Could the Internet of Things Be Used to Enhance Student Nurses' Experiences in a Disaster Simulation?

The Internet of Things (IoT) created opportunities for enhancing human lives. A recent undergraduate nursing disaster simulation experience prompted a thought as to whether IoT technologies could further enhance the educational experience of undergraduate nursing students in future disaster simulations.

Individually optimized estimation of energy expenditure in rescue workers using a tri-axial accelerometer and heart rate monitor.

Objectives: This study aimed to provide an improved energy expenditure estimation for heavy-load physical labor using accelerometer data and heart rate (HR) measured by wearables and to support food preparation and supply management for disaster relief and rescue operations as an expedition team. Methods: To achieve an individually optimized estimation for energy expenditure, a model equation parameter was determined based on the measurements of physical activity and HR during simulated rescue operations. The metabolic equivalent of task (MET), which was measured by using a tri-axial accelerometer and individual HR, was used, where two (minimum and maximum) or three (minimum, intermediate, and maximum) representative reference points were selected for each individual model fitting. In demonstrating the applicability of our approach in a realistic situation, accelerometer-based METs and HR of 30 males were measured using the tri-axial accelerometer and wearable HR during simulated rescue operations over 2 days. Results: Data sets of 27 rescue operations (age:34.2 ± 7.5 years; body mass index (BMI):22.9 ± 1.5 kg/m2) were used for the energy expenditure estimation after excluding three rescue workers due to their activity type and insufficient HR measurement. Using the combined approach with a tri-axial accelerometer and HR, the total energy expenditure increased by 143% for two points and 133% for three points, compared with the estimated total energy expenditure using only the accelerometer-based method. Conclusion: The use of wearables provided a reasonable estimation of energy expenditure for physical workers with heavy equipment. The application of our approach to disaster relief and rescue operations can provide important insights into nutrition and healthcare management.

Training of Medical Students for Mass Casualty Incidents Using Table-Top Gamification.

INTRODUCTION: "Table-top" exercises can improve knowledge and skills related to mass casualty incidents (MCIs) with little logistical efforts. We aim to evaluate the learning process of 5th year medical school students related to MCI response using table-top simulation and measure their methodology perception. METHODS: A theoretical part plus an MCI simulation board exercise was organized. Knowledge pretest and 1 mo after posttest was scored, and an assessment questionnaire with 27 questions with a Likert-type scale with 3 dimensions: methodology, knowledge acquisition, and skills acquisition was administered. Students did not receive any written or training material between pretest and posttest. RESULTS: A total of 108 (80%) completed the evaluation questionnaire, pretest, and posttest. For the pretest, average grade was 4.25 (SD = 1.71) and 42% passed, and for the posttest, average grade was 8.33 (SD = 1.28) and 97 % pass (P < 0.0001). All variables measuring methodology perception scored more than 8, except for the duration of the exercise (7.3). Most knowledge acquisition scored above 9. Self-perception skill acquisition scores were slightly lower, although all above 7. CONCLUSIONS: "Table-top" methodology is useful for acquiring knowledge and skills related to MCI response. Retention of knowledge is very high. Students consider that this methodology can be very useful for medical studies. Active or nonactive role is a factor that only influences final results in specific items.

Earthquake Preparedness and Knowledge of Recommended Self-Protective Actions: A Survey of Nursing Students.

OBJECTIVE: Nurses are a vital workforce to the disaster response of an earthquake. The aim of this study was to assess preexisting knowledge in baccalaureate nursing students about disaster preparedness and self-protective behavioral responses during an earthquake. METHODS: A descriptive cross-sectional survey of nursing students from a seismologically active region was conducted. Data were collected prior to earthquake preparedness education and ShakeOut drills designed to enhance personal safety. RESULTS: A total of 274 nursing students participated in the survey (response rate - 93%). More than half (57%) of respondents did not feel prepared for an earthquake; 88% were without a household emergency plan and 82% lacked emergency supplies. Self-protective actions of drop, cover, and hold on and stay in bed were accurately identified by 77% and 96% of respondents, respectively. Hazardous actions selected included stand in a doorway (77% of respondents) and go outside into the street (23% of respondents). CONCLUSIONS: These results demonstrate a lack of personal disaster preparedness in nursing students and several behavioral responses that do not promote self-preservation during seismic activity. Although existing baccalaureate nursing education addresses competencies for disaster care, actions are needed to develop curriculum that emphasizes preparedness and safety to regional environmental hazards.

Rapidly building surge capacity within a pandemic response using simulation-based clinical systems testing.

Introduction: As the SARS-CoV-2 virus spread across the globe, hospitals around the USA began preparing for its arrival. Building on previous experience with alternative care sites (ACS) during surge events, Texas Children's Hospital (TCH) opted to redeploy their mobile paediatric emergency response teams. Simulation-based clinical systems testing (SbCST) uses simulation to test preoccupancy spaces and new processes. We developed rapid SbCST with social distancing for our deployed ACS, with collaboration between emergency management, paediatric emergency medicine and the simulation team. Methods: A two-phased approach included an initial virtual tabletop activity followed by SbCST at each campus, conducted simultaneously in-person and virtually. These activities were completed while also respecting the need for social distancing amidst a pandemic response. Each activity's discussion was facilitated using Promoting Excellence and Reflective Learning in Simulation (PEARLS) for systems integration debriefing methodology and was followed by compilation of a failure mode and effects analysis (FMEA), which was then disseminated to campus leaders. Results: Within a 2-week period, participants from 20 different departments identified 109 latent safety threats (LSTs) across the four activities, with 71 identified as being very high or high priority items. Very high and high priority threats were prioritised in mitigation efforts by hospital leadership. Discussion: SbCST can be rapidly implemented to hone pandemic responses and identify LSTs. We used SbCST to allow for virtual participation and social distancing within a rapidly accelerated timeline. With prioritised FMEA reporting, leadership was able to mitigate concerns surrounding the four Ss of surge capacity: staff, stuff, structure and systems.

Evaluation of two simulation methods for teaching a disaster skill.

Introduction: With increasing use of virtual reality simulation (VRS) in nursing education, there is a paucity of research exploring learning outcomes following training with VRS as compared with traditional mannequin-based simulation. Given the resource intensive nature of mannequin-based simulation, especially for disaster education, understanding outcomes from newer technologies like VRS are needed. Methods: A quasi-experimental design was used to examine the differences in learning outcomes for the disaster skill of decontamination, based on type of simulation. The study was framed by the National Leage for Nursing (NLN) Jeffries Simulation Theory, with participant outcomes identified by the framework (satisfaction, self-confidence and performance). Outcomes were measured using the NLN Student Satisfaction and Self- Confidence in Learning scale and a Decontamination Checklist. Senior nursing students in the final semester of a baccalaureate nursing programme were recruited to participate during one of their scheduled laboratory days. Following a didactic presentation, students were randomly assigned to one of two treatment groups (VRS or mannequin-based simulation training) to learn the skill of decontamination. Results: A total of 121 participants took part in the study. No statistically significant results were noted for any of the study outcomes: performance (accuracy and time), satisfaction and self-efficacy. Results of the study demonstrate that VRS is as effective as mannequin-based simulation in training participants for the skill of decontamination. Conclusions: Simulation-based education experiences must be matched to learning outcomes and evaluated for effectiveness. As evidence emerges regarding use of newer technologies, like VRS, educators will have more options for providing students with opportunities that best match available resources.

Simulation-based training programme and preparedness testing for COVID-19 using system integration methodology.

Background: COVID-19 pandemic is presenting serious challenges to the world's healthcare systems. The high communicability of the COVID-19 necessitates robust medical preparedness and vigilance. Objective: To report on the simulation-based training and test preparedness activities to prepare healthcare workers (HCWs) for effective and safe handling of patients with COVID-19. Methodology: Two activities were conducted: simulation-based training to all HCWs and a full-scale unannounced simulation-based disaster exercise at King Fahad Medical City (KFMC). The online module was designed to enhance the knowledge on COVID-19. This module was available to all KFMC staff. The five hands-on practical part of the course was available to frontliner HCWs. The unannounced undercover simulated patients' full-scale COVID-19 simulation-based disaster exercise took place in the emergency department over 3 hours. Six scenarios were executed to test the existing plan in providing care of suspected COVID-19 cases. Results: 2620 HCWs took the online module, 17 courses were conducted and 337 frontliner HCWs were trained. 94% of learners were satisfied and recommended the activity to others. The overall compliance rate of the full-scale COVID-19 disaster drill with infection control guidelines was 90%. Post-drill debriefing sessions recommended reinforcing PPE training, ensuring availability of different sizes of PPEs and developing an algorithm to transfer patients to designated quarantine areas. Conclusion: Simulation-based training and preparedness testing activities are vital in identifying gaps to apply corrective actions immediately. In the presence of a highly hazardous contagious disease like COVID-19, such exercises are a necessity to any healthcare institution.

Development of computer simulator 'Kawauchi Legends' as disaster response medical training software: overcoming the COVID-19 pandemic.

Medical disaster response training is provided for international students in Kawauchi Village to share the lessons learnt from the accident at Fukushima Daiichi nuclear power plant. At present, this is difficult due to the coronavirus disease 2019 (COVID-19) pandemic. The purpose of this article is to report the development of hands-on medical training software on a topic that does not require in-person attendance. The 'Kawauchi Legends' disaster simulator was developed as a useful tool to teach the medical response to various disasters, and this was applied in a 3-day webinar in October 2020. Fourteen students participated in the webinar and successfully learnt medical management, manipulating their avatars in the virtual environment. This software can be an effective substitute for in-person disaster training without physical involvement. Such innovative teaching methods mean that lessons from the Fukushima accident can continue to be shared, even in the COVID-19 pandemic situation.

Disaster Healthcare Workers' Experience of Using the Psychological First Aid Mobile App During Disaster Simulation Training.

OBJECTIVE: The study aimed to examine the experience of disaster healthcare workers with simulation training using the Psychological First Aid (PFA) mobile app. METHODS: This study was designed using qualitative research methodology with focus group interviews. The participants were 19 disaster healthcare workers from community mental health service centers who attended disaster simulation training in flood, fire, or leakage of hazardous chemicals. Before the simulation, participants were provided the PFA mobile app and allowed to practice the PFA techniques to apply them during the simulation. Data were collected through focus group interviews and qualitatively analyzed using the content analysis method. RESULTS: The findings were divided into 6 categories: experience in realistic disaster situations, satisfaction with education methods using a mobile app, effectiveness of the PFA app in disaster relief, confidence in disaster relief by integrating experience and knowledge of the PFA app, self-reflection as a disaster healthcare worker, and identifying limitations and making developmental suggestions. CONCLUSIONS: Based on the participants' developmental proposals in this study, the disaster simulation training, incorporating improvements in the disaster simulation training and the PFA app features, will serve as a new framework for disaster support education and systematic mental health services to survivors by disaster healthcare workers.

Cost-effectiveness of a video game versus live simulation for disaster training.

Introduction: Disaster triage training for emergency medical service (EMS) providers is unstandardised. We hypothesised that disaster triage training with the paediatric disaster triage (PDT) video game '60 s to Survival' would be a cost-effective alternative to live simulation-based PDT training. Methods: We synthesised data for a cost-effectiveness analysis from two previous studies. The video game data were from the intervention arm of a randomised controlled trial that compared triage accuracy in a live simulation scenario of exposed vs unexposed groups to the video game. The live simulation and feedback data were from a prospective cohort study evaluating live simulation and feedback for improving disaster triage skills. Postintervention scores of triage accuracy were measured for participants via live simulations and compared between both groups. Cost-effectiveness between the live simulation and video game groups was assessed using (1) A net benefit regression model at various willingness-to-pay (WTP) values. (2) A cost-effectiveness acceptability curve (CEAC). Results: The total cost for the live simulation and feedback training programme was $81 313.50 and the cost for the video game was $67 822. Incremental net benefit values at various WTP values revealed positive incremental net benefit values, indicating that the video game is more cost-effective compared with live simulation and feedback. Moreover, the CEAC revealed a high probability (>0.6) at various WTP values that the video game is more cost-effective. Conclusions: A video game-based simulation disaster triage training programme was more cost-effective than a live simulation and feedback-based programme. Video game-based training could be a simple, scalable and sustainable solution to training EMS providers.

Interprofessional education: A disaster response simulation activity for military medics, nursing, & paramedic science students.

Health care providers need to be able to function and react appropriately and efficiently during a community-wide disaster situation. Traditional health care education is not adequately structured to provide realistic experiences with respect to high-risk or infrequently encountered events such as a disaster. As a result, many healthcare providers graduate into practice with inadequate exposure or skills to intervene in a disastrous event. Previous studies validate that active participation by students during a simulation can translate into positive, meaningful learning applicable to practice. This paper describes how a disaster response simulation can be utilized as an innovative experiential learning technique. Additionally, interprofessional collaboration and positive learning experiences were fostered between military trainees and health care students in nursing and paramedic sciences. The constructivist framework utilized enabled educators to incorporate interprofessional collaboration, clinical reasoning, and technical skills in the safe learning environment of a simulation.

Preparing the Intensive Care Unit for Disaster.

Critical care teams can face a dramatic surge in demand for ICU beds and organ support during a disaster. Through effective preparedness, teams can enable a more effective response and hasten recovery back to normal operations. Disaster preparedness needs to balance an all-hazards approach with focused hazard-specific preparation guided by a critical care-specific hazard-vulnerability analysis. Broad stakeholder input from within and outside the critical care team is necessary to avoid gaps in planning. Evaluation of critical care disaster plans require frequent exercises, with a mechanism in place to ensure lessons learned effectively prompt improvements in the plan.

Evaluation of a Novel Disaster Nursing Education Method.

OBJECTIVE: A common method of disaster training is needed to improve disaster nursing education and facilitate better communication among interprofessional disaster responders. To inform the development of disaster nursing curricula, a novel disaster nursing education method consistent with Homeland Security Exercise and Evaluation Program (HSEEP) and the International Council of Nurses (ICN) framework was developed to improve disaster nursing competencies in a baccalaureate nursing program. METHODS: In total, 89 undergraduate nursing students participated. Perceived disaster nursing knowledge, confidence, and training/response were assessed with 14 items before and after the education. RESULTS: Exploratory factor analysis showed 3 factors, knowledge, confidence, and training/response, explained 71% of variation in items. Nursing students showed large improvements in perceived disaster nursing knowledge (t=11.95, P<0.001, Cohen's d=1.76), moderate increases in perceived confidence (t=4.54, P<0.001, d=0.67), and no change in disaster training and response (t=0.94, P=0.351, d=0.13). CONCLUSIONS: Results show preliminary evidence supporting the effectiveness of disaster nursing education informed by HSEEP. This training has the potential to fill current practice gaps in disaster nursing knowledge and build confidence to use those skills in practice. (Disaster Med Public Health Preparedness. 2018;12:703-710).

Use of a Novel, Portable, LED-Based Capillary Refill Time Simulator within a Disaster Triage Context.

Introduction A simple, portable capillary refill time (CRT) simulator is not commercially available. This device would be useful in mass-casualty simulations with multiple volunteers or mannequins depicting a variety of clinical findings and CRTs. The objective of this study was to develop and evaluate a prototype CRT simulator in a disaster simulation context. METHODS: A CRT prototype simulator was developed by embedding a pressure-sensitive piezo crystal, and a single red light-emitting diode (LED) light was embedded, within a flesh-toned resin. The LED light was programmed to turn white proportionate to the pressure applied, and gradually to return to red on release. The time to color return was adjustable with an external dial. The prototype was tested for feasibility among two cohorts: emergency medicine physicians in a tabletop exercise and second year medical students within an actual disaster triage drill. The realism of the simulator was compared to video-based CRT, and participants used a Visual Analog Scale (VAS) ranging from "completely artificial" to "as if on a real patient." The VAS evaluated both the visual realism and the functional (eg, tactile) realism. Accuracy of CRT was evaluated only by the physician cohort. Data were analyzed using parametric and non-parametric statistics, and mean Cohen's Kappas were used to describe inter-rater reliability. RESULTS: The CRT simulator was generally well received by the participants. The simulator was perceived to have slightly higher functional realism (P=.06, P=.01) but lower visual realism (P=.002, P=.11) than the video-based CRT. Emergency medicine physicians had higher accuracy on portrayed CRT on the simulator than the videos (92.6% versus 71.1%; P<.001). Inter-rater reliability was higher for the simulator (0.78 versus 0.27; P<.001). CONCLUSIONS: A simple, LED-based CRT simulator was well received in both settings. Prior to widespread use for disaster triage training, validation on participants' ability to accurately triage disaster victims using CRT simulators and video-based CRT simulations should be performed. Chang TP , Santillanes G , Claudius I , Pham PK , Koved J , Cheyne J , Gausche-Hill M , Kaji AH , Srinivasan S , Donofrio JJ , Bir C . Use of a novel, portable, LED-based capillary refill time simulator within a disaster triage context. Prehosp Disaster Med. 2017;32(4):451-456.

Preparing for disasters: education and management strategies explored.

During the last half of the 20th century, the focus of nursing changed from home and field to high-tech clinics and hospitals. Nursing in the absence of technology due to man-made or natural disasters almost disappeared from the curriculum of many nursing schools. Numerous disaster events and threats in the early 21st century caused educators and practitioners to increase the emphasis on disaster nursing and those principles that guide the nurse's practice in response to disasters. This article chronicles tools used by nurse educators to integrate disaster nursing into the didactic and clinical experiences of baccalaureate nursing students. We represent two nursing schools about 90 miles apart that collaborated to provide students with practical application of disaster nursing concepts. Part 1: An educational journey toward disaster nursing competencies: A curriculum in action provides an overview of the curricular tools used to insure adequate coverage of disaster nursing concepts across the curriculum. Part 2: Collaborative learning in Community Health Nursing for emergency preparedness relates the steps taken to plan, implement, and evaluate two different collaborative disaster simulation events. In this manuscript we have attempted transparency so that others can learn from our successes and our failures.