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. Mass casualty incidents
푝푎푡푖푒푛푡푠 (푃)
푚푒푑푖푐푎푙 푟푒푠푠표푢푟푐푒푠 (푀)
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
Prehospital phase
INCIDENT
> 1
푝푎푡푖푒푛푡푠 (푃)
푚푒푑푖푐푎푙 푟푒푠푠표푢푟푐푒푠 (푀)
= 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)?
• A MCI…
– 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)
• 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. Evaluating emergency preparedness with exercise
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
monitoring

6. Continuous improvement in Emergency Management
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
Identify
the
Need
Incident
Planning
Incident Training
Evaluation
Review
Exercise

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
Example - Exercise Scenario
• mass casualty incident after
a “fictive” bombing attack
• 27 casualties
– to be rescued out of
dangerous area
– triaged in:
9 red,
9 yellow
9 green patients
– get first aid measures
– localization of additional
threats (second hit)

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
New requirements for evaluation
A scientific evaluation for the assessment of MCI exercises
must:
• produce comparable and reproducible results
• utility, feasibility, propriety and accuracy (Deutsche
Gesellschaft für Evaluation)
• be universal and independent of operational concepts
• 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

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
Required data
• measurement of exercise performance (concept driven)
– time of capturing / technical rescue / treatment / transport
– quality of processes
– decision quality
• new approach: Benchmark system for measurement of
performance and comparison of concepts
But how can the date being collected?

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
TECHNIQUES USED FOR DATA
ACQUISITION

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
1. Mobil-Tele-Voting-System (TED)
• Assessing Votes of Patient Performers
– I was rescued
– I was triaged
– I received first aid measures
– I was transported
Data base
of
timestamps
sensor
network

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
2. Local Positioning System (Tracking)
• Tracking and recording of personnel, incidents and equipment
• Analysis of moving profiles and location of personnel
• Technical combination with camera pictures (smart moving
eye system)

13. Paramedic
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)
• Implementation of Real-Time Locating System (RTLS)
Patient

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
Results (example)

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
Agent-based observation
• “Controlled/structured” monitoring
1. Observe
2. Write down
3. Classify
4. Qualify
5. Evaluate
6. Report

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
Benchmarking System
• health status of patients‘ are documented (before exercise)
• measurement: satisfaction of patients‘ needs (e.g. capturing,
rescue, treatment, transport)
• counting points according time schedule
• satisfaction is measurable and presentable (in situ)
Data base
of
timestamps
(TED System)
Benchmark
process

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
Conclusion
• evaluation approach works (validation through testing)
• results: in situ measurement of patients satisfaction of basic
needs
• quality can be evaluated at critical interfaces
• documentation of exercise (without gaps)
• benchmark system allows assessment of different concepts
• separation of objective and subjective data

18. THANK YOU FOR YOUR ATTENTION
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
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

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
References
• 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
• 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.
• Hirshberg, A.; Mattox, K. (2009) Modeling and Simulation in Terror Medicine. In: Essentials of terror medicine, S. 79–94.
• 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.
• Kromrey, H. (2006) Empirische Sozialforschung. Modelle und Methoden der standardisierten Datenerhebung und Datenauswertung.
12. Aufl. Stuttgart: Lucius & Lucius.
• 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_2
008.pdf.
• 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.
• Lechleuthner, A.; Weber, B.; Käser, B. (2010) LÜKEX 2010. Beobachtungen und Auswertungen. Übungsbericht. Fachhochschule Köln,
Köln. Rettungsingenieurwesen und Gefahrenabwehr.
• Levi, L.; Bregman, D.; Geva, H.; Revah, M. (1998) Hospital disastermanagement simulation system. In: Prehospital and disaster medicine
(13), S. 22–27.
• Marten, D. (2011) Allgemeines Beobachtungskonzept. Grundsatz der FH Köln (IRG). Masterprojekt. Fachhochschule Köln, Köln. Institut
für Rettungsingenieurwesen und Gefahrenabwehr.
• 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
• Prokoph, K.; Rieger-Ndakorerwa, G.; Paschen, H.R (2006) Katastrophenschutzübung zum Massenanfall von Verletzten. In: Notfall +
Rettungsmedizin, S. 271–280.

20. Added value for the Post 2015 Framework for
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
Disaster Risk Reduction
• How did your work support the implementation of the Hyogo Framework for Action:
– a methodology for evaluation of MCI exercises support the education in specific training and learning
on handling disasters (training of handling possible disasters)
– evaluation of disaster management capacities
• 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
– 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.
– 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.
– 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.
– 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.