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Disaster medicine- performance indicators, information support and documentation: A study of an evaluation tool
Linköping University, Department of Biomedicine and Surgery. Linköping University, Faculty of Health Sciences.
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The science of disaster medicine is more a descriptive than analytical type. Research, in most instances, has not employed quantitative methods and there is very sparse knowledge based on analytical statistics. One consequence of this is that similar mistakes are repeated over and over. Lessons that should be learned are merely observed.

Moreover, there are almost no practical or ethical ways in which randomised controlled studies can be performed.

The management, command and control of situations on different levels of hierarchy has eldom been evaluated and there have been no standards against which performance can be evaluated. Furthermore, the documentation of decisions and staff work is rarely sufficient enough to evaluate command and control functions.

Setting standards that may be used as templates for evaluation and research is an issue that is constantly being addressed by leading experts in the field of disaster medicine and this is also an important issue that is expressed in the Utstein Template.

Swedish National Board of Health and Welfare, templates of performance indicators were developed. These were tested on reports available from incidents, and our conclusion was that documentation in this form was not adequate enough for use in this method of evaluation.

Documentation must be improved and data probably need to be captured and stored with the help of information systems.

A template developed for the evaluation of medical command and control at the scene was tested in standardised examinations. When using this template in this setting it was possible to obtain specific information on those aspects of command and control that need to be improved.

An information system using on-line Internet technique was studied twice. The first study concluded that in spite of technical disturbances the system was acceptable to the organisation but could not yet be recommended for use during major incidents. The second study concluded that the retrieval of information was, in all respects not as good as the control system, a conventional ambulance file system.

In a study of staff procedure skills during training of management staffs in command and control it was concluded that documentation during training sessions was not adequate and this lack of staff procedure skills could possibly be a contributing factor to the fact that lessons in command and control are not learned from incidents.

Conclusions in thesis are that measurable performance indicators can be used in the training of command and control. If performance indicators are to be used in real incidents and disasters, functioning information systems have to be developed. This may lead to a better knowledge of command and control and could possibly contribute to a process where lessons are learned and mistakes are not repeated.

Place, publisher, year, edition, pages
Institutionen för biomedicin och kirurgi , 2006.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 972
Series
Keyword [en]
disaster medicine, performance indicators, evaluation, information system, documentation, staff skills, command and control, management
National Category
Anesthesiology and Intensive Care
Identifiers
URN: urn:nbn:se:liu:diva-7990ISBN: 91-85643-55-6 (print)OAI: oai:DiVA.org:liu-7990DiVA: diva2:22887
Public defence
2006-12-14, Aulan, Katastrofmedicinskt Centrum, Campus US, Linköpings Universitet, Linköping, 10:30 (English)
Opponent
Supervisors
Available from: 2007-01-04 Created: 2007-01-04 Last updated: 2009-06-01
List of papers
1. A new system for transmission of on-line information from scene of accident and ambulances to hospitals
Open this publication in new window or tab >>A new system for transmission of on-line information from scene of accident and ambulances to hospitals
2003 (English)In: International Journal of Disaster Medicine, ISSN 1503-1438, Vol. 1, no 2, 127-131 p.Article in journal (Refereed) Published
Abstract [en]

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 recorded as well as all cases when the ambulance crew alerted the hospital through the alert function. All technical problems and any period of time when the system was 'out of use' were noted. Results. During the period of the study, the system was successfully used to transfer data from the scene to hospital in a total of 3353 missions, including transport of a patient from the scene to an emergency department. Of these, in 150 transports the transferred data served as a base for immediate support on arrival at the hospital that was of critical importance for primary management in the hospital. In all, 2883 different kinds of medical data were transmitted. The local help-desk was notified of problems with the system on 11 occasions; six of these were technical problems and the rest were user-related. The IS Swede system was not operational during parts of 3 days (<5%) of the time. Conclusions. Despite the introduction of new equipment and new standard operating procedures, IS Swede was accepted within the organization to a degree which could be considered operational in major incidents. Technical problems with IS Swede caused only minor disturbances during the study period.

Keyword
communication, ambulance, internet, Mobitex®, on-line information
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-14196 (URN)10.1080/15031430310031366 (DOI)
Available from: 2007-01-04 Created: 2007-01-04
2. Performance indicators for major incident medical management: a possible tool for quality control?
Open this publication in new window or tab >>Performance indicators for major incident medical management: a possible tool for quality control?
2004 (English)In: International Journal of Disaster Medicine, ISSN 1503-1438, Vol. 2, no 1-2, 52-55 p.Article in journal (Refereed) Published
Abstract [en]

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.

Keyword
control and command; objectives; goals; management; scene of accident; strategic level; KAMEDO reports
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-14197 (URN)10.1080/15031430410023355 (DOI)
Available from: 2007-01-04 Created: 2007-01-04
3. Performance indicators for prehospital command and control in training of medical first responders
Open this publication in new window or tab >>Performance indicators for prehospital command and control in training of medical first responders
2004 (English)In: International Journal of Disaster Medicine, ISSN 1503-1438, Vol. 2, no 3, 89-92 p.Article in journal (Refereed) Published
Abstract [en]

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.

Keyword
medical response, disaster management, quality control, ambulance crew
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-14198 (URN)10.1080/15031430510032804 (DOI)
Available from: 2007-01-04 Created: 2007-01-04 Last updated: 2010-04-08
4. Comparison of an on-line information system with a conventional ambulance file system regarding the retrieval of information after missions
Open this publication in new window or tab >>Comparison of an on-line information system with a conventional ambulance file system regarding the retrieval of information after missions
2005 (English)In: International Journal of Disaster Medicine, ISSN 1503-1438, Vol. 3, no 1-4, 37-40 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: To determine if an on-line information system is superior to a conventional ambulance file system regarding the possibility of retrieving information as follow-up in daily use and also with reference to disaster situations.

Materials and methods: The study was designed as a prospective study where two systems that have been operational for several years were compared. One system was a system primarily built for on-line registration and the other a conventional ambulance file system.

Results: In all aspects data regarding ambulance missions and patients were more thoroughly registered in the conventional file system. Also data were easier to retrieve with less time consumption compared to the on-line system.

Conclusion: The on-line information system studied was less accurate for storing and retrieving information than a conventional ambulance file system. Thus, more technical development is needed before this on-line system can be recommended for use in major incidents or disasters.

Keyword
ambulance files; performance indicators; evaluation
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-14199 (URN)10.1080/15031430500535232 (DOI)
Available from: 2007-01-04 Created: 2007-01-04 Last updated: 2009-03-11
5. Staff procedure skills in management groups during exercise in disaster medicine
Open this publication in new window or tab >>Staff procedure skills in management groups during exercise in disaster medicine
2006 (English)In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 22, no 4, 318-324 p.Article in journal (Refereed) Submitted
Abstract [en]

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.

Place, publisher, year, edition, pages
Cambridge University Press, 2006
Keyword
disaster; exercise; management groups; medical management; performance indicators; procedure; skills
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-14200 (URN)
Available from: 2007-01-04 Created: 2007-01-04 Last updated: 2017-12-13

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