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ORIGINAL RESEARCH Factors That May Influence the Preparation of Standards of Procedures for Dealing with Mass-Casualty Incidents Bruria Adini, MA;1,2...

Week 5 Reading assignment and content analysis

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Content analysis exercise – Read Adini, B., Goldberg, A., Loar, D., Cohen, R., and Yoen Bar-Dayan, Y. (2006). Factors That May Influence the Preparation of Standards of Procedures for Dealing with Mass-Casualty Incidents. Prehospital and Disaster Medicine. May–June 2007 located in the Web Resources are of the e-classroom under Week 5.

Conduct a two-page content analysis on this report to determine its major priority and message. In your response, explain how you determined the priority and message and upload to your Student Folder. The goal of this assignment is to articulate what this report is trying to convey.
May June 2007 Prehospital and Disaster Medicine ORIGINAL RESEARCH 1. Emergency and Disaster Management Division, Ministry of Health, Israel 2. Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel 3. Center for Medical Education, Hebrew University, Jerusalem, Israel 4. Israel Defense Forces Home Front Command Correspondence: Col. Dr. Y. Bar-Dayan MD MHA 16 Dolev St. Neve Savion, Or-Yehuda Israel E-mail: [email protected] Keywords: evaluation; hospitals; management; mass-casualty incident; preparedness; standards of procedure Abbreviations: MCI = mass-casualty incident SOP = standards of procedure Received: 15 June 2006 Accepted: 19 September 2006 Web publication: 19 June 2007 Factors That May Influence the Preparation of Standards of Procedures for Dealing with Mass-Casualty Incidents Bruria Adini, MA; 1,2 Avishay Goldberg, MA, MPH, PhD; 2 Danny Laor, MD, MHA; 1 Robert Cohen, PhD; 3 Col. Yaron Bar-Dayan MD, MHA 2,4 Introduction General hospitals in Israel are required to develop and maintain standards of procedures (SOPs) to facilitate the management of a mass-casualty incident (MCI). 1 These SOPs provide guidelines for the hospital to plan its response to MCIs, prepare the infrastructure required, and train medical teams to deal with MCIs. 2 The guidelines and checklists that comprise the SOP are neces- sary components of the process required for maintaining a high level of pre- paredness; however, they are only the beginning of this process. 3,4 For an SOP to be effective in guiding hospital personnel in the manage- ment of MCIs, a number of basic steps must be adopted by the hospital: (1) the SOP must be distributed widely among the departments that are likely to be involved in the management of a MCI; (2) drills must be conducted to pro- Abstract Introduction: General hospitals in Israel are required to develop standards of procedures (SOPs) to facilitate the management of mass-casualty incidents (MCIs). These SOPs represent the initial step in a continuous process, pro- viding guidelines for hospitals to manage MCIs in an organized and efficient manner. Evaluation of the preparedness levels of hospitals in dealing with MCIs is required in order to promote an effective response, and to identify factors that might impact the quality of SOPs. The aim of this study was to identify the characteristics of hospitals that have an impact on the preparation of SOPs. Methods: An evaluation tool was developed to assess the SOPs from 22 hos- pitals during the management of a MCI. The results of the evaluations were analyzed, in relation to the size, trauma capabilities, ownership, geographic location, urban versus rural status of the hospitals, the proximity to other hos- pitals, participation in drills during the year prior to the evaluation, and num- ber of actual MCIs the hospital managed in the past three years. Results: The evaluation scores of the SOPs of 11 of the 22 hospitals (50%) were very high, so their SOPs did not require modifications.The SOPs of four hospitals (18%) were rated highly, requiring only minor modifications. The SOPs of four hospitals (18%) received poor ratings, requiring major modifi- cations, and three hospitals (14%) were found to have incomplete SOPs and received very poor ratings. No significant differences were found between the ratings of SOPs in relation to the different characteristics of the hospitals analyzed. A low correlation between the level of SOPs and the number of MCIs that the hospital managed was found ( r = 0.266, NS). Conclusions: The tool developed to evaluate the quality of the SOPs of hos- pitals to manage MCIs was logistically feasible and capable of differentiating between hospital SOPs. The comprehensiveness and completeness of the SOPs appears to be unrelated to the characteristics of the hospitals included in this study. Of particular note was the lack of a significant correlation between the SOP rating and the number of actual MCIs managed by a hospital. Adini B, Goldberg A, Laor D, Cohen R, Bar-Dayan Y: Factors that may influence the preparation of standards of procedures for dealing with mass- casualty incidents. Prehosp Disast Med 2007;22(3):175–180.
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Prehospital and Disaster Medicine Vol. 22, No. 3 176 Factors that May Influence Preparation of Standards vide the opportunity to practice teamwork, analyze short- comings, and identify areas that require improvement; 5,6 and (3) hospital personnel, on a regular basis, should evaluate the applicability of the SOP, preferably from the lessons learned from conducting MCI drills. 7 Mass-casualty incident drills, such as actual simulations and tabletop exercises, are impor- tant in the process of maintaining readiness to manage MCIs, as they provide some indication of the ability of the hospital to manage MCIs. A number of studies have shown that drills can positively impact the performance of hospitals in dealing with MCIs. 8 The fact that a hospital has prepared a SOP does not automatically result in the effective management of MCIs. 9 Evaluation of preparedness levels for a MCI are required in order to promote an effective response. 10 The impact of various characteristics of hospitals on the completeness and comprehensiveness of SOPs for managing MCIs, such as the size of the hospital, trauma capabilities, geographic location,urban versus rural facilities,proximity to other hospitals,participation in drills,and experience in cop- ing with MCIs, has not been well-documented.The aim of this study was to investigate the impact of selected hospital characteristics on the completeness and comprehensiveness of hospital SOPs for the management of MCIs. Organization of the Israeli Healthcare System for the Management of MCIs The National Health Insurance Act in Israel mandates that the healthcare system must provide comprehensive medical ser- vices to all citizens. 11 Twenty-four general hospitals operate emergency rooms capable of managing MCIs.The Ministry of Health provides directives to all general hospitals requiring them to prepare SOPs based on a national doctrine for the management of MCIs. These plans define the operational response model deemed appropriate for each type of MCI. Methods Evaluation of SOPs for MCIs In order to assess the quality of hospital SOPs, parameters deemed as being required for the effective management of a MCI were identified.The parameters were identified by means of a comprehensive literature review and the recommendations of health professionals who were identified as experts in the management of MCIs, from the Ministry of Health, Home Front Command, and general hospitals. There were a total of 95 parameters identified that were classified into 11 categories according to their operational function (Table 1). In order to evaluate the SOPs for MCIs, an evaluation tool was developed based on the 95 parameters that were identified as having an impact on emergency preparedness. The parameters were classified into categories by a team of emergency preparedness experts according to their impor- tance for managing MCIs in an efficient and competent manner. The relative importance of each category was defined. The parameters in each category were classified into one of three levels of importance: Level A consisted of the parameters that were rated as being very important (and contributed 60% of the total grade); Level B consist- ed of parameters that were rated as having a moderate impact (30% of total grade); and Level C consisted of para- meters having the lowest impact (10% of total grade). The relative importance of the categories and the extent of parameters in each category, are presented in Table 1. The scaling and classifications were made utilizing a modified Delphi process with the content experts. 12 Utilizing an Evaluation Tool to Measure Quality of SOP for MCIs The evaluation tool was tested in a pilot study conducted in two hospitals, and subsequently, modifications were made to the evaluation tool as required. The final evalua- tion tool was distributed to all the general hospitals in Israel to enable them to familiarize themselves with the elements to be included in the SOP evaluation process. Three months after the distribution of the evaluation tool, the SOPs of 22 general hospitals were evaluated by the Ministry of Health and the Home Front Command. The two hospitals that participated in the pilot study were not included in the study. In each of the 22 hospitals, the evaluation was conducted by two evaluators who were required to make their ratings of the SOP independently. When the rating process was com- plete,the two evaluators compared their ratings—differences were identified and discussed until they mutually agreed upon a rating. A single rating representing the consensus between the two evaluators for each of the 95 parameters were entered into a computer program written specifically for calculating the level of preparedness of the hospital. Based on the final score, the SOPs were classified into four groups: (1) Very High (91–100%) indicating that the SOP required no modifications; (2) High (81–90%), SOP required only minor modifications; (3) Poor (65–80%), SOP required major modifications; and (4) Very Poor (<65%), SOP inade- quate and a new SOP must be prepared. Relationship between the Quality of SOPs and Selected Hospital Characteristics The quality of SOPs for dealing with MCIs was evaluated uti- lizing a pre-formulated evaluation tool.The derived evaluation scores were analyzed to determine if there was a relationship between the quality (comprehensiveness and completeness) of the SOP and the following hospitals characteristics: 1. Size of hospitals —Six small hospitals with <400 beds, nine medium size hospitals with 400–700 beds, and seven large hospitals with >700 beds. 2. Trauma capabilities —Six Level-1 trauma centers, 12 hospitals with Level-2 trauma rooms, and four hos- pitals with limited trauma capabilities. 3. Ownership of hospitals —Eight government-owned hospitals (operated by the Ministry of Health), two municipal hospitals (operated by the municipalities of Tel Aviv and Haifa), five semi-private hospitals (operated by non-profit foundations), and seven hospitals owned by the Health Maintenance Organization (HMO). 4. Geographic location —Seven northern region hospi- tals, eight central region hospitals, four Jerusalem area hospitals, and three southern region hospitals. 5. Urban versus peripheral hospitals —16 hospitals were located in urban areas, and six in the peripheral areas.
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