Anders Rüter

Performance Indicators for Major Incident Medical Management – A Possible Tool for Quality Control?

Objective: The objective was to determine the outcome when applying a set of proposed performance indicators on previously published reports from major incidents. Methods: A set of 20 different performance indicators were proposed. These indicators were applied to 13 reports from major incidents issued by the KAMEDO organization. Results: The most frequently reported problems were command and control at the scene (11/13) followed by communication and command and control at the strategic level. In 25% of the published reports there was enough information available to apply the performance indicators, and in these the goal and/or objective was met in 67%. Conclusion: Performance indicators for the medical management of major incidents and disaster can to a limited extent be applicable to retrospective studies. Performance indicators might be a tool for evaluating the medical response if reports are made with a different template. Further studies are needed in order to validate which indicators to use.

Evaluation of medical command and control using performance indicators in a full-scale, major aircraft accident exercise.

INTRODUCTION 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 greater than 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.

Performance Indicators as Quality Control for Testing and Evaluating Hospital Management Groups: A Pilot Study

INTRODUCTION An important issue in disaster medicine is the establishment of standards that can be used as a template for evaluation. With the establishment of standards, the ability to compare results will improve, both within and between different organizations involved in disaster management. OBJECTIVE Performance indicators were developed for testing in simulations exercises with the purpose of evaluating the skills of hospital management groups. The objective of this study is to demonstrate how these indicators can be used to create numerically expressed results that can be compared. METHODS Three different management groups were tested in standardized simulation exercises. The testing took place according to the organizations own disaster plan and within their own facilities. Trained observers used a pre-designed protocol of performance indicators as a template for the evaluation. RESULTS The management group that scored lowest in management skills also scored lowest in staff skills. CONCLUSION The use of performance indicators for evaluating the management skills of hospital groups can provide comparable results in testing situations and could provide a new tool for quality improvement of evaluations of real incidents and disasters.

Performance indicators for prehospital command and control in training of medical first responders

The objective of this study was to determine if a set of performance indicators could indicate what part of medical command and control needs to be improved in a training concept designed for medical officers at major incidents. A set of 11 different performance indicators previously proposed was used as a template when examining ambulance staff in medical command and control. The results were graded 0 to 2 where 0 = not acceptable, 1 = partially correct and 2 = correct. A total of 46 examinations comprising more than 200 students was included. Performing a correct second report (score 1.15), the ability to establish general guidelines for medical response (score 1.20), setting level of medical ambition (score 1.24) and informing media (score 1.33) had significantly lower scores than the other performance indicators. Performance indicators for medical management in a major incident can be used in a training setting for identifying areas that need improvement.

Staff procedure skills in management groups during exercises in disaster medicine.

INTRODUCTION In stressful situations such as the management of major incidents and disasters, the ability to work in a structured way is important. Medical management groups initially are formed by personnel from different operations that are on-call when the incident or disaster occurs. OBJECTIVE The aim of this study was to test if performance indicators for staff procedure skills in medical management groups during simulations could be used as a quality control tool for finding areas that require improvement. METHODS A total of 44 management groups were evaluated using performance indicators in which results could be expressed numerically during simulations. RESULTS The lowest scores were given to documentation and to the introduction of new staff members. The highest score was given the utilization of technical equipment. CONCLUSIONS Staff procedure skills can be measured during simulations exercises. A logging system may lead to enhancing areas requiring improvement.

KAMEDO Report 90: terrorist attacks in Madrid, Spain, 2004.

This is a descriptive study of the medical responses to the bombings by terrorists in Madrid on 11 March 2004. The nature of the event, the human damage, and the responses are described. It describes the: (1) nature and operations associated with the alarm; (2) assignment of responding units and personnel; (3) establishment and operations of casualty collection points; (4) medical transport and distribution of injured victims; (5) prioritization and command; (6) hospital care; (7) psychosocial care; (8) identification of the dead; and (9) police investigation and actions. Each of these descriptions is discussed in terms of what currently is known and the implications for future planning, preparedness, and response.

Management of resources at major incidents and disasters in relation to patient outcome : A pilot study of an educational model

Background and objectives Organizations involved in disaster response often have a defined operative level of management (command and control) that can take the overall decisions regarding the mobilization and distribution of resources and distribution of casualties. This level of management can be referred to as strategic management. The aim of this pilot study was to show the possibility, in simulation exercises, to relate decisions made regarding resources to patient outcome. Methods The simulation system used measures to determine if lifesaving interventions are performed in time or not in relation to patient outcome. Evaluation was made with sets of performance indicators as templates and all management groups were evaluated not only as to how the decisions were made (management skills), but also how staff work was performed (staff procedure skills). Results Owing to inadequate response and insufficient distribution of patients to hospitals, 11 ‘patients’ died in the simulated incident, a fire at a football stand with subsequent collapse. The strategic level of management received 16 points out of a possible 22 according to a predesigned template of performance indicators. Conclusion The pilot study demonstrated the possibility to, in simulation exercises, relate decisions made regarding resources to patient outcome. This training technique could possibly lead to increased knowledge in what decisions are crucial to make in an early phase to minimize mortality and morbidity.

Increased situation awareness in major incidents - radio frequency identification (RFID) technique : a promising tool

INTRODUCTION In mass-casualty situations, communications and information management to improve situational awareness is a major challenge for responders. In this study, the feasibility of a prototype system that utilizes commercially available, low-cost components, including Radio Frequency Identification (RFID) and mobile phone technology, was tested in two simulated mass-casualty incidents. METHODS The feasibility and the direct benefits of the system were evaluated in two simulated mass-casualty situations: one in Finland involving a passenger ship accident resulting in multiple drowning/hypothermia patients, and another at a major airport in Sweden using an aircraft crash scenario. Both simulations involved multiple agencies and functioned as test settings for comparing the disaster managements situational awareness with and without using the RFID-based system. Triage documentation was done using both an RFID-based system, which automatically sent the data to the Medical Command, and a traditional method using paper triage tags. The situational awareness was measured by comparing the availability of up-to date information at different points in the care chain using both systems. RESULTS Information regarding the numbers and status or triage classification of the casualties was available approximately one hour earlier using the RFID system compared to the data obtained using the traditional method. CONCLUSIONS The tested prototype system was quick, stable, and easy to use, and proved to work seamlessly even in harsh field conditions. It surpassed the paper-based system in all respects except simplicity of use. It also improved the general view of the mass-casualty situations, and enhanced medical emergency readiness in a multi-organizational medical setting. The tested technology is feasible in a mass-casualty incident; further development and testing should take place.

A New System for Transmission of On-Line Information from Scene of Accident and Ambulances to Hospitals

Objective. The ‘Swede information system’ was introduced in a county with approximately 450,000 inhabitants in April 2000. The implementation of this information system, intended to be operative in major incidents and disasters, has included the introduction of new technologies as well as new standard operating procedures for both ambulance crews and hospital staff. The objective of this study was to see how this information system with digitally mediated transmission was used as a daily routine during a 2‐month period, 1 year after its introduction. Methods. The Swede information system sends on‐line information from ambulances to emergency wards in the county. The technique used is a LAN (local area net) for communication within the site of the accident, Mobitex® from the ambulances to a data server and from this by Internet to the hospitals. During March and April 2001 all events when an ambulance was dispatched were recorded. All cases when the system was used to notify the receiving hospital were rec...

Improved Staff Procedure Skills Lead to Improved Management Skills : An Observational Study in an Educational Setting

INTRODUCTION Good staff procedure skills in a management group during incidents and disasters are believed to be a prerequisite for good management of the situation. However, this has not been demonstrated scientifically. Templates for evaluation results from performance indicators during simulation exercises have previously been tested. The aim of this study was to demonstrate the possibility that these indicators can be used as a tool for studying the relationship between good management skills and good staff procedure skills. HYPOTHESIS Good and structured work (staff procedure skills) in a hospital management group during simulation exercises in disaster medicine is related to good and timely decisions (good management skills). METHODS Results from 29 consecutive simulation exercises in which staff procedure skills and management skills were evaluated using quantitative measurements were included. The statistical analysis method used was simple linear regression with staff procedure skills as the response variable and management skills as the predictor variable. RESULTS An overall significant relationship was identified between staff procedure skills and management skills (p(2)0.05). CONCLUSIONS This study suggests that there is a relationship between staff procedure skills and management skills in the educational setting used. Future studies are needed to demonstrate if this also can be observed during actual incidents.