| 1. |
- Gryth, Dan, et al.
(author)
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Evaluation of medical command and control using performance indicators in a full-scale, major aircraft accident exercise.
- 2010
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In: Prehospital and Disaster Medicine. - : Cambridge University Press. - 1049-023X .- 1945-1938. ; 25:2, s. 118-123
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Journal article (peer-reviewed)abstract
- INTRODUCTION: Large, functional, disaster exercises are expensive to plan and execute, and often are difficult to evaluate objectively. Command and control in disaster medicine organizations can benefit from objective results from disaster exercises to identify areas that must be improved.OBJECTIVE: The objective of this pilot study was to examine if it is possible to use performance indicators for documentation and evaluation of medical command and control in a full-scale major incident exercise at two levels: (1) local level (scene of the incident and hospital); and (2) strategic level of command and control. Staff procedure skills also were evaluated.METHODS: Trained observers were placed in each of the three command and control locations. These observers recorded and scored the performance of command and control using templates of performance indicators. The observers scored the level of performance by awarding 2, 1, or 0 points according to the template and evaluated content and timing of decisions. Results from 11 performance indicators were recorded at each template and scores greater than 11 were considered as acceptable.RESULTS: Prehospital command and control had the lowest score. This also was expressed by problems at the scene of the incident. The scores in management and staff skills were at the strategic level 15 and 17, respectively; and at the hospital level, 17 and 21, respectively.CONCLUSIONS: It is possible to use performance indicators in a full-scale, major incident exercise for evaluation of medical command and control. The results could be used to compare similar exercises and evaluate real incidents in the future.
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| 2. |
- Gyllencreutz, Lina, et al.
(author)
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Templates for handling multi-agency collaboration activities and priorities in mining injury incidents : a Delphi study
- 2020
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In: International Journal of Emergency Services. - : Emerald Group Publishing Limited. - 2047-0894 .- 2047-0908. ; 9:3, s. 257-271
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Journal article (peer-reviewed)abstract
- Purpose: The purpose of this study was from a Swedish perspective to map experts' opinions on theoretical statements of essential collaboration activities for management of mining injury incidents.Design/methodology/approach: A Delphi technique was performed, asking opinions from experts in iterative rounds to generate understanding and form consensus on group opinion around multi-agency management. The experts were personnel from emergency medical service, rescue service and mine industry, all with operative command positions.Findings: Three iterative rounds were performed. The first round was conducted as a workshop to collect opinions about the most important multi-agency collaboration activities to optimize victim's outcome from an injury incident in an underground mine. This resulted in 63 statements and additional three were added during the second round. The statements were divided into one trajectory and seventh time phases and comprised, e.g. early alarm routines, support of early life-saving interventions, relevant resources and equipment for the assignment and command and control center and functions with predefined action plans for response. It also comprised shared and communicated decisions about each agency's responsibility and safety. All statements reached consensus among the experts in Round 3.Research limitations/implications: The experts included in this study seem to be adequate but there could be other experts and different statements that other researchers might consider.Practical implications: These statements could be used to evaluate collaboration in major incidents exercises. The statements can also be quality indicators for reporting results from multi-agency management.Originality/value: This paper contributes to the research field of collaboration and joint practices between and among personnel involved in rescue operations.
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| 3. |
- Holmgren, Cecilia, et al.
(author)
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Charge nurses’ perceived experience in managing daily work and major incidents in emergency departments : A qualitative study
- 2022
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In: Australasian Emergency Care. - : Elsevier. - 2588-994X. ; 25:4, s. 296-301
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Journal article (peer-reviewed)abstract
- Background Emergency department charge nurses are expected to oversee the quality of patient care, direct work, and the allocation of resources. The charge nurse is the unit’s frontline leader, and he/she must have proper leadership training and support to carry out duties effectively. This study explores how charge nurses perceive their role in managing daily work and major incidents at the emergency department. Methods A qualitative study based on focus group discussions using a semi-structured interview. Participants were 12 charge nurses from four Swedish emergency departments. Results For data analysis, a systematic text condensation method was used. The analysis of data generated four categories: (1) Coping with chaos; (2) Need for further training; (3) Feeling of inadequacy; and (4) Lack of strategies. Conclusions The study concluded that the emergency department charge nurse has frontline duties that are diverse, multifaceted, require good leadership qualities, and lack detailed job description. Charge nurses confront many challenges in their daily work, often with little training or the opportunity to develop in their professional. This study provides understanding of the concerns charge nurses hold about working as frontline leaders and that departmental heads must support the education and training of their charge nurses.
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| 4. |
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| 5. |
- Murphy, Jason
(author)
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Disaster response and preparedness : Focus on hospital incident command groups and emergency department registered nurses
- 2021
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Doctoral thesis (other academic/artistic)abstract
- Background: While disasters per definition are rare, incidents that cause mass casualties that threaten to overwhelm its limited resources are an ever-present risk. Disaster medicine is a specific discipline of medicine dedicated to providing adequate health care to patients of major incidents through the development of preventive-, preparedness-, response and recovery interventions. Emergency department registered nurses are among the first to receive, assess and treat patients of a major incident, highlighting the importance of their preparedness and disaster medicine competencies. However, when an incident threatens to overwhelm health care’s resources, a specific type of management group may be required to aid and guide hospital response. The hospital incident command group aids in hospital response through timely decision-making and allocation of resources. Despite these two groups being recognized as vital components of disaster response, little has been known concerning the disaster preparedness of these two groups. emergency department registered nurses’ disaster preparedness. The overall aim of the thesis was to assess disaster medicine preparedness in Stockholm, Sweden through the evaluation of hospital incident command groups and emergency department registered nurses.The aim of study I was to identify the essential disaster nursing competencies. Sixty-nine specific disaster medicine competencies were identified through a modified Delphi method in which experts within the field of emergency- or disaster medicine reached consensus concerning necessary disaster medicine competencies for emergency department registered nurses.The aim of study II was to assess emergency department registered nurses’ self-perceived disaster preparedness using the results in study one as the basis of a questionnaire. A cross- sectional method was used to assess the preparedness of nurses in the study setting. The results of this study indicate that emergency department registered nurses may be less than competent and overestimate their preparedness.The aim of study III was to assess hospital incident command groups’ preparedness. This was done through an observational study in which measurable indicators were used to evaluate hospital incident command groups during simulations. The results in this study indicate that proactive decision-making correlates with overall command group response. Shortly after the simulations in study III, an antagonistic incident occurred in Stockholm, Sweden. This provided a unique opportunity to compare planned preparedness with actual preparedness. through exploration of disaster preparedness coordinators' experiences of hospital response during a major incident.Thus, the aim of study IV was to explore registered nurses’ experiences as disaster preparedness coordinators (DPC) of hospital incident command groups during an MI. This was done through one focus group discussion with six disaster preparedness coordinators and six follow-up interviews with the same coordinators were conducted. Data were analyzed using inductive content analysis. One main category, Expectations, prior experiences, and uncertainty affect HICG response during a major incident and three categories. Gaining situational awareness, transitioning to management, and actions taken during uncertainty were identified.The thesis concludes that disaster medicine preparedness in the study setting may be adequate but that response may be dependent upon several factors including the type and timing of the incident, frequency and type of training, education, experience, and the ability to reduce uncertainty in order to make timely and relevant decisions.
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| 6. |
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| 7. |
- Murphy, Jason, et al.
(author)
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Emergency department registered nurses overestimate their disaster competency : A cross-sectional study
- 2021
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In: International Emergency Nursing. - : Elsevier. - 1755-599X .- 1878-013X. ; 58
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Journal article (peer-reviewed)abstract
- BACKGROUND: Major incidents continue to pose a threat to health care systems by overwhelming them with a sudden surge of patients. A major factor impacting a hospital's surge capacity is the skills, abilities, and knowledge of emergency department (ED) registered nurses (RN). The level of disaster nursing competency they possess affects patient safety and outcome. ED RNs' ability to accurately assess their competency and knowledge is imperative for mitigating the effect of major incidents. ED RN's perception of overall disaster preparedness has not been thoroughly addressed. The aim of this study was to assess emergency department registered nurses' self-perceived disaster preparedness.METHOD: The study was a cross-sectional study per the STROBE checklist. A self-assessment questionnaire based on the results of a study identifying specific disaster nursing competencies for ED RNs was distributed to all ED RNs at six participating hospitals between January 10th to February 19th of 2019. A five-point Likert-type scale was used to assess competency.RESULTS: ED RNs' disaster preparedness according to the Total Disaster Competency mean was low. Furthermore, the results indicate that ED RNs' significantly overestimate their disaster nursing competency when compared to the Total Disaster Competency mean. Additionally, this study identified factors such as experience and education were positively associated with disaster preparedness and self-assessment ability.CONCLUSION: ED RNs' overestimate their disaster preparedness. However, ED RNs with experience and education may be better prepared. ED RNs with formal disaster education appeared to have better insight concerning their preparedness. Clinical experience, advanced levels of education, and training were positively associated with preparedness. Overestimating disaster competencies may negatively impact patient outcomes during a major incident.
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| 8. |
- Murphy, Jason P, et al.
(author)
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Registered nurses' experience as disaster preparedness coordinators during a major incident : A qualitative study
- 2022
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In: Nursing Open. - : John Wiley & Sons. - 2054-1058. ; 9:1, s. 329-338
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Journal article (peer-reviewed)abstract
- AIMS: To explore registered nurses' experiences as disaster preparedness coordinators of hospital incident command groups' during a major incident.DESIGN: A qualitative descriptive design using semi-structured interview.METHODS: This was a qualitative study based on one focus group discussion and six individual follow-up interviews. Participants were registered nurses in their capacity as disaster preparedness coordinators with experience from Major Incident simulations and a real-life Major Incident. The interviews were transcribed verbatim and analysed using content analysis. The COREQ checklist was used for reporting the findings.RESULTS: The analysis of data generated the main category: Expectations, previous experience and uncertainty affect hospital incident command group response during a Major Incident and three categories, (I) Gaining situational awareness (containing two subcategories), (II) Transitioning to management (containing three subcategories) and (III) Actions taken during uncertainty (containing two subcategories).
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| 9. |
- Rüter, Anders, et al.
(author)
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Evaluation of Disaster Preparedness Based on Simulation Exercises : A Comparison of Two Models
- 2016
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In: Disaster medicine and public health preparedness. - : Cambridge University Press (CUP). - 1938-744X .- 1935-7893. ; 10:4, s. 544-548
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Journal article (peer-reviewed)abstract
- OBJECTIVE: The objective of this study was to highlight 2 models, the Hospital Incident Command System (HICS) and the Disaster Management Indicator model (DiMI), for evaluating the in-hospital management of a disaster situation through simulation exercises.METHODS: Two disaster exercises, A and B, with similar scenarios were performed. Both exercises were evaluated with regard to actions, processes, and structures. After the exercises, the results were calculated and compared.RESULTS: In exercise A the HICS model indicated that 32% of the required positions for the immediate phase were taken under consideration with an average performance of 70%. For exercise B, the corresponding scores were 42% and 68%, respectively. According to the DiMI model, the results for exercise A were a score of 68% for management processes and 63% for management structure (staff skills). In B the results were 77% and 86%, respectively.CONCLUSIONS: Both models demonstrated acceptable results in relation to previous studies. More research in this area is needed to validate which of these methods best evaluates disaster preparedness based on simulation exercises or whether the methods are complementary and should therefore be used together.
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| 10. |
- Rådestad, Monica, et al.
(author)
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Attitudes Towards and Experience of the Use of Triage Tags in Major Incidents : A Mixed Method Study
- 2016
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In: Prehospital and Disaster Medicine. - 1049-023X .- 1945-1938. ; 31:4, s. 376-85
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Journal article (peer-reviewed)abstract
- Introduction Disaster triage is the allocation of limited medical resources in order to optimize patient outcome. There are several studies showing the poor use of triage tagging, but there are few studies that have investigated the reasons behind this. The aim of this study was to explore ambulance personnel attitude towards, and experiences of, practicing triage tagging during day-to-day management of trauma patients, as well as in major incidents (MIs).METHODS: A mixed method design was used. The first part of the study was in the form of a web-survey of attitudes answered by ambulance personnel. The question explored was: Is it likely that systems that are not used in everyday practice will be used during MIs? Two identical web-based surveys were conducted, before and after implementing a new strategy for triage tagging. This strategy consisted of a time-limited triage routine where ambulance services assigned triage category and applied triage tags in day-to-day trauma incidents in order to improve field triage. The second part comprised three focus group interviews (FGIs) in order to provide a deeper insight into the attitudes towards, and experience of, the use of triage tags. Data were analyzed using qualitative content analysis.RESULTS: The overall finding was the need for daily routine when failure in practice. Analysis of the web-survey revealed three changes: ambulance personnel were more prone to use tags in minor accidents, the sort scoring system was considered to be more valuable, but it also was more time consuming after the intervention. In the analysis of FGIs, four categories emerged that describe the construction of the overall category: perceived usability, daily routine, documentation, and need for organizational strategies.CONCLUSION: Triage is part of the foundation of ambulance skills, but even so, ambulance personnel seldom use this in routine practice. They fully understand the benefit of accurate triage decisions, and also that the use of a triage algorithm and color coded tags is intended to make it easier and more secure to perform triage. However, despite the knowledge and understanding of these benefits, sparse incidents and infrequent exercises lead to ambulance personnel's uncertainty concerning the use of triage tagging during a MI and will therefore, most likely, avoid using them. Rådestad M , Lennquist Montán K , Rüter A , Castrén M , Svensson L , Gryth D , Fossum B . Attitudes towards and experience of the use of triage tags in major incidents: a mixed method study. Prehosp Disaster Med. 2016;31(4):1-10.
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