NATO ADVANCED TRAINING COURSE Integrated Emergency Management for Mass Casualty Emergencies Florence, Italy 26th – 29th October 2011Medical 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
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 fromDisaster 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 internationalexperience”. 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 theearthquake and compled the process by the end of the first day”. N Engl J Med 2003; 348: 1349 - 55
Hospital vulnerability“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 15years ago, had to be evacuatedbecause part of it collapsed”Zarocostas J. “ Disaster agencies treat wounded after Italian earthquake damageshospitals” BMJ 2009; 338:b1524.
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“*...+ 15 firefigthers, 12 nurses, 12 physisicians and 2 respiratorytherapists (a total of 41 persons) involved in the drill”. Disaster management and response 2004; 2:14 -9.
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 numerousand readly available in an University hospital... So where we can find skilled people in few minutes from the disaster?
Medical students and disaster medicineSeveral institutions already organised disaster medicinecourse for medical students...
Medical students and disaster medicineAnd many course already use peer – education teachingtecniques, because of his effectivness...
Medical students and disaster medicine Disaster MedicineMedical students Peer – assisted learning
Medical students and disaster medicineIn – hospital disasterresponse and rescue
“In-hospital disaster response and rescue”The “In-hospital disaster response and rescue” trainingprogramme has been set in the medical school curriculum of theUniversity of Florence as an elective course and consists of 4sessions of 4 hours each, for a total of 16 hours.The course has been given for 3 years, from the academic year2008-2009 to the academic year 2010-2011, during which 125medical school students from the 3rd to the 6th year have takenpart in the course.
Organizing groupA 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 basedStudents had the possibility to become teachersthemselves after a 2 steps training programme.STUDENT CO-TRAINER TRAINEREach student was granted an amount ofUniversity Training Credits at the end of theprogramme.
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 ModuleThis 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 ModuleThe technical module consists of three mainsections:- an engineering section concerning self-protectionand 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 researchIn 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)
ResultsBoth variables show definitely higher scoresdifferences in the tests filled-in by the studentsincluded in the experimental group incomparison 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 Mobile Emergency on Emergency and Rescue
ARIES - Associazione Ricerca Interdisciplinare Emergenza e Soccorso Association for the Research on Emergency and Rescue http://associazionearies.jimdo.com
MobileEmergencyMobileEmergency Team:Prof. Paolo NesiProf. Alessandro FantechiProf. Sergio BoncinelliIng. Luca MalandrinoDott. Marco ManginiDott. Francesco GrossiIng. Pierfrancesco BelliniDott. Antonio Cappuccio Available for free on Itunes http://itunes.apple.com/us/app/mobile-emergency
Mobile EmergencyThe main idea behind of Mobile Emergency is toprovide a support for managing communicationsamong medical personnel during a disaster thatmay 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 EmergencyWe 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
Test with the application: rescue and evacation
MobileEmergencyMobileEmergency Team:Prof. Paolo NesiProf. Alessandro FantechiProf. Sergio BoncinelliIng. Luca MalandrinoDr. Marco ManginiDr. Francesco GrossiIng. Pierfrancesco BelliniDr. Antonio Cappuccio Available for free on Itunes http://itunes.apple.com/us/app/mobile-emergency
Thank you!!! Marco Manginieat83@hotmail.com Francesco Grossifrancesco@grossi.us