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Performance indicators for initial regional medical response to major incidents: a possible quality control tool
Region Östergötland, Katastrofmedicinskt centrum. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Katastrofmedicin. Linköpings universitet, Hälsouniversitetet.
Linköpings universitet, Institutionen för klinisk och experimentell medicin, Katastrofmedicin. Linköpings universitet, Hälsouniversitetet.
Region Östergötland, Katastrofmedicinskt centrum. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Katastrofmedicin. Linköpings universitet, Hälsouniversitetet.
2012 (engelsk)Inngår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 20, nr 81Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Background

Timely decisions concerning mobilization and allocation of resources and distribution of casualties are crucial in medical management of major incidents. The aim of this study was to evaluate documented initial regional medical responses to major incidents by applying a set of 11 measurable performance indicators for regional medical command and control and test the feasibility of the indicators.

Methods

Retrospective data were collected from documentation from regional medical command and control at major incidents that occurred in two Swedish County Councils. Each incident was assigned to one of nine different categories and 11 measurable performance indicators for initial regional medical command and control were systematically applied. Two-way analysis of variance with one observation per cell was used for statistical analysis and the post hoc Tukey test was used for pairwise comparisons.

Results

The set of indicators for regional medical command and control could be applied in 102 of the130 major incidents (78%), but 36 incidents had to be excluded due to incomplete documentation. The indicators were not applicable as a set for 28 incidents (21.5%) due to different characteristics and time frames. Based on the indicators studied in 66 major incidents, the results demonstrate that the regional medical management performed according to the standard in the early phases (1–10 min after alert), but there were weaknesses in the secondary phase (10–30 min after alert). The significantly lowest scores were found for Indicator 8 (formulate general guidelines for response) and Indicator 10 (decide whether or not resources in own organization are adequate).

Conclusions

Measurable performance indicators for regional medical command and control can be applied to incidents that directly or indirectly involve casualties provided there is sufficient documentation available. Measurable performance indicators can enhance follow- up and be used as a structured quality control tool as well as constitute measurable parts of a nationally based follow-up system for major incidents. Additional indicators need to be developed for hospital-related incidents such as interference with hospital infrastructure.

sted, utgiver, år, opplag, sider
BioMed Central, 2012. Vol. 20, nr 81
Emneord [en]
Emergency response, Disaster management, Casualty incident, Quality measurement, Resource management
HSV kategori
Identifikatorer
URN: urn:nbn:se:liu:diva-89534DOI: 10.1186/1757-7241-20-81ISI: 000313973900001OAI: oai:DiVA.org:liu-89534DiVA, id: diva2:608557
Merknad

Funding Agencies|Swedish National Board of Health and Welfare||

Tilgjengelig fra: 2013-02-28 Laget: 2013-02-26 Sist oppdatert: 2017-12-06
Inngår i avhandling
1. Demand for Rapid and Accurate Regional Medical Response at Major Incidents
Åpne denne publikasjonen i ny fane eller vindu >>Demand for Rapid and Accurate Regional Medical Response at Major Incidents
2013 (engelsk)Doktoravhandling, med artikler (Annet vitenskapelig)
Abstract [en]

The ultimate goal in major incidents is to optimize care for the greatest number of patients. This means matching patients with facilities that have the appropriate resources available in sufficient quantities to provide the necessary care. A major incident is a situation where the available resources are inadequate in relation to the urgent need. As health care resources have become increasingly constrained, it is imperative that all resources be optimized from a regional and sometimes a national perspective.

In Sweden, the number of major incidents per year is still unknown. In order to implement effective quality control of response to major incidents, specific standards for regional medical response need to be set and agreed on from a national perspective. This will probably also enhance follow-up and comparison of major incidents in the future.

The overall aim of this thesis is to improve understanding of the demand for rapid and accurate regional medical response at major incidents. The objectives were to systematically analyse specific decisions within regional medical response and to identify factors that can influence patient outcome in major incidents.

This research is based on four studies in which a set of 11 measurable performance indicators for initial regional medical command and control have been used as an evaluation instrument together with a simulation system where the assessment of each patient could be evaluated. The collection of data was made during several disaster management programs but also in real major incidents that occurred in two county councils in Sweden. In one of the studies, the national disaster medical response plan for burns was evaluated.

This research shows that measurable performance indicators for regional medical response allow standardized evaluation such that it is possible to find crucial decisions that can be related to patient outcome. The indicators can be applied to major incidents that directly or indirectly involve casualties provided there is sufficient documentation available and thereby could constitute a measurable part of regional and national follow-up of major incidents. Reproducible simulations of mass casualty events that combine process and outcome indicators can create important results on medical surge capability and may serve to support disaster planning.

The research also identified that there is a risk for delay in distribution of severely injured when many county councils needs to be involved due to different regional response times to major incidents. Furthermore, the coordination between health care and other authorities concerning ambulance helicopter transport in mass casualty events needs to be further addressed. It is concluded that there is a demand for rapid and accurate response to major incidents that is similar in all county councils. Like all other fields of medicine, these processes need to be quality assured.

sted, utgiver, år, opplag, sider
Linköping: Linköping University Electronic Press, 2013. s. 98
Serie
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1350
HSV kategori
Identifikatorer
urn:nbn:se:liu:diva-86597 (URN)9789175197135 (ISBN)
Disputas
2013-01-25, Aulan på Katastrofmedicinskt Centrum, Campus US, Linköpings universitet, Linköping, 13:00 (engelsk)
Opponent
Veileder
Tilgjengelig fra: 2012-12-19 Laget: 2012-12-19 Sist oppdatert: 2017-12-14bibliografisk kontrollert

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