5th International Disaster and Risk Conference IDRC 2014 Integrative Risk Management - The role of science, technology & practice 24-28 August 2014 in Davos, Switzerland

1. 5th International Disaster and Risk Conference IDRC 2014
‘Integrative Risk Management - The role of science, technology & practice‘ • 24-28 August 2014 • Davos • Switzerland
www.grforum.org
Evaluation of mass casualty incident (MCI) exercises to improve concepts and training for staff by using a MCI-benchmark system
F. Brauner, M. Stiehl, C. Baumgarten, C. Bentler,
O.A. Mudimu, A. Lechleuthner
Cologne University of Applied Sciences (CUAS), Institute of Rescue Engineering and Civil Protection, Cologne, Germany

2. 5th International Disaster and Risk Conference IDRC 2014
‘Integrative Risk Management - The role of science, technology & practice‘ • 24-28 August 2014 • Davos • Switzerland
www.grforum.org
What is a mass casualty incident?
Train crash subway Cologne 1999
67 casualties (source: http://archiv.rhein- zeitung.de/on/99/08/24/)
Train crash Eschede 1998 - 101 dead / 88 injured passengers (source: dpa)
Bus accident Sider / Swiss 2012 28 dead / 24 casualties (source: afp)

3. 5th International Disaster and Risk Conference IDRC 2014
‘Integrative Risk Management - The role of science, technology & practice‘ • 24-28 August 2014 • Davos • Switzerland
www.grforum.org
Hospital phase
Mass casualty incidents
Prehospital phase
INCIDENT
푝푝푝푝푝푝푝푝푝푝푝푝푝푝푝푝 (푃푃) 푚푚푚푚푚푚푚푚푚푚푚 푟푟푟푟푟푟푟푟푟푟 (푀푀) >1
푝푝푎푠 (푃푃) 푚푚푚푚푚푚푚푚푚푚푚 푟푟푟푟푟푟푟푟푟푟 (푀푀) =1

4. 5th International Disaster and Risk Conference IDRC 2014
‘Integrative Risk Management - The role of science, technology & practice‘ • 24-28 August 2014 • Davos • Switzerland
www.grforum.org
What is a mass casualty incident (MCI)?
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A MCI…
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is any incident in which emergency medical services resources, such as personnel and equipment, are overwhelmed by the number and severity of casualties. (Brady Prehospital Emergency Care Sixth Edition; Mistovich, Joseph J. et al. pg 866)
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This means: no patient-centered care,
-> instead life saving treatment on scene + fast transport to hospital
•In Germany every district has its own concept!
But which concept is the best?

5. 5th International Disaster and Risk Conference IDRC 2014
‘Integrative Risk Management - The role of science, technology & practice‘ • 24-28 August 2014 • Davos • Switzerland
www.grforum.org
Evaluating emergency preparedness with exercise monitoring

6. 5th International Disaster and Risk Conference IDRC 2014
‘Integrative Risk Management - The role of science, technology & practice‘ • 24-28 August 2014 • Davos • Switzerland
www.grforum.org
Research Project evalMANV (2010-2012)
Mainly deals with basic research to define parameters for comparison of different strategies in mass casualty incidents
Objectives are…
•the definition of parameters to measure and to evaluate the quality of emergency service
•the development of tools for decision support and prognosis
Partners:
Universität Paderborn Institut Computeranwendung und Integration in Konstruktion und Planung
VOMATEC International GmbH
Institut für Gefahrenabwehr GmbH Sankt Augustin
Institut für Notfallmedizin der Berufsfeuerwehr Köln

7. 5th International Disaster and Risk Conference IDRC 2014
‘Integrative Risk Management - The role of science, technology & practice‘ • 24-28 August 2014 • Davos • Switzerland
www.grforum.org
Continuous improvement in Emergency Management
Identify the Need
Incident Planning
Training
Incident
Evaluation
Review
Exercise

8. 5th International Disaster and Risk Conference IDRC 2014
‘Integrative Risk Management - The role of science, technology & practice‘ • 24-28 August 2014 • Davos • Switzerland
www.grforum.org
Purpose of Exercises
•
to train the personnel and processes
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test the functionality of a plan / protocol and concepts
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to identify strengths, weaknesses, & bottlenecks of the procedures
…under (almost) real circumstances!
ambulance drive
medical examination

9. 5th International Disaster and Risk Conference IDRC 2014
‘Integrative Risk Management - The role of science, technology & practice‘ • 24-28 August 2014 • Davos • Switzerland
www.grforum.org
Example - Exercise Scenario
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mass casualty incident after a “fictive” bombing attack
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27 casualties
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to be rescued out of dangerous area
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triaged in:
9 red,
9 yellow
9 green patients
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get first aid measures
–
localization of additional threats (second hit)

10. 5th International Disaster and Risk Conference IDRC 2014
‘Integrative Risk Management - The role of science, technology & practice‘ • 24-28 August 2014 • Davos • Switzerland
www.grforum.org
Evaluation of Exercise
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Evaluation by observers (mystery shopper method)
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problem: subjective results
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need for objective assessment, rating and comparision

11. 5th International Disaster and Risk Conference IDRC 2014
‘Integrative Risk Management - The role of science, technology & practice‘ • 24-28 August 2014 • Davos • Switzerland
www.grforum.org
New requirements for evaluation
A scientific evaluation for the assessment of MCI exercises must:
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produce comparable and reproducible results
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utility, feasibility, propriety and accuracy (Deutsche Gesellschaft für Evaluation)
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be universal and independent of operational concepts
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achieve the operational objective, thus making patient care measurable
source: Brauner, F.; Stiehl, M.; Lechleuthner, A.; Mudimu, O.A. (2014) Evaluation of mass casualty incident (MCI) exercises - Requirements for scientific assessment of MCI exercises. Notfall Rettungsmed 2014; 17:147-152. DOI: 10.1007/s10049-013-1722-x Springer-Verlag Berlin Heidelberg 2014

12. 5th International Disaster and Risk Conference IDRC 2014
‘Integrative Risk Management - The role of science, technology & practice‘ • 24-28 August 2014 • Davos • Switzerland
www.grforum.org
Required data
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measurement of exercise performance (concept driven)
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time of capturing / technical rescue / treatment / transport
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quality of processes
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decision quality
•new approach: Benchmark system for measurement of performance and comparison of concepts
But how can the date being collected?

13. 5th International Disaster and Risk Conference IDRC 2014
‘Integrative Risk Management - The role of science, technology & practice‘ • 24-28 August 2014 • Davos • Switzerland
www.grforum.org
TECHNIQUES USED FOR DATA ACQUISITION

14. 5th International Disaster and Risk Conference IDRC 2014
‘Integrative Risk Management - The role of science, technology & practice‘ • 24-28 August 2014 • Davos • Switzerland
www.grforum.org
1. Mobil-Tele-Voting-System (TED)
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Assessing Votes of Patient Performers
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I was rescued
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I was triaged
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I received first aid measures
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I was transported
Data base
of timestamps
sensor network

15. 5th International Disaster and Risk Conference IDRC 2014
‘Integrative Risk Management - The role of science, technology & practice‘ • 24-28 August 2014 • Davos • Switzerland
www.grforum.org
2. Local Positioning System (Tracking)
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Tracking and recording of personnel, incidents and equipment
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Analysis of moving profiles and location of personnel
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Technical combination with camera pictures (smart moving eye system)

16. 5th International Disaster and Risk Conference IDRC 2014
‘Integrative Risk Management - The role of science, technology & practice‘ • 24-28 August 2014 • Davos • Switzerland
www.grforum.org
Local Positioning System (Tracking)
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Implementation of Real-Time Locating System (RTLS)
Patient
Paramedic

17. 5th International Disaster and Risk Conference IDRC 2014
‘Integrative Risk Management - The role of science, technology & practice‘ • 24-28 August 2014 • Davos • Switzerland
www.grforum.org
Results (example)

18. 5th International Disaster and Risk Conference IDRC 2014
‘Integrative Risk Management - The role of science, technology & practice‘ • 24-28 August 2014 • Davos • Switzerland
www.grforum.org
Agent-based observation
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“Controlled/structured” monitoring
1.
Observe
2.
Write down
3.
Classify
4.
Qualify
5.
Evaluate
6.
Report

19. 5th International Disaster and Risk Conference IDRC 2014
‘Integrative Risk Management - The role of science, technology & practice‘ • 24-28 August 2014 • Davos • Switzerland
www.grforum.org
Benchmarking System
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health status of patients‘ are documented (before exercise)
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measurement: satisfaction of patients‘ needs (e.g. capturing, rescue, treatment, transport)
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counting points according time schedule
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satisfaction is measurable and presentable (in situ)
Data base of timestamps (TED System)
Benchmark process

20. 5th International Disaster and Risk Conference IDRC 2014
‘Integrative Risk Management - The role of science, technology & practice‘ • 24-28 August 2014 • Davos • Switzerland
www.grforum.org
Conclusion
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evaluation approach works (validation through testing)
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results: in situ measurement of patients satisfaction of basic needs
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quality can be evaluated at critical interfaces
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documentation of exercise (without gaps)
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benchmark system allows assessment of different concepts
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separation of objective and subjective data

21. 5th International Disaster and Risk Conference IDRC 2014
‘Integrative Risk Management - The role of science, technology & practice‘ • 24-28 August 2014 • Davos • Switzerland
www.grforum.org
THANK YOU FOR YOUR ATTENTION
M.Sc. B.Eng. Florian Brauner
Cologne University of Applied Sciences
Institute of Rescue Engineering and Civil Protection
Betzdorfer Str. 2
50679 Cologne, Germany
Fon: +49 221 8275 2149
Fax: +49 221 8275 2202
rikov@f09.fh-koeln.de

22. 5th International Disaster and Risk Conference IDRC 2014
‘Integrative Risk Management - The role of science, technology & practice‘ • 24-28 August 2014 • Davos • Switzerland
www.grforum.org
References
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Brauner, F. , Stiehl, M. , Lechleuthner, A., Mudimu, O.A. (2014) Evaluation of mass casualty incident (MCI) exercises. Requirements for scientific assessment of MCI exercises. Notfall und Rettungsmedizin; Volume 17, Issue 2, 2014, Pages 147-152; DOI: 10.1007/s10049- 013-1722-x
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Flemming, A.; Adams, H. A. (2007) Rettungsdienstliche Versorgung beim Massenanfall von Verletzten (MANV). In: Intensivmed 44 (7), S. 452–459, zuletzt geprüft am 29.06.2011.
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Hirshberg, A.; Mattox, K. (2009) Modeling and Simulation in Terror Medicine. In: Essentials of terror medicine, S. 79–94.
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Kanz, K.G; Hornburger, P.; Kay, M. V. (2006) mSTaRT-Algorithmus für Sichtung, Behandlung und Transport bei einem Massenanfall von Verletzten. In: Notfall + Rettungsmedizin (3), S. 264–270.
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Kromrey, H. (2006) Empirische Sozialforschung. Modelle und Methoden der standardisierten Datenerhebung und Datenauswertung. 12. Aufl. Stuttgart: Lucius & Lucius.
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Lechleuthner, A. (2008) Stellungnahme und Empfehlung zum Vorsorgeerlass NRW. Gesundheitliche Vorplanung bei Großschadensereignissen in NRW. RdErl. d. Ministeriums für Gesundheit, Soziales, Frauen und Familie v. 12.2.2004. Köln. Online verfügbar unter http://www.f09.fh- koeln.de/imperia/md/content/personen/lechleuthner_alex/sonstiges/stellungnahme_und_empfehlungen_zum_vorsorgeerlass_nrw_2008.pdf.
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Lechleuthner, A.; Bouillon, B. (1990) Die 4 Phasen eines Massenanfalles von Verletzten (MANV). Ein Konzept für Management, Fehleranalyse und Qualitätssicherung. In: Notarzt (6), S. 160–165.
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Lechleuthner, A.; Weber, B.; Käser, B. (2010) LÜKEX 2010. Beobachtungen und Auswertungen. Übungsbericht. Fachhochschule Köln, Köln. Rettungsingenieurwesen und Gefahrenabwehr.
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Levi, L.; Bregman, D.; Geva, H.; Revah, M. (1998) Hospital disaster management simulation system. In: Prehospital and disaster medicine (13), S. 22–27.
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Marten, D. (2011) Allgemeines Beobachtungskonzept. Grundsatz der FH Köln (IRG). Masterprojekt. Fachhochschule Köln, Köln. Institut für Rettungsingenieurwesen und Gefahrenabwehr.
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Marten, D., Weiss, S., Stiehl, M., Roth, K., Mudimu, O.A., Lechleuthner, A. (2012) Evaluating emergency preparedness with exercise monitoring. WIT Transactions on Information and Communication Technologies; Volume 44, 2012, Pages 417-425 / 8th International Conference on Simulation in Risk Analysis and Hazard Mitigation, RISK 2012; Island of Brac; Croatia; 19 September 2012 through 21 September 2012
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Prokoph, K.; Rieger-Ndakorerwa, G.; Paschen, H.R (2006) Katastrophenschutzübung zum Massenanfall von Verletzten. In: Notfall + Rettungsmedizin, S. 271–280.

23. 5th International Disaster and Risk Conference IDRC 2014
‘Integrative Risk Management - The role of science, technology & practice‘ • 24-28 August 2014 • Davos • Switzerland
www.grforum.org
Added value for the Post 2015 Framework for Disaster Risk Reduction
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How did your work support the implementation of the Hyogo Framework for Action:
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a methodology for evaluation of MCI exercises support the education in specific training and learning on handling disasters (training of handling possible disasters)
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evaluation of disaster management capacities
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From your perspective what are the main gaps, needs and further steps to be addressed in the Post 2015 Framework for Disaster Risk Reduction in
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Research: “Integrative Risk Management” = an interdisciplinary topic; knowledge of end-users is necessary to overcome the gap between theoretical approaches and the application; iterative evaluation through an end-user advisory board should be ensured.
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Education & Training: no scientific evaluation methodologies to capture and feedback disaster exercises; training and education of rescue staff shall be evaluated with scientific standards and methods. Guidelines and scientific methodologies are needed to evaluate exercises independently trained scenarios and concepts to ensure comparability and improve performance.
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Implementation & Practice: The implementation and practice of research results have to be a major objective of sciences and be considered right from the beginning. Especially integrative risk management solutions shall be user-friendly, understandable and applicable. Therefore, user requirement studies should be executed.
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Policy: Policy has a major influence on risk and disaster management. Therefore, policy can support and also inhibit certain developments and guide research strategies. In dialogue with all stakeholders, strategies should be discussed to improve risk and disaster management to face the challenges from today and tomorrow. Policy might take the moderating role of this dialogue.