Literature Review For Radiological, Nuclear And Explosive Emergencies – Preparedness Of Paramedics And Emergency Health Care Practitioners

Broad Scan

Discuss about the Literature Review for Radiological, Nuclear and Explosive Emergencies.

This literature review is on the topic of ‘disaster preparedness of paramedics and emergency health care for chemical, biological, radiological, nuclear and explosive emergencies (CBRNE)’. Herein, there will be a review of two peer-reviewed journal articles, the first one (Worall 2012) exploring the preparedness of nurses and healthcare assistants in minor injury units while the second journal article (Debrera et al 2012) explores disaster preparedness among general practitioners. The following procedures will be followed during the selection and review of the journal articles. 

Firstly, there will be a broad scan which will entail a general identification, collection of the journal articles and a compilation of the selected papers’ bibliography. Secondly, there will be a focused scanning of the journal articles characterized by filtering of the selected papers to identify the most relevant. As recommended by Smith (2010), this focused scan will be followed by an updating of the bibliography to capture the filtered papers. The subsequent sections will contain a detailed literature review of the two selected journal articles, an outline of the literature review chapter, and finally an introduction to the topic of study.  

Herein, there was a selection of the topic and a search of the relevant journal articles using different keywords as recommended by Bernard (2011), Groat & Wang (2013) and (Bernard 2013). Specifically, the journal articles were searched from various online databases such including EBSCO, Google Scholar, VU library, and JSTOR.

 The filing System 

 In the interest of word limits, the bibliographic file for the selected journal articles is attached

This activity mainly entailed a detailed research on the selected journal articles and a further selection/filtering to select the two journal articles for review.

Again, in the interest of word limits, the updated bibliography from the focused review is attached  

The unpredictable nature of disasters has always posed a challenge to paramedics and other emergency health care practitioners such as nurses and general practitioners (Hoang et al 2014). Furthermore, according to Hansen et al (2015), the unknown magnitude and the multidimensional character of disaster require nurses and paramedics to always be prepared to respond to any injuries that occur thereafter. Worrall (2012) explores disaster preparedness among healthcare assistants and nurses working in minor injury units. In doing so, the study evaluates the effectiveness of the Emergency Preparedness Information Questionnaire (EPIQ) as a tool to help the nurses get prepared for CBRNE emergencies. In this section, there will be a discussion of the study’s background and the problem it tries to solve, followed by an identification of the study methodology.  The penultimate part will highlight the results of the study in form of a discussion. Ultimately, there will an identification of the study finding’s implication on policy and practice.  

Research Journal

Events that characterized the US September 11 terrorist attack called for a review of the extent to which nurses are prepared for disasters (Worrall 2012). The author notes further that the July 2005 London bombings revealed a need for disaster preparedness among both paramedics and emergency health care workers across the globe. On the same note, the outbreak of several biological disasters such as swine flu, avian flu, and acute respiratory syndrome; and the occurrence of several other show that paramedics and nurses must be ready to respond to wide range of disasters that may occur near their stations of work (Worrall 2012).

According to Worrall (2012), paramedics and nurses require skills, knowledge, abilities and action-oriented attitudes, yet there are concerns that most nurses may not be in possession of these requirements. While it is impossible to achieve a perfect preparedness for all disasters, the author opines that nurses and paramedics should at least have an understanding of the logistics, and basic techniques of handling or managing CBRNE emergencies because even the hospital facilities may be overwhelmed or inadequate for the same. In fact, Worrall (2012) cites a study which found that during CBRNE disasters, a majority of patients (66%- 93%) present themselves to the nearest facility typically within a short time (30 minutes) after the disaster – before notifying neither the nurses nor the facility managers. Consequently, according to Worrall (2012), it may be assumed that minor injury nurses are the most prepared because they handle patients with a wide range of minor injuries who mostly self-present themselves to the facility. However, Worrall argues that the assumption that all minor injury nurses are always prepared can hinder the establishment of proper disaster preparedness plans and strategies among nurses. Against this backdrop, the scholar launched a study to explore the level of minor injury nurses’ preparedness for CBRNE disasters. 

The study mainly targeted the effectiveness of EPIQ as a tool used by nurses to enhance their disaster preparedness. To effectively achieve this objective, there was a need to establish the nurses’ understanding of this tool in terms of its elements and usability. As a result, a qualitative survey was launched; in which data was collected through interviews and questionnaires. According to Worrall (2012), questionnaires were used to identify the familiarity of the respondents with the tool, with options ranging from ‘very familiar’ to unfamiliar. Similarly, a total of 1663 respondents participated in the survey which also included online administration of the EPIQ questionnaire to evaluate nurses’ ability to use it, and data was analysed through quantitative methods. It is worth noting that all the study participants were kept anonymous and that a response rate of 98% was achieved.

The Filing System

The results showed that participants were most familiar with disaster preparedness dimensions relating to triage, incident command system, clinical resource assessment, and reporting (Worrall 2012). On the other hand, according to the author, there was a low familiarity among nurses in regards to special populations, clinical decision-making, and epidemiology. While discussing the results, Worrall et al (2012) noted that EPIQ is an important instrument for measuring nurses’ preparedness for CBRNE disasters by identifying their familiarity with the basic elements of disaster preparedness. All in all, the results suggest that EPIQ is an effective tool for identifying disaster trends because it is formatted to capture both biological and chemical events and the necessary elements needed to prepare for these events. However, Worrall (2012) acknowledge that the tool’s scope should be expanded to cover for other types of disasters including terrorist and natural disasters.

Conclusion and recommendation 

The study concluded that while there is an established familiarity of nurses with elements of disaster preparedness enshrined within EPIQ, the study was limited to only a small sample population and therefore its findings should not be generalized. Further research is therefore recommended to establish a proper familiarity of the nurses with various elements of disaster preparedness.  

Events with mass gatherings such as geopolitical gatherings and sporting activities are known for proneness to terrorist threats including chemical, nuclear, radiological and biological attacks (Debrera et al 2012). Based on this, the idea of disaster preparedness among paramedics and emergency health workers has received much emphasis especially due to the potentially high number of individuals likely to be affected when such incidences occur. While there has been a wide body of research conducted in this area, Debrera et al (2012) acknowledge that a few have focused on general practitioners with a majority of them highlighting the preparedness among clinicians. Against this backdrop, Debrera and colleagues launched a study to explore the extent and importance of disaster preparedness among general practitioners (GP) in the UK. According to the authors, GPs were of great interest due to the important role that they play in responding to CBRNE incidences including undertaking disaster risk assessment and communicating with worried patients.

The study took a qualitative approach, in which questionnaires were used to gather information from the participant GPs about several elements of disaster preparedness such as their perceived role during CBRNE emergencies, their perceived preparedness, the frequency of training and the training needs they might have. Similarly, the questionnaire was designed to gather information pertaining to resource availability and policies that guide their practice. According to Debrera et al (2012), their study targeted GPs working in three primary care trust (PCT) areas within close proximity to sporting and mass-gathering event venues. The questionnaires were distributed to 157 identifies GPs through the internet, 56 of which respondent positively.

Disaster Preparedness among Health Care Assistants and Nurses

With regards to the role of GP in disaster preparedness, 73% of the respondents agreed to be familiar with their roles. However, there are some GPs who attested not to be aware of their roles in disaster preparedness. Noteworthy, those who accepted to be aware of their roles gave examples such as receiving and reporting the number of casualties, recognizing injury and illness of the victims, and having information about decontamination in the case of chemical or biological disasters. According to Debrera et al (2012), some of the respondents explained their role as conducting an appropriate triage of the worried well victims and patients to prevent further spread of the hazard. When asked about their general attitude and feeling over disaster preparedness, a majority of the respondents claimed that they were not feeling prepared.  

While a majority of the respondents agreed to be in knowledge of their role in disaster preparedness, it is revealed that most participants perceived themselves not to be prepared for any CBRNE disaster at the time of the study. According to the authors’ discussion, most of the respondents attributed their unpreparedness to failure to attend the previous training session on disaster preparedness. Hence, as it comes out, training and education not only equip GPs with adequate knowledge but also contributes to a positive attitude and willingness towards disaster preparedness. 

Conclusion and Recommendation

The study concludes that GPs play an important role in response to CBRNE disasters. The study also concludes that there is a need for a regular training and education of GPs on latest disaster preparedness techniques to boost their capabilities and to ensure that they have the right attitude. Because this study was only limited to three health facilities, it recommends further research on the topic area albeit with a broader scope (e.g. within the whole country) so that the findings can be generalized.

Disaster Preparedness among Health Care Assistants and Nurses (Selected paper 1)

Background

Study methodology

Results and discussion

Conclusion and recommendation

Disaster Preparedness among General Practitioners (Selected paper 2)

Background

Study methodology

Findings

Discussion

Conclusion and recommendation 

Chemical, biological, radiological, nuclear and explosive emergencies (CBRNE) disasters have had adverse effects on humans from time immemorial. As a result, societies, as well as individuals, have made several efforts to reduce the incidences or the impact of these disasters by developing prevention and coping strategies. However, several studies (Gomez & Jones 2010; Gibson et al 2012; Gershon et al 2014, Jenkins et al 2016, and Johnsen et al 2017) reveal that disaster preparedness is among the key strategies implemented by both paramedics and emergency health practitioners to reduce the impact of or manage CBRNE disasters. This literature review is aimed at validating the argument that disaster preparedness among paramedics and other health workers is an important element of disaster management.   

References 

Bernard, H. R. (2013). Social Research Methods: Qualitative And Quantitative Approaches. Los Angeles, Sage Publications.

Bernard, H. R. (2011). Research Methods In Anthropology: Qualitative And Quantitative Approaches. Lanham, Md, Altamira Press.

Gomez, B., & Jones, J. P. (2010). Research Methods In Geography A Critical Introduction. Chichester, West Sussex, U.K., Wiley-Blackwell.

Gibson, P, Theadore, F, & Jellison, J 2012, ‘The Common Ground Preparedness Framework: A Comprehensive Description of Public Health Emergency Preparedness’, American Journal Of Public Health, 102, 4, pp. 633-642.

Gowan, M, Sloan, J, & Kirk, R 2015, ‘Prepared for what? addressing the disaster readiness gap beyond preparedness for survival’, BMC Public Health, 15, 1, pp. 1-5.

Gershon, R, Orr, M, Qi, Z, Merrill, J, Chen, D, Riley, H, & Sherman, M 2014, ‘Mass fatality preparedness among medical examiners/coroners in the United States: a crosssectional study’, BMC Public Health, 14, 1, pp. 644-672.

Groat, L. N., & Wang, D. (2013). Architectural Research Methods. Chichester, Wiley.

Hoang Van, M, Tran Tuan, A, Rocklöv, J, Sahlen, K, Nilsson, M, Weinehall, L, Kim Bao, G, & Le Quynh, T 2014, ‘Primary healthcare system capacities for responding to storm and flood-related health problems: a case study from a rural district in central Vietnam’, Global Health Action, 7, pp. 1-11.

Hansen, S, Brøndum, S, Thomas, G, Rasmussen, S, Kvist, B, Christensen, A, Lyng, C, Lindberg, J, Lauritsen, T, Lippert, F, Torp-Pedersen, C, & Hansen, P 2015, ‘Home Care Providers to the Rescue: A Novel First-Responder Programme’, Plos ONE, 10, 10, p. 1.

Jenkins, N, Smith, G, Stewart, S, & Kamphuis, C 2016, ‘Pre-employment physical capacity testing as a predictor for musculoskeletal injury in paramedic.

Johnsen, A, Sollid, S, Vigerust, T, Jystad, M, & Rehn, M 2017, ‘Helicopter emergency medical services in major incident management: A national Norwegian cross-sectional survey’, Plos ONE, 12, 2, pp. 1-12.

Smith, M. (2010). Research Methods In Sport. London, Sage Publications.