05:Pandemic Drill

Avian Influenza (H5N1) is an infectious viral disease of birds that can cause serious infection in people; as a matter of fact, more than 60% of people who had been infected by avian flu have died. According to World Health Organization (WHO), since 2003 more than 600 people from all over the world have been infected and more than 370 have died. There is also the possibility of human-to-human transmission. We can, therefore, definitely regard this as an imminent threat to our lives.

Indeed, in order for the practitioners of healthcare services and management to quickly and effectively respond to urgent crisis as such, they need to be trained for managing infectious diseases outbreaks on a daily basis.

To that end, in the Department of Health Service Administration at Nippon Medical School, Dr. Kenichi Akiyama, who is a respiratory physician with an extensive expertise and experience with infectious disease and treatment, has developed an experiential educational program called “ Pandemic Drill”.

This pandemic drill is a simulated drill that trains medical personnel for the effective management of a pandemic influenza. Dr. John Mahoney at University of Pittsburgh School of Medicine developed the original drill, and Dr. Akiyama modified it to be in line with Japanese medical situation. The program has been introduced to the educational curriculum of Nippon Medical School and Nursing School since 2009.

Dr. Akiyama, who took initiative in developing this pandemic drill in Japan told us that he strongly believes that this simulated pandemic drill will help the medical students to understand the importance of medical teamwork especially at the time of urgent crisis, and to be well-prepared and be equipped with the skills necessary for infectious disease management.

Let us take a look at the content of this drill here. The drill is divided into three sections. First of all, the students will take lectures on general knowledge such as influenza pandemic　and hospital acquired infections. The lectures will discuss comprehensively on basic medical science, clinical medicine, and social medicine; more specifically, on the structure of influenza virus, its treatment methods, the history of Spanish flu, the problem of public health during pandemic, and management of hospital acquired infections .

Once the students finish taking these lectures, the students will proceed to taking lessons from the infection control certified nurses. They will learn, for example, the proper hand washing procedures and the proper usage of the Personal Protective Equipment (PPE).

Lastly the students will go through simulation-type drill. In this drill, the main goal is for the students to actually experience simulated emergencies in which the influenza pandemic is taking place and react as effective as possible to help patients receive proper treatment as soon as possible .

In simulation-type drill, four students will make one medical team: One doctor, two nurses and one assistant; and these four will be responsible for taking care of a pseudo-ward of a hospital.
All the patients are made out of cardboard and each patient will have a symptom flag placed in his/her left chest pocket. Each flag indicates the patients’ physical situation. The flags indicate what treatment is needed, for example, whether the cardboard-made patients need treatment for fever, drip infusion or need to see a doctor .

Then students will go to the nurse station to get the treatment flags that will treat the indicated symptoms and bring them back and place and match the right treatment flags in the pockets with the symptom flags. Once the patients’ pockets have two flags, the treatment is complete . Upon completion of this task, the staff will keep on putting in new symptoms in the patients’ pockets. According to Dr. Akiyama, as time goes by, the patients’ physical condition changes rapidly.

Students will treat the patients in accordance to the actual jobs and responsibilities that they have in reality . For example, only the doctors are allowed to give out “ death certificate”. Therefore, as Dr. Akiyama puts it, “ the students have to give the best possible treatment that they are permitted to give in the simulate- pandemic ward.”

In addition, just like in real hospital situation, when the beds become available due to patient’s death or patient’s being transferred to ICU, new patients will soon be sent to these beds making the beds fully occupied. Also, in the drill, drips and oxygen do run out eventually and medical supplies do deplete along with students getting sick themselves- indeed, every situation that the students encounter in these drills can actually happen in real pandemic outbreaks. Therefore, many changes and happenings take place every minute, making the students panic and confused as chaos takes over .

Under these circumstances, Dr. Akiyama pointed the following six points that he wishes the students to experience in pandemic drill.
1. Acknowledge the chaos that can be brought about by pandemics
2. The importance of prioritizing patients’ management and treatment
3. The importance of teamwork with staff from other medical sections
4. Acknowledge the limited number of practitioners who can help and limits in medical supply
5. The importance of communication
. The importance of leadership

Dr. Akiyama realizes that the above-mentioned six pointers are not easy to thoroughly understand only through lectures. He believes, “students can only understand by actually going through the experience by taking initiative in dealing directly with the difficult and challenging situation and by communicating with many different professionals to solve the problem.” In this respect, simulation education is very effective because it allows the students to imagine what it would be like if and when pandemic outbreaks ever take place.

After the training, the students were asked to answer some questionnaires regarding the drill that they took and more than 90% of the students answered positively. Some said that in every simulated pandemic situation they experienced, they were able to picture themselves in the actual case of pandemic emergency. Others said that at least somewhat they were able to picture what it will be like . In addition to these findings, Dr. Akiyama was able to find out another important factor by reading the description and comments that the students had written freely about the drill. “ The students were able to strongly feel the importance of teamwork and communication among different areas of medical professions. They have also felt deep appreciation for other professions.” Dr. Akiyama appreciated the fact that the students regarded this drill not only interesting and new but also as a very valuable experience.

Lastly, Dr. Akiyama said that unlike the regular lectures in which the students learn passively, in experiential lessons, the students actively get involved. In case of pandemic influenza, not only the patients but also the doctors and nurses and other medical staff are at risk.

Thus, as Dr. Akiyama puts it, “if students are able to learn something valuable out of this drill that they cannot learn from books and lectures alone, I believe the goal of this drill is achieved.” Furthermore, Dr. Akiyama is willing to continue developing more educational tools and material by applying the concept of this simulation-based learning so that the new drills that he would create would orchestrate many other medical departments and would contribute to the many medical areas and facilities of the region.