The incident command system in disasters: evaluation methods for a hospital-based exercise.

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.

Development of emergency medical services in Guatemala.

Guatemala has recently undergone many advances in emergency medical services (EMS) training and disaster management. Industrialization and demographic changes have led to a continuing decline in the prevalence of infectious disease, while trauma and cardiovascular-related deaths have become increasingly important. Trauma now accounts for the nation's single greatest cause of productive years of life lost, a major indicator of a disease's impact on society. This "demographic transition" has dramatically increased the number of incidents where early prehospital intervention can have a positive impact on morbidity and mortality. However, until recently, prehospital medical care was provided by firefighters, who lacked formal medical training. Responding to a perceived need, increased collaborative efforts between prehospital care providers and governmental and nongovernmental agencies have rapidly improved provider training, initiated care standardization, and improved disaster preparedness. These efforts may serve as a model to other developing nations seeking to improve their EMS systems.