Biomedical Engineering Reference
In-Depth Information
plans and protocols should not be left to the
addition of a written report that is placed in the
notebook labeled, “Policies & Procedures” and
then expecting hospital personnel to be aware
and prepared to act on such proceedings in an
acute crisis. This is a setup for potential disaster.
The main objectives of drills are two-fold:
evaluate both the “system” issues and the human
performance. The essential components of the
system must be intact for the personnel to perform
optimally, and conversely, the personnel must be
capable of using the system to deliver the desired
medical care. For example, if the well-trained
out-of-hospital emergency personnel cannot triage
the patient properly to the main facility due to
a faulty communication chain of command, this
demonstrate a system failure. Conversely, if the
ICU and operating room personnel are not aware
of the hierarchy of chain of command and the
steps required to decontaminate an “exposed”
victim who has slipped past the confusion of the
emergency department, both system and personnel
deficiencies exist. People cannot be expected to
perform adequately if they lack training, their
experience is deficient or marginal and they are not
confident and comfortable working within a well-
planned system. There is little doubt that a well run
disaster drill is dependent on a well conceived plan
that has been tested so to allow the “kinks” to be
worked out and coupled with personnel who have
been briefed, educated and have trained with the
protocols, equipment and system issues. A recent
survey of UK clinicians regarding the presentation
and management of victims of chemical and
biological agents suggested there are significant
gaps in the knowledge and training of these
individuals in regards to understanding decon-
tamination, presenting features, and recommended
therapies. Only a minority had participated in
relevant training exercises related to bioterrorism
[35]. Moreover, though recently updated protocols
and incident plans have been enacted, many
physicians who provide “frontline” care of victims
of bioterrorism remain poorly integrated into the
institution care schema [36]. Furthermore, some
of the more straightforward steps in resuscitation,
i.e., airway management, may be hampered
Pre-hospital response
City vs. small town
Air and ground ambulance transport issues
Training and equipment
Emergency department
Triage
Trauma mass casualty
Training
Equipment
Physician, nursing and ancillary/support staff
Figure 20.5
First responders: potential areas of simulation
drills.
Isolation, training, preparation, etc.
Individual medical/surgical departments
Critical care response
OR management of
infected or contaminated
patients
Coordination between departments
i.e., PACU/ICU/ED
Nursing
Hospital administration
Human resources
Finance
Pharmacy
Support/ancillary staff
Command and control
Security
Clinical engineering/biomedical engineering
Facilities management
Hospital power supply
Communications
Information services
Data security
Data communication reliability
Sensors and detectors for bioterror agents
Figure 20.6
Second tier of responders: potential areas of
simulation drills.
20.9 Simulation Drills for Bioterrorism
The individual institution must decide what its
level of commitment to preparedness is desired
and required by the local and regional populace
it serves. The development of a relationship with
local, regional and national agencies involved
in preparedness is the first step in involving
the hospital and its personnel.
Incorporating
