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medical students as a new resource in hospital mass casualty events
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Medical students as a new resource in hospital mass-casualty events
Dr. Marco Mangini Resident Physician in Anesthesiology
and Intensive Care Post-Graduate School
Dr. Francesco Grossi Resident Physician in Cardiology Post-Graduate School
Integrated Emergency Management for Mass Casualty Emergencies
NATO ADVANCED TRAINING COURSE
Florence, Italy 26th – 29th October 2011
Hospital vulnerability
Hospitals are... “A prerequisite for stability and economic
development”
And Have.. “ A symbolic social and political value wich
contribute to a community’s sense of security and well being”
UN/ Internation Study for Disaster Risk Reduction (ISDR). Hospital Safe from
Disaster 2008 – 2009: Wordl Disaster Reduction Campaign.
Hospital vulnerability
But even in developed countries they are vulnerable: In UK 7% of Hospital and 9% of primary health care facilities are located in high to moderate risk area for flooding.
Bagaria et Al. “Evacuation and sheltering of hospital in emergency: a rewiev on international experience”. Prehospital and Disaster Medicine 2009; 24(5): 461 – 467.
Hospital evacuation
• In case a disaster strikes sometimse the evacuation of patient from the structure is mandatory....
Hospital evacuation
“ Eight on 91 acute care hospital (nine percent) were Evacuated” “Six institutions begans evacuation within the first hours after the earthquake and compled the process by the end of the first day”.
N Engl J Med 2003; 348: 1349 - 55
Hospital vulnerability
Zarocostas J. “ Disaster agencies treat wounded after Italian earthquake damages hospitals” BMJ 2009; 338:b1524.
“The earthquake that struck the town of L’Aquila, in central Italy, on 6 April [...] had magnitude 6.3”.
“L’Aquila’s 500 bed hospital, built 15 years ago, had to be evacuated because part of it collapsed”
Hospital evacuation
Patients vertical evacuation needs a lot of resources in term of medical, paramedical
and technical staff.
This is especially true for criticall ill patients, who need continous and special treatment (
es: mechanical ventilation).
Hospital evacuation
Disaster management and response 2004; 2:14 -9.
“*...+ 15 firefigthers, 12 nurses, 12 physisicians and 2 respiratory therapists (a total of 41 persons) involved in the drill”.
Hospital evacuation
“Time required to prepared a patient range from 3 – 8 minutes and and 6 to 7 persons were required to evacuate each patien” “Overall the drill required 93 minutes to evacuated 12 patients down 4 flights of stairs”.
Disaster management and response 2004; 2:14 -9.
Hospital evacuation
Resource could not be so numerous and readly available in an University hospital...
So where we can find skilled people in few minutes from the disaster?
Hospital evacuation
Medical Students
Medical students and disaster medicine
Several institutions already organised disaster medicine
course for medical students...
Medical students and disaster medicine
And many course already use peer – education teaching
tecniques, because of his effectivness...
Medical students and disaster medicine
Medical students
Disaster Medicine
Peer – assisted learning
Medical students and disaster medicine
In – hospital disaster
response and rescue
The Course
“In-hospital disaster response and rescue”
The “In-hospital disaster response and rescue” training programme has been set in the medical school curriculum of the University of Florence as an elective course and consists of 4 sessions of 4 hours each, for a total of 16 hours.
The course has been given for 3 years, from the academic year 2008-2009 to the academic year 2010-2011, during which 125 medical school students from the 3rd to the 6th year have taken part in the course.
Organizing group
A multidisciplinary group of young professionals interested in disaster medicine.
All the lessons were at first given by senior medical students, young doctors, engineers,
linguists, psychologists, fire-fighting technicians and chemists
Peer-education based
Students had the possibility to become teachers themselves after a 2 steps training programme.
STUDENT CO-TRAINER TRAINER
Each student was granted an amount of University Training Credits at the end of the programme.
Course modules
• Medical module
- triage (START protocol)
-communication in emergency situations
-First Aid (bleeding, burns, electrocution)
- Basic Life Support (BLS) both adult and paediatric
- Rescue to traumatized patients.
Such themes are also dealt with in practical lessons.
Course modules
• Psychological /social Module This module deals with people’s possible
behaviours in case of emergency: - Thought processes and cognitive distortions in
emergency situations - Trauma, post-stress traumatic disorder and
various ways to approach victims according to their reactions
- Language and communication problems in the hospital environment
Course modules
• Technical Module The technical module consists of three main sections: - an engineering section concerning self-protection and safety; - a chemistry section concerning fires, explosions
and poisoning; - a practical fire-fighting section concerning
techniques to extinguish fires and evacuate smoke filled places.
Our research
In order to verify the effectiveness of the course, participating students were required to fill-in a pre-test that included a “Knowledge Test” and
an “Attitude Test”. At the end of the programme the same tests where submitted
Results: Experimental Group
• Attitude test (behaviour test)
-Pre-course (44.06)
-Post-course (50.15)
• Knowledge test (disaster medicine quiz)
-Pre-course (8.02)
-Post-course (20.10)
Results
Experimental Group
- Attitude Difference = 6.09 points
- Knowledge difference= 12.08 points
Control Group
- Attitude Difference= 0.59 points
- Knowledge Difference= 1.05 points
Results
Both variables show definitely higher scores differences in the tests filled-in by the students included in the experimental group in comparison to the control group.
Discussion
- the training programme has met with good acceptance, as testified by the number of students who decided to enrol in the course and followed the lessons.
- students who attended the course did it in an active way, participating in the lessons with a pro-active behaviour
The course opened the way to other experiences:
Association for the Research on Emergency and Rescue
Mobile Emergency
ARIES - Associazione Ricerca Interdisciplinare Emergenza e Soccorso
Association for the Research on Emergency and Rescue
http://associazionearies.jimdo.com
MobileEmergency
Available for free on Itunes
http://itunes.apple.com/us/app/mobile-emergency
Prof. Paolo Nesi Prof. Alessandro Fantechi Prof. Sergio Boncinelli
Ing. Pierfrancesco Bellini Dott. Antonio Cappuccio
Ing. Luca Malandrino Dott. Marco Mangini Dott. Francesco Grossi
MobileEmergency Team:
Mobile Emergency
The main idea behind of Mobile Emergency is to provide a support for managing communications among medical personnel during a disaster that may occur into large medical centers.
Mobile Emergency
• Careggi Hospital: nearly 182 acres, 13 departments, 1,660 beds, 135,000 patients per year admitted in the ER, 5.900 employees
• In this large and complex scenarios, several emergency events may occur per week. They may range from simple water problems (flooding or lack), lack of power, problems on oxygen, to fire, etc.
Emergency Scenario
• 19 October 2011 : Isopropyl Alcool Release from a container into the molecular biology laboratory
Common needs in emergency situations in a hospital setting
- Informing the command center about the emergency
- recalling in short time medical personnel from other areas of the hospital.
- supporting hospital personnel providing them missing informations
- moving personnel and patients from a place to another
Hospital personnel need to be:
• informed about the occurrence of an emergency situations
• informed about the effective severity of the emergency, if they are in danger or if their help is needed
• supported in finding an escape path to get the exit and/or join a collecting area
Mobile Emergency
We imagined an application that also could:
• support at identifying medical personnel that need help.
• support the aggregation of collaborative teams and the establishing of a coordinator
• Deliver an image and/or a video depicting the emergency event.
• Find the position of a person inside the hospital and communicate it to the emergency command room
How the application works
How to localize yourself in the hospital
Tests with the application: smoke conditions
Test with the application: rescue and evacation
MobileEmergency
Available for free on Itunes
http://itunes.apple.com/us/app/mobile-emergency
Prof. Paolo Nesi Prof. Alessandro Fantechi Prof. Sergio Boncinelli
Ing. Pierfrancesco Bellini Dr. Antonio Cappuccio
Ing. Luca Malandrino Dr. Marco Mangini Dr. Francesco Grossi
MobileEmergency Team:
