E. Goralnick1,2,3,4, R. Sarin2,5, C. Ezeibe3,4, S. Loo6, P. Halpern7, R. Serino4, E. McNulty4, L. Marcus4, G. Ortega3,4, K. Peleg7 1Brigham And Women’s Hospital,Department Of Emergency Medicine,Boston, MA, USA 2Harvard School Of Medicine,Department Of Emergency Medicine,Brookline, MA, USA 3Brigham And Women’s Hospital,Center For Surgery And Public Health,Boston, MA, USA 4Harvard School Of Public Health,Boston, MA, USA 5Beth Israel Deaconess Medical Center,Department Of Emergency Medicine,Boston, MA, USA 6Boston University,School Of Public Health,Boston, MA, USA 7Tel Aviv University,Tel Aviv, Israel
Introduction: Recent mass casualty incidents (MCI) have highlighted the need for clinicians to integrate MCI planning into their emergency management preparations. Current sharing of MCI knowledge is limited to anecdotal after-action reports with limited ability to compare events systematically and improve practices. Our aim was to pilot a qualitative tool with clinicians from three recent urban terror events to capture common themes, best practices, and unresolved challenges during MCIs. This could then be used to create a standardized after-action report to populate a database to aid in improving MCI patient care.
Methods: A qualitative study was performed in two stages. First, two in-person focus groups were conducted utilizing Poll Everywhere© to solicit initial perspectives, as well as additional comments regarding the experience of clinicians from the following MCIs: Boston (April 2013), Paris (November 2015), and Brussels (March 2016). Data collected was qualitatively analyzed by two investigators who then designed semi-structured interview guides, used to conduct key informant interviews. These interviews were recorded, transcribed, and coded. Content analysis was used to identify emergent themes.
Results: Overall, 14 individuals participated in two focus groups and 11 participated in follow up interviews. There were five overarching themes that emerged from our analysis: 1) exercises and training, 2) military to civilian translation, 3) personnel management, 4) planning for failure and 5) recovery to normal operations. While each theme highlighted both strengths and improvement opportunities, all participants identified that recovery was the most challenging phase. Psychological impacts, either lack of or variability in debriefing, and patient identification were each identified as key recovery gaps across all three MCI sites.
Conclusion: To advance disaster preparedness, common themes can be identified across multiple MCIs to clarify best practices and gaps to target future innovation. Although immediate response is often highlighted anecdotally, the recovery phase warrants further focus and investigation to improve quality of care during disasters.
