Disaster response drills are the most effective way to engage staff with an emergency response plan and ensure their readiness, but they can be expensive in terms of resources and manpower. A full-scale drill requires more than a year of coordination and planning with regional emergency medical services (fire, police, and paramedics) and hospital-based staff. However, smaller portions of the emergency response plan realistically can be tested by the respiratory therapy department through case study testing and small-scale mock disasters.
Case studies can help to improve staff therapists' knowledge of the emergency response plans without requiring significant set-up and resources. Using your emergency room and department disaster plans, staff would be required to identify how to initiate the plan, what steps are important to initiate preparation, what resources they believe are available to respond, and how many staff they would require. This process, which should take 30 minutes, gives staff the chance to use the framework of the emergency response plan to challenge themselves to respond appropriately and to challenge the validity of the plan itself.
The first step in organizing this drill is to ask two or three staff therapists to spearhead the development of several clinical scenarios that may present to their emergency rooms. The clinical scenarios should involve multiple casualties (between 10 and 40), advanced but short notice, different times of day and night, and should consider holiday staffing or flu season. The situation could be a traffic, airline, or cruise ship accident; an educational-based event (shooting, chemical leak, or fire); natural disaster; or outbreak (for example, a flu in a nursing home). (See sidebar for example.)The patient/casualty mix can be diverse but should include a representative mix for your client base. Department leadership can review the scenarios and refine the details to challenge the staff and the ERP (emergency response plan).
The scenario should be kept "under wraps" until the date of the presentation. Staff can be warned that there will be a case study and allowed to review the emergency response plan (if they choose to) or fly by the seat of their pants. To increase interest in the exercise, staff could be divided into teams with some prize (pizza lunch, etc.) for the group that most successfully completes the challenge. Half the day could be focused on coordination and resources, and half on the mock disaster, tabletop exercise. The overall goal is to have fun, learn, and compete using the ERP.
Small-scale mock disaster
Organizing a small-scale, hands-on exercise requires the approval of the senior department leadership because drilling even a small-scale mock disaster costs money. Additional staffing and equipment will be required to ensure that day-to-day operations are not affected by the exercise and there will be some consumable waste. Senior leaders also will need to establish that the resources available realistically reflect those typical for your facility.
Involving staff in development of the scenario is important to ensuring their buy-in. They should work in conjunction with local EMS to make the scenario reflect the most likely mass casualty incident for your geographic region. This helps reinforce your staff's working relationship with EMS and establishes your facility's expertise in the eyes of the community. The team also should determine what they expect to get out of the exercise (e.g., team building, skills improvement, fun, competition) before completing the exercise planning and under what conditions the exercise is ended (e.g., risk to participants, actual medical situations, security concerns).
A local high school or community college can be approached to provide "casualties" and EMS may recommend a makeup artist for their injuries. A staff member should be designated to brief the casualties the day of the event on what their injuries are, their response to questions regarding medical history, and current signs and symptoms associated with their injuries. An injury card can help them respond to clinically expected questions. On the reverse side of the card should be the patient's triage category. You will need to find some monitors who will observe and score staff performance during the exercise. These monitors will need to have some medical experience so they can effectively score and should be familiar with the various emergency response plans that participants will be using.
At the designated starting time, an announcement should be made to all stakeholders (hospital and EMS) that the exercise is happening. My facility typically announces "Exercise, exercise - internal disaster exercise drill - exercise, exercise" with the facility equivalent (code orange internal). The emergency response staff should be briefed on the disaster scenario, given appropriate preparation time, and then the casualties should begin to arrive. As the team begins to respond, monitors should take positions at observation points in triage and the resuscitation bay and circulate throughout the exercise. They do not interact with the participants but may make notes during the exercise to keep an "on time" record of events and responses.
In order to prevent any interruption in regular service to patients, only specific areas should be utilized during the exercise. All actual patients should be briefed (when possible) on the exercise and assured that it will not impact the care provided. Do not forget that the exercise also is an excellent public relations opportunity and plenty of pictures should be taken.
At the conclusion of the exercise, the primary casualty officer (MD in charge) and the senior monitor should make an overhead announcement informing participants and staff that the exercise is concluded (For example, "Exercise, exercise - internal disaster exercise drill concluded - exercise, exercise").The casualties should meet at a designated assembly point for a quick debrief and thanks. Their safety and security should be verified prior to leaving the facility; some may be overwhelmed by the event.
Within 24 hours of the exercise, the monitors should meet with staff participants for an informal discussion of the exercise's successes and challenges and to help the teams evaluate their own performance. It is essential to remember that participants often are their own worse critics, so the debrief needs to be kept positive. Everyone who wishes to speak should be granted time, but all critiques should be non-personal and non-confrontational. The staff's comments should be used to evaluate and improve the ERP and the teams' ability to respond. A final report prepared by the monitors will provide senior leadership with a transparent evaluation of the ERP; the teams' preparedness, strengths, and weaknesses; and their ability to sustain activities during an actual mass casualty event.
Any ERP only is effective as the people using it; the small-sized exercise is an excellent first step to prepare your staff to successfully handle a real event.