Computer Simulation as a Tool for Assessing Decision-Making in Pandemic Influenza Response Training

Abstract

Introduction: We sought to develop and test a computer-based, interactive simulation of a hypothetical pandemic influenza outbreak. Fidelity was enhanced with integrated video and branching decision trees, built upon the 2007 federal planning assumptions. We conducted a before-and-after study of the simulation effectiveness to assess the simulations' ability to assess participants' beliefs regarding their own hospitals' mass casualty incident preparedness.Methods: Development: Using a Delphi process, we finalized a simulation that serves up a minimum of over 50 key decisions to 6 role-players on networked laptops in a conference area. The simulation played out an 8-week scenario, beginning with pre-incident decisions. Testing: Role-players and trainees (N=155) were facilitated to make decisions during the pandemic. Because decision responses vary, the simulation plays out differently, and a casualty counter quantifies hypothetical losses. The facilitator reviews and critiques key factors for casualty control, including effective communications, working with external organizations, development of internal policies and procedures, maintaining supplies and services, technical infrastructure support, public relations and training. Pre- and post-survey data were compared on trainees.Results: Post-simulation trainees indicated a greater likelihood of needing to improve their organization in terms of communications, mass casualty incident planning, public information and training. Participants also recognized which key factors required immediate attention at their own home facilities.Conclusion: The use of a computer-simulation was effective in providing a facilitated environment for determining the perception of preparedness, evaluating general preparedness concepts and introduced participants to critical decisions involved in handling a regional pandemic influenza surge.

A Systematic Review of Literature on Effectiveness of Training in Emergency Risk Communication

“…Among the few specific findings about key factors in successful training, an exercise involving 17 local health district risk communicators in Georgia, U.S.A., found that participants had much greater difficulty following risk communication principles under the time pressures of a realistic and stressful simulation than they did in a tabletop exercise. Participants did report highly enhanced awareness, readiness, and knowledge after the real-time simulation Ablah, et al, 2007;Dausey et al, 2006;Leaming, et al, 2013;Sandstrom et al, 2014;Uddin et al, 2008; forgetting to include expression of empathy and using too much bureaucratic speech; media talking points not shared with hospitals and other agencies; participants not adequately monitoring media developments; notification lists often used indiscriminately and not usable by back-ups in their current format; departments waiting until they were contacted to start communicating with the public, meaning they often responded defensively and had trouble quickly formulating an initial message that was clear, informative, and alleviated anxiety. In South Africa, hospital preparedness for risk communication and public relations was found to be among the lowest preparedness of areas assessed.…”

“…(NHLBI tool) Low Leaming, et al, 2013 Computer simulation for decision-making in pandemic influenza response scenario. Purpose: to introduce personnel to critical decisions involved in handling a pandemic influenza surge and assess their opinion of current preparedness at home institution in U.S.A. Used a Delphi process to finalize an 8-week scenario exercise.…”

“…Evidence from Norway found training in media use was especially needed in head offices as opposed to regional and local levels, perhaps because those offices have a more complex task and are more concerned with strategic and political aspects of media relations. Leaming, et al, 2013;Malet & Korbitz, 2015Morris, et al, 2012 CERQual Multi-Method studies: Moderate GRADE: Very low CERQual Qualitative studies: Low OVERALL: Low to Moderate…”

Comparison of Computerized Patients versus Live Moulaged Actors for a Mass-casualty Drill

“…Computerized scenarios can also be used to simulate large numbers of patients in an MCI without significant equipment or personnel costs. Computerized scenarios have been used to improve response to a pandemic influenza surge and for mass-casualty planning on a larger scale 8 9 A handful of groups have designed online MCI virtual scenarios for provider education, demonstrating equivalent learning to simulation mannequins 10 and overall receptiveness of participants 11 .…”

“…Computerized scenarios have been used to improve response to a pandemic influenza surge and for mass-casualty planning on a larger scale. 8,9 A handful of groups have designed online MCI virtual scenarios for provider education, demonstrating equivalent learning to simulation mannequins 10 and overall receptiveness of participants. 11 A few papers have described interactive computerized games for MCI teaching.…”