Disaster response and preparedness : focus on hospital incident command groups and emergency department registered nurses

Sammanfattning: Background: While disasters per definition are rare, incidents that cause mass casualties that threaten to overwhelm its limited resources are an ever-present risk. Disaster medicine is a specific discipline of medicine dedicated to providing adequate health care to patients of major incidents through the development of preventive-, preparedness-, response and recovery interventions. Emergency department registered nurses are among the first to receive, assess and treat patients of a major incident, highlighting the importance of their preparedness and disaster medicine competencies. However, when an incident threatens to overwhelm health care’s resources, a specific type of management group may be required to aid and guide hospital response. The hospital incident command group aids in hospital response through timely decision-making and allocation of resources. Despite these two groups being recognized as vital components of disaster response, little has been known concerning the disaster preparedness of these two groups. emergency department registered nurses’ disaster preparedness. The overall aim of the thesis was to assess disaster medicine preparedness in Stockholm, Sweden through the evaluation of hospital incident command groups and emergency department registered nurses. The aim of study I was to identify the essential disaster nursing competencies. Sixty-nine specific disaster medicine competencies were identified through a modified Delphi method in which experts within the field of emergency- or disaster medicine reached consensus concerning necessary disaster medicine competencies for emergency department registered nurses. The aim of study II was to assess emergency department registered nurses’ self-perceived disaster preparedness using the results in study one as the basis of a questionnaire. A cross- sectional method was used to assess the preparedness of nurses in the study setting. The results of this study indicate that emergency department registered nurses may be less than competent and overestimate their preparedness. The aim of study III was to assess hospital incident command groups’ preparedness. This was done through an observational study in which measurable indicators were used to evaluate hospital incident command groups during simulations. The results in this study indicate that proactive decision-making correlates with overall command group response. Shortly after the simulations in study III, an antagonistic incident occurred in Stockholm, Sweden. This provided a unique opportunity to compare planned preparedness with actual preparedness. through exploration of disaster preparedness coordinators' experiences of hospital response during a major incident. Thus, the aim of study IV was to explore registered nurses’ experiences as disaster preparedness coordinators (DPC) of hospital incident command groups during an MI. This was done through one focus group discussion with six disaster preparedness coordinators and six follow-up interviews with the same coordinators were conducted. Data were analyzed using inductive content analysis. One main category, Expectations, prior experiences, and uncertainty affect HICG response during a major incident and three categories. Gaining situational awareness, transitioning to management, and actions taken during uncertainty were identified. The thesis concludes that disaster medicine preparedness in the study setting may be adequate but that response may be dependent upon several factors including the type and timing of the incident, frequency and type of training, education, experience, and the ability to reduce uncertainty in order to make timely and relevant decisions.

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