The Evolution of MCI Disaster Drills in a Pediatric Hospital
Brent Kaziny, MD1; Christi Reeves, MSN, RN1; James MItchell1; Katherine Gautreaux, BSN, RN1; Bindi Naik-Mathuria, MD, MPH 1; Jenna Blair, RN1; Aaron Freedkin1
1Texas Children's Hospital, Houston, TX; 2Baylor College of Medicine, Texas Children's Hospital, Houston, TX
Background: Mass Casualty Incidents (MCI) have increased in frequency and mortality while the worldwide problem of emergency department (ED) overcrowding is multiplying.1 It has become increasingly crucial that hospitals exercise their surge plans to prepare for MCIs.1
Methods: We began MCI drills to meet minimum requirements set forth by The Joint Commission. Starting in 2013, we used yardsticks with triage tags to simulate 12 patient arrivals to the ED. Through annual exercise we continued to improve our drills. In 2016, a large-scale drill was implemented to focus on community collaboration and pre-hospital processes. The drill ended in the ED with 50 moulaged students presenting for care. In 2017, we focused on involving hospital partners outside of the ED to refine coordination of care. We employed actors to simulate 25 patients. This drill was carried beyond the ED to the operating room (OR), incorporated ancillary departments, and tested notification of trauma surgeons that allowed a text response of availability. FINDINGS: Although accuracy of using JumpSTART triage can be variable, and previous studies reported an accuracy of 85.7%.2Our most recent drill utilizing moulaged patients showed a triage accuracy rate of 96%. It is challenging to incorporate multiple departments to test preparedness in largescale MCI drill with moulaged pediatric actors without impacting care of actual patients in crowded EDs.
Conclusions: Enriching MCI drills and integrating disaster simulation enhances the confidence and competence of health care providers in disaster situations. Next steps include involving more area and establishing a tiered hospital wide team activation.
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