To support learning, evaluations of crisis management efforts must be effective and lead to actionable recommendations that are implemented. However, little is known regarding what approaches are currently employed to evaluate crisis management efforts, the degree of implementation of recommendations, or if certain approaches are associated with a higher degree of implementation. This study explored these areas by analysing 24 evaluation reports from a Swedish regional public healthcare organisation and examining the implementation status of the presented recommendations.

The analysis of the evaluation reports showed that evaluations can be improved in terms of methodology and presentation, for example, by providing arguments for methodological choices and more clearly stating the purpose of evaluations.

A focus group categorised all 202 recommendations from the analysed evaluation reports to assess their implementation. The results showed that 28 % of the recommendations had been implemented with a clear connection to a specific evaluation, while 45 % were implemented with an unclear connection. Only 12 % were categorised as unimplemented, and 15 % were categorised as unknown. This suggests that evaluations of crisis management efforts have an impact. However, questions regarding their direct impact remain, given that most recommendations were categorised as implemented with unclear connections to specific evaluations.

Combining the results from the analysis of the evaluation reports with the categorisations by the focus group showed that including stakeholders in evaluations and providing arguments for why recommendations should be implemented can increase the direct impact of evaluations of crisis management efforts.

The current study explores immediate responders’ experience of collaboration in first aid. A preliminarydeductive content analysis of ten interviews showed three themes connecting the immediate respondersexperience of collaboration with theoretical teamwork constructs. Future work will investigate theexperience of specific teamwork constructs in the entire interview material.

When an accident has occurred, first aid before a professional response arrives can improve the outcome for the victims. However, little research has been done on the effect of coordination and leadership on first aid responses. This work-in-progress study reports an experiment using a simulated scenario, i.e. traffic accident, to understand the effect of coordination and leadership on first aid performance in ad-hoc groups of immediate responders. The results showed that coordination and leadership are significantly related to increased self-evaluated team performance while expertise and authority differentiation is not. These results provide a first insight to the coordination and leadership in ad-hoc groups of immediate responders, but more research is needed to validate these results. Structured performance evaluation with subject matter experts is planned as an extension to the present work-in-progress.

Introduction:

The Covid-19 pandemic strained most of the world’s health care organizations to, and sometimes beyond, their limits. To anticipate, coordinate, mobilize, and prioritize hospital resources, Sweden’s health care regions established regional medical command and control teams according to the medical major incident structure. This command structure was initially developed based on an all-hazards approach focused primarily on sudden mass casualty incidents with a relatively short time frame. Covid-19 management was active for several months with a most intense operations period during the spring of 2020. This study aimed at identifying competence needs by employing a co-creative approach with members of the staff involved in the pandemic management.

Method:

Data was collected and analyzed using a modified Delphi consensus method. The respondents were subject matter experts serving in the regional medical command and control teams during the COVID-19 pandemic. One workshop was held to gather opinions, which were included as statements in a consensus survey and answered by the participants after the first workshop. A second workshop was held to discuss statements that did not reach initial consensus in the survey and establish final consensus.

Results:

The consensus agreed statements were sorted into five themes, which constituted the collective agreement of medical command and control core abilities. The five core competence themes were: Situation report, Team organization, Co-operation, Competence management, and Analysis. The consensus agreed statements highlighted competencies needed for creating situation reports, organizing medical command and control teams, effective cross-organization co-operation, decision-making, and medical intelligence analysis.

Conclusion:

The core competencies of medical command and control identified in the present study can be used to further affirm current learning objectives and to formulate future learning objectives for education and exercises. The evaluation approach could potentially be used as a post-incident review to fine-tune an organization’s training plan.

Introduction:The Covid-19 pandemic strained health care organizations to their limits, and sometimes beyond. Different countries took different approaches to minimize the effects of the pandemic, both to protect public health and to safeguard the capability of the health care system.

A collaborative project between Sweden and Bosnia-Hercegovina with the aim to share and learn from experiences of managing the COVID-19 pandemic from a medical command and control perspective, initiated in 2021.

The project departed from three theoretical stances: sociotechnical systems perspective, experiential learning theory, and organizational learning theory. Framing the problem using a holistic systems approach, compared to focusing on individual experts, allows for understanding interactions on a system level. Hence, could these theories contribute to supporting individuals' learning and organizational change?

Method:A two-day workshop involving participants from both Swedish and Bosnian (N=21) medical command and control allowed for the exchange of experiences and another's perspective on similar challenges. During the workshop, two themes were addressed: common operational picture and evaluation. First, an introductory presentation was held, then the theme was discussed and reflected upon in small groups. After this, the groups presented their conclusions, and a full group discussion was moderated.

Results:The discussions resulted in participants sharing perspectives on the selected themes, providing personal insights and experience, allowing for deepened and increased understanding of the theme. In spite of major differences between the Swedish and the Bosnian health care systems and Covid-19 approaches, several shared conclusions were identified. For example, reflections on decision processes and strategies, as well as interest in improving the crisis organization.

Conclusion:Exposing participants to different views on well-known processes and challenges allows for reflecting, verbalizing, and reaching a deeper understanding. By displaying a culturally differently organized way of approaching the challenges the contrast is even more evident.

Vid masskadehändelser uppstår en omedelbar obalans mellan tillgänglig sjukvårdspersonal och behovet hos de skadade. Denna obalans kan kvarstå även efter att professionell mobiliserats till skadeplatsen och senare under vårdförloppet på enskilda sjukhus och i regioner. Masskadetriagesystem har syftet att tillgänglig personal ska göra det viktigaste först och ge bästa möjliga behandling för flest möjliga. Masskadetriagesystem innehåller sållningssteg och algoritmer baserade på vitalparametrar för att kategorisera patienter i prioriteringsnivå. Detta kan innebära att skadade som kan vänta behöver vänta, och att svårt skadade med stort vårdbehov och låg chans till överlevnad inte prioriteras för vård.

För ett land som Sverige inte har ett nationell fastställt masskadetriagesystem innebär det utmaningar att urskilja vilket masskadetriagesystem som bör införas, och hur detta bör gå till. Denna studie fokuserar på frågeställningarna om råd och förväntningar en nationell panel experter hade på ett införande ett nationellt masskadetriagesystem. Studien genomfördes på uppdrag av Socialstyrelsen med utgångspunkt i myndighetens arbete med nationell masskadeplan delvis baserat på regeringsuppdrag S2021/02921.

Semistrukturerade intervjuer genomfördes med 17 personer (7 kvinnor, 10 män) från tio olika regioner med yrkesbakgrund inom prehospital sjukvård och katastrofmedicinsk beredskap. En tematisk analys genomfördes på materialitet vilket genererade fem teman om hur masskadetriage bör definieras, hur triagering används idag, hur framtida masskadetriagering bör utföras, hur masskadetriagesystemet bör införas och förvaltas. Respondenterna menade att ett nationellt system förenklar samverkan över regiongränser och tog även upp behovet av ett enkelt system som alla kan använda, även aktörer som polis, räddningstjänst och Försvarsmakten. Det fanns behov av att fastställa systemet nationellt och det framkom förslag på effektiva sätt att införa systemet för att främja bred acceptans i Sverige. Respondenterna tar även upp behov av vetenskaplig förankring, utbildning och etiska diskussioner. Förvaltning av systemet bör enligt deltagarna utföras av en arbetsgrupp eller kunskapscenter med ansvar att följa upp användandet och identifiera behov av revision efter implementation av systemet.

Resultaten från studien visar på ett behov av och en acceptans för, att införa ett nationellt triagesystem för masskadetriage i Sverige. Utifrån experternas råd och förväntningar ger studien rekommendationer till fortsatt arbete i utvecklingen och införandet av ett nationellt masskadetriagessystem i Sverige.