The results suggest that the level of hospital preparedness, as measured by functional capacity, is related to the socioeconomic level of the country. The challenge is therefore to enhance hospital preparedness in countries with a weaker economy, since all hospitals need to be prepared for a disaster. There is also room for improvement in more affluent countries.

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 >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. Gryth D, Radestad M, Nilsson H, Nerf O, Svensson L, Castren M, Riiter A: Evaluation of medical command and control using performance indicators in a full-scale, major aircraft accident exercise. Prehosp DisasterMed 2010;25(2):118-124. IntroductionDisaster medicine can be difficult to evaluate scientifically. Riiter et al studied 13 major incident reports in Sweden. Based on these reports and results from a modeling process, standards for major incident medical management were developed. 1 ' 2 These performance indicators enable minor parts of different components of disaster management to be evaluated. 3 Using these indicators, it is possible to identify areas in which improvements can and should be made, and less attention can be paid to what already functions adequately. Also, if standards are expressed numerically, statistical methods can be applied and results can be compared. 4 Before measuring results from performance indicators in real incidents, it is advisable to first develop a system for education and training in which these indicators are taught and used. If the staff involved in incident management are not informed of the criteria the evaluation is based on, the evaluation results probably will not lead to improvement.One advantage of the use of performance indicators is that they can be used through the whole "chain", from education and training (and functional

BackgroundRegistration of data from a major incident or disaster serves several purposes such as to record data for evaluation of response as well as for research. Data needed can often be retrieved after an incident while other must be recorded during the incident. There is a need for a consensus on what is essential to record from a disaster response. The aim of this study was to identify key indicators essential for initial disaster medical response registration. By this is meant nationally accepted processes involved, from the time of the emergency call to the emergency medical communication centre until medical care is provided at the emergency department.MethodsA three round Delphi study was conducted. Thirty experts with a broad knowledge in disaster and emergency response and medical management were invited. In this study we estimated 30 experts to be approximately one third of the number in Sweden eligible for recruitment. Process, structure and outcome indicators for the initial disaster medical response were identified. These were based on previous research and expressed as statements and were grouped into eight categories, and presented to the panel of experts. The experts were instructed to score each statement, using a five point Likert scale, and were also invited to include additional statements. Statements reaching a predefined consensus level of 80% were considered as essential to register.ResultsIn total 97 statements were generated, 77 statements reached consensus. The 77 statements covered parts of all relevant aspects involved in the initial disaster medical response. The 20 indicators that did not reach consensus mostly concerned patient related times in hospital, types of support systems and security for health care staff.ConclusionsThe Delphi technique can be used for reaching consensus of data, comprising process, structure and outcome indicators, identified as essential for recording from major incidents and disasters.