medical students as a new resource in hospital mass casualty events

1. NATO ADVANCED TRAINING COURSE
Integrated Emergency Management for Mass Casualty Emergencies
Florence, Italy 26th – 29th October 2011
Medical students as a new resource
in hospital mass-casualty events
Dr. Marco Mangini
Resident Physician in Anesthesiology
and Intensive Care Post-Graduate School
Dr. Francesco Grossi
Resident Physician in Cardiology Post-Graduate School

2. Hospital vulnerability
Hospitals are...
“A prerequisite for stability and economic
development”
And Have..
“ A symbolic social and political value wich
contribute to a community’s sense of security and
well being”
UN/ Internation Study for Disaster Risk Reduction (ISDR). Hospital Safe from
Disaster 2008 – 2009: Wordl Disaster Reduction Campaign.

3. Hospital vulnerability
But even in developed countries they are
vulnerable:
In UK 7% of Hospital and 9% of primary
health care facilities are located in high to
moderate risk area for flooding.
Bagaria et Al. “Evacuation and sheltering of hospital in emergency: a rewiev on international
experience”. Prehospital and Disaster Medicine 2009; 24(5): 461 – 467.

4. Hospital evacuation
• In case a disaster strikes sometimse the
evacuation of patient from the structure is
mandatory....

5. Hospital evacuation
“ Eight on 91 acute care hospital (nine percent) were Evacuated”
“Six institutions begans evacuation within the first hours after the
earthquake and compled the process by the end of the first day”.
N Engl J Med 2003; 348: 1349 - 55

6. Hospital vulnerability
“The earthquake that struck the town of L’Aquila, in central Italy,
on 6 April [...] had magnitude 6.3”.
“L’Aquila’s 500 bed hospital, built 15
years ago, had to be evacuated
because part of it collapsed”
Zarocostas J. “ Disaster agencies treat wounded after Italian earthquake damages
hospitals” BMJ 2009; 338:b1524.

7. Hospital evacuation
Patients vertical evacuation needs a lot of
resources in term of medical, paramedical
and technical staff.
This is especially true for criticall ill patients,
who need continous and special treatment (
es: mechanical ventilation).

8. Hospital evacuation
“*...+ 15 firefigthers, 12 nurses, 12 physisicians and 2 respiratory
therapists (a total of 41 persons) involved in the drill”.
Disaster management and response 2004; 2:14 -9.

9. Hospital evacuation
“Time required to prepared a
patient range from 3 – 8 minutes
and and 6 to 7 persons were
required to evacuate each patien”
“Overall the drill required 93
minutes to evacuated 12 patients
down 4 flights of stairs”.
Disaster management and response 2004; 2:14 -9.

10. Hospital evacuation
Resource could not be so numerous
and readly available in an University hospital...
So where we can find skilled people in few
minutes from the disaster?

11. Hospital evacuation
Medical Students

12. Medical students and
disaster medicine
Several institutions already organised disaster medicine
course for medical students...

13. Medical students and
disaster medicine
And many course already use peer – education teaching
tecniques, because of his effectivness...

14. Medical students and
disaster medicine
Disaster Medicine
Medical students Peer – assisted learning

15. Medical students and
disaster medicine
In – hospital disaster
response and rescue

16. “In-hospital disaster response
and rescue”
The “In-hospital disaster response and rescue” training
programme has been set in the medical school curriculum of the
University of Florence as an elective course and consists of 4
sessions of 4 hours each, for a total of 16 hours.
The course has been given for 3 years, from the academic year
2008-2009 to the academic year 2010-2011, during which 125
medical school students from the 3rd to the 6th year have taken
part in the course.

17. Organizing group
A multidisciplinary group of young professionals
interested in disaster medicine.
All the lessons were at first given by senior
medical students, young doctors, engineers,
linguists, psychologists, fire-fighting technicians
and chemists

18. Peer-education based
Students had the possibility to become teachers
themselves after a 2 steps training programme.
STUDENT CO-TRAINER TRAINER
Each student was granted an amount of
University Training Credits at the end of the
programme.

19. Course modules
• Medical module
- triage (START protocol)
-communication in emergency situations
-First Aid (bleeding, burns, electrocution)
- Basic Life Support (BLS) both adult and paediatric
- Rescue to traumatized patients.
Such themes are also dealt with in practical lessons.

20. Course modules
• Psychological /social Module
This module deals with people’s possible
behaviours in case of emergency:
- Thought processes and cognitive distortions in
emergency situations
- Trauma, post-stress traumatic disorder and
various ways to approach victims according to
their reactions
- Language and communication problems in the
hospital environment

21. Course modules
• Technical Module
The technical module consists of three main
sections:
- an engineering section concerning self-protection
and safety;
- a chemistry section concerning fires, explosions
and poisoning;
- a practical fire-fighting section concerning
techniques to extinguish fires and evacuate
smoke filled places.

22. Our research
In order to verify the effectiveness of the course,
participating students were required to fill-in a
pre-test that included a “Knowledge Test” and
an “Attitude Test”. At the end of the programme
the same tests where submitted

23. Results: Experimental Group
• Attitude test (behaviour test)
-Pre-course (44.06)
-Post-course (50.15)
• Knowledge test (disaster medicine quiz)
-Pre-course (8.02)
-Post-course (20.10)

24. Results
Experimental Group
- Attitude Difference = 6.09 points
- Knowledge difference= 12.08 points
Control Group
- Attitude Difference= 0.59 points
- Knowledge Difference= 1.05 points

25. Results
Both variables show definitely higher scores
differences in the tests filled-in by the students
included in the experimental group in
comparison to the control group.

26. Discussion
- the training programme has met with good
acceptance, as testified by the number of
students who decided to enrol in the course
and followed the lessons.
- students who attended the course did it in an
active way, participating in the lessons with a
pro-active behaviour

30. The course opened the way to other
experiences:
Association for the Research
Mobile Emergency
on Emergency and Rescue

31. ARIES - Associazione Ricerca Interdisciplinare
Emergenza e Soccorso
Association for the Research
on Emergency and Rescue
http://associazionearies.jimdo.com

33. MobileEmergency
MobileEmergency Team:
Prof. Paolo Nesi
Prof. Alessandro Fantechi
Prof. Sergio Boncinelli
Ing. Luca Malandrino
Dott. Marco Mangini
Dott. Francesco Grossi
Ing. Pierfrancesco Bellini
Dott. Antonio Cappuccio
Available for free on Itunes
http://itunes.apple.com/us/app/mobile-emergency

34. Mobile Emergency
The main idea behind of Mobile Emergency is to
provide a support for managing communications
among medical personnel during a disaster that
may occur into large medical centers.

35. Mobile Emergency
• Careggi Hospital: nearly 182 acres, 13
departments, 1,660 beds, 135,000 patients
per year admitted in the ER, 5.900 employees
• In this large and complex scenarios, several
emergency events may occur per week. They
may range from simple water problems
(flooding or lack), lack of power, problems on
oxygen, to fire, etc.

36. Emergency Scenario
• 19 October 2011 : Isopropyl Alcool Release
from a container into the molecular biology
laboratory

37. Common needs in emergency
situations in a hospital setting
- Informing the command center about the
emergency
- recalling in short time medical personnel from
other areas of the hospital.
- supporting hospital personnel providing them
missing informations
- moving personnel and patients from a place to
another

38. Hospital personnel need to be:
• informed about the occurrence of an
emergency situations
• informed about the effective severity of the
emergency, if they are in danger or if their
help is needed
• supported in finding an escape path to get the
exit and/or join a collecting area

39. Mobile Emergency
We imagined an application that also could:
• support at identifying medical personnel that need
help.
• support the aggregation of collaborative teams and
the establishing of a coordinator
• Deliver an image and/or a video depicting the
emergency event.
• Find the position of a person inside the hospital and
communicate it to the emergency command room

40. How the application works

41. How to localize yourself in the hospital

42. Tests with the application: smoke
conditions

43. Test with the application: rescue
and evacation

44. MobileEmergency
MobileEmergency Team:
Prof. Paolo Nesi
Prof. Alessandro Fantechi
Prof. Sergio Boncinelli
Ing. Luca Malandrino
Dr. Marco Mangini
Dr. Francesco Grossi
Ing. Pierfrancesco Bellini
Dr. Antonio Cappuccio
Available for free on Itunes
http://itunes.apple.com/us/app/mobile-emergency

45. Thank you!!!
Marco Mangini
eat83@hotmail.com
Francesco Grossi
francesco@grossi.us