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Ugelvik KS, Thomassen Ø, Braut GS, Geisner T, Sjøvold JE, Agri J, Montan C. Evaluation of prehospital preparedness for major incidents on a national level, with focus on mass casualty incidents. Eur J Trauma Emerg Surg 2024; 50:945-957. [PMID: 38117294 PMCID: PMC11249512 DOI: 10.1007/s00068-023-02386-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/21/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE To investigate prehospital preparedness work for Mass Casualty Incidents (MCI) and Major Incidents (MI) in Norway. METHOD A national cross-sectional descriptive study of Norway's prehospital MI preparedness through a web-based survey. A representative selection of Rescue and Emergency Services were included, excluding Non-Governmental Organisations and military. The survey consisted of 59 questions focused on organisation, planning, education/training, exercises and evaluation. RESULTS Totally, 151/157 (96%) respondents answered the survey. The results showed variance regarding contingency planning for MCI/MI, revisions of the plans, use of national triage guidelines, knowledge requirements, as well as haemostatic and tactical first aid skills training. Participation in interdisciplinary on-going life-threatening violence (PLIVO) exercises was high among Ambulance, Police and Fire/Rescue Emergency Services. Simulations of terrorist attacks or disasters with multiple injured the last five years were reported by 21/151 (14%) on a regional level and 74/151 (48%) on a local level. Evaluation routines after MCI/MI events were reported by half of the respondents (75/151) and 70/149 (47%) described a dedicated function to perform such evaluation. CONCLUSION The study indicates considerable variance and gaps among Prehospital Rescue and Emergency Services in Norway regarding MCI/MI preparedness work, calling for national benchmarks, minimum requirements, follow-up routines of the organisations and future reassessments. Implementation of mandatory PLIVO exercises seems to have contributed to interdisciplinary exercises between Fire/Rescue, Police and Ambulance Emergency Service. Repeated standardised surveys can be a useful tool to assess and follow-up the MI preparedness work among Prehospital Rescue and Emergency Services at a national, regional and local level.
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Affiliation(s)
- Kristina Stølen Ugelvik
- University of Bergen, Bergen, Norway.
- Regional Trauma Centre, Haukeland University Hospital, Bergen, Norway.
| | - Øyvind Thomassen
- University of Bergen, Bergen, Norway
- HEMS, Haukeland University Hospital, Bergen, Norway
- Norwegian Air Ambulance Foundation, Oslo, Norway
| | - Geir Sverre Braut
- Stavanger University Hospital, Stavanger, Norway
- Western Norway University of Applied Sciences, Stavanger, Norway
| | - Thomas Geisner
- Gastrosurgical Department, Haukeland University Hospital, Bergen, Norway
| | | | - Joakim Agri
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Carl Montan
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Perry O, Jaffe E, Goldberg A, Bitan Y. Incident commander decision making: Quantitative evaluation of instantaneous and considered decisions. APPLIED ERGONOMICS 2024; 114:104139. [PMID: 37748355 DOI: 10.1016/j.apergo.2023.104139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/14/2023] [Accepted: 09/11/2023] [Indexed: 09/27/2023]
Abstract
The Incident Commander (IC) decision-making process has previously been modeled primarily by qualitative evaluation methods, which has made it difficult to generalize an objective model. In this study, we took a quantitative approach to elucidate a decision-making model based on the "dual-process" model that consists of instantaneous decisions ("System 1") and considered decisions ("System 2") to gain new insights regarding the IC decision-making process. High-fidelity simulation data from eight mass-casualty incidents (MCIs) were analyzed in two categories. The first category represents cues of new information and the IC's actions, divided into three main subcategories: actions following the MCI protocol, responses following cues, and actions without a cue. The second category divides the simulation into three MCI management phases: (1) evaluation and triage, (2) treatment and preparedness for evacuation, and (3) evacuation. Actions that followed the MCI protocol were significantly higher in the first phase compared to the other two phases (p<0.01 for both phases). Responses following cues were significantly higher in the second phase compared to the first (p<0.01). Actions without a cue were significantly higher in both the second and third phases compared to the first (p<0.01 for both phases). The results reveal that the IC followed MCI protocol guidance in the simulation initiation and immediately responded to cues, which fits "System 1". As the simulation evolved, the IC made more planned tasks and initiated actions without leading cues, which fits "System 2". The study found that ICs can change their decision-making mode, and this understanding can serve to improve their decision-making process and increase casualty survival rates.
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Affiliation(s)
- Omer Perry
- Department of Health Policy & Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Eli Jaffe
- Magen-David-Adom, Israeli National Emergency Medical Services, Israel.
| | - Avishay Goldberg
- Department of Health Policy & Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Yuval Bitan
- Department of Health Policy & Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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Phattharapornjaroen P, Carlström E, Atiksawedparit P, Holmqvist LD, Pitidhammabhorn D, Sittichanbuncha Y, Khorram-Manesh A. The impact of the three-level collaboration exercise on collaboration and leadership during scenario-based hospital evacuation exercises using flexible surge capacity concept: a mixed method cross-sectional study. BMC Health Serv Res 2023; 23:862. [PMID: 37580718 PMCID: PMC10426132 DOI: 10.1186/s12913-023-09882-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/07/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Hospitals play a crucial role in responding to disasters and public health emergencies. However, they are also vulnerable to threats such as fire or flooding and can fail to respond or evacuate adequately due to unpreparedness and lack of evacuation measures. The United Nations Office for Disaster Risk Reduction has emphasised the importance of partnerships and capacity building in disaster response. One effective way to improve and develop disaster response is through exercises that focus on collaboration and leadership. This study aimed to examine the effectiveness of using the 3-level collaboration (3LC) exercise in developing collaboration and leadership in districts in Thailand, using the concept of flexible surge capacity (FSC) and its collaborative tool during a hospital evacuation simulation. METHODS A mixed-method cross-sectional study was conducted with 40 participants recruited from disaster-response organisations and communities. The data from several scenario-based simulations were collected according to the collaborative elements (Command and control, Safety, Communication, Assessment, Triage, Treatment, Transport), in the disaster response education, "Major Incident Medical Management and Support" using self-evaluation survey pre- and post-exercises, and direct observation. RESULTS The 3LC exercise effectively facilitated participants to gain a mutual understanding of collaboration, leadership, and individual and organisational flexibility. The exercise also identified gaps in communication and the utilisation of available resources. Additionally, the importance of early community engagement was highlighted to build up a flexible surge capacity during hospital evacuation preparedness. CONCLUSIONS the 3LC exercise is valuable for improving leadership skills and multiagency collaboration by incorporating the collaborative factors of Flexible Surge Capacity concept in hospital evacuation preparedness.
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Affiliation(s)
- Phatthranit Phattharapornjaroen
- Institute of Clinical Sciences, Department of Surgery, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 40530, Sweden.
- Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand.
| | - Eric Carlström
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 40100, Sweden
- Gothenburg Emergency Medicine Research Group, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 40530, Sweden
- USN School of Business, University of South-Eastern Norway, Kongsberg, 3603, Norway
| | - Pongsakorn Atiksawedparit
- Faculty of Medicine Ramathibodi Hospital, Chakri Naruebodindra Medical Institute, Mahidol University, Samut Prakan, 10540, Thailand
| | - Lina Dahlén Holmqvist
- Gothenburg Emergency Medicine Research Group, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 40530, Sweden
- Institute of Medicine, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska University Hospital, Gothenburg, 40530, Sweden
| | - Dhanesh Pitidhammabhorn
- Faculty of Medicine Ramathibodi Hospital, Chakri Naruebodindra Medical Institute, Mahidol University, Samut Prakan, 10540, Thailand
| | - Yuwares Sittichanbuncha
- Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Amir Khorram-Manesh
- Institute of Clinical Sciences, Department of Surgery, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 40530, Sweden
- Gothenburg Emergency Medicine Research Group, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 40530, Sweden
- Disaster Medicine Center, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 40530, Sweden
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A Scoping Review of the Essential Components of Emergency Medical Response Systems for Mass Casualty Incidents. Disaster Med Public Health Prep 2023; 17:e274. [PMID: 36597790 DOI: 10.1017/dmp.2022.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Emergency medical (EM) response systems require extensive coordination, particularly during mass casualty incidents (MCIs). The recognition of preparedness gaps and contextual priorities to MCI response capacity in low- and middle-income countries (LMICs) can be better understood through the components of EM reponse systems. This study aims to delineate essential components and provide a framework for effective emergency medical response to MCIs. METHODS A scoping review was conducted using 4 databases. Title and abstract screening was followed by full-text review. Thematic analysis was conducted to identify themes pertaining to the essential components and integration of EM response systems. RESULTS Of 20,456 screened citations, 181 articles were included in the analysis. Seven major and 40 sub-themes emerged from the content analysis as the essential components and supportive elements of MCI medical response. The essential components of MCI response were integrated into a framework demonstrating interrelated connections between essential and supportive elements. CONCLUSIONS Definitions of essential components of EM response to MCIs vary considerably. Most literature pertaining to MCI response originates from high income countries with far fewer reports from LMICs. Integration of essential components is needed in different geopolitical and economic contexts to ensure an effective MCI emergency medical response.
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Identifying the Challenges of Simulating the Hospital Emergency Department in the Event of Emergencies and Providing Effective Solutions: A Qualitative Study. Disaster Med Public Health Prep 2022; 17:e202. [PMID: 35844108 DOI: 10.1017/dmp.2022.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Emergencies and disasters occur in any society, and it is the hospitals and their emergency department staff who must be prepared in such cases. Therefore, 1 of the effective methods of training medical care staff is the use of simulators. However, when introducing new simulation approaches, we face many challenges. The aim of this study was to identify challenges of the simulation of the hospital emergency department during disasters and provide effective solutions. METHODS This conventional content, thematic, analysis study was conducted in 2021. Participants were selected from Iranian experts using purposeful and snowball sampling methods. Data were collected using semi-structured interviews and were analyzed by the content analysis. RESULTS After analyzing the data, the challenges of simulating the hospital emergency department during disasters were identified in 2 main components and 6 perspectives, which included organizational components (inappropriate and aimless training methods, lack of interaction and cooperation, lack of funding, and inadequate physical space) and technological components (weak information management and lack of interdisciplinary cooperation). Solutions included management (resource support) and data sharing and exchange (infrastructures, cooperation and coordination). CONCLUSION The simulation technology can be used as a method for training and improving the quality of health care services in emergencies. Considering that most of these challenges can be solved and need the full support of managers and policy makers, by examining these issues, supporting staff of health care centers are advised to make a significant contribution to the advancement of education and problem reduction in the event of disasters.
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Perry O, Jaffe E, Bitan Y. Dynamic Communication Quantification Model for Measuring Information Management During Mass-Casualty Incident Simulations. HUMAN FACTORS 2022; 64:228-249. [PMID: 34275344 PMCID: PMC8873974 DOI: 10.1177/00187208211018880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 02/25/2021] [Accepted: 04/22/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To develop a new model to quantify information management dynamically and to identify factors that lead to information gaps. BACKGROUND Information management is a core task for emergency medical service (EMS) team leaders during the prehospital phase of a mass-casualty incident (MCI). Lessons learned from past MCIs indicate that poor information management can lead to increased mortality. Various instruments are used to evaluate information management during MCI training simulations, but the challenge of measuring and improving team leaders' abilities to manage information remains. METHOD The Dynamic Communication Quantification (DCQ) model was developed based on the knowledge representation typology. Using multi point-of-view synchronized video, the model quantifies and visualizes information management. It was applied to six MCI simulations between 2014 and 2019, to identify factors that led to information gaps, and compared with other evaluation methods. RESULTS Out of the three methods applied, only the DCQ model revealed two factors that led to information gaps: first, consolidation of numerous casualties from different areas, and second, tracking of casualty arrivals to the medical treatment area and departures from the MCI site. CONCLUSION The DCQ model allows information management to be objectively quantified. Thus, it reveals a new layer of knowledge, presenting information gaps during an MCI. Because the model is applicable to all MCI team leaders, it can make MCI simulations more effective. APPLICATION This DCQ model quantifies information management dynamically during MCI training simulations.
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Affiliation(s)
- Omer Perry
- 26732 Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eli Jaffe
- 26732 Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Magen David Adom (MDA), Israel
| | - Yuval Bitan
- 26732 Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Svensøy JN, Nilsson H, Rimstad R. A Qualitative Study on Researchers' Experiences after Publishing Scientific Reports on Major Incidents, Mass-Casualty Incidents, and Disasters. Prehosp Disaster Med 2021; 36:536-542. [PMID: 34486507 PMCID: PMC8459171 DOI: 10.1017/s1049023x21000911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/21/2021] [Accepted: 07/10/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION AND OBJECTIVE Scientific reporting on major incidents, mass-casualty incidents (MCIs), and disasters is challenging and made difficult by the nature of the medical response. Many obstacles might explain why there are few and primarily non-heterogenous published articles available. This study examines the process of scientific reporting through first-hand experiences from authors of published reports. It aims to identify learning points and challenges that are important to address to mitigate and improve scientific reporting after major incidents. METHODS This was a qualitative study design using semi-structured interviews. Participants were selected based on a comprehensive literature search. Ten researchers, who had published reports on major incidents, MCIs, or disasters from 2013-2018 were included, of both genders, from eight countries on three continents. The researchers reported on large fires, terrorist attacks, shootings, complex road accidents, transportation accidents, and earthquakes. RESULTS The interview was themed around initiation, workload, data collection, guidelines/templates, and motivation factors for reporting. The most challenging aspects of the reporting process proved to be a lack of dedicated time, difficulties concerning data collection, and structuring the report. Most researchers had no prior experience in reporting on major incidents. Guidelines and templates were often chosen based on how easily accessible and user-friendly they were. CONCLUSION AND RELEVANCE There are few articles presenting first-hand experience from the process of scientific reporting on major incidents, MCIs, and disasters. This study presents motivation factors, challenges during reporting, and factors that affected the researchers' choice of reporting tools such as guidelines and templates. This study shows that the structural tools available for gathering data and writing scientific reports need to be more widely promoted to improve systematic reporting in Emergency and Disaster Medicine. Through gathering, comparing, and analyzing data, knowledge can be acquired to strengthen and improve responses to future major incidents. This study indicates that transparency and willingness to share information are requisite for forming a successful scientific report.
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Affiliation(s)
- Johannes Nordsteien Svensøy
- Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS), Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway
| | - Helene Nilsson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Swedish Civil Contingencies Agency 651 81 Karlstad, Sweden
| | - Rune Rimstad
- Norwegian Armed Forces Joint Medical Services, Oslo, Norway
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Hugelius K, Edelbring S, Blomberg K. Prehospital major incident management: how do training and real-life situations relate? A qualitative study. BMJ Open 2021; 11:e048792. [PMID: 34556511 PMCID: PMC8461747 DOI: 10.1136/bmjopen-2021-048792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To explore the relationship between preparations and real-life experiences among prehospital major incident commanders. DESIGN An explorative, qualitative design was used. SETTING Prehospital major incidents in Sweden. Data were collected between December 2019 and August 2020. PARTICIPANTS Prehospital major incident commanders (n=15) with real-life experiences from major events, such as fires, bus accidents, a bridge collapse and terrorist attacks, were included. All but one had participated in 2-day training focusing on the prehospital management of major incidents. In addition, about half of the participants had participated in simulation exercises, academic courses and other training in the management of major incidents. METHODS Data from two-session individual interviews were analysed using inductive thematic analysis. RESULTS The conformity between real-life major incidents and preparations was good regarding prehospital major incident commanders' knowledge of the operational procedures applied in major incidents. However, the preparations did not allow for the complexities and endurance strategies required in real-life incidents. Personal preparations, such as mental preparedness or stress management, were not sufficiently covered in the preparations. To some extent, professional experience (such as training) could compensate for the lack of formal preparations. CONCLUSIONS This study identified perceived gaps between preparations and real-life experiences of being a prehospital major incident commander. To minimise the gaps between demands and expectations on perceived control and to better prepare individuals for being prehospital major incident commanders, the training and other preparations should reflect complexities of real-life incidents. Preparations should develop both technical skills required, such as principles and methodology used, and personal preparedness. Personal preparations should include improving one's mental preparedness, self-knowledge and professional self-confidence required to successfully act as a prehospital incident commander. Since little is known about what pedagogical methods that should be used to enhance this, further research is needed.
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Affiliation(s)
- Karin Hugelius
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Samuel Edelbring
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Karin Blomberg
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Hugelius K, Rådestad M, Al-Dhahir H, Kurland L. Decision-making by medical officer in charge during major incidents: a qualitative study. Scand J Trauma Resusc Emerg Med 2021; 29:120. [PMID: 34419113 PMCID: PMC8379797 DOI: 10.1186/s13049-021-00937-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 08/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An incident command structure is commonly used to manage responses to major incidents. In the hospital incident command structure, the medical officer in charge (MOC) is in a key position. The decision-making process is essential to effective management, but little is known about which factors influence the process. Therefore, the current study aimed to describe factors influencing decision-making of MOCs. METHODS A conventional content analysis was conducted based on 16 individual interviews with medical doctors who had been deployed as MOCs at Swedish hospitals during major incidents. RESULTS The results showed that the decision-making and re-evaluation process was a comprehensive analysis influenced by three categories of factors: event factors, including consequences from the type of event, levels of uncertainty and the circumstances; organizational factors, including the doctor's role, information management and the response to the event; and personal factors, such as competence, personality and mental preparedness. CONCLUSIONS Reliable and timely information management structure enabling the gathering and analysis of essential information, a clear command structure and appropriate personal qualities were essential and contributed to successful MOCs decision making in major incidents.
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Affiliation(s)
- Karin Hugelius
- Faculty of Medicine and Health, Örebro University, 70182, Örebro, Sweden.
| | - Monica Rådestad
- Department of Clinical Science and Education, Karolinska Institutet, SödersjukhusetStockholm, Sweden.,Capio St. Görans Hospital, Stockholm, Sweden
| | - H Al-Dhahir
- Department of Emergency Medicine, Örebro University Hospital, Örebro, Sweden
| | - L Kurland
- Department of Emergency Medicine, Örebro University Hospital, Örebro, Sweden.,Department of Medical Sciences, Örebro University, Örebro, Sweden
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Rao S, Kwan BM, Curtis DJ, Swanson A, Bakel LA, Bajaj L, Boguniewicz J, Lockwood JM, Ogawa K, Pemberton K, Fuhlbrigge RC, Brumbaugh D, Givens P, Nozik ES, Sills MR. Implementation of a Rapid Evidence Assessment Infrastructure during the Coronavirus Disease 2019 (COVID-19) Pandemic to Develop Policies, Clinical Pathways, Stimulate Academic Research, and Create Educational Opportunities. J Pediatr 2021; 230:4-8.e2. [PMID: 33091418 PMCID: PMC7572277 DOI: 10.1016/j.jpeds.2020.10.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 10/14/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Suchitra Rao
- Department of Pediatrics (Infectious Diseases), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO; Department of Pediatrics (Epidemiology), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO; Department of Pediatrics (Hospital Medicine), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Bethany M Kwan
- Department of Family Medicine, University of Colorado Denver - Anschutz Medical Campus, Aurora, CO
| | - Donna J Curtis
- Department of Pediatrics (Infectious Diseases), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Angela Swanson
- Clinical Effectiveness, Children's Hospital Colorado, Aurora, CO
| | - Leigh Anne Bakel
- Department of Pediatrics (Hospital Medicine), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Lalit Bajaj
- Clinical Effectiveness, Children's Hospital Colorado, Aurora, CO; Department of Pediatrics (Emergency Medicine), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Juri Boguniewicz
- Department of Pediatrics (Infectious Diseases), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Justin M Lockwood
- Department of Pediatrics (Hospital Medicine), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Kaleigh Ogawa
- Clinical Effectiveness, Children's Hospital Colorado, Aurora, CO
| | | | - Robert C Fuhlbrigge
- Department of Pediatrics (Rheumatology), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - David Brumbaugh
- Department of Pediatrics (Gastroenterology), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Patricia Givens
- Department of Nursing, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Eva S Nozik
- Department of Pediatrics (Critical Care), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Marion R Sills
- Department of Pediatrics (Emergency Medicine), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO.
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Kippnich M, Meybohm P, Wurmb T. [Prehospital and In-hospital Concepts for Disaster Response and Preparedness]. Anasthesiol Intensivmed Notfallmed Schmerzther 2021; 56:111-123. [PMID: 33607672 DOI: 10.1055/a-1085-6671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Disaster medicine faces complex challenges and will play an increasing role in the future. Disaster medicine is dominated by a phased imbalance of available and required resources. Various factors, such as a possible hazard for the rescue forces, inaccessible terrain or even destroyed infrastructure increase the complexity enormously. For casualties, this can mean a concentration of medical care on life-threatening conditions. The primary goal of emergency planning is to ensure standard or contingency care and to avoid crisis care.Hospitals and the preclinical emergency organizations must prepare for possible major emergencies or disasters. Easy-to-understand and just as easy to apply emergency plans are an important prerequisite for successful emergency management. These plans can only be guiding structures; the adaptation to the actual circumstances of the incident and the situation-adapted interpretation of the plans is the responsibility of the operational commanders. A clear leadership structure is essential for both preclinical and clinical operations. In this article, we describe important basic principles of disaster medicine mission planning and management.
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Eklund A, Saveman BI, Gyllencreutz L. Situational awareness during a full-scale exercise in an underground mine: A qualitative single-case study of the ambulance incident commander. Int Emerg Nurs 2020; 54:100950. [PMID: 33326908 DOI: 10.1016/j.ienj.2020.100950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/08/2020] [Accepted: 10/20/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Underground environments present challenges for providing and managing effective emergency care. Situational awareness (SA) has been suggested as a critical process to the management of care. AIM This study aims to explore the process of SA in the tasks of an ambulance incident commander (AIC) during a fullscale underground mine exercise. METHODS Data consisted of video recordings, audiotapes and fieldnotes; these were subjected to content analysis based on the categories from the Busby Theory of Situational Awareness in Multi-casualty Incidents. RESULTS The results show that the underground mining environment presented the AIC with specific challenges for the SA process with respect to aspects such as situational information about the scene and the victims, as well as with making decisions for ambulance personnel so they could perform their work safely, and having a structured manner to counteract information overload. Both technical and non-technical aspects influenced the process. CONCLUSION The AIC's situational awareness was largely built through coordinated communications and actions with collaborating actors. The results of this study can be used for further exploration of how to train and support people in medical leadership roles on aspects of SA in emergency care, as well as on how to evaluate educational outcomes through exercises.
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Affiliation(s)
- Annika Eklund
- Department of Health Sciences, Section for Advanced Nursing, University West, 461 86 Trollhättan, Sweden.
| | - Britt-Inger Saveman
- Department of Surgery and Perioperative Sciences, Section for Surgery, Umeå University, 901 87 Umeå, Sweden; Department of Nursing, Umeå University, 901 87 Umeå, Sweden.
| | - Lina Gyllencreutz
- Department of Surgery and Perioperative Sciences, Section for Surgery, Umeå University, 901 87 Umeå, Sweden; Department of Nursing, Umeå University, 901 87 Umeå, Sweden.
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Sangal RB, Scofi JE, Parwani V, Pickens AT, Ulrich A, Venkatesh AK. Less social emergency departments: implementation of workplace contact reduction during COVID-19. Emerg Med J 2020; 37:463-466. [PMID: 32581052 PMCID: PMC7418594 DOI: 10.1136/emermed-2020-209826] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/26/2020] [Accepted: 06/05/2020] [Indexed: 11/23/2022]
Abstract
The COVID-19 pandemic has led to rapid changes in community and healthcare delivery policies creating new and unique challenges to managing ED pandemic response efforts. One example is the practice of social distancing in the workplace as an internationally recommended non-pharmaceutical intervention to reduce transmission. While attention has been focused on public health measures, healthcare workers cannot overlook the transmission risk they present to their colleagues and patients. Our network of three EDs are all high traffic areas for both patients and staff, which makes the limitation of close person-to-person contact particularly difficult to achieve. To design, implement and communicate contact reduction changes in the ED workplace, our COVID-19 task force formalised a set of multidisciplinary recommendations that enumerated concrete ways to reduce healthcare worker transmission to coworkers and to patients from ED patient arrival to discharge. We also addressed staff-to-staff contact reduction strategies when not performing direct patient care. We describe our conceptual approach and successful implementation of workplace distancing.
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Affiliation(s)
- Rohit B Sangal
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jean E Scofi
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Vivek Parwani
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Andrew T Pickens
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Andrew Ulrich
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Arjun K Venkatesh
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.,Center for Outcomes Research and Evaluation, Yale University, New Haven, Connecticut, USA
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Brunton G, Oliver S, Thomas J. Innovations in framework synthesis as a systematic review method. Res Synth Methods 2020; 11:316-330. [PMID: 32090479 DOI: 10.1002/jrsm.1399] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 01/25/2020] [Accepted: 02/04/2020] [Indexed: 01/09/2023]
Abstract
Framework synthesis is one systematic review method employed to address health care practice and policy. Adapted from framework analysis methods, it has been used increasingly, using both qualitative and mixed-method systematic review methods. This article demonstrates a spectrum of approaches to framework synthesis that are dependent on the extent to which theory is tentative, emergent, refined, or established; and that stakeholder involvement may help to understand the topic's complexity where theory is more nascent. The choice of approach depends on the degree of match with existing theories and, in the absence of existing theory, the scale and heterogeneity of the literature to be managed.
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Affiliation(s)
- Ginny Brunton
- OntarioTech University, Faculty of Health Sciences, School of Nursing, Oshawa, ON, Canada
- University College London Institute of Education, EPPI-Centre, London, UK
- McMaster University, McMaster Midwifery Research Centre, Hamilton, ON, Canada
| | - Sandy Oliver
- University College London Institute of Education, EPPI-Centre, London, UK
- University of Johannesburg Faculty of Humanities, Africa Centre for Evidence, Johannesburg, South Africa
| | - James Thomas
- University College London Institute of Education, EPPI-Centre, London, UK
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Five Challenges When Managing Mass Casualty or Disaster Situations: A Review Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17093068. [PMID: 32354076 PMCID: PMC7246560 DOI: 10.3390/ijerph17093068] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/16/2020] [Accepted: 04/22/2020] [Indexed: 12/15/2022]
Abstract
Background: Managing mass casualty or disaster incidents is challenging to any person or organisation. Therefore, this paper identifies and describes common challenges to managing such situations, using case and lessons learned reports. It focuses on sudden onset, man-made or technologically caused mass casualty or disaster situations. Methods: A management review was conducted based on a structured search in the PubMed and Web of Science databases. Results: The review included 20 case—and lessons learned reports covering natural disasters, man-made events, and accidents across Europe, the United States of Amerika (USA), Asia and the Middle East. Five common challenges were identified: (1) to identify the situation and deal with uncertainty, (2) to balance the mismatch between the contingency plan and the reality, (3) to establish a functional crisis organization, (4) to adapt the medical response to the actual and overall situation and (5) to ensure a resilient response. Conclusions: The challenges when managing mass casualty or disaster events involved were mainly related to the ability to manage uncertainty and surprising situations, using structured processes to respond. The ability to change mind set, organization and procedures, both from an organizational- and individual perspective, was essential. Non-medical factors and internal factors influenced the medical management. In order to respond in an effective, timely and resilient way, all these factors should be taken into consideration.
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Hu X, Chen H, Yu M. Exploring the non-technical competencies for on-scene public health responders in chemical, biological, radiological, and nuclear emergencies: a qualitative study. Public Health 2020; 183:23-29. [PMID: 32413805 PMCID: PMC7167558 DOI: 10.1016/j.puhe.2020.04.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/04/2020] [Accepted: 04/07/2020] [Indexed: 12/30/2022]
Abstract
Objectives The purpose of this study was to define and delineate specific non-technical competencies for first-line public health responders in Chemical, Biological, Radiological, and Nuclear (CBRN) emergencies in China. Study design A qualitative study was conducted in China involving interviews with key informants in the field of health response to CBRN disasters. Methods One-on-one in-depth interviews were carried out with 20 participants, including expert members of National Medical Response Teams for CBRN disasters, officials at emergency management authorities, and scholars of academic institutions related to CBRN emergency. Interviews were recorded using audio equipment, transcribed, and coded into codable passages as per grounded theory using NVivo software. Themes were identified within the transcriptions by using thematic analysis. Results A total of 159 codable passages were produced. Eight domains of non-technical core competencies were identified: (1) situation awareness, (2) communication skills, (3) collaboration, (4) resource management, (5) task management, (6) cultural competency, (7) austere environment skills, and (8) physical stamina. Conclusions The study identified a variety of competencies for on-scene public health responders in CBRN emergencies. The findings of this study could specifically benefit development of strategy and improvement of content of education and training. Further research that involves input from the disaster response community at large is needed for the validation of these competencies. Non-technical competencies affect performance of health response to Chemical, Biological, Radiological, and Nuclear (CBRN) disasters. Austere environment skills and physical stamina are priority non-technical competencies for on-site public health responders in CBRN events. Effective CBRN health emergency training should integrate and synchronize courses based on non-technical/technical competency.
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Affiliation(s)
- X Hu
- Department of Health Services Administration, Air Force Medical University, Xi'an, China
| | - H Chen
- Department of Health Services Administration, Air Force Medical University, Xi'an, China
| | - M Yu
- Department of Health Services Administration, Air Force Medical University, Xi'an, China; Department of Health Services Administration, Academy of Military Medical Sciences, Beijing, China.
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Nontechnical Competency Framework for Health Professionals in All-Hazard Emergency Environment: A Systematic Review. Disaster Med Public Health Prep 2020; 15:255-265. [PMID: 32029017 DOI: 10.1017/dmp.2019.146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To summarize characteristics and commonalities of non-technical competency frameworks for health professionals in emergency and disaster. METHODS An electronic literature search was conducted in PubMed, MEDLINE, ERIC, Scopus, Cochrane database, and Google Scholar to identify original English-language articles related to development, evaluation or application of the nontechnical competency frameworks. Reviewers assessed identified articles for exclusion/inclusion criteria and abstracted data on study design, framework characteristics, and reliability/validity evidence. RESULTS Of the 9627 abstracts screened, 65 frameworks were identified from 94 studies that were eligible for result extraction. Sixty (63.8%) studies concentrated on clinical settings. Common scenarios of the studies were acute critical events in hospitals (44;46.8%) and nonspecified disasters (39;41.5%). Most of the participants (76; 80.9%) were clinical practitioners, and participants in 36 (38.3%) studies were multispecialty. Thirty-three (50.8%) and 42 (64.6%) frameworks had not reported evidence on reliability and validity, respectively. Fourteen of the most commonly involved domains were identified from the frameworks. CONCLUSIONS Nontechnical competency frameworks applied to multidisciplinary emergency health professionals are heterogeneous in construct and application. A fundamental framework with standardized terminology for the articulation of competency should be developed and validated so as to be accepted and adapted universally by health professionals in all-hazard emergency environment.
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Hylander J, Saveman BI, Björnstig U, Gyllencreutz L. Prehospital management provided by medical on-scene commanders in tunnel incidents in Oslo, Norway - an interview study. Scand J Trauma Resusc Emerg Med 2019; 27:78. [PMID: 31429788 PMCID: PMC6701069 DOI: 10.1186/s13049-019-0649-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/19/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND High demands are placed on the emergency medical services to handle rescue operations in challenging environments such as tunnels. In Oslo, Norway a specialised management function within the emergency medical services, the medical on-scene commander, in line with the command structure within the police and fire brigade, might support or take over command and control from the ambulance incident officer arriving as the first ambulance personnel on scene. The aim was to shed light on the emergency medical service experiences from real tunnel incidents described by the Oslo medical on-scene commanders. METHODS Interviews were conducted with six of the seven medical on-scene commander in Oslo, Norway. Data were analysed using a qualitative content analysis. RESULTS The overall theme was "A need for mutual understanding of a tunnel incident". The medical on-scene commander provided tactical support, using their special knowledge of risk objects and resources in the local area. They established operation plans with other emergency services (the police and fire brigade) in a structured and trustful way, thus creating a fluent and coordinated mission. Also, less time was spent arguing at the incident site. By socialising also outside ordinary working hours, a strong foundation of reliance was built between the different parties. A challenge in recent years has been the increasing ordinary workload, giving less opportunity for training and exchange of experiences between the three emergency services. CONCLUSIONS The enthusiastic pioneers within the three emergency services have created a sense of familiarity and trust. A specially trained medical on-scene commander at a tunnel incident is regarded to improve the medical management. To improve efficiency, this might be worth studying for other emergency medical services with similar conditions, i.e. tunnels in densely populated areas.
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Affiliation(s)
- Johan Hylander
- Department of Surgical and Perioperative Sciences, Surgery, Centre for Disaster Medicine, Umeå University, 901 87 Umeå, Sweden
| | - Britt-Inger Saveman
- Department of Surgical and Perioperative Sciences, Surgery, Centre for Disaster Medicine, Umeå University, 901 87 Umeå, Sweden
| | - Ulf Björnstig
- Department of Surgical and Perioperative Sciences, Surgery, Centre for Disaster Medicine, Umeå University, 901 87 Umeå, Sweden
| | - Lina Gyllencreutz
- Department of Surgical and Perioperative Sciences, Surgery, Centre for Disaster Medicine, Umeå University, 901 87 Umeå, Sweden
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Hardy S, Fattah S, Wisborg T, Raatiniemi L, Staff T, Rehn M. Systematic reporting to improve the emergency medical response to major incidents: a pilot study. BMC Emerg Med 2018; 18:4. [PMID: 29368642 PMCID: PMC5784690 DOI: 10.1186/s12873-018-0153-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Accepted: 01/07/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Major incidents affect us globally, and are occurring with increasing frequency. There is still no evidence-based standard regarding the best medical emergency response to major incidents. Currently, reports on major incidents are non-standardised and variable in quality. This pilot study examines the first systematic reports from a consensus-based, freely accessible database, aiming to identify how descriptive analysis of reports submitted to this database can be used to improve the major incident response. METHODS Majorincidentreporting.net is a website collecting reports on major incidents using a standardised template. Data from these reports were analysed to compare the emergency response to each incident. RESULTS Data from eight reports showed that effective triage by experienced individuals and the use of volunteers for transport were notable successes of the major incident response. Inadequate resources, lack of a common triage system, confusion over command and control and failure of communication were reported failures. The following trends were identified: Fires had the slowest times for several aspects of the response and the only three countries to have a single dialling number for all three emergency services had faster response times. Helicopter Emergency Medical services (HEMS) were used for transport and treatment in rural locations and for triage and treatment in urban locations. In two incidents, a major incident was declared before the arrival of the first Emergency Medical Services (EMS) personnel. CONCLUSION This study shows that we can obtain relevant data from major incidents by using systematic reporting. Though the sample size from this pilot study is not large enough to draw any specific conclusions it illustrates the potential for future analyses. Identified lessons could be used to improve the emergency medical response to major incidents.
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Affiliation(s)
- Sophie Hardy
- Emergency Department, St George's Hospital, Tooting, London, UK.
| | - Sabina Fattah
- The Norwegian Air Ambulance Foundation, Drøbak, Norway
- Anaesthesia and Critical Care Research Group, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
| | - Torben Wisborg
- Anaesthesia and Critical Care Research Group, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
- Hammerfest Hospital, Department of Anaesthesiology and Intensive Care, Finnmark Health Trust, Hammerfest, Norway
- Norwegian National Advisory Unit on Trauma, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Lasse Raatiniemi
- Hammerfest Hospital, Department of Anaesthesiology and Intensive Care, Finnmark Health Trust, Hammerfest, Norway
- Centre for Pre-Hospital Emergency Care/ FinnHEMS 50, Oulu University Hospital, Oulu, Finland
- Anaesthesia Research Group, MRC, University of Oulu, Oulu, Finland
| | - Trine Staff
- Paramedic Sciences, Oslo and Akershus University College, Oslo, Norway
| | - Marius Rehn
- The Norwegian Air Ambulance Foundation, Drøbak, Norway
- Department of Health Studies, University of Stavanger, Stavanger, Norway
- Division of Emergencies and Critical Care. Department of Anaesthesia, Oslo University Hospital, Oslo, Norway
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Rose DA, Murthy S, Brooks J, Bryant J. The Evolution of Public Health Emergency Management as a Field of Practice. Am J Public Health 2017; 107:S126-S133. [PMID: 28892444 DOI: 10.2105/ajph.2017.303947] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The health impacts of recent global infectious disease outbreaks and other disasters have demonstrated the importance of strengthening public health systems to better protect communities from naturally occurring and human-caused threats. Public health emergency management (PHEM) is an emergent field of practice that draws on specific sets of knowledge, techniques, and organizing principles necessary for the effective management of complex health events. We highlight how the nascent field of PHEM has evolved in recent years. We explore this development by first examining multiple sites of intersection between the fields of public health and emergency management. We then analyze 2 of the principal pillars on which PHEM was built: organizational and programmatic (i.e., industry) standards and the incident management system. This is followed by a sketch of the key domains, or functional areas, of PHEM and their application to the emergency management cycle. We conclude with some observations about PHEM in a global context and discuss how the field might continue to evolve.
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Affiliation(s)
- Dale A Rose
- Dale A. Rose, Shivani Murthy, Jennifer Brooks, and Jeffrey Bryant are with the Office of Public Health Preparedness and Response, Division of Emergency Operations, Centers for Disease Control and Prevention, Atlanta, GA
| | - Shivani Murthy
- Dale A. Rose, Shivani Murthy, Jennifer Brooks, and Jeffrey Bryant are with the Office of Public Health Preparedness and Response, Division of Emergency Operations, Centers for Disease Control and Prevention, Atlanta, GA
| | - Jennifer Brooks
- Dale A. Rose, Shivani Murthy, Jennifer Brooks, and Jeffrey Bryant are with the Office of Public Health Preparedness and Response, Division of Emergency Operations, Centers for Disease Control and Prevention, Atlanta, GA
| | - Jeffrey Bryant
- Dale A. Rose, Shivani Murthy, Jennifer Brooks, and Jeffrey Bryant are with the Office of Public Health Preparedness and Response, Division of Emergency Operations, Centers for Disease Control and Prevention, Atlanta, GA
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Rosander M, Jonson CO. Professional confidence in the roles as ambulance and medical incident commander. JOURNAL OF CONTINGENCIES AND CRISIS MANAGEMENT 2017. [DOI: 10.1111/1468-5973.12156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Michael Rosander
- Department of Behavioural Sciences and Learning; Linköping University; 58183 Linköping Sweden
| | - Carl-Oscar Jonson
- Center for Disaster Medicine and Traumatology; and Department of Clinical and Experimental Medicine; Linköping University; 58185 Linköping Sweden
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Affiliation(s)
- Chih-Hao Lin
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Wei-Hung Chang
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chen-Long Wu
- Department of Environmental and Occupational Health, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shih-Tien Pan
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Chih-Hsien Chi
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Rimstad R. Medical command in mass casualty incidents. Acta Anaesthesiol Scand 2016. [DOI: 10.1111/aas.12708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
AbstractIntroductionIt is not known what constitutes the optimal emergency management system, nor is there a consensus on how effectiveness and efficiency in emergency response should be measured or evaluated. Literature on the role and tasks of commanders in the prehospital emergency services in the setting of mass-casualty incidents has not been summarized and published.ProblemThis comprehensive literature review addresses some of the needs for future research in emergency management through three research questions: (1) What are the basic assumptions underlying incident command systems (ICSs)? (2) What are the tasks of ambulance and medical commanders in the field? And (3) How can field commanders’ performances be measured and assessed?MethodsA systematic literature search in MEDLINE, PubMed, PsycINFO, Embase, Cochrane Central Register of Controlled Trials, Cochrane Library, ISI Web of Science, Scopus, International Security & Counter Terrorism Reference Center, Current Controlled Trials, and PROSPERO covering January 1, 1990 through March 1, 2014 was conducted. Reference lists of included literature were hand searched. Included papers were analyzed using Framework synthesis.ResultsThe literature search identified 6,049 unique records, of which, 76 articles and books where included in qualitative synthesis. Most ICSs are described commonly as hierarchical, bureaucratic, and based on military principles. These assumptions are contested strongly, as is the applicability of such systems. Linking of the chains of command in cooperating agencies is a basic difficulty. Incident command systems are flexible in the sense that the organization may be expanded as needed. Commanders may command by direction, by planning, or by influence. Commanders’ tasks may be summarized as: conducting scene assessment, developing an action plan, distributing resources, monitoring operations, and making decisions. There is considerable variation between authors in nomenclature and what tasks are included or highlighted. There are no widely acknowledged measurement tools of commanders’ performances, though several performance indicators have been suggested.ConclusionThe competence and experience of the commanders, upon which an efficient ICS has to rely, cannot be compensated significantly by plans and procedures, or even by guidance from superior organizational elements such as coordination centers. This study finds that neither a certain system or structure, or a specific set of plans, are better than others, nor can it conclude what system prerequisites are necessary or sufficient for efficient incident management. Commanders need to be sure about their authority, responsibility, and the functional demands posed upon them.RimstadR, BrautGS. Literature review on medical incident command. Prehosp Disaster Med. 2015;30(2):1-11.
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