Annals of emergency medicine
-
Multicenter Study
Assessment of the reliability of the Johns Hopkins/Agency for Healthcare Research and Quality hospital disaster drill evaluation tool.
The Joint Commission requires hospitals to implement 2 disaster drills per year to test the response phase of their emergency management plans. Despite this requirement, there is no direct evidence that such drills improve disaster response. Furthermore, there is no generally accepted, validated tool to evaluate hospital performance during disaster drills. We characterize the internal and interrater reliability of a hospital disaster drill performance evaluation tool developed by the Johns Hopkins University Evidence-based Practice Center, under contract from the Agency for Healthcare Research and Quality (AHRQ). ⋯ We found a high degree of internal reliability in the AHRQ instrument's items, suggesting the underlying construct of hospital preparedness is valid. Conversely, we found substantial variability in interrater reliability, suggesting that the instrument needs revision or substantial user training, as well as verification of interrater reliability in a particular setting before use.
-
Evidence-based medical literature is lacking about the best methods to train health care providers in disaster response. We systematically review the recent literature to report whether training interventions in disaster preparedness improve knowledge and skills in disaster response. ⋯ The available evidence is insufficient to determine whether training interventions for health care providers are effective in improving knowledge and skills in disaster response.
-
Emergency medical services (EMS) provide care to acutely ill or injured patients in settings less controlled than other health care environments. Although reports describing individual EMS adverse events exist, few broader descriptions exist. The objective of the study is to characterize the types, frequencies, and outcomes of adverse events associated with insurance tort claims against EMS providers. ⋯ Emergency vehicle crashes and patient handling mishaps were the most common adverse events associated with tort claims against EMS agencies. Clinical management and other incidents were less common. This effort highlights potential areas for improving EMS operations and care.
-
Multicenter Study
Cardiocerebral resuscitation improves neurologically intact survival of patients with out-of-hospital cardiac arrest.
In an effort to improve neurologically normal survival of victims of cardiac arrest, a new out-of-hospital protocol was implemented by the emergency medical system medical directors in 2 south-central rural Wisconsin counties. The project was undertaken because the existing guidelines for care of such patients, despite their international scope and periodic updates, had not substantially improved survival rates for such patients during nearly 4 decades. ⋯ In adult patients with a witnessed cardiac arrest and an initially shockable rhythm, implementation of an out-of-hospital treatment protocol based on the principles of cardiocerebral resuscitation was associated with a dramatic improvement in neurologically intact survival.