THE POSITIVE EFFECT OF AN INTEGRATED MEDICAL RESPONSE PROTOCOL ON THE KNOWLEDGE, ATTITUDE AND PRACTICE OF MEDICAL RESPONSE DURING FLOOD DISASTER AMONG HEALTHCARE PROVIDERS IN KELANTAN: A SIMULATION-BASED RANDOMIZED CONTROLLED TRIAL
The Integrated Medical Response protocol (IMP) is a new protocol of medical response during the response phase of a flood disaster in Kelantan, Malaysia. It integrates response workflows of various rescue agencies involved in patient care during response phase of flood disaster. Traditionally, health care services in this region used either an all-hazard protocol or those not specific to Kelantan. The present study is aimed to test the effectiveness of IMP on knowledge, attitude and practice of healthcare providers (HCP) involved in managing patients during flood disaster in Kelantan. This study was a prospective parallel group, single blinded, randomized controlled trial. The unit of randomization was the district within Kelantan on a 1:1 basis into either the control or intervention group using cluster randomized method. The hospitals within the district were subsequently assigned to the allocated group. Investigators were blinded to the assignments. The knowledge, attitude and practice scores of HCP were assessed by FloodDMQ-BM© and was evaluated 2 weeks before and immediately after a flood disaster table-top exercise. Data was analyzed using two-way repeated measure ANOVA. Our findings showed that intervention was essential to improve the knowledge [F (1,100) = 6.947, p-value 0.010 (<0.05)] and attitude scores [F (1,100) = 31.56, p-value 0.001]. Meanwhile, practice score was improved in both control and intervention group with time [F (1,100) = 226.56, p-value 0.001]. Thus, our localized IMP specific to response phase of flood disaster was crucial to further enhance the knowledge and attitude levels among HCP while practice level showed similar improvement in both control and intervention group post table-top exercise.
Chan NW. Flood disaster management in Malaysia: an evaluation of the effectiveness of government resettlement schemes. Disaster Prevention and Management: An International Journal. 1995;4(4):22-9.
Persson ES, Nyberg L, Svedung I. Flood warning in a Swedish local risk management context. Disaster Prevention and Management: An International Journal. 2015;24(3):383-96.
Rattanakanlaya K, Sukonthasarn A, Wangsrikhun S, Chanprasit C. A survey of flood disaster preparedness among hospitals in the central region of Thailand. Australasian Emergency Nursing Journal. 2016;19(4):191-7.
Su-Lyn B. Kelantan floods like Japan's 2011 Tsunami, says NSC. 2015. Malaysia: The Malay Mail Online; 2015.
Franc JM, Nichols D, Dong SL. Increasing Emergency Medicine Residents’ Confidence in Disaster Management: Use of an Emergency Department Simulator and an Expedited Curriculum. Prehospital and Disaster Medicine. 2012;27(01):31-5.
Agensi Pengurusan Bencana (NADMA). Arahan MKN No. 20 : Dasar dan Mekanisme Pengurusan Bencana Negara 2012 [cited 2019 5/1/2019]. Available from: http://portalbencana.nadma.gov.my.
Donner A, Klar N. Pitfalls of and Controversies in Cluster Randomization Trials. American Journal of Public Health. 2004;94(3):416-22.
Farrin A, Russell I, Torgerson D, Underwood M. Differential recruitment in a cluster randomized trial in primary care: the experience of the UK Back pain, Exercise, Active management and Manipulation (UK BEAM) feasibility study. Clinical Trials. 2005;2(2):119-24.
Ghani A, Tuan Hairulnizam TK, MFM MF, Arifin WN, Chew KS. Development and psychometric evaluation of flood disaster management questionnaire-(FloodDMQ-BM): Exploratory factor analysis and item response theory analysis. International Journal of Public Health and Clinical Sciences. 2016 Jun 21;3(3):59-70.
Kaplan BG, Connor A, Ferranti EP, Holmes L, Spencer L. Use of an emergency preparedness disaster simulation with undergraduate nursing students. Public health nursing (Boston, Mass). 2012;29(1):44-51.
Jonson C-O, Pettersson J, Rybing J, Nilsson H, Prytz E. Short simulation exercises to improve emergency department nurses' self-efficacy for initial disaster management: Controlled before and after study. Nurse Education Today. 2017;55:20-5.
Savoia E, Biddinger PD, Fox P, Levin DE, Stone L, Stoto MA. Impact of Tabletop Exercises on Participants’ Knowledge of and Confidence in Legal Authorities for Infectious Disease Emergencies. Disaster Med Public Health Prep. 2013;3(2):104-10.
Handbook on simualation exercises in EU public health setting - How to develop simulation exercises within the framework of public health response to communicable diseases. [Internet]. ECDC. 2014.
Chi C-H, Chao W-H, Chuang C-C, Tsai M-C, Tsai L-M. Emergency medical technicians' disaster training by tabletop exercise. The American Journal of Emergency Medicine. 2001;19(5):433-6.
Skryabina E, Reedy G, Amlôt R, Jaye P, Riley P. What is the value of health emergency preparedness exercises? A scoping review study. International Journal of Disaster Risk Reduction. 2017;21:274-83.
Barton A. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. AORN Journal.90(4):601-2.
Nazli NNNN, Sipon S, Radzi HM. Analysis of Training Needs in Disaster Preparedness. Procedia - Social and Behavioral Sciences. 2014;140:576-80.
Williams J, Nocera M, Casteel C. The Effectiveness of Disaster Training for Health Care Workers: A Systematic Review. Annals of Emergency Medicine. 2008;52(3):211-22.e2.
Hsu EB, Jenckes MW, Catlett CL, Robinson KA, Feuerstein C, Cosgrove SE, et al. Effectiveness of Hospital Staff Mass-Casualty Incident Training Methods: A Systematic Literature Review. Prehospital and Disaster Medicine. 2012;19(3):191-9.
Linkous D, Carter KF. Responding to the Shootings at Virginia Tech: Planning and Preparedness. Journal of Emergency Nursing. 2009;35(4):321-5.
Tuan Hairulnizam TK, Rahman NHNA, Sheng CK, Fudzi MFMM, Hamzah MSSC, Ghani MNA, et al. Results of Focus Group Discussion and Elite Interview on Patient Managment during Flood Disaster in Kelantan. Kelantan International Health Conference: School of Medicine, Universiti Sains Malaysia; 2015.
A Hospital System’s Response To A Hurricane Offers Lessons, Including The Need For Mandatory Interfacility Drills. Health Aff (Millwood). 2012;31(8):1814-21.
M. PD, W. PR. The impacts of disaster exercises on participants. Disaster Prevention and Management: An International Journal. 1999;8(4):241-55.
Klima DA, Seiler SH, Peterson JB, Christmas AB, Green JM, Fleming G, et al. Full-scale regional exercises: closing the gaps in disaster preparedness. The journal of trauma and acute care surgery. 2012;73(3):592-7; discussion 7-8.
McBrien B. Translating change: The development of a person-centred triage training programme for emergency nurses. International Emergency Nursing. 2009;17(1):31-7.
Perry RW. Disaster Exercise Outcomes for Professional Emergency Personnel and Citizen Volunteers. Journal of Contingencies and Crisis Management. 2004;12(2):64-75.
Ford JK, Schmidt AM. Emergency response training: strategies for enhancing real-world performance. Journal of Hazardous Materials. 2000;75(2–3):195-215.
Sarpy SA, Warren CR, Kaplan S, Bradley J, Howe R. Simulating public health response to a severe acute respiratory syndrome (SARS) event: a comprehensive and systematic approach to designing, implementing, and evaluating a tabletop exercise. Journal of public health management and practice. 2005;11(6):S75-S82.
Leiba A, Goldberg A, Hourvitz A, Weiss G, Peres M, Karskass A, et al. Who Should Worry for the “Worried Well”? Analysis of Mild Casualties Center Drills in Non-Conventional Scenarios. Prehospital and Disaster Medicine. 2012;21(6):441-4.
Vinson E. Managing Bioterrorism Mass Casualties in an Emergency Department: Lessons Learned From a Rural Community Hospital Disaster Drill. Disaster Manag Response. 2007;5(1):18-21.
Cone DC, MacMillan DS, Parwani V, Van Gelder C. Pilot Test of a Proposed Chemical/Biological/Radiation/ Nuclear-Capable Mass Casualty Triage System. Prehosp Emerg Care. 2008;12(2):236-40.
Beaton RD, Johnson LC. Instrument Development and Evaluation of Domestic Preparedness Training for First Responders. Prehospital and Disaster Medicine. 2012;17(3):119-25.