Risk mitigation measures captured by a tertiary hospital's disaster simulation: an observational study

Aim: To document the challenges experienced and adaptations made during a simulated hospital disaster, and consider the implications of the observations for hospital disaster preparedness.

Design: Nonparticipant observational assessment.

Methods: Nonparticipant observations of an exercise simulating a disaster were undertaken by two researchers. The researchers shadowed triage team members, complementing this with observations of the Hospital-Emergency-Operations-Centre, theaters, wards, and Emergency Department subsections such as Resuscitation, Acute, Minor-Injuries-Clinic, Children's emergency, and Mental health. Field notes were coded line-by-line through an inductive thematic analysis, which synthesized both challenges and observed adaptations to those challenges.

Results: The major challenges observed were deaths due to lack of critical care equipment, management of high number of minor injuries, lack of situational awareness, shortage of orderlies, and difficulties in patient tracking and bed allocations. Observed adaptations included pediatricians' treatment of adult patients with minor injuries, fast-tracking triage through ranking, manual ventilation during transfers, and batching of patients requiring imaging to utilize limited orderlies for transfers.

Conclusion: This observational study distills both challenges that clinicians may face in real disasters, and the improvisations that they can make to manage mass casualties.

Implications for Clinical Professions: Research findings hold promising potential in enhancing clinicians' disaster preparedness by articulating specific interventions on mass-casualty management within limited resources.

Impact: Unforeseen challenges arise when clinicians are confronted with disaster casualties. This study addresses that problem by not only preempting such challenges, but by also discussing practical solutions. The findings can enable a positive impact on clinicians' readiness for mass casualty influx.

Reporting Method: The 21-item checklist of the Standards for Reporting Qualitative Research (SRQR).

Patient or Public Contribution: Although this study was not focused on a patient population, our research institute incorporates healthcare consumers' advice in all our work.