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Evaluation of Medical Command and Control Using Performance Indicators in a Full-Scale, Major Aircraft Accident Exercise

Published online by Cambridge University Press:  28 June 2012

Dan Gryth ,
Monica Rådestad ,
Heléne Nilsson ,
Ola Nerf ,
Leif Svensson ,
Maaret Castrén  and
Anders Rüter
Dan Gryth*
Affiliation:
Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm Prehospital Centre, Stockholm, Sweden
Monica Rådestad
Affiliation:
Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm Prehospital Centre, Stockholm, Sweden
Heléne Nilsson
Affiliation:
Centre for Teaching and Research in Disaster Medicine and Traumatology, Linköping University, Linköping, Sweden
Ola Nerf
Affiliation:
Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm Prehospital Centre, Stockholm, Sweden
Leif Svensson
Affiliation:
Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm Prehospital Centre, Stockholm, Sweden
Maaret Castrén
Affiliation:
Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm Prehospital Centre, Stockholm, Sweden
Anders Rüter
Affiliation:
Centre for Teaching and Research in Disaster Medicine and Traumatology, Linköping University, Linköping, Sweden
*
Department of Clinical Science and Education, Södersjukhuset Karolinska Institutet Stockholm Prehospital Centre S-118 83 Stockholm Sweden E-mail: dan.gryth@sodersjukhuset.se
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Abstract

Introdution:

Large, functional, disaster exercises are expensive to plan and execute, and often are difficult to evaluate objectively. Command and control in disaster medicine organizations can benefit from objective results from disaster exercises to identify areas that must be improved.

Objective:

The objective of this pilot study was to examine if it is possible to use performance indicators for documentation and evaluation of medical command and control in a full-scale major incident exercise at two levels: (1) local level (scene of the incident and hospital); and (2) strategic level of command and control. Staff procedure skills also were evaluated.

Methods:

Trained observers were placed in each of the three command and control locations. These observers recorded and scored the performance of command and control using templates of performance indicators. The observers scored the level of performance by awarding 2, 1, or 0 points according to the template and evaluated content and timing of decisions. Results from 11 performance indicators were recorded at each template and scores >11 were considered as acceptable.

Results:

Prehospital command and control had the lowest score. This also was expressed by problems at the scene of the incident. The scores in management and staff skills were at the strategic level 15 and 17, respectively; and at the hospital level, 17 and 21, respectively.

Conclusions:

It is possible to use performance indicators in a full-scale, major incident exercise for evaluation of medical command and control. The results could be used to compare similar exercises and evaluate real incidents in the future.

Keywords

aircraft accident exerciseairport drilldisaster evaluationdisaster medicinedisaster preparednesslessons learnedperformance indicatorsprehospital managementsafetysecuritystrategic management

Information

Type
Research Article
Information
Prehospital and Disaster Medicine , Volume 25 , Issue 2 , April 2010 , pp. 118 - 123
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2010

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References

1. Rüter, A, Örtenwall, P, Vikström, T: Performance indicators for major medical management—A possible tool for quality control. International Journal of Disaster Medicine 2004;2:52–55.CrossRefGoogle Scholar
2. Rüter, A, Vikström, T: Indicateures de performance: De la théorie à la pratique. Approache scientifique à propos de la médecine de catastrophe. Urgence Pratique 2009;93:41–44.Google Scholar
3. Rüter, A, Nilsson, H, Vikström, T: Prehospital command and control, a certifying training concept. Scand J Trauma Resusc Emerg Med 2004;12:148–149.Google Scholar
4. Rüter, A, Örtenwall, P, Vikström, T: Performance indicators for prehospital command and control in training of medical first responders. International Journal of Disaster Medicine 2005;1–4.Google Scholar
5.LFV. Available at http://www.lfv.se. Accessed 22 March 2010.Google Scholar
6. Rüter, A, Nilsson, H, Vikström, T: Performance indicators as quality control for testing and evaluating hospital management groups: A pilot study. Prehosp Disaster Med 2006;21(6):423–426.CrossRefGoogle ScholarPubMed
7. Rüter, A, Örtenwall, P, Vikström, T: Staff procedure skills in management groups during exercices in disaster medicine. Prehosp Disaster Med 2007;22(4):318–321.10.1017/S1049023X00004933CrossRefGoogle Scholar
8. Rüter, A, Lundmark, T, Ödmansson, E, Wikström, T: The development of a national doctrine for management of major incidents and disaster. Scandinavian Journal of Resuscitation Emergency Medicine 2006;14:189–194.Google Scholar
9.Aviation Safety Network. Available at http://www.aviation-safety.net. Accessed 05 February 2009.Google Scholar
10. Ernsting, J, Nicholson, A, Rainford, D: Aviation Medicine, 3d Ed. Oxford: Butterworth Heinemann, 1999.Google Scholar
11. Rüter, A, Nilsson, H, Vikström, T: Medical Command and Control at Incidents and Disasters—From the Scene of the Incident to the Hospital Ward. Studentlitteratur ISBN 91-44-01951-3. September 2006.Google Scholar
12. National Association of Emergency Medical Technicians: Prehospital Trauma Life Support, 6th [rev.] ed. St. Louis: Elsevier Mosby, 2007.Google Scholar
13. American College of Surgeons: Advanced Trauma Life Support Program for Doctors, 7th ed. Chicago: American College of Surgeons, 2004.Google Scholar
14. Driscoll, P, Kent, A: The effect of scene time on survival. The effect of scene time on survival. Trauma 1999;1:23–30.10.1177/146040869900100103CrossRefGoogle Scholar
15. Murdock, D: Trauma: When there's no time to count. AORN J 2008;87(2):322–328.10.1016/j.aorn.2007.07.008CrossRefGoogle Scholar
16. Demetriades, D, Martin, M, Salim, A, Rhee, P, Brown, C, Chan, L: The effect of trauma centre designation and trauma volume on outcome in specific severe injuries. Ann Surg 2005;242(4):512–517; discussion 517-519.CrossRefGoogle ScholarPubMed
17. Nilsson, H, Rüter, A: Management of resources at major incidents and disasters in relation to patient outcome: A pilot study of an educational model. European Journal of Emergency Medicine 2008;15:162–165.10.1097/MEJ.0b013e3282f4d14bCrossRefGoogle ScholarPubMed
18. Hsu, E, Jenckes, M, Catlett, C, et al: Effectiveness of hospital staff mass-causellty incident training methods: A systematic literature review. Prehospital Disast Med 2004;19:191–199.CrossRefGoogle ScholarPubMed
19. Gebbie, K, Vales, J, Merrill, J, Morse, S: Role of exercises and drills in the evaluation of public health in emergency response. Prehospital Disast Med 2006;21:173–182.10.1017/S1049023X00003642CrossRefGoogle ScholarPubMed
20. Hersche, B, Wenker, O: Case report: Lasing mining accident. Internet Journal of Rescue and Disaster Medicine 2000;2(1).Google Scholar