Emergency Response Drills

December 08, 2011

A Vital Component in your Training Plan

Rich Bricker
Facilities Coordinator – RecSports
University of Tennessee, Knoxville

At the University of Tennessee RecSports department the Facilities and Aquatics program areas are involved in running drills on their staff. As a result of a fatal cardiac arrest in 2007 and a near drowning in 2009 both of these program areas decided to add more hands-on training to the current emergency response plan in the form of drills. For the purposes of UT RecSports, a drill is a scenario in which student workers are placed in a false crisis in order to practice emergency response procedures. These situations take place in various locations throughout all RecSports facilities.

The following article contains two parts: practical drills and research. The first section deals with our drill program, and the article explains the approach that the University of Tennessee RecSports program takes to ensure that our manager level staff has practical experience in dealing with emergency situations. By using a drill scenario, we believe that we are getting as close to a “real life” crisis as possible. In the second section, the article explains some of the research that was performed using the RecSports Facilities managers. We wanted to determine if running drills affected the self-reported level of confidence that the managers felt when dealing with emergency situations.

Practical Drills
The Facilities program area focuses on non aquatic locations. These types of drills primarily consist of skills associated with adult CPR, unconscious choking, shock, seizures, first aid, and emergency communication. All manager level student staff participates in at least one drill per semester. During the course of the drill other program areas may respond including Fitness and Aquatics. All student staff mangers are required to be certified through the American Red Cross in Adult/Child/ Infant CPR, adult AED, and first aid. While entry level students are not typically the first responders in drills, they are required to obtain these certifications.

The Aquatics program area focuses on emergencies in and around the pool. Aquatics drills consist of seizers, spinal injuries, active drowning victims, and unconscious patrons. Each head lifeguard is required to set up and monitor one drill per semester for their fellow lifeguards with the help from the Aquatics Graduate Assistant. All lifeguards are certified through the American Red Cross in Lifeguarding/ First Aid and CPR/AED for the professional rescuer. Every head lifeguard is also a certified Lifeguard Instructor.

At RecSports the three basic components of a drill are a Facilitators Briefing, The Drill, and Evaluation. At the Facilitators Briefing we discuss what should occur, risks involved, the different duties of the facilitators, inform other key staff members of when and where the drill will take place. The second component is the actual Drill. Lastly, the Evaluation involves the facilitators’ critique of the drill with the participant.

Facilitator’s Briefing:

• Choose the type of drill and location
• Confirm that other key staff members are aware of the drill
• Decide specific duties of each facilitator
  – One at the scene to monitor and critique the participant’s skills
  – One following the drill participant to monitor their actions
  – One monitoring the expected location of the outgoing phone call to EMS

• Unless a prompt is need the monitor acts as if they are not present
• Gather supplies
  – Mannequin
  – Cleaning supplies: alcohol pads to clean mannequin face
  – Radios
  – Timer
  – Checklist

• How to get the manager to the scene
• Set-up the scene

The Drill:

• Set up the scene — Select an area that will not interrupt programming or disturb patrons’ workouts. Depending on the scenario, we may place a dangerous object or make the scene unsafe or find a live victim.
• How to get the drill participant to the scene – Utilize emergency call buttons throughout the facility or use radio calls or patrons.
• Checklist
  — Ease of supervision
  — Provides prompts for monitor to give to drill participant
  — Used to determine the timeline of the drill

• The Call to UTPD — Monitor ensures that the call does not go out to UTPD but that the caller knows the number and what to say
• Securing the drill — We make a radio call to announce that the drill is completed

Evaluation:

• The monitors discuss and critique how the drill went
• Monitors ask the participant to critique themselves
• Then we review the steps of the drill from start to finish
• Discus positives and negatives
• Practice skills on a mannequin if needed
• Offer suggestions for improvement
• File the checklist in the participants’ personal file

Research — Does running emergency response drills affect the confidence levels of its participants?

Everyone assumes that drills will have a positive effect on being able to handle emergency situations. After all, practice makes perfect. So we decided to allow our managers to self-report their confidence level to perform certain tasks (finding the nearest AED, performing CPR on an unconscious adult, performing rescue breathing on an infant, etc.) during an emergency. At the beginning of the semester, they would complete a self-efficacy survey. During the semester, each manager would be the first responder to at least one type of emergency response drill. At the end of the semester, they would take the same self-efficacy survey. We completed this cycle for three semesters which included 22 student managers.

We wanted to learn if the level of confidence reported by these managers would undergo a change that could be related to the drills. The following graphs represent a small portion of the data that was found:

Chart 1 Pre Test vs. Post Test in Various Scenarios

The results show that there is a general increase in confidence (with the exception of Checking for Signs of Life on a Child) level when we ran drills on the managers. It is interesting to note that even in areas that were not drilled (Providing Care for a Burn and Performing Rescue Breathing on an Infant), confidence levels increased. This may suggest that confidence in one’s own ability to deal with emergencies may increase regardless of the drill that was performed.

Chart 2. CPR – Unconscious Adult

Chart 3. Checking Signs of Life – Child

Increases in the highest “Probably Can” score (90) and the “Definitely Can” score were reported for Recognizing an Epileptic Seizure, Rescue Breathing – Infant, CPR – Unconscious Adult (above), Giving Directions to the Scene, and Finding the Nearest AED. However, for Evacuating during a Fire, Checking Signs of Life – Child, Assigning Priority to Multiple Injuries, and Providing Care for 3rd Degree Burns, a general increase in confidence was marked by a decrease in “Definitely Can” scores. These results suggest that drills may cause students to take a more realistic appraisal of their ability to perform in emergency situations, particularly those that are more severe or more complex.

Chart 4. Confidence Level over Time

Three of the tasks on the survey were common to almost every drill: Finding the Nearest AED, Performing CPR on an Unconscious Adult, and Giving Directions to the Scene. For Finding the Nearest AED, confidence levels were high (Definitely Can) on both pre-test and post-test results. Our main facility only has 4 AEDs, so these few locations may account for the high level. It is interesting to note that the last trial shows a slight decrease after the drills. For Performing CPR on an Unconscious Adult and Giving Directions to the Scene, the increases are steeper and typically move from “Probably Can” closer to “Definitely Can” on the confidence scale. It is also interesting that at each pre-test the confidence levels started lower than the post-test levels for the previous semester. While this may have been the first pre-test for some responders, most of the managers had already run some type of drills prior to the pre-test.

In conclusion, the overall affect of running emergency response drills seem to show some improvement in the confidence level of the participants. Unfortunately, it was difficult to control for other factors that contributed to confidence (real emergencies, longevity in dealing with emergencies, additional classroom/lecture training, etc.). Therefore, this data argues that there is a correlation rather than causation. However, the following responses taken from the drill participants provide a good argument for any program to perform emergency response drills.

The following answers were received when asking specific questions to the drill participants:

When asked to describe feelings leading up to a drill, student managers responded with:

• Anxious, not knowing when it is going to happen
• Keeps you running through (emergency) procedures in your head
• You go through procedures with RSA (subordinate staff) to prepare for drill

Student staff was asked to describe how they felt during their drill:

• Nerve wrecking knowing you’re being critiqued while administering care
• Adrenaline rush, hands shaking
• Thankful this is a drill and not an actual emergency
• Nervous having people watch you, time you, and write notes down

When asked to explain what students got out of their drill, they answered with:

• More confident if it were to happen in real life
• Critiques let us know what to improve on
• Refresher for CPR, classes alone never put you in a stressful emergency situation
• You never really know what’s going to happen
• Upset with myself for not being as prepared as I would have liked