Professional Documents
Culture Documents
Dimension Score between 1 (‘very familiar’) and 5 (‘unfamiliar’) the extent to which are you familiar with: Score
Incident 1. The functional group in the incident command system (ICS) to which you are assigned during large‑scale
command emergency events.
system 2. The location to which you would report if a large-scale emergency event occurred.
3. Your agency’s preparedness for responding to large-scale emergency events.
4. The content of the emergency operations plan, or major incident plan, in the local primary care trust.
5. The strategic rationale for the ICS response and action plan.
6. Assessing site safety for yourself, co-workers and victims during large-scale emergency events.
7. Differences between the ICS’s decision-making processes for large-scale emergency and non‑emergency events.
8. Tasks that should not be delegated to volunteers during large-scale emergency events.
Psychological 21. Signs of post-traumatic stress in patients who have been seen for routine healthcare checks following
issues and a large‑scale emergency event.
special 22. Detecting and evaluating post-traumatic stress or other mental health problems in a child or teenager.
populations 23. Appropriate psychological support for all people involved in a large-scale emergency event.
24. Providing health counselling and education to patients on the long-term impact of chemical, biological,
radiological, nuclear and explosive (CBRNE) agents.
25. The appropriate care of especially vulnerable patients during large-scale emergency events.
26. Procedures for providing care to children and younger people during large-scale emergency events
when consent cannot be obtained from their parents or legal guardians.
Isolation, 27. Selecting the appropriate personal protective equipment when caring for patients exposed to CBRNE agents.
decontamination 28. Isolation procedures for people exposed to biological or chemical agents.
and quarantine 29. Your facility’s isolation and quarantine procedures.
30. The decontamination procedures stated in your facility’s emergency operations or major incident plans.
31. The impact on the environment of large-scale emergency events.
Epidemiology 32. Assessing history and physical data when there is a high index of suspicion that a patient has been exposed
and clinical to a biological agent.
decision making 33. Identifying the exacerbation of underlying diseases due to exposure to CBRNE agents.
34. The ethical, legal, cultural and safety issues relating to the proper handling of the dead during large‑scale
emergency events.
Reporting and 35. The diseases that are immediately reportable to the Department of Health.
accessing critical 36. When unusual symptoms should be reported.
resources 37. Determining the appropriate agency to which reportable diseases are to be directed.
38. Accessing up-to-date resources quickly about specific CBRNE agents.
Biological agents 39. Modes of transmission for different types of biological agents such as anthrax and smallpox.
40. Signs and symptoms of exposure to different biological agents.
41. Assessing staff familiarity with response activities and preparedness during large-scale emergency events.
Table 2 Familiarity scores and difference from the Health Protection Agency (Heptonstall
and Gent 2008). Participation in the pilot study
Dimension Question Mean familiarity score before Difference
number and after intervention was anonymous and the consent of participants
was assumed by their completion and return of
Before After
the questionnaires.
A Incident 1 4.12 2.72 Forty one members of staff, of whom
command system 2 3.45 2.63
3 4.37 3.09 33 are registered nurses and eight are healthcare
4 4.02 3.03 assistants, agreed to take part in the study.
5 4.45 2.96 Forty (98 per cent) participants completed the
6 3.82 2.72 questionnaires and took part in the learning
7 4.27 2.96 intervention. Of these, 33 (80 per cent) completed
8 4.00 2.54
the questionnaires again.
Mean familiarity score 3.80 2.76 1.04
B Triage 9 3.60 2.66 Results and discussion
10 3.67 2.66 After participants had provided familiarity scores
11 3.35 2.54
12 4.30 3.03 for each statement, the mean scores, as well as
13 4.10 2.93 the standard deviation and mean standard error,
Mean familiarity score 3.81 2.79 1.02 before and after the intervention were calculated.
Also calculated were the mean familiarity scores
C Communications 14 4.60 3.03
and connectivity 15 4.17 3.06 for each emergency preparedness dimension, the
16 4.25 3.09 differences between them and the mean familiarity
17 4.35 3.12 score for the questionnaire as a whole. The results
18 4.42 3.06 can be seen in Table 2.
19 4.20 2.78 The familiarity scores before and after the
20 3.45 2.81
intervention were then subject to paired t-tests to
Mean familiarity score 4.06 2.83 1.23 find out if differences between them are significant.
D Psychological 21 4.25 2.81 The results of the paired t-tests were found to be
issues and special 22 4.47 3.18 statistically significant, indicating that the adapted
populations 23 4.15 2.93
24 4.77 3.36 EPIQ is a robust instrument for assessing self-
25 4.07 3.06 reported preparedness for disasters. Intermediate
26 4.15 2.96 values used in the calculations are shown in Table 3.
Mean familiarity score 4.20 2.93 1.34 Participants’ scores before and after the
E Isolation, 27 3.85 2.87 intervention show that they are most familiar
decontamination 28 4.35 2.93 with the emergency preparedness dimensions
and quarantine 29 4.55 3.18 relating to the incident command system, triage,
30 4.32 3.24 and reporting and assessing clinical resources.
31 4.10 3.03 They recorded low familiarity scores before and
Mean familiarity score 4.23 2.99 1.21 after the intervention in two dimensions, namely
F Epidemiology and 32 4.50 3.09 epidemiology and clinical decision making, and
clinical decision 33 4.60 2.96 psychological issues and special populations.
making 34 4.35 2.96
Differences between the pre- and
Mean familiarity score 4.27 3.00 1.48 post‑intervention dimension scores indicate the
G Reporting and 35 3.45 2.57 extent to which the interventions had familiarised
accessing critical 36 3.67 2.75 participants with the relevant dimensions.
resources 37 3.97 2.78
Nine participants (23 per cent of the total
38 4.17 3.09
who took part) indicated on the pre-intervention
Mean familiarity score 4.31 3.05 1.18
questionnaires that they had received previous
H Biological agents 39 4.30 2.96 emergency preparedness training. Of these,
40 4.25 2.90
two (5 per cent) had received training in the previous
41 4.45 3.00
12 months and four (10 per cent) had received
Mean familiarity score 4.48 3.05 1.26
it in the previous three years. The remaining
Total mean familiarity score 4.1390 2.9276 1.2114 31 (78 per cent) claimed they had had no previous
Standard deviation 0.3489 0.1945 emergency preparedness training.
Mean standard error 0.0545 0.0304 The results of the study suggest that the
adapted EPIQ is a robust instrument for measuring
self‑assessed familiarity with emergency Table 3 Paired t-test results and intermediate values used in calculations
preparedness among MIU staff. Results of the
EPIQ should be interpreted cautiously, however, Two-tailed P value and statistical significance < 0.0001
because self-assessments are by definition
subjective. Comparisons of the original and adapted Ninety five per cent confidence interval of difference 1.1395 – 1.2834
EPIQs should also be interpreted cautiously, for between mean scores
four reasons:
■■ The adapted EPIQ is accompanied by a learning t value 34.0410
intervention but the original version is not.
■■ The adapted EPIQ was delivered directly to Degrees of freedom 40
participants whereas the original version was
completed online. Standard error of difference 0.036
■■ Completing the same questionnaire in the
same format twice may have led participants and reflect on their skills. This shows that the use
to exaggerate their scores in the second of the EPIQ can highlight concerns about lack of
questionnaire needlessly. emergency preparedness but, without the inclusion
■■ In Wisniewski et al’s (2004a) and Garbutt et al’s of a learning intervention, cannot necessarily
(2008) studies, only nurses had completed the address them.
EPIQ. In the study under discussion, the adapted All participants had received instructions on
EPIQ was completed by unregistered staff too. the use of personal protective equipment (PPE)
Nevertheless, there are similarities between during influenza pandemics and all of those who
Wisniewski et al’s (2004a) and Garbutt et al’s are registered nurses had received mandatory
(2008) study results, and those of the author’s immunisation training, including the management
study. For example, the dimension with which MIU of H1N1, as part of their standard education
staff were found to be most familiar was triage, programmes. No participants referred to this
probably because this forms part of their training as ‘previous training’ in their pre-intervention
and day‑to‑day practice. Similarly, the part of the questionnaires, however, which indicates that
learning intervention that concerns triage was they, and by extension MIU staff in general, may
largely familiar to MIU staff, and so the difference not understand what constitutes emergency
in mean familiarity scores for triage before and preparedness training.
after the intervention is smaller than that for the Kerby et al (2005) suggest that many healthcare
other dimensions. workers are poor judges of their knowledge,
It should be noted, however, that the triage and that such poor judgement is not always revealed
system adopted in disaster situations can differ by single self-assessments. However, offering
significantly from that followed in conventional healthcare staff opportunities to assess themselves
emergency care settings (Castle 2006), which means can encourage them to take responsibility for
that participants in the study may have indicated their work and evaluate their decision-making
that they know more about the kinds of triage skills skills, both of which are important elements
needed in disaster situations than they do. of emergency preparedness. Pre- and post-
Participants stated that they were less familiar intervention self-assessment opportunities can also
with isolation, decontamination and quarantine, inform the development of training programmes.
and the difference in mean familiarity scores before
and after the intervention was greater than that Limitations
for triage. Again, this suggests the participants The sample size in this study is small compared with
initially considered themselves more familiar with those by Wisniewski et al (2004a) and Garbutt et al
isolation, decontamination and quarantine than (2008). Given this, and the need to preserve the
they actually were. anonymity of participants, the study includes no
The dimension with which participants were demographic data.
least familiar before undertaking the intervention, In addition, the views of the participants, all of
and in which the difference between mean pre- and whom work in nurse-led MIUs, do not necessarily
post-intervention scores was largest, concerned represent those of staff in MIUs that are affiliated
biological agents. to EDs and not led by nurses.
The differences in mean familiarity scores for Finally, it had been decided that the adapted
all the dimensions shows that, by undertaking the EPIQ’s scoring system, in which greater familiarity
intervention, participants were able to reappraise is indicated by lower scores, should be identical
to the original version and as the EPIQ appears emergency preparedness needs of MIU nurses
online. Participants are more familiar with a is more important.
scoring system in which greater familiarity is
indicated by higher scores, and may have become Disaster trends Garbutt et al (2008) suggest that
confused. This may have the influenced results. the EPIQ can be used to survey the opinions of
It should be noted that, in Wisniewski et al’s nurses in any practice settings. In its current
(2004a) and Garbutt et al’s (2008) studies, the EPIQ format, it concerns mainly biological and chemical
was completed anonymously online and it is possible events, which may be considered a limitation, but
that some nurses took part in both studies. If so, there is scope for adapting it to reflect disaster
such nurses may have completed the second of trends and demands. In addition, the EPIQ’s
the studies inaccurately. This problem may have eight emergency preparedness dimensions can
been avoided if the studies had included learning be the framework for a modular-type training
interventions, and this should be borne in mind programme. The questions, which concern mainly
in future studies of emergency preparedness that terrorism events, can be changed to encompass
involve the EPIQ. all types of disaster, or new questions or dimensions
can be added.
Further research
Comparison The EPIQ appears to be the only Different grades The author’s study is the first
emergency preparedness self-assessment tool in which healthcare assistants have completed a
to be evaluated, so there is no similar tool with version of the EPIQ, although they are not identified
which it can be compared. The readiness estimate as such in the data analysis. Because of the study’s
and deployability index (Reineck et al 2001), small sample size, the familiarity with emergency
a self‑assessment instrument for military nurses preparedness of nurses of specific grades could not
working in austere environments, has been adapted be assessed, but should be considered as a subject
for civilian nurses (Reineck 2004) but there are of further studies.
no reports on its use. While a comparison of the The structure and content of the EPIQ should be
EPIQ with other self-assessment tools is desirable, relevant to all bands of registered and non‑registered
development of the EPIQ to reflect the diverse nurses, and should allow participants to provide
References
Barnett DJ, Balicer RD, Blodgett DW et al Duong K (2009) Disaster education and training Gebbie K, Qureshi K (2002) Emergency and Kerby DS, Brand MW Elledge et al (2005)
(2005) Applying risk perception theory to public of emergency nurses in South Australia. disaster preparedness: core competencies Are public health workers aware of what they
health workforce preparedness training. Journal Australasian Emergency Nursing Journal. for nurses: what every nurse should but don’t know? Biosecurity and Bioterrorism:
of Public Health Management and Practice. 12, 3, 86‑92. may not know. American Journal of Nursing. Biodefense Strategy Practice Science. 3, 1, 31‑38.
11, 6, s33‑s37. 102, 1, 46‑50.
Fung OW, Loke AY, Lai CK (2008) Disaster Krau SD, Parsons LC (2007) Avian Influenza:
Castle N (2006) Triage and transport decisions preparedness among Hong Kong nurses. Gilmore Commission (2003) Fourth Annual are we ready? Critical Care Nursing Clinics of
after mass casualty incidents. Emergency Nurse. Journal of Advanced Nursing. 62, 6, 698‑703. Report to the President and the Congress North America. 19, 1, 107‑113.
14, 1, 22‑25. of the Advisory Panel to Assess Domestic
Fung OW, Lai CK, Loke AY (2009) Nurses’ Lockey DJ, Mackenzie R, Redhead J et al
Response Capabilities for Terrorism Involving
Cole FL (2005) The role of the nurse practioner perception of disaster: implications for disaster (2005) London bombings July 2005:
Weapons of Mass Destruction: Implementing
in disaster planning and response. Nursing nursing curriculum. Journal of Clinical Nursing. the immediate pre-hospital medical response.
the National Strategy. http://tiny.cc/7ppff
Clinics of North America. 40, 3, 511‑521. 18, 22, 3165‑3171. Resuscitation. 66, 2, 9‑12.
(Last accessed: January 18 2012.)
Considine J, Mitchell B (2009) Chemical Garbutt SJ, Peltier JW, Fitzpatrick JJ (2008) Nursing Emergency Preparedness Education
Heptonstall J, Gent N (2008) CBRN Incidents:
biological and radiological incidents: Evaluation of an instrument to measure nurses’ Coalition (2003) Educational Competencies
Clinical Management and Health Protection.
preparedness and perceptions of emergency familiarity with emergency preparedness. for Registered Nurses Responding to Mass
Version 4. Health Protection Agency, London.
nurses. Disasters. 33, 3, 482‑497. Military Medicine. 173, 11, 1073‑1077. Casualty Incidents. http://tiny.cc/6utqw
Hoyois P, Below R, Scheuren J et al (2007) (Last accessed: January 18 2012.)
Douglas V (2007) Developing disaster Garfield R, Ward N (2008) Where are we and
Annual Disaster Statistical Review: Numbers
management modules: a collaborative approach. where shall we go in nursing and emergencies? Nursing and Midwifery Council (2011)
and Trends 2006. Centre for Research on the
British Journal of Nursing. 16, 9, 526‑529. Special report. Prehospital and Disaster Annual Fitness to Practise Report 2010-2011.
Epidemiology of Disasters, Brussels.
Medicine. 23, 1, s9‑s10. The Stationery Office, London.
feedback. Qualitative methods of data collection, such size precluded any investigation of the influence
as focus groups, may allow different perspectives to of gender on emergency preparedness.
be discussed and clarified. In adopting such methods
of data collection, it may be beneficial to group Conclusion
participants, according to their levels of qualification, Although the pilot study discussed in this article
to reflect on their specific training needs. This could has produced useful data on familiarity with
result in a complete revision of the EPIQ to consider emergency preparedness among MIU nurses, such
the issues specific to MIU staff. familiarity among healthcare professionals in general
Regardless of band, individuals may be expected remains largely unexplored and further research into
to assume a variety of roles during disasters, so it is the topic is essential. Online archive
vital they have the skills and knowledge to perform If completed in conjunction with a learning
For related information, visit
effectively and efficiently, and that they are not intervention, the EPIQ is useful for measuring
our online archive of more
assigned roles for which they are unprepared. self-assessed familiarity. When used without an than 6,000 articles and
intervention, the EPIQ may fail to raise participants’ search using the keywords
Gender difference O’Boyle et al (2006) suggest awareness of emergency preparedness or to
that emergency preparedness involves more than stimulate reflective thinking among them. Conflict of interest
access to material resources or the acquiring Natural and non-natural events are distinct from Research for this study was
undertaken as part of a master’s
of skills, while Barnett et al (2005) state that one another and this distinction should be taken degree in disaster relief health
emergency preparedness and risk perception into account in assessments of disaster management care. The author is an emergency
can be influenced by a range of factors including trends. The EPIQ’s chief value, therefore, may be in nurse practitioner in the minor
injury service sampled in the study
emotional and practical problems. its use as a template for emergency preparedness
O’Sullivan et al (2008) suggest that women tools that can measure the needs of individual Acknowledgement
tend to perceive higher levels of risk than men healthcare professionals. The author would like to
thank the teaching staff at
and, given that women comprise 89 per cent of It is hoped that the study findings will inform the the University of Glamorgan,
the UK nursing workforce (Nursing and Midwifery development of emergency preparedness training for particularly lecturer in critical
Council 2011), this could be the subject of further MIU nurses locally and will prompt nurses in a range care physiology Ray Higginson
and professor of health research
exploration. In the author’s study, all but one of clinical settings to review their perception of, and George Kernohan, for their
participant were women, and the small sample familiarity with, emergency preparedness. support and encouragement
O’Boyle C, Robertson C, Secor‑Turner M (2006) Reilly M, Markenson D (2009) Education and Slepski LA (2005) Emergency preparedness: Veenema TG (2006) Expanding educational
Nurses’ beliefs about public health emergencies: training of hospital workers: who are essential concept development for nursing practice. opportunities in disaster response and
fear of abandonment. American Journal of personnel during a disaster? Prehospital and Nursing Clinics of North America. emergency preparedness for nurses.
Infection Control. 34, 6, 351‑357. Disaster Medicine. 24, 3, 239‑245. 40, 3, 419‑430. Nursing Education Perspectives. 27, 2, 93‑99.
O’Sullivan T, Dow D, Turner M et al (2008) Reineck C, Finstuen K, Connelly L et al (2001) Stanley JM (2005) Disaster competency Weiner E (2006) Preparing nurses
Disaster and emergency management: Canadian Army nurse readiness instrument: psychometric development and integration in nursing internationally for emergency planning
nurses perceptions of preparedness on hospital evaluation and field administration. Military education. Nursing Clinics of North America. and response. Online Journal of Issues
front lines. Prehospital and Disaster Medicine. Medicine. 166, 11, 931‑939. 40, 3, 453‑467. in Nursing. 11, 3, 4.
23, 3, s11‑s18.
Reineck C (2004) The readiness estimate and Subbarao I, Lyznicki J, Hsu E et al (2008) Williams J, Nocera M, Casteel C (2008)
Pelaccia T, Delplancq H, Triby E et al (2008) deployability index: a self‑assessment tool A consensus‑based educational framework The effectiveness of disaster training for
Can teaching methods based on pattern for emergency center RNs in preparation for and competency set for the discipline healthcare workers: a systematic review.
recognition skill development optimise triage disaster care. Topics in Emergency Medicine. of disaster medicine and public health Annals of Emergency Medicine. 52, 3, 211‑222.
in mass casualty incidents? Emergency Medicine 26, 4, 349‑356. preparedness. Disaster Medicine and Public
Wisniewski R. Dennik‑Champion G, Peltier J
Journal. 26, 12, 899‑902. Health Preparedness. 2, 1, 57‑68.
Robinson SM, Sutherland HR, Spooner DJ et al (2004a) Emergency preparedness competencies
Powers R (2009) Evidence‑based ED disaster (2009) Ten things your emergency department Taylor I (2005) Terrorism: the reality of blast assessing nurses’ educational needs. Journal
planning. Journal of Emergency Nursing. should consider to prepare for pandemic injuries. Emergency Nurse. 13, 8, 22‑25. of Nursing Administration. 34, 10, 475‑480.
35, 3, 218‑223. influenza. Emergency Medicine Journal.
Turale S (2008) How prepared are nurses and Wisniewski R. Dennik‑Champion G,
26, 7, 497‑500.
Rebman T (2006) Defining bio‑terrorism other professionals to cope in and manage Peltier J (2004b) Emergency Preparedness
preparedness for nurses: concept analysis. disaster situations? Nursing and Health Information Questionnaire. http://tiny.cc/vwbei
Journal of Advanced Nursing. 54, 5, 623‑632. Sciences. 10, 3, 165‑166. (Last accessed: January 18 2012.)