Biomedical Engineering Reference
In-Depth Information
companied by experience, additional knowledge,
or implementation capability. Lack of effective
follow-up creates the all-too-common phenomenon
of “trainers” who teach few if any classes and
soon lose whatever competencies they may have
acquired—particularly if there is no executive
support for continued training.
1.8.1 What Type of Training Should be
Provided?
There are many training options, but the most
common (and the most applicable) include the
HEICS (currently being updated) [29], terrorism
and weapons of mass destruction, and general
and medical management of hazardous materials.
HEICS is a standardized incident management
system adapted from incident command system
variants used by local, state, and federal public-
safety and emergency-management personnel. It
is specified in the JCAHO emergency manage-
ment standards and is one of the few consis-
tencies in hospital preparedness training. Beyond
HEICS, options are numerous and unregulated,
with varying degrees of standardization. How
much training should be provided? What are useful
and realistic competencies? What will an indi-
vidual hospital, hospital group, or regional consor-
tium support? To add to the mix, sweeping (and
verging on the arbitrary) training requirements
related to compliance with the National Inci-
dent Management System and other federal home-
land security initiatives consume substantial staff
resources while yielding little apparent benefit.
1.9 Staff Protection
Essential components of staff protection include
personal protective equipment (PPE) for common
tasks and decontamination, chemoprophylaxis and
immunization, and sufficient training, education,
and policy development to ensure that they are
available and appropriately used. Common PPE
pitfalls include inadequate training for existing
equipment, inadequate equipment itself, and inef-
fective policies and procedures governing PPE use.
The SARS outbreak of 2003 and the effect it had
on hospitals and EMS staff is an excellent example:
insufficient and inappropriate PPE contributed
to the disruptive effect on health systems and
exposure among healthcare workers [30,31]. The
safety net that chemoprophylaxis (for example,
antibiotics for possible anthrax exposures) and
immunization (for example, smallpox vaccine for
healthcare workers) can provide will fail if it is not
made available promptly and to all affected and
potentially affected employees. Employees who
are not confident that their employer will offer
appropriate protection are unlikely to show up for
work during a crisis. Likewise, employees who are
concerned about the health and safety of their fami-
lies are unlikely to perform their duties well, if at
all, if their concerns are not adequately addressed.
This is by no means limited to issues of terrorism,
but extends to all potentially catastrophic events.
1.8.2 Who Should be Trained?
Principal distinctions include clinical vs. non-
clinical, executive vs. managerial vs. labor, deter-
mining which departments should be included,
the number of trained staff needed to provide
adequate coverage on all shifts, frequency of
initial and refresher training, and how much effort
should be made to include physicians, particu-
larly those who contract with hospitals (a common
arrangement, especially in the ED). High turnover
rates can quickly deprive a facility of trained
employees. Insufficient or ineffective refresher
training can produce the same effect as high
turnover, as hard-won skills deteriorate due to
lack of use. Many preparedness and decontami-
nation training programs are provided in “train-
the-trainer” format—that is, a small group of
employees is trained and expected to cascade
the training down to fellow employees, even
though their newly acquired “expertise” is unac-
1.10 Exercise Design and Conduct
So far we have examined common pitfalls that
relate to staffing, equipment, training, and proce-
dures. One of the mechanisms for determining and
evaluating these and other challenges can itself be
a challenge: exercises. The purpose of an exercise
is to evaluate one or more measurable performance
