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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
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1 to 25 of 26 Research Studies DisplayedKman NE, Price A, Berezina-Blackburn V
First Responder Virtual Reality Simulator to train and assess emergency personnel for mass casualty response.
This paper describes the First Responder Virtual Reality Simulator, a high-fidelity, fully immersive, automated, programmable virtual reality (VR) simulation designed to train frontline responders to treat and triage victims of mass casualty incidents. First responder trainees wear a wireless VR head-mounted display linked to a compatible desktop computer. Autonomous, interactive victims who are programmed to simulate individuals with injuries consistent with an explosion in an underground space are used. The trainees are armed with a virtual medical kit, who are then tasked with triaging and treating the victims on the scene. Increased challenges can be added such as increasing the environmental chaos, adding patients, or increasing the acuity of patient injuries.
AHRQ-funded; HS025915.
Citation: Kman NE, Price A, Berezina-Blackburn V .
First Responder Virtual Reality Simulator to train and assess emergency personnel for mass casualty response.
J Am Coll Emerg Physicians Open 2023 Feb;4(1):e12903. doi: 10.1002/emp2.12903.
Keywords: Emergency Medical Services (EMS), Simulation, Health Information Technology (HIT), Training, Emergency Preparedness
Heslin KC, Barrett ML, Hensche M
Effects of hurricanes on emergency department utilization: an analysis across 7 US storms.
This study examines changes in emergency department (ED) utilization for residents of 344 counties after the occurrence of 7 US hurricanes between 2005 and 2016. Using HCUP data, findings showed that the overall population rate of weekly ED visits changed little post-hurricane, but rates by disease categories and age demonstrated varying results. ED utilization rates for respiratory disorders exhibited the largest post-hurricane increase, especially 2-3 weeks following the hurricane. The change in population rates by disease categories and age tended to be higher for people residing in counties closer to the hurricane path.
Citation: Heslin KC, Barrett ML, Hensche M .
Effects of hurricanes on emergency department utilization: an analysis across 7 US storms.
Disaster Med Public Health Prep 2021 Dec;15(6):762-69. doi: 10.1017/dmp.2020.281..
Keywords: Healthcare Cost and Utilization Project (HCUP), Emergency Department, Healthcare Utilization, Emergency Preparedness
Jones K, Mantey J, Washer L
When planning meets reality: COVID-19 interpandemic survey of Michigan nursing homes.
This survey examined conditions at Michigan nursing homes (NHs) during the COVID-19 pandemic period. This survey evaluated preparedness, staffing, testing, and adaptations made due to COVID. Of 452 Michigan NHs contacted via email, 145 opened the survey of those,143 responded from May 1-12, 2020. Two-thirds reported shortages of personal protective equipment. Half lacked sufficient testing resources with only 36% able to test residents and staff when needed. A majority (55%) experienced staffing shortages, with 63% experiencing resignations with front-line clinical staff more likely to resign. Facilities showed rapid adaptation, with 78% creating COVID-19 units to care for patients on site. To reduce isolation, most NHs facilitated communication via phone calls, videoconferencing, and window visits. The majority continued to provide normal required therapies (90%).
AHRQ-funded; HS025451.
Citation: Jones K, Mantey J, Washer L .
When planning meets reality: COVID-19 interpandemic survey of Michigan nursing homes.
Am J Infect Control 2021 Nov;49(11):1343-49. doi: 10.1016/j.ajic.2021.03.016..
Keywords: COVID-19, Nursing Homes, Public Health, Emergency Preparedness
Applebury DE, Robinson EJ, Gold JA
Pilot testing of simulation in the evaluation of a novel, rapidly deployable electronic health record for use in disaster intensive care.
This purpose of this study was to present the application of simulation to assess a quickly scalable hub-and-spoke model for Electronic Health Record (EHR) system deployment and monitoring, utilizing asynchronous training. The researchers modified existing commercial EHR products to function as the entry point from a simulated hospital and a separate system for tele-ICU support and data monitoring. A modular video-based curriculum was developed for asynchronous training of users. The curriculum's effectiveness was evaluated through the completion of standard ICU documentation tasks in a high-fidelity simulation. Additional endpoints included EHR navigation assessment, user satisfaction (Net Promoter), system usability (System Usability Scale-SUS), and cognitive load (NASA-TLX). The study found that 5 participants achieved a 100% task completion rate in all domains, except for ventilator data (91%). The systems demonstrated high satisfaction, satisfactory usability, and acceptable cognitive load, with higher cognitive loads correlating to the number of screens used.
AHRQ-funded; HS023793.
Citation: Applebury DE, Robinson EJ, Gold JA .
Pilot testing of simulation in the evaluation of a novel, rapidly deployable electronic health record for use in disaster intensive care.
Disaster Med Public Health Prep 2021 Oct 22; 17:e51. doi: 10.1017/dmp.2021.302..
Keywords: COVID-19, Emergency Preparedness, Electronic Health Records (EHRs), Health Information Technology (HIT), Public Health, Intensive Care Unit (ICU), Critical Care
Chelen JSC, White DB, Zaza S
US ventilator allocation and patient triage policies in anticipation of the COVID-19 surge.
Researchers assessed policy preparedness and substantive triage criteria within existing policies using a cross-sectional survey distributed to public health personnel and healthcare providers between March 23 and April 23, 2020. They found that their sample of policies reflected organizational strategies of exemplar-based policy development and the use of objective criteria in triage decisions, either before or instead of clinical judgment, to support ethical distribution of resources.
AHRQ-funded; HS024075.
Citation: Chelen JSC, White DB, Zaza S .
US ventilator allocation and patient triage policies in anticipation of the COVID-19 surge.
Health Secur 2021 Sep-Oct;19(5):459-67. doi: 10.1089/hs.2020.0166..
Keywords: COVID-19, Public Health, Emergency Preparedness, Policy
Ma AL, Loughland MED, Lapcharoensap W
California and Oregon NICU wildfire disaster preparedness tools.
In a follow-up to their previous study, the authors asked, "what tools/strategies do medical professionals deem as important and most helpful as they are preparing for wildfire disaster response?" They conducted surveys in 11 Oregon and Southwest Washington NICUs about their wildfire evacuation preparedness and interviewed two neonatologists about their wildfire disaster evacuation and preparation experiences. Their findings suggested that there is more work needed to fully prepare NICUs for wildfire disasters, and they hope that their work helps to educate and support future NICU disaster preparedness responses.
AHRQ-funded; HS023506.
Citation: Ma AL, Loughland MED, Lapcharoensap W .
California and Oregon NICU wildfire disaster preparedness tools.
Children 2021 Jun;8(6). doi: 10.3390/children8060465..
Keywords: Emergency Preparedness, Newborns/Infants, Neonatal Intensive Care Unit (NICU), Intensive Care Unit (ICU)
Barry CL, Anderson KE, Han H
Change over time in public support for social distancing, mask wearing, and contact tracing to combat the COVID-19 pandemic among US adults, April to November 2020.
This study examined changes over time in attitudes towards social distancing, mask wearing, and contact tracing to combat the COVID-19 pandemic among US adults, April to November 2020. Surveys of a nationally representative cohort of US adults were conducted in April, July, and November 2020. Support for social distancing dropped from 89% in April to 79% in July but remained stable in November at 78%. In July and November, more than 75% of respondents supported mask wearing and nearly as many supported contact tracing. Support differences were most pronounced by age, partisanship, and trust in science. Higher support for contact tracing was independently predicted by having a more fluid worldview.
AHRQ-funded; HS000029.
Citation: Barry CL, Anderson KE, Han H .
Change over time in public support for social distancing, mask wearing, and contact tracing to combat the COVID-19 pandemic among US adults, April to November 2020.
Am J Public Health 2021 May;111(5):937-48. doi: 10.2105/ajph.2020.306148..
Keywords: COVID-19, Public Health, Emergency Preparedness, Infectious Diseases
Ma AL, Cohen RS, Lee HC
Learning from wildfire disaster experience in California NICUs.
The authors’ objective was to learn how personnel working in neonatal intensive care units (NICUs) of California hospitals handled issues of neonatal transfer during wildfire disasters in recent years; their ultimate goal was to share lessons learned with healthcare teams on disaster preparedness. They found that while describing disaster preparedness, equipment (such as bassinets and backpacks), ambulance access/transport and documentation/charting were noted as important and essential. They concluded that teamwork, willingness to do other tasks that are not part of typical job descriptions, and unconventional strategies contributed to the success of keeping NICU babies safe when California wildfire strikes.
AHRQ-funded; HS023506.
Citation: Ma AL, Cohen RS, Lee HC .
Learning from wildfire disaster experience in California NICUs.
Children 2020 Oct;7(10):E155. doi: 10.3390/children7100155..
Keywords: Newborns/Infants, Neonatal Intensive Care Unit (NICU), Intensive Care Unit (ICU), Transitions of Care, Emergency Preparedness, Teams, Healthcare Delivery
Shuman CJ, Costa DK
Stepping in, stepping up, and stepping out: competencies for intensive care unit nursing leaders during disasters, emergencies, and outbreaks.
In this paper, the authors discuss competencies for intensive care unit nursing leaders during disasters, emergencies, and outbreaks. They draw on the recent example of COVID-19s substantially burdened intensive care units and nursing staff. Informed by extant literature, American Organization of Nurse Leaders--identified competencies, and expert opinion, the authors suggest 3 areas of focused skill development to ensure leaders, especially leaders in ICU settings, are prepared for future crises.
AHRQ-funded; HS024552.
Citation: Shuman CJ, Costa DK .
Stepping in, stepping up, and stepping out: competencies for intensive care unit nursing leaders during disasters, emergencies, and outbreaks.
Am J Crit Care 2020 Sep 1;29(5):403-06. doi: 10.4037/ajcc2020421..
Keywords: Critical Care, Provider: Nurse, Nursing, COVID-19, Emergency Preparedness
Auerbach A, O'Leary KJ, Greysen SR
Hospital ward adaptation during the COVID-19 pandemic: a national survey of academic medical centers.
The authors sought to characterize inpatient adaptations to care for non-ICU COVID-19 patients. They found that the COVID-19 pandemic has required medical wards to rapidly adapt with expanding use of respiratory isolation units and use of technology emerging as critical approaches. Reports of unrecognized or delayed diagnoses highlight how such adaptations may produce potential adverse effects on care.
AHRQ-funded; HS026383; HS026215; HS027369.
Citation: Auerbach A, O'Leary KJ, Greysen SR .
Hospital ward adaptation during the COVID-19 pandemic: a national survey of academic medical centers.
J Hosp Med 2020 Aug;15(8):483-88. doi: 10.12788/jhm.3476..
Keywords: COVID-19, Emergency Preparedness, Hospitals, Public Health, Healthcare Delivery, Inpatient Care
Abrams EM, Greenhawt M
Risk communication during COVID-19.
This article focuses on ways the healthcare community can best communicate risk of COVID-19 to the public. Poor risk communication results in hoarding behavior which can lead to lack of medications and personal protective equipment. Utilizing social media channels to ensure an ongoing consistent media presence is one potential way to ensure appropriate risk communication. Including all stakeholders in broader public health messaging is also important.
AHRQ-funded; HS024599.
Citation: Abrams EM, Greenhawt M .
Risk communication during COVID-19.
J Allergy Clin Immunol Pract 2020 Jun;8(6):1791-94. doi: 10.1016/j.jaip.2020.04.012..
Keywords: COVID-19, Communication, Risk, Public Health, Emergency Preparedness
Jones KM, Mantey J, Mills JP
COVID-19 preparedness in Michigan nursing homes.
The objectives of this study were to understand preparedness among Michigan nursing homes (NHs) in the midst of an ongoing pandemic and to compare with a 2007 survey on pandemic influenza preparedness in Michigan NHs. Findings showed that, in 2020, NHs were able to make policy and procedure changes within 1 week in response to urgent guidance from CMS and the CDC, which likely helped the facilities prepare for the COVID-19 pandemic. Most NHs had a dedicated staff member responsible for preparedness and were willing to accept patients from hospitals to assist in their surge capacity planning, particularly for non-COVID patients. NHs did express concerns about staffing shortages and PPE supply constraints as cases rose.
AHRQ-funded; HS025451.
Citation: Jones KM, Mantey J, Mills JP .
COVID-19 preparedness in Michigan nursing homes.
J Am Geriatr Soc 2020 May;68(5):937-39. doi: 10.1111/jgs.16490..
Keywords: COVID-19, Elderly, Nursing Homes, Long-Term Care, Emergency Preparedness, Public Health
Shaker MS, Oppenheimer J, Grayson M
COVID-19: pandemic contingency planning for the allergy and immunology clinic.
In the event of a global infectious pandemic, drastic measures may be needed that limit or require adjustment of ambulatory allergy services. However, no rationale for how to prioritize service shut down and patient care exists. A consensus-based ad-hoc expert panel of allergy/immunology specialists from the United States and Canada developed a service and patient prioritization schematic to temporarily triage allergy/immunology services. This paper describes the process, recommendations and feedback.
AHRQ-funded; HS024599.
Citation: Shaker MS, Oppenheimer J, Grayson M .
COVID-19: pandemic contingency planning for the allergy and immunology clinic.
J Allergy Clin Immunol Pract 2020 May;8(5):1477-88.e5. doi: 10.1016/j.jaip.2020.03.012..
Keywords: COVID-19, Respiratory Conditions, Emergency Preparedness, Public Health, Healthcare Delivery, Ambulatory Care and Surgery, Infectious Diseases
Steuart R, Huang FS, Schaffzin JK
Finding the value in personal protective equipment for hospitalized patients during a pandemic and beyond.
Innovative protocols have been conceptualized and used to conserve PPE in hospitals. Conservation protocols often fail to identify missed opportunities to improve the value of personal protective equipment (PPE) that already exist in hospital care. By defining the value of inpatient PPE, hospitals can identify opportunities for value improvement. Changes implemented now will maximize PPE value and preserve supply during this pandemic and beyond. In this article, the authors discuss the value in PPE for hospitalized patients during a pandemic and beyond.
AHRQ-funded; HS025138.
Citation: Steuart R, Huang FS, Schaffzin JK .
Finding the value in personal protective equipment for hospitalized patients during a pandemic and beyond.
J Hosp Med 2020 May;15(5):295-98. doi: 10.12788/jhm.3429..
Keywords: COVID-19, Emergency Preparedness, Public Health, Hospitals, Patient Safety
Myers SR, DeSimone JD, Lorch SA
US hospital type and proximity to mass shooting events.
This study used data on mass shootings to examine the proximity of adult trauma centers, pediatric trauma centers (TCs), and non–trauma center hospitals to such events. The investigators concluded that based on the data, to ensure the success of trauma care everywhere, all hospitals regardless of TC status should expect and prepare for the eventuality of a mass-casualty event involving both adults and children. All hospitals must be ready to serve as the combat forward-field hospital.
AHRQ-funded; HS023806.
Citation: Myers SR, DeSimone JD, Lorch SA .
US hospital type and proximity to mass shooting events.
JAMA Surg 2020 May;155(5):446-7. doi: 10.1001/jamasurg.2020.0095..
Keywords: Hospitals, Trauma, Emergency Department, Emergency Preparedness
Feldman AG, Hsu EK, Mack CL
The importance of prioritizing pre and posttransplant immunizations in an era of vaccine refusal and epidemic outbreaks.
This paper discusses the prevalence of vaccine-preventable outbreaks occurring both nationally and internationally. Rates of vaccine hesitancy and refusal have been increasing which leads to decreased herd immunity. This poses greater risk to immunosuppressed transplant recipients, and currently 1 in 6 pediatric solid organ transplant recipients are hospitalized with a vaccine-preventable infection in the first 5 years posttransplant. This often results in significant morbidity, mortality, and increased hospitalization costs. Surprisingly, many transplant recipients are not up-to-date on age appropriate immunizations at the time of transplant and thereafter. The authors feel that immunizations must be prioritized in both pre and posttransplant care. They call for more research to understand how to monitor immune response to vaccines in immunosuppressed patients and when to optimally immunize patients posttransplant. They also recommend reexamination of the administration of live vaccines posttransplant.
AHRQ-funded; HS026510.
Citation: Feldman AG, Hsu EK, Mack CL .
The importance of prioritizing pre and posttransplant immunizations in an era of vaccine refusal and epidemic outbreaks.
Transplantation 2020 Jan;104(1):33-38. doi: 10.1097/tp.0000000000002936..
Keywords: Vaccination, Medication, Emergency Preparedness, Public Health, Transplantation
Farra S, Hodgson E, Miller ET
Effects of virtual reality simulation on worker emergency evacuation of neonates.
This study compared differences in learning outcomes among newborn intensive care unit (NICU) workers who underwent emergency evacuation training either with virtual reality simulation (VRS) or web-based clinical updates (CU). The workers were evaluated based on knowledge gained, confidence with evacuation, and performance in a live evacuation exercise. Workers were randomly assigned to VRS or CU. The groups did not statistically differ based on Cognitive Assessment scores or self-evaluations. However, the VRS group performed statistically better than the CU group in the live exercise. This study points to the effectiveness of virtual reality training.
AHRQ-funded; HS023149.
Citation: Farra S, Hodgson E, Miller ET .
Effects of virtual reality simulation on worker emergency evacuation of neonates.
Disaster Med Public Health Prep 2019 Apr;13(2):301-08. doi: 10.1017/dmp.2018.58..
Keywords: Emergency Preparedness, Newborns/Infants, Intensive Care Unit (ICU), Simulation, Training, Education: Continuing Medical Education
Cicero MX, Whitfill T, Walsh B
Correlation between paramedic disaster triage accuracy in screen-based simulations and immersive simulations.
This study examined the effectiveness of adding a screen-based simulation (SBS) to immersive simulation of a disaster for triage education of paramedics and emergency medical technicians (EMTs). A randomized controlled trial (RCT) was conducted with emergency medical personnel who had completed an immersive simulation of a school shooting, interacted with an SBS for 13 weeks, and completed the immersive simulation again. The participants were divided into groups: one who had gone through the Seconds to Survival (60S) disaster triage SBS and the other who had not. There was a significant increase in triage accuracy with immersive simulation, but SBS did not correlate with performance in the immersive simlation.
AHRQ-funded; HS022837.
Citation: Cicero MX, Whitfill T, Walsh B .
Correlation between paramedic disaster triage accuracy in screen-based simulations and immersive simulations.
Prehosp Emerg Care 2019 Jan-Feb;23(1):83-89. doi: 10.1080/10903127.2018.1475530..
Keywords: Emergency Preparedness, Emergency Medical Services (EMS), Simulation, Training, Education: Continuing Medical Education
Farra SL, Miller ET, Gneuhs M
Disaster management: communication up, across, and down.
This case study uses the National Preparedness Leadership Initiative’s (NPLI) meta-leadership model as the guiding framework for developing and implementing an evacuation exercise focused on the safe evacuation of neonates. Key components of this framework include strategies for communicating up, across, and down among various stakeholders.
AHRQ-funded; HS023149.
Citation: Farra SL, Miller ET, Gneuhs M .
Disaster management: communication up, across, and down.
Nurs Manage 2017 Jul;48(7):51-54. doi: 10.1097/01.NUMA.0000520720.78549.e4..
Keywords: Emergency Preparedness, Communication, Nursing, Case Study
Cicero MX, Whitfill T, Munjal K
60 seconds to survival: a pilot study of a disaster triage video game for prehospital providers.
The researchers hypothesized that players of the video game "60 Seconds to Survival" (60S) would have greater improvements in disaster triage accuracy compared to control subjects who did not play 60S. The video game intervention demonstrated a significant improvement in accuracy from baseline to time 2 while the control did not.
AHRQ-funded; HS022837.
Citation: Cicero MX, Whitfill T, Munjal K .
60 seconds to survival: a pilot study of a disaster triage video game for prehospital providers.
Am J Disaster Med 2017 Spring;12(2):75-83. doi: 10.5055/ajdm.2017.0263.
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Keywords: Emergency Medical Services (EMS), Emergency Preparedness, Training
Morris AM, Ricci KA, Griffin AR
Personal and professional challenges confronted by hospital staff following hurricane sandy: a qualitative assessment of management perspectives.
This qualitative study assessed the personal and professional challenges that affected staff decisions to report to work following a natural disaster and examined the role of management in addressing staff needs and concerns. Results indicated that staff encountered several barriers in the initial post-Sandy period including transportation problems, personal property damage, and communication issues.
AHRQ-authored.
Citation: Morris AM, Ricci KA, Griffin AR .
Personal and professional challenges confronted by hospital staff following hurricane sandy: a qualitative assessment of management perspectives.
BMC Emerg Med 2016 May 5;16(1):18. doi: 10.1186/s12873-016-0082-5.
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Keywords: Communication, Emergency Preparedness, Workforce
Farra S, Miller ET, Gneuhs M
Evacuation performance evaluation tool.
The authors described the development and implications of a disaster evacuation performance tool that measures one portion of the very complex process of evacuation. The tool was pilot tested with an administrative, medical, and nursing leadership group and then implemented with a group of healthcare workers during a disaster exercise. The authors found that the Delphi process based on the conceptual framework of DeVellis yielded a psychometrically sound evacuation performance evaluation tool for a neonatal intensive care unit.
AHRQ-funded; HS023149.
Citation: Farra S, Miller ET, Gneuhs M .
Evacuation performance evaluation tool.
Am J Disaster Med 2016 Spring;11(2):131-36. doi: 10.5055/ajdm.2016.0232.
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Keywords: Emergency Preparedness, Hospitals, Neonatal Intensive Care Unit (NICU), Children/Adolescents, Training
Jenkins PC, Richardson CR, Norton EC
Trauma surge index: advancing the measurement of trauma surges and their influence on mortality.
The authors developed a new measure of hospital capacity strain corresponding to trauma admissions and examined the relationship between trauma surges and inpatient mortality. Their Trauma Surge Index (TSI) method can be implemented by hospitals and trauma systems to examine periods of high-capacity strain retrospectively, identify specific resources that might have been needed, and better direct future investments in an evidence-based manner.
AHRQ-funded; HS020672.
Citation: Jenkins PC, Richardson CR, Norton EC .
Trauma surge index: advancing the measurement of trauma surges and their influence on mortality.
J Am Coll Surg 2015 Sep;221(3):729-38.e1. doi: 10.1016/j.jamcollsurg.2015.05.016.
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Keywords: Emergency Preparedness, Hospitals, Injuries and Wounds, Mortality, Trauma
Ricci KA, Griffin AR, Heslin KC
Evacuate or shelter-in-place? The role of corporate memory and political environment in hospital-evacuation decision making.
This study was conducted to identify factors that most heavily influenced the decisions to evacuate the Manhattan Veterans Administration Medical Center before Hurricane Irene in 2011 and Hurricane Sandy in 2012. The researchers conducted semi-structured interviews with 11 senior leaders on the processes and factors that influenced their evacuation decisions.
AHRQ-authored
Citation: Ricci KA, Griffin AR, Heslin KC .
Evacuate or shelter-in-place? The role of corporate memory and political environment in hospital-evacuation decision making.
Prehosp Disaster Med. 2015 Jun;30(3):233-8. doi: 10.1017/s1049023x15000229..
Keywords: Emergency Preparedness, Decision Making, Hospitals
Matthews Pillemer F, Blendon RJ, Zaslavsky AM
Predicting support for non-pharmaceutical interventions during infectious outbreaks: a four region analysis.
Non-pharmaceutical interventions (NPIs) such as quarantines and face masks are socially and economically disruptive, and usually require compliance by a significant proportion of the population to be effective. The researchers investigated the predictors of NPI support in Hong Kong, Singapore, Taiwan, and the United States. They found NPI support varies widely by region, possibly because of cultural variation and prior experience.
AHRQ-funded; HS000055; HS017587.
Citation: Matthews Pillemer F, Blendon RJ, Zaslavsky AM .
Predicting support for non-pharmaceutical interventions during infectious outbreaks: a four region analysis.
Disasters 2015 Jan;39(1):125-45. doi: 10.1111/disa.12089..
Keywords: Public Health, Prevention, Infectious Diseases, Emergency Preparedness
