:“A STUDY TO ASSESS THE KNOWLEDGE ON MANAGEMENT OF MASS CASUALTY INCIDENCE AMONG STAFF NURSES IN SELECTED HOSPITALS AT BENGALURU WITH A VIEW DEVELOP AN INFORMATION BOOKLET.”
6. BRIEF RESUME O F THE INTENDED WORK
“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 deaths due to manmade disasters during the period 2009–10 were nearly 12 times higher than those caused by natural calamities. Consequently, disasters result in large number of deaths, both human and animal, in a short span of time that place overwhelming stress on individuals, society and the administration with an uncommon challenge of handling large numbers of survivors seeking medical attention due to the effects of the hazard(s).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.”
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:
Incidence of mass casualty incidence.
Review related to competencies of health agencies and effective management of mass casualty incidence.
Nurses knowledge on management of mass casualty incidence.
Incidence mass casualty incidence
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
Review related to competencies of health agencies and effective management of mass casualty incidence.
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
Nurses knowledge on management of mass casualty incidence
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.15
The 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
It is assumed that nurses may have some knowledge regarding Mass Casualty Incidence.
6.5 OPERATIONAL DEFINITIONS
1. Assess: It is the statistical measurement of knowledge of staff nurses on management of mass casuality incidence.
Knowledge: Refers to the level of understanding of staff nurses regarding mass casualty incidence as assessed by their responses to the items of knowledge questionnaire.
Management : Art and science of getting work done through ourself or by others.
Mass casualty incident:refers to any incident in which emergency medical services personnel and equipment at the scene are overwhelmed by the number and severity of casualties.
Nurses: Refers to individuals both male and female those who have registered nurses and mid wife certificate
Information Booklet: It is organized information regarding the meaning, causes precautions and safety measures regarding Mass casualty incident.
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
7.2.7 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?
Has ethical clearance has been obtained from your institution?
Yes, ethical clearance has been obtained from the concerned authority of the institution and principal .
Informed written consent will be obtained from the participants prior to the study.
Privacy, confidentiality and anonymity will be guarded.
Scientific objectivity of the study will be maintained with honesty and impartiality
08. LIST OF REFERENCES
National disaster management authority. Government of India.
Available from URL: hppt://ndma.gov.in/ndma/guidelines/MedicalPreparedness.pdf
Joseph Donoghue.CPP EMT-B Fidelity Investments Corporate Security.
Available from: URL: www.asisonline.org/councils/fire/MCI
Joanne Selkurt MD.FAAP Getting docs into the disaster preparedness loop.
Available from: URL: www.aap.org/visit/disaster_preparedness.ppt
Klinicni center Ljubljana.Resevalna postaja.Organization of emergency medical care in mass disasters.Lijec Vjesn. 2007.129 Suppl 5:24-7.
Available from: URL: http://www.ncbi.nlm.nih.gov/pubmed/18283872
C. R. Darnall Army Medical Center.Medical preparedness aspects of disasters
Available from: URL: http://ndma.gov.in/ndma/guidelines/MedicalPreparedness.pdf
Andersson A. Hansebo G. Elderly peoples' experience of nursing care after a stroke: from a gender perspective. J Adv Nurs. 2009 Jul 22.
Available from: URL: http://www.ncbi.nlm.nih.gov/pubmed
Perry RW.Lindell MK.Hospital planning for weapons of mass destruction incidents.J Postgrad Med. 2006 Apr-Jun;52(2):116-20;
Available from: URL: http://www.ncbi.nlm.nih.gov/pubmed/16679675
Fink A.; Organization of emergency medical care in mass disasters; Lijec Vjesn.2007;129 Suppl 5:24-7; Available from: URL: http://www.ncbi.nlm.nih.gov/pubmed/18283872
Kosashvili Y,Aharonson-Daniel L; Israeli hospital preparedness for terrorism-related multiple casualty incidents: can the surge capacity and injury severity distribution be better predicted; Injury.2009 Jul;40(7):727-31. Epub 2009 Apr 23; Available from: URL: http://www.ncbi.nlm.nih.gov/pubmed/19394934
SS Dalvie, PR Pai, SG Shenoy, RD Bapat; Analytical data of January 1993 communal riot victims--the KEM Hospital experience; journal of postgraduate medicine; ear 2010 | October-December, Volume 56, Issue 4;
Available from: URL: http://www.jpgmonline.com/article.asp?
C S Milkhu, D C J Howell; Mass casualty incidents: are NHS staff prepared? An audit of one NHS foundation trust; Emerg Med J2008; Volume 25, Issue 9; 25:562-564; Available from: URL: http://www.ncbi.nlm.nih.gov/pubmed/19394934
Perry RW, Lindell MK; Hospital planning for weapons of mass destruction incidents; J Postgrad Med. 2006 Apr-Jun;52(2):116-20; Available from: URL: http://www.ncbi.nlm.nih.gov/pubmed/16679675
C S Milkhu, D C J Howell; Mass casualty incidents: are NHS staff prepared? An audit of one NHS foundation trust; Emerg Med J2008; Volume 25, Issue 9; 25:562-564; Available from: URL: http://emj.bmj.com/content/25/9/562.abstract.
Karen Duong; Disaster education and training of emergency nurses in South Australia; australasian emergency nursing journal; August 2009; Volume 12, Issue 3, Pages 86-92; Available from: URL: http://www.aenj.org.au/article/S1574-6267(09)00078-0/abstract
Slepski LA; Emergency preparedness and professional competency among health care providers during hurricanes Katrina and Rita: pilot study results; Disaster Manag Response.2007 Oct-Dec;5(4):99-110; Available from: URL: http://www.ncbi.nlm.nih.gov/pubmed/17996654
Whitty, Kristin; Factors Influencing the Importance of Incorporating Competencies Regarding Mass Casualty Incidents into Baccalaureate-Degree Nursing Programs as Perceived by Currently Employed Faculty; Electronic thesis and dissertation collection; Title page for ETD etd-10272006-114027; Available from: URL: http://etd.lsu.edu/docs/available/etd-10272006-114027/