Hazardous material and chemical, biological, radiological, and nuclear incident readiness among prehospital care professionals in the State of Qatar

Figures & data

Figure 1. Process map of HazMat-CBRN incident management by HMCAS-Qatar.

Figure 2. Study design.

Table 1. Baseline knowledge assessment: Items’ quality analysis

a. Item difficulty indexes:
Items (Q^a)		Q2	Q5	Q6	Q7	Q8	Q9	Q10	Total Mean
N	Valid	224	224	224	224	224	224	224
	Missing	0	0	0	0	0	0	0
Mean		0.68	0.39	0.34	0.21	0.94	0.34	0.5
Median		1	0	0	0	1	0	0
Sum		152	88	76	47	210	76	111
Difficulty Index		67.86%	39.29%	33.93%	20.98%	93.75%	33.93%	49.55%	48.47%
Interpretation^†		Average	Average	Average	Too Difficult	Too Easy	Average	Average	Average
b. Discrimination Index Analysis: Upper-lower quartile differences:
Items		Bottom Quartile Item Mean	Top Quartile Item Mean	Discrimination Index		Interpretation^††
				Upper-Lower Difference
Q2		0.45	0.93	0.48		The item is functioning satisfactorily
Q5		0.05	0.64	0.59		The item is functioning satisfactorily
Q6		0.09	0.64	0.55		The item is functioning satisfactorily
Q7		0.04	0.52	0.48		The item is functioning satisfactorily
Q8		0.79	1	0.21		The item is marginal and needs to be revised
Q9		0.07	0.71	0.64		The item is functioning satisfactorily
Q10		0.05	0.79	0.74		The item is functioning satisfactorily
c. Distractors Efficiency: Mean of distractors items between low and high-performance groups:
Items		Low-Performance Group		High-Performance Group		Interpretation^†††
Q2		0.55		0.07		Functioning Distractor
Q5		0.95		0.36		Functioning Distractor
Q6		0.91		0.36		Functioning Distractor
Q7		0.96		0.48		Functioning Distractor
Q8		0.21		0		Non-functioning Distractor
Q9		0.93		0.29		Functioning Distractor
Q10		0.95		0.21		Functioning Distractor

^aQ: question

(^†): Item difficulty index interpretation:

If Difficulty Index>70%, then the item is ‘Too easy’.

If 30% = <Difficulty Index = <70%, then the item is ‘Average’.

If Difficulty Index<30%, then the item is ‘Too Difficult’.

(^††): Item discrimination index interpretation: Discrimination index<0.2, then the item is poor and should be eliminated.

0.2 = <Discrimination index<0.3, then the item is fair but needs to be revised.

0.3 = <Discrimination index<0.4, then the item is acceptable.

Discrimination index≥0.4, then the item is functioning satisfactorily.

(^†††): Distractors efficiency interpretation:

A non-functioning distractor is defined as an option with either a response frequency of <5% of the chosen options in the lower performance group.

Table 2. Baseline Knowledge assessment: Validity and reliability tests

a.Content validity Analysis: Analysis of the results of the Pearson’s product moments of 9 assessment items (N = 249)^a:
Items (Q^b)	r	Association pattern with the total assessment’s score	p value		r square	r square percentage	Significance of r^2%
Q2	0.342**	0.2 < r < 0.4 ⇒ weak	0.000	Valid	0.117	11.70%	11.70% of the score variation explained by Q2
Q3	0.300**	0.2 < r < 0.4 ⇒ weak	0.000	Valid	0.09	9.00%	9% of the score variation explained by Q3
Q4	0.391**	0.2 < r < 0.4 ⇒ weak	0.000	Valid	0.153	15.29%	15.29% of the score variation explained by Q4
Q5	0.415**	0.4 < r < 0.6 ⇒ moderate	0.000	Valid	0.172	17.22%	17.22% of the score variation explained by Q5
Q6	0.410**	0.4 < r < 0.6 ⇒ moderate	0.000	Valid	0.168	16.81%	16.81% of the score variation explained by Q6
Q7	0.435**	0.4 < r < 0.6 ⇒ moderate	0.000	Valid	0.189	18.92%	18.92% of the score variation explained by Q7
Q8	0.401**	0.4 < r < 0.6 ⇒ moderate	0.000	Valid	0.161	16.08%	16.08% of the score variation explained by Q8
Q9	0.488**	0.4 < r < 0.6 ⇒ moderate	0.000	Valid	0.238	23.81%	23.81% of the score variation explained by Q9
Q10	0.474**	0.4 < r < 0.6 ⇒ moderate	0.000	Valid	0.225	22.47%	22.47% of the score variation explained by Q10
**. Correlation is significant at the 0.01 level (2-tailed). *. Correlation is significant at the 0.05 level (2-tailed).
b. Reliability Analysis:
Cronbach’s alpha^c		Cronbach’s Alpha Based on Standardised Items			Number of Items
0.566		0.611			2

^aN is 249 responses

^bQ: question

^cCronbach’ alpha or KR₂₀ for binary data

Table 3. Baseline knowledge assessment themes

Domain assessed in the baseline knowledge assessment	Items
1.Definition of HazMat CBRN incident	Q2, Q3
2.Identification of HazMat-CBRN threat and exposure risk, Safety measures in HazMat-CBRN incident in prehospital setting	Q6, Q8 and Q9 Q4
3.Surge capacity resources in HazMat-CBRN incident in prehospital setting	Q5, Q7
4.Medical clinical assessment of HazMat-CBRN agent	Q10

Table 4. Pre- and post-course assessments hypothesis analysis

a.Normality tests:
Pre-Course Assessment Scores											Post-Course Assessment Scores
	Kolmogorov-Smirnov^†					Shapiro-Wilk					Kolmogorov-Smirnov^‡								Shapiro-Wilk
	Statistic	Df		Sig.		Statistic		Df	Sig.				Statistic				Df	Sig.	Statistic		Df	Sig.
Pre- course	0.255	186		0.000		0.785		186	0.000		Post- Course		0.194				185	0.000	0.908		185	0.000
^†Lilliefors Significance Correction											^‡Lilliefors Significance Correction
b.Paired t-test:
			Mean		Std. Deviation					95% Confidence Interval of the Difference											Sig.(2-tailed)
								Std. Error Mean		Lower					Upper			t		df
Pair 1: Pre-course -Post-course			−8.254		2.992			0.22		−8.688					−7.82			− 37.5		184	0.000
c. Multiple Linear Regression:
c1. Coefficients^†††:
Model									Standardise d Coefficients			T		Sig.				95.0% Confidence Interval for B
									Beta									Lower Bound			Upper Bound
1§	(Constant)					10.244		1.692				6.053		0.000				6.905			13.584
	Pre-test					0.028		0.052	0.04			0.534		0.594				−0.074			0.129
	Gender					0.779		0.564	0.103			1.382		0.169				−0.333			1.892
	Position					0.063		0.099	0.047			0.634		0.527				−0.133			0.258
	Status					0.748		0.786	0.071			0.952		0.343				−0.803			2.3
^†††Dependent Variable: Post-course assessment score
c2. Model Summary^††††:
Model	R	R square		Adjusted R square			Std. Error of the Estimate			Change Statistics
										R Squared Change						F Change		f1		df2	Sig. F Change
1	.139^§	0.019		−0.002			1.722			0.019						0.89		4		180	0.471
^††††Dependent Variable: Post-course assessment score
^§Predictors: (Constant), status, gender, position, and re-course assessment score

Table

All mentioned materials below were approved by the Ambulance Service Operations Management Team, Communication Management Team, and Training Department
PowerPoint Presentation Prepared by Hassan Farhat	Definition of HazMat and weapons of mass destruction. Health problems induced by Hazmat-CBRN risks. International system of HazMat identification by the 1^st responder who is a healthcare provider in case of related incident (manufacturer, on the road, or in a storage facility) or terrorist attack. Presentation of the call-taking system used by HMCAS Communication Directorate in the National Command Centre (NCC) to manage all emergency 999 calls related to HazMat-CBRN. HazMat-CBRN major incident medical management in a prehospital setting. Presentation of HazMat-CBRN first responder guidelines. Practice the use of the Emergency Response Guidebook (ERG) through HazMat-CBRN scenarios coordinated by the facilitators. Presentation of response guidelines and special cases.
Group discussion/Role play Prepared by Hassan Farhat Role play: Call taking of 999 HazMat CBRN emergency call. Prehospital setting first responder management Challenges	Scenario 1: Chemical terrorist attack in Al-Wakra Metro station. Scenario 2: ‘Is it a highly contagious communicable disease or food intoxication?’ Scenario 3: Chemical incident in industrial area. Scenario 4: RTA involving hazardous material. Scenario 5: Special case 1: Biological accident in hospital lab. Scenario 6: Special case 2: RTA involving HazMat and fire.
Video: (15 min) Editor: Hassan Farhat 15 mins: Initial first response steps Donning/Doffing (Applicable when responding to highly contagious communicable diseases)	Uploaded on ‘YouTube’: https://www.youtube.com/watch?v = oxAVCDO2zsM