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Demand for Rapid and Accurate Regional Medical Response at Major Incidents
Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences.
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
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.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2013. , 98 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1350
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-86597ISBN: 978‐91‐7519‐713‐5 OAI: oai:DiVA.org:liu-86597DiVA: diva2:579248
Public defence
2013-01-25, Aulan på Katastrofmedicinskt Centrum, Campus US, Linköpings universitet, Linköping, 13:00 (English)
Opponent
Supervisors
Available from: 2012-12-19 Created: 2012-12-19 Last updated: 2013-10-24Bibliographically approved
List of papers
1. Management of resources at major incidents and disasters in relation to patient outcome: A pilot study of an educational model
Open this publication in new window or tab >>Management of resources at major incidents and disasters in relation to patient outcome: A pilot study of an educational model
2008 (English)In: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 15, no 3, 162-165 p.Article in journal (Refereed) Published
Abstract [en]

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. © 2008 Lippincott Williams & Wilkins, Inc.

Keyword
Bioterrorism Decision Making Disaster Planning/*methods Health Care Rationing Humans *Models, Educational Natural Disasters Pilot Projects *Quality Assurance, Health Care Sweden Triage
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-43451 (URN)10.1097/MEJ.0b013e3282f4d14b (DOI)73886 (Local ID)73886 (Archive number)73886 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2013-10-24Bibliographically approved
2. Quality control in disaster medicine training: Initial regional medical command and control as an example
Open this publication in new window or tab >>Quality control in disaster medicine training: Initial regional medical command and control as an example
2010 (English)In: American journal of disaster medicine, ISSN 1932-149X, Vol. 5, no 1, 35-40 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The aim of this study was to show the possibility to identify what decisions in the initial regional medical command and control (IRMCC) that have to be improved. DESIGN: This was a prospective, observational study conducted during nine similar educational programs for regional and hospital medical command and control in major incidents and disasters. Eighteen management groups were evaluated during 18 standardized simulation exercises. MAIN OUTCOME MEASURE: More detailed and quantitative evaluation methods for systematic evaluation within disaster medicine have been asked for. The hypothesis was that measurable performance indicators can create comparable results and identify weak and strong areas of performance in disaster management education and training. Methods: Evaluation of each exercise was made with a set of 11 measurable performance indicators for IRMCC. The results of each indicator were scored 0, 1, or 2 according to the performance of each management group. RESULTS: The average of the total score for IRMCC was 14.05 of 22. The two best scored performance indicators, No 1 "declaring major incident" and No 2 "deciding on level of preparedness for staff" differed significantly from the two lowest scoring performance indicators, No 7 "first information to media" and No 8 "formulate general guidelines for response." CONCLUSION: The study demonstrated that decisions such as "formulating guidelines for response and "first information to media" were areas in initial medical command and control that need to be improved. This method can serve as a quality control tool in disaster management education programs.

Place, publisher, year, edition, pages
Weston, MA, USA: Weston Medical Publishing, LLC, 2010
Keyword
performance indicators, disaster management, education, quality measurement
National Category
Engineering and Technology
Identifiers
urn:nbn:se:liu:diva-57033 (URN)20349701 (PubMedID)
Available from: 2010-06-14 Created: 2010-06-09 Last updated: 2014-10-07
3. Performance indicators for initial regional medical response to major incidents: a possible quality control tool
Open this publication in new window or tab >>Performance indicators for initial regional medical response to major incidents: a possible quality control tool
2012 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, Vol. 20, no 81Article in journal (Refereed) 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.

Place, publisher, year, edition, pages
BioMed Central, 2012
Keyword
Emergency response, Disaster management, Casualty incident, Quality measurement, Resource management
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-89534 (URN)10.1186/1757-7241-20-81 (DOI)000313973900001 ()
Note

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

Available from: 2013-02-28 Created: 2013-02-26 Last updated: 2015-03-26
4. Simulation-assisted burn disaster planning
Open this publication in new window or tab >>Simulation-assisted burn disaster planning
Show others...
2013 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 39, no 6, 1122-1130 p.Article in journal (Refereed) Published
Abstract [en]

The aim of the study was to evaluate the Swedish medical systems response to a mass casualty burn incident in a rural area with a focus on national coordination of burn care. Data were collected from two simulations of a mass casualty incident with burns in a rural area in the mid portion of Sweden close to the Norwegian border, based on a large inventory of emergency resources available in this area as well as regional hospitals, university hospitals and burn centres in Sweden and abroad. The simulation system Emergo Train System (R) (ETS) was used and risk for preventable death and complications were used as outcome measures: simulation I, 18.5% (n = 13) preventable deaths and 15.5% (n = 11) preventable complications; simulation II, 11.4% (n = 8) preventable deaths and 11.4% (n = 8) preventable complications. The last T1 patient was evacuated after 7 h in simulation I, compared with 5 h in simulation II. Better national coordination of burn care and more timely distribution based on the experience from the first simulation, and possibly a learning effect, led to a better patient outcome in simulation II. The experience using a system that combines both process and outcome indicators can create important results that may support disaster planning.

Place, publisher, year, edition, pages
Elsevier, 2013
Keyword
Burns; Rural areas; Surge capacity; Mass casualty incidents; Preparedness
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-86596 (URN)10.1016/j.burns.2013.01.018 (DOI)000324349700014 ()
Available from: 2012-12-19 Created: 2012-12-19 Last updated: 2015-03-26Bibliographically approved

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