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.