During a pandemic influenza, emergency departments will be overwhelmed with a large influx of patients seeking care. Although all hospitals should have a written plan for dealing with this surge of health care utilization, most hospitals struggle with ways to educate the staff and practice for potentially catastrophic events.

To better prepare hospital staff for a patient surge, a novel educational curriculum was developed utilizing an emergency department for a patient surge functional drill.

A multidisciplinary team of medical educators, evaluators, emergency preparedness experts, and technology specialists developed a curriculum to: (1) train novice users to function in their job class in a multi-user virtual environment (MUVE); (2) obtain appropriate pre-drill disaster preparedness training; (3) perform functional team exercises in a MUVE; and (4) reflect on their performance after the drill.

A total of 14 students participated in one of two iterations of the pilot training program; seven nurses completed the emergency department triage course, and seven hospital administrators completed the Command Post (CP) course. All participants reported positive experiences in written course evaluations and structured verbal debriefings, and self-reported increase in disaster preparedness knowledge. Students also reported improved team communication, planning, team decision making, and the ability to visualize and reflect on their performance.

Data from this pilot program suggest that the immersive, virtual teaching method is well suited to team-based, reflective practice and learning of disaster management skills.

GreciLS, RamlollR, HurstS, GarmanK, BeedasyJ, PieperEB, HuangR, HigginbothamE, AghaZ. vTrain: A Novel Curriculum for Patient Surge Training in a Multi-User Virtual Environment (MUVE). Prehosp Disaster Med.2013;28(3):1-8.

A substantial barrier to improving disaster preparedness in Australia is a lack of prescriptive national guidelines based on individual hospital capabilities. A recent literature review revealed that only one Australian hospital has published data regarding its current preparedness level.

To establish baseline levels of disaster knowledge, preparedness, and willingness to respond to a disaster among one hospital's staff, and thus enable the implementation of national disaster preparedness guidelines based on realistic capabilities of individual hospitals.

An anonymous questionnaire was distributed to individuals and departments that play key roles in the hospital's external disaster response. Questions concerned prior education and experience specific to disasters, general preparedness knowledge, perceived preparedness of themselves and their department, and willingness to respond to a disaster from a conventional and/or chemical, biological, or radiological incident.

Responses were received from 140 individuals representing nine hospital departments. Eighty-three participants (59.3%) had previously received disaster education; 53 (37.9%) had attended a disaster simulation drill, and 18 (12.9%) had responded to an actual disaster. The average disaster preparedness knowledge score was 3.57 out of 10. The majority of respondents rated themselves as “not really” prepared and were “unsure” of their respective departments’ level of preparedness. Most respondents indicated a willingness to participate in both a conventional incident involving burns and/or physical trauma, and an incident involving chemical, biological or radiological (CBR) weapons.

Australian hospital staff are under-prepared to respond to a disaster because of a lack of education, insufficient simulation exercises, and limited disaster experience. The absence of specific national standards and guidelines through which individual hospitals can develop their capabilities further compounds the poverty in preparedness.

CorriganE , SamrasingheI . Disaster Preparedness in an Australian Urban Trauma Center: Staff Knowledge and Perceptions. Prehosp Disaster Med.2012;27(5):1-7.

Predisaster Drill Activities (PDAs) may act as predictors of preparedness, but have been studied inadequately. To address this gap, a descriptive study of PDAswas conducted at two large hospitals.

A longitudinal study was conducted at two large academic hospitals (A: a tertiary care university hospital, and B: an urban, municipal, Level-1 Trauma Center) in Brooklyn, New York. Both were equipped with disaster plans. Over a period of five weeks preceding a full-scale drill of a simulated pandemic influenza outbreak, eight sequential public health alerts were issued. Hospital responses to pre-identified components were recorded: (1) training; (2) equipment; (3) communications; (4) incident command centers; (5) supplies; (6) staffing; (7) infection control measures; and (8) miscellaneous. A descriptive statistical analysis was performed.

The overall response rate to all die alerts for Hospital A was 67%, while that for Hospital B was 40% (p <0.009).The median delay in responding to alerts for Hospital A was six days (range = 0–19 days), and B was seven days (range = 0–21 days). Training was die most frequendy cited component (n = 20), however the median delays (days) were two (range = 0–13), and nine (range = 4–21) for hospitals A and B, respectively. Responses to communications, supplies and incident command center components were delayed or inadequate. Some additional unexpected responses such as supplemental meetings (n = 4) and additional infection control measures (n = 3) were elicited at both hospitals.

There were disparate responses to identical triggers at similar sites. Pre-disaster Drill Activities may help identify emergency response preparedness gaps and augment available resources for optimal utilization.

Sri Lanka has experienced a 24-year civil war with monthly terrorist incidents. Disaster drills, as a method of teinforcing collaboration and improved communication, can enhance military and civil response coordination and ultimately benefit the community and the injured victim.

Two large-scale disaster drills occurred in Sri Lanka in 2008 with participation of military disaster response teams, civil hospitals, international non-governmental organizations (INGOs), the World Health Organization, American universities and hospitals, the local governments, Ministry of Health, non-governmental organizations, the Red Cross, and others. Training occurred in incident command, communication, clinical response, crowd control, evaluation, and the planning process. Civil and private prehospital care responders worked closely with the military during the drill. More than 400 participants gave active feedback and an educational video of the recorded drills was distributed for future training exercises.

Military and civil responders identified challenges and strengths and discussed improvements for future operations. In the days following the drill, participants responded to actual mass casualty incidents with improved skills, coordination and communication. Subsequent drills and task-force meetings were conducted. The INGOs supported follow-up activities and provided training materials. International partnerships were forged with military, civilian representatives, and disaster medicine specialists. Military and civil response teams had never performed a drill together before and felt it was invaluable for their coordination.

The promotion of drills involving military, civil society, and communities should be encouraged to improve response, especially in countries with ongoing civil conflict and high terrorist activity. Drills can help military and civil partners reach a broader understanding of the others' role and methodology of response, which may improve the outcome and timeliness of a disaster response.