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A retrospective observational study of medical incident command and decision-making in the 2011 Oslo bombing.

Rimstad R, Sollid SJ - Int J Emerg Med (2015)

Bottom Line: In the studied mass casualty incident, the commanders made most critical decisions in the early stages of the emergency response when resources did not meet demand.Decisions were made under significant uncertainty and time pressure.Ambulance and medical commanders should be prepared to make situation assessments and decisions early and be ready to adjust as uncertainties are reduced.

View Article: PubMed Central - PubMed

Affiliation: Department of Research and Development, Norwegian Air Ambulance Foundation, Holterveien 24, 1448 Drøbak, Norway ; Medicine, Health and Development, Oslo University Hospital, Kirkeveien 166, 0424 Oslo, Nydalen Norway ; Department of Industrial Economics, Risk Management and Planning, University of Stavanger, Kjell Arholms gate 41, 4036 Stavanger, Norway.

ABSTRACT

Background: A core task for commanders in charge of an emergency response operation is to make decisions. The purposes of the study were to describe what critical decisions the ambulance commander and the medical commander make in a mass casualty incident response and to explore what the underlying conditions affecting decision-making are. The study was conducted in the context of the 2011 government district terrorist bombing in Norway.

Methods: The study was a retrospective, descriptive observational study collecting data through participating observation, semi-structured interviews, and recordings of emergency medical services' radio communications. Analysis was conducted using systematic text condensation. The ambulance commander was interviewed using the critical decision method.

Results: The medical emergency response lasted 6.5 h, with little clinical activity after 2 h. Most critical decisions were made within the first 30 min, with the ambulance commander making the bulk of decisions. Situation assessment and underlying uncertainties strongly affected decision-making, but there was a mutual interaction between these three factors that developed throughout the different stages of the operation. Knowledge and experience were major determinants of how easily commanders picked up sensory cues and translated them into situation assessments. The number and magnitude of uncertainties were largest in the development stage, after most of the critical decisions had been made.

Conclusions: In the studied mass casualty incident, the commanders made most critical decisions in the early stages of the emergency response when resources did not meet demand. Decisions were made under significant uncertainty and time pressure. Ambulance and medical commanders should be prepared to make situation assessments and decisions early and be ready to adjust as uncertainties are reduced.

No MeSH data available.


Related in: MedlinePlus

Stages, uncertainties, and critical decisions. Based on knowledge and experience, the commanders used visual, audio, and olfactory cues to rapidly make situation assessments. The focus of attention and the overall situational awareness changed throughout the stages of operation: mobilization/en route, on arrival, initial response, development, and conclusion. The temporal correlation of uncertainties and critical decisions is shown in relation to the different stages of the emergency response. Major uncertainties affecting decision-making included location and boundaries of the incident ground, number of casualties, commander roles, personnel safety, and lack of resource oversight. The number and magnitude of uncertainties was largest in the development stage, after most of the critical decisions had been made. Details and the use of symbols for each of these factors are presented in Figures 2, 3, and 4.
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Fig5: Stages, uncertainties, and critical decisions. Based on knowledge and experience, the commanders used visual, audio, and olfactory cues to rapidly make situation assessments. The focus of attention and the overall situational awareness changed throughout the stages of operation: mobilization/en route, on arrival, initial response, development, and conclusion. The temporal correlation of uncertainties and critical decisions is shown in relation to the different stages of the emergency response. Major uncertainties affecting decision-making included location and boundaries of the incident ground, number of casualties, commander roles, personnel safety, and lack of resource oversight. The number and magnitude of uncertainties was largest in the development stage, after most of the critical decisions had been made. Details and the use of symbols for each of these factors are presented in Figures 2, 3, and 4.

Mentions: In the 2011 Oslo bombing emergency medical response operation, the ambulance commander made critical decisions regarding dispatch, distribution, and demobilization of resources, major incident mobilization in nearby hospitals, and conditions for personnel safety. The medical commander made critical decisions regarding communication with and distribution of patients to nearby health institutions, as well as distribution and demobilization of resources. The ambulance commander was highly visible as a decision maker to all personnel. The medical commander had a withdrawn, monitoring role. Most critical decisions were made within the first 30 min of the operation, cf. Figure 5.Figure 5


A retrospective observational study of medical incident command and decision-making in the 2011 Oslo bombing.

Rimstad R, Sollid SJ - Int J Emerg Med (2015)

Stages, uncertainties, and critical decisions. Based on knowledge and experience, the commanders used visual, audio, and olfactory cues to rapidly make situation assessments. The focus of attention and the overall situational awareness changed throughout the stages of operation: mobilization/en route, on arrival, initial response, development, and conclusion. The temporal correlation of uncertainties and critical decisions is shown in relation to the different stages of the emergency response. Major uncertainties affecting decision-making included location and boundaries of the incident ground, number of casualties, commander roles, personnel safety, and lack of resource oversight. The number and magnitude of uncertainties was largest in the development stage, after most of the critical decisions had been made. Details and the use of symbols for each of these factors are presented in Figures 2, 3, and 4.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4385130&req=5

Fig5: Stages, uncertainties, and critical decisions. Based on knowledge and experience, the commanders used visual, audio, and olfactory cues to rapidly make situation assessments. The focus of attention and the overall situational awareness changed throughout the stages of operation: mobilization/en route, on arrival, initial response, development, and conclusion. The temporal correlation of uncertainties and critical decisions is shown in relation to the different stages of the emergency response. Major uncertainties affecting decision-making included location and boundaries of the incident ground, number of casualties, commander roles, personnel safety, and lack of resource oversight. The number and magnitude of uncertainties was largest in the development stage, after most of the critical decisions had been made. Details and the use of symbols for each of these factors are presented in Figures 2, 3, and 4.
Mentions: In the 2011 Oslo bombing emergency medical response operation, the ambulance commander made critical decisions regarding dispatch, distribution, and demobilization of resources, major incident mobilization in nearby hospitals, and conditions for personnel safety. The medical commander made critical decisions regarding communication with and distribution of patients to nearby health institutions, as well as distribution and demobilization of resources. The ambulance commander was highly visible as a decision maker to all personnel. The medical commander had a withdrawn, monitoring role. Most critical decisions were made within the first 30 min of the operation, cf. Figure 5.Figure 5

Bottom Line: In the studied mass casualty incident, the commanders made most critical decisions in the early stages of the emergency response when resources did not meet demand.Decisions were made under significant uncertainty and time pressure.Ambulance and medical commanders should be prepared to make situation assessments and decisions early and be ready to adjust as uncertainties are reduced.

View Article: PubMed Central - PubMed

Affiliation: Department of Research and Development, Norwegian Air Ambulance Foundation, Holterveien 24, 1448 Drøbak, Norway ; Medicine, Health and Development, Oslo University Hospital, Kirkeveien 166, 0424 Oslo, Nydalen Norway ; Department of Industrial Economics, Risk Management and Planning, University of Stavanger, Kjell Arholms gate 41, 4036 Stavanger, Norway.

ABSTRACT

Background: A core task for commanders in charge of an emergency response operation is to make decisions. The purposes of the study were to describe what critical decisions the ambulance commander and the medical commander make in a mass casualty incident response and to explore what the underlying conditions affecting decision-making are. The study was conducted in the context of the 2011 government district terrorist bombing in Norway.

Methods: The study was a retrospective, descriptive observational study collecting data through participating observation, semi-structured interviews, and recordings of emergency medical services' radio communications. Analysis was conducted using systematic text condensation. The ambulance commander was interviewed using the critical decision method.

Results: The medical emergency response lasted 6.5 h, with little clinical activity after 2 h. Most critical decisions were made within the first 30 min, with the ambulance commander making the bulk of decisions. Situation assessment and underlying uncertainties strongly affected decision-making, but there was a mutual interaction between these three factors that developed throughout the different stages of the operation. Knowledge and experience were major determinants of how easily commanders picked up sensory cues and translated them into situation assessments. The number and magnitude of uncertainties were largest in the development stage, after most of the critical decisions had been made.

Conclusions: In the studied mass casualty incident, the commanders made most critical decisions in the early stages of the emergency response when resources did not meet demand. Decisions were made under significant uncertainty and time pressure. Ambulance and medical commanders should be prepared to make situation assessments and decisions early and be ready to adjust as uncertainties are reduced.

No MeSH data available.


Related in: MedlinePlus