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Healthcare Emergency Incident Management Operations Guide

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Healthcare Emergency Incident Management Operations Guide

Healthcare Emergency Incident Management Operations Guide Book
Author : Jan Glarum
Publisher : Butterworth-Heinemann
Release : 2017-07-18
ISBN : 0128132000
Language : En, Es, Fr & De

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Book Description :

Healthcare Emergency Incident Management Operations Guide offers healthcare personnel a quick and intuitive guide to preparing for, responding to and recovering from events which have the potential to impact their operations. The recently updated Centers for Medicaid & Medicare Services (CMS) rules for emergency preparedness added 10-15 new healthcare organizations into the mix that require emergency preparedness efforts. The Hospital Incident Command System (HICS) is a good tool for event management but, like all tools, it requires practice. Many hospital personnel take online ICS courses and rarely practice enough to be proficient. This is a comprehensive guide to the HICS and can be referenced during initial and refresher training as well as during event management. Covers how to utilize the Hospital incident Command System (HICS) and Incident Action Planning (IAP) processes Includes Initial Incident Action Plan considerations for common disaster events Features exercises for initial and refresher training

Health Care Emergency Management

Health Care Emergency Management Book
Author : Michael J. Reilly,David S. Markenson
Publisher : Jones & Bartlett Learning
Release : 2010-10-25
ISBN : 0763755133
Language : En, Es, Fr & De

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Book Description :

Recent research underscores a serious lack of preparedness among hospitals nationwide and a dearth of credible educational programs and resources on hospital emergency preparedness. As the only resource of its kind, Health Care Emergency Management: Principles and Practice specifically addresses hospital and health system preparedness in the face of a large scale disaster or other emergency. Administrators, emergency preparedness coordinators, and clinical staff who are charged with managing preparedness and emergency management functions for hospitals or healthcare systems will turn to this guide as an essential reference in planning for disasters, terrorism, and public health emergencies. Health Care Emergency Management is also ideal for emergency preparedness courses in programs of health administration or public health. Through case studies and practical examples, this book engages the reader in active learning about this exciting, challenging, and rewarding field. Key Features: • Chapters are contributed by leading authorities on the topic of disaster planning. • The only text that focuses on disaster planning for hospitals and health systems. • Each chapter offers concrete objectives for focused learning as well case studies and practical examples that help the reader understand key concepts • Downloadable resources including PowerPoints and a TestBank are available for qualified instructors. Courses can be found through the FEMA Emergency Management Institute College list page: http://training.fema.gov/EMIWeb/edu/collegelist/

Decision Making in Emergency Management

Decision Making in Emergency Management Book
Author : Jan Glarum,Carl Adrianopoli
Publisher : Butterworth-Heinemann
Release : 2019-10
ISBN : 0128157690
Language : En, Es, Fr & De

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Book Description :

Decision-Making in Emergency Management examines decisions the authors have made over their careers based on their combined training, experience and instinct. Through a broad range of case studies, readers discover how experience impacts decision-making in conjunction with research and tools available. While the use of science, data and industry standards are always the best option when it comes to handling emergency situations, not all emergency situations fit one known solution. This book comprehensively explores the question "Is 'instinct' a viable factor when faced with a challenging situation and how close does it match up with the best science available?" Includes case studies from natural and manmade disasters, providing readers with decision-making skills in various global settings Provides readers the opportunity to learn from someone else's decisions Inspires emergency response personnel to continuously pursue learning, question their strategies and apply changes as appropriate

Emergency Incident Management Systems

Emergency Incident Management Systems Book
Author : Mark S. Warnick,Louis N. Molino, Sr.
Publisher : John Wiley & Sons
Release : 2020-02-11
ISBN : 1119267110
Language : En, Es, Fr & De

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Book Description :

The second edition was to be written in order to keep both reader and student current in incident management. This was grounded in the fact that incident management systems are continually developing. These updates are needed to ensure the most recent and relevant information is provided to the reader. While the overall theme of the book will remain the same of the first edition, research and research-based case studies will be used to support the need for utilizing emergency incident management systems. Contemporary research in the use (and non-use) of an incident management system provides clear and convincing evidence of successes and failures in managing emergencies. This research provides areas where first responders have misunderstood the scope and use of an emergency incident management system and what the outcomes were. Contemporary and historical (research-based) case studies in the United States and around the globe have shown the consequences of not using emergency incident management systems, including some that led to increased suffering and death rates. Research-based case studies from major incidents will be used to show the detrimental effects of not using or misunderstanding these principles. One of the more interesting chapters in the new edition is what incident management is used around the world.

Handbook of Healthcare Operations Management

Handbook of Healthcare Operations Management Book
Author : Brian T. Denton
Publisher : Springer Science & Business Media
Release : 2013-02-28
ISBN : 1461458854
Language : En, Es, Fr & De

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Book Description :

From the Preface: Collectively, the chapters in this book address application domains including inpatient and outpatient services, public health networks, supply chain management, and resource constrained settings in developing countries. Many of the chapters provide specific examples or case studies illustrating the applications of operations research methods across the globe, including Africa, Australia, Belgium, Canada, the United Kingdom, and the United States. Chapters 1-4 review operations research methods that are most commonly applied to health care operations management including: queuing, simulation, and mathematical programming. Chapters 5-7 address challenges related to inpatient services in hospitals such as surgery, intensive care units, and hospital wards. Chapters 8-10 cover outpatient services, the fastest growing part of many health systems, and describe operations research models for primary and specialty care services, and how to plan for patient no-shows. Chapters 12 – 16 cover topics related to the broader integration of health services in the context of public health, including optimizing the location of emergency vehicles, planning for mass vaccination events, and the coordination among different parts of a health system. Chapters 17-18 address supply chain management within hospitals, with a focus on pharmaceutical supply management, and the challenges of managing inventory for nursing units. Finally, Chapters 19-20 provide examples of important and emerging research in the realm of humanitarian logistics.

Sheehy s Manual of Emergency Care E Book

Sheehy   s Manual of Emergency Care   E Book Book
Author : ENA
Publisher : Elsevier Health Sciences
Release : 2012-11-12
ISBN : 0323171109
Language : En, Es, Fr & De

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Book Description :

Thoroughly revised and featuring a more efficient and streamlined design, the new 7th edition of Sheehy's trusted emergency care resource offers complete, up-to-date coverage of the essentials emergency nurses need to know. Each condition commonly seen in the emergency setting is thoroughly addressed, from signs and symptoms, to diagnosis, treatment, developmental considerations, patient education, and more. Updated material and easy-to-reference contents make this resource a must-have for current practice. Comprehensive content presents thorough discussion of signs and symptoms, diagnosis, treatment, age/developmental considerations, and patient/family education for each condition. Authorship from the Emergency Nurses Association ensures this book contains the best practices in emergency nursing. Quick-reference format uses a consistent layout to help you find information quickly and easily. NEW! 2-column format features new Tricks of the Trade boxes to give you a professional's perspective on common issues in emergency nursing. NEW! Fully revised content from the ENA and a broad panel of expert contributors includes up-to-date, practical information on topics such as critical care in the ED, time management, the morbidly obese patient, electronic medical records, disaster nursing, forensic nursing, and workplace violence.

Hospital Emergency Response Teams

Hospital Emergency Response Teams Book
Author : Jan Glarum,Don Birou,Ed Cetaruk
Publisher : Butterworth-Heinemann
Release : 2009-11-19
ISBN : 9780080964959
Language : En, Es, Fr & De

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Book Description :

Hospital Emergency Response Teams aims to provide authoritative training for hospital personnel in the emergency department, as well community-level medical service personnel, assisting them in times of disaster and emergency. Comprised of six chapters, the book covers various aspects of emergency response. Some of the aspects are the National Incident Management System (NIMS) implementation activities for hospitals and health care systems and the Hospital Incident Command System (HICS) IV missions. The book also explains the implementation issues, requirements, and timelines in establishing an internal HICS IV program. It presents the assessment of likely mass casualty events and potential hospital impact. The book also features appendices for emergency response team checklists, PPE donning and doffing guide, ambulatory and non-ambulatory decontamination setup, ETA exercises, and ETA drills. The book is intended to provide understanding of emergency response to first emergency medicine professionals, first responders, security staff, community-level disaster planners, and public health and disaster management researchers. Common sense approach shows what really works, not what is theoretically achievable Forms, checklists, and guidelines can be used to develop concrete response plans, validate existing operations, or simply expand knowledge base The latest from OSHA, Joint Commission and NIMS (National Incident Management System) Cross-disciplinary author team ensures material is appropriate for all member of this important collaboration

Risk Management Handbook for Health Care Organizations 3 Volume Set

Risk Management Handbook for Health Care Organizations  3 Volume Set Book
Author : American Society for Healthcare Risk Management (ASHRM)
Publisher : John Wiley & Sons
Release : 2011-01-06
ISBN : 0470649194
Language : En, Es, Fr & De

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Book Description :

Continuing its superiority in the health care risk management field, this sixth edition of The Risk Management Handbook for Health Care Organizations is written by the key practitioners and consultant in the field. It contains more practical chapters and health care examples and additional material on methods and techniques of risk reduction and management. It also revises the structure of the previous edition, and focuses on operational and organizational structure rather than risk areas and functions. The three volumes are written using a practical and user-friendly approach.

Emergency Management Compliance Manual

Emergency Management Compliance Manual Book
Author : Thomas J. Huser
Publisher : HC Pro, Inc.
Release : 2008-10-27
ISBN : 1601462956
Language : En, Es, Fr & De

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Book Description :

Emergency Management Compliance Manual: A Guide to the Joint Commission Standards Thomas J. Huser, MS, CHSP Over the last decade, catastrophic events such as 9/11 and Hurricane Katrina have turned the spotlight on how healthcare organizations prepare for disasters. Today, from tornados and power outages to pandemic flu, the pressure is on safety officers and emergency management coordinators to protect their facility, staff, and patients from emergencies, no matter what the size. The Joint Commission's emergency management standards require hospitals not only to be prepared to protect their facility, staff, and patients, but also to demonstrate compliance. The Emergency Management Compliance Manual: A Guide to the Joint Commission Standards helps you cut through the confusion and provides best practices to help you meet these provisions. The Emergency Management Compliance Manual helps you to: Develop emergency management and operations plans that work (e.g., EM.01.01.01 and EM.02.01.01) Define an emergency and complete a hazard vulnerability analysis (e.g., EM.01.01.01) Address The Joint Commission's six critical areas (e.g., EM.02.01.01 through EM.02.02.15) Understand disaster privileging and assigning responsibilities during an emergency (e.g., EM.02.02.13 and EM.02.02.15) Evaluate the effectiveness of your planning (e.g., EM.03.01.01 and EM.03.01.03) Recognize hotspots and take action before they happen This manual and CD-ROM set has the answers you need to be prepared for the challenges that lie ahead. Trusted safety professional and author Thomas J. Huser, MS, CHSP, strategically provides compliance tips and advice for emergency management compliance success. Safety officers and emergency management coordinators alike use this reference on a daily basis to create policies and procedures to comply with Joint Commission requirements. Bonus CD-ROM included with your binder The accompanying CD-ROM contains electronic versions of all the forms and tools, making it easy to download and customize them to meet your facility's unique needs. A customizable tool that you'll refer to daily This manual is packaged in a portable 10 x 11 binder, making it easy to snap it open and add your own documents and policies.

Pandemic Influenza

Pandemic Influenza Book
Author : Jeffrey R. Ryan
Publisher : CRC Press
Release : 2008-08-01
ISBN : 9781420060881
Language : En, Es, Fr & De

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Book Description :

The swine flu emergency needn’t become a crisis. This critically acclaimed work provides public health officials, doctors, responders, and emergency planners with accurate current information that will help them understand the nature of an outbreak, assess risk, answer public concerns, and develop informed strategies. Devoid of sensationalism and agenda, this CRC Press resource provides all the information needed to understand pandemic influenzas including, avian, swine, and human variations and outlines the steps needed to develop and implement prevention, stabilization, and recovery efforts as needed at the local level. "... an amazing resource ... Dr. Ryan has assembled some of the best experts in the field to guide you in understanding the threat of pandemic influenza and how it can affect you and the people you are responsible for. ..." --From the foreword by Lynn A. Slepski, Captain, United States Public Health Service Make certain your response to Swine Flu is proactive and informed Edited by Jeffrey Ryan, Institute for Emergency Preparedness, this volume — Arms planners and responders with guidance from 13 leading experts Takes lessons from past pandemics Covers biological and clinical aspects of influenza Discusses pharmaceutical and non-pharmaceutical measures Details response actions related to communication, travel, and quarantine While the swine flu outbreak has impacted Mexico; influenza has no respect for boundaries and is already being felt up north. Despite warnings from the World Health Organization, our preparedness continues to lag. Part of the problem is that the real action must occur at the local level. Triage, care, and containment, along with maintenance of infrastructure, are functions that must be carried out by local planners and responders. The first section reviews the history of pandemics. The middle chapters examine the biology of a virus and clinical aspects of influenza. The final chapters examine international and federal programs and discuss response at the local level, including service continuation planning and fatality management.

Public Health Nursing E Book

Public Health Nursing   E Book Book
Author : Marcia Stanhope,Jeanette Lancaster
Publisher : Elsevier Health Sciences
Release : 2014-07-21
ISBN : 0323294103
Language : En, Es, Fr & De

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Book Description :

Now in its 8th edition, the "gold standard" in community health nursing provides comprehensive and up-to-date content to keep you at the forefront of the ever-changing community health climate and prepare you for an effective nursing career. In addition to a solid foundation in concepts and interventions for individuals, families, and communities, you will find real-life applications of the public nurse's role, Healthy People 2020 initiatives, new chapters on forensics and genomics, plus timely coverage of disaster management and important client populations such as pregnant teens, the homeless, immigrants, and more. Evidence-Based Practice boxes illustrate how the latest research findings apply to public/community health nursing. Separate chapters on disease outbreak investigation and disaster management describe the nurse's role in surveilling public health and managing these types of threats to public health. Separate unit on the public/community health nurse's role describes the different roles and functions of the public/community health nurse within the community. Levels of Prevention boxes show how community/public health nurses deliver health care interventions at the primary, secondary, and tertiary levels of prevention. What Do You Think?, Did You Know?, and How To? boxes use practical examples and critical thinking exercises to illustrate chapter content. The Cutting Edge highlights significant issues and new approaches to community-oriented nursing practice. Practice Application provides case studies with critical thinking questions. Separate chapters on community health initiatives thoroughly describe different approaches to promoting health among populations. Appendixes offer additional resources and key information, such as screening and assessment tools and clinical practice guidelines. Linking Content to Practice boxes provide real-life applications for chapter content. NEW! Healthy People 2020 feature boxes highlight the goals and objectives for promoting health and wellness over the next decade. NEW! The Nurse in Forensics chapter focuses on the unique role of forensic nurses in public health and safety, interpersonal violence, mass violence, and disasters. NEW! Genomics in Public Health Nursing chapter includes a history of genetics and genomics and their impact on public/community health nursing care.

Emergency Medical Services

Emergency Medical Services Book
Author : American Society for Testing & Materials,Astm
Publisher : ASTM International
Release : 2004-09
ISBN : 9780803137608
Language : En, Es, Fr & De

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Book Description :

This volume provides the latest standards for: Emergency Medical Services covers emergency medical dispatch, ambulances, fixed wing basic and specialized units, basic training for emergency medical technicians. Search and Rescue appearing in this section are standards for search, rescue, and recovery operations, which cover testing and maintenance of equipment; management and operations, and personnel training.

Healthcare Safety for Nursing Personnel

Healthcare Safety for Nursing Personnel Book
Author : James T. Tweedy
Publisher : CRC Press
Release : 2014-12-10
ISBN : 1482230283
Language : En, Es, Fr & De

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Book Description :

Nursing personnel play an integral role in healthcare and medical delivery organizations. Nurses not only work to keep patients safe, but must also contend with a number of safety and health risks. Illustrating the occupational risks nurses face, Healthcare Safety for Nursing Personnel: An Organizational Guide to Achieving Results addresses healthcare safety as related to nursing personnel risks, hazards, and responsibilities in hospitals and healthcare facilities. The book begins with an introduction to nursing safety that supplies a fundamental understanding of patient, nursing, and facility safety. Next, it delves into the range of safety issues that nurses must contend with. Topics covered include administrative area safety, bloodborne pathogens, workplace violence, infection control and prevention, emergency management, fire safety, and radiation hazards. Examining the concepts and principles of patient safety as related to organizational dynamics, culture, system methods, and key patient safety initiatives, the book supplies essential knowledge of healthcare safety risks, challenges, and controls. It includes information on leadership, management, communication skills, and understanding accidents. The book includes helpful resources in the appendices, such as a nurse safety perception survey, an accident causal factor chart, sample ergonomics symptoms report, sample TB exposure control plan, and a model respirator plan for small organizations. Complete with review exercises in each chapter, this book is ideal for certification training in nursing programs and as a reference for developing nursing in-service safety sessions.

Outdoor Emergency Care a Patroller s Guide to Medical Care

Outdoor Emergency Care  a Patroller s Guide to Medical Care Book
Author : PATROL
Publisher : Jones & Bartlett Publishers
Release : 2020-05-06
ISBN : 1284205258
Language : En, Es, Fr & De

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Book Description :

Developed in partnership with the National Ski Patrol, Outdoor Emergency Care: A Patroller's Guide to Medical Care, Sixth Edition, is designed to prepare first responders to handle any medical situation in the outdoor environment, during all seasons. The Sixth Edition features: A straightforward, consistent patient assessment process. The patient assessment process is presented in the same way patients are assessed in the health care system. Flowcharts are provided throughout the Patient Assessment chapter to keep the reader focused on each step of the process. Up-to-date content. As you read through each chapter, you will find new information that is current with present prehospital patient care. Subject matter that meets and, in many cases, exceeds the National Emergency Medical Responder criteria. Information unique for ski and bicycle patrollers, including extrication, is included. This material is presented in a format that combines the disciplines of urban EMS and wilderness medical rescue. Continuous case studies. A continuous case study is included in each chapter to encourage critical thinking and application of the information as readers progress through the chapter. End-of-chapter review questions. The review questions included at the end of each chapter allow students to evaluate the knowledge they have gained while reading the chapter. Focus on learning objectives. Specific objectives listed at the beginning of each chapter tell students at the outset what they are expected to learn as they move through the chapter.

Emergency and Trauma Care for Nurses and Paramedics

Emergency and Trauma Care for Nurses and Paramedics Book
Author : Kate Curtis,Clair Ramsden
Publisher : Elsevier Health Sciences
Release : 2011-08-15
ISBN : 0729579824
Language : En, Es, Fr & De

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Book Description :

Emergency and Trauma Care is written for Australian emergency care providers including paramedics, emergency nurses, pre-hospital care providers, nurse practitioners, general practice nurses and allied health practitioners including occupational therapists and physiotherapists who are caring for trauma patients. This book follows the patient journey from pre-hospital to definitive care. Using a body systems approach, each chapter provides comprehensive coverage of all aspects of adult and paediatric emergencies. Implications for clinical practice is supported by chapters of professional practice, clinical skills, research, evidence-based practice, and legal, ethical and cultural issues. Clinical assessment, physiology, management and rationale for intervention of common and not so common emergency presentations are provided, with each chapter providing clear and relevant examples for both Paramedics and Nurses. Emergency and Trauma Care brings together a team of highly respected clinical practitioners and academics to deliver the most up-to-date text dealing with the practical procedures and evidence experienced by emergency and trauma care providers every day. Chapter 2 Pre-hospital care overview in Australia and NZ Chapter 10 Scene assessment, management and rescue Chapter 11 Pre-Hospital Clinical Reasoning, Triage and Communication Pre-hospital and emergency nursing considerations included in all relevant chapters Chapter 5 Cultural Considerations in Emergency Care addresses cultural diversity, beliefs and values and focuses on Aboriginal and Torres Strait Islander health and Maori health Chapter 19 Resuscitation includes advanced life support, airway management and incorporates the 2010 Australian Resuscitation Council guidelines Chapter 37 People with disabilities provides assessment, examination and communication strategies for working with clients with intellectual and physical disabilities Section 5 focuses on examination and communication strategies for working with unique population groups, including the elderly, disabled, obstetric and paediatric patients Section 6 details major trauma assessment and management, blast injury, and trauma to specific body regions Essentials outline the main points addressed in each chapter Practice tips assist with communication skills, procedures and assessment Case studies supported by questions throughout Summaries and Key points, review questions, web links and references provide for consolidation and further research. Evolve resources include Power point slides, 30 additional Case studies, image bank, web links Three paramedic specific chapters (including scene assessment and management)

Publications Catalog

Publications Catalog Book
Author : United States. Defense Civil Preparedness Agency
Publisher :
Release : 1974
ISBN :
Language : En, Es, Fr & De

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Book Description :

Healthcare Information Technology Exam Guide for CHTS and CAHIMS Certifications

Healthcare Information Technology Exam Guide for CHTS and CAHIMS Certifications Book
Author : Kathleen A. McCormick,Brian Gugerty,John E. Mattison
Publisher : McGraw Hill Professional
Release : 2017-09-15
ISBN : 1259836959
Language : En, Es, Fr & De

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Book Description :

The Complete Healthcare Information Technology Reference and Exam Guide Gain the skills and knowledge required to implement and support healthcare IT (HIT) systems in various clinical and healthcare business settings. Health Information Technology Exam Guide for CHTS and CAHIMS Certifications prepares IT professionals to transition into HIT with coverage of topics ranging from health data standards to project management. This new edition includes broadened security content in addition to coverage of disruptive innovations such as complex platforms that support big data, genomics, telemedicine, mobile devices, and consumers. Learn about achieving true interoperability, updates to HIPAA rules, and FHIR and SMART standards. “This book is an invaluable reference for understanding what has come before and what trends are likely to shape the future. The world of big data, precision medicine, genomics, and telehealth require us to break old paradigms of architecture and functionality while not interrupting existing care processes and revenue cycles... We’re dealing with state sponsored cyberterrorism, hacktivism, and organized crime. I describe healthcare IT security as a cold war... You’ll hear from the experts who created many of the regulations and best practices we’re using today to keep information private. I hope you enjoy this book as much as I have and that it finds a place of importance on your book shelf.” From the Foreword by John D. Halamka, MD, Chief Information Officer, CAREGROUP, Boston, MA Coverage includes: • Healthcare and Information Technology in the United States • Fundamentals of Healthcare Information Science • Healthcare Information Standards and Regulation • Implementing, Managing, and Maintaining Healthcare Information Technology • Optimizing Healthcare Information Technology • Making Healthcare Information Technology Private, Secure, and Confidential Electronic content includes: • Practice exams for CHTS and CAHIMS • Secure PDF copy of the book

Disaster Nursing and Emergency Preparedness

Disaster Nursing and Emergency Preparedness Book
Author : Tener Goodwin Veenema, PhD, MPH, MS, CPNP, FAAN
Publisher : Springer Publishing Company
Release : 2012-08-24
ISBN : 0826108652
Language : En, Es, Fr & De

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Book Description :

The new edition of this AJN Book of the Year continues to provide nurses with the most comprehensive, current, and reliable information available so they can develop the skills to efficiently and effectively respond to disasters or public health emergencies. Meticulously researched and reviewed by the worldís foremost experts in preparedness for terrorism, natural disasters, and other unanticipated health emergencies, the text has been revised and updated with significant new content, including 10 new chapters and a digital adjunct teacher's guide with exercises and critical thinking questions. This new edition has strengthened its pediatric focus with updated and expanded chapters on caring for children's physical, mental, and behavioral health following a disaster. New chapters address climate change, global complex human emergencies, caring for patients with HIV/AIDS following a disaster, information technology and disaster response, and hospital and emergency department preparedness. The text provides a vast amount of evidence-based information on disaster planning and response for natural and environmental disasters and those caused by chemical, biological, and radiological elements, as well as disaster recovery. It also addresses leadership, management, and policy issues in disaster nursing and deepens our understanding of the importance of protecting mental health throughout the disaster life cycle. Each chapter is clearly formatted and includes Key Messages and Learning Objectives. Appendices present diagnosis and treatment regimens, creating personal disaster plans, a damage assessment guide, a glossary of terms, and more. Consistent with the Federal Disaster Response Framework, the book promotes competency-based expert nursing care during disasters and positive health outcomes for small and large populations. Key Features: Provides 10 new chapters and new content throughout the text Includes digital teacherís guide with exercises and critical thinking questions Consistent with current U.S. federal guidelines for disaster response Disseminates state-of-the-science, evidence-based information New Chapters: Management of the Pregnant Woman and Newborn During Disasters Management of Patients With HIV/AIDS During Disasters Disaster Nursing in Schools and Other Child Congregate Care Settings Global Complex Human Emergencies Climate Change and the Role of the Nurse in Policy and Practice Human Services Needs Following Disaster Events and Disaster Case Management Hospital and Emergency Department Preparedness National Nurse Preparedness: Achieving Competency-Based Expert Practice Medical Countermeasures Dispensing