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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
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
Nature Webhttp://www.nature.com/nature/focus/sars/map.html
Global Outbreaks: SARS, MERS, Ebola & H7N9
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
A Clinical, Research & Educational Venue
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
Adaptation & Expansion of Materials
• 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
National Ebola Training & Education Center
Assistant Secretary for Preparedness and Response (ASPR): Training, Simulation and Quarantine Center
National Disaster Medical Systems (NDMS) Training
Atlanta, July 2018
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
UNMC: Dept of State & Dept of Defense Expanded Transport Exercises & Research
International Collaborations
16
Mission Essential Competencies for Biocontainment
Mission Essential Competencies TM
Integrity Service Excellence
17
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
18
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
19
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
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
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
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
23
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
Use of MEC Data
• Develop unique training opportunities
o Active learning
o Creating realism
• Develop assessment criteria
o Knowledge
o Skills
Competency Assessment
2D/3D
Interactive Virtual
RealityHolographic Augmented
Reality
Task
Trainers
Standardized
Patients
Advanced & Human
Patient Simulators
Active Learning
Active LearningSpecialized Training Modalities
Creating RealismTraining Unit
o Patient Rooms w/adjoining Ante Roomo Laboratoryo Clean/Dirty Utilityo Debriefing
Practice, Practice, PracticeTent
o Austere environmento Temperatureo Smells
Transport and Patient Care
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