Quality control in disaster medicine training—Initial regional medical command and control as an example

Authors

  • Heléne Nilsson, RN
  • Tore Vikström, MD, PhD
  • Anders Rüter, MD, PhD

DOI:

https://doi.org/10.5055/ajdm.2010.0004

Keywords:

performance indicators, disaster management, education, quality measurement

Abstract

Objective: The aim of this study was to show the possibility to identify what decisions in the initial regional medical command and control (IRMCC) that have to be improved.
Design: This was a prospective, observational study conducted during nine similar educational programs for regional and hospital medical command and control in major incidents and disasters. Eighteen management groups were evaluated during 18 standardized simulation exercises.
Main Outcome Measure: More detailed and quantitative evaluation methods for systematic evaluation within disaster medicine have been asked for. The hypothesis was that measurable performance indicators can create comparable results and identify weak and strong areas of performance in disaster management education and training.
Methods: Evaluation of each exercise was made with a set of 11 measurable performance indicators for IRMCC. The results of each indicator were scored 0, 1, or 2 according to the performance of each management group.
Results: The average of the total score for IRMCC was 14.05 of 22. The two best scored performance indicators, No 1 “declaring major incident” and No 2 “deciding on level of preparedness for staff,” differed significantly from the two lowest scoring performance indicators, No 7 “first information to media” and No 8 “formulate general guidelines for response.”
Conclusion: The study demonstrated that decisions such as “formulating guidelines for response” and “first information to media” were areas in initial medical command and control that need to be improved. This method can serve as a quality control tool in disaster management education programs.

Author Biographies

Heléne Nilsson, RN

Department of Clinical and Experimental Medicine, Faculty of Health Science, Centre for Teaching and Research in Disaster Medicine and Traumatology (KMC), Linköping University, Linköping, Sweden.

Tore Vikström, MD, PhD

Department of Clinical and Experimental Medicine, Faculty of Health Science, Centre for Teaching and Research in Disaster Medicine and Traumatology (KMC), Linköping University, Linköping, Sweden.

Anders Rüter, MD, PhD

Department of Clinical and Experimental Medicine, Faculty of Health Science, Centre for Teaching and Research in Disaster Medicine and Traumatology (KMC), Linköping University, Linköping, Sweden.

References

Willis CD, Stoelwinder JU, Cameron PA: Interpreting process indicators in trauma care: Construct validity versus confounding by indication. Int J Qual Health Care. 2008; 20: 331-338.

Mainz J: Defining and classifying clinical indicators for quality improvement. Int J Qual Health Care. 2003; 15: 523-530.

Lennquist S: Promotion disaster medicine to a scientific discipline— A slow and painful but necessary process. Int J Dis Med. 2003; 2: 95-96.

Sundnes KO, Birnbaum ML: Health disaster management: Guidelines for evaluation and research in then Utstein style. Prehosp Disast Med. 2002; 17(Suppl 3): 25-29.

De Boer J, Debacker M: A more rational approach to medical disaster management applied retrospectively to the Enschede fireworks disaster, 13 May 2000. Eur J Emerg Med. 2003; 10: 117-123.

Regulation SOSFS 2005:12: Control Systems for Quality Management and Patient Safety in Health Care. Stockholm: The Swedish National Board of Health and Welfare, 2005. Available at www.socialstyrelsen.se/sosfs/2005-12/Documents/2005_12.pdf. Accessed November 1, 2009.

Regulation SOSFS 2005:13: Disaster Medicine Preparedness for Peacetime. Stockholm: The Swedish National Board of Health and Welfare, 2005. Available at www.socialstyrelsen.se/sosfs/2005-13/ Documents/2005_13.pdf. Accessed November 1, 2009.

Rüter A, Örtenwall P, Vikström T: Performance indicators for major incident medical management—A possible tool for quality control. Int J Dis Med. 2004; 2: 1-4.

Lohrin H: 35 Years of Disaster Medicine Studies—The Swedish National Board of Health and Welfare. Stockholm: Socialstyrelsen, 1999.

Bloch YH, Schwartz D, Pinkert M, et al.: Distribution of casualities in a mass-casuality incident with three local hospitals in the perihery of densely populated area: Lessons learned from the medical management of a terrorist attack. Prehosp Disast Med. 2007; 22: 186-192.

Hogan DE, Burnstein JL: Disaster medicine. 2d ed. Philadelphia: Lippincott Williams & Wilkins, 2002: 108-111.

Green WG III: Command and Control of Disaster Operations. USA: Universal Publishers, 2001: 9-33.

Smart CJ, Maconochie I: How and why do you declare a major incident? Prehosp Disast Med. 2008; 23: 70-75.

Khorram-Manesh A, Hedelin A, Örtenwall P: Hospital-related incidents: Causes and its impact on disaster preparedness and prehospital organisations. Scand J Trauma Resusc Emerg Med. 2009; 17: 1-6, doi.10.1186/757-7241-17-26.

Group ALS (ed.): Major Incident Medical Management and Support—The Practical Approach, 2nd ed. London: BMJ Publishing Group, 2002.

Nilsson H, Rüter A: Management of resources at major incidents and disasters in relation to patient outcome—A pilot study of an educational model. Euro J Emerg Med. 2006; 15: 162-165.

Tamara LT, Hsu EB, Hong KK, et al.: The incident command system in disasters: Evaluation methods for a hospital-based exercise. Prehosp Disast Med. 2005; 20: 14-23.

Rüter A, Lundmark T, Ödmansson E, et al.: The development of a national doctrine for management of major incidents and disasters. Scand J Trauma Resusc Emerg Med. 2006; 14: 189-194.

Rüter A, Vikström T: Performance indicators—From theory to implementation; one method of scientific approach to disaster medicine. Urgence Pratique. 2009; 93: 41-44. [English version available at http://liu.diva-portal.org/smash/record.jsf?pid= diva2:275781].

Stratton SJ: The editorial: A means OD advancing knowledge and science. Prehosp Disast Med. 2003; 18: 2-3.

Rüter A, Nilsson H,Vikström T: Performance indicators as quality control for testing and evaluating hospital management groups: A pilot study. Prehosp Disast Med. 2006; 21: 423-426.

Rüter A, Örtenwall P, Vikström T: Performance indicators for prehospital command and control in training of medical first responders. Int J Dis Med. 2004; 2: 89-92.

Sutingco N: The incident command system. In Ciottone GR (ed): Disaster Medicine. Philadelphia: Mosby Elsevier, 2006: 208-214.

Rüter A, Nilsson H, Vikström T: Medical Command and Control at Incidents and Disaster—From the Scene to the Hospital Ward. Lund: Studentlitteratur, 2006.

Boorman D: Today’s electronic checklists reduce likelihood of crew errors and help prevent mishaps. ICAO J. 2001; 1: 17-22.

Helmreich R: On error management: Lessons from aviation. BMJ. 2000; 320(7237): 781, doi:10.1136/bmj.320.7237.781.

Driscoll P, Kent A: The effect of scene time on survival. J Trauma. 1999; 1: 22-30.

Published

01/01/2010

How to Cite

Nilsson, RN, H., T. Vikström, MD, PhD, and A. Rüter, MD, PhD. “Quality Control in Disaster Medicine training—Initial Regional Medical Command and Control As an Example”. American Journal of Disaster Medicine, vol. 5, no. 1, Jan. 2010, pp. 35-40, doi:10.5055/ajdm.2010.0004.