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Impact of Wireless Electronic Medical Record System on the Quality of Patient Documentation by Emergency Field Responders during a Disaster Mass-Casualty Exercise

  • Theodore C. Chan (a1), William G. Griswold (a2), Colleen Buono (a1), David Kirsh (a3), Joachim Lyon (a4), James P. Killeen (a1), Edward M. Castillo (a1) and Leslie Lenert (a1)...

Introduction: The use of wireless, electronic, medical records and communications in the prehospital and disaster field is increasing.

Objective: This study examines the role of wireless, electronic, medical records and communications technologies on the quality of patient documentation by emergency field responders during a mass-casualty exercise.

Methods: A controlled, side-to-side comparison of the quality of the field responder patient documentation between responders utilizing National Institutes of Health-funded, wireless, electronic, field, medical record system prototype (“Wireless Internet Information System for medicAl Response to Disasters” or WIISARD) versus those utilizing conventional, paper-based methods during a mass-casualty field exercise. Medical data, including basic victim identification information, acuity status, triage information using Simple Triage and Rapid Treatment (START), decontamination status, and disposition, were collected for simulated patients from all paper and electronic logs used during the exercise. The data were compared for quality of documentation and record completeness comparing WIISARD-enabled field responders and those using conventional paper methods. Statistical analysis was performed with Fisher’s Exact Testing of Proportions with differences and 95% confidence intervals reported.

Results: One hundred simulated disaster victim volunteers participated in the exercise, 50 assigned to WIISARD and 50 to the conventional pathway. Of those victims who completed the exercise and were transported to area hospitals, medical documentation of victim START components and triage acuity were significantly better for WIISARD compared to controls (overall acuity was documented for 100% vs 89.5%, respectively, difference = 10.5% [95%CI = 0.5–24.1%]). Similarly, tracking of decontamination status also was higher for the WIISARD group (decontamination status documented for 59.0% vs 0%, respectively, difference = 9.0% [95%CI = 40.9–72.0%]). Documentation of disposition and destination of victims was not different statistically (92.3% vs. 89.5%, respectively, difference = 2.8% [95%CI = -11.3–17.3%]).

Conclusions: In a simulated, mass-casualty field exercise, documentation and tracking of victim status including acuity was significantly improved when using a wireless, field electronic medical record system compared to the use of conventional paper methods.

Corresponding author
Correspondence: Theodore Chan, MD UCSD DEM200 West Arbor Drive #8676San Diego, California 92103 USA E-mail:
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TC Chan , J Killeen , WG Griswold , L Lenert : Information technology and emergency medical care during disasters. Acad Emerg Med 2004;11:12291236.

LO Gostin , D Hanfling : National preparedness for a catastrophic emergency. JAMA 2009;302:23652366.

JM Teich , MM Wagner , CF Mackenzie , KO Schafer : The informatics response in disaster, terrorism, and war. J Am Med Inform Assoc 2002;9:97104.

AK Jha , CM Desroches , EG Campbell , K Donelan , SR Rao , TG Ferris , A Shields , S Rosenbaium , D Blumenthal : Use of electronic health records in US hospitals. N Engl J Med 2009;360:16281638.

CA Kahn , CH Schultz , KT Miller , CL Anderson : Does START triage work? An outcomes assessment after a disaster. Ann Emerg Med 2009;54:431436.

SM Briggs : Disaster management teams. Curr Opin Crit Care 2005;11:585589.

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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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