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

Gryth, Dan; Rådestad, Monica; Nilsson, Heléne; Nerf, Ola; Svensson, Leif; Castrèn, Maaret; Rüter, Anders

doi:10.1017/s1049023x00007834

Cited by 28 publications

(42 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The measurable performance indicators extracted from this process have been used for many years in Swedish disaster management training. In addition, the same indicators have been used in an international study and as an evaluation tool in full-scale exercises [18-21]. …”

Section: Introductionmentioning

confidence: 99%

Performance indicators for initial regional medical response to major incidents: a possible quality control tool

Nilsson

Vikström

Jonson

2012

Scand J Trauma Resusc Emerg Med

Self Cite

View full text Add to dashboard Cite

BackgroundTimely decisions concerning mobilization and allocation of resources and distribution of casualties are crucial in medical management of major incidents. The aim of this study was to evaluate documented initial regional medical responses to major incidents by applying a set of 11 measurable performance indicators for regional medical command and control and test the feasibility of the indicators.MethodsRetrospective data were collected from documentation from regional medical command and control at major incidents that occurred in two Swedish County Councils. Each incident was assigned to one of nine different categories and 11 measurable performance indicators for initial regional medical command and control were systematically applied. Two-way analysis of variance with one observation per cell was used for statistical analysis and the post hoc Tukey test was used for pairwise comparisons.ResultsThe set of indicators for regional medical command and control could be applied in 102 of the130 major incidents (78%), but 36 incidents had to be excluded due to incomplete documentation. The indicators were not applicable as a set for 28 incidents (21.5%) due to different characteristics and time frames. Based on the indicators studied in 66 major incidents, the results demonstrate that the regional medical management performed according to the standard in the early phases (1–10 min after alert), but there were weaknesses in the secondary phase (10–30 min after alert). The significantly lowest scores were found for Indicator 8 (formulate general guidelines for response) and Indicator 10 (decide whether or not resources in own organization are adequate).ConclusionsMeasurable performance indicators for regional medical command and control can be applied to incidents that directly or indirectly involve casualties provided there is sufficient documentation available. Measurable performance indicators can enhance follow- up and be used as a structured quality control tool as well as constitute measurable parts of a nationally based follow-up system for major incidents. Additional indicators need to be developed for hospital-related incidents such as interference with hospital infrastructure.

show abstract

Section: Introductionmentioning

confidence: 99%

Performance indicators for initial regional medical response to major incidents: a possible quality control tool

Nilsson

Vikström

Jonson

2012

Scand J Trauma Resusc Emerg Med

Self Cite

View full text Add to dashboard Cite

show abstract

“…It has also been used in the European Journal of Trauma and Emergency Surgery 43 44 and mentioned in an editorial in the same journal 45. Two of the templates31 34 39 are routinely used for reporting from exercises. Data on medical management during a mass casualty incident exercise31 are normally used to assess the healthcare system in a mass casualty incident simulation and exercise.…”

Section: Resultsmentioning

confidence: 99%

“…An online registry for the healthcare system is designed using this instrument. Performance indicators for major incident medical management34 39 have also been used in additional publications 17 46–50. For the three publications lacking author email,23 36 38 we were unable to attain information on whether they have been used.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Systematic literature review of templates for reporting prehospital major incident medical management

et al. 2013

View full text Add to dashboard Cite

ObjectiveTo identify and describe the content of templates for reporting prehospital major incident medical management.DesignSystematic literature review according to PRISMA guidelines.Data sourcesPubMed/MEDLINE, EMBASE, CINAHL, Scopus and Web of Knowledge. Grey literature was also searched.Eligibility criteria for selected studiesTemplates published after 1 January 1990 and up to 19 March 2012. Non-English language literature, except Scandinavian; literature without an available abstract; and literature reporting only psychological aspects were excluded.ResultsThe main database search identified 8497 articles, among which 8389 were excluded based on title and abstract. An additional 96 were excluded based on the full-text. The remaining 12 articles were included in the analysis. A total of 107 articles were identified in the grey literature and excluded. The reference lists for the included articles identified five additional articles. A relevant article published after completing the search was also included. In the 18 articles included in the study, 10 different templates or sets of data are described: 2 methodologies for assessing major incident responses, 3 templates intended for reporting from exercises, 2 guidelines for reporting in medical journals, 2 analyses of previous disasters and 1 Utstein-style template.ConclusionsMore than one template exists for generating reports. The limitations of the existing templates involve internal and external validity, and none of them have been tested for feasibility in real-life incidents.Trial registrationThe review is registered in PROSPERO (registration number: CRD42012002051).

show abstract

“…Studies have found positive effects from training using simulation methods on various aspects of EMS work, such as team processes, management, patient safety, mass casualty triage, clinical performance, self-efficacy, and more (Brannan et al, 2008;Daniels & Auguste, 2013;Okuda & Bryson, 2009;Pattillo, 2006;Salas, Gregory, & King, 2011;Weaver et al, 2014). Full-scale exercises with a high degree of fidelity are often considered the best approach to teaching medical management (D. Cohen et al, 2013;Gryth et al, 2010). However, there has been criticism of high fidelity training -such as the naïve realism claimsand much of medical management training is performed using low-fidelity simulations (Bewley & O'Neil, 2013;Legemaate, Burkle Jr., & Bierens, 2012;Lennquist, 2005;Sundnes & Birnbaum, 2003).…”

Section: Use Of Simulationsmentioning

confidence: 99%

Studying Simulations with Distributed Cognition

Rybing¹

View full text Add to dashboard Cite

Simulations are frequently used techniques for training, performance assessment, and prediction of future outcomes. In this thesis, the term "human-centered simulation" is used to refer to any simulation in which humans and human cognition are integral to the simulation's function and purpose (e.g., simulation-based training). A general problem for human-centered simulations is to capture the cognitive processes and activities of the target situation (i.e., the real world task) and recreate them accurately in the simulation. The prevalent view within the simulation research community is that cognition is internal, decontextualized computational processes of individuals. However, contemporary theories of cognition emphasize the importance of the external environment, use of tools, as well as social and cultural factors in cognitive practice. Consequently, there is a need for research on how such contemporary perspectives can be used to describe human-centered simulations, re-interpret theoretical constructs of such simulations, and direct how simulations should be modeled, designed, and evaluated.This thesis adopts distributed cognition as a framework for studying human-centered simulations. Training and assessment of emergency medical management in a Swedish context using the Emergo Train System (ETS) simulator was adopted as a case study. ETS simulations were studied and analyzed using the distributed cognition for teamwork (DiCoT) methodology with the goal of understanding, evaluating, and testing the validity of the ETS simulator. Moreover, to explore distributed cognition as a basis for simulator design, a digital re-design of ETS (DIGEMERGO) was developed based on the DiCoT analysis. The aim of the DIGEMERGO system was to retain core distributed cognitive features of ETS, to increase validity, outcome reliability, and to provide a digital platform for emergency medical studies. DIGEMERGO was evaluated in three separate studies; first, a usefulness, usability, and facevalidation study that involved subject-matter-experts; second, a comparative validation study using an expert-novice group comparison; and finally, a transfer of training study based on self-efficacy and management performance. Overall, the results showed that DIGEMERGO was perceived as a useful, immersive, and promising simulator -with mixed evidence for validity -that demonstrated increased general self-efficacy and management performance following simulation exercises.This thesis demonstrates that distributed cognition, using DiCoT, is a useful framework for understanding, designing and evaluating simulated environments. In addition, the thesis conceptualizes and re-interprets central constructs of human-centered simulation in terms of distributed cognition. In doing so, the thesis shows how distributed cognitive processes relate to validity, fidelity, functionality, and usefulness of human-centered simulations. This thesis thus provides a new understanding of human-centered simulations that is grounded in distributed cognition theor...

show abstract

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

Cited by 28 publications

References 10 publications

Performance indicators for initial regional medical response to major incidents: a possible quality control tool

Performance indicators for initial regional medical response to major incidents: a possible quality control tool

Systematic literature review of templates for reporting prehospital major incident medical management

Studying Simulations with Distributed Cognition

Contact Info

Product

Resources

About