medical mission essential competencies: biocontainment
TRANSCRIPT
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Chris Kratochvil, MD
Associate Vice Chancellor for Clinical Research
Vice President for Research, Nebraska Medicine
Benjamin Stobbe, RN, MBA
Assistant Vice Chancellor, Clinical Simulation
Medical Mission Essential
Competencies: Biocontainment
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Mission
Our mission is to lead the world in transforming lives to create a healthy future for all individuals and communities through premier educational programs, innovative research and extraordinary patient care.
We are Nebraska Medicine and UNMC
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Nature Webhttp://www.nature.com/nature/focus/sars/map.html
Global Outbreaks: SARS, MERS, Ebola & H7N9
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Why Nebraska?
• Homeland Security – A new Federal agency
• Monkey Pox – Healthcare Workers afraid to care for patients
• SARS– Emerging diseases are a threat to Public Health
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A Clinical, Research & Educational Venue
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Nebraska Biocontainment Unit Activation 2014
▪September 5, 2014: Received a patient diagnosed with Ebola Virus Disease (EVD), medically evacuated from Liberia
▪October 6, 2014: Received a patient diagnosed with EVD, medically evacuated from Liberia
▪November 15, 2014: Received a patient diagnosed with EVD, medically evacuated from Sierra Leone
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Adaptation & Expansion of Materials
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• General information on Ebola
• Best Practices
• Personal Protective Equipment (PPE)
• Triage in ER & Clinics
• Patient Management
• Employee Exposure
• Laboratory
• Cleaning/Waste
• Transportation
https://www.unmc.edu/cce/neb_ebola.htm
Apple iTunes U
Global Center for Health Security
The Nebraska Ebola Method For Clinicians
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National Ebola Training & Education Center
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Assistant Secretary for Preparedness and Response (ASPR): Training, Simulation and Quarantine Center
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National Disaster Medical Systems (NDMS) Training
Atlanta, July 2018
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National Strategic Research Institute
• One of 13 University Affiliated Research Centers (UARCs) in the U.S.
• UARCs established by Congress and administered via the Office of Secretary of Defense
• Sponsored by US Strategic Command
• Partnership with the University of Nebraska
• Core Competencies1. Nuclear detection and forensics
2. Detection of chemical and biological weapons
3. Active and Passive defense against weapons of mass destruction
4. Consequence management
5. Mission related Research
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UNMC: Dept of State & Dept of Defense Expanded Transport Exercises & Research
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International Collaborations
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Mission Essential Competencies for Biocontainment
Mission Essential Competencies TM
Integrity Service Excellence
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What is a MEC Workshop?
• A facilitated, Subject Matter Expert centered multi-day session that results in specific outcomes to address training and education needs
• Subject Matter Experts represent the range of roles/positions• Workshop 1 generates Tasks, and required Knowledge/Skills, and
Supporting Competencies, by role (2.5 days, UNMC/NebraskaMedicine SMEs)
• Workshop 2 results in Mission Essential Competencies, minimum required level for each Knowledge/Skill by role, and important Developmental Experiences (3 days, UNMC/Nebraska Medicine/Bellevue NY/Emory SMEs)
• Following a survey, Workshop 3 results in identification of training gaps by Developmental Experience and Knowledge/Skill by role, and linkages among Developmental Experiences and Knowledge and Skills
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The Full MEC Process
Field Surveys
Customers provide the data and make
the conclusions
1st Workshop
Mission Review
Knowledge& Skills
Supporting Competencies
Draft MECs
2nd Workshop
Review & ReviseMECs
ID Experiences
Final MECs – Survey InfoCOMMAND Workshop
ID Training Gaps
ID Methods and Media
Conclusions drive training programs and applications
Validity/Reliability
Checks
Data Analysis/Summary
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Terms
• Mission Essential Competency (MEC) o Individual / team / inter-team competencies required for successful
mission completion under adverse conditions in a non-permissive environment
• Supporting Competency (SC) o High level skills that support the MECs
• Knowledge & Skills (K&S) o Knowledge – info or fact that can be accessed quickly under stress
o Skill – compiled actions that can be carried out free of error under stress
• Experience o Developmental event during training and/or career necessary to learn a K
or S, or practice a MEC or SC under operational conditions
• Learning Environmento Situation or event where it is possible to provide an operator with the
identified experiences
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12 MECs for Biocontainment
• Plan and Prepare
• Activate Unit
• Coordinate and Communicate with Internal and External Agencies
• Execute Rapid Clinical Research Process
• Manage Unit Operations
• Provide Clinical Care
• Utilize Telemedicine Capabilities
• Establish and Maintain Infection Control
• Decontaminate
• Provide Patient and Family Support
• Maintain Mutual Support
• Manage Patient Disposition
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Roles/Functions:
• Program Scope/Operations: Oversight and approval authority Manager of Clinical Operations:
• Manager of Non-Clinical Operations:
• Researcher:
• Liaison:
• Physician:
• Nurse
• Respiratory care
• Other clinical or Non-Clinical Task Assistance Provider
• Laboratory Testing Personnel
• Other Diagnostic Study Personnel
• Waste Management Personnel
• Decontamination Personnel
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The following key is used to identify the roles/functions and the K/S standards:
PS: Program Scope/Operations MCO: Manager of Clinical Operations MNCO: Manager of Non-Clinical Operations R: Researcher L: Liaison P: Physician N: Nurse RC: Respiratory Care A: Other clinical or Non-Clinical Task Assistance Provider LAB: Laboratory Testing Personnel ODP: Other Diagnostic Study Personnel WM: Waste Management Personnel D: Decontamination Personnel
Roles & Functions
Title Description PS MCO MNCO R L P N RC A LAB ODP WM D
1. Communicates with Team
Communicates effectively both internally and external to the team
A A A A A A A A A A A A A
2. Maintains Composure while Communicating
Maintains composure in communications (e.g., maintain calm, state facts)
A A A A A A A A A A A A A
3. Communication Restrictions
Knows role and when to communicate and when not to communicate (e.g., social media, media, gossip)
A A A A A A A A A A A A A
4. Updates Communication Plan
Updates communication plan (e.g., different agencies to be notified)
A A A A A NA NA NA NA NA NA NA NA
5.
Identifies and Communicates Lessons Learned
Identifies and communicates lessons learned for process and procedure improvement during and in-between shifts, to include updating checklists
A A A A A I I I I I I I I
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Potential Benefits/Outcomes of Biocontainment MEC Process
• Multi-level specification (Competencies, Knowledge and Skills) of fully prepared biocontainment personnel
• Identification of short-falls (“gaps”) in current training
• Training gaps can be compared (“cross-walked”) against relevant curricula to identify recommended refinements
• Help specify training media/methods (e.g., where simulation most effective)
• Establish minimum standards for training
• Provide basis for performance measures (e.g., for residents)
• Provide justification within grant proposals for training enhancement, simulation, etc.
• Suggest ideas for further research, publication
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Use of MEC Data
• Develop unique training opportunities
o Active learning
o Creating realism
• Develop assessment criteria
o Knowledge
o Skills
Competency Assessment
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2D/3D
Interactive Virtual
RealityHolographic Augmented
Reality
Task
Trainers
Standardized
Patients
Advanced & Human
Patient Simulators
Active Learning
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Active LearningSpecialized Training Modalities
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Creating RealismTraining Unit
o Patient Rooms w/adjoining Ante Roomo Laboratoryo Clean/Dirty Utilityo Debriefing
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Practice, Practice, PracticeTent
o Austere environmento Temperatureo Smells
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Transport and Patient Care
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Next Steps• Continue development and deployment of
biocontainment training program
• Continue to practice and refine procedures
• Identify clinical areas for future MEC workshops
o Trauma
o Anesthesia
Chris Kratochvil, MD
Associate Vice Chancellor for Clinical Research
Vice President for Research, Nebraska Medicine
Benjamin Stobbe, RN, MBA
Assistant Vice Chancellor, Clinical Simulation