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Training of Hospital Staff to Respond to a Mass Casualty Incident
Evidence Reports/Technology Assessments, No. 95
Investigators: Edbert B Hsu, MD, MPH, Mollie W Jenckes, MHSc, BSN, Christina L Catlett, MD, Karen A Robinson, MSc, Carolyn J Feuerstein, Sara E Cosgrove, MD, MS, Gary Green, MD, MPH, Otto C Guedelhoefer, and Eric B Bass, MD, MPH.
Structured Abstract
Context:
Because of recent terrorist attacks, hospitals are devoting increased attention to disaster preparedness by reexamining disaster plans and training hospital staff to respond to a mass casualty incident (MCI). An MCI is defined in this report as an incident that results in multiple casualties that overwhelm local resources and that may involve natural, biological, chemical, nuclear, or other agents.
Objectives:
This evidence report identifies and synthesizes evidence on the effectiveness of hospital disaster drills, computer simulations, and tabletop or other exercises in training hospital staff to respond to an MCI, and it reviews the methods or tools that have been used to evaluate these types of training activities.
Data Sources:
The Evidence-based Practice Center (EPC) searched for articles published through January 2003 using six electronic databases, including PubMed®, the Cochrane Central Register of Controlled Trials, the Excerpta Medica database (EMBASE), the Educational Research Information Clearinghouse, the specialized Register of Effective Practice and Organization of Care Cochrane Review Group, and the Research and Development Resource Base in Continuing Medical Education. Search terms included mass casualty, disaster, disaster planning, and drill. The EPC also conducted a hand search of references and selected journals.
Study Selection:
Paired investigators reviewed the titles and abstracts of citations located by the search to identify articles that were written in English, included original human data, and reported on the evaluation of disaster training for hospital staff.
Data Extraction:
Paired reviewers evaluated study quality in terms of the representativeness of the targeted hospital staff, potential bias and confounding, description of the intervention, assessment of outcomes, and analysis. The reviewers extracted information on the studies (e.g., geographic location, MCI type, training intervention, hospital staff targeted, other entities involved, objectives, evaluation methods, and results).
Data Synthesis:
Sixteen studies addressed hospital disaster drills as a training method for hospital staff to respond to an MCI and indicated lessons learned. The studies had significant limitations in design and evaluation methods. One study addressed computer simulation for training hospital staff to respond to an MCI and identified bottlenecks in patient care, security problems, and other issues. Four studies, covering issues from burn care to a regional coordinated response to a biological attack, addressed the effectiveness of tabletop or other exercises in training hospital staff to respond to an MCI. The reviewed studies used a variety of methods to evaluate the effectiveness of hospital drills, computer simulations, and tabletop and other exercises in training hospital staff to respond to an MCI, and they targeted different groups of hospital staff. Internal and external communications were the key to disaster response (e.g., a well-defined incident command center reduced confusion, conference calls were inefficient, and accurate phone numbers were vital).
Conclusions:
We concluded that enough studies were available to suggest that hospital disaster drills were effective in training hospital staff to respond to an MCI; however, weaknesses in study design limit the strength of these conclusions. Although computer simulations and tabletop and other exercises may have a role in identifying problems in disaster preparedness, the evidence is insufficient to judge their effectiveness in training.
Contents
- Preface
- Acknowledgements
- Summary
- 1. Introduction
- 2. Methods
- Recruitment of Experts
- Target Population
- Identifying the Specific Questions
- Analytic Framework
- Literature Search Methods
- Sources
- Search Terms and Strategies
- Organization and Tracking of Literature Search
- Abstract Review Process
- Qualitative and Quantitative Data Abstraction
- Article Review Process
- Evidence Grading
- Evidence Tables
- Peer Review Process
- 3. Results
- 4. Discussion
- References
- Appendixes
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.1 Contract No. 290-02-0018. Prepared by: The Johns Hopkins University Evidence-based Practice Center, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.
Suggested citation:
Hsu EB, Jenckes MW, Catlett CL, Robinson KA, Feuerstein CJ, Cosgrove SE, Green G, Guedelhoefer OG, Bass EB. Training of Hospital Staff to Respond to a Mass Casualty Incident. Evidence Report/Technology Assessment No. 95. (Prepared by the Johns Hopkins University Evidence-based Practice Center under Contract No. 290-02-0018.) AHRQ Publication No. 04-E015-2. Rockville, MD: Agency for Healthcare Research and Quality. June 2004.
This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.
AHRQ is the lead Federal agency charged with supporting research designed to improve the quality of health care, reduce its cost, address patient safety and medical errors, and broaden access to essential services. AHRQ sponsors and conducts research that provides evidence-based information on health care outcomes; quality; and cost, use, and access. The information helps health care decisionmakers—patients and clinicians, health system leaders, and policymakers—make more informed decisions and improve the quality of health care services.
The authors of this report are responsible for its content. Statements in the report should not be construed as endorsement by the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services of a particular drug, device, test, treatment, or other clinical service.
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540 Gaither Road, Rockville, MD 20850. www
.ahrq.gov
- Review Effectiveness of hospital staff mass-casualty incident training methods: a systematic literature review.[Prehosp Disaster Med. 2004]Review Effectiveness of hospital staff mass-casualty incident training methods: a systematic literature review.Hsu EB, Jenckes MW, Catlett CL, Robinson KA, Feuerstein C, Cosgrove SE, Green GB, Bass EB. Prehosp Disaster Med. 2004 Jul-Sep; 19(3):191-9.
- A state survey of emergency department preparedness for the care of children in a mass casualty event.[Am J Disaster Med. 2009]A state survey of emergency department preparedness for the care of children in a mass casualty event.Thompson T, Lyle K, Mullins SH, Dick R, Graham J. Am J Disaster Med. 2009 Jul-Aug; 4(4):227-32.
- Key topics for emergency health education in the Pacific.[Pac Health Dialog. 2002]Key topics for emergency health education in the Pacific.Keim M. Pac Health Dialog. 2002 Mar; 9(1):104-8.
- Disaster management among pediatric surgeons: preparedness, training and involvement.[Am J Disaster Med. 2008]Disaster management among pediatric surgeons: preparedness, training and involvement.Chokshi NK, Behar S, Nager AL, Dorey F, Upperman JS. Am J Disaster Med. 2008 Jan-Feb; 3(1):5-14.
- Review Development of evaluation modules for use in hospital disaster drills.[Am J Disaster Med. 2007]Review Development of evaluation modules for use in hospital disaster drills.Jenckes MW, Catlett CL, Hsu EB, Kohri K, Green GB, Robinson KA, Bass EB, Cosgrove SE. Am J Disaster Med. 2007 Mar-Apr; 2(2):87-95.
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