Development and content validation of the checklist for assessing placement of a small-bore chest tube (CAPS) for small-bore chest tube placement.

Background: Small-bore chest tube (SBCT) placement via modified Seldinger technique is a commonly performed invasive procedure for treatment of pleural effusion and pneumothorax. When performed suboptimally, it may lead to serious complications. Validated checklists are central to teaching and assessing procedural skills and may result in improved health care quality. In this paper, we describe the development and content validation of a SBCT placement checklist. Methods: A literature review across multiple medical databases and seminal textbooks was performed to identify all publications describing procedural steps involved in SBCT placement. No studies were identified that involved systematic development of a checklist for this purpose. After the first iteration of a comprehensive checklist (CAPS) based on literature review was developed, the modified Delphi technique involving a panel of nine multidisciplinary experts was used to modify it and establish its content validity. Results: After four Delphi rounds, the mean expert-rated Likert score across all checklist items was 6.85 ± 0.68 (out of 7). The final, 31-item checklist had a high internal consistency (Cronbach's alpha = 0.846) with 95% of the responses (by nine experts across 31 checklist items) being a numerical score of 6 or 7. Conclusions: This study reports the development and content validity of a comprehensive checklist for teaching and assessing SBCT placement. For purposes of demonstrating construct validity, this checklist should next be studied in the simulation and clinical setting.

Chemical Disaster Preparedness for Hospitals and Emergency Departments.

Preparing to evaluate and treat victims of a chemical exposure incident is one aspect of hospital disaster preparedness. Past chemical disasters, including terrorist attacks and industrial or transit accidents, have highlighted the need for hospital planning, preparation, and training. Emergency department and hospital staff members must be familiar with their facility-specific protocols and be trained for their individual roles during these incidents. This article provides a brief review of the requirements and guidelines related to chemical disaster response from a healthcare perspective. Resources for training and the evaluation of chemically contaminated patients are discussed. Decontamination procedures, including pre-hospital and hospital-based decontamination of ambulatory, non-ambulatory, and at-risk patients are also reviewed. Physicians and clinicians, especially in the emergency department, must be familiar with methods of evaluating chemical exposures, identifying substances, recognizing toxidromes, ensuring appropriate personal protective equipment (PPE) use, performing decontamination, and initiating treatments for life-threatening conditions. By understanding the guidelines and resources available, clinicians will be better equipped to safely evaluate and treat chemically exposed or contaminated patients.

Implementing a Disaster Preparedness Curriculum for Medical Students.

OBJECTIVES: Training in disaster medicine and preparedness is minimal or absent in the curricula of many medical schools in the United States. Despite a 2003 joint recommendation by the Association of American Medical Colleges and the Centers for Disease Control and Prevention, few medical schools require disaster training for medical students. The challenges of including disaster training in an already rigorous medical school curriculum are significant. We evaluated medical students' experiences with mandatory disaster training during a 2-year period in a medical university setting. METHODS: Disaster training has been mandatory at Thomas Jefferson University since 2002 and requires all first-year medical students to attend lectures, undergo practical skills simulation training, and participate in the hospital's interdisciplinary disaster exercise. Medical students were encouraged to complete a survey after each component of the required training. Twenty-three survey questions focused on assessing students' experiences and opinions of the training, including evaluation of the disaster exercise. Students provided ratings on a 5-point Likert scale (5 = strongly agree, 1 = strongly disagree). RESULTS: A total of 503 medical students participated in the disaster preparedness curriculum during the course of 2 years. Survey response rates were high for each portion of the training: lectures (91%), skills sessions (84%), and disaster exercise (100%). Students believed that disaster preparedness should remain part of the medical school curriculum (rating 4.58/5). The disaster lectures were considered valuable (rating 4.26/5) and practical skills sessions should continue to be part of the first-year curriculum (4.97/5). Students also believed that participation in the disaster exercise allowed them to better understand the difficulties faced in a real disaster situation (4.2/5). CONCLUSIONS: Our mandatory disaster preparedness training course was successfully integrated into the first-year curriculum >10 years ago and has been well received by students without compromising the existing university curriculum. Integrating interdisciplinary teams and course components important to other education stakeholders may help other schools overcome obstacles to implementing disaster medicine training. Future education research should focus on developing interdisciplinary education to help disseminate disaster medicine topics across all 4 years of medical school.

The development of a validated checklist for radial arterial line placement: preliminary results.

Radial arterial line placement is an invasive procedure that may result in complications. Validated checklists are central to teaching and assessing procedural skills and may result in improved health care quality. The results of the first step of the validation of a radial arterial line placement checklist are described. A comprehensive literature review of articles published on radial arterial line placement did not yield a checklist validated by the Delphi method. A modified Delphi technique, involving a panel of 9 interdisciplinary, interinstitutional experts, was used to develop a radial arterial line placement checklist. The internal consistency coefficient using Cronbach α was .99. Developing a 22-item checklist for teaching and assessing radial arterial line placement is the first step in the validation process. For this checklist to become further validated, it should be implemented and studied in the simulation and clinical environments.

Disaster preparedness: what training do our interns receive during medical school?

Disaster preparedness training is a critical component of medical student education. Despite recent natural and man-made disasters, there is no national consensus on a disaster preparedness curriculum. The authors designed a survey to assess prior disaster preparedness training among incoming interns at an academic teaching hospital. In 2010, the authors surveyed incoming interns (n = 130) regarding the number of hours of training in disaster preparedness received during medical school, including formal didactic sessions and simulation, and their level of self-perceived proficiency in disaster management. Survey respondents represented 42 medical schools located in 20 states. Results demonstrated that 47% of interns received formal training in disaster preparedness in medical school; 64% of these training programs included some type of simulation. There is a need to improve the level of disaster preparedness training in medical school. A national curriculum should be developed with aspects that promote knowledge retention.

Are medical students being taught invasive skills using simulation?

INTRODUCTION: Basic invasive procedural skills are traditionally taught during clerkships. Using simulation to teach invasive skills provides students the opportunity to practice in a structured environment without risking patient safety. We surveyed incoming interns at Thomas Jefferson University Hospital to assess the prevalence of simulation training for invasive and semi-invasive procedural skills during medical school. METHODS: From 2008 to 2010, we surveyed 357 incoming interns at Thomas Jefferson University Hospital. The questionnaire asked incoming interns if they received formal instruction or procedural training with or without a simulation component for 34 procedures during medical school. Interns indicated their number of attempts and successes for each procedure in clinical care. RESULTS: All 357 incoming interns completed the survey. Experience in 28 procedures is reported in this article. For all but three basic procedures, more than 75% of interns received formal didactic instruction. Only 3 advanced procedures were formally taught to most interns. The prevalence of simulation training for the basic and advanced procedures was 46% and 23%, respectively. For the basic procedures, the average number of attempts and successes was 6.5 (range, 0-13.9) and 6.2 (range, 0-13.4), respectively. For the advanced procedures, the average number of attempts and successes was 1.5 (range, 0-4.8) and 1.3 (range, 0-4.7), respectively. CONCLUSIONS: Although most medical students receive formal instruction in basic procedures, fewer receive formal instruction in advanced procedures. The use of simulation to complement this training occurs less often. Simulation training should be increased in undergraduate medical education and integrated into graduate medical education.

Field testing a head-of-household method to dispense antibiotics.

OBJECTIVES: Using a simulated anthrax exposure scenario, the Philadelphia Department of Public Health tested how rapidly and accurately a head-of-household (HoH) point of dispensing (PoD) site with an express dispensing line could provide medication to heads of households collecting antibiotics for all household members. METHODS: The 8 pretrained PoD leadership staff trained the other 42 PoD staff in the hour before the field trial. During the 2-hour field trial, proxy-HoHs used scripts with pertinent information describing household members to complete a HoH PoD intake form. PoD staff, 6 with medical training, used the form to direct HoHs to either express dispensing, where only adult dosing of ciprofloxacin was provided for each household member, or to screening, where targeted information was collected before antibiotics were dispensed. RESULTS: In 2 hours, 717 individual HoHs picked up medication for a total of 2,120 household members (average household size = 2.96 persons) with a throughput rate of 1,060 person-medication doses dispensed per hour. Among 616 (86%) HoHs with a recorded PoD transit time, the 294 express-line-eligible HoHs passed through twice as fast as the 322 HoHs who required screening (medians = 3 versus 8 minutes, respectively, p < 0.01). Ninety-seven percent of people were accurately prescribed antibiotics. CONCLUSIONS: HoH PoDs, using a limited number of medically trained staff, can rapidly and accurately provide medication to a large population. The express dispensing line speeded transit time without compromising medication dispensing accuracy. Dispensing medications to HoHs can be an accurate and effective way to reach large populations during a public health emergency.

Preparedness of hospitals to respond to a radiological terrorism event as assessed by a full-scale exercise.

Hospitals and healthcare workers face the challenge of being prepared to manage victims of acts of terrorism that involve chemical, biological, and radiological agents that they do not commonly encounter. One example that is often cited as a potential terrorism scenario is the use of a conventional explosive that is mixed with radioactive material. On November 10, 2004, we conducted a regional multihospital full-scale exercise involving 11 hospitals and 358 victim-observers to evaluate hospital preparedness for such an event. Our results demonstrate that hospitals are not adequately prepared to manage mass casualties with associated radiological contamination.

Large-scale urban disaster drill involving an explosion: lessons learned by an academic medical center.

Disaster drills are an effective way to test a hospital's preparedness for real-life disasters, but an extensive amount of coordination and time is necessary to host a successful drill with a large number of victims. The lessons learned in this drill include a number of planning, education, orientation, and follow-up issues. It is not realistic to believe that a drill can be perfectly planned and practiced; therefore each drill provides another opportunity to improve on past experience.