The role of emergency preparedness exercises in the response to a mass casualty terrorist incident: A mixed methods study

Abstract

Simulation exercises are an important part of emergency preparedness activities for the healthcare community but evidence of their impact on the response to real major incidents is limited. This project studied the impact of health emergency preparedness exercises (HEPEs) on the response to a mass casualty terrorist incident. The mixed methods study design was adopted comprising an on-line survey and follow up individual interviews. Participants were healthcare staff who took part in responses to three major terrorist incidents in the UK in 2017. Descriptive statistics and analysis of variance were undertaken with quantitative data. Content and thematic analysis methods were used for qualitative data analysis. The online survey generated 86 responses; 79 (92%) were from the responders to the Manchester Arena bombing. Twenty-one survey respondents shared their experiences in in-depth interviews. Healthcare staff who took part in HEPEs felt better prepared to respond than those who did not attend an exercise. The most commonly reported benefits from HEPEs were awareness of major incident plans and having the opportunity to practice responding to a similar scenario in the recent exercise. Specific benefits included: improved coordination of the response through adherence to recently practiced incident plans ; confidence with response roles; real-time modifications of the response and support provided to staff who did not take part in exercises. Exercise recency was highlighted as an important facilitating factor. The study provides strong objective evidence that the response to a mass casualty terrorist incident was enhanced by training and service development achieved through HEPEs.

UK healthcare staff experiences and perceptions of a mass casualty terrorist incident response: a mixed-methods study

“…Interview participants discussed in depth their experiences with the response as well as shared their perspectives about emergency preparedness training, and the role of health emergency preparedness exercises (HEPEs) in preparing them for the response. 20 Interviews were conducted by telephone from 31 October 2017 to 29 December 2017 with the responders to the Manchester Arena bombing. The average interview length was 48 min (range 27-69 min).…”

“…So some of what we were doing was working out between the adults and the children's side, whether the child or the parent was going to theatre, when that was going to happen… I was surprised at just being able to manage parents and children so well together. [20] Recent HEPEs and training…”

“…So we did have a problem with that. [20] After event management and follow-up support Concern was expressed that psychological well-being of staff and depletion of human and physical resources were not given appropriate consideration when managing return to 'normal' post incident, and in particular the coordination of elective surgical work. The psychological impact of the incident on healthcare staff involved in the response and recovery was one of the prevalent themes from individual interviews with 21 responders to the Manchester Arena bombing response.…”

“…These novel solutions were largely supported by recent system-level simulation exercise experiences in response to a similar simulated incident. 20 This suggests the potential value of regular multidisciplinary training, including a broader range of specialties (eg, blood bank, radiology and paediatric trauma) to facilitate understanding of roles and coordination in the response. Third, workable incident plans, which supported the response well, were tested and refined through recent HEPEs; those training opportunities also built confidence in the system's capability to cope with the allocation from NHS England's mass casualty distribution plan.…”

“…Third, workable incident plans, which supported the response well, were tested and refined through recent HEPEs; those training opportunities also built confidence in the system's capability to cope with the allocation from NHS England's mass casualty distribution plan. 20 A few limitations were noted. The impact of an MCI on health staff psychological well-being was underestimated, and support for the immediate and delayed psychological and social impacts of traumatic events was identified by participants in its absence.…”