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– Look at two of my classmate’s posts. I need you to respond to each one separately. Don’t write about how good their posts or how bad. All you need to do is to choose one point of the post and explore it a little bit with one source support for each response. In the attachment, you will find all the classmates posts.- APA Style.
students_post_649_12.docx

assessing_hospital_disaster_preparedness.pdf

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– Look at two of my classmate’s posts. I need you to respond to each one
separately. Don’t write about how good their posts or how bad. All you need to
do is to choose one point of the post and explore it a little bit with one source
support for each response. In the attachment, you will find all the classmates
posts.
– APA Style.
– Reading:
Reilly, M., &Markenson, D. S. (2010). Health Care Emergency Management: Principles and Practice


Chapter 6: Introduction to Exercise Design and Evaluation
Chapter 8: Education and Training Emergency management principles and practices for
healthcare systems (2006).
Kaji, A, Langford, V, Lewis,R (2008) Assessing Hospital Disaster Preparedness: A Comparison of an
On-Site Survey, Directly Observed Drill Performance, and Video Analysis of Teamwork, Annals of
Emergency Medicine V52, No3, 195-201

Assessing Hospital Disaster Preparedness.pdf
– Discussion
Board Question?
* What are some of the biggest challenges in developing and implementing a preparedness
exercise in a hospital setting?
* What differences/similarities exist between hospital and municipal preparedness
exercises?
Student 1 post:
Challenges Facing the Healthcare System During Emergencies
The healthcare system plays an important role in times of disasters. Through
proper planning, training, command, and coordination the system should always be
responsive. However, the situation on the ground is different. Most hospitals are
caught up in times of disasters which end up making the already bad situation
worse. The main challenge lies with developing and implementing the required
preparedness action.
Among the greatest challenges in hospice organizations is a surge in capacity.
Most hospitals in the densely populated areas operate at or near full capacity.
Consequently during disasters, the hospitals are seriously limited on their
expansion capability (Kaji & Lewis, 2004 ). Some of the surveys done, for
example, have found that availability of beds, ventilators, isolation beds, and drugs
are insufficient in times of large scale disaster.
Another challenge is the lack of a good communication network. There is a need to
put more emphasis on the importance of a good flow and channel of
communication. It’s a fact that communication assists in ensuring victims are
directed to the most appropriate facilities. Besides, hospitals have a prior alert on
the number of victims to expect and the type of response is required. According to
Niska and Burt (2005), very few hospitals have a provision for their bioterrorism
response plan at 72% . Hence, it can be stated that the communication systems for
most hospitals are considerably weak.
Similarities Between the Municipal and Hospital Preparedness
The teams tasked with the tackling emergencies in cases of a disaster are the
municipal and the healthcare workers. Both teams share a lot when it comes to
disasters management. The municipal team for instance provides emergency plan
templates training and exercises development and facilitation of the same. In
addition, the municipal enhance information sharing with the different hospitals;
creating situational awareness on the primary care needs before and after a disaster.
In conclusion, the mutual partnership between healthcare providers and the local
authorities is imperative and more resources should be channeled to enhance this
cooperation. The management of hospitals around the country should come up
with realistic policies that can be implemented to make sure disasters and
emergencies are averted in the shortest possible time.
References
Kaji, A. H., Langford, V., & Lewis, R. J. (2008). Assessing hospital disaster preparedness:
A comparison of an on-site survey, directly observed drill performance, and video
analysis of teamwork. Annals of emergency medicine, 52(3), 195-201.doi:
10.1016/j.annemergmed.2007.10.026.
Niska, R. W., & Burt, C. W. (2005). Bioterrorism and mass casualty preparedness
in hospitals: United States, 2003. Emmitsburg, MD: National Emergency Training
Center.
Rand Corporation. (2004). RAND study shows compensation for 9/11 terror
attacks tops $38 billion. Businesses Receive Biggest Share. Retrieved from
http://www.rand.org/news/press.04/11.08b.html
Student 2 post:
Hospital preparedness especially when it comes to disasters is a common requirement
that should be taken seriously. Majority of hospitals in the urban and rural sectors do not use
disaster preparation techniques in managing disasters (Beitsch et al,2006). This usually
results to most of them failing when a disaster takes place. It is essential that hospitals should
always be prepared in handling these situations since they handle the lives of people. There
are many challenges that make it difficult for hospitals to either develop or implement their
preparedness plans; this paper will discuss some of them.
Budgets are some of the leading problems that affect planning an implementation of
preparedness plans. The hospital sector will always require enough financial allocations for
buying emergency types of equipment that will help in rescuing people from arising dangers.
In some cases, the hospitals may be forced to spend too much on patients’ recovery. This,
therefore, means that there should always be money that is available to take care of this.
Some finances can be used for other preparations and the training of staff.
Some hospitals face problems with the administration; The administrators do not
consider emergencies when they are planning for or allocating the available resources. This,
therefore, leads to the misuse of resources that would have instead been used for preparing
for disasters. Training of staff is a requirement that should be accomplished in every hospital
so that they are able to deal with emergencies (Leinhos et al, 2014). Emergencies in the
health-care sector cannot be handled by just anyone, special knowledge is required so as not
to cause more harm. There is also a lack of enough guidelines to provide direction to the
staff; this can help in avoiding switching of roles.
Communication is another important factor that is not taken seriously in health care
preparedness. Through good communication, the nurses and other staff are informed of their
roles beforehand so they know what to do, this avoids any sort of confusion. Communication
is important in ensuring there is coordination. Coordination is also another problem that
affects the development and implementation of preparedness plans in the hospital setting.
Coordination between different sectors such as wards and the administration help in ensuring
a hospital is fully prepared.
The above-explained factors help in showing that indeed there is a difference between
the municipal preparedness and the hospital preparedness for an emergency. The hospital, for
instance, requires qualified staff that are fully trained on how to handle emergency situations
(CAUDLE, 2009). The hospital setting is more important hence requires more attention. The
importance is derived from its ability to also treat the affected people from any emergency
situation. It is also important to remember that both sectors are similar in a way; they both
deal with emergency and require revenue. This, therefore, means that financial allocation
affects all of them.
In summary, emergency services are always important since they ensure any disaster
or sudden occurrence is controlled properly. It is clear that capital is important in planning for
control of such situations. Training of the staff is also another factor that helps in the
efficiency of the operation. The management in hospitals and the municipal sectors are also
expected to be qualified so that they can do their work as required and for proper use of
resources. They should also ensure that they work with all sectors to enable the process of
emergency control. Through communication, every staff will be made aware of the situation
whenever it comes about. The hospitals should also contain the emergency department
section with the teams who work together in controlling disasters. This can help in
specialization in this sector so that it is remembered when funds are being allocated.
References
Beitsch, L., Kodolikar, S., Stephens, T., Shodell, D., Clawson, A., Menachemi, N., & Brooks,
R. (2006). A State-Based Analysis of Public Health Preparedness Programs in
the United States. Public Health Reports (1974-), 121(6), 737-745.
CAUDLE, S. (2009). AN OPTION FOR HOMELAND SECURITY PREPAREDNESS
REQUIREMENTS: Consensus Management System Standards. Public
Performance & Management Review,33(1), 141-155.
Leinhos, M., Qari, S., & Williams-Johnson, M. (2014). Preparedness and Emergency
Response Research Centers: Using a Public Health Systems Approach to
Improve All-Hazards Preparedness and Response. Public Health Reports
(1974-), 129, 8-18.
DISASTER MEDICINE/ORIGINAL RESEARCH
Assessing Hospital Disaster Preparedness: A Comparison of an
On-Site Survey, Directly Observed Drill Performance, and Video
Analysis of Teamwork
Amy H. Kaji, MD, MPH
Vinette Langford, RN, MSN
Roger J. Lewis, MD, PhD
From the Department of Emergency Medicine, Harbor–UCLA Medical Center, Los Angeles, CA (Kaji,
Lewis); David Geffen School of Medicine at UCLA, Torrance, CA (Kaji, Lewis); Los Angeles Biomedical
Research Institute, Torrance, CA (Kaji, Lewis); The South Bay Disaster Resource Center at
Harbor–UCLA Medical Center, Los Angeles, CA (Kaji); and MedTeams and Healthcare Programs Training
Development and Implementation, Dynamics Research Corporation, Andover, MA (Langford).
Study objective: There is currently no validated method for assessing hospital disaster preparedness.
We determine the degree of correlation between the results of 3 methods for assessing hospital disaster
preparedness: administration of an on-site survey, drill observation using a structured evaluation tool, and
video analysis of team performance in the hospital incident command center.
Methods: This was a prospective, observational study conducted during a regional disaster drill,
comparing the results from an on-site survey, a structured disaster drill evaluation tool, and a video
analysis of teamwork, performed at 6 911-receiving hospitals in Los Angeles County, CA. The on-site
survey was conducted separately from the drill and assessed hospital disaster plan structure, vendor
agreements, modes of communication, medical and surgical supplies, involvement of law enforcement,
mutual aid agreements with other facilities, drills and training, surge capacity, decontamination capability,
and pharmaceutical stockpiles. The drill evaluation tool, developed by Johns Hopkins University under
contract from the Agency for Healthcare Research and Quality, was used to assess various aspects of
drill performance, such as the availability of the hospital disaster plan, the geographic configuration of the
incident command center, whether drill participants were identifiable, whether the noise level interfered
with effective communication, and how often key information (eg, number of available staffed floor,
intensive care, and isolation beds; number of arriving victims; expected triage level of victims; number of
potential discharges) was received by the incident command center. Teamwork behaviors in the incident
command center were quantitatively assessed, using the MedTeams analysis of the video recordings
obtained during the disaster drill. Spearman rank correlations of the results between pair-wise groupings
of the 3 assessment methods were calculated.
Results: The 3 evaluation methods demonstrated qualitatively different results with respect to each
hospital’s level of disaster preparedness. The Spearman rank correlation coefficient between the
results of the on-site survey and the video analysis of teamwork was – 0.34; between the results of
the on-site survey and the structured drill evaluation tool, 0.15; and between the results of the video
analysis and the drill evaluation tool, 0.82.
Conclusion: The disparate results obtained from the 3 methods suggest that each measures distinct
aspects of disaster preparedness, and perhaps no single method adequately characterizes overall
hospital preparedness. [Ann Emerg Med. 2008;52:195-201.]
0196-0644/$-see front matter
Copyright © 2008 by the American College of Emergency Physicians.
doi:10.1016/j.annemergmed.2007.10.026
INTRODUCTION
A disaster may be defined as a natural or manmade event
that results in an imbalance between the supply and demand
for resources.1 Events of September 11, 2001, and the
devastation from Hurricanes Katrina and Rita have recently
Volume , .  : September 
highlighted the importance of hospital disaster preparedness
and response. Previous disasters have demonstrated
weaknesses in hospital disaster management, including
confusion over roles and responsibilities, poor
communication, lack of planning, suboptimal training, and a
Annals of Emergency Medicine 195
Assessing Hospital Disaster Preparedness
Editor’s Capsule Summary
What is already known on this topic
Extremely little is known on how to objectively and
accurately rate hospital disaster preparedness. Scales and
measurements have been developed but not extensively
validated; most evaluations are highly subjective and
subject to bias.
What question this study addressed
At 6 sites, 3 evaluation methods, an onsite predrill
survey, a real-time drill performance rating tool, and a
video teamwork analysis, were used and correlations
among evaluation methods examined.
What this study adds to our knowledge
The 3 methods produced disparate evaluations of
preparedness, suggesting that the instruments are flawed,
they are measuring different things, or both.
How this might change clinical practice
Better assessment tools for hospital disaster preparedness
need to be developed, perhaps beginning with the careful
definition of what aspects of preparedness are to be
measured.
lack of hospital integration into community disaster
planning.2
Despite The Joint Commission’s emphasis on emergency
preparedness for all hospitals, including requirements for having
a written disaster plan and participating in disaster drills, there is
currently no validated, standardized method for assessing
hospital disaster preparedness. This lack of validated assessment
methods may reflect the complex and multifaceted nature of
hospital preparedness.
To be prepared to care for an influx of victims, a hospital
must have adequate supplies, equipment, and space, as well as
the appropriate medical and nonmedical staff. Survey
instruments, either self-administered or conducted on site, may
be used to assess these resources. Although surveys and
questionnaires attempt to capture a hospital’s level of
preparedness through quantifying hospital beds, ventilators,
isolation capacity, morgue space, available modes of
communication, frequency of drills, and other aspects of disaster
preparedness,3-8 it is unclear whether they are reliable or valid
predictors of hospital performance during an actual disaster, or
even during a drill. In contrast to surveys, which assess hospital
resources and characteristics during a period of usual activity,
disaster drills make use of moulaged victims to gauge hospital
preparedness and assess staff interactions in a dynamic
environment in real time.
Although hospitals routinely conduct after-drill debriefing
sessions, during which participants discuss deficiencies
warranting improvement, there is no commonly used and
196 Annals of Emergency Medicine
Kaji, Langford & Lewis
validated method for evaluating hospital performance during
disaster drills. To address this gap, the Johns Hopkins
University Evidence-based Practice Center, with support from
the Agency for Healthcare Research and Quality (AHRQ),
developed a hospital disaster drill evaluation tool.9 The tool
includes separate modules for the incident command center,
triage area, decontamination zone, and treatment areas. In a
recent study, conducted in parallel with the study reported here,
we described the AHRQ evaluation tool’s internal and interrater
reliability.10 We found a high degree of internal reliability in the
instrument’s items but substantial variability in interrater
reliability.10
Recently, evidence has suggested that enhancing teamwork
among medical providers optimizes the provision of health care,
especially in a stressful setting, and some experts working in this
area have adopted the aviation model as a basis for designing
teamwork programs to reduce medical errors.11 In 1998,
researchers from MedTeams, a research corporation that focuses
on observing and rating team behaviors, set out to evaluate the
effectiveness of using aviation-based crew resource management
programs to teach teamwork behaviors in emergency
departments (EDs), conducting a prospective, multicenter,
controlled study.12 The MedTeams study, published in 2002,
demonstrated a statistically significant improvement in the
quality of team behaviors, as well as a reduction in the clinical
error rate, after completion of the Emergency Team
Coordination Course.12
Because effective teamwork and communication are essential
to achieving an organized disaster response, assessing teamwork
behavior may be a key element in a comprehensive evaluation of
hospital disaster response. Evaluating teamwork behaviors
involves the assessment of the overall interpersonal climate, the
ability of team members to plan and problem-solve, the degree
of reciprocity among team members in giving and receiving
information and assistance, the team’s ability to manage
changing levels of workload, and the ability of the team to
monitor and review its performance and improve its teamwork
processes.12 In addition to observing team members in real
time, MedTeams researchers routinely review videotaped
interactions among team members as a method of quantifying
teamwork behaviors.
The objective of our study was to determine the degree of
correlation between 3 measures of assessing hospital disaster
preparedness: an on-site survey, directly observed drill
performance, and video analysis of teamwork behaviors.
MATERIALS AND METHODS
Six 911-receiving hospitals, participating in the annual,
statewide disaster drill in November 2005, agreed to complete
the site survey and undergo the drill evaluation and video
analysis. The selection of the sample of hospitals and their
characteristics has been described previously.10 The drill
scenario included an explosion at a public venue, with multiple
victims. To preserve the anonymity of the hospitals, they are
designated numerically 1 through 6. Because all data were
Volume , .  : September 
Kaji, Langford & Lewis
deidentified and reported in aggregate, our study was verified as
exempt by the institutional review board of the Los Angeles
Biomedical Research Institute at Harbor–UCLA Medical
Center.
We used an on-site survey (included in Appendix E1,
available online at http://www.annemergmed.com), which
included 79 items focusing on areas previously identified as
standards or evidence of preparedness.1-3,13-28 The survey was a
modification of an instrument we used in a previous study.8
Compared with the original survey instrument, the number of
items was reduced from 117 to 79 by the study investigators to
eliminate items that had limited discriminatory capacity and to
reduce redundancy and workload. Survey items included a
description of the structure of the hospital disaster plan, modes
of intra- and interhospital communication, decontamination
capability and training, characteristics of drills, pharmaceutical
stockpiles, and each facility’s surge capacity (assessed by
monthly ED diversion status, number of available beds,
ventilators, negative pressure isolation rooms, etc). Because a
survey performed in 1994 demonstrated that hospitals were
better prepared when the medical d …
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