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- Lundberg, L, et al.
(author)
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Weak and strong points in training of prehospital command and control. Are results possible to measure?
- 2008
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In: International Review of the Armed Forces Medical Services / Revue internationale des services de santé des forces armées. - Paris, France : International Committee of Military Medicine. - 0259-8582. ; 81:3, s. 131-134
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Journal article (peer-reviewed)abstract
- Dans l'évaluation des entraînements et des exercices militaires, les points faibles sont souvent exprimés en termes généraux. C'est pourquoi il est difficile de savoir précisément ce qui nécessite une amélioration. Les leçons qui devraient en être tirées ont rarement été observées. Il est nécessaire d'avoir une approche méthodique et quantitative de ce problème et des outils sont maintenant disponibles. Les indicateurs de performance ont déjà été testés sur un exercice militaire, et se sont avérés applicables. La présente étude s'est intéressée de plus près à ces indicateurs de performance. Les critères mis en place pour les usages civils devraient pouvoir être utilisés dans dix cas sur onze. L'indicateur de performance où l'objectif n'est le plus souvent pas atteint est de pouvoir évacuer le premier patient en moins de 15 minutes. Le prochain pas est d'appliquer ces indicateurs à l'entraînement militaire de base, aux entraînements officiels de préparation aux missions ainsi qu'aux exercices réalisés dans la zone de mission.
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- Nilsson, Heléne, et al.
(author)
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Attitudes on the use of priority tags
- 2007
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In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - London, UK : BioMed Central. - 1757-7241. ; 15, s. 71-73
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Journal article (peer-reviewed)abstract
- Prioritising of victims as well as the use of priority tags in different colours is an important part of all training in patient management at disasters and major incidents. The actual use of priority tags in incidents and disasters has so far not been systematically studied. The aim of this study was to demonstrate attitudes among researchers as well as prehospital personnel on the actual use of priority tags. In 38 KAMEDO reports issued by the Swedish National Board of Health and Welfare describing major incidents and disasters from 1977-2004, we found no documentation on the use of priority tags. In a questionnaire to personnel within the prehospital medical system 133 (68%) replied that they only have used priority tags in training. 20 (10%) had used priority tags in a real accident/incident and 43 (21%) answered that they have never used priority tags. Reports from incidents should include the issues on the use of priority tags and clearly defi ned criteria on prioritising and labelling of patients at an incident/disaster, as well as in daily work, should be defi ned.
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- Nilsson, Helene, et al.
(author)
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Management of resources at major incidents and disasters in relation to patient outcome : A pilot study of an educational model
- 2008
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In: European journal of emergency medicine. - 0969-9546 .- 1473-5695. ; 15:3, s. 162-165
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Journal article (peer-reviewed)abstract
- BACKGROUND AND OBJECTIVES: Organizations involved in disaster response often have a defined operative level of management (command and control) that can take the overall decisions regarding the mobilization and distribution of resources and distribution of casualties. This level of management can be referred to as strategic management. The aim of this pilot study was to show the possibility, in simulation exercises, to relate decisions made regarding resources to patient outcome. METHODS: The simulation system used measures to determine if lifesaving interventions are performed in time or not in relation to patient outcome. Evaluation was made with sets of performance indicators as templates and all management groups were evaluated not only as to how the decisions were made (management skills), but also how staff work was performed (staff procedure skills). RESULTS: Owing to inadequate response and insufficient distribution of patients to hospitals, 11 'patients' died in the simulated incident, a fire at a football stand with subsequent collapse. The strategic level of management received 16 points out of a possible 22 according to a predesigned template of performance indicators. CONCLUSION: The pilot study demonstrated the possibility to, in simulation exercises, relate decisions made regarding resources to patient outcome. This training technique could possibly lead to increased knowledge in what decisions are crucial to make in an early phase to minimize mortality and morbidity. © 2008 Lippincott Williams & Wilkins, Inc.
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- Rüter, Anders, 1954-
(author)
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Disaster medicine- performance indicators, information support and documentation : A study of an evaluation tool
- 2006
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Doctoral thesis (other academic/artistic)abstract
- The science of disaster medicine is more a descriptive than analytical type. Research, in most instances, has not employed quantitative methods and there is very sparse knowledge based on analytical statistics. One consequence of this is that similar mistakes are repeated over and over. Lessons that should be learned are merely observed.Moreover, there are almost no practical or ethical ways in which randomised controlled studies can be performed.The management, command and control of situations on different levels of hierarchy has eldom been evaluated and there have been no standards against which performance can be evaluated. Furthermore, the documentation of decisions and staff work is rarely sufficient enough to evaluate command and control functions.Setting standards that may be used as templates for evaluation and research is an issue that is constantly being addressed by leading experts in the field of disaster medicine and this is also an important issue that is expressed in the Utstein Template.Swedish National Board of Health and Welfare, templates of performance indicators were developed. These were tested on reports available from incidents, and our conclusion was that documentation in this form was not adequate enough for use in this method of evaluation.Documentation must be improved and data probably need to be captured and stored with the help of information systems.A template developed for the evaluation of medical command and control at the scene was tested in standardised examinations. When using this template in this setting it was possible to obtain specific information on those aspects of command and control that need to be improved.An information system using on-line Internet technique was studied twice. The first study concluded that in spite of technical disturbances the system was acceptable to the organisation but could not yet be recommended for use during major incidents. The second study concluded that the retrieval of information was, in all respects not as good as the control system, a conventional ambulance file system.In a study of staff procedure skills during training of management staffs in command and control it was concluded that documentation during training sessions was not adequate and this lack of staff procedure skills could possibly be a contributing factor to the fact that lessons in command and control are not learned from incidents.Conclusions in thesis are that measurable performance indicators can be used in the training of command and control. If performance indicators are to be used in real incidents and disasters, functioning information systems have to be developed. This may lead to a better knowledge of command and control and could possibly contribute to a process where lessons are learned and mistakes are not repeated.
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- Rüter, Anders, 1954-, et al.
(author)
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Performance indicators as quality control for testing and evaluating hospital management groups : a pilot study.
- 2006
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In: Prehospital and Disaster Medicine. - Cambridge, UK : Cambridge University Press. - 1049-023X .- 1945-1938. ; 21:6, s. 423-426
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Journal article (peer-reviewed)abstract
- INTRODUCTION: An important issue in disaster medicine is the establishment of standards that can be used as a template for evaluation. With the establishment of standards, the ability to compare results will improve, both within and between different organizations involved in disaster management.OBJECTIVE: Performance indicators were developed for testing in simulations exercises with the purpose of evaluating the skills of hospital management groups. The objective of this study is to demonstrate how these indicators can be used to create numerically expressed results that can be compared.METHODS: Three different management groups were tested in standardized simulation exercises. The testing took place according to the organization's own disaster plan and within their own facilities. Trained observers used a pre-designed protocol of performance indicators as a template for the evaluation.RESULTS: The management group that scored lowest in management skills also scored lowest in staff skills. CONCLUSION: The use of performance indicators for evaluating the management skills of hospital groups can provide comparable results in testing situations and could provide a new tool for quality improvement of evaluations of real incidents and disasters.
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