The global pool of simulation exercise materials in health emergency preparedness and response: a scoping review with a health system perspective

McDarby, Geraldine; Reynolds, Lindy; Zibwowa, Zandile; Syed, Shams; Kelley, Ed; Saikat, Sohel

simex consideration of health system functionality and system underpinning Eight materials were identified for further analyses on the functionality/system aspect of the six building blocks, using a set of questions (box 1). Most materials tested activation of appropriate emergency response mechanisms and structures within the respective administrative levels tested, for example, a facility-level exercise testing activation of all appropriate response mechanisms within the health facility. Some materials tested activation across different levels within the system, for example, a health facility responding to an outbreak activating regional or national response systems. Emergency response systems were generally assumed to have been activated, without testing system triggering. As was apparent with the building block analysis, healthcare functions were generally not tested in an integrated way. For example, a mass dispensing drill had no regard for the parallel response structures with which they would have to integrate during a response. 13 Similarly, a facility response to a sarin attack failed to integrate with national response agencies. 13 14 Reporting of alignment with national command and control structures or response plans was limited as was evidence of consideration of the impact of the PHE on other health system-level facilities or management structures. Materials to test the impact of emergencies on primary healthcare (PHC) or its response were extremely limited and community resilience materials, where identified, failed to link with health systems. [15] [16] [17] The materials were limited in their focus on testing the quality of services delivered in the context of response to a PHE. Where present, measures tended to focus on clinical aspects of care rather than system and process measures. Measures to test the maintenance of essential services from a quality perspective were not identified in any of the eight selected materials.