Discussion: The Hospital Incident Command System

Discussion: The Hospital Incident Command System ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Discussion: The Hospital Incident Command System – Read the attached file and answer these three questions : How difficult is it to operationalize HICS? What are some of the challenges associated with HICS implementation? What are some solutions to the identified challenges? Discussion: The Hospital Incident Command System Who needs to be trained in HICS and why? Should different staff receive different levels of training in HICS? – Two paragraphs for each one of them. – APA Style – Two references at least – education_and_training_of_hospital_workers___who_are_essential_personnel_during_a_disaster.pdf the_united_states____experience.pdf ORIGINAL RESEARCH Education and Training of Hospital Workers: Who Are Essential Personnel during a Disaster? Michael Reilly, MPH, NREMT-P;1 David S. Markenson, MD, EMT-P2 Abstract Hospital plans often vary when it comes to the specific functional roles that are included in emergency and incident management positions. Bioterrorism coordinators and emergency managers for 31 hospitals in a seven-county region outside of a major metropolitan area, with urban, suburban, and rural demographics were surveyed to determine which specific functional roles were considered “essential” to their hospital’s emergency operations plans. Furthermore, they were asked to estimate the percentage of their “essential” staff trained to perform the functional roles delineated in the hospital’s plan. Responses were entered into a database and descriptive statistical computations were performed. Only three categories of hospital personnel were reported to be “essential” by all hospitals to their emergency preparedness plans: emergency department physicians, nurse, and support staff. Training for overall “essential” staff ranged by Correspondence: hospital 73.6-83.3%. Some hospitals reported that these staff members have Michael J. Reilly, M P H , NREMT-P received no training in their anticipated role based on the hospital emergency New York Medical College, School of response plan. Allied health professionals and emergency medical techniPublic Health rd cians/paramedics (that are employed by hospitals) had the least amount of SPH Bldg. 3 , Suite 100 training on their role in the hospital preparedness and response plan, 33.3% Valhalla, New York 10595 USA and 22.2% respectively. Without improved guidance on benchmarks for preE-mail: [email protected] paredness from regulators and professional organizations, hospitals will continue to lack the capacity to effectively respond to disasters and public health emergencies. This manuscript and the data collection activities were 1. Assistant Director, Center for Disaster Medicine, Assistant Professor of Public Health Practice, New York Medical College School of Public Health, Valhalla, New York USA 2. Director, Center for Disaster Medicine, Associate Professor of Public Health Practice, New York Medical College, School of Public Health, Valhalla, New York USA partially supported with fundingfrom the New York State Department ofHealth through Health Research Reilly M, Markenson DS: Education and training of hospital workers: Wh o are Inc., and the Health Resources and Services essential personnel during a disaster? PrebospitalDisastM?rf2009;24(3):239-245. Administration (HRSA), Bioterrorism—Hospital Preparedness Program Cooperative Agreement Introduction (HRSA Grant #15-0282-04) to the Westchester Acute care hospitals and medical centers are a vital component of healthcare County Health Care Corporation, Regional Resourceinfrastructure.Discussion: The Hospital Incident Command System Each day these facilities are relied upon to provide acute, rouCenter, and a contract (CMC-6385) with New York tine, and primary health care to millions of Americans. In times of public Medical College. health crisis, the acute care hospital will be expected to render a prompt and Keywords: disasters; functional roles; hospital preparedness; personnel; training Abbreviations: EMS = emergency medical services E M T = emergency medical technician FEMA = Federal Emergency Management Agency HICS = hospital incident command system HRSA = Health Resources and Services Administration ICS = incident command system NIMS = [US] National Incident Management System OSHA = [US] Occupational Safety and Health Administration PPE = personal protective equipment May-June 2009 competent response to assist in minimizing morbidity and mortality. In spite of the obvious roles and responsibilities of acute care hospitals during a major health or medical crisis in the United States, numerous deficiencies have been described concerning the lack of preparedness among the nation’s hospitals and trauma centers.1?7 In response to these deficiencies, several governmental agencies and professional organizations have required and/or recommended standards for hospitals that are related to education, training, and preparedness for disasters and public health emergencies.8?11 Although some guidelines exist, there is no universal standard that describes which roles or job functions within a hospital are essential to the hospital’s ability to respond to and recover from a disaster or public health emergency. The current federal guidance, including that from the National Incident Management System (NIMS) Integration Center as well as the Occupational Received: 08 July 2008 Accepted: 31 July 2008 http://pdm.medicine.wisc.edu Web publication: 22 June 2009 Prehospital and Disaster Medicine 240 Education and Training of Hospital Workers 1. Of the following staff roles in your facility, what percentage have been trained in each of the following categories? Staff Roles Training Categories ED Director ICS/HEICS ED Support Staff NIMS ED Physician PPE (for contaminated and highly infectious patients) ED Nurse Decontamination Staff Nurse Medical Management of CBRNE Patients Staff Physician Functional Role in Emergency/Disaster Allied Health (PT, OT, etc.) Nursing Assistants/Aides Hospital Administrators Security Facilities/Janitorial Housekeeping EMTs/Paramedics Clerical/Admissions 2.Discussion: The Hospital Incident Command System Of the following staff roles in your facility, which would you consider essential to your hospital preparedness plan in an emergency or disaster? Of these essential staff, what percentage have received training related to their intended role during a disaster or emergency? Staff Roles ED Director ED Support Staff ED Physician ED Nurse Staff Nurse Staff Physician Allied Health (PT, OT, etc.) Nursing Assistants/Aides Hospital Administrators Security Facilities/Janitorial Housekeeping EMTs/Paramedics Clerical/Admissions 3. Of the following staff roles outside, but affiliated with your facility, what percentage have received training to be a part of your facility’s surge plan? Outpatient Nurse Outpatient Physician Outpatient Allied Health Outpatient Nursing Aide Outpatient Clerical Outpatient Administrators Community Nurse Community Physician Community Medical Assistant Community Allied Health Visiting/Home Health Nurse Visiting/Home Health Aide Visiting/Home Allied Health 4. List the specific preparedness-related training programs offered to your hospital staff in the past 36 months. 5. Please explain how appropriate courses are identified to train your hospital staff? What steps are taken to assure that course content is reliable and credible? 6. Have you identified any specific areas where training is needed but not currently available? If so, what type of training and in what area(s)? Reilly © 2009 Prehospital and Disaster Medicine Figure 1—Survey instrument (CBRNE = chemical, biological, radiological, nuclear, or explosive; ED = emergency department; EMT = emergency medical technician; HEICS = Hospital Emergency Incident Command System; ICS = incident command system; NIMS = National Incident Management System; OT = occupational therapy; PPE = personal protective equipment; PT = physical therapy) Safety and Health Administration (OSHA), has been unclear regarding, specifically, who should be educated and trained to perform key functional roles at a hospital during disasters or public health emergencies. This extends from the boardroom, in simply staffing the hospital’s emergency operations center (EOC), to the workers performing emergency patient decontamination in the emergency department. As such, there is considerable institutional variability among Prehospital and Disaster Medicine hospital preparedness plans as to the specific functional roles that are expected to be called upon or utilized in times of disasters or major incidents. Discussion: The Hospital Incident Command System The purpose of this study was to determine the compliance of hospitals with recommended hospital staff training and to determine which hospital workers are viewed by healthcare emergency planners as “essential” to their hospital’s emergency operations plans. http://pdm.medicine.wisc.edu Vol. 24, No. 3 Reilly, Markenson 241 ICS/HEICS % NIMS % PPE (for contaminated and highly infectious patients) % Decontamination % Medical Management of CBRNE Patients % ED Director 80 45 85 70 78 ED Support Staff 35 2 66 55 42 ED Physician 37 10 67 53 60 ED Nurse 46 12 70 63 55 Staff Nurse 33 3 58 27 30 Staff Physician 23 5 60 22 34 Allied Health (PT, OT, etc.) 25 6 55 22 20 Nursing Assistants/Aides 30 6 62 28 23 Hospital Administrators 69 28 54 26 34 Security 61 26 67 51 38 Facilities/Janitorial 37 9 60 39 29 Housekeeping 29 5 48 27 20 EMTs/Paramedics 29 18 70 41 51 Clerical/Admissions 29 3 39 17 16 40.3 12.7 61.5 38.7 37.8 Reilly © 2009 Prehospital and Disaster Medicine Table 1—Percentages of hospital staff trained in specific knowledge areas (CBRNE = chemical, biological, radiological, nuclear, explosive; ED = emergency department; EMT = emergency medical technician; ICS/HEICS = incident command system/Hospital Emergency Incident Command System; NIMS = National Incident Management System; OT = occupational therapist; PPE = personal protective equipment; PT = physical therapist) Methods Bioterrorism coordinators and emergency managers for 31 hospitals in a seven-county region immediately north of a major metropolitan area, with urban, suburban, and rural demographics were surveyed to determine which specific job functions were “essential” to their hospital’s emergency and disaster plan, and what percentage of the personnel in these roles had received training in their anticipated emergency duties according to the hospital’s emergency operations plan. Standardized, six-item telephone surveys were designed by the investigators with input from the regional hospital preparedness coordinating body, as assigned by the State Public Health Department. The survey initially was assessed by members of this group to determine its usability. The goals of the State Public Health Department were used to assess a component of the hospitals systems’ emergency preparedness planning. Fourteen common, regionally accepted, hospital job functions were selected for analysis in this survey. Survey items 1 and 2 focused on these specific functional roles. Item 3 assessed 14 hospital-affiliated, outpatient or community job areas that have a clear counterpart within the hospital. Items 4-6 were qualitative items designed to indicate the education and training needs of each specific hospital for regional planning purposes (Figure 1). Interviewers were trained by the authors and provided with contact information (e-mail, telephone numbers, addresses) for each hospital’s Bioterrorism Coordinator/Emergency Manager. Discussion: The Hospital Incident Command System Interviewers contacted each hospital representative May-June 2009 by telephone to complete the survey. Non-respondents subsequently were contacted via telephone, e-mail, and standard mail to complete the survey. Responses were recorded by the interviewers and entered into a database. All responses were pooled and basic summary statistical processing was performed on the aggregate data to assist in depicting regional trends. Microsoft Excel Standard Edition 2003 (Microsoft, Inc., Redmond, WA) was utilized to perform basic descriptive statistical calculations. Initially, the project was conducted under the authority of the Public Health Department to assess the ability of hospitals to respond to disasters as part of their oversight of the hospital system. Following this, a database of the results with all hospital and other identifying data removed was created for further analysis. As an existing database with no identifying data was evaluated, this project was considered exempt research. Summary statistics were calculated using pooled, aggregate response data to generalize the survey results throughout the region. Individual hospital’s responses are not reported. Results Surveys were completed during a five-week period. The response rate of the hospitals in the region was 24/31 (77.4%) at the completion of the survey. Table 1 is a list of a topic-specific types of training by job function. The training topics included are common by required or suggested training programs by regulatory http://pdm.medicine.wisc.edu Prehospital and Disaster Medicine Education and Training of Hospital Workers 242 Essential % Training in Role % 95.0 89.3 ED Support Staff 100.0 73.8 ED Physician 100.0 81.0 ED Nurse 100.0 83.3 Staff Nurse 79.2 66.5 ED Director Staff Physician 70.8 54.8 Allied Health (PT, OT, etc) 33.3 26.1 Nursing Assistants/Aides 54.2 46.7 Hospital Administrators 83.3 75.8 Security 79.2 69.7 Facilities/Janitorial 62.5 52.4 Housekeeping 50.0 48.8 EMTs/Paramedics 22.2 23.2 Clerical/Admissions 62.5 55.2 Reilly © 2009 Hrehospital and Disaster Medicine Table 2—Percentage of hospitals who indicated each function was “essential” to their disaster plan and the amount of functional role training that has been provided to these personnel. (ED = emergency department; EMT = emergency medical technician; OT = occupational therapist; PT = physical therapist) agencies, professional associations, or scientific bodies. These topics include incident command system/National Incident Management System (ICS/NIMS); personal protective equipment (PPE); decontamination; medical management of patients exposed to chemical, biological, radiological, nuclear, or explosive (CBRNE) materials; and functional roles during emergencies or disasters. The emergency department directors had the highest percentages of training in all of the content areas including training related to their role in the hospital response plan (89.25%). Discussion: The Hospital Incident Command System Emergency medical technicians (EMTs) and paramedics employed by hospitals had the least amount of training in functional roles (23.2%), and clerical and administrative staff had the overall lowest percentages of training in all categories (Tables 1 and 2). Staff physicians received the least amount of training in ICS/HICS (23%) and ED support staff received the least amount of training in NIMS (2%). In all other categories, emergency department directors had the highest percentages of training and clerical and administrative personnel had the lowest percentages (Table 1). The percentage of hospitals that indicated that specific staff were “essential” to their disaster plan, and the amount of training they have received to perform their functional roles are listed in Table 2. Overall, about 60.5% of hospital staff had received some training on their individual functional roles as described in the hospital Emergency Operations Plan (EOP). Prehospital and Disaster Medicine Only three categories of hospital personnel were reported to be “essential” to all hospitals’ internal emergency preparedness plans: emergency department physicians, emergency department support staff, and emergency department nurses. Allied health professionals (physical therapy, occupational therapy, etc.), emergency medical technicians and paramedics were most infrequently described as “essential” to the hospital preparedness/disaster response plan, 33.3% and 22.2% respectively (Table 2). Training for the staff described by hospitals as “essential” ranged from (73.6-83.3%). Furthermore, as these are aggregate data, it is noted that some of the hospitals reported that these “essential” staff members have received no training in their anticipated functional role described in the hospital’s emergency and disaster response plan. Hospital staff also responded regarding the inclusion of non-inpatient and hospital-affiliated providers in disaster and emergency-related training. These include physicians on staff at the hospital and their office staff, outpatient departments, and community-based healthcare providers. The highest percentage of affiliated staff who received training to provide emergency surge capacity to the hospital in a disaster or emergency were outpatient nurses (34.7%). In contrast, community-based and visiting/home care allied health professionals received the least amount of training (7.8-8.4%). Overall, only about 19.2% of non-hospital based staff had been trained to provide any surge capacity to the hospital in times of public health emergencies or disasters (Table 3). In the qualitative items, responses varied widely in the perceived needs of each hospital. Discussion: The Hospital Incident Command System Thirteen (54.2%) hospitals reported that the most frequent training program they offer to hospital staff is ICS training. Interestingly, 20/24 (83.3%) of hospitals surveyed reported that they use no formal process or procedure to identify appropriate training courses for hospital staff to assure that course content is reliable and credible. Despite the apparent deficiencies in training among “essential” staff, 11/24 (45.8%) of hospitals reported that there are no content areas for which training is needed but currendy is not available to them (Figure 2). This was confirmed by investigators through the State Health Department and the regional hospital resource centers that confirmed that training is available to each of the hospitals, in each content area, free of charge, at their location, at any time they request it. Discussion There are no clear definitions on who are considered essential hospital staff during a disaster or public health emergency. Although there have been attempts at creating common roles and responsibilities through systems like HICS, OSHA’s Hospital First Receiver Program, and Federal Emergency Management Agency’s (FEMA) Hospital Emergency Response Training program, the lack of adherence to these models shows that frequendy the hospital administration decide who it thinks is important or “essential” to their internal hospital operations during an emergency. Overall the respondents reported that the emergency department staff was the most “essential” to their hospital emergency response plans, although, out of all personnel in http://pdm.medicine.wisc.edu Vol. 24, No. 3 Reilly, Markenson 243 % Preparedness-related training programs offered to hospital staff in the past 36 months Outpatient Nurse 34.7 Outpatient Physician 27.0 ICS 13 Outpatient Allied Health 11.6 Decontamination 11 Outpatient Nursing Aide 27.0 NIMS 4 Outpatient Clerical 27.0 HAZMAT 4 Outpatient Administrators 27.0 Evacuation 3 Community Nurse 18.3 POD Training 4 Community Physician 15.5 Emergency Management 3 Community Medical Assist. 15.5 CBRNE Management 3 PPE 1 Community Allied Health 7.8 Community Clerical 15.5 Mental Health in Disasters 1 Visiting/Home Health Nurse 16.8 General disaster training 1 Visiting/Home Health Aide 16.8 Staff functional roles 1 Visiting/Home Allied Health 8.4 Process or procedure for identification of reliable, credible, and appropriate courses to train hospital staff Discussion: The Hospital Incident Command System 19.2 Reilly © 2009 Prehospital and Disaster Medicine Table 3—Percentages of affiliated hospital staff who are trained to provide surge staffing by job role Formal Process 3 Informal Process 1 the hospital, emergency department support staff had the lowest training compliance with current NIMS guidelines. Furthermore, emergency department directors had the highest percentage of training in all areas; however, the emergency department directors only represent a single individual in the hospital. Although emergency department staff have a clear role in disasters, it is important for hospital emergency planners not to undervalue staff in other functional areas. For example, not all patients entering or exiting a hospital during a disaster or emergency will be admitted through the emergency department. A small fire or a need to evacuate a single patient floor may not affect or involve eme … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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