Teaching Emergency Preparedness

Teaching Emergency
Preparedness
From Competencies to Curriculum

Association for Prevention Teaching and Research
And
Center for Health Policy
Columbia University School of Nursing
2006-2007
Goals for this workshop
 Review the relationship of competencies and
curriculum
 Review the core emergency preparedness
competencies for clinicians
 Discuss the steps in moving from any
competency set to a curriculum
 Practice the process of planning an
educational experience that includes an
emergency exercise as a learning opportunity
A well-built curriculum
 Does not have to be complex
 Is worth thinking through before
presentation
 Is definitely more than a one-time
content presentation
 Can make the difference in having a
well-prepared workforce!
Competency
 an individual measure of applied skills and
knowledge that enable people to perform
work.
 consists of
 action verb (observable or measurable
performance of a worker)
 content (subject matter, type of performance,
specific task)
 context (limitations or conditions of work
environment).
Emergency preparedness
competencies are known
 Public health workers
 Hospital workers
 Clinicians
 Nurses (INCMCE)
 Basic and advanced disaster Life
support (AMA)
These vary on several
dimensions
 Focus on education or workplace
 Focus on level of attainment
 Focus on various workers
Education or the workplace?
 Workplace statements
 complex performance within the workplace, akin
to KSAs of job classifications.
 a series of embedded tasks that are either
sequential or parallel.
 demonstrated over long periods of time.
 require contextual measurement.
 allow for a range of indicators to measure
competence.
Example of a workplace
competency
 A clinician is able to respond to an
emergency event within the emergency
management system of his/her practice,
institution and community.
Education or the workplace?
 Instructional Competencies
 the building blocks of learning experiences.
 structured learning activities.
 require higher levels of performance to be
built upon lower level ones.
 determine the measurement indicators.
 require measurement in the short term.
Example of an instructional
competency
 The medical student will be able to
conduct a physical exam that is guided
by information about exposure or
potential exposure to CBRNE
Levels?
Or different competencies?
 Aware: Basic level of mastery of the
competency. Individuals may be able to
identify the concept or skill but have limited
ability to perform the skill.
 Knowledgeable: Intermediate level of
mastery of the competency. Individuals are
able to apply and describe the skill.
 Proficient: Advanced level of mastery of the
competency. Individuals are able to
synthesize, critique or teach the skill.
Level of worker expertise
 Novice: new to a skill or attribute
 entry-level
 seasoned professional with limited exposure to the
area.
 Intermediate: detailed knowledge in area
 Often mid-level and has supervisory
responsibilities.
 Expert: mastery of a skill
 Often this person the highest ranking person in
the skill area.
How do competencies fit in?
Workforce Organizational
competencies performance
Intervening
Variables*
Instructional
Competencies Individual worker
& Curriculum performance
*Intervening variable include all of the non-human components

of the organization, plus the impact of the surrounding community
Competency Verbs:
Bloom’s Taxonomy
Increasing
independence
EVALUATION
SYNTHESIS
ANALYSIS
APPLICATION
COMPREHENSION
KNOWLEDGE
Sample Skills by Bloom’s
Taxonomy
Knowledge: name, list, arrange, relate, specify,
enumerate, define, recall, label, cite, repeat,
copy, order, record
Comprehension: describe, iterate, recognize,
summarize, explain, discuss, locate, input,
translate, paraphrase, itemize
Application: practice, calculate, compute, sketch,
illustrate, interview, operate, simulate,
demonstrate, apply, schedule, utilize, relate,
diversify
Sample Skills by Bloom’s
Taxonomy
Analysis: interpret, test, differentiate, scrutinize,
investigate, interpret, compare, contrast,
discriminate, distinguish, question, manipulate,
dissect, estimate, measure
Synthesis: compose, construct, predict, reason,
hypothesize, design, formulate, manage, develop,
assemble, propose, theorize, invent, attribute,
simplify
Evaluation: judge, assess, recommend, determine,
criticize, argue, defend, estimate, appraise, justify,
feedback, review
The clinician competencies
 Licensed healthcare providers (e.g., MD, DO,
DDS, RN, Advanced Practice Nurse, Physician
Assistant, Clinical Psychologist, Clinical Social
Worker, Optometrist) who see and triage
patients or communicate with patients and
are in a position to recognize initial cases and
manage the initial care and referral of
patients.
 In all cases, the competencies are understood
to be defined or limited by the legal scope of
practice of the specific clinician.
The clinician in an initial assessment
and decision-making role is able to
 describe his/her expected role in
emergency response in the specific
practice setting as a part of the
institution or community response.
 respond to an emergency event within
the emergency management system of
his/her practice, institution and
community.
and
 recognize an illness or injury as potentially
resulting from exposure to a biologic,
chemical or radiologic agent possibly
associated with a terrorist event.
 recognize uncommon presentations of common
diseases and distinguish these from common
presentations of uncommon diseases that may be
related to a terrorist event or emerging infectious
disease.
 recognize emerging patterns or clusters of unusual
presentations
and
 institute appropriate steps to limit spread,
including infection control measures,
decontamination techniques and use of
appropriate personal protective equipment.
 report identified cases or events to the public
health system to facilitate surveillance and
investigation using the established institutional
or local communication protocol.
 initiate patient care within your professional
scope of practice and arrange for prompt
referral appropriate to the identified
condition(s).
and
 use reliable information sources for current
referral and management guidelines.
 provide reliable information to others (e.g.,
institutional administration, other patients) as
relevant to the specific practice site and
emergency response protocol.
 communicate risks and actions taken clearly
and accurately to patients and concerned
others.
and finally
 identify and manage the expected
stress/anxiety associated with emergency
events, making referrals for mental health
services if needed.
 participate in post-event feedback and
assessment of response with the local public
health system and take needed steps to
improve future response.
Steps to a curriculum
1. Select competency(ies) 6. Relate an evaluation
2. Define key words or procedure to learning
phrases within the objectives
competency 7. Provide relevant
3. Describe the target content (theory and
audience practice) for each sub-
4. Sequentially separate competency
all required sub- 8. Plan specific learning
competencies experiences for all
5. Develop objectives for identified objectives
each sub-competency 9. Present and Evaluate
Example: Emergency
Preparedness Continuing Ed
 Assumption: you have been asked to
plan a program for the staff of a local
community clinic
 Goal: assure that all of the clinical staff
are prepared to follow the community
emergency plan in which the clinic
becomes a site for minor triage and
supportive care.
Step 1. Competency selected
 This may be based on organizational or
individual needs assessment
 Your contact person has said that a key problem is
adherence to emergency chain of command
 Selection from the emergency preparedness
competencies for clinicians
 respond to an emergency event within the
emergency management system of his/her
practice, institution and community.
Step 2. Definition of key terms
Emergency management system:
 The Incident Command System (ICS)
linking clinics to the health sector within
the unified command structure of the
county, consistent with the principles of
the National Incident Management System
(NIMS).
 Add key terms used locally.
Step 3. Define target audience
 All clinical staff of the community clinic,
including MD, PA, NP, DDS, RN.
 Some of these individuals work part-
time, and several are new to the
practice
 Additional needs assessment may be
conducted
Step 4. Separate the sub-
competencies
 Describe the principles of ICS
 Describe the XYZ county emergency management
system
 Discuss the chain of command that links the clinic to
the health sector in the ICS plan
 Identify the chain of command that will exist within
the clinic during an emergency
 Follow the chain of command during an exercise or
real emergency
 Identify contingencies such as off hour planning
Step 5.
Learning objective 1
 Describe the principles of ICS
 Predictable chain of command
 Modular organization, flexible organization
chart
 Accountability and clearly defined roles
 Common terminology
 Use of action plans with a defined
operational period
Step 5.
 Describe the XYZ county emergency
management system
 Modify standard ICS chart to be consistent
with XYZ county
 Fill in names of all key agency players
Step 5.
 Discuss the chain of command that links the
clinic to the health sector in the ICS plan
 Describe all components of the health sector in
the ICS plan
 Health department
 Hospitals
 Long term care facilities
 Community clinics
 Medical Reserve Corps unit
 Discuss the activation and functioning of the chain
of command
Step 5.
 Identify the chain of command that will exist
within the clinic during an emergency
 How is an emergency identified
 Who assumes command
 What does the individual clinician do
 If at work when the emergency begins
 If at home when the emergency begins
 If he/she has responsibilities within another institution
Step 6:
Select evaluation procedures*
 Objective test * in order of efficiency
 Objective self report

 Essay
 Oral report
 Planned observation
 Product
 Performance
 Chosen in this case because of the 4th objective
Step 7.
Identify relevant key content
 Expert consultation
 Publications
 Policy and procedure manual for clinic
Step 8.
Plan the learning experiences
 Map out a sequence of classroom, self-guided
or experiential learning experiences that can
take the learner to the desired level of
competency.
 If there are multiple competencies to learn,
the individual experiences may combine
several
 The curriculum may occur in a compressed
period, or be spread over many months.
Step 8.
Plan the learning experiences
 A one-hour classroom lecture/discussion can
cover all key content areas identified
 The evaluation exercise will require an
additional hour, and may follow the
classroom experience immediately, or at a
later date
 Both should be repeated a sufficient number
of times that ALL clinicians can participate
Step 9.
Present and evaluate
 This is the fun part!!
 Make sure that audience is attentive
and engaged.
 Make sure any observers are
acquainted with the goals and remain
unobtrusive.
Drills and exercises
 These are both experiential learning
and an opportunity to evaluate
 Once you move beyond workshops,
they are easier to work with as system-
level evaluation rather than individual
assessment
Defining any drill
ORIENTATION TABLETOP FUNCTIONAL FULL
Or SEMINAR EXERCISE DRILL SCALE
DEFINITION
PURPOSE/
OBJECTIVES
SETTING
MATERIALS
PARTICIPANTS
CONDUCT
EVALUATION
Exercise investment
 Exercises don’t just “happen”
 Costs
 Time
 Advance training
 Materials/resources
Planning an exercise
 Define the Purpose of the Exercise
 Identify Goals & Measurable Objectives
 Define the Scope of the Exercise
 Define the Scale of the Exercise
 Select the Exercise Scenario
 Select the Exercise Format
 Define the Evaluation Method
 Develop the Exercise Work Plan and Schedule
Examples
 Design risk communication and
methods to disseminate public
education information on exposure
hazards and effective public response.
 Practice clinician behavior associated
with transition into emergency role
assigned by local health agency
Examples
 Test a POD operational model:
 introduce students to POD management
and Job Action Sheet (JAS) responsibilities.
 provide students with an opportunity to
practice ICS & functional staff roles to
expeditiously receive and dispense
appropriate medications.
Draft goal: activate POD clinic
 Is the goal realistic?
 Has the organization opened a POD before?
 Does the organization have the resources and
support to open a POD?
 Is the goal achievable?
 Is there a time limit on how quickly the POD
needs to be set up?
 Is the target number of patient through-put too
high or too low?
Discussion-Based Exercises
Tabletops (TTX)
 Purpose is training
 A controller orients participants to objectives, ground
rules and communication and simulation procedures.
 The scenario describes an event or emergency
incident and brings participants up to a simulated
present time.
 May use an imaginary jurisdiction or use participants
knowledge of actual local resources.
 The controller sets the pace.
Operation-Based Exercise
Drills
 Purpose is to instruct thoroughly by repetition.
 Used to test personnel training, response time,
interagency cooperation and resources, manpower
and equipment capabilities.
 Staff should have an understanding of the function
being tested and be given an opportunity to ask
questions.
 A briefing by the drill designer sets the scene and
reviews it’s purpose and objectives.
 Operational procedures to be tested and safety
precautions are reviewed before the drill begins.
Example of options
 Practice clinician behavior associated with transition
into emergency role assigned by local health agency
 Tabletop
 Vignettes about clinic activity & specific patients
challenging clinicians to change from usual care to
emergency plan
 Scenario requires a clinician to assume command
function
 Functional drill
 Announce change to emergency plan, manage ‘patients’
already in clinic and convert clinic to fit emergency plan
 Challenge process by activating some clinicians to roles
elsewhere in community
Using the National Planning
Scenarios
 Scenario 1: Nuclear Detonation  Scenario 9: Natural Disaster –
 Scenario 2: Biological Attack – Major Earthquake
Aerosol Anthrax  Scenario 10: Natural Disaster –
 Scenario 3: Biological Disease Major Hurricane
Outbreak – Pandemic Influenza  Scenario 11: Radiological Attack
 Scenario 4: Biological Attack – – Radiological Dispersal Devices
Plague  Scenario 12: Explosives Attack –
 Scenario 5: Chemical Attack – Bombing Using Improvised
Blister Agent Explosive Devices
 Scenario 6: Chemical Attack –  Scenario 13: Biological Attack –
Toxic Industrial Chemicals Food Contamination
 Scenario 7: Chemical Attack –  Scenario 14: Biological Attack –
Nerve Agent Foreign Animal Disease (Foot
 Scenario 8: Chemical Attack – and Mouth Disease)
Chlorine Tank Explosion  Scenario 15: Cyber Attack
Evaluation questions
 Did you reach the point you wanted?
 Did you reach that point when you
wanted to?
 Were all students appropriately
involved?
 Were you pleased with the manner in
which you got to the end point?
Be clear on what you are
evaluating, such as
 The exercise process
 An organization’s emergency plan
 The ability of the organization to fulfill the
plan
 The speed with which some portion of the
plan is put in to place
 The efficiency with which some portion of the
plan can be carried out
 The competency of individuals in some
specific functional roles
Example: Individual
competency in functional roles
 Identify in advance the functional roles
that need to be assessed
 Competency statements and applicable
JAS must be incorporated into the
assessment
Ways to evaluate
External Participant
evaluator
Objective Checklist with Post-event

stated checklist
objectives
Subjective Narrative of ‘Hot wash’
observations comments
Sample for recording
Exercise Objective Number (1___): Objective: Demonstrate ability to develop and
adapt Section Action Plan during an emergency
Anticipated Actions: Met Not Not

Met Observed
1. Identify expectations from IAP
2. Prepare initial SAP for time frame
3. Communicate SAP to team members with JAS
4. Develop revised SAP with new data or new IAP
5. Communicate new SAP to team members

Pre-drill
 Identify all functional roles to be activated
 Include those functional roles likely to be
identified if initial participants perform as
desired
 Example:
 Planning unit activated
 Planning calls for extensive field epidemiology
Pre-drill
 Prepare observer documents
 Criteria to be observed
 JAS to be observed
 Prepared participant feedback form
 One form for those carrying out assigned JAS
 One form for any individual playing parts of
community members or patients during the
drill.
Thank you for your participation!
Association for
Prevention
Teaching and
Research
http://www.aptrweb.org/ http://cpmcnet.columbia.edu/dept/
nursing/chphsr/index.html

Teaching Emergency Preparedness

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Teaching Emergency Preparedness

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Teaching Emergency

From Competencies to Curriculum

*Intervening variable include all of the non-human components

 Objective self report

Objective Checklist with Post-event

Anticipated Actions: Met Not Not

2. Prepare initial SAP for time frame

3. Communicate SAP to team members with JAS

4. Develop revised SAP with new data or new IAP

5. Communicate new SAP to team members

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