Initial Test of Emergency Procedure Performance in Temporary Negative Pressure Isolation by Using Simulation Technologies
Presented at the Temporary Negative Pressure Isolation Leadership Meeting, August 2005, Arlington, VA.
Received 31 August 2006; received in revised form 23 January 2007 and 5 April 2007; accepted 18 April 2007. published online 28 August 2007.
Study objective
The potential of infectious disease spread in diseases such as tuberculosis, infectious disease epidemic such as avian flu and the threat of terrorism with agents capable of airborne transmission have focused attention on the need for increased surge capacity for patient isolation. Total negative pressure isolation using portable bioisolation tents may provide a solution. The study assesses the ability of health care workers to perform emergency procedures in this environment.
Methods
Physician performance in completing predetermined critical actions in 5 emergency care scenarios inside and outside of a bioisolation tent (“setting”) was studied in an advanced medical simulation laboratory. By design, no pretraining of subjects about total negative pressure isolation use occurred. Impact of setting on time to completion of predetermined critical actions was the primary outcome measured. Secondary variables studied included impact of study groups, scenarios, and run order (inside or outside of the tent first). Subjective assessments were obtained through questionnaires.
Results
Four teams of 3 physicians completed 5 emergency patient care scenarios during 2 4-hour sessions. Mean time to completion of critical actions was for tent/no tent 298 seconds/284 seconds (P=.69, one way ANOVA), respectively. Mean time to completion for first versus second performance of a scenario in the crossover design was 338 versus 243 (P=.01). The mean score for self-assessed performance did not differ according to setting.
Conclusion
The ability of physicians naive to the total negative pressure isolation environment to perform emergency medical critical actions was not significantly degraded by a simulated bioisolation tent patient care environment.
aInstitute for International Emergency Medicine and Health, Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
bSTRATUS Center for Medical Simulation, Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
eEmergency Medicine Residency Training Program, Brigham and Women’s Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA
fBrigham and Women’s Hospital Center for Clinical Investigation, Boston, MA.
Address for reprints: Mark A. Davis, MD, MS, Institute for International Emergency Medicine and Health Department of Emergency Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115.
Supervising editor: Gregory J. Moran, MD
Author contributions: MAD was the principal coordinator and the individual with overall responsible for study design, implementation, and article preparation. R Landesman organized the progress of the study within the simulation laboratory and was the primary person responsible for data collection for statistical review. BT, MH, and GS provided expertise in bioagent threats, protocols for bioisolation implementation, and technical support in tent construction and modification. TB, CMP, ESB, SN, and RL Look participated in the design and execution of simulation laboratory-based critical care scenarios. They also assisted with article preparation. MS was responsible for statistical analysis and article review. RMW participated in simulation design, experiment implementation, and article preparation and review. MD takes responsibility for the paper as a whole.
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article, that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. This study was partially funded by Unconventional Concepts, Inc. and Collective Protection Engineering companies, with technical assistance from Cerberus, Inc. Cerberus, Inc. is now dissolved, and its former members serve as strategic consultants in emergency and disaster response planning.
Publication dates: Available online August 24, 2007.
ABSTRACT