DMM 648 UNH Management for Special Needs People in Refugee Camps Research Proposal so my friend now we need to put all the work we did on this topic togeth

DMM 648 UNH Management for Special Needs People in Refugee Camps Research Proposal so my friend now we need to put all the work we did on this topic together and finish a research propasal and then you can finish the research the paper so I will put all the work we did here and also I will be the instructions on how to put the research proposal together and an example to so you can have an idea how to put them together , it should be easy since we did all the work MCI triage research outline
Mass casualty field triage protocols
Mass casualty field triage protocols: A look at standardization.
Joshua Bezanson
Philadelphia University
DMM-657
September 27, 2009
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MCI triage research outline
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Mass casualty field triage protocols: A look at standardization.
Research outline
Abstract
Objective: To evaluate the level of standardization in mass casualty triage
techniques among disaster response agencies in Canada. The hypothesis of the study
is that there is little to no uniformity in how pre-hospital care providers currently triage or
categorize victims of a mass casualty incident between different agencies in Canada.
Methods: The research consists of an online questionnaire that is designed to
collect specific information about the surveyed organization and its plans or policies for
triaging mass casualties such as what triage technique they currently use and its
similarity to neighboring response agencies. Invitations to participate will be distributed
electronically and by mail to a list of 113 stakeholder organizations.
Results: The results will provide reliable data about the current triage programs
in use in Canada and prove of disprove the hypothesis that there is little to no uniformity
in how pre-hospital care providers currently triage mass casualties.
Introduction
Mass casualty triage is a dynamic and inherently complex operation. A manmade or natural disaster such as a hurricane, toxic chemical release or act of terrorism
may require that a large amount of patients be evaluated and prioritized in a short
period of time. Triage is that operation. Sztajnkrycer, Madsen & Ba´ez (2006) describe it
as “the most important initial medical function during a mass casualty event” and the
“system that occurs when available resources are insufficient to provide for the needs of
all patients” (p. 4). These occurrences are often referred to as an MCI (Mass Casualty
Incident). Since a disaster may strike anywhere, there are many different players who
could be involved in conducting triage such as emergency medical services, fire
departments, volunteer first responders or the military. Disasters also often overwhelm
local resources and require multiple agencies such as those listed above to work
MCI triage research outline
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together. Effective interoperability is essential however may be difficult if each agency
uses discrete terminology and techniques. As Lerner puts it; “Large scale disaster
require cross-jurisdictional cooperation and highlight the need for a national,
standardized approach to mass casualty triage” (Lerner, E. B. et al. , 2008). To date it
is unclear to what extent any standardized approach to triage has been taken in Canada
and that is what this study intends to determine.
It is the further hope of the researcher that the collection of this data will support
the need for the adoption of a national mass casualty triage standard and encourage
subsequent research to refine it once adopted. It is not the intent of this study to
compare any individual triage method to another or to evaluate its effectiveness.
Review of the literature
This study will add to the current body of knowledge regarding mass casualty
triage by collecting valid data surrounding the current state of standardization of triage
techniques specifically in the Canadian context. The literature contains many anecdotal
reports of various triage schemes that were used during mass casualty events but with
mixed evidence and conclusions as to their effectiveness (Lerner, E. B. et al. , 2008).
Some of the more common triage schemes are START (Simple Triage and Rapid
Treatment/ Transport), MASS (Move, Assess, Sort, Send), STM, (Sacco triage method),
CareFlite, SALT (Sort, Assess, life-saving interventions, transport) and military triage.
While investigators such as Asaeda (2002), Kahn (2007) and Frykberg (2002)
anecdotally state that the START triage method is the most widely used in the United
States, there is no firm data to support this or that the same could be said for Canada.
MCI triage research outline
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The relevance and usefulness of this study is based on a few key assumptions
that the current literature supports. The first is that MCI triage is not a trivial matter and
may have a direct impact on victim outcome. Fryberg (2002) does provide data to
support that effective triage can both be lifesaving and can be improved significantly
with minimal training of the triage provider. The second assumption is that there is value
to be had by increased interoperability and that communication and terminology are
important components of that. Australian researchers such as Nocera and Garner
(1999) have provided evidence to support both of these conclusions in terms of triage
effectiveness. The concept that terminology alone may act as a significant
communication barrier in disasters is also supported by NIMS (National Incident
Management System) that prohibits the use of agency specific terminology such as
radio 10-codes. The terminology and color coding of the various triage techniques in
relation to clinical significance is far from uniform (Lerner, E. B. et al. , 2008).
The literature thus provides us with a solid foot-hold on which to continue our
investigation. As researchers continually develop and introduce more new triage
schemes, the level of variety of those used in the field will likely also increase.
Methods
This study will utilize on online questionnaire that is purposely designed to be
concise to increase the likelihood of participant response. The questionnaire contains 7
questions. The first 3 deal specifically with current triage practices and will be most
useful in proving or disproving the hypothesis. To add additional context to the data
there are also two questions that ask respondents to categorize their agency or
organization and response jurisdiction. The final questions ask if the organization would
MCI triage research outline
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be interested in conforming to a national triage standard if one were adopted (as
supplemental information) and also provide an optional entry of contact information for
follow-up. There is a final text box that allows for additional participant comments to be
added in an effort to collect any additional qualitative data since all of the other
collection points require formatted data or check boxes. The open text box may thus
allow for further triangulation of methods or offer relevant information the researcher
was unaware of. A copy of the full questionnaire is included in the appendix.
The survey population that will be contacted was identified as a convenience
sample representing all the major stakeholders that might be involved in providing mass
casualty triage at the local, provincial and federal levels. 113 contacts were identified in
total. At the federal level this included organizations such as the military, coast guard,
public health agencies, NGO’s, professional organizations and service groups such as
the Canadian Ski Patrol system and St.John Ambulance. The provincial level included
emergency management agencies, search and rescue organizations, DMAT (Disaster
Medical Assistance Teams), PERT’s, (Provincial Emergency Response Teams),
HUSAR (Heavy Urban Search and Rescue) groups and provincial air ambulance
providers. To maintain a reasonable scope of local first response agencies such as
municipal fire departments and EMS (emergency medical services providers), the
researcher used a convenience sample of including the fire and EMS departments from
the three largest municipalities of each province. The three Canadian territories;
Nunavut, The Yukon and the Northwest Territories, due to their remote nature and
limited populations only had identifiable EMS response agencies in their three capital
cities respectively.
MCI triage research outline
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Each of the 113 contacts were then subdivided again into three categories:
Parent organization / association, response agency or other stakeholder. This was done
to facilitate a customized invitation letter for each stakeholder to attempt to gain as
many responses as possible. The parent organization category includes contacts such
as the National Search and Rescue secretariat that represents hundreds of various
search and rescue organizations across the country. The invitation to participate will
request organizations such as these to freely distribute the link to the online
questionnaire to all of their members. Thus the expectation of the researcher is to
receive many more than 113 responses. The response agencies will be requested to
answer based on their individual triage protocols/ plans and the other stakeholder group
represent government agencies or professional groups that may only have a regulatory
or standard setting role instead of a response role. The full list of identified stakeholders
is also listed in the appendix.
The data will be collected electronically over the period of 2 months with a
reminder mailing sent out to participants that do not respond within 1 month. The online
questionnaire allows for a total response count, simple statistical calculation of
responses and accounting of questions that were skipped or omitted.
Limitations
While this study may yield data about what MCI triage techniques are most
popular in Canada, this study will not provide any reliable data about what techniques
are most effective nor should any relation of such be inferred. While the sample size is
reasonable, the distribution list is based on a convenience sample and thus may not be
reflective of all agencies. Although an online survey is cost effective and reliable, one
MCI triage research outline
potential limitation may be the unrestricted public access to participation in the survey.
The questionnaire web application does allow for a geographic restriction of nonCanadian computer IP addresses and multiple entries from one computer, however we
are reliant on the participants correct and truthful reporting of their organizational
affiliations to reflect good data. A pass-code to take the survey will prevent other nonparticipant internet users from completing the questionnaire however that will only be
effective if the pass-codes are kept private among participant groups.
Work Plan
Week 1 : Ensure IRB approval, review contact list information for accuracy.
Week 2 : Activate survey online and invite stakeholders to participate.
Week 3 -5: Monitor and review survey results.
Week 6 : Send out reminder invitation to stakeholder who have not yet replied
Week 7 – 9 : Monitor and review survey results.
Week 10 : Close online questionnaire, begin to analyze and sort data.
Week 11-12 : Author final research findings and submit for potential publication (ex. CJEM,
Canadian Journal of Emergency Medicine).
Expected data and Conclusions
At the completion of this study the author expects to have obtained strong
numerical data to outline the various triage techniques in use in Canada. If the data
suggests that the majority of respondents are using the same triage scheme (ie.
START) across Canada then the hypothesis will have been disproven. If the data
suggests a more fragmented and non-uniform distribution of triage schemes it will have
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MCI triage research outline
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be proven. This may then further support the need for a more standardized approach.
Of interest will be analyzing themes to determine if the various triage systems are used
more or less by certain agencies (ie. EMS departments and DMAT’s prefer SALT while
Fire departments prefer MASS). These sorts of findings would then also call for future
investigation. Regardless of outcome, it is the hope of this researcher that the results
will add a valuable contribution to the current body of knowledge regarding MCI triage
and be of value to the emergency planner, EMS medical director, triage practitioner and
the public they serve.
References
Asaeda, G. (2002). The day that the START triage system came to a STOP:
observations from the world trade center disaster. [ABSTRACT] Academic
Emergency Medicine. [Electronic version]. Retrieved September 26, 2009,
from Pubmed. PMID: 11874794
Federal Emergeny Management Agency. (2009, September 10). NIMS alert:
NIMS and use of plain language. [Electronic resource] Retrieved
September 19, 2009, from
http://www.fema.gov/pdf/emergency/nims/NIMS_ALERT_06-09.pdf
Frykberg, E. R. (2002.) Medical management of disasters and mass casualties
from terrorist bombings: how can we cope? Journal of Trauma [Electronic
version]. Retrieved September 26, 2009, from Pubmed. PMID: 12169923
MCI triage research outline
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Kahn C, Schultz C, Miller K, et al. Does START triage work? An outcomes-level
assessment of use at a mass casualty event. Academic Emergency
Medicine. [Electronic Version]. Retrieved September 26, 2009, from
http://dc8qa4cy3n.search.serialssolutions.com/?
V=1.0&N=150&L=DC8QA4CY3N&S=AC_T_B&C=academic+emergency+
medicine
Lerner, E. Brooke, Schwartz, Richard B., Coule, Phillip L., Weinstein, Eric S.,
Cone, David C., Hunt, Richard C., Sasser, Scott M., Liu, J. Marc, Nudell,
Nikiah G., Wedmore, Ian S., Hammond, Jeffrey, Bulger, Eileen M.,
Salomone, Jeffrey P., Sanddal, Teri L., Lord, Graydon C., Markenson,
David, O’Connor, Robert E. (2008). Mass Casualty Triage: An Evaluation
of the Data and Development of a Proposed National Guideline. Disaster
medicine and public health preparedness.
Nocera, A. & Garner A. (1999) An Australian mass casualty triage system for the
future based upon triage mistakes of the past: the homebush triage
standard. The Australian and New Zealand Journal of Surgery. [Electronic
version]. Retrieved September 26, 2009, from Pubmed. PMID: 10472920
Sztajnkrycer, D. Madsen, B. E. & Ba´ez, A. A. (2006) Unstable ethical plateaus
and disaster triage. Emergency Medicine Clinics of North America.
MCI triage research outline
Appendices
Survey screenshots.
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MCI triage research outline
List of Contacts.
Region
National
Organization
EMS Chiefs of Canada
Paramedic Association of Canada
CAEP- Canadian Assoc of Emergency
Physicians
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MCI triage research outline
NAEMSP, Canadian Committee – Nntl Assoc.
of EMS Physicians
NSS – National Search and Rescue
Secretariat
PHAC – Public Health Agency of Canada
NOHERT – National Office of Health
Emergency Response Teams
PSC – Public Safety Canada, Emergency
Management division
Canada Command Search and Rescue,
National Defense
Canadian Forces, Health Services
Canadian Forces, DRDC
Canadian Coast Guard, SAR
Canadian Coast Guard Auxillary
Canadian Police Association
St.John Ambulance, Brigade response
Canadian Ski Patrol System
Canadian Red Cross Disaster services
ACERT – Assoc. of Campus Emergency
Response Teams of Canada
Civil Air Search and Rescue Association
Alberta
British
Columbia
Manitoba
Alberta Health Services, EMS branch
Alberta Emergency Management Agency
Alberta College of Paramedics
City of Calgary Emergency Medical Services
City of Calgary Fire Department
City of Edmonton Emergency Medical
Services
City of Edmonton Fire Department
CANTF2 – Heavy Urban Search and Rescue
Search and Rescue Alberta
STARS – Shock Trauma Air Rescue Society
Red Deer Emergency Services
British Columbia Ambulance Service
British Columbia Emergency Management
City of Vancouver Fire Department
City of Surrey Fire Department
City of Burnaby Fire Department
Search and Rescue British Columbia
CANTF1 – Heavy Urban Search and Rescue
Ambulance Paramedics of British Columbia
Manitoba Emergency Measures Organization
Manitoba Health – EMS branch
Winnipeg Fire Paramedic Service
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MCI triage research outline
Brandon Fire/EMS Department
City of Thompson Emergency Services
CANTF4 Manitoba HUSAR
Paramedic Association of Manitoba
Manitoba Search & Rescue
Nefoundland&
Labrador
Emergency Measures Organization
Paramedic Association of Newfoundland and
Labrador
Provincial Medical Oversight Program
Newfoundland Association of Ambulance
Services
Newfoundland and Labrador Community
Ambulance Operators Association
The Newfoundland and Labrador Search and
Rescue Association
St. John’s Regional Fire Department
Corner Brook Fire Department
New Brunswick
Nova Scotia
Ontario
New Brunswick health / Ambulance NB
New Brunswick Emergency Measures
Organization
Paramedic Association of New Brunswick
New Brunswick Ground Search and Rescue
Association
Saint John Fire Department
Moncton Fire Department
City of Fredericton Fire Department
Nova Scotia EHS – Emergency Health
Services
EMO Nova Scotia
CANTF 5 -HUSAR
College of Paramedics of Nova Scotia
Halifax Regional Fire & Emergency Service
Cape Breton Regional Municipality Fire
Services
Cape Breton Regional Municipality
Emergency Measures Organization
New Glasgow Fire Department
Ontario Ministry of Health EHS
Emergency Management Ontario
Ornge
Ontario Paramedic Association
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MCI triage research outline
Ontario EMAT – Emerg Medical Assistance
team
Ontario Provincial Police – PERT
CANTF-3 HUSAR
Toronto EMS
Toronto Fire Service
Mississauga Fire & Emergency Services
Ottawa Paramedic Service
Ottawa Fire Service
Ontario Volunteer SAR association
OVERT – Ontario Volunteer Emerg. Response
Prince Edward
Island
Department of Health, PEI
EMO PEI
Summerside Fire Department
Charlottetown Fire Department
PEI Ground Search and Rescue
Quebec
Quebec Health and Social Services
L’association des paramedics du Quebec
Quebec Civil protection
Urgences-Sante
Montreal Fire department
Quebec City Fire department
Laval Fire department
Saskatchewan
Saskatchewan Health
SaskEMO – Emergency Mangagement
Saskatchewan College of Paramedics
MD Ambulance
Saskatoon Fire & Protective services
Regina Fire department
Prince Albert Fire and Emergency Service
SarSav – SAR Sask. Assoc. of Volunteers
Territories
(YK,NWT,NVT)
NWT Health & Social Services
Yukon Health & Social Services
Nunavut Health & Social Services
NWT MACA’s Emergency Management office
Yukon Emergency Measures Organization
Nunavut Emergency Management
City of Yellowknife Fire division
City of Whitehorse Fire department
Iqaluit Fire department
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MCI triage research outline
Mass casualty field triage protocols
Mass casualty field triage protocols: A study of standardization.
Joshua Bezanson
Philadelphia University
The Centre for Excellence in Emergency Preparedness
October 24, 2009
1
MCI triage research outline
2
Mass casualty field triage protocols: A study of standardization.
Research outline
Abstract
Objective: To evaluate and describe the level of standardization in mass
casualty triage techniques among disaster response agencies in Canada. The
prediction of the study is that there is little to no uniformity in how pre-hospital care
providers currently triage or categorize victims of a mass casualty incident between
different agencies in Canada.
Methods: The research consists of an online questionnaire that is designed to
collect specific information about the surveyed organization and its plans or policies for
triaging mass casualties such as what triage technique they currently use and its
similarity to neighboring response agencies. Invitations to participate will be distributed
electronically and by mail to a list of 113 stakeholder organizations.
Results: The results will provide reliable data about the current triage programs
in use in Canada and prove of disprove the prediction that there is little to no uniformity
in how pre-hospital care providers currently triage mass casualties.
Introduction
Mass casualty triage is a dynamic and inherently complex operation. A manmade or natural disaster such as a hurricane, toxic chemical release or act of terrorism
may require that a large amount of patients be evaluated and prioritized in a short
period of time. Triage is that operation. Sztajnkrycer, Madsen & Ba´ez (2006) describe it
as “the most important initial medical function durin…
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