Alternative Leadership in Flexible Surge Capacity—The Perceived Impact of Tabletop Simulation Exercises on Thai Emergency Physicians Capability to Manage a Major Incident
Abstract
:1. Introduction
2. Aim
3. Method
3.1. Population
3.2. Course Design
3.3. Pre- and Post-Course Test
3.4. Observational Evaluation
3.5. Observational Evaluation
4. Results
- Command and control (C2): There was an increasing knowledge of C2 after the course. Around 20% of the EPs (n = 10) had little or very little knowledge about C2, and 46% (n = 24) had medium knowledge. At the end of the course, there was a shift to the positive end, where the majority of our participants had a good to a very good understanding of C2 function (n = 49, 94%) (Figure 1). The change was statistically significant (p = 0.00, z = −5.436).
- Safety: There was an increasing knowledge of safety issues after the course. Around 15% of the EPs (n = 8) had no or very little knowledge about safety issues, and 44% (n = 23) had medium knowledge. At the end of the course, there was a shift to the positive end, where the majority of our participants had a good to a very good understanding of safety issues (n = 50, 96%) (Figure 2). The change was statistically significant (p = 0.00, z = −6.056).
- Communication: There was an increasing knowledge of communication ways and difficulties after the course. Around 21% (n = 11) of the EPs had none or very little knowledge about communications issues, and 44% (n = 23) had medium knowledge. At the end of the course, there was a shift to the positive end, where the majority of our participants had a good to a very good understanding of safety issues (n = 48, 92%) (Figure 3). The change was statistically significant (p = 0.00, z = −5.872).
- Assessment: There was an increasing knowledge about the importance of the assessment during a major incident after the course. Around 17% (n = 9) of the EPs had no or very little knowledge about assessment and its association with the incident management, and 48% (n = 25) had medium knowledge. At the end of the course, there was a shift to the positive end, where the majority of our participants had a good to a very good understanding of assessment issues (n = 48, 92%) (Figure 4). The change was statistically significant (p = 0.00, z = −5.464).
- Triage: There was an increasing knowledge about the importance of triage and associated dilemmas during a major incident after the course. Around 17% (n = 9) of the EPs had no or very little knowledge about triage and its role during incident management, and 30% (n = 16) had medium knowledge. Although 29 EPs reported a good or very good knowledge, there was still a shift to the positive end at the end of the course, where the majority of our participants had a good to a very good understanding of triage issues (n = 46, 88%) (Figure 5). The change was statistically significant (p = 0.00, z = −4.585).
- Treatment: There was an increasing knowledge about the treatment alternatives and options at the right time and right place during a major incident after the course. Around 17% (n = 9) of the EPs had none or very little knowledge about the treatment given during incident management, and 28% (n = 15) had medium knowledge. Although 28 EPs reported good or very good knowledge, there was still a shift to the positive end at the end of the course, where the majority of the participants had good to a very good understanding of triage issues (n = 37, 71%) (Figure 6). The change was statistically significant (p = 0.00, z = −5.287).
- Transport: There was an increasing knowledge about the importance of triage and associated dilemmas during a major incident after the course. Around 21% (n = 11) of the EPs had none or very little knowledge about triage and its role during incident management, and 32% (n = 17) had medium knowledge. At the end of the course, there was a shift to the positive end, where the majority of our participants had a good to a very good understanding of assessment issues (n = 38, 73%) (Figure 7). The change was statistically significant (p = 0.00, z = −5.634).
- Observations: Two critical observations were reported (Figure 8). Both observers collected their documented results in which they had specifically commented on the ability of decision-making, communication, accountability, empowerment of other group member and delegation of tasks. Consensus was made and the groups were exposed to the observers’ understanding to unearth individual motivations or behaviors that were not immediately obvious in a group setting [24,25].
- During the exercises, each team selected its leader with three leadership styles, without any previous knowledge and spontaneously;
- Consensus leadership (G3): The leader tried to reach consensus with other members before any decision. Slower decision-making process.
- Passive leadership (G2): The leader laid back and observed other members and only interrupted if needed. Decisions were made, but sometimes not of the leader.
- Active Leadership (G1): The leader had the last word in every decision and continuously directed the group. Less delegation and empowerment.
- Each group developed its communication method consisting of a mobile telephone, paper-based messages, and signs.
5. Discussion
6. Limitations
7. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Appendix A
Appendix A.1. Scenarios, 3LC Exercises, Bangkok, Thailand
Scenario 1: A bomb
Scenario 2: A Fire in a Tall Building
Scenario 3: Riot and Active Shooter
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Phattharapornjaroen, P.; Glantz, V.; Carlström, E.; Dahlén Holmqvist, L.; Khorram-Manesh, A. Alternative Leadership in Flexible Surge Capacity—The Perceived Impact of Tabletop Simulation Exercises on Thai Emergency Physicians Capability to Manage a Major Incident. Sustainability 2020, 12, 6216. https://doi.org/10.3390/su12156216
Phattharapornjaroen P, Glantz V, Carlström E, Dahlén Holmqvist L, Khorram-Manesh A. Alternative Leadership in Flexible Surge Capacity—The Perceived Impact of Tabletop Simulation Exercises on Thai Emergency Physicians Capability to Manage a Major Incident. Sustainability. 2020; 12(15):6216. https://doi.org/10.3390/su12156216
Chicago/Turabian StylePhattharapornjaroen, Phatthranit, Viktor Glantz, Eric Carlström, Lina Dahlén Holmqvist, and Amir Khorram-Manesh. 2020. "Alternative Leadership in Flexible Surge Capacity—The Perceived Impact of Tabletop Simulation Exercises on Thai Emergency Physicians Capability to Manage a Major Incident" Sustainability 12, no. 15: 6216. https://doi.org/10.3390/su12156216