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

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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

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

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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

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