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The Incident Command System in Disasters: Evaluation Methods for a Hospital-based Exercise

Published online by Cambridge University Press:  28 June 2012

Tamara L. Thomas,
Edbert B. Hsu,
Hong K. Kim,
Sara Colli,
Guillermo Arana and
Gary B. Green
Tamara L. Thomas
Affiliation:
Department of Emergency Medicine, Loma Linda University School of Medicine, Loma Linda, California, USA
Edbert B. Hsu
Affiliation:
Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Hong K. Kim
Affiliation:
Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Sara Colli
Affiliation:
Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Guillermo Arana
Affiliation:
Ministry of Health of Panama, Panama City, Panama
Gary B. Green*
Affiliation:
Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
*
Department of Emergency Medicine, The Johns Hopkins University School of Medicine, 1830 E. Monument Street, Suite 6-100, Baltimore, MD 21205 USA E-mail: ggreen@jhmi.edu
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Abstract

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Objectives:

No universally accepted methods for objective evaluation of the function of the Incident Command System (ICS) in disaster exercises currently exist. An ICS evaluation method for disaster simulations was derived and piloted.

Methods:

A comprehensive variable list for ICS function was created and four distinct ICS evaluation methods (quantitative and qualitative) were derived and piloted prospectively during an exercise. Delay times for key provider-victim interactions were recorded through a system of data collection using participant and observer-based instruments. Two different post exercise surveys (commanders, other participants) were used to assess knowledge and perceptions of assigned roles, organization, and communications. Direct observation by trained observers and a structured debriefing session also were employed.

Results:

A total of 45 volunteers participated in the exercise that included 20 mock victims. First, mean, and last victim delay times (from exercise initiation) were 2.1, 4.0, and 9.3 minutes (min) until triage, and 5.2, 11.9, and 22.0 min for scene evacuation, respectively. First, mean, and last victim delay times to definitive treatment were 6.0, 14.5, and 25.0 min. Mean time to triage (and range) for scene Zones I (nearest entrance), II (intermediate) and III (ground zero) were 2.9 (2.0–4.0), 4.1 (3.0–5.0) and 5.2 (3.0–9.0) min, respectively. The lowest acuity level (Green) victims had the shortest mean times for triage (3.5 min), evacuation (4.0 min), and treatment (10.0 min) while the highest acuity level (Red) victims had the longest mean times for all measures; patterns consistent with independent rather than ICS-directed rescuer activities. Specific ICS problem areas were identified.

Conclusions:

A structured, objective, quantitative evaluation of ICS function can identify deficiencies that can become the focus for subsequent improvement efforts.

Keywords

data collectiondefinitive treatmentdisastersdrillsevaluationexercisehospitalsincident command systemmethodstimestransporttriage

Information

Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 20 , Issue 1 , February 2005, pp. 14 - 23
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2005

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