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Dark P, Smith M, Ziman H, Carley S, Lecky F. Healthcare system impacts of the 2017 Manchester Arena bombing: evidence from a national trauma registry patient case series and hospital performance data. Emerg Med J 2021; 38:746-755. [PMID: 33888513 PMCID: PMC8461451 DOI: 10.1136/emermed-2019-208575] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/04/2021] [Accepted: 04/08/2021] [Indexed: 11/14/2022]
Abstract
Introduction In response to detonation of an improvised explosive device at the Manchester Arena on 22 May 2017, we aimed to use detailed information about injured patients flowing through hospital healthcare to objectively evaluate the preplanned responses of a regional trauma care system and to show how routinely collected hospital performance data can be used to assess impact on regional healthcare. Methods Data about injury severity, management and outcome for patients presenting to hospitals were collated using England’s major trauma registry for 30 days following hospital attendance. System-wide data about hospital performance were collated by National Health Service England’s North West Utilisation Management Unit and presented as Shewhart charts from 15 April 2017 to 25 June 2017. Results Detailed information was obtained on 153 patients (109 adults and 44 children) who attended hospital emergency departments after the incident. Within 6 hours, a network of 11 regional trauma care hospitals received a total of 138 patients (90%). For the whole patient cohort, median Injury Severity Score (ISS) was 1 (IQR 1–10) and median New ISS (NISS) was 2 (IQR 1–14). For the 75 patients (49%) attending a major trauma centre, median ISS was 7.5 (IQR 1–14) and NISS was 10 (IQR 3–22). Limb and torso body regions predominated when injuries were classified as major life threatening (Abbreviated Injury Scale>3). Ninety-three patients (61%) required hospital admission following emergency department management, with 21 (14%) requiring emergency damage control surgery and 24 (16%) requiring critical care. Three fatalities occurred during early resuscitative treatment and 150 (98%) survived to day 30. The increased system-wide hospital admissions and care activity was linked to increases in regional hospital care capacity through cancellations of elective surgery and increased community care. Consequently, there were sustained system-wide hospital service improvements over the following weeks. Conclusions The systematic collation of injured patient and healthcare system data has provided an objective evaluation of a regional major incident plan and provided insight into healthcare system resilience. Hospital patient care data indicated that a prerehearsed patient dispersal plan at incident scene was implemented effectively.
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Affiliation(s)
- Paul Dark
- Humanitarian and Conflict Response Institute, University of Manchester, Manchester, UK
| | - Martin Smith
- Emergency Department, Salford Royal Hospitals NHS Trust, Salford, UK
| | | | - Simon Carley
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Fiona Lecky
- Centre for Urgent and Emergency Care Research, The University of Sheffield, Sheffield, UK
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Wu W, Huo Y, Ding X, Zhou Y, Gu S, Gao Y. Identification of the risks in CAR T-cell therapy clinical trials in China: a Delphi study. Ther Adv Med Oncol 2020; 12:1758835920966574. [PMID: 33149770 PMCID: PMC7580145 DOI: 10.1177/1758835920966574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 07/13/2020] [Indexed: 11/16/2022] Open
Abstract
Aims: Within the past few years, there has been tremendous growth in clinical trials of chimeric antigen receptor (CAR) T-cell therapies. Unlike those of many small-molecule pharmaceuticals, CAR T-cell therapy clinical trials are fraught with risks due to the use of live cell products. The aim of this study is to reach a consensus with experts on the most relevant set of risks that practically occur in CAR T-cell therapy clinical trials. Methods: A Delphi method of consensus development was used to identify the risks in CAR T-cell therapy clinical trials, comprising three survey rounds. The expert panel consisted of principal investigators, clinical research physicians, members of institutional ethics committees, and Good Clinical Practice managers. Results: Of the 24 experts invited to participate in this Delphi study, 20 participants completed Round 1, Round 2, and Round 3. Finally, consensus (defined as >80% agreement) was achieved for 54 risks relating to CAR T-cell clinical trials. Effective interventions related to these risks are needed to ensure the proper protection of subject health and safety. Conclusion: The Delphi method was successful in gaining a consensus on risks relevant to CAR T-cell clinical trials in a geographically diverse expert association. It is hoped that this work can benefit future risk-based quality management in clinical trials and can potentially promote the better development of CAR T-cell therapy products.
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Affiliation(s)
- Weijia Wu
- Department of Clinical Pharmacy and Pharmaceutical Management, School of Pharmacy, Fudan University, Shanghai, China
| | - Yan Huo
- National Institution of Food and Drug Control, National Medical Products Administration, Beijing, China
| | - Xueying Ding
- Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee
| | - Yuhong Zhou
- Department of Medical Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shengying Gu
- Clinical Research Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuan Gao
- Department of Clinical Pharmacy and Pharmaceutical Management, School of Pharmacy, Fudan University, Pudong District, Shanghai, 200433, China
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Vaughan-Graham J, Cheryl C, Holland A, Michielsen M, Magri A, Suzuki M, Brooks D. Developing a revised definition of the Bobath concept: Phase three. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2019; 25:e1832. [PMID: 31889391 DOI: 10.1002/pri.1832] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/17/2019] [Accepted: 12/13/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To develop a revised definition of the Bobath concept that incorporates the perspectives of members of the International Bobath Instructors Training Association (IBITA). METHODS A three-phase consensus building design utilizing (i) focus groups; (ii) survey methods; and, (iii) real-time Delphi. This paper presents the findings from the real-time Delphi, an iterative process to collect and synthesize expert opinions anonymously, provide controlled feedback, with the overall goal of achieving consensus. RESULTS One hundred and twenty-one IBITA members participated in the real-time Delphi. Over three Delphi Rounds, consensus was reached on six overarching conceptual statements and 11 statements representing unique aspects of Bobath clinical practice. One statement that aimed to describe the Bobath clinical term of "placing" was eliminated in Round One due to participant reservations that a text description was insufficient for this term. Seven statements underwent minor wording revisions in Round Two and Three to improve sentence clarity. CONCLUSION Using the real-time Delphi, we were successful in gaining consensus in an expert group on a series of statements on which a revised definition of the Bobath concept could be based.
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Affiliation(s)
- Julie Vaughan-Graham
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, Ontario, Canada
| | - Cott Cheryl
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, Ontario, Canada
| | - Ann Holland
- Neurorehabilitation and Therapy Services, The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK
| | | | - Alba Magri
- Studio Erre- Physiotherapy Clinic, Via della Badia, 18, Brescia-, Italy
| | - Mitsuo Suzuki
- Rokujizo Genenal Hospital, 9 Naramchi, Rokujizo Uji-shi, Kyoto, Japan
| | - Dina Brooks
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, Ontario, Canada
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Identifying Factors That May Influence Decision-Making Related to the Distribution of Patients During a Mass Casualty Incident. Disaster Med Public Health Prep 2017; 12:101-108. [PMID: 28918763 DOI: 10.1017/dmp.2017.43] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE We aimed to identify and seek agreement on factors that may influence decision-making related to the distribution of patients during a mass casualty incident. METHODS A qualitative thematic analysis of a literature review identified 56 unique factors related to the distribution of patients in a mass casualty incident. A modified Delphi study was conducted and used purposive sampling to identify peer reviewers that had either (1) a peer-reviewed publication within the area of disaster management or (2) disaster management experience. In round one, peer reviewers ranked the 56 factors and identified an additional 8 factors that resulted in 64 factors being ranked during the two-round Delphi study. The criteria for agreement were defined as a median score greater than or equal to 7 (on a 9-point Likert scale) and a percentage distribution of 75% or greater of ratings being in the highest tertile. RESULTS Fifty-four disaster management peer reviewers, with hospital and prehospital practice settings most represented, assessed a total of 64 factors, of which 29 factors (45%) met the criteria for agreement. CONCLUSIONS Agreement from this formative study suggests that certain factors are influential to decision-making related to the distribution of patients during a mass casualty incident. (Disaster Med Public Health Preparedness. 2018;12:101-108).
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Vaughan-Graham J, Cott C. Defining a Bobath clinical framework – A modified e-Delphi study. Physiother Theory Pract 2016; 32:612-627. [DOI: 10.1080/09593985.2016.1228722] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Julie Vaughan-Graham
- Department of Physical Therapy, Rehabilitation Science Institute, University of Toronto, Toronto, ON, Canada
| | - Cheryl Cott
- Department of Physical Therapy, Rehabilitation Science Institute, University of Toronto, Toronto, ON, Canada
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International Consensus on Key Concepts and Data Definitions for Mass-gathering Health: Process and Progress. Prehosp Disaster Med 2016; 31:220-3. [DOI: 10.1017/s1049023x1600011x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractMass gatherings (MGs) occur worldwide on any given day, yet mass-gathering health (MGH) is a relatively new field of scientific inquiry. As the science underpinning the study of MGH continues to develop, there will be increasing opportunities to improve health and safety of those attending events. The emerging body of MG literature demonstrates considerable variation in the collection and reporting of data. This complicates comparison across settings and limits the value and utility of these reported data. Standardization of data points and/or reporting in relation to events would aid in creating a robust evidence base from which governments, researchers, clinicians, and event planners could benefit. Moving towards international consensus on any topic is a complex undertaking. This report describes a collaborative initiative to develop consensus on key concepts and data definitions for a MGH “Minimum Data Set.” This report makes transparent the process undertaken, demonstrates a pragmatic way of managing international collaboration, and proposes a number of steps for progressing international consensus. The process included correspondence through a journal, face-to-face meetings at a conference, then a four-day working meeting; virtual meetings over a two-year period supported by online project management tools; consultation with an international group of MGH researchers via an online Delphi process; and a workshop delivered at the 19thWorld Congress on Disaster and Emergency Medicine held in Cape Town, South Africa in April 2015. This resulted in an agreement by workshop participants that there is a need for international consensus on key concepts and data definitions.TurrisSA,SteenkampM,LundA,HuttonA,RanseJ,BowlesR,ArbuthnottK,AnikeevaO,ArbonP.International consensus on key concepts and data definitions for mass-gathering health: process and progress.Prehosp Disaster Med.2016;31(2):220–223.
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Marung H, Gräsner J, Bohn A, Hackstein A, Kaufmann F, Kersting J, Orlob S, Roessler M, Schmid O, Seewald S, Wnent J, Weiß C, Kreimeier U. Qualitätsmanagement bei der Telefonreanimation − mehr Daten für mehr Überlebende. Notf Rett Med 2015. [DOI: 10.1007/s10049-015-0010-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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What are the research needs for the field of disaster nursing? An international Delphi study. Prehosp Disaster Med 2014; 29:448-54. [PMID: 25162761 DOI: 10.1017/s1049023x14000946] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Internationally there is an increasing amount of peer-reviewed literature pertaining to disaster nursing. The literature includes personal anecdotes, reflections, and accounts of single case studies. Furthermore, issues such as the willingness of nurses to assist in disasters, the role of nurses in disasters, leadership, competencies, and educational preparedness for nurses have been the focus of the literature. AIM The aim of this research was to determine the international research priorities for disaster nursing. METHOD This research used a three-round Delphi technique. The first round used a face-to-face workshop to generate research statements with nursing members of the World Association for Disaster and Emergency Medicine (WADEM). The second and third rounds included the ranking of statements on a 5-point Likert scale with nursing members of WADEM and the World Society of Disaster Nursing (WSDN). Statements that achieved a mean of four or greater were considered a priority and progressed. RESULTS Participants were from multiple countries. Research statements were generated in the areas of: education, training, and curriculum; psychosocial; strategy, relationship, and networking; and clinical practice. Psychosocial aspects of disaster nursing ranked the highest, with five statements appearing in the top ten research areas, followed by statements relating to: education, training, and curriculum; clinical practice; and finally, strategy, relationship, and networking. CONCLUSIONS Future disaster nursing research should focus on the area of psychosocial aspects of disaster nursing, in particular, both the psychosocial needs of a disaster-affected community and the psychosocial wellbeing of nurses who assist in disaster health activities.
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Boyd A, Chambers N, French S, Shaw D, King R, Whitehead A. Emergency planning and management in health care: priority research topics. Health Syst (Basingstoke) 2014; 3:83-92. [PMID: 25013721 PMCID: PMC4063321 DOI: 10.1057/hs.2013.15] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 07/24/2013] [Accepted: 10/18/2013] [Indexed: 11/21/2022] Open
Abstract
Many major incidents have significant impacts on people's health, placing additional demands on health-care organisations. The main aim of this paper is to suggest a prioritised agenda for organisational and management research on emergency planning and management relevant to U.K. health care, based on a scoping study. A secondary aim is to enhance knowledge and understanding of health-care emergency planning among the wider research community, by highlighting key issues and perspectives on the subject and presenting a conceptual model. The study findings have much in common with those of previous U.S.-focused scoping reviews, and with a recent U.K.-based review, confirming the relative paucity of U.K.-based research. No individual research topic scored highly on all of the key measures identified, with communities and organisations appearing to differ about which topics are the most important. Four broad research priorities are suggested: the affected public; inter- and intra-organisational collaboration; preparing responders and their organisations; and prioritisation and decision making.
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Affiliation(s)
- Alan Boyd
- Manchester Business School, The University of Manchester , Manchester, U.K
| | - Naomi Chambers
- Manchester Business School, The University of Manchester , Manchester, U.K
| | | | | | - Russell King
- Royal Free London NHS Foundation Trust , London, U.K
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Medford-Davis LN, Kapur GB. Preparing for effective communications during disasters: lessons from a World Health Organization quality improvement project. Int J Emerg Med 2014; 7:15. [PMID: 24646607 PMCID: PMC4000058 DOI: 10.1186/1865-1380-7-15] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 02/10/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND One hundred ninety-four member nations turn to the World Health Organization (WHO) for guidance and assistance during disasters. Purposes of disaster communication include preventing panic, promoting appropriate health behaviors, coordinating response among stakeholders, advocating for affected populations, and mobilizing resources. METHODS A quality improvement project was undertaken to gather expert consensus on best practices that could be used to improve WHO protocols for disaster communication. Open-ended surveys of 26 WHO Communications Officers with disaster response experience were conducted. Responses were categorized to determine the common themes of disaster response communication and areas for practice improvement. RESULTS Disasters where the participants had experience included 29 outbreaks of 13 different diseases in 16 countries, 18 natural disasters of 6 different types in 15 countries, 2 technical disasters in 2 countries, and ten conflicts in 10 countries. CONCLUSION Recommendations to build communications capacity prior to a disaster include pre-writing public service announcements in multiple languages on questions that frequently arise during disasters; maintaining a database of statistics for different regions and types of disaster; maintaining lists of the locally trusted sources of information for frequently affected countries and regions; maintaining email listservs of employees, international media outlet contacts, and government and non-governmental organization contacts that can be used to rapidly disseminate information; developing a global network with 24-h cross-coverage by participants from each time zone; and creating a central electronic sharepoint where all of these materials can be accessed by communications officers around the globe.
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Affiliation(s)
| | - G Bobby Kapur
- Section of Emergency Medicine, Baylor College of Medicine, Ben Taub General Hospital Emergency Center, Houston TX, USA.
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Rimstad R, Njå O, Rake EL, Braut GS. Incident Command and Information Flows in a Large-Scale Emergency Operation. JOURNAL OF CONTINGENCIES AND CRISIS MANAGEMENT 2014. [DOI: 10.1111/1468-5973.12033] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Rune Rimstad
- Norwegian Air Ambulance Foundation; Drøbak Norway
- Department of Industrial Economics, Risk Management and Planning; University of Stavanger; Stavanger Norway
- Oslo University Hospital; Oslo Norway
| | - Ove Njå
- Department of Industrial Economics, Risk Management and Planning; University of Stavanger; Stavanger Norway
| | | | - Geir Sverre Braut
- Norwegian Board of Health; Oslo Norway
- Stord/Haugesund University College; Stord/Haugesund Norway
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Rådestad M, Jirwe M, Castrén M, Svensson L, Gryth D, Rüter A. Essential key indicators for disaster medical response suggested to be included in a national uniform protocol for documentation of major incidents: a Delphi study. Scand J Trauma Resusc Emerg Med 2013; 21:68. [PMID: 24025366 PMCID: PMC3848492 DOI: 10.1186/1757-7241-21-68] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 09/08/2013] [Indexed: 11/28/2022] Open
Abstract
Background Registration of data from a major incident or disaster serves several purposes such as to record data for evaluation of response as well as for research. Data needed can often be retrieved after an incident while other must be recorded during the incident. There is a need for a consensus on what is essential to record from a disaster response. The aim of this study was to identify key indicators essential for initial disaster medical response registration. By this is meant nationally accepted processes involved, from the time of the emergency call to the emergency medical communication centre until medical care is provided at the emergency department. Methods A three round Delphi study was conducted. Thirty experts with a broad knowledge in disaster and emergency response and medical management were invited. In this study we estimated 30 experts to be approximately one third of the number in Sweden eligible for recruitment. Process, structure and outcome indicators for the initial disaster medical response were identified. These were based on previous research and expressed as statements and were grouped into eight categories, and presented to the panel of experts. The experts were instructed to score each statement, using a five point Likert scale, and were also invited to include additional statements. Statements reaching a predefined consensus level of 80% were considered as essential to register. Results In total 97 statements were generated, 77 statements reached consensus. The 77 statements covered parts of all relevant aspects involved in the initial disaster medical response. The 20 indicators that did not reach consensus mostly concerned patient related times in hospital, types of support systems and security for health care staff. Conclusions The Delphi technique can be used for reaching consensus of data, comprising process, structure and outcome indicators, identified as essential for recording from major incidents and disasters.
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Affiliation(s)
- Monica Rådestad
- Department of Clinical Science and Education and Section of Emergency Medicine, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
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Fattah S, Rehn M, Reierth E, Wisborg T. Systematic literature review of templates for reporting prehospital major incident medical management. BMJ Open 2013; 3:bmjopen-2013-002658. [PMID: 23906946 PMCID: PMC3733314 DOI: 10.1136/bmjopen-2013-002658] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To identify and describe the content of templates for reporting prehospital major incident medical management. DESIGN Systematic literature review according to PRISMA guidelines. DATA SOURCES PubMed/MEDLINE, EMBASE, CINAHL, Scopus and Web of Knowledge. Grey literature was also searched. ELIGIBILITY CRITERIA FOR SELECTED STUDIES Templates published after 1 January 1990 and up to 19 March 2012. Non-English language literature, except Scandinavian; literature without an available abstract; and literature reporting only psychological aspects were excluded. RESULTS The main database search identified 8497 articles, among which 8389 were excluded based on title and abstract. An additional 96 were excluded based on the full-text. The remaining 12 articles were included in the analysis. A total of 107 articles were identified in the grey literature and excluded. The reference lists for the included articles identified five additional articles. A relevant article published after completing the search was also included. In the 18 articles included in the study, 10 different templates or sets of data are described: 2 methodologies for assessing major incident responses, 3 templates intended for reporting from exercises, 2 guidelines for reporting in medical journals, 2 analyses of previous disasters and 1 Utstein-style template. CONCLUSIONS More than one template exists for generating reports. The limitations of the existing templates involve internal and external validity, and none of them have been tested for feasibility in real-life incidents. TRIAL REGISTRATION The review is registered in PROSPERO (registration number: CRD42012002051).
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Affiliation(s)
- Sabina Fattah
- Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway
- Anaesthesia and Critical Care Research Group, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
| | - Marius Rehn
- Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway
- Network of Medical Sciences, Field of Pre-hospital Critical Care, University of Stavanger, Stavanger, Norway
- Department of Anaesthesia and Intensive Care, Akershus University Hospital, Lørenskog, Norway
| | - Eirik Reierth
- Science and Health Library, University Library of Tromsø, University of Tromsø, Tromsø, Norway
| | - Torben Wisborg
- Anaesthesia and Critical Care Research Group, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
- Department of Anaesthesiology and Intensive Care, Hammerfest Hospital, Finnmark Health Trust, Hammerfest, Norway
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