Bangalore, karnataka. Proforma for registration of subject for dissertation
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| RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA. PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
6. BRIEF RESUME O F THE INTENDED WORK 6.0 INTRODUCTION “This, there was no comparison. It was probably the largest mass casualty incident anybody had responded to.” John Crowley A mass casualty incident often shortened to MCI and sometimes called a multiple-casualty incident or multiple-casualty situation, is any incident in which emergency medical services personnel and equipment at the scene are overwhelmed by the number and severity of casualties. For example, an incident where a two-person crew is responding to a motor vehicle collision with three severely injured people could be considered a mass casualty incident. The general public more commonly recognizes events such as building collapses, train and bus collisions, earthquakes and other large-scale emergencies as mass casualty incidents. Events such as the Oklahoma City bombing in 1995 and the Washington Metro train collision in Washington D.C. in 2009 are well publicized examples of mass casualty incidents.1 Mass casualty incidence means more than one patient and system resources are taxed at the time or any time there are more Patients than Rescuers. The causes of whole casualty incidence classified under two categories like man-made and natural. Both of this will lead to mass casualty.. the man made hazards include Fires, Explosive devices, Firearms, Structural collapse, Transportation event Air, Rail, Roadway, Water, etc.and natural hazards include Earthquake, Landslides, Avalanche, Volcano, Tornado, Hurricanes, floods, Fires, Meteors, Etc.2 Hospitals are essential life line service providers. And emergency response and mass casualty management is a distinctive stage of disaster management activities at the hospitals. Quick response is one of the key objectives and a significant yardstick of success of effective mass casualty management during pre and hospital phase of disaster management. This requires special attention due to the vital functions hospitals and emergency responders perform. Planning for quick and effective mass casualty management is aimed to include core dimensions such as field and hospital triage, triage principles and methods, pre-hospital emergency care, emergency room management, hospital mass casualty plan, dealing with special mass casualty issues, Basic Life Support, psychological triage.3
The hospital preparedness for disasters is a dynamic process and plays crucial role in easy mobilization of the staff, bed, equipments and supplies in a safe environment during any mass casualty or mass gathering incidents. These occasions could happen due to terrorism, bomb blast, festival gathering, natural disasters such as earthquakes, major 2 vehicular accidents, communal riots, etc. Therefore, strengthening the capacity of casualty medical officers, hospital managers and surgeons on basics of mass casualty management is essential for any hospital’s better disaster preparedness and effective response to the patients to avoid the situation of a secondary disaster.3 While responding to a mass casualty event, the goal of the health and medical response is to save as many lives as possible. Rather than doing everything possible to save every life, it will be necessary to allocate limited resources in a modified manner to save as many lives as possible.3 6.1 NEED FOR THE STUDY “All those things we do anyway, like mass casualty drills. We do stand prepared to handle emergencies as they come.” Scott Hill The world has seen many disasters over the years. Many were caused by people - wars, terrorists... Others are sometimes referred to as "acts of God". It's very difficult to rank them because there are different ways of defining "worst" All of these disasters took more than 25,000 lives. 43 of these disasters took over 100,000 lives. Every day at least one mass casualty incident happens in the world.4 The study has been conduced to know the incidence of large-scale urban attacks on civilian populations has significantly increased across the globe over the past decade. Which are very challenging to hospital teams.5 India’s unique geo-climatic conditions make it vulnerable to natural disasters like flood, drought, cyclone, earthquake, and epidemics/pandemics (latest being Influenza ‘A’ or H1N1) leading to sizable number of human casualties. To elucidate the mass casualty potential of natural disasters in the last one decade, the Orissa Super Cyclone (October 1999) caused more than 9,000 deaths; The Bhuj earthquake (January 2001) resulted in 14,000 deaths while the Tsunami (December 2004) accounted for the death of nearly 15,000 victims. Air India crashes in Mangalore on 22 may 2010, 160 dead in Air crash, Mangalore air crash. The dimensions of modernization and industrialization’s are manmade disasters such as road/rail/air accidents, fire, and stampede having also mass casualty potential; New dimension being Chemical, Biological, Radiological and Nuclear (CBRN) disaster occurring accidentally or caused by terrorism activities.1 Disasters which are small in shapes and sizes impact a small number of people and put intense demands on the health system for a short period, while other mega disasters may involve a large number of casualties but reach a plateau only after a latent period, placing heavy continuing demands on the health system. For some natural disasters like cyclones, floods and volcanoes-hospitals are likely to receive advance warning and be able to activate their disaster plan before the event. For other natural disasters, such as earthquakes and landslides, and many man-made disasters such as chemical plant explosions, industrial accidents, building collapses and acts of terrorism do not provide advance warning. Because of the heavy demand placed on their services at the time of a disaster, hospitals need to be prepared to handle such an unusual workload with and without prior warning. This necessitates a well documented and tested disaster management plan (DMP) to be in place in every hospital.6 As terrorists attacks increase in frequency in India, Terrorists attacks is the one of the most important cause of mass casualty incidence. Hospital disaster plans need to be scrutinized to ensure that they take into account issues unique to weapons of mass destruction.7 In additional to all above factor the trigging factors the investigator has a felt need to do this study among nurses, because when researcher was in Kerala flooding took place near to my village. As there was lack of infrastructure in hospital and lack of knowledgeable health care professionals to handled the situation can lead to a dangerous consequences like spreading of communicable disease occurred. This incidence prompts a researcher to create awareness among nurses about management of mass casualty incidence 6.2 REVIEW OF LITERATURE This chapter deals with selected studies which are related to the objectives of proposed study:
The study has been conducted in utter praesh regarding Mass casualty incident revealed that every day at least one mass casualty incident happens in the world, it is event with several injured or acutely ill persons, which is impossible to manage with available resources bit it can be managed after activation of special plan and spare resources. 11 such incidents happened in the last 40 years.8 Another study has been conducted in India, to know the incidence of large-scale urban attacks on civilian populations has significantly increased across the globe over the past decade. which are very challenging to hospital teams.9 A study has been conducted on violent outbreak of communal rioting in January 1993 in Mumbai. Four hundred and thirteen casualties were treated in the KEM hospital from January 7 to January 15, of which 194 required admission and further management. Twenty-seven were brought dead on arrival. The large influx of casualties sustained over a period of 9 days tended to overwhelm the medical facilities. The data of the admitted patients are analyzed to identify the frequency of admissions, cause and nature of injuries sustained, management and prognosis of casualties in such a catastrophe. An attempt is also made to identify the problems faced during such a crisis and a few suggestions made for their solution.10
This retrospective study was performed to evaluate the efficacy of the current readiness guidelines based on the epidemiology of encountered Hospital mass casualty incidence (HMCIs). In between November 2000 and June 2003. Hospital preparedness can be better defined by a fixed number of casualties rather than a percentile of its bed capacity. Only 20% of the arriving casualties will require immediate medical treatment. Implementation of this concept may improve the utilisation of national emergency health resources both in the preparation phase and on real time.11 This paper reports a review of the literature addressing hospital experiences with such incidents and the planning lessons thus learned. Construction of hospital disaster plans is examined as an ongoing process guided by the disaster planning committee. Hospitals are conceived as one of the components of a larger community disaster planning efforts, with specific attention devoted to defining important linkages among response organizations12
A study was conducted to assessing the knowledge of the mass casualty incident policy by clinical staff working in a central London major acute National Health Survey trust designated to receive casualties on a 24-h basis during a Mass Casualty Incidence. A 12-question proforma was distributed to 307 nursing and medical staff in the hospital, designed to assess their knowledge of the major incident policy. Completed proformas were collected over a 2-month period between December 2006 and February 2007. Nurses had significantly (p<0.01) more awareness of the policy than doctors, but the overall knowledge is poor. There is still scope for an improvement in awareness, however, particularly concerning knowledge of action cards, which are now displayed routinely throughout clinical areas and will be incorporated into induction packs13 The study was conducted in South Asia in late 2006. A survey was circulated among registered nurses (RN) working in public hospital emergency departments (ED) in the metropolitan area. The research demonstrated that South Asia emergency nurses perceived themselves to have a decreased level of disaster preparedness. Limited education opportunities and previous disaster response experience may be responsible for diminished confidence and disaster awareness among emergency nurses in South Asia. Although 95% of nurses agreed that disaster education for emergency nurses is important, 39% of participants have never had disaster training, while 63% of participants have never been involved in a disaster response in their professional life.14 A study has been conducted for systematic examination of the preparedness of individual health care providers and their response capabilities during a large-scale disaster. As a result, very little is known about what knowledge, skills and abilities, or professional competencies are needed, or how professional competency requirements may change depending on the circumstances of a disaster. To collect, explore, and describe background data on professional competencies from health care providers who were involved in the Hurricanes Katrina and/or Rita disaster responses. Half of the respondents reported knowledge deficits. Current training programs generally focus on providing skills information. Further research is required to determine if training programs should address facilitating the transition process.15The study has been conducted to identify factors that influence the importance of educational competencies regarding MCIs into the existing curricula as perceived by faculty of baccalaureate degree nursing programs in Louisiana. Findings revealed that Louisiana baccalaureate nursing educators are an older workforce with minimal training and/or life experiences regarding MCIs. Additional findings are that Louisiana baccalaureate nursing educators perceive themselves to have limited knowledge of MCI core competencies, but perceive these same competencies as highly important for inclusion into current nursing curricula. Another finding of this study is that a positive relationship exists between knowledge and importance of MCI preparation. Results from this study support the need for Louisiana baccalaureate nursing educators to receive immediate knowledge and training of MCI core competencies in order to equip them with the knowledge and skills necessary to teach this information to students prior to graduation16 STATEMENT OF THE PROBLEM “A Study To Assess The Knowledge On Management Of Mass Casualty Incidence Among Staff Nurses In Selected Hospitals At Bangalore With A View To Develop An Information Booklet.” 6.3 OBJECTIVES OF THE STUDY 1. To assess the knowledge on mass casualty incidence among staff nurses 2. To find out the association between knowledge on mass casualty incidence among staff nurses and selected socio demographic variables. 3. To develop an information booklet on mass casualty incidence among staff nurses 6.4 ASSUMPTION
6.5 OPERATIONAL DEFINITIONS 1. Assess: It is the statistical measurement of knowledge of staff nurses on management of mass casuality incidence.
7. Selected Hospitals: It refers to selected private hospitals in Bangalore. 7. MATERIALS AND METHODS 7.1 SOURCE OF DATA: Data will be collected from staff nurses working in selected hospital in Bangalore. 7.2 Method of data Collection: 7.2.1 Definition of the Study : Staff nurses working in selected hospital in Bangalore 7.2.2 Inclusion and Exclusion Criteria (a) Inclusion Criteria : 1. Staff nurses who are present at the time of collection. 2. Staff nurses who are willing to participate in study (b) Exclusion Criteria : 1. Staff nurses who are not willing to participate. 7.2.3 Research Design : Descriptive research design 7.2.4 Setting : Selected hospitals in Bangalore. 7.2.5 Sampling Technique : Purposive sampling 7.2.6 (a) Sample Size : 100 staff nurses (b) Duration of Stud : 4 Weeks. 7.2.7 Tools of Research : The structured quetionnaire sechedule will be constructed in two parts Part 1 –Demographic profile. Part 2 - Structured questionnaire on Knowledge Regarding mass casuality incidence 7.2.8 Collection of Data : The investigator herself collects the data from staff nurses of selected hospitals using structured questionnaire. 7.2.9 Method of Data Analysis and presentation : The investigator will analysis the data by using descriptive and Inferential statistical technique. 7.3 Does the study require any investigation or intervention to be conducted on the patient or other human beings or animals? NO
08. LIST OF REFERENCES
Available from URL: hppt://ndma.gov.in/ndma/guidelines/MedicalPreparedness.pdf
Available from: URL: www.asisonline.org/councils/fire/MCI
Available from: URL: www.aap.org/visit/disaster_preparedness.ppt
Available from: URL: http://www.ncbi.nlm.nih.gov/pubmed/18283872
Available from: URL: http://ndma.gov.in/ndma/guidelines/MedicalPreparedness.pdf
Available from: URL: http://www.ncbi.nlm.nih.gov/pubmed
Available from: URL: http://www.ncbi.nlm.nih.gov/pubmed/16679675
Available from: URL: http://www.jpgmonline.com/article.asp?
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