Prehospital & Disaster Medicine
Volume 30 – Issue 02 – April 2015
https://journals.cambridge.org/action/displayIssue?jid=PDM&tab=currentissue

Original Research
Building Health Care System Capacity to Respond to Disasters: Successes and Challenges of Disaster Preparedness Health Care Coalitions
Lauren Walsha1 c1 id1, Hillary Craddocka1, Kelly Gulleya1, Kandra Strauss-Riggsa1 and Kenneth W. Schora1
a1 National Center for Disaster Medicine and Public Health, Uniformed Services University of the Health Sciences, Rockville, Maryland USA
Abstract
Introduction
This research aimed to learn from the experiences of leaders of well-developed, disaster preparedness-focused health care coalitions (HCCs), both the challenges and the successes, for the purposes of identifying common areas for improvement and sharing “promising practices.”
Hypothesis/Problem
Little data have been collected regarding the successes and challenges of disaster preparedness-focused HCCs in augmenting health care system preparedness for disasters.
Methods
Semi-structured interviews were conducted with a sample of nine HCC leaders. Transcripts were analyzed qualitatively.
Results
The commonly noted benefits of HCCs were: community-wide and regional partnership building, providing an impartial forum for capacity building, sharing of education and training opportunities, staff- and resource-sharing, incentivizing the participation of clinical partners in preparedness activities, better communication with the public, and the ability to surge. Frequently noted challenges included: stakeholder engagement, staffing, funding, rural needs, cross-border partnerships, education and training, and grant requirements. Promising practices addressed: stakeholder engagement, communicating value and purpose, simplifying processes, formalizing connections, and incentivizing participation.
Conclusions
Strengthening HCCs and their underlying systems could lead to improved national resilience to disasters. However, despite many successes, coalition leaders are faced with obstacles that may preclude optimal system functioning. Additional research could: provide further insight regarding the benefit of HCCs to local communities, uncover obstacles that prohibit local disaster-response capacity building, and identify opportunities for an improved system capacity to respond to, and recover from, disasters.

Brief Report
Preparing for Euro 2012: Developing a Hazard Risk Assessment
Evan G. Wonga1, Tarek Razeka1, Artem Luhovya1, Irina Mogilevkinaa2, Yuriy Prudnikova2, Fedor Klimovitskiya2, Yuriy Yutovetsa2, Kosar A. Khwajaa1 and Dan L. Deckelbauma1 c1
a1 Centre for Global Surgery, McGill University Health Centre, Montreal, Quebec, Canada
a2 Donetsk Research and Development Institute of Traumatology and Orthopedics, Donetsk National Medical University, Donetsk, Ukraine
Abstract
Introduction
Risk assessment is a vital step in the disaster-preparedness continuum as it is the foundation of subsequent phases, including mitigation, response, and recovery.
Hypothesis/Problem To develop a risk assessment tool geared specifically towards the Union of European Football Associations (UEFA) Euro 2012.
Methods
In partnership with the Donetsk National Medical University, Donetsk Research and Development Institute of Traumatology and Orthopedics, Donetsk Regional Public Health Administration, and the Ministry of Emergency of Ukraine, a table-based tool was created, which, based on historical evidence, identifies relevant potential threats, evaluates their impacts and likelihoods on graded scales based on previous available data, identifies potential mitigating shortcomings, and recommends further mitigation measures.
Results
This risk assessment tool has been applied in the vulnerability-assessment-phase of the UEFA Euro 2012. Twenty-three sub-types of potential hazards were identified and analyzed. Ten specific hazards were recognized as likely to very likely to occur, including natural disasters, bombing and blast events, road traffic collisions, and disorderly conduct. Preventative measures, such as increased stadium security and zero tolerance for impaired driving, were recommended. Mitigating factors were suggested, including clear, incident-specific preparedness plans and enhanced inter-agency communication.
Conclusion
This hazard risk assessment tool is a simple aid in vulnerability assessment, essential for disaster preparedness and response, and may be applied broadly to future international events.

Comprehensive Review
Literature Review on Medical Incident Command
Rune Rimstada1a2a3 c1 and Geir Sverre Brauta4a5
a1 Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway
a2 Department of Industrial Economics, Risk Management, and Planning, University of Stavanger, Stavanger, Norway
a3 Medicine, Health, and Development, Oslo University Hospital, Oslo, Norway
a4 Department of Research, Stavanger University Hospital, Stavanger, Norway
a5 Stord Haugesund University College, Haugesund, Norway
Abstract
Introduction
It is not known what constitutes the optimal emergency management system, nor is there a consensus on how effectiveness and efficiency in emergency response should be measured or evaluated. Literature on the role and tasks of commanders in the prehospital emergency services in the setting of mass-casualty incidents has not been summarized and published.
Problem
This comprehensive literature review addresses some of the needs for future research in emergency management through three research questions: (1) What are the basic assumptions underlying incident command systems (ICSs)? (2) What are the tasks of ambulance and medical commanders in the field? And (3) How can field commanders’ performances be measured and assessed?
Methods
A systematic literature search in MEDLINE, PubMed, PsycINFO, Embase, Cochrane Central Register of Controlled Trials, Cochrane Library, ISI Web of Science, Scopus, International Security & Counter Terrorism Reference Center, Current Controlled Trials, and PROSPERO covering January 1, 1990 through March 1, 2014 was conducted. Reference lists of included literature were hand searched. Included papers were analyzed using Framework synthesis.
Results
The literature search identified 6,049 unique records, of which, 76 articles and books where included in qualitative synthesis. Most ICSs are described commonly as hierarchical, bureaucratic, and based on military principles. These assumptions are contested strongly, as is the applicability of such systems. Linking of the chains of command in cooperating agencies is a basic difficulty. Incident command systems are flexible in the sense that the organization may be expanded as needed. Commanders may command by direction, by planning, or by influence. Commanders’ tasks may be summarized as: conducting scene assessment, developing an action plan, distributing resources, monitoring operations, and making decisions. There is considerable variation between authors in nomenclature and what tasks are included or highlighted. There are no widely acknowledged measurement tools of commanders’ performances, though several performance indicators have been suggested.
Conclusion
The competence and experience of the commanders, upon which an efficient ICS has to rely, cannot be compensated significantly by plans and procedures, or even by guidance from superior organizational elements such as coordination centers. This study finds that neither a certain system or structure, or a specific set of plans, are better than others, nor can it conclude what system prerequisites are necessary or sufficient for efficient incident management. Commanders need to be sure about their authority, responsibility, and the functional demands posed upon them.

Comprehensive Review
A Literature Review of Medical Record Keeping by Foreign Medical Teams in Sudden Onset Disasters
Anisa J. N. Jafara1 c1, Ian Nortona2, Fiona Leckya3 and Anthony D. Redmonda1
a1 HCRI, Ellen Wilkinson Building, University of Manchester, Manchester, United Kingdom
a2 National Critical Care and Trauma Response Center, Darwin, Australia
a3 EMRiS Group, ScHARR, Sheffield, United Kingdom
Abstract
Background Medical records are a tenet of good medical practice and provide one method of communicating individual follow-up arrangements, informing research data, and documenting medical intervention.
Methods The objective of this review was to look at one source (the published literature) of medical records used by foreign medical teams (FMTs) in sudden onset disasters (SODs). The published literature was searched systematically for evidence of what medical records have been used by FMTs in SODs.
Findings The style and content of medical records kept by FMTs in SODs varied widely according to the published literature. Similarly, there was great variability in practice as to what happens to the record and/or the data from the record following its use during a patient encounter. However, there was a paucity of published work comprehensively detailing the exact content of records used.
Interpretation Without standardization of the content of medical records kept by FMTs in SODs, it is difficult to ensure robust follow-up arrangements are documented. This may hinder communication between different FMTs and local medical teams (LMTs)/other FMTs who may then need to provide follow-up care for an individual. Furthermore, without a standard method of reporting data, there is an inaccurate picture of the work carried out. Therefore, there is not a solid evidence base for improving the quality of future response to SODs. Further research targeting FMTs and LMTs directly is essential to inform any development of an internationally agreed minimum data set (MDS), for both recording and reporting, in order that FMTs can reach the World Health Organization (WHO) standards for FMT practice.