officers recruited from mandatory police trainings between 2011 and 2013. Descriptive statistics were used to analyze 141 self-administered questionnaires, and principles of grounded theory were used to analyze open-ended questionnaire responses and 11 additional qualitative interviews. Eighty-nine percent of officers reported interacting with older adults at least monthly. Although 84% of police reported prior training in working with older adults, only 32% rated themselves as knowledgeable about aging-related health. Participants described themselves as first responders to medical and social emergencies involving older adults and identified several challenges, including identifying and responding to aging-related conditions and ensuring appropriate medical and social service handoffs. To address these challenges, officers recommended developing trainings focused on recognizing and responding to aging-related conditions and improving police knowledge of community resources for older adults. They also called for enhanced communication and collaboration between police and clinicians. These findings suggest that, because they assume a front-line role in responding to older adults with complex medical and social needs, many police may benefit from additional knowledge about aging-related health and community resources. Collaboration between police and healthcare providers presents an important opportunity to develop geriatrics training and interprofessional systems of care to support police work with a rapidly aging population.

Increasing access and support for emergency management higher education programs.

The number of emergency management higher education programs has grown dramatically since 1994 when the FEMA Higher Education Program was created to propagate and support such growth. Data collected annually since 2007 from emergency management higher education programs shows that these programs face some consistent challenges. These challenges were coupled with annual data on program access and support indicators via dimensional analysis to answer the questions: To what extent are the challenges linked to a lack of access or support? If there is linkage, what can be gleaned from these linkages that can help address the challenges through improving access and support? The analysis showed that lack of access to funding and resources, and lack of support from partner organizations, has an impact on emergency management higher education. Discussion of that impact is followed with detailed recommendations that are focused on strengthening both internal and external access and support relationships for emergency management higher education programs.

[Out of hospital emergencies towards a safety culture]. / Las emergencias extrahospitalarias ante la cultura de seguridad.

OBJECTIVES: The aim of this study is to measure the degree of safety culture (CS) among healthcare professional workers of an out-of-hospital Emergency Medical Service. Most patient safety studies have been conducted in relation to the hospital rather than pre-hospital Emergency Medical Services. The objective is to analyze the dimensions with lower scores in order to plan futures strategies. MATERIAL AND METHODS: A descriptive study using the AHRQ (Agency for Healthcare Research and Quality) questionnaire. The questionnaire was delivered to all healthcare professionals workers of 061 Advanced Life Support Units of Aragón, during the month of August 2013. RESULTS: The response rate was 55%. Main strengths detected: an adequate number of staff (96%), good working conditions (89%), tasks supported from immediate superior (77%), teamwork climate (74%), and non-punitive environment to report adverse events (68%). Areas for improvement: insufficient training in patient safety (53%) and lack of feedback of incidents reported (50%). CONCLUSIONS: The opportunities for improvement identified focus on the training of professionals in order to ensure safer care, while extending the safety culture. Also, the implementation of a system of notification and registration of adverse events in the service is deemed necessary.

The enduring mental health impact of the September 11th terrorist attacks: challenges and lessons learned.

The authors review the existing literature on the mental health impact of the September 11th attacks and the implications for disaster mental health clinicians and policy makers. The authors discuss the demographic characteristics of those affected and the state of mental health needs and existing mental health delivery services; the nature of the disaster and primary impacts on lives, infrastructure, and socioeconomic factors; the acute aftermath in the days and weeks after the attacks; the persistent mental health impact and evolution of services of the postacute aftermath; and the implications for future disaster mental health practitioners and policy makers.

Managing multiple-casualty incidents: a rural medical preparedness training assessment.

OBJECTIVE: The objectives of this study were to develop a novel training model for using mass-casualty incident (MCI) scenarios that trained hospital and prehospital staff together using Microsoft Visio, images from Google Earth and icons representing first responders, equipment resources, local hospital emergency department bed capacity, and trauma victims. The authors also tested participants' knowledge in the areas of communications, incident command systems (ICS), and triage. METHODS: Participants attended Managing Multiple-Casualty Incidents (MCIs), a one-day training which offered pre- and post-tests, two one-hour functional exercises, and four distinct, one-hour didactic instructional periods. Two MCI functional exercises were conducted. The one-hour trainings focused on communications, National Incident Management Systems/Incident Command Systems (NIMS/ICS) and professional roles and responsibilities in NIMS and triage. The trainings were offered throughout communities in western Montana. First response resource inventories and general manpower statistics for fire, police, Emergency Medical Services (EMS), and emergency department hospital bed capacity were determined prior to MCI scenario construction. A test was given prior to and after the training activities. RESULTS: A total of 175 firefighters, EMS, law enforcement, hospital personnel or other first-responders completed the pre- and post-test. Firefighters produced higher baseline scores than all other disciplines during pre-test analysis. At the end of the training all disciplines demonstrated significantly higher scores on the post-test when compared with their respective baseline averages. Improvements in post-test scores were noted for participants from all disciplines and in all didactic areas: communications, NIMS/ICS, and triage. CONCLUSIONS: Mass-casualty incidents offer significant challenges for prehospital and emergency room workers. Fire, Police and EMS personnel must secure the scene, establish communications, define individuals' roles and responsibilities, allocate resources, triage patients, and assign transport priorities. After emergency department notification and in advance of arrival, emergency department personnel must assess available physical resources and availability and type of manpower, all while managing patients already under their care. Mass-casualty incident trainings should strengthen the key, individual elements essential to well-coordinated response such as communications, incident management system and triage. The practice scenarios should be matched to the specific resources of the community. The authors also believe that these trainings should be provided with all disciplines represented to eliminate training "silos," to allow for discussion of overlapping jurisdictional or organizational responsibilities, and to facilitate team building.

Teaching wilderness first aid in a remote First Nations community: the story of the Sachigo Lake Wilderness Emergency Response Education Initiative.

OBJECTIVE: To understand how community members of a remote First Nations community respond to an emergency first aid education programme. STUDY DESIGN: A qualitative study involving focus groups and participant observation as part of a community-based participatory research project, which involved the development and implementation of a wilderness first aid course in collaboration with the community. METHODS: Twenty community members participated in the course and agreed to be part of the research focus groups. Three community research partners validated and reviewed the data collected from this process. These data were coded and analysed using open coding. RESULTS: Community members responded to the course in ways related to their past experiences with injury and first aid, both as individuals and as members of the community. Feelings of confidence and self-efficacy related access to care and treatment of injury surfaced during the course. Findings also highlighted how the context of the remote First Nations community influenced the delivery and development of course materials. CONCLUSIONS: Developing and delivering a first aid course in a remote community requires sensitivity towards the response of participants to the course, as well as the context in which it is being delivered. Employing collaborative approaches to teaching first aid can aim to address these unique needs. Though delivery of a first response training programme in a small remote community will probably not impact the morbidity and mortality associated with injury, it has the potential to impact community self-efficacy and confidence when responding to an emergency situation.