Hostname: page-component-76fb5796d-9pm4c Total loading time: 0 Render date: 2024-04-29T14:35:27.625Z Has data issue: false hasContentIssue false
  • English
  • Français

Efficacy of Critical Incident Monitoring for Evaluating Disaster Medical Readiness and Response During the Sydney 2000 Olympic Games

Published online by Cambridge University Press:  28 June 2012

Arthas Flabouris ,
Antony Nocera  and
Alan Garner
Arthas Flabouris*
Affiliation:
Medical Team Leaders, Disaster Medical Response Teams, New South Wales (NSW) Health, Liverpool BC, New South Wales, Australia
Antony Nocera
Affiliation:
Medical Team Leaders, Disaster Medical Response Teams, New South Wales (NSW) Health, Liverpool BC, New South Wales, Australia
Alan Garner
Affiliation:
Medical Team Leaders, Disaster Medical Response Teams, New South Wales (NSW) Health, Liverpool BC, New South Wales, Australia
*
Intensive Care Unit, Liverpool Health Service, Locked Bag 7103, Liverpool BC, NSW 1871Australia E-mail: Arthas.Flabouris@swsahs.nsw.gov.au
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Multiple casualty incidents (MCI) are infrequent events for medical systems. This renders audit and quality improvement of the medical responses difficult. Quality tools and use of such tools for improvement is necessary to ensure that the design of medical systems facilitates the best possible response to MCI.

Objective:

To describe the utility of incident reporting as a quality monitoring and improvement tool during the deployment of medical teams for mass gatherings and multiple casualty incidents.

Methods:

Voluntary and confidential reporting of incidents was provided by members of the disaster medical response teams during the period of disaster medical team deployment for the 2000 Sydney Olympic Games. Qualitative evaluations were conducted of reported incidents. The main outcome measures included the nature of incident and associated contributing factors, minimization factors, harm potential, and comparison with the post-deployment, cold debriefings.

Results:

A total of 53 incidents were reported. Management-based decisions, poor or non-existent protocols, and equipment and communicationrelated issues were the principal contributing factors. Eighty nine percent of the incidents were considered preventable. A potential for harm to patients and/or team members was documented in 58% of reports, of which 76% were likely to cause at least significant harm. Of equipment incidents, personal protective equipment (33%), medical equipment (27%), provision of equipment (22%), and communication equipment (17%) predominated. Personal protective equipment (50%) was reported as the most frequent occupational health and safety incident followed by fatigue (25%). Predeployment planning was the most important factor for future incident impact minimization.

Conclusions:

Incident monitoring was efficacious as a quality tool in identifying incident contributing factors. Incident monitoring allowed for greater systems evaluation. Further evaluation of this quality tool within different disaster settings is required.

Keywords

critical incident monitoringmedical responsemultiple casualty incidentsquality improvement
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 19 , Issue 2 , June 2004 , pp. 164 - 168
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2004

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Beyersdorf, SR, Nania, JN, Luna, GK: Community medical response to the Fairchild mass casualty event. Am J Surg 1996;171:467–470.CrossRefGoogle Scholar
2Frykberg, ER, Tepas, JJ: Terrorist bombings: Lessons learned form Belfast to Beirut. Ann Surg 1988;208(5):569–576.CrossRefGoogle Scholar
3Leibovici, D, Gofrit, ON, Heruti, RJ, et al. : Interhospital patient transfer: A quality improvement indicator for prehospital triage in mass casualties. Am J Emerg Med 1997;15:341–344.CrossRefGoogle ScholarPubMed
4Flanagan, JC: The critical incident technique. Psychol Bull 1954;51:327–358.CrossRefGoogle ScholarPubMed
5Williamson, JA, Webb, RK, Pryor, GL: Anaesthesia safety and the critical incident technique. Aust J Clin Review 1985;5:57–61.Google Scholar
6Webb, RK, Currie, M, Morgan, CA, et al. : The Australian incident monitoring study: An analysis of 2000 incident reports. Anaesth Intens Care 1993;21:520–528.CrossRefGoogle ScholarPubMed
7Beckmann, U, Baldwin, I, Hart, GK, Runciman, WB: The Australian incident monitoring study in intensive care: AIMS-ICU. An analysis of the first year of reporting. Anaesth Intens Care 1996;24:320–329.CrossRefGoogle ScholarPubMed
8Vinen, J: Incident monitoring in emergency departments: An Australian model. Acad Emerg Med 2000;7(11):1290–1297.CrossRefGoogle ScholarPubMed
9Flabouris, A, Seppelt, I: Optimal interhospital transport systems for the critically ill. In: Vincent, JL (ed): 2001 Yearbook of Intensive Care and Emergency Medicine. Springer 2001. pp. 647–660.CrossRefGoogle Scholar
10NSW Health Department: NSW Healthplan. State Health Publication No: (PH) 960098 ISBN No: 7310 922220 1.Google Scholar
11NSW Health Department1: NSW Health Services for the Sydney 2000 Olympic and Para-Olympic Games. December 2000. State Health Publication No: (OPU) 000 201 ISBN No: 0 7347 3251 1.CrossRefGoogle Scholar
12Auf der Heide, E: Disaster planning, part II: Disaster problems, issues, and challenges identified in the research literature. Emergency Medicine Clinics of North America 1996;4(2):453–480.CrossRefGoogle Scholar
13Runciman, WB, Sellen, A, Webb, RK, et al. : Errors, incidents and accidents in anaesthetic practice. Anaesth Intens Care 1993;21:506–519.CrossRefGoogle ScholarPubMed
14Nancekievill, DG: Disaster management: Practice makes perfect. BMJ 1989;298:477.Google Scholar
15Nancekievill, DG: On-site medical services at major incidents. BMJ 1992;305:726–727.CrossRefGoogle ScholarPubMed
16Fletcher, V: When the music stopped. Nursing Times 1986;82:30–32.Google ScholarPubMed
17Shaftan, GW: Disaster and medical care. J Trauma 1962;2:111–116.CrossRefGoogle ScholarPubMed
18New, B: Too Many Cooks? The response of the health-related services to major incidents in London. King's Fund Institute Research Report No.15, London, 1992.Google Scholar
19Cooke, MW: Arrangements for on scene medical care at major incidents. BMJ 1992;305:748.CrossRefGoogle ScholarPubMed
20Jacobs, LM, Goody, BA, Sinclair, A: The role of a trauma center in disaster management. J Trauma 1983;23:697–701.CrossRefGoogle ScholarPubMed
21Garner, A, Nocera, A: Should New South Wales Hospital disaster teams be sent to major incident sites? Aust NZ J Surg 1999;69:702–706.CrossRefGoogle ScholarPubMed
22Steedman, DJ, Gordon, MWG, Cusack, S, et al. : Lessons for mobile medical teams following the Lockerbie and Guthrie Street disasters. Injury 1991;22:215–218.CrossRefGoogle ScholarPubMed
23Miller, PJ: The Nuneaton derailment. Injury 1980;12:130–138.CrossRefGoogle ScholarPubMed
24Hidden, A: Investigation into the Clapham Junction Railway Accident. Department of Transport 1989; HMSO, London.Google Scholar
25Finch, P, Nancekievill, DG: The role of hospital medical teams at a major accident. Anaesthesia 1975;30:666–676.CrossRefGoogle Scholar
26McGregor, P, Driscoll, P, Sammy, I, et al. : Are UK mobile medical teams safe? Prehospital Immediate Care 1997;1:183–188.Google Scholar
27Klein, JS, Weigelt, JA: Disaster management: Lessons learned. Surg Clin North Am 1991;71:257–266.CrossRefGoogle ScholarPubMed
28Stevens, KLH, Partridge, R: The Clapham rail disaster. Injury 1990;21:37–40.CrossRefGoogle ScholarPubMed
29Christopher, PJ, Selig, M: Medical Aspects of the Granville Rail Disaster. Med J Aust 1977;2(12):383–386.CrossRefGoogle ScholarPubMed
30Staff of the accident and emergency departments of Derbyshire Royal Infirmary, Leicester Royal Infirmary, and Queens Medical Centre, Nottingham: Coping with the early stages of the M1 disaster: at the scene and on arrival at hospital. BMJ 1989;298:651–654.CrossRefGoogle Scholar
31Malone, WD: Lessons to be learned from the major disaster following the civil airliner crash at Kegworth in January 1989. Injury 1990;21:49–52.CrossRefGoogle ScholarPubMed