by: Melinda Hirshouer
Hospital leaders must prepare for a variety of internal or external events that cause enough disruption to force normal operations into crisis mode. If the employees designated to lead the hospital in its response to casualties, property damage, or suspending patient care are unprepared or make ineffective decisions, the crisis will quickly escalate to a disaster (Sternberg, 2003). In a 2008 study, Niska and Shimizu found that while greater than 95% of hospitals have emergency preparedness plans for chemical, biological, or natural disasters, only 73.37% of facilities were prepared for loss of utilities and 47.6% of hospitals were prepared to manage and shelter mobility impaired patients (Niska & Shimizu, 2011). This is particularly important to post-acute areas as most of their patients would fit this description.
In the post-acute care setting, there is some reluctance by leaders to admit that these practice settings are also susceptible to the same types of crises as acute care hospitals. Post-acute care areas face additional challenges that come from having space, skill, and equipment to provide care for patients with physical and cognitive disabilities and having to contemplate a complex evacuation while maintaining their care or receiving patients from another unit or facility that may have been impacted. It is during these times of crisis, when the post-acute care staff members, including the nurses, look to their leaders for guidance and support.
As a part of my DNP program, I completed a scholarly project entitled Use of a Structured Emergency Management Training Protocol in a Post-Acute Care Setting. The project intervention included providing a structured disaster training protocol specifically targeted to post-acute leaders. The protocol included an introductory in-service, successful completion of four FEMA online training modules and participation in two tabletop exercises. The in-service was designed to expose leaders to emergency management in post-acute care areas and the brief tabletop exercises were developed to highlight specific post-acute care scenarios and set realistic expectations for the probability of an event occurrence.
The evidence-based practice project improved the number of post-acute leaders with emergency management training from 0%-92%. Additionally there was an increase in the participants’ ability to retain knowledge from the training, with an increase of the mean number of questions correct (before the training was 9.5 compared to 16.3 after the training) which represented a statistically significant increase (p<0.001), as well as an increase from 35% to 90% in the ability to complete critical tasks in the tabletop exercises. Finally, there was a significant increase in the participants’ perception of their emergency management preparedness at the completion of the training with a mean level of readiness before the training of 2.4 compared to 8.2 after the training (p<0.001). The project demonstrated that post-acute leaders were able to successfully complete emergency management training and apply the knowledge that they had learned.
Identifying that emergency management (EM) training is necessary is not enough to encourage completion. The value of why this matters to me must be addressed in order to engage participants from the beginning. Additionally, constructing the TTX so that there is a safe environment for the team to talk through the scenario and discuss solutions helps to reinforce a culture of learning and preparedness. Current events that can be applied to TTXs and can be used to reinforce the importance of training also proved helpful. Finally, as the FEMA modules ICS 700 and ICS 800 provided basic information on the structure of the ICS, the completion of these modules before ICS 100 and ICS 200 seemed to improve the participants’ understanding of the material that was being presented. Leaders from acute care and post-acute care areas should be brought together for training and planning for any event whether natural or manmade, planned or unplanned that may cause a surge of patients into any area of the facility.
- Niska, R. W., & Shimizu, I. (2011). Hospital preparedness for emergency response United States, 2008. Hyattsville, MD: U.S. Dept. of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics.
- Sternberg, E. (2003). Planning for Resilience in Hospital Internal Disaster. Prehospital and Disaster Medicine,18(4), 291-299. doi:10.1017/S1049023X00001230