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Evaluation of Medical Command and Control Using Performance Indicators in a Full-Scale, Major Aircraft Accident Exercise

  • Dan Gryth (a1), Monica Rådestad (a1), Heléne Nilsson (a2), Ola Nerf (a1), Leif Svensson (a1), Maaret Castrén (a1) and Anders Rüter (a2)...
Abstract<span class='bold'>Introdution:</span>

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.

<span class='bold'>Objective:</span>

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.

<span class='bold'>Methods:</span>

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 >11 were considered as acceptable.

<span class='bold'>Results:</span>

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.

<span class='bold'>Conclusions:</span>

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.

Corresponding author
Department of Clinical Science and Education, Södersjukhuset Karolinska Institutet Stockholm Prehospital Centre S-118 83 Stockholm Sweden E-mail:
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This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

1. A Rüter , P Örtenwall , T Vikström : Performance indicators for major medical management—A possible tool for quality control. International Journal of Disaster Medicine 2004;2:5255.

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7. A Rüter , P Örtenwall , T Vikström : Staff procedure skills in management groups during exercices in disaster medicine. Prehosp Disaster Med 2007;22(4):318321.

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15. D Murdock : Trauma: When there's no time to count. AORN J 2008;87(2):322328.

17. H Nilsson , A Rüter : Management of resources at major incidents and disasters in relation to patient outcome: A pilot study of an educational model. European Journal of Emergency Medicine 2008;15:162165.

18. E Hsu , M Jenckes , C Catlett , et al: Effectiveness of hospital staff mass-causellty incident training methods: A systematic literature review. Prehospital Disast Med 2004;19:191199.

19. K Gebbie , J Vales , J Merrill , S Morse : Role of exercises and drills in the evaluation of public health in emergency response. Prehospital Disast Med 2006;21:173182.

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Prehospital and Disaster Medicine
  • ISSN: 1049-023X
  • EISSN: 1945-1938
  • URL: /core/journals/prehospital-and-disaster-medicine
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