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Simulation-assisted burn disaster planning
Region Östergötland, Center for Disaster Medicine and Traumatology. Linköping University, Department of Clinical and Experimental Medicine, Disaster Medicine and Traumatology. Linköping University, Faculty of Health Sciences.
Region Östergötland, Center for Disaster Medicine and Traumatology. Linköping University, Department of Clinical and Experimental Medicine, Disaster Medicine and Traumatology. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences.
Region Östergötland, Center for Disaster Medicine and Traumatology. Linköping University, Department of Clinical and Experimental Medicine, Disaster Medicine and Traumatology. Linköping University, Faculty of Health Sciences.
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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. Vol. 39, no 6, 1122-1130 p.
Keyword [en]
Burns; Rural areas; Surge capacity; Mass casualty incidents; Preparedness
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-86596DOI: 10.1016/j.burns.2013.01.018ISI: 000324349700014OAI: oai:DiVA.org:liu-86596DiVA: diva2:579232
Available from: 2012-12-19 Created: 2012-12-19 Last updated: 2017-12-06Bibliographically approved
In thesis
1. Demand for Rapid and Accurate Regional Medical Response at Major Incidents
Open this publication in new window or tab >>Demand for Rapid and Accurate Regional Medical Response at Major Incidents
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:nbn:se:liu:diva-86597 (URN)9789175197135 (ISBN)
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: 2017-12-14Bibliographically approved

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Nilsson, HeléneJonson, Carl-OscarVikström, ToreThorfinn, JohanHuss, FredrikSjöberg, Folke

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Nilsson, HeléneJonson, Carl-OscarVikström, ToreThorfinn, JohanHuss, FredrikSjöberg, Folke
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Center for Disaster Medicine and TraumatologyDisaster Medicine and TraumatologyFaculty of Health SciencesSurgeryDepartment of Hand and Plastic SurgeryBurn CenterDivision of Clinical SciencesDepartment of Anaesthesiology and Intensive Care in Linköping
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Burns
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