EMD Disaster Drill TOMORROW (SATURDAY)--Helpful Tips
Andi Tenner
Disaster Drill Information
Disaster drill date: 14 Nov 2015
All participants should be in the EMD by 7:30am.
Patients should arrive by 7am at the Muhimbili Football Pitch
Location: Muhimbili EMD
Flow of the day:
1. Preparation of the “patients”
We will collect the patients on the football pitch and prepare them and apply makeup to make them look injured. Once the patients have their individual scenarios, are numbered, they will be walked over to the EMD and arranged in front of the EMD. At that point, the drill participants in the EMD will be notified that the drill has started and will be allowed to come out and assess the patients and the drill will begin.
2. In the EMD:
Triage will be set up in the ED Thursday conference area as it usually is during a disaster. All disaster policies and procedures should be followed with as little deviation from these procedures as possible (with the exception of those necessary due to accommodations for real patient care and simulation). The “Green” area will be in the hallway in front of the nursing office and Treatment 5. If the patient volume allows it, the “Red” area will be in Resus 1, which should be kept clear in the morning on the day of the drill. (The patients should be distributed between resus 3 and 4, and 2 if needed.) If there are not too many patients, Resus 2 will be the “Yellow” area. If Resus 2 is occupied (true patient care takes priority!) then we will use the hall in front of resus 2 or the area near the command center depending on the patient volume that day.
The area for the dead or dispositioned patients (i.e. the patients who we have assessed and decided they need to go to the OT, the ward, or MOI) will be the hallway outside the ED between the ED conference room and the new construction. This area will be called the “Dispo Area”. Patients will be instructed to wait there until the debriefing.
Once the drill is completed, everyone who participated will gather for a debrief again in the ED Thursday conference area.
3. Simulation:
· Patient Simulation
Patients will each be given a number. There will be a card for each patient that the Drill Coordinator (Andi for this drill) will carry that has the scenario for that patient, the diagnosis, and the treatment that should have been given to the patient. Each section’s observers will have the cards for the patients that should be in their areas as well. At the end of the scenario each active patient’s management will be reviewed.
The patient s themselves will be given a role and a scenario for each patient. They will be given instructions to follow. Any patient that is unconscious will not be arousable and will not talk or assist you in moving them in any way. However, once a patient is marked as dead they may walk over to the Dispo Area. Patients who are not dead but are to go to OT, MOI, or the ward will need to be taken by health attendant to the Dispo Area. (This is to simulate a real MCI—dead patients would not be brought into the ED, but patients who are alive will need to be transported by hospital staff).
Patient’s respiratory rate and circulatory assessment will be pinned to their clothing. If a patient is not breathing and you reposition the airway, s/he will take a LARGE, OBVIOUS breath if s/he is meant to start breathing again, and the patient should be managed as a patient who started breathing after his/her airway was opened. If the patient’s card says s/he is not breathing, you open the airway and the patient DOES NOT take a large breath (but continues breathing as normal, since the actor is still alive), you assume this to mean the patient does not start breathing after opening the airway and the patient should be managed as such.
Further vital signs/findings will be written on cards that the patient will have and can give to you when asked (including unconscious patients—this DOES NOT mean that they have regained consciousness in the scenario—they will just hand you the card but remain unconscious).
Also, DO NOT cut clothing of the patients. They are simulating being patients, but we do not have a budget for replacement clothing—do not cut their clothing or attempt to completely remove it.
· Procedure Simulation
All invasive medical procedures (IV cannula insertion, chest tubes, etc.) will be simulated by placing a piece of plaster over the site and writing on it what it represents. (For example, to place an IV cannula, a piece of plaster will be placed over the antecubital fossa with the words “IV” written on it.)
Other procedures that require disposable equipment will be simulated where possible to keep from using too much of the ED’s equipment. This includes tourniquets, splints, bulky dressings to stop bleeding, etc. The plaster markings should be used here as well.
· Imaging simulation
For the purpose of this drill, we will assume that the CT scanner is down. If you want xrays on a patient, you have to ask for them and the patient will hand you a card with a reading. If s/he does not have a card, assume the xray is normal. NOTE: “Unconscious” patients will have to do this as well. This does NOT mean that the patient is no longer unconscious.
Ultrasound exams should be performed. Once the procedure is performed, the patient will give you a card with the results.
· Documentation Simulation
Documentation is an essential component of successful disaster management. It is absolutely essential that documentation is completed both quickly and in a manner that is complete enough to let other caregivers know what has already been done for the patient and what remains to be done, how the patient presented initially in case the patient’s condition deteriorates, and to track patients for concerned friends and loved ones. All documentation should be performed as it would if there were a real disaster, including ordering imaging and medications, etc.
4. Monitoring
Observers will be assigned to specific areas to analyse the drill progression and response. The observers will be clearly identified by pinning a gold ribbon on their shoulders and are “invisible”—they are not a part of the drill, cannot say anything to the participants and cannot intervene in any way if mistakes are made.
Additionally, Shally will be filming for the department. She will have a gold ribbon on her shoulder as well to identify her and she will not be a part of the scenario.
5. When the simulation ends
The simulation ends when all of the patients have been dispositioned. When all patients are in the Disposition Area, the end will be announced and all patients and drill participants will return to the ED Thursday conference area for the debrief.
6. Debrief
The debrief is an essential part of the drill to learn what went right and what could be improved. The observers in each section will talk about how the drill went, any gaps in management or on flow, and any issues that were identified and need to be addressed. Additionally, participants and patients will be able to give their own assessments of the drill and their feedback at that time.
The Scenario:
Given the need for this drill to be as realistic as possible, no one other than the Drill Coordinator (Andi for this drill) will know the scenario until the day of the drill. When the patients are being prepped, the observers will be given the drill details but are strictly forbidden from communicating with anyone in the EMD or drill who is not a patient or another observer. At the end of the drill, the scenario will be revealed and the patient scenario and write-ups will be given to the EMD to keep as an example for future use.
Feedback:
The debrief will be the first formal feedback from the drill. All participants and observers will have a chance to give their assessment of the drill and the observers will go through their checklists and give their initial assessment of the drill. After that, the observers will compile their notes, and compile a report that will be submitted to the Department, along with recommendations for improvement. The EMD, lead by the Disaster Team, will then be responsible for implementing the recommendations.
Preparation
Attached are the MNH Disaster Response Plan and the START triage cards to refresh your memory. Also attached is the Evaluation form that we will be using to evaluate the drill for your reference.
Looking forward to the drill and see you tomorrow!
andi
