Prepared by: Wan Nur `Izzatulfadilah binti Wan Embong (0913660) AN ANALYSIS OF DISASTER-RELATED EDUCATION/TRAINING (dret) AMONG HOSPITALS IN SELANGOR Prepared by: Wan Nur `Izzatulfadilah binti Wan Embong (0913660)

Background of Study Catastrophic events in 2012: typhoon in Philippines; floods in Thailand; floods and landslides in India in Assam state; explosion in gas factory in Mexico, near Reynosa. Author(s) Results Adini, et al. (2012) A strong to very strong relationship was found between training and drills and the total preparedness score (Israel) Duong (2009) South Australia: Disaster-related training are conducted every 2 years (57%) Never been conducted/Unsure (21%) Hsu et al. (2004) Hospital drills are effective: hospital employees are familiar with disaster procedures DISASTER: “an event that occurs suddenly in complex and the resulting loss of life, damage to property or the environment and affects the activities of the local community.”

Significance of the Study Organization Able to prepare for disaster beforehand Health Care System Effective disaster management DISASTER: “an event that occurs suddenly in complex and the resulting loss of life, damage to property or the environment and affects the activities of the local community.”

Problems Statement Disaster preparedness is still lacking hospitals weren’t prepared for large road traffic accidents (Norman et al., 2012) Documentation on disaster-related education/training is poor drill exercise charts were incomplete (Claudius et al., 2008) Health care personnel lack of disaster-related education/training 39% never had disaster training 3% never involved in a disaster response (Duong, 2009)

Objectives General objective To analyze the occurrence of DRET among hospitals in Selangor Specific objectives To determine the frequency of DRET conducted in Selangor To determine the association of frequency of DRET with hospital’s background, geographical location and resources

Research Questions What are the frequencies of DRET methods conducted among hospitals in Selangor? Is there any association between the hospital’s background and the frequencies of DRET methods? Is there any association between the hospital’s geographical location and the frequencies of DRET methods? Is there any association between the hospital’s resources background and the frequencies of DRET methods?

Research Hypotheses NULL OR ALTERNATIVE!!! Hospitals in high-risk disaster area are more prepared with DRET methods compared to hospitals in non high-risk disaster area. There is an association between hospital’s background and the frequencies of DRET methods. Hospitals with emergency physician have higher frequencies of DRET methods compared to hospitals without emergency physician.

Malaysia’s performance Literature Reviews Effectiveness of DRET Allow hospital employees to be familiar with disaster management (Hsu et al., 2004) May serve to assess level of preparedness (Beitsch, 2006) Malaysia’s performance Highland Towers 1993: Personnel were untrained Tsunami, Aceh 2004: Inadequate stockpile of medications and equipments

Research Methodology Study Design Retrospective Study Setting 10 HOSPITALS IN Selangor district Sampling Universal Sample Size 10 hospitals REFER BACK TO WHAT HAVE BEEN DISCUSSED WITH SR. AZIZAH Self-developed questionnaire is used due to the limited amount of knowledge in the area; a survey tool would be more appropriate to generate a basic understanding

Instrument/Tools Step 1 Self-developed questionnaire from literature search Step 2 Discussion with the expert from HTAA and Hospital Selayang Content validity is assumed Step 3 Questionnaires were distributed to the Head of Emergency Department

RESULTS & discussion

WHAT IS THE PURPOSE OF MEAN. YOUR ANSWER IS EITHER YES OR NO AJE KAN WHAT IS THE PURPOSE OF MEAN!!! YOUR ANSWER IS EITHER YES OR NO AJE KAN!!! NAK BUAT APE MEAN TUE!!! KALO AGE KE TOTAL MARK KE BOLEH LA BUAT MEAN!!!

Nearby high-risk disaster area? Results 1 YOUR HYPOTHESIS IS NULL OR ALTERNATIVE!!! Hypothesis 1: Hospitals in high-risk disaster area are more prepared with DRET methods compared to hospitals in non high-risk disaster area. Nearby high-risk disaster area? TOTAL Yes No Adequacy Adequate 6 (60%) 0 (0%) 6 Inadequate 3 (30%) 1 (10%) 4 9 1 10 Fisher’s Exact Test: p = 0.400

Discussion 1 So , your statement must refer to previous slide whether is null or alternative!!! Alternative hypothesis is rejected. Failed to reject the null hypothesis It may be due to the reason that every hospital has their own policy own DRET, regardless of its geographical location.

Result 2 Hypothesis 2: There is an association between hospital’s background and frequencies of DRET methods. DO YOU READ MY COMMENTS??? At A2 Type of hospital TOTAL District Tertiary Adequacy Adequate 1 (10%) 5 (50%) 6 Inadequate 4 (40%) 0 (0%) 4 5 10 Fisher’s Exact Test: p = 0.048

Discussion 2 Alternative hypothesis is failed to reject. Fail to reject the null hypothesis The is no association between hospital’s background and frequencies of DRET methods. The tertiary hospitals have longer experience as shown by the previous study demonstrated that funding, standards and experience in disaster management are the improving factors for hospital preparedness (Djalali et. al, 2012).

Availability of counsellors Results 3 Hypothesis 3: There is an association between hospital’s resources’ background and frequencies of DRET methods. Availability of counsellors TOTAL Yes No Adequacy Adequate 5 (50%) 1 (10%) 6 Inadequate 0 (0%) 4 (40%) 4 5 10 Fisher’s Exact Test: p = 0.048

Discussion 3 There is an association between hospital’s resources’ background and frequencies of DRET methods. So, null hypothesis is rejected or fail to reject the alternative hypothesis!!! Physical and human resources needed for appropriate levels of care should be available for the health services to be available and functioning at maximum capacity immediately after disasters (Gomez, Haas, Ahmed, Tien & Nathens, 2010).

Have emergency physicians Results 4 Hypothesis 4: Hospitals with emergency physicians have higher frequencies of DRET methods. Have emergency physicians TOTAL Yes No Adequacy Adequate 5 (50%) 1 (10%) 6 Inadequate 0 (0%) 4 (40%) 4 5 10 I plan to explain the finding orally. Fisher’s Exact Test: p = 0.190

Discussion 4 Alternative hypothesis is rejected. Alternative hypothesis is failed to reject. Fail to reject the null hypothesis Physicians usually play a leading role in their institutions (Gomez, Haas, Ahmed, Tien & Nathens, 2010). Not significant result may be affected by: The role of their hospital in responding to the disaster. The type of the hospital The experience of the HCP in disasters (involvement in international disaster relief work proved to be significant, p = 0.048)

Limited generalizability Limitations Limited sample size Limited generalizability Possibility of bias Limited sample size: the 10 may not be enough to provide the analysis on DRET Limited generalizability: The survey was conducted in Selangor with its unique hazards. Although the survey benefited from high response rate, the data presented is from the perspective of the head of department. Although they are well-positioned to answer the questionnaire, by its nature, there’s possible introduction to bias.

Implications This study provides data on the frequency of DRET methods conducted among hospitals in Selangor and the factors affecting it. As DRET is closely related to hospitals’ preparedness, this study provide essential data on the hospital’s capacity to respond during disaster.

Recommendations To expand the study to the other states. To implement hospital, regional, or state-level policy mandating increased frequency of drills and training, outlining the basic core training that all emergency and facility personnel should receive (Powers & Hill, 2007). To expand the study to the other states. Malaysian government has not yet set a benchmark for DRET for the hospitals and HCPs. Other countries: USA: 2 disaster drills per year for HCPs (Duong, 2009) Many communities have become over-confident in their ability to manage disasters or are so uninterested that they ignore necessary training and skills (Hartley, Stella & Walsh, 2006). The same may apply to Malaysia, because of its lack of disaster. To implement hospital, regional, or state-level policy mandating increased frequency of drills and training, outlining the basic core training that all emergency and facility personnel should receive (Powers & Hill, 2007).

Conclusion All participating hospitals have hospitals’ disaster plan and respective code to activate their plan according to their standard of procedure. 7 hospitals have disaster command centre but only 6 hospitals have experience operating the system. Out of 10 hospitals, only 6 were found to have adequate frequency of DRET (>5 times). 6 of the HODs rated their ED as fair in managing victims during disaster while the remaining 4 rated as good.

References Adini, B., Goldberg, A., Cohen, R., Laor, D. & Bar-Dayan, Y. (2012). Evidence-based support for the all-hazards approach to emergency preparedness. Israel Journal of Health Policy Research, 1 (40). Retrieved September 6, 2012, from http://www.ijhpr.org/content/1/1/40. Beitsch, L. M., Kodolikar, S., Stephens, T., Shodell, D., Clawson, A., Menachemi, N. & Brooks, R. G. (2006). A State-based Analysis of Public Health Preparedness Programs in the Unites States. Public Health Reports, 121, 737-745. Retrieved September 15, 2012, from www.ncbi.nlm.nih.gov/pubmed/17278409 Claudius, I., Solomon, B., Ballow, S., Wood, R., Stevenson, K., Blake, N. & Upperman, J. S. (2008). Disaster Drill Exercise Documentation and Management: Are We Drilling to Standard?. Journal of Emergency Nursing, 34, 504-508. doi: 10.1016/j.jen.2008.03.006 Djalali, A., Castren, M., Hosseinijenab, V., Khatib, M., Ohlen, G. & Kurland, S. (2012). Hospital Incidence Command System (HICS) Performance in Iran; Decision Making during Disaster. Scandinavian Journal of Trauma, Resuscitation and Emergency Medinice, 20 (14). doi:10.1186/1757-7241-20-14

References Duong, K. (2009). Disaster education and training of emergency nurses in South Australia. Australasian Emergency Nursing Journal, 12, 86-92. Gomez, D., Haas, B., Ahmed, N., Tien, H. & Nathens A. (2011). Disaster preparedness of Canadian trauma centres: the perspective of medical directors of trauma. Canadian Journal of Surgery, 54 (1), 9-16. doi: 10.1503/cjs.022909. Hsu, B. E., Jenckes, M. W., Catlett, C. L., Robinson, K. A., Feuerstein, C., Cosgrove, S. E., Green, G. B. & Bass, E. B. (2004). Effectiveness of Hospital Staff Mass-Casualty Incident Training Methods: A Systematic Literature Review. Prehospital and Disaster Medicine, 19 (3), 191-199. doi: http://dx.doi.org/10.1017/s1049023x00001771 Norman, D., Aikins, M., Binka, F. N. & Nyarko, K. M. (2012). Hospital All-Risk Emergency Preparedness in Ghana. Ghana Medical Journal, 46 (1), 34-42. Retrieved September 5, 2012, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3353500/