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Systematic literature review of templates for reporting pre- hospital major incident medical management
ForJournal: peerBMJ Open review only Manuscript ID: bmjopen-2013-002658
Article Type: Research
Date Submitted by the Author: 30-Jan-2013
Complete List of Authors: Fattah, Sabina; Norwegian Air Ambulance Foundation, Department of Research and Development,; University of Tromsø, Anaesthesia and Critical Care Research Group, Faculty of Health Sciences, Rehn, Marius; Norwegian Air Ambulance Foundation, Department of Research and Development,; Akershus University Hospital, Department of Anaesthesia and Intensive Care, Reierth, Eirik; University of Tromsø, University Library of Tromsø, Science and Health Library, Wisborg, Torben; University of Tromsø, Anaesthesia and Critical Care Research Group, Faculty of Health Sciences,; Finnmark Health Trust, Hammerfest Hospital, Department of Anaesthesiology and Intensive Care,
Primary Subject Emergency medicine Heading: http://bmjopen.bmj.com/ Secondary Subject Heading: Medical management, Evidence based practice, Anaesthesia
Disaster Medicine, Emergencies, Mass Casualty Incidents, Data Collection, Keywords: Health Care Management
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1 2 3 Systematic literature review of templates for reporting pre-hospital 4 5 major incident medical management 6 7 8 Sabina Fattah, MD1, 2. Marius Rehn, MD PhD1, 3. Eirik Reierth, Dr.scient4. 9 10 Torben Wisborg, Professor2, 5. 11 12 13 1. Department of Research and Development, Norwegian Air Ambulance Foundation, 14 15 Drøbak,For Norway peer review only 16 17 2. Anaesthesia and Critical Care Research Group, Faculty of Health Sciences, University 18 of Tromsø, Tromsø, Norway 19 20 3. Department of Anaesthesia and Intensive Care, Akershus University Hospital, 21 22 Lørenskog, Norway 23 4. Science and Health Library, University Library of Tromsø, University of Tromsø, 24 25 Tromsø, Norway 26 27 5. Department of Anaesthesiology and Intensive Care, Hammerfest Hospital, Finnmark 28 Health Trust, Hammerfest, Norway 29 30 31 32 33 Corresponding author: http://bmjopen.bmj.com/ 34 35 Sabina Fattah 36 37 Postal address: P.O box 94, 1448 Drøbak, Norway 38 E-mail: [email protected] 39 40 Telephone: +47 64 90 44 44 41 42 Fax: +47 64 90 44 45 on September 30, 2021 by guest. Protected copyright. 43 44 45 Keywords: Disaster Medicine, Emergencies, Mass Casualty Incidents, Data Collection, 46 47 Health Care Management. 48 49 50 51 Word count – 1933. 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 1 BMJ Open Page 2 of 21 BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 4 5 6 ABSTRACT 7 8 Objective: To identify, describe and quality appraise templates for reporting pre-hospital 9 major incident medical management. 10 11 Design: Systematic literature review according to PRISMA guidelines. 12 13 Data sources: PubMed/Medline, EMBASE, Cinahl, Scopus and Web of Knowledge. Grey 14 literature was also searched. 15 For peer review only 16 Eligibility criteria for selected studies: Templates published after 1 January 1990 and until 17 18 19 March 2012. All non-English literature except Scandinavian language literature, literature 19 without an available abstract and literature reporting only psychological aspects were 20 21 excluded. 22 23 Results: Main database searches identified 8497 articles. Of these 8389 were excluded based 24 on title and abstract. A further 96 were excluded with reason based on full-text. The 25 26 remaining 12 articles were included. In the grey literature all 107 retrieved articles were 27 28 excluded. Reference lists of the included literature identified five articles. A relevant article 29 published after completion of the search was also included. In the total of 18 included articles 30 31 10 different templates or sets of data are described; two methodologies for assessing major 32 33 incident response, three templates intended for reporting from exercises, two guidelines for http://bmjopen.bmj.com/ 34 reporting in medical journals, two analyses of previous disasters, and one Utstein-Style 35 36 template. 37 38 Conclusion: This study revealed a lack of a field-friendly, evidence based and validated 39 template for reporting from pre-hospital major incident medical management. In order to 40 41 allow rapid dissemination of areas for improvement, there is a need for a field-friendly 42 on September 30, 2021 by guest. Protected copyright. 43 template that is especially designed for the purpose. 44 Trial registration: The review is registered in PROSPERO (registration number: 45 46 CRD42012002051). 47 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 2 Page 3 of 21 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 ARTICLE SUMMARY 4 5 Article focus: identifying templates that enable systematic and uniform reporting of pre- 6 hospital major incident medical management. Further, to appraise the quality of and to extract 7 8 data fields from included templates. 9 10 Key messages: templates for reporting major incident medical management exist in different 11 formats, but none have been tested for feasibility. A uniform template with clearly defined 12 13 data variables focusing on reporting from the pre-hospital phase is necessary. 14 15 Strengths andFor limitations peer of the study: reviewThe strength of the study only is that it is a systematic 16 review following the PRISMA guidelines. The protocol was published and deviations from 17 18 protocol are revealed in the study report. A limitation is that only English and Scandinavian 19 20 language literature was included. 21 22 23 The original protocol of the study 24 25 The study protocol is available in BMJ Open (1). 26 27 28 INTRODUCTION 29 30 There has been an evolving trend in disaster medicine calling for elevated level of science 31 32 through improved reporting from major incidents (2-7). Previous expert group processes have 33 defined uniform data sets for reporting both in emergency medicine in general (8, 9) and in http://bmjopen.bmj.com/ 34 35 disaster medicine specifically (10, 11). These templates were designated as Utstein style 36 37 templates after the Norwegian monastery where their development took place. Qualitative 38 research methods have also been used to identify areas within pre-hospital critical care and 39 40 major incident management requiring further research (12, 13). A recent review identified that 41 42 data reporting from mass gatherings is non-uniform and called for consistent data to enable on September 30, 2021 by guest. Protected copyright. 43 future research (14). The importance of evaluating disaster exercises using pre-defined, high- 44 45 quality data has also been discussed as a potential for improving disaster health management 46 47 (15) and to compare outcome from different exercises (16). Analysis of standardized data 48 from previous incidents can allow decision-makers to make well-informed decisions (17). 49 50 51 52 This systematic review was designed to identify, describe and appraise the quality of 53 templates for reporting pre-hospital major incident medical management. Based on the 54 55 findings the need for a field-friendly, feasible template for uniform reporting from such 56 57 management was assessed. 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 3 BMJ Open Page 4 of 21 BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 METHODS 4 5 Search strategy 6 7 A systematic literature search was conducted to identify templates published between 1 8 9 January 1990 and until the date of the literature search (1). The controlled vocabulary of 10 Medical Subject Headings (MeSH) from PubMed, including subheadings, publication types 11 12 and supplementary concepts were used. The search was performed in the period from the 24 13 14 February to the 19 March 2012. A systematic search in grey literature was performed between 15 25 and 29 JuneFor 2012. peer review only 16 17 18 19 In the main database searches three sets of entry terms were applied and combined (cf figure 1 20 for search strategy). The first set of entry terms describes major incidents and the second set 21 22 of entry terms describes templates. In addition to the MeSH terms in the first two sets, a third 23 24 set of entry terms with free search phrases were included. For the grey literature search only 25 two sets of entry terms were combined (1). 26 27 28 29 30 Inclusion criteria 31 − Templates reporting medical management of the pre-hospital phase of major incidents. 32 33 −
Templates published after 1 January 1990 (inclusive) and until the date of the http://bmjopen.bmj.com/ 34 35 literature search. 36 37 38 39 Exclusion criteria 40 − 41 All non-English literature except Scandinavian language. on September 30, 2021 by guest. Protected copyright. 42 − Literature without an available abstract. 43 44 − Literature reporting only psychological aspects. 45 46 47 48 Search findings 49 50 A total of 10,136 results from each individual database search were sent to Endnote X5 51 52 (Thomson Reuters, NY, USA). After removing duplicates the number of results was 8,497. 53 The grey literature search gave 107 results (cf figure 2 for search findings depicted in a flow 54 55 diagram). 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 4 Page 5 of 21 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 Deviations from protocol in search strategy 4 5 Combination of the three sets of entry terms resulted in 225 individual searches to be 6 performed in each database. If any of these individual searches returned more than 700 7 8 results, the search was performed again with a fourth entry term (disaster prevention) 9 10 combined with the Boolean operator AND. 11 12 13 In Scopus two entry terms, “questionnaires” and “learning”, were excluded due to large 14 15 numbers of irrelevantFor results. peer In Scopus allreview searches were limited only to the subject areas of life 16 sciences, health sciences and physical sciences. Searches in Scopus were further limited to 17 18 article title, abstract and keywords. In Web of Knowledge (ISI) all searches were limited to 19 20 articles and reviews. The term disaster prevention was used to refine and decrease the number 21 of search results in four of the individual searches performed in this database. ProQuest 22 23 Research Library was excluded. This database returned too many non-relevant results, and the 24 25 most relevant subjects were found to be covered by the searches performed in 26 PubMed/Medline, Web of Knowledge and Scopus. 27 28 29 30 The Grey literature databases revealed a wide range in quality and how searchable they were. 31 System for Information on Grey Literature in Europe (OpenSIGLE) was excluded due to the 32 33 fact that documents from this database had to be ordered from the original source or a library. http://bmjopen.bmj.com/ 34 35 Only the document title was available on the webpage, making it impossible to determine 36 which documents to order. 37 38 39 40 The deviations in the search strategy were necessary in order to make the systematic literature 41
review feasible, a larger number of findings might have made the completion of the study on September 30, 2021 by guest. Protected copyright. 42 43 impossible. 44 45 46 Analysis of identified literature 47 48 One author scanned titles and abstracts of identified literature. Literature not complying with 49 50 the inclusion criteria pertaining to title or abstract was excluded. Uncertain articles were 51 obtained in full text and inclusion was subject to consensus between three authors. 52 53 After data extraction of included literature, quality appraisal was conducted using a 15 item 54 55 checklist instead of a quality score (18). Contact authors with an available e-mail address 56 were asked whether the template had been used in real incidents. Reference lists of included 57 58 literature were scanned and relevant literature was included. A quantitative synthesis (meta- 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 5 BMJ Open Page 6 of 21 BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 analysis) was not performed. The Preferred Reporting Items for Systematic Reviews and 4 5 Meta-Analyses (PRISMA) guidelines were followed (19, 20). 6 7 8 9 Deviations from protocol regarding quality appraisal 10 In study protocol it was proposed to appraise whether the medical outcomes in the templates 11 12 had been predicted valid and to evaluate what the outcomes have been from use of the 13 14 templates. Both these questions proved difficult to answer and were therefore removed from 15 the quality appraisal.For peer review only 16 17 18 19 RESULTS 20 21 From the main database search 12 articles were included (21-32), five articles were identified 22 from the literature lists of included articles (33-37) and one relevant article was published 23 24 after the literature search was completed (11) (cf figure 2 for search findings depicted in a 25 26 flow diagram). In the total of 18 articles included 10 different templates or guidelines for 27 reporting are described. Data extraction (Figure 3) and quality appraisal (Figure 4) are 28 29 depicted in figures. 30 31 32 We succeeded in contacting authors for seven templates. Five of these have according to the 33 http://bmjopen.bmj.com/ 34 authors been used in other publications and one is currently being used to retrospectively 35 36 evaluate disaster management. DISAST-CIR (22-28, 33) is routinely used to report after each 37 mass casualty incident in the registry of the Israeli Defence Force Home Front and Ministry 38 39 of Health. Two of the templates (29, 32, 37) are routinely used for reporting from exercises. 40 41 Guidelines for reports on health crises and critical health events (35) have been used to report on September 30, 2021 by guest. Protected copyright. 42 from disasters internationally, these publications were not available as official publications at 43 44 the time of correspondence with the authors. Protocol for Reports from Major Accidents and 45 46 Disasters (31) was also previously published in the International Journal of Disaster Medicine 47 (38, 39). It has been used in reports in the International Journal of Disaster Medicine (40) and 48 49 in the European Journal of Trauma and Emergency Surgery (41, 42). It was also mentioned in 50 51 an editorial in the European Journal of Trauma and Emergency Surgery (43). Performance 52 Indicators for Major Incident Medical Management (32, 37) has also been used in further 53 54 publications (16, 44-48). 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 6 Page 7 of 21 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 DISCUSSION 4 5 We identified 10 templates for reporting pre-hospital major incident medical management. 6 These were heterogeneous with regards to the data they reported. The quality appraisal shows 7 8 that methodology for developing the templates was not clearly explained for the majority. 9 10 Further, the data variables were not clearly defined in all templates and the rationale for 11 choosing the data variables only explained in half. Only three describe handling of missing 12 13 data and two depict whether an ethics committee approved the templates. We chose to 14 15 interpret thatFor the template peer was developed review in the region where theonly authors had their affiliation, 16 although this was not specified. Only two templates stated where it is intended used. None of 17 18 the articles discuss the clinical credibility of the template and no feasibility studies have been 19 20 performed. In all cases the use of the template as a tool for evaluation was mentioned. 21 22 23 Data variables for reporting should be uniformly defined to allow improved research and 24 25 scientific development. Further, templates should be ethical pre-approved to allow immediate 26 reporting and rapid dissemination of data on improvement potential. For a template to be used 27 28 it needs to be both clinically credible and feasible. Furthermore, if a template is to be used in a 29 30 specific region ideally it should be developed together with experts from that region. If this is 31 not possible, feasibility studies regarding regional differences should be undertaken. 32 33 Representatives directly involved in responding to or managing the major incident should be http://bmjopen.bmj.com/ 34 35 the ones reporting, these should be individuals with in-depth local knowledge. The ultimate 36 goal of reporting should be that it would lead to evaluation of the response and identify areas 37 38 for improvement, and enable those responsible in similar settings to improve their 39 40 preparedness. 41
on September 30, 2021 by guest. Protected copyright. 42 43 Not all included literature was intended for reporting prospectively from real-incidents. 44 45 However, to not overlook potentially relevant aspects of major incident reporting, literature 46 aimed at reporting from exercises (29, 32, 34, 37) and literature using a systematic method for 47 48 reporting in general were included (21, 30). A clear weakness is that templates in other 49 50 languages than those included may exist. Accordingly, we invite others to identify these. 51 Another limitation is that only one author performed the initial review of included literature. 52 53 54 55 Our findings show that there is a need for a template especially focused on reporting pre- 56 hospital major incident medical management. A template should include pre-defined uniform 57 58 data variables, be field friendly and be tested for feasibility. This facilitates reporting in due 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 7 BMJ Open Page 8 of 21 BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 time after an incident allowing relevant experiences to be disseminated to others. 4 5 6 7 CONCLUSIONS 8 This study revealed a lack of a field-friendly, evidence based and validated template for 9 10 reporting from pre-hospital major incident medical management. A total of 10 templates were 11 identified and may be used as a basis for designing a template that is specifically aimed at the 12 13 pre-hospital medical care. The work to create such a template seems warranted, and is now 14 15 underway. For peer review only 16 17 18 Authors’ contributions 19 20 SF, MR and TW conceived the idea and designed the study. ER designed and conducted the 21 22 search strategy for the literature search. SF conducted the screening of identified literature. 23 TW, MR and SF considered the eligibility of uncertain literature. SF performed data 24 25 extraction and quality analysis of the included literature. TW and MR checked these results 26 27 and were mentors in the process. SF, MR, ER and TW approved the final version of the 28 manuscript. 29 30 31 32 Competing interests 33 http://bmjopen.bmj.com/ 34 The authors declare no competing interests. 35 36 37 Funding 38 39 The Norwegian Air Ambulance employs SF and MR as research fellows. ER and TW 40 41 received departmental funding only. No additional funding was obtained. on September 30, 2021 by guest. Protected copyright. 42 43 44 45 46 Figure legends 47 48 Figure 1: The two first sets of entry terms consist of 15 terms each and the third set of entry 49 terms of eight free search phrases. Combining these three sets resulted in 225 individual 50 51 searches to be performed in each database. 52 53 Figure 2: PRISMA flow diagram depicting the different stages of the systematic literature 54 review. 55 56 Figure 3: Data extraction from included literature. : yes, : no, ?: unclear. 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 8 Page 9 of 21 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 Figure 4: Quality appraisal of the included literature. : yes, : no, ?: unclear, *: a study is 4 5 ongoing. 6 7 8 REFERENCES: 9 10 11 1. Fattah S, Rehn M, Reierth E, et al. Templates for reporting pre-hospital major incident 12 13 medical management: systematic literature review. BMJ Open 2012;2:e001082. 14 15 2. Bradt DA,For Aitken P. Disasterpeer medicine review reporting: the need foronly new guidelines and the 16 17 CONFIDE statement. Emerg Med Australas 2010;22:483-7. 18 19 3. Stratton SJ. Use of structured observational methods in disaster research: "Recurrent 20 21 22 medical response problems in five recent disasters in the Netherlands". Prehosp Disaster Med 23 24 2010;25:137-8. 25 26 4. Stratton SJ. The Utstein-style Template for uniform data reporting of acute medical 27 28 response in disasters. Prehosp Disaster Med 2012;27:219. 29 30 31 5. Castren M, Hubloue I, Debacker M. Improving the science and evidence for the medical 32 33 management of disasters: Utstein style. Eur J Emerg Med 2012;19:275-6. http://bmjopen.bmj.com/ 34 35 6. Lockey DJ. The shootings in Oslo and Utoya island July 22, 2011: lessons for the 36 37 International EMS community. Scand J Trauma Resusc Emerg Med 2012;20:4. 38 39 7. Lennquist S. Introduction to the third "Focus-on" issue specially devoted to papers within 40 41 42 the field of the ESTES section for Disaster and Military Surgery. Eur J Trauma Emerg Surg on September 30, 2021 by guest. Protected copyright. 43 44 2011;37:1-2. 45 46 8. Langhelle A, Nolan J, Herlitz J, et al. Recommended guidelines for reviewing, reporting, 47 48 and conducting research on post-resuscitation care: the Utstein style. Resuscitation 49 50 51 2005;66:271-83. 52 53 9. Ringdal KG, Coats TJ, Lefering R, et al. The Utstein template for uniform reporting of data 54 55 following major trauma: a joint revision by SCANTEM, TARN, DGU-TR and RITG. Scand J 56 57 Trauma Resusc Emerg Med 2008;16:7. 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 9 BMJ Open Page 10 of 21 BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 10. Sundnes KO. Health disaster management: guidelines for evaluation and research in the 4 5 Utstein style: executive summary. Task Force on Quality Control of Disaster Management. 6 7 Prehosp Disaster Med 1999;14:43-52. 8 9 10 11. Debacker M, Hubloue I, Dhondt E, et al. Utstein-style template for uniform data reporting 11 12 of acute medical response in disasters. PLoS Curr 2012;4:e4f6cf3e8df15a. 13 14 12. Fevang E, Lockey D, Thompson J, et al. The top five research priorities in physician- 15 For peer review only 16 provided pre-hospital critical care: a consensus report from a European research collaboration. 17 18 Scand J Trauma Resusc Emerg Med 2011;19:57. 19 20 21 13. Mackway-Jones K, Carley S. An international expert delphi study to determine research 22 23 needs in major incident management. Prehosp Disaster Med 2012;27:351-8. 24 25 14. Ranse J, Hutton A. Minimum data set for mass-gathering health research and evaluation: a 26 27 discussion paper. Prehosp Disaster Med 2012;27:1-8. 28 29 30 15. Legemaate GA, Burkle FM, Jr., Bierens JJ. The evaluation of research methods during 31 32 disaster exercises: applicability for improving disaster health management. Prehosp Disaster 33 http://bmjopen.bmj.com/ 34 Med 2012;27:18-26. 35 36 16. Radestad M, Nilsson H, Castren M, et al. Combining performance and outcome indicators 37 38 can be used in a standardized way: a pilot study of two multidisciplinary, full-scale major 39 40 41 aircraft exercises. Scand J Trauma Resusc Emerg Med 2012;20:58. 42 on September 30, 2021 by guest. Protected copyright. 43 17. Clarke M. Evidence Aid-from the Asian tsunami to the Wenchuan earthquake. J Evid 44 45 Based Med 2008;1:9-11. 46 47 18. Whiting P, Harbord R, Kleijnen J. No role for quality scores in systematic reviews of 48 49 50 diagnostic accuracy studies. BMC Med Res Methodol 2005;5:19. 51 52 19. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews 53 54 and meta-analyses: the PRISMA statement. PLoS Med 2009;6:e1000097. 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 10 Page 11 of 21 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 20. Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic 4 5 reviews and meta-analyses of studies that evaluate health care interventions: explanation and 6 7 elaboration. PLoS Med 2009;6:e1000100. 8 9 10 21. Anderson PB. A comparative analysis of the emergency medical services and rescue 11 12 responses to eight airliner crashes in the United States, 1987-1991. Prehosp Disaster Med 13 14 1995;10:142-53. 15 For peer review only 16 22. Bloch YH, Schwartz D, Pinkert M, et al. Distribution of casualties in a mass-casualty 17 18 incident with three local hospitals in the periphery of a densely populated area: lessons 19 20 21 learned from the medical management of a terrorist attack. Prehosp Disaster Med 22 23 2007;22:186-92. 24 25 23. Leiba A, Schwartz D, Eran T, et al. DISAST-CIR: Disastrous incidents systematic 26 27 analysis through components, interactions and results: application to a large-scale train 28 29 30 accident. J Emerg Med 2009;37:46-50. 31 32 24. Schwartz D, Bar-Dayan Y. Injury patterns in clashes between citizens and security forces 33 http://bmjopen.bmj.com/ 34 during forced evacuation. Emerg Med J 2008;25:695-8. 35 36 25. Schwartz D, Ostfeld I, Bar-Dayan Y. A single, improvised "Kassam" rocket explosion can 37 38 cause a mass casualty incident: a potential threat for future international terrorism? Emerg 39 40 41 Med J 2009;26:293-8. 42 on September 30, 2021 by guest. Protected copyright. 43 26. Raiter Y, Farfel A, Lehavi O, et al. Mass casualty incident management, triage, injury 44 45 distribution of casualties and rate of arrival of casualties at the hospitals: lessons from a 46 47 suicide bomber attack in downtown Tel Aviv. Emerg Med J 2008;25:225-9. 48 49 50 27. Pinkert M, Lehavi O, Goren OB, et al. Primary triage, evacuation priorities, and rapid 51 52 primary distribution between adjacent hospitals - lessons learned from a suicide bomber 53 54 attack in downtown Tel-Aviv. Prehosp Disaster Med 2008;23:337-41. 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 11 BMJ Open Page 12 of 21 BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 28. Pinkert M, Leiba A, Zaltsman E, et al. The significance of a small, level-3 'semi 4 5 evacuation' hospital in a terrorist attack in a nearby town. Disasters. 2007;31:227-35. 6 7 29. Ingrassia PL, Prato F, Geddo A, et al. Evaluation of medical management during a mass 8 9 10 casualty incident exercise: an objective assessment tool to enhance direct observation. J 11 12 Emerg Med 2010;39:629-36. 13 14 30. Juffermans J, Bierens JJ. Recurrent medical response problems during five recent 15 For peer review only 16 disasters in the Netherlands. Prehosp Disaster Med 2010;25:127-36. 17 18 31. Lennquist S. Protocol for Reports from Major Accidents and Disasters in the International 19 20 21 Journal of Disaster Medicine. Eur J Trauma Emerg Surg 2008;34:486-92. 22 23 32. Gryth D, Radestad M, Nilsson H, et al. Evaluation of medical command and control using 24 25 performance indicators in a full-scale, major aircraft accident exercise. Prehosp Disaster Med 26 27 2010;25:118-23. 28 29 30 33. Schwartz D, Pinkert M, Leiba A, et al. Significance of a Level-2, "selective, secondary 31 32 evacuation" hospital during a peripheral town terrorist attack. Prehosp Disaster Med 33 http://bmjopen.bmj.com/ 34 2007;22:59-66. 35 36 34. Green GB, Modi S, Lunney K, et al. Generic evaluation methods for disaster drills in 37 38 developing countries. Ann Emerg Med 2003;41:689-99. 39 40 41 35. Kulling P, Birnbaum M, Murray V, et al. Guidelines for reports on health crises and 42 on September 30, 2021 by guest. Protected copyright. 43 critical health events. Prehosp Disaster Med 2010;25:377-83. 44 45 36. Ricci E, Pretto E. Assessment of Prehospital and Hospital Response in Disaster. Crit Care 46 47 Clin 1991;7:471-84. 48 49 50 37. Ruter A, P. Wiström, T. Performance Indicators for Major Incident Medical Management 51 52 - A Possible Tool for Quality Control? Int J Disaster Med 2004;2:52-5. 53 54 38. Lennquist S. Protocol for reports from major accidents and disasters in the International 55 56 Journal of Disaster Medicine. Int J Disaster Med 2003;1:79-86. 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 12 Page 13 of 21 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 39. Lennquist S. Protocol for reports from major accidents and disasters in the International 4 5 Journal of Disaster Medicine. Int J Disaster Med 2004;2:57-64. 6 7 40. Backman K, Albertsson P, Petterson S, et al. Protocol from the coach crash in 8 9 10 Ängelsberg, Sweden January 2003. Int J Disaster Med 2004;2:93-104. 11 12 41. Dami F, Fuchs V, Peclard E, et al. Coordination of emergency medical services for a 13 14 major road traffic accident on a Swiss suburban highway. Eur J Trauma Emerg Surg. 15 For peer review only 16 2009;35:265-70. 17 18 42. Marres GMH, Eijk JVD. Evaluation of admissions to the Major Incident Hospital based 19 20 21 on standardized protocol. Eur J Trauma Emerg Surg 2011;37:19-29. 22 23 43. Lennquist S. Introduction to the second “Focus on” Disaster and Military Surgery. Eur J 24 25 Trauma Emerg Surg 2009;35:199-200. 26 27 44. France JM, Nichols D, Dong S: Increasing emergency medicine residents´ confidence 28 29 30 in disaster management: use of an Emergency Department simulator and an expedited 31 32 curriculum. Prehosp Disaster Med 2012;27:31-35. 33 http://bmjopen.bmj.com/ 34 45. Rüter A, Örtenwall P, Wikström T. Performance indicators for prehospital command and 35 36 control in training of medical first responders. Int J Disaster Med 2004;2:89-92. 37 38 46. Rüter A, Wikstrom T. Improved staff procedyre skills lead to improved management 39 40 41 skills: an observational study in an educational setting. Prehosp Disaster Med 2009;24:376- 42 on September 30, 2021 by guest. Protected copyright. 43 379. 44 45 47. Rüter A, Nilsson H, Vilkström T. Performance indicators as quality control for testing and 46 47 evaluating hospital management groups: a pilot study. Prehosp Disast Med 2006;21:423-426. 48 49 50 48. Rüter A, Vikström A. Indicateurs de performance: De la théorie a la pratique. Approche 51 52 scientifique à propos de la medicine de catastrophe. Urgence Pratique. 2009;93:41-44. 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 13 BMJ Open Page 14 of 21 BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 For peer review only 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 http://bmjopen.bmj.com/ 34 35 36 37 38 39 40 41 42 on September 30, 2021 by guest. Protected copyright. 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
Excluded: 455 455 Excluded: included papers included reference lists of lists of reference studies studies identified through through identified Additional records records Additional 5 fulltext fulltext 5 eligibility eligibility assessed for assessed title and some abstracts: 460 460 abstracts: some title and Articles screened on basis of of basis on screened Articles Total number of records: 460 460 records: of Total number Studies included in included Studies qualitative synthesis qualitative synthesis 5 literature: included from reference lists lists of reference from
Documents: Excluded: 107 Excluded:
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Total number of records: 107 107 records: of Total number Articles Articles screened on basis
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For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
For peer review8497 : only synthesis synthesis 10 136 136 10 from main main database:12 from abstract title and abstract Removing duplicatesRemoving Full-text studies studies Full-text (“uncertain”) 108 108 (“uncertain”) Studies included in qualitative in qualitative included Studies Total number of records: 8497 8497 records: of number Total Total number of records: of records: number Total Articles screened on basis of screenedon of Articles basis assessed for eligibility eligibility for assessed
PubMed/Medline EMBASE Cinahl Scopus Web of(WoK) Knowledge Library ProQuest Research references 3246 references 2856 Excluded references 347 references 279 references 3408 Database: References:
IIdentification IIdentification Eligibility Eligibility Screening Screening Included Included
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Other patient characteristic descriptors characteristic patient Other
✔ ✕ ✔ ✔✔ ✕ ✕✕ ✔ ✔✔ ✔ ✔✔ ✕ ✕✕ ✔ ✔✔ ✔ ✔✔ ✔ ✔✔ ✔ ✔✔ ✕ ✕✕ How medical illness was classified was illness medical How
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injuries/illnesses? The most frequent medical medical frequent most The
✔ ✔✔✔ ✔ ✔ ✔✔ ✔✔✔ ✔ ✕ ✕✕ ✕✕✕ ✕ ✕ ✕✕ ✕ ✕✕ ✕ ✕✕ ✕ ✕✕ ✕✕✕ ✕ Median/mean injury score reported? reported? score injury Median/mean
✔✔✔ ✔ ✔✔✔ ✔ ✕✕✕ ✕ ✕✕✕ ✕ ✕✕✕ ✕ ✕ ✕✕ ✕✕✕ ✕ ✕✕✕ ✕ ✕✕✕ ✕ ✕✕✕ ✕ Injury models used? used? models Injury
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level of care? of level Triage before transport to next immediate immediate next to transport before Triage
✕ ✕ ✕ ✕✕✕ ✕ ✕✕✕ ✕ ✕✕✕ ✕ ✕ ✕✕ ✕✕✕ ✕ ✕✕✕ ✕ ✕ ✕✕ ✕✕✕ ✕ ✕✕✕ ✕ ✕✕✕ ✕ Triage at first evaluation on scene? on evaluation first at Triage
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✔ ✔✔ ✔ ✔✔ ✔ ✔✔ ✕✕✕ ✕ ✕✕✕ ✕ ✕✕✕ ✕ ✕✕✕ ✕ ✕✕✕ ✕ ✕✕✕ ✕ ✕✕✕ ✕ PATIENT DESCRIPTORSCHARACTERISTIC
through ADC? ADC? through Triage classification patients received received patients classification Triage
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groups involved? involved? groups Children, adults, senior citizens or all age age all or citizens senior adults, Children,
✕ ✕ ✕ ✕ ✕ ✕ ✕ ✕✕✕ ✕ ✕✕✕ ✕ ✕✕✕ ✕ ✕✕✕ ✕ ✕✕✕ ✕ ✕✕✕ ✕ ✕✕✕ ✕ ✔ ✔✔ ✔ ✔✔ ✔ ✔✔ Other system characteristics reported? reported? characteristics system Other
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Scaling up and scaling down of response? response? of down scaling and up Scaling scaling up scaling only only
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✕ ✕✕ ✕ ✕✕ ✕ ✕✕ ✔✔✔ ✔ ✔✔✔ ✔ ✕ ✕✕ ✕ ✕✕ ✕ ✕✕ ✔✔✔ ✔
site to immediate next level of care? of level next immediate to site Time required for moving casualties from from casualties moving for required Time
✔ ✔ ✔ ✕ ✕ ✔ ✔✔ ✔ ✔✔ ✔ ✔✔ ✕ ✕✕ ✕✕✕ ✕ ✕✕✕ ✕ ✔✔✔ ✔ ✔ ✔✔ ✔ ✔✔ ✕ ✕✕ Coordination of rescue/relief work? rescue/relief of Coordination
✕✕✕ ✕ ✔✔✔ ✔ ✕ ✕✕ ✔✔✔ ✔ ✔✔✔ ✔ ✔ ✔✔ ✕ ✕✕ ✔ ✔✔ ✕✕✕ ✕ ✕ ✕✕
workers/aid organizations? workers/aid Communication between rescue rescue between Communication
✕ ✔ ✕ ✔
✕✕✕ ✕ ✔✔✔ ✔ ✕✕✕ ✕ ✔✔✔ ✔ ✔✔✔ ✔ ✔✔✔ ✔ ✕✕✕ ✕ ✔✔✔ ✔ ✕✕✕ ✕ ✕✕✕ ✕
telecommunications system? telecommunications Situation of pre-hospital pre-hospital of Situation
✔ ✕ ✔ ✔ ✔ ✔✔ ✕ ✕✕ ✔✔✔ ✔ ✔✔✔ ✔ ✕✕✕ ✕ ✔✔✔ ✔ ✔ ✔✔ ✕✕✕ ✕ ✕ ✕✕ ✕✕✕ ✕ Pre-hospital triage systems used? used? systems triage Pre-hospital
✕ ✔ ✕ ✕ ✕ ✕✕ ✔ ✔✔ ✕ ✕✕ ✕ ✕✕ ✕✕✕ ✕ ✔✔✔ ✔ ✔✔✔ ✔ ✕✕✕ ✕ ✕✕✕ ✕ ✕✕✕ ✕ Pre-hospital resources lacking? resources Pre-hospital
✕ ✔ ✕✕✕ ✕ ✔✔✔ ✔ ✔ ✔✔ ✕ ✕✕ ✔✔✔ ✔ ✔ ✔✔ ✔ ✔✔ ✕✕✕ ✕ ✕✕✕ ✕ ✕✕✕ ✕ Available pre-hospital resources? pre-hospital Available
✔ ✕ ✔ ✔ ✕ ✔ ✔
✔✔✔ ✔ ✕✕✕ ✕ ✔ ✔✔ ✔✔✔ ✔ ✕ ✕✕ ✔✔✔ ✔ ✔✔✔ ✔ ✕✕✕ ✕ ✕✕✕ ✕ ✕✕✕ ✕
site? Safety situation at and around incident incident around and at situation Safety
✕ ✔ ✕ ✕ ✕ ✕✕ ✔ ✔✔ ✕ ✕✕ ✕ ✕✕ ✕ ✕✕ ✔ ✔✔ ✕✕✕ ✕ ✕✕✕ ✕ ✕ ✕✕ ✕✕✕ ✕ SYSTEM CHARACTERISTICS Time from alarm to arrival at scene? at arrival to alarm from Time BMJ Open
http://bmjopen.bmj.com/ ✕ ✔ ✔ ✕ ✕ ✔ ✔ ✕✕✕ ✕ ✔✔✔ ✔ ✔ ✔✔ ✕ ✕✕ ✕✕✕ ✕ ✔ ✔✔ ✔ ✔✔ ✕✕✕ ✕ ✕✕✕ ✕ ✕✕✕ ✕ Accesibility of the incident site? incident the of Accesibility
✔ ✕
? ✔ ✔✔ ✕ ✕✕ ✕✕✕ ✕ ✕ ✕✕ ✕✕✕ ✕ ✕ ✕✕ ✔ ✔✔ ✕✕✕ ✕ ✕ ✕✕
responder? Information provided by ADC to to ADC by provided Information
✔ ✕
✔ ✔✔ ✕✕✕ ✕ ✕ ✕✕ ✕✕✕ ✕ ✕✕✕ ✕ ✕ ✕✕ ✕✕✕ ✕ ✔✔✔ ✔ ✕✕✕ ✕ ✕✕✕ ✕
dispatch centre (ADC)? centre dispatch Information received by ambulance ambulance by received Information
✕ ✕ ✕ ✕ ✕ ✕ ✔ ✕✕✕ ✕ ✕ ✕✕ ✕✕✕ ✕ ✕✕✕ ✕ ✕✕✕ ✕ ✕✕✕ ✕ ✔ ✔✔ ✔✔✔ ✔ ✕✕✕ ✕ ✕✕✕ ✕ Other incident information reported? information incident Other
✔ ✔ ✔ ✔ ✔✔ ✔ ✔✔ ✔✔✔ ✔ ✔ ✔✔ ✔ ✔✔ ✔ ✔✔ ✕✕✕ ✕ ✔ ✔✔ ✕ ✕✕ ✕✕✕ ✕
Number uninjured? Number incidents not all all not
✕ ✕ ✕✕ ✕ ✕✕ ✔✔✔ ✔ ✔✔✔ ✔ ✔✔✔ ✔ ✕✕✕ ✕ ✔✔✔ ✔ ✕✕✕ ✕ ✕✕✕ ✕ Number slightly injured? slightly Number on September 30, 2021 by guest. Protected copyright.
✔ ✔ ✔✔ ✕✕✕ ✕ ✔✔✔ ✔ ✔ ✔✔ ✔✔✔ ✔ ✔✔✔ ✔ ✕✕✕ ✕ ✔✔✔ ✔ ✕✕✕ ✕ ✕✕✕ ✕
Number moderately injured? moderately Number incidents not all all not
✕✕✕ ✕ ✔✔✔ ✔ ✔✔✔ ✔ ✔✔✔ ✔ ✔✔✔ ✔ ✕✕✕ ✕ ✔✔✔ ✔ ✕✕✕ ✕ ✕✕✕ ✕
Number severly injured severly Number incidents not all all not
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml ✕ ✕✕✕ ✕ ✔✔✔ ✔ ✔✔✔ ✔ ✔✔✔ ✔ ✔✔✔ ✔ ✕✕✕ ✕ ✔✔✔ ✔ ✕✕✕ ✕ ✕✕✕ ✕ Number deceased Number INCIDENT CHARACTERISTICS ✔✔✔ ✔ ✔ ✔✔ ✔ ✔✔ ✔✔✔ ✔ ✔✔✔ ✔ ✔✔✔ ✔ ✕✕✕ ✕ ✔✔✔ ✔ ✕✕✕ ✕ ✕✕✕ ✕
Description of damage caused by MI by caused damage of For Description peer review only
✔ ✔ ✔✔✔ ✔ ✔✔✔ ✔ ✔✔✔ ✔ ✔✔✔ ✔ ✔✔✔ ✔ ✔✔✔ ✔ ✕✕✕ ✕ ✔✔✔ ✔ ✕✕✕ ✕ ✕✕✕ ✕
Time and date of MI of date and Time only date only
✔✔✔ ✔ ✔✔✔ ✔ ✔✔✔ ✔ ✔✔✔ ✔ ✕✕✕ ✕ ✕ ✕✕ ✔✔✔ ✔ ✕✕✕ ✕ ✕✕✕ ✕ Other pre-event information reported? information pre-event Other
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✔✔✔ ✔ ✔✔✔ ✔ ✔✔✔ ✔ ✔✔✔ ✔ ✕✕✕ ✕ ✕✕✕ ✕ ✔ ✔✔ ✔✔✔ ✔ ✕✕✕ ✕ ✕✕✕ ✕
population prior to MI? to prior population Characteristics and number of the affected affected the of number and Characteristics
✕ ✕✕ ✔✔✔ ✔ ✕ ✕✕ ✕✕✕ ✕ ✕✕✕ ✕ ✔✔✔ ✔ ✔✔✔ ✔ ✕ ✕✕ ✕✕✕ ✕ ✕✕✕ ✕ Basic info on affected area? affected on info Basic DEMOGRAPHY ✕ ✔ ✕ ✕ ✕ ✔ ✔ ✕ ✕ ✕ ✕✕✕ ✕ ✔✔✔ ✔ ✕✕✕ ✕ ✕✕✕ ✕ ✕✕✕ ✕ ✔✔✔ ✔ ✔✔✔ ✔ ✕✕✕ ✕ ✕✕✕ ✕ ✕✕✕ ✕ Anderson Debacker DISAST-CIR Ingrassia Juffermans Kulling Lennquist Performance indicators Ricci Green First Author First 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
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1 2
3
4
5 (30) (31)
(29) (21) (11)
CIR
6 (35) - (34) 7 (36)
8 33) 28, -
9 (32,37) Ricci Ricci indicators (22 10 Green Kulling Kulling Performance Performance DISAST Debacker Debacker Anderson Anderson Ingrassia 11 Lennquist Quality appraisal of included literatureFor peer review only Juffermans 12 13 1. Was the methodology for developing 14 ✕ ✔ ✕ ✔ ✕ ✔ ✔ ✕ ✕ ✕ 15 the template clearly explained? 16
2. Are the data variables listed in the http://bmjopen.bmj.com/ 17 ✕ ✔ ✔ ✔ ✕ ✕ ✔ ✔ ✔ ✕ 18 template clearly defined? 19 20 3. Is the rationale for the data variables ✕ ✔ ✕ ✔ ✔ ✔ ✔ ✕ ✕ ✕ 21 described? 22 23
24 4. Is handling of missing data described? ✕ ✔ ✕ ✔ ✕ ✕ ✔ ✕ ✕ ✕ Internal validity 25 on September 30, 2021 by guest. Protected copyright. 26 27 5. Has an ethics committee approved the ✕ ✕ ✕ ✔ ✕ ✔ ✕ ✕ ✕ ✕ 28 template? 29 30 6a. Does the literature state who ✕ ✔ ✔ ✔ ✕ ✕ ✔ ✕ ✔ ✕ 31 developed the template? 32 33 34 b. How the process was funded ✕ ✔ ✔ ✔ ✕ ✕ ✔ ✕ ✕ ✕ 35 36 37 7a. Which continent/country/organization
✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ External validity 38 was the template developed in? 39 40 41 42 43 44 45 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
BMJ Open Page 18 of 21
1 2 3 4 b. Where (specific region) it is intended ✕ ✔ ✔ ✔ ✕ ✕ ✕ ✕ ✕ ✕ 5 to be used? 6 7 8. Are the data variables transferable to 8 other countries or major incident ✕ ✔ ✔ ✔ ✕ ✕ ✔ ✔ ✔ ✕ 9 10 management systems? 11 For peer review only 12 9. Is it possible to report the incident ✕ ✔ ✔ ✔ ✕ ✔ ✔ ✔ ✕ ✕ 13 timeline? 14 15 10. Is a valid discussion included about 16 ✕ ✔ ✔ ✔ ✔ ✔ ✔ ✕ ✔ ✕ 17 possible sources of bias? http://bmjopen.bmj.com/ 18 19 11. Do the authors discuss using the ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ 20 template as a tool for evaluation? 21 22 23 12. Has the clinical credibility of the tool ✕ ✕ ✕ ✕ ✕ ✕ ✕ ✕ ✕ ✕ 24 been evaluated? 25 on September 30, 2021 by guest. Protected copyright. 26 13. Has the feasibility of the template 27 ✕ ✕ ✕ ✕ ✕ ✕ ✕ ✕ ✕ ✕ 28 been evaluated? 29 30 14. Has the template been used in other 31 ? * ✔ ? ✔ ✕ ✔ ✔ ✔ ? 32 publications? 33 34 35 36 37 38 39 40 41 42 43 44 45 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60
BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from .5 .5 .4-6. .4-6. on page # # page on Reported Reported N/A N/A Fig. 3 Fig. Fig. 4 Fig. Fig. 4 Fig. 5 Figure 1, Figure p Fig. 2, Fig. p 4 3+2 3 3 2 1 up) report up) characteristics and (e.g., considered, years BMJ Open http://bmjopen.bmj.com/ analysis). -
on September 30, 2021 by guest. Protected copyright.
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml registration registration informationincluding registration number. State the State principal summarymeasures (e.g., risk ratio,means). difference in Describe methods Describe used for assessing risk studies of of bias individual (including specification of this whether was the study at done outcomeor andhow this level), information be usedto is in any datasynthesis. List and define List variables all for data which sought were (e.g., PICOS,fundingsources) any assumptionsand and simplificationsmade. Describe method Describe of dataextraction from reports(e.g., forms, piloted inindependently, duplicate) and any processes forand confirming obtaining datafrom investigators. State the State process for studies selecting (i.e., screening, eligibility, includedin systematic and,if review, applicable, includedin the meta Present full electronicPresent search strategyfor least one at database, including limits any used, such that it could be repeated. Describe all Describe information sources databases (e.g., of with dates coverage, contact study with authors to identify studies) additional in the search and datelast searched. Specify study Specify characteristics PICOS, (e.g., length of follow - Indicate Indicate review if a protocolexists, if andcan it where Webaccessed (e.g.,be address), and, if available, provide Provide anProvide statement explicit of questions being addressedwithreference to participants, interventions,comparisons, outcomes,study and (PICOS). design Describe the Describe rationale for review inthe the context of what already is known. Provide a structured a Provide summary including, asapplicable: background; objectives;datasources; study eligibilitycriteria, participants,and interventions; study appraisal and synthesis methods; results; limitations;conclusions and implicationsoffindings; key systematic registration review number. Identify the Identify report systematic asa meta-analysis, review, both.or Checklist item item Checklist For peer review language, publicationstatus) ascriteria used for eligibility, rationale. giving only
1 8 2 4 7 9 3 6 # 11 12 13
PRISMA2009 ChecklistPRISMA 2009 Checklist PRISMA2009 ChecklistPRISMA 2009 Checklist
Summarymeasures Riskindividual in of bias studies Data Data items Data collection Data process 10 Study selection Study Search Search Information sourcesInformation Eligibility criteria Eligibility Protocol and registrationProtocol 5 METHODS METHODS Objectives Objectives Rationale Rationale INTRODUCTION INTRODUCTION Structuredsummary ABSTRACT ABSTRACT Title Title TITLE TITLE Section/topic Section/topic Page 19 of 21 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60
BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
Page 20 of 21 on page # # page on Reported Reported 8 7 7 7 N/A N/A N/A N/A N/A N/A N/A N/A Fig. 3 Fig. Fig. 3+4 Fig. Fig. 2 Fig. N/A N/A N/A N/A N/A N/A
Page 1 of 2 2 1 of Page BMJ Open http://bmjopen.bmj.com/ analysis. -
on September 30, 2021 by guest. Protected copyright. specified. -
foreach meta ) ) For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 2 Describe sources Describe of funding for systematic the review support and (e.g., other supply of data); role of funders for the systematic review. Provide a a Provide general interpretationof the results thecontext in of other evidence, and implications for future research. Discussstudy limitations at and outcome(e.g., level risk review-level ofand at bias), (e.g., incomplete retrieval of identifiedresearch, reporting bias). Summarizethe main findings the strengthincluding ofevidencefor main each outcome; their consider relevance to Give results ofresults Give additional analyses, if (e.g.,done sensitivity subgroupor analyses, meta-regression Item [see 16]). Present results Present of any assessmentof risk across of (see Itembias studies 15). Present results Present of each meta-analysis done, including confidence intervalsand measures of consistency. For all outcomes Forall considered(benefits harms),or for study: each present, (a) simple summary datafor each groupintervention (b) effectestimates confidence and intervals, forest ideally witha plot. Present Present dataon risk of ofstudy and, each bias ifavailable, outcome any assessmentlevel (see item 12). For each study, Foreach present characteristics for which data extracted were (e.g., study PICOS,follow-upsize, period) and citations. provide the Give numbersGive screened,of studies assessed for eligibility, and includedin the review, reasons with for exclusions at stage, each flow ideally witha diagram. Describe methods Describe of additional analyses (e.g., sensitivity subgroupor analyses, meta-regression),if indicating done, Specify Specify assessment any riskofthat may bias cumulative affectof evidence(e.g., the publication bias,selective studies).reporting within Checklist item item Checklist Describe the Describe methods of handling dataand combining ofresults studies, if done, includingmeasures of consistency I (e.g., key groups key (e.g., healthcare providers, users, and policymakers). For prewhich were peer review only
# 21 14 17 25 27 26 16 23
PRISMA2009 ChecklistPRISMA 2009 Checklist PRISMA2009 ChecklistPRISMA 2009 Checklist
Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(6): e1000097. From: Funding Funding FUNDING FUNDING Conclusions Limitations Summaryof evidence 24 DISCUSSION DISCUSSION Riskacross of bias studies 22 Synthesisof results Results of Results individual studies 20 Riskstudies within of bias 19 Study characteristics Study 18 Study selection Study RESULTS RESULTS Riskacross of bias studies 15 Section/topic Section/topic Synthesisof results doi:10.1371/journal.pmed1000097 doi:10.1371/journal.pmed1000097 Additional Additional analysis Additional Additional analyses 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from . . - statement.org
www.prisma
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For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml For peer review only PRISMA2009 ChecklistPRISMA 2009 Checklist PRISMA2009 ChecklistPRISMA 2009 Checklist Page 21 of 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
Systematic literature review of templates for reporting pre- hospital major incident medical management
ForJournal: peerBMJ Open review only Manuscript ID: bmjopen-2013-002658.R1
Article Type: Research
Date Submitted by the Author: 14-Apr-2013
Complete List of Authors: Fattah, Sabina; Norwegian Air Ambulance Foundation, Department of Research and Development,; University of Tromsø, Anaesthesia and Critical Care Research Group, Faculty of Health Sciences, Rehn, Marius; Norwegian Air Ambulance Foundation, Department of Research and Development,; Akershus University Hospital, Department of Anaesthesia and Intensive Care, Reierth, Eirik; University of Tromsø, University Library of Tromsø, Science and Health Library, Wisborg, Torben; University of Tromsø, Anaesthesia and Critical Care Research Group, Faculty of Health Sciences,; Finnmark Health Trust, Hammerfest Hospital, Department of Anaesthesiology and Intensive Care,
Primary Subject Emergency medicine Heading: http://bmjopen.bmj.com/ Secondary Subject Heading: Medical management, Evidence based practice, Anaesthesia
Disaster Medicine, Emergencies, Mass Casualty Incidents, Data Collection, Keywords: Health Care Management
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1 2 3 Systematic literature review of templates for reporting pre-hospital 4 5 major incident medical management 6 7 8 9 10 Sabina Fattah, MD1, 2. Marius Rehn, MD PhD1, 3, 4. Eirik Reierth, Dr.scient5. 11 2, 6 12 Torben Wisborg, Professor . 13 14 15 1. DepartmentFor of Research peer and Development, review Norwegian Aironly Ambulance Foundation, 16 17 Drøbak, Norway 18 2. Anaesthesia and Critical Care Research Group, Faculty of Health Sciences, University 19 20 of Tromsø, Tromsø, Norway 21 22 3. Field of Pre hospital Critical Care, Network of Medical Sciences, University of 23 Stavanger, Stavanger, Norway 24 25 4. Department of Anaesthesia and Intensive Care, Akershus University Hospital, 26 27 Lørenskog, Norway 28 5. Science and Health Library, University Library of Tromsø, University of Tromsø, 29 30 Tromsø, Norway 31 32 6. Department of Anaesthesiology and Intensive Care, Hammerfest Hospital, Finnmark 33 Health Trust, Hammerfest, Norway http://bmjopen.bmj.com/ 34 35 36 37 38 Corresponding author: 39 40 Sabina Fattah 41 42 Postal address: P.O box 94, 1448 Drøbak, Norway on September 30, 2021 by guest. Protected copyright. 43 E mail: [email protected] 44 45 Telephone: +47 64 90 44 44 46 47 Fax: +47 64 90 44 45 48 49 50 Keywords: Disaster Medicine, Emergencies, Mass Casualty Incidents, Data Collection, 51 52 Health Care Management. 53 54 55 56 Word count – 2339. 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 1 BMJ Open Page 2 of 42 BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 ABSTRACT 4 5 Objective: To identify and describe the content of templates for reporting pre hospital major 6 incident medical management. 7 8 Design: Systematic literature review according to PRISMA guidelines. 9 10 Data sources: PubMed/Medline, EMBASE, Cinahl, Scopus, and Web of Knowledge. Grey 11 literature was also searched. 12 13 Eligibility criteria for selected studies: Templates published after 1 January 1990 and up to 14 15 19 March 2012.For Non English peer language literature,review except Scandinavian; only literature without an 16 available abstract; and literature reporting only psychological aspects were excluded. 17 18 Results: The main database search identified 8497 articles, among which 8389 were excluded 19 20 based on title and abstract. An additional 96 were excluded based on the full text. The 21 remaining 12 articles were included in the analysis. A total of 107 articles were identified in 22 23 the grey literature and excluded. The reference lists for the included articles identified five 24 25 additional articles. A relevant article published after completing the search was also included. 26 In the 18 articles included in the study, 10 different templates or sets of data are described; 27 28 two methodologies for assessing major incident responses, three templates intended for 29 30 reporting from exercises, two guidelines for reporting in medical journals, two analyses of 31 previous disasters, and one Utstein Style template. 32 33 Conclusion: More than one template exists for generating reports. The limitations of the http://bmjopen.bmj.com/ 34 35 existing templates involve internal and external validity, and none of them have been tested 36 for feasibility in real life incidents. 37 38 Trial registration: The review is registered in PROSPERO (registration number: 39 40 CRD42012002051). 41
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1 2 3 ARTICLE SUMMARY 4 5 Article focus: 6 Identify templates that enable systematic and uniform reporting of pre hospital major incident 7 8 medical management. 9 10 Appraise the data fields in the included templates regarding internal and external validity. 11 Key messages: 12 13 Templates for reporting major incident medical management exist in different formats, but 14 15 none have beenFor tested for peer feasibility. review only 16 A template for generating reports from the pre hospital phase with clearly defined data 17 18 variables enabling comparative analysis is needed. 19 20 21 Strengths and limitations of the study: 22 23 A systematic review following the PRISMA guidelines. 24 25 The protocol was published and deviations from protocol are revealed in the study report. 26 Only English and Scandinavian language literature was included. 27 28 29 30 The original protocol of the study 31 32 The study protocol is available in BMJ Open [1]. 33 http://bmjopen.bmj.com/ 34 35 INTRODUCTION 36 37 Major incidents, such as natural disasters, accidents, and terrorist attacks, affect millions of 38 lives each year. In 2011, natural disasters alone killed more than 30,000 people and injured 39 40 244 million people worldwide. The 332 natural disasters in 2011 caused the highest economic 41 42 damage ever recorded; Asia was the continent most often hit, followed by the Americas, on September 30, 2021 by guest. Protected copyright. 43 Africa, Europe, and Oceania. This regional distribution of disaster resembles the profile 44 45 observed from 2001 to 2010. Over the last decade, China, the United States, the Philippines, 46 47 India, and Indonesia were the five countries most frequently hit by natural disasters [2]. 48 49 50 51 52 Although disaster medicine can be traced back to the Middle Ages, it has become a distinct 53 54 scientific discipline in only the last 60 years [3]. An evolving trend in disaster medicine calls 55 for improved reporting of major incidents in order to increase the level of science within this 56 57 field [4 9]. Previous expert group processes defined uniform data sets for reporting in both 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 3 BMJ Open Page 4 of 42 BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 emergency medicine in general [10, 11] and in disaster medicine specifically [12, 13]. These 4 5 templates were designated as Utstein style templates after the Norwegian monastery where 6 they were developed. Qualitative research methods have also been used to identify areas 7 8 within pre hospital critical care and major incident management that require further research 9 10 [14, 15]. A recent review identified data from mass gatherings as non uniform and called for 11 consistent data to enable future research [16]. The importance of evaluating disaster exercises 12 13 using pre defined, high quality data has also been discussed as a potential for improving 14 15 disaster healthFor management peer [17] and for reviewcomparing outcomes fromonly different exercises [18]. 16 The analysis of standardized data from previous incidents can allow decision makers to make 17 18 well informed decisions [19]. 19 20 21 22 This systematic review was designed to identify and describe the content of templates for 23 24 reporting pre hospital major incident medical management. The need for a template for 25 26 uniform reporting was assessed based on the findings. To the best of our knowledge, no 27 similar studies have been performed or registered in the Cochrane or Prospero databases. 28 29 30 31 METHODS 32 33 Search strategy http://bmjopen.bmj.com/ 34 35 A systematic literature search was performed to identify templates published after 1 January 36 37 1990 and up to 19 March 2012 [1]. The controlled vocabulary of Medical Subject Headings 38 (MeSH) from PubMed, including subheadings, publication types, and supplementary 39 40 concepts, was used. The search was performed between 24 February 2012 and 19 March 41 42 2012. A systematic search of the grey literature was performed 25 29 June 2012. on September 30, 2021 by guest. Protected copyright. 43 44 45 In the main database search, three sets of entry terms were applied and combined (figure 1). 46 47 The first set of entry terms describes major incidents. The second set of entry terms describes 48 templates. In addition to the MeSH terms in the first two sets, a third set of entry terms with 49 50 free search phrases was included. For the grey literature search, only two sets of entry terms 51 52 were combined [1]. 53 54 55 56 Inclusion criteria 57 − 58 Templates reporting pre hospital major incident medical management. 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 4 Page 5 of 42 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 − Templates published after 1 January 1990 (inclusive) and until the date of the 4 5 literature search. 6 7 8 9 Exclusion criteria 10 − 11 All non English language literature, except Scandinavian. 12 − Literature without an available abstract. 13 14 − Literature reporting only psychological aspects. 15 For peer review only 16 17 18 Deviations from protocol in search strategy 19 20 Combining the three sets of entry terms resulted in 225 individual searches in each database. 21 If any of these individual searches returned more than 700 results, the search was performed 22 23 again with a fourth entry term (disaster prevention) using the Boolean operator AND. 24 25 26 In Scopus, two entry terms, “questionnaires” and “learning”, were excluded due to a large 27 28 number of irrelevant results, and all searches were limited to the subject areas of life sciences, 29 30 health sciences, and physical sciences. Searches in Scopus were further limited to article title, 31 abstract, and keywords. In Web of Knowledge (ISI), all searches were limited to articles and 32 33 reviews. The term “disaster prevention” was used to refine and decrease the number of search http://bmjopen.bmj.com/ 34 35 results in four of the individual searches performed in this database. ProQuest Research 36 Library was excluded as it returned too many irrelevant results and the most relevant subjects 37 38 were covered by the searches performed in PubMed/Medline, Web of Knowledge, and 39 40 Scopus. 41 on September 30, 2021 by guest. Protected copyright. 42 43 The grey literature databases revealed a broad range of quality and searchability. The System 44 45 for Information on Grey Literature in Europe (OpenSIGLE) was excluded due to the need to 46 order the documents from the original source or a library. Only the document title was 47 48 available on the web page, making it impossible to determine which documents to order. 49 50 51 Deviations in the search strategy were necessary in order to make the systematic literature 52 53 review feasible, as a larger number of findings might have made completion of the study 54 55 impossible. 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 5 BMJ Open Page 6 of 42 BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 Search findings 4 5 The search was performed according to the deviations described above. A total of 10,136 6 results from each individual database search were sent to Endnote X5 (Thomson Reuters, 7 8 NY, USA). After removing duplicates, the number of results was 8,497. The grey literature 9 10 search returned 107 results (figure 2). A total of 18 articles were included for data extraction 11 and quality appraisal. 12 13 14 15 Analysis of identifiedFor literature peer review only 16 One author scanned the titles and abstracts of the identified literature. Literature not 17 18 complying with the inclusion criteria was excluded. The full text was obtained for uncertain 19 20 articles, and inclusion was subject to consensus among three of the authors. 21 After data extraction from the included literature, the appraisal was conducted using a 22 23 checklist [20] designed by the authors prior to data collection based on the authors’ 24 25 assumptions of the data relevant to report in a template. The contact authors of articles that 26 provided an e mail address were asked whether the template had been used in real life 27 28 incidents. The reference lists of the included literature were scanned and relevant literature 29 30 included. A quantitative synthesis (meta analysis) was not performed. The Preferred 31 Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines were 32 33 followed [21, 22]. http://bmjopen.bmj.com/ 34 35 36 37 Data extraction 38 39 We extracted 34 data items from each template (figure 3). The data were classified into four 40 41 categories: demographics, incident characteristics, system characteristics, and descriptors of on September 30, 2021 by guest. Protected copyright. 42 patient characteristics. 43 44 45 46 47 Deviations from protocol regarding quality appraisal 48 49 The study protocol proposed to appraise whether the medical outcomes predicted by the 50 templates were valid and to evaluate the outcome of using the templates. Both of these 51 52 questions proved difficult to answer and were removed from the appraisal. 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 6 Page 7 of 42 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 RESULTS 4 5 A total of 12 articles were included from the main database search [23 34], five articles were 6 identified from the literature lists of included articles [35 39], and one relevant article was 7 8 published after the literature search was completed [13] (figure 2). The total 18 articles 9 10 included 10 different templates or guidelines for reporting (table 1). 11 12 13 Table 1 An overview of included literature. 14 15 Anderson, 1995For Debacker peer et DISAST-CIR, review Green only et al, Ingrassia et al, 16 (23) al, 2012 (13) 2007-2008 (24 2003 (36) 2010 (31) 17 30, 35) 18 19 A comparative Utstein style Seven articles Generic Evaluation of 20 analysis of the template for using a template evaluation medical 21 emergency uniform data (DISAST CIR) methods for management 22 medical services reporting of for reporting disaster drills in during a mass 23 and rescue acute medical from mass developing casualty incident 24 25 responses to responses in casualty countries. exercise. 26 eight airliner disaster. incidents. 27 crashes in the Documented in 28 United States, the registry of 29 1987 1991. the Israeli 30 Defence Force 31 Home Front and 32 Ministry of 33 Health. http://bmjopen.bmj.com/ 34 35 36 Retrospective Template for Systematic Systematic Systematic 37 analysis of real future method for method for method for 38 events using a reporting of reporting real reporting from reporting from 39 systematic real incidents. incidents. field exercises. field exercises. 40 method. 41
Juffermans et Kulling et al, Lennquist, 2008 Performance Ricci et al, 1991 on September 30, 2021 by guest. Protected copyright. 42 al, 2010 (32) 2010 (37) (33) indicators, (38) 43 44 2004, 2010 (34, 45 39) 46 47 Recurrent Guidelines for Protocol for An evaluation Assessment of 48 medical response report on Reports from tool for reporting Prehospital and 49 problems during health crisis Major Accidents major incident Hospital 50 five recent and critical and Disasters in medical Response in 51 disasters in the health events. the International management Disasters. 52 Netherlands. Journal of from disaster 53 54 Disaster exercises. 55 Medicine. 56 57 Retrospective Guidelines for Guideline for Systematic Guidelines for 58 analysis of real systematic systematic method for systematic 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 7 BMJ Open Page 8 of 42 BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 events using a reporting from reporting from reporting from reporting from 4 systematic real incidents. real incidents. field exercises. real incidents. 5 method. 6 7 8 9 Data extraction 10 Six of the 10 templates contained other pre event information, such as climate, child mortality 11 12 rate, and descriptions of hazards. Seven of the 10 templates contained other incident 13 14 information, such as a description of the incident. All templates included more system 15 characteristicsFor than what peerwe extracted, includingreview on site medical only care, distribution of 16 17 casualties, independent action by medical disaster response personnel, continuation of day to 18 19 day care, and decision flow and information management. Seven templates contained other 20 descriptors of patient characteristics, such as different triage systems used, description of 21 22 psychological reactions, and morbidity using hospital data. 23 24 25 26 Quality appraisal 27 28 The appraisal using a pre defined checklist is shown in Figure 4. The first five questions 29 30 regarding internal validity indicated that two of the templates contained none of the data we 31 were looking for, four templates contained one of the data items we found relevant, and the 32 33 remaining four templates included three or more data items included on our list of desirable http://bmjopen.bmj.com/ 34 35 information. The 11 items regarding external validity were also heterogeneous in regarding to 36 which and how many of the items each template contained. 37 38 39 40 Use of templates 41 42 We succeeded in contacting the authors of seven templates. According to the authors, five of on September 30, 2021 by guest. Protected copyright. 43 44 these templates were used in other publications, and one is currently being used to 45 retrospectively evaluate disaster management. DISAST CIR [24 30, 35] is routinely used to 46 47 report each mass casualty incident in the registry of the Israeli Defence Force Home Front and 48 49 Ministry of Health. Two of the templates [31, 34, 39] are routinely used for reporting from 50 exercises. Guidelines for reporting health crises and critical health events [37] have been used 51 52 to report international disasters, but these publications were not available as official 53 54 publications at the time of correspondence with the authors. The protocol for reports of major 55 accidents and disasters [33] was also published previously in the International Journal of 56 57 Disaster Medicine [40, 41]. This protocol has been used for reports in the International 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 8 Page 9 of 42 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 Journal of Disaster Medicine [42] and the European Journal of Trauma and Emergency 4 5 Surgery [43, 44]. The protocol was also mentioned in an editorial in the European Journal of 6 Trauma and Emergency Surgery [45]. Performance indicators for major incident medical 7 8 management [34, 39] has also been used in additional publications [18, 46 50]. 9 10 11 12 DISCUSSION 13 We identified 10 templates for reporting pre hospital major incident medical management that 14 15 were heterogeneousFor with peerregards to the datareview they reported. The onlyquality appraisal revealed that, 16 17 for most of the templates, the methodology for developing them was not clearly explained. In 18 addition, the data variables were not clearly defined for all templates, and the rationale for 19 20 choosing the data variables was only explained for half of the templates. Only three of the 21 22 articles describe the handling of missing data and two depict whether an ethics committee 23 approved the templates. All of these factors are important for internal validity, but the results 24 25 were also heterogeneous for external validity. We chose to interpret that the template was 26 27 developed in the region affiliated with the authors, though this was not specified. Only two 28 templates stated where it was intended to be used. None of the articles discussed the clinical 29 30 credibility of the template, and no feasibility studies have been performed. In all cases, the use 31 32 of the template as a tool for evaluation was mentioned. 33 http://bmjopen.bmj.com/ 34 35 Data variables for reporting should be uniformly defined in order to improve research and 36 37 allow scientific development. Templates should be pre approved by ethics committees to 38 allow immediate reporting and rapid dissemination of data on the potential for improvement. 39 40 For a template to be used, it needs to be both clinically credible and feasible. Ideally, if a 41 42 template is to be used in a specific region, it should be developed together with experts from on September 30, 2021 by guest. Protected copyright. 43 that region; if this is not possible, feasibility studies regarding regional differences should be 44 45 performed. Representatives directly involved in responding to or managing the major incident 46 47 should be the ones reporting it, and these individuals should have in depth local knowledge. 48 The ultimate goal of reporting should be an evaluation of the response and identification of 49 50 areas for improvement, enabling those responsible in similar settings to improve their 51 52 preparedness. For this kind of evaluation to occur, comparable, standardized reports that 53 allow for research need to be published. Thus far, reporting on the scale needed for 54 55 comparisons has not been achieved. 56 57 58 Limitations 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 9 BMJ Open Page 10 of 42 BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 Not all of the included literature was intended for prospectively reporting real life incidents. 4 5 However, in order to not overlook potentially relevant aspects of major incident reporting, the 6 literature aimed to report from exercises [31, 34, 36, 39] and literature using a systematic 7 8 method for reporting in general were included [23, 32]. A clear weakness was that templates 9 10 may exist in other languages than those included. We invite others to identify these templates. 11 Another limitation is that only literature in which an abstract was available was included. 12 13 With more that 8000 articles identified in the search, reviewing full articles at the initial stage 14 15 was not feasible.For Another peer limitation was reviewthat only one author performedonly the initial review of 16 the literature for inclusion. One author performed data extraction and the appraisal and a 17 18 second author checked the results, but this can still allow room for subjective interpretations 19 20 of the content of the templates. The aim of the appraisal was to systematically extract 21 information that the authors thought would be important for reporting major incident medical 22 23 management. 24 25 26 27 28 CONCLUSIONS 29 30 Our findings show that more than one template exists for generating reports. Limitations are 31 32 present in the existing templates regarding internal and external validity, and none of them 33 have been tested for feasibility in real life incidents. Uniform reporting can allow the analysis http://bmjopen.bmj.com/ 34 35 and comparison of medical management for different major incidents and identify areas that 36 37 need improvement. Indirectly, this information can lead to better resource use and improved 38 outcomes for patients and society. The identified templates may be used as a basis for 39 40 designing a template that is specifically aimed at pre hospital medical care and at generating 41 42 reports in such a quantity that comparative analysis can be performed. The work to create on September 30, 2021 by guest. Protected copyright. 43 such a template seems warranted and is now underway. 44 45 46 47 Authors’ contributions 48 SF, MR, and TW conceived the idea and designed the study. ER designed and conducted the 49 50 search strategy for the literature search. SF screened the identified literature. TW, MR, and SF 51 52 considered the eligibility of uncertain literature. SF performed data extraction and quality 53 analysis of the included literature. TW and MR checked these results and were mentors in the 54 55 process. SF, MR, ER, and TW approved the final version of the manuscript. 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 10 Page 11 of 42 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 Competing interests 4 5 The authors declare no competing interests. 6 7 8 Funding 9 10 The Norwegian Air Ambulance employs SF and MR as research fellows. ER and TW 11 12 received departmental funding only. No additional funding was obtained. 13 14 15 Figure legendsFor peer review only 16 17 Figure 1 Search strategy. The two first sets of entry terms consisted of 15 terms each, and the 18 third set of eight free search phrases. Combining these three sets resulted in 225 individual 19 20 searches in each database. 21 22 Figure 2 PRISMA flow diagram depicting the different stages of the systematic literature 23 review. 24 25 Figure 3 Data extraction from included literature. : yes, : no, ?: unclear, : not for all 26 27 incidents, π: only date, Ф: only scaling up. 28 Figure 4 Quality appraisal of the included literature. : yes, : no, ?: unclear, *: study is 29 30 ongoing. 31 32 33 http://bmjopen.bmj.com/ 34 35 REFERENCES 36 1 Fattah S, Rehn M, Reierth E, et al. Templates for reporting pre hospital major incident 37 38 39 medical management: systematic literature review. BMJ Open 2012;2:e001082. 40 41 2 Guha Sapir D, Vos F, Below R, et al. Annual Disaster Statistical Review 2011: The 42 on September 30, 2021 by guest. Protected copyright. 43 Numbers and Trends. Centre for Research on the Epidemiology of Disasters, Brussels, 2012. 44 45 http://cred.be/sites/default/files/2012.07.05.ADSR_2011.pdf (accessed 31.03.2013). 46 47 48 3 Dara SI, Ashton RW, Farmer JC, et al. Worldwide disaster medical response: An historical 49 50 perspective. Crit Care Med 2005;33:S2 S6. 51 52 4 Bradt DA, Aitken P. Disaster medicine reporting: the need for new guidelines and the 53 54 CONFIDE statement. Emerg Med Australas 2010;22:483 7. 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 11 BMJ Open Page 12 of 42 BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 5 Stratton SJ. Use of structured observational methods in disaster research: "Recurrent 4 5 medical response problems in five recent disasters in the Netherlands". Prehosp Disaster Med 6 7 2010;25:137 8. 8 9 10 6 Stratton SJ. The Utstein style Template for uniform data reporting of acute medical 11 12 response in disasters. Prehosp Disaster Med 2012;27:219. 13 14 7 Castren M, Hubloue I, Debacker M. Improving the science and evidence for the medical 15 For peer review only 16 management of disasters: Utstein style. Eur J Emerg Med 2012;19:275 6. 17 18 8 Lockey DJ. The shootings in Oslo and Utoya island July 22, 2011: lessons for the 19 20 21 International EMS community. Scand J Trauma Resusc Emerg Med 2012;20:4. 22 23 9 Lennquist S. Introduction to the third "Focus on" issue specially devoted to papers within 24 25 the field of the ESTES section for Disaster and Military Surgery. Eur J Trauma Emerg Surg 26 27 2011;37:1 2. 28 29 30 10 Langhelle A, Nolan J, Herlitz J, et al. Recommended guidelines for reviewing, reporting, 31 32 and conducting research on post resuscitation care: the Utstein style. Resuscitation 33 http://bmjopen.bmj.com/ 34 2005;66:271 83. 35 36 11 Ringdal KG, Coats TJ, Lefering R, et al. The Utstein template for uniform reporting of 37 38 data following major trauma: a joint revision by SCANTEM, TARN, DGU TR and RITG. 39 40 41 Scand J Trauma Resusc Emerg Med 2008;16:7. 42 on September 30, 2021 by guest. Protected copyright. 43 12 Sundnes KO. Health disaster management: guidelines for evaluation and research in the 44 45 Utstein style: executive summary. Task Force on Quality Control of Disaster Management. 46 47 Prehosp Disaster Med 1999;14:43 52. 48 49 50 13 Debacker M, Hubloue I, Dhondt E, et al. Utstein style template for uniform data reporting 51 52 of acute medical response in disasters. PLoS Curr 2012;4:e4f6cf3e8df15a. 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 12 Page 13 of 42 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 14 Fevang E, Lockey D, Thompson J, et al. The top five research priorities in physician 4 5 provided pre hospital critical care: a consensus report from a European research collaboration. 6 7 Scand J Trauma Resusc Emerg Med 2011;19:57. 8 9 10 15 Mackway Jones K, Carley S. An international expert delphi study to determine research 11 12 needs in major incident management. Prehosp Disaster Med 2012;27:351 8. 13 14 16 Ranse J, Hutton A. Minimum data set for mass gathering health research and evaluation: a 15 For peer review only 16 discussion paper. Prehosp Disaster Med 2012;27:1 8. 17 18 17 Legemaate GA, Burkle FM, Jr., Bierens JJ. The evaluation of research methods during 19 20 21 disaster exercises: applicability for improving disaster health management. Prehosp Disaster 22 23 Med 2012;27:18 26. 24 25 18 Radestad M, Nilsson H, Castren M, et al. Combining performance and outcome indicators 26 27 can be used in a standardized way: a pilot study of two multidisciplinary, full scale major 28 29 30 aircraft exercises. Scand J Trauma Resusc Emerg Med 2012;20:58. 31 32 19 Clarke M. Evidence Aid from the Asian tsunami to the Wenchuan earthquake. J Evid 33 http://bmjopen.bmj.com/ 34 Based Med 2008;1:9 11. 35 36 20 Whiting P, Harbord R, Kleijnen J. No role for quality scores in systematic reviews of 37 38 diagnostic accuracy studies. BMC Med Res Methodol 2005;5:19. 39 40 41 21 Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and 42 on September 30, 2021 by guest. Protected copyright. 43 meta analyses: the PRISMA statement. PLoS Med 2009;6:e1000097. 44 45 22 Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic 46 47 reviews and meta analyses of studies that evaluate health care interventions: explanation and 48 49 50 elaboration. PLoS Med 2009;6:e1000100. 51 52 23 Anderson PB. A comparative analysis of the emergency medical services and rescue 53 54 responses to eight airliner crashes in the United States, 1987 1991. Prehosp Disaster Med 55 56 1995;10:142 53. 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 13 BMJ Open Page 14 of 42 BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 24 Bloch YH, Schwartz D, Pinkert M, et al. Distribution of casualties in a mass casualty 4 5 incident with three local hospitals in the periphery of a densely populated area: lessons 6 7 learned from the medical management of a terrorist attack. Prehosp Disaster Med 8 9 10 2007;22:186 92. 11 12 25 Leiba A, Schwartz D, Eran T, et al. DISAST CIR: Disastrous incidents systematic analysis 13 14 through components, interactions and results: application to a large scale train accident. J 15 For peer review only 16 Emerg Med 2009;37:46 50. 17 18 26 Schwartz D, Bar Dayan Y. Injury patterns in clashes between citizens and security forces 19 20 21 during forced evacuation. Emerg Med J 2008;25:695 8. 22 23 27 Schwartz D, Ostfeld I, Bar Dayan Y. A single, improvised "Kassam" rocket explosion can 24 25 cause a mass casualty incident: a potential threat for future international terrorism? Emerg 26 27 Med J 2009;26:293 8. 28 29 30 28 Raiter Y, Farfel A, Lehavi O, et al. Mass casualty incident management, triage, injury 31 32 distribution of casualties and rate of arrival of casualties at the hospitals: lessons from a 33 http://bmjopen.bmj.com/ 34 suicide bomber attack in downtown Tel Aviv. Emerg Med J 2008;25:225 9. 35 36 29 Pinkert M, Lehavi O, Goren OB, et al. Primary triage, evacuation priorities, and rapid 37 38 primary distribution between adjacent hospitals lessons learned from a suicide bomber attack 39 40 41 in downtown Tel Aviv. Prehosp Disaster Med 2008;23:337 41. 42 on September 30, 2021 by guest. Protected copyright. 43 30 Pinkert M, Leiba A, Zaltsman E, et al. The significance of a small, level 3 'semi 44 45 evacuation' hospital in a terrorist attack in a nearby town. Disasters 2007;31:227 35. 46 47 31 Ingrassia PL, Prato F, Geddo A, et al. Evaluation of medical management during a mass 48 49 50 casualty incident exercise: an objective assessment tool to enhance direct observation. J 51 52 Emerg Med 2010;39:629 36. 53 54 32 Juffermans J, Bierens JJ. Recurrent medical response problems during five recent disasters 55 56 in the Netherlands. Prehosp Disaster Med 2010;25:127 36. 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 14 Page 15 of 42 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 33 Lennquist S. Protocol for Reports from Major Accidents and Disasters in the International 4 5 Journal of Disaster Medicine. Eur J Trauma Emerg Surg 2008;34:486 92. 6 7 34 Gryth D, Radestad M, Nilsson H, et al. Evaluation of medical command and control using 8 9 10 performance indicators in a full scale, major aircraft accident exercise. Prehosp Disaster Med 11 12 2010;25:118 23. 13 14 35 Schwartz D, Pinkert M, Leiba A, et al. Significance of a Level 2, "selective, secondary 15 For peer review only 16 evacuation" hospital during a peripheral town terrorist attack. Prehosp Disaster Med 17 18 2007;22:59 66. 19 20 21 36 Green GB, Modi S, Lunney K, et al. Generic evaluation methods for disaster drills in 22 23 developing countries. Ann Emerg Med 2003;41:689 99. 24 25 37 Kulling P, Birnbaum M, Murray V, et al. Guidelines for reports on health crises and 26 27 critical health events. Prehosp Disaster Med 2010;25:377 83. 28 29 30 38 Ricci E, Pretto E. Assessment of Prehospital and Hospital Response in Disaster. Crit Care 31 32 Clin 1991;7:471 84. 33 http://bmjopen.bmj.com/ 34 39 Ruter A, P. Wiström, T. Performance Indicators for Major Incident Medical Management 35 36 A Possible Tool for Quality Control? Int J Disaster Med 2004;2:52 5. 37 38 40 Lennquist S. Protocol for reports from major accidents and disasters in the International 39 40 41 Journal of Disaster Medicine. Int J Disaster Med 2003;1:79 86. 42 on September 30, 2021 by guest. Protected copyright. 43 41 Lennquist S. Protocol for reports from major accidents and disasters in the International 44 45 Journal of Disaster Medicine. Int J Disaster Med 2004;2:57 64. 46 47 42 Backman K, Albertsson P, Petterson S, et al. Protocol from the coach crash in Ängelsberg, 48 49 50 Sweden January 2003. Int J Disaster Med 2004;2:93 104. 51 52 43 Dami F, Fuchs V, Peclard E, et al. Coordination of emergency medical services for a major 53 54 road traffic accident on a Swiss suburban highway. Eur J Trauma Emerg Surg. 2009;35:265 55 56 70. 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 15 BMJ Open Page 16 of 42 BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 44 Marres GMH, Eijk JVD. Evaluation of admissions to the Major Incident Hospital based on 4 5 standardized protocol. Eur J Trauma Emerg Surg 2011;37:19 29. 6 7 45 Lennquist S. Introduction to the second “Focus on” Disaster and Military Surgery. Eur J 8 9 10 Trauma Emerg Surg 2009;35:199 200. 11 12 46 France JM, Nichols D, Dong S: Increasing emergency medicine residents´ confidence 13 14 in disaster management: use of an Emergency Department simulator and an expedited 15 For peer review only 16 curriculum. Prehosp Disaster Med 2012;27:31 35. 17 18 47 Rüter A, Örtenwall P, Wikström T. Performance indicators for prehospital command and 19 20 21 control in training of medical first responders. Int J Disaster Med 2004;2:89 92. 22 23 48 Rüter A, Wikstrom T. Improved staff procedyre skills lead to improved management 24 25 skills: an observational study in an educational setting. Prehosp Disaster Med 2009;24:376 26 27 379. 28 29 30 49 Rüter A, Nilsson H, Vilkström T. Performance indicators as quality control for testing and 31 32 evaluating hospital management groups: a pilot study. Prehosp Disast Med 2006;21:423 426. 33 http://bmjopen.bmj.com/ 34 50 Rüter A, Vikström A. Indicateurs de performance: De la théorie a la pratique. Approche 35 36 scientifique à propos de la medicine de catastrophe. Urgence Pratique. 2009;93:41 44. 37 38 39 40 41 42 on September 30, 2021 by guest. Protected copyright. 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 16 Page 17 of 42 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 Systematic literature review of templates for reporting pre-hospital 4 5 major incident medical management 6 7 8 9 10 Sabina Fattah, MD1, 2. Marius Rehn, MD PhD1, 3, 4. Eirik Reierth, Dr.scient5. 11 2, 6 12 Torben Wisborg, Professor . 13 14 15 1. DepartmentFor of Research peer and Development, review Norwegian Aironly Ambulance Foundation, 16 17 Drøbak, Norway 18 2. Anaesthesia and Critical Care Research Group, Faculty of Health Sciences, University 19 20 of Tromsø, Tromsø, Norway 21 22 3. Field of Pre hospital Critical Care, Network of Medical Sciences, University of 23 Stavanger, Stavanger, Norway 24 25 4. Department of Anaesthesia and Intensive Care, Akershus University Hospital, 26 27 Lørenskog, Norway 28 5. Science and Health Library, University Library of Tromsø, University of Tromsø, 29 30 Tromsø, Norway 31 32 6. Department of Anaesthesiology and Intensive Care, Hammerfest Hospital, Finnmark 33 Health Trust, Hammerfest, Norway http://bmjopen.bmj.com/ 34 35 36 37 38 Corresponding author: 39 40 Sabina Fattah 41 42 Postal address: P.O box 94, 1448 Drøbak, Norway on September 30, 2021 by guest. Protected copyright. 43 E mail: [email protected] 44 45 Telephone: +47 64 90 44 44 46 47 Fax: +47 64 90 44 45 48 49 50 Keywords: Disaster Medicine, Emergencies, Mass Casualty Incidents, Data Collection, 51 52 Health Care Management. 53 54 55 56 Word count – 2339. 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 1 BMJ Open Page 18 of 42 BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 ABSTRACT 4 5 Objective: To identify and describe the content of templates for reporting pre hospital major 6 incident medical management. 7 8 Design: Systematic literature review according to PRISMA guidelines. 9 10 Data sources: PubMed/Medline, EMBASE, Cinahl, Scopus, and Web of Knowledge. Grey 11 literature was also searched. 12 13 Eligibility criteria for selected studies: Templates published after 1 January 1990 and up to 14 15 19 March 2012.For Non English peer language literature,review except Scandinavian; only literature without an 16 available abstract; and literature reporting only psychological aspects were excluded. 17 18 Results: The main database search identified 8497 articles, among which 8389 were excluded 19 20 based on title and abstract. An additional 96 were excluded based on the full text. The 21 remaining 12 articles were included in the analysis. A total of 107 articles were identified in 22 23 the grey literature and excluded. The reference lists for the included articles identified five 24 25 additional articles. A relevant article published after completing the search was also included. 26 In the 18 articles included in the study, 10 different templates or sets of data are described; 27 28 two methodologies for assessing major incident responses, three templates intended for 29 30 reporting from exercises, two guidelines for reporting in medical journals, two analyses of 31 previous disasters, and one Utstein Style template. 32 33 Conclusion: More than one template exists for generating reports. The limitations of the http://bmjopen.bmj.com/ 34 35 existing templates involve internal and external validity, and none of them have been tested 36 for feasibility in real life incidents. 37 38 Trial registration: The review is registered in PROSPERO (registration number: 39 40 CRD42012002051). 41
on September 30, 2021 by guest. Protected copyright. 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 2 Page 19 of 42 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 ARTICLE SUMMARY 4 5 Article focus: 6 Identify templates that enable systematic and uniform reporting of pre hospital major incident 7 8 medical management. 9 10 Appraise the data fields in the included templates regarding internal and external validity. 11 Key messages: 12 13 Templates for reporting major incident medical management exist in different formats, but 14 15 none have beenFor tested for peer feasibility. review only 16 A template for generating reports from the pre hospital phase with clearly defined data 17 18 variables enabling comparative analysis is needed. 19 20 21 Strengths and limitations of the study: 22 23 A systematic review following the PRISMA guidelines. 24 25 The protocol was published and deviations from protocol are revealed in the study report. 26 Only English and Scandinavian language literature was included. 27 28 29 30 The original protocol of the study 31 32 The study protocol is available in BMJ Open [1]. 33 http://bmjopen.bmj.com/ 34 35 INTRODUCTION 36 37 Major incidents, such as natural disasters, accidents, and terrorist attacks, affect millions of 38 lives each year. In 2011, natural disasters alone killed more than 30,000 people and injured 39 40 244 million people worldwide. The 332 natural disasters in 2011 caused the highest economic 41 42 damage ever recorded; Asia was the continent most often hit, followed by the Americas, on September 30, 2021 by guest. Protected copyright. 43 Africa, Europe, and Oceania. This regional distribution of disaster resembles the profile 44 45 observed from 2001 to 2010. Over the last decade, China, the United States, the Philippines, 46 47 India, and Indonesia were the five countries most frequently hit by natural disasters [2]. 48 49 50 51 52 Although disaster medicine can be traced back to the Middle Ages, it has become a distinct 53 54 scientific discipline in only the last 60 years [3]. An evolving trend in disaster medicine calls 55 for improved reporting of major incidents in order to increase the level of science within this 56 57 field [4 9]. Previous expert group processes defined uniform data sets for reporting in both 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 3 BMJ Open Page 20 of 42 BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 emergency medicine in general [10, 11] and in disaster medicine specifically [12, 13]. These 4 5 templates were designated as Utstein style templates after the Norwegian monastery where 6 they were developed. Qualitative research methods have also been used to identify areas 7 8 within pre hospital critical care and major incident management that require further research 9 10 [14, 15]. A recent review identified data from mass gatherings as non uniform and called for 11 consistent data to enable future research [16]. The importance of evaluating disaster exercises 12 13 using pre defined, high quality data has also been discussed as a potential for improving 14 15 disaster healthFor management peer [17] and for reviewcomparing outcomes fromonly different exercises [18]. 16 The analysis of standardized data from previous incidents can allow decision makers to make 17 18 well informed decisions [19]. 19 20 21 22 This systematic review was designed to identify and describe the content of templates for 23 24 reporting pre hospital major incident medical management. The need for a template for 25 26 uniform reporting was assessed based on the findings. To the best of our knowledge, no 27 similar studies have been performed or registered in the Cochrane or Prospero databases. 28 29 30 31 METHODS 32 33 Search strategy http://bmjopen.bmj.com/ 34 35 A systematic literature search was performed to identify templates published after 1 January 36 37 1990 and up to 19 March 2012 [1]. The controlled vocabulary of Medical Subject Headings 38 (MeSH) from PubMed, including subheadings, publication types, and supplementary 39 40 concepts, was used. The search was performed between 24 February 2012 and 19 March 41 42 2012. A systematic search of the grey literature was performed 25 29 June 2012. on September 30, 2021 by guest. Protected copyright. 43 44 45 In the main database search, three sets of entry terms were applied and combined (figure 1). 46 47 The first set of entry terms describes major incidents. The second set of entry terms describes 48 templates. In addition to the MeSH terms in the first two sets, a third set of entry terms with 49 50 free search phrases was included. For the grey literature search, only two sets of entry terms 51 52 were combined [1]. 53 54 55 56 Inclusion criteria 57 − 58 Templates reporting pre hospital major incident medical management. 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 4 Page 21 of 42 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 − Templates published after 1 January 1990 (inclusive) and until the date of the 4 5 literature search. 6 7 8 9 Exclusion criteria 10 − 11 All non English language literature, except Scandinavian. 12 − Literature without an available abstract. 13 14 − Literature reporting only psychological aspects. 15 For peer review only 16 17 18 Deviations from protocol in search strategy 19 20 Combining the three sets of entry terms resulted in 225 individual searches in each database. 21 If any of these individual searches returned more than 700 results, the search was performed 22 23 again with a fourth entry term (disaster prevention) using the Boolean operator AND. 24 25 26 In Scopus, two entry terms, “questionnaires” and “learning”, were excluded due to a large 27 28 number of irrelevant results, and all searches were limited to the subject areas of life sciences, 29 30 health sciences, and physical sciences. Searches in Scopus were further limited to article title, 31 abstract, and keywords. In Web of Knowledge (ISI), all searches were limited to articles and 32 33 reviews. The term “disaster prevention” was used to refine and decrease the number of search http://bmjopen.bmj.com/ 34 35 results in four of the individual searches performed in this database. ProQuest Research 36 Library was excluded as it returned too many irrelevant results and the most relevant subjects 37 38 were covered by the searches performed in PubMed/Medline, Web of Knowledge, and 39 40 Scopus. 41 on September 30, 2021 by guest. Protected copyright. 42 43 The grey literature databases revealed a broad range of quality and searchability. The System 44 45 for Information on Grey Literature in Europe (OpenSIGLE) was excluded due to the need to 46 order the documents from the original source or a library. Only the document title was 47 48 available on the web page, making it impossible to determine which documents to order. 49 50 51 Deviations in the search strategy were necessary in order to make the systematic literature 52 53 review feasible, as a larger number of findings might have made completion of the study 54 55 impossible. 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 5 BMJ Open Page 22 of 42 BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 Search findings 4 5 The search was performed according to the deviations described above. A total of 10,136 6 results from each individual database search were sent to Endnote X5 (Thomson Reuters, 7 8 NY, USA). After removing duplicates, the number of results was 8,497. The grey literature 9 10 search returned 107 results (figure 2). A total of 18 articles were included for data extraction 11 and quality appraisal. 12 13 14 15 Analysis of identifiedFor literature peer review only 16 One author scanned the titles and abstracts of the identified literature. Literature not 17 18 complying with the inclusion criteria was excluded. The full text was obtained for uncertain 19 20 articles, and inclusion was subject to consensus among three of the authors. 21 After data extraction from the included literature, the appraisal was conducted using a 22 23 checklist [20] designed by the authors prior to data collection based on the authors’ 24 25 assumptions of the data relevant to report in a template. The contact authors of articles that 26 provided an e mail address were asked whether the template had been used in real life 27 28 incidents. The reference lists of the included literature were scanned and relevant literature 29 30 included. A quantitative synthesis (meta analysis) was not performed. The Preferred 31 Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines were 32 33 followed [21, 22]. http://bmjopen.bmj.com/ 34 35 36 37 Data extraction 38 39 We extracted 34 data items from each template (figure 3). The data were classified into four 40 41 categories: demographics, incident characteristics, system characteristics, and descriptors of on September 30, 2021 by guest. Protected copyright. 42 patient characteristics. 43 44 45 46 47 Deviations from protocol regarding quality appraisal 48 49 The study protocol proposed to appraise whether the medical outcomes predicted by the 50 templates were valid and to evaluate the outcome of using the templates. Both of these 51 52 questions proved difficult to answer and were removed from the appraisal. 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 6 Page 23 of 42 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 RESULTS 4 5 A total of 12 articles were included from the main database search [23 34], five articles were 6 identified from the literature lists of included articles [35 39], and one relevant article was 7 8 published after the literature search was completed [13] (figure 2). The total 18 articles 9 10 included 10 different templates or guidelines for reporting (table 1). 11 12 13 Table 1 An overview of included literature. 14 15 Anderson, 1995For Debacker peer et DISAST-CIR, review Green only et al, Ingrassia et al, 16 (23) al, 2012 (13) 2007-2008 (24 2003 (36) 2010 (31) 17 30, 35) 18 19 A comparative Utstein style Seven articles Generic Evaluation of 20 analysis of the template for using a template evaluation medical 21 emergency uniform data (DISAST CIR) methods for management 22 medical services reporting of for reporting disaster drills in during a mass 23 and rescue acute medical from mass developing casualty incident 24 25 responses to responses in casualty countries. exercise. 26 eight airliner disaster. incidents. 27 crashes in the Documented in 28 United States, the registry of 29 1987 1991. the Israeli 30 Defence Force 31 Home Front and 32 Ministry of 33 Health. http://bmjopen.bmj.com/ 34 35 36 Retrospective Template for Systematic Systematic Systematic 37 analysis of real future method for method for method for 38 events using a reporting of reporting real reporting from reporting from 39 systematic real incidents. incidents. field exercises. field exercises. 40 method. 41
Juffermans et Kulling et al, Lennquist, 2008 Performance Ricci et al, 1991 on September 30, 2021 by guest. Protected copyright. 42 al, 2010 (32) 2010 (37) (33) indicators, (38) 43 44 2004, 2010 (34, 45 39) 46 47 Recurrent Guidelines for Protocol for An evaluation Assessment of 48 medical response report on Reports from tool for reporting Prehospital and 49 problems during health crisis Major Accidents major incident Hospital 50 five recent and critical and Disasters in medical Response in 51 disasters in the health events. the International management Disasters. 52 Netherlands. Journal of from disaster 53 54 Disaster exercises. 55 Medicine. 56 57 Retrospective Guidelines for Guideline for Systematic Guidelines for 58 analysis of real systematic systematic method for systematic 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 7 BMJ Open Page 24 of 42 BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 events using a reporting from reporting from reporting from reporting from 4 systematic real incidents. real incidents. field exercises. real incidents. 5 method. 6 7 8 9 Data extraction 10 Six of the 10 templates contained other pre event information, such as climate, child mortality 11 12 rate, and descriptions of hazards. Seven of the 10 templates contained other incident 13 14 information, such as a description of the incident. All templates included more system 15 characteristicsFor than what peerwe extracted, includingreview on site medical only care, distribution of 16 17 casualties, independent action by medical disaster response personnel, continuation of day to 18 19 day care, and decision flow and information management. Seven templates contained other 20 descriptors of patient characteristics, such as different triage systems used, description of 21 22 psychological reactions, and morbidity using hospital data. 23 24 25 26 Quality appraisal 27 28 The appraisal using a pre defined checklist is shown in Figure 4. The first five questions 29 30 regarding internal validity indicated that two of the templates contained none of the data we 31 were looking for, four templates contained one of the data items we found relevant, and the 32 33 remaining four templates included three or more data items included on our list of desirable http://bmjopen.bmj.com/ 34 35 information. The 11 items regarding external validity were also heterogeneous in regarding to 36 which and how many of the items each template contained. 37 38 39 40 Use of templates 41 42 We succeeded in contacting the authors of seven templates. According to the authors, five of on September 30, 2021 by guest. Protected copyright. 43 44 these templates were used in other publications, and one is currently being used to 45 retrospectively evaluate disaster management. DISAST CIR [24 30, 35] is routinely used to 46 47 report each mass casualty incident in the registry of the Israeli Defence Force Home Front and 48 49 Ministry of Health. Two of the templates [31, 34, 39] are routinely used for reporting from 50 exercises. Guidelines for reporting health crises and critical health events [37] have been used 51 52 to report international disasters, but these publications were not available as official 53 54 publications at the time of correspondence with the authors. The protocol for reports of major 55 accidents and disasters [33] was also published previously in the International Journal of 56 57 Disaster Medicine [40, 41]. This protocol has been used for reports in the International 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 8 Page 25 of 42 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 Journal of Disaster Medicine [42] and the European Journal of Trauma and Emergency 4 5 Surgery [43, 44]. The protocol was also mentioned in an editorial in the European Journal of 6 Trauma and Emergency Surgery [45]. Performance indicators for major incident medical 7 8 management [34, 39] has also been used in additional publications [18, 46 50]. 9 10 11 12 DISCUSSION 13 We identified 10 templates for reporting pre hospital major incident medical management that 14 15 were heterogeneousFor with peerregards to the datareview they reported. The onlyquality appraisal revealed that, 16 17 for most of the templates, the methodology for developing them was not clearly explained. In 18 addition, the data variables were not clearly defined for all templates, and the rationale for 19 20 choosing the data variables was only explained for half of the templates. Only three of the 21 22 articles describe the handling of missing data and two depict whether an ethics committee 23 approved the templates. All of these factors are important for internal validity, but the results 24 25 were also heterogeneous for external validity. We chose to interpret that the template was 26 27 developed in the region affiliated with the authors, though this was not specified. Only two 28 templates stated where it was intended to be used. None of the articles discussed the clinical 29 30 credibility of the template, and no feasibility studies have been performed. In all cases, the use 31 32 of the template as a tool for evaluation was mentioned. 33 http://bmjopen.bmj.com/ 34 35 Data variables for reporting should be uniformly defined in order to improve research and 36 37 allow scientific development. Templates should be pre approved by ethics committees to 38 allow immediate reporting and rapid dissemination of data on the potential for improvement. 39 40 For a template to be used, it needs to be both clinically credible and feasible. Ideally, if a 41 42 template is to be used in a specific region, it should be developed together with experts from on September 30, 2021 by guest. Protected copyright. 43 that region; if this is not possible, feasibility studies regarding regional differences should be 44 45 performed. Representatives directly involved in responding to or managing the major incident 46 47 should be the ones reporting it, and these individuals should have in depth local knowledge. 48 The ultimate goal of reporting should be an evaluation of the response and identification of 49 50 areas for improvement, enabling those responsible in similar settings to improve their 51 52 preparedness. For this kind of evaluation to occur, comparable, standardized reports that 53 allow for research need to be published. Thus far, reporting on the scale needed for 54 55 comparisons has not been achieved. 56 57 58 Limitations 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 9 BMJ Open Page 26 of 42 BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 Not all of the included literature was intended for prospectively reporting real life incidents. 4 5 However, in order to not overlook potentially relevant aspects of major incident reporting, the 6 literature aimed to report from exercises [31, 34, 36, 39] and literature using a systematic 7 8 method for reporting in general were included [23, 32]. A clear weakness was that templates 9 10 may exist in other languages than those included. We invite others to identify these templates. 11 Another limitation is that only literature in which an abstract was available was included. 12 13 With more that 8000 articles identified in the search, reviewing full articles at the initial stage 14 15 was not feasible.For Another peer limitation was reviewthat only one author performedonly the initial review of 16 the literature for inclusion. One author performed data extraction and the appraisal and a 17 18 second author checked the results, but this can still allow room for subjective interpretations 19 20 of the content of the templates. The aim of the appraisal was to systematically extract 21 information that the authors thought would be important for reporting major incident medical 22 23 management. 24 25 26 27 28 CONCLUSIONS 29 30 Our findings show that more than one template exists for generating reports. Limitations are 31 32 present in the existing templates regarding internal and external validity, and none of them 33 have been tested for feasibility in real life incidents. Uniform reporting can allow the analysis http://bmjopen.bmj.com/ 34 35 and comparison of medical management for different major incidents and identify areas that 36 37 need improvement. Indirectly, this information can lead to better resource use and improved 38 outcomes for patients and society. The identified templates may be used as a basis for 39 40 designing a template that is specifically aimed at pre hospital medical care and at generating 41 42 reports in such a quantity that comparative analysis can be performed. The work to create on September 30, 2021 by guest. Protected copyright. 43 such a template seems warranted and is now underway. 44 45 46 47 Authors’ contributions 48 SF, MR, and TW conceived the idea and designed the study. ER designed and conducted the 49 50 search strategy for the literature search. SF screened the identified literature. TW, MR, and SF 51 52 considered the eligibility of uncertain literature. SF performed data extraction and quality 53 analysis of the included literature. TW and MR checked these results and were mentors in the 54 55 process. SF, MR, ER, and TW approved the final version of the manuscript. 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 10 Page 27 of 42 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 Competing interests 4 5 The authors declare no competing interests. 6 7 8 Funding 9 10 The Norwegian Air Ambulance employs SF and MR as research fellows. ER and TW 11 12 received departmental funding only. No additional funding was obtained. 13 14 15 Figure legendsFor peer review only 16 17 Figure 1 Search strategy. The two first sets of entry terms consisted of 15 terms each, and the 18 third set of eight free search phrases. Combining these three sets resulted in 225 individual 19 20 searches in each database. 21 22 Figure 2 PRISMA flow diagram depicting the different stages of the systematic literature 23 review. 24 25 Figure 3 Data extraction from included literature. : yes, : no, ?: unclear, : not for all 26 27 incidents, π: only date, Ф: only scaling up. 28 Figure 4 Quality appraisal of the included literature. : yes, : no, ?: unclear, *: study is 29 30 ongoing. 31 32 33 http://bmjopen.bmj.com/ 34 35 REFERENCES 36 1 Fattah S, Rehn M, Reierth E, et al. Templates for reporting pre hospital major incident 37 38 39 medical management: systematic literature review. BMJ Open 2012;2:e001082. 40 41 2 Guha Sapir D, Vos F, Below R, et al. Annual Disaster Statistical Review 2011: The 42 on September 30, 2021 by guest. Protected copyright. 43 Numbers and Trends. Centre for Research on the Epidemiology of Disasters, Brussels, 2012. 44 45 http://cred.be/sites/default/files/2012.07.05.ADSR_2011.pdf (accessed 31.03.2013). 46 47 48 3 Dara SI, Ashton RW, Farmer JC, et al. Worldwide disaster medical response: An historical 49 50 perspective. Crit Care Med 2005;33:S2 S6. 51 52 4 Bradt DA, Aitken P. Disaster medicine reporting: the need for new guidelines and the 53 54 CONFIDE statement. Emerg Med Australas 2010;22:483 7. 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 11 BMJ Open Page 28 of 42 BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 5 Stratton SJ. Use of structured observational methods in disaster research: "Recurrent 4 5 medical response problems in five recent disasters in the Netherlands". Prehosp Disaster Med 6 7 2010;25:137 8. 8 9 10 6 Stratton SJ. The Utstein style Template for uniform data reporting of acute medical 11 12 response in disasters. Prehosp Disaster Med 2012;27:219. 13 14 7 Castren M, Hubloue I, Debacker M. Improving the science and evidence for the medical 15 For peer review only 16 management of disasters: Utstein style. Eur J Emerg Med 2012;19:275 6. 17 18 8 Lockey DJ. The shootings in Oslo and Utoya island July 22, 2011: lessons for the 19 20 21 International EMS community. Scand J Trauma Resusc Emerg Med 2012;20:4. 22 23 9 Lennquist S. Introduction to the third "Focus on" issue specially devoted to papers within 24 25 the field of the ESTES section for Disaster and Military Surgery. Eur J Trauma Emerg Surg 26 27 2011;37:1 2. 28 29 30 10 Langhelle A, Nolan J, Herlitz J, et al. Recommended guidelines for reviewing, reporting, 31 32 and conducting research on post resuscitation care: the Utstein style. Resuscitation 33 http://bmjopen.bmj.com/ 34 2005;66:271 83. 35 36 11 Ringdal KG, Coats TJ, Lefering R, et al. The Utstein template for uniform reporting of 37 38 data following major trauma: a joint revision by SCANTEM, TARN, DGU TR and RITG. 39 40 41 Scand J Trauma Resusc Emerg Med 2008;16:7. 42 on September 30, 2021 by guest. Protected copyright. 43 12 Sundnes KO. Health disaster management: guidelines for evaluation and research in the 44 45 Utstein style: executive summary. Task Force on Quality Control of Disaster Management. 46 47 Prehosp Disaster Med 1999;14:43 52. 48 49 50 13 Debacker M, Hubloue I, Dhondt E, et al. Utstein style template for uniform data reporting 51 52 of acute medical response in disasters. PLoS Curr 2012;4:e4f6cf3e8df15a. 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 12 Page 29 of 42 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 14 Fevang E, Lockey D, Thompson J, et al. The top five research priorities in physician 4 5 provided pre hospital critical care: a consensus report from a European research collaboration. 6 7 Scand J Trauma Resusc Emerg Med 2011;19:57. 8 9 10 15 Mackway Jones K, Carley S. An international expert delphi study to determine research 11 12 needs in major incident management. Prehosp Disaster Med 2012;27:351 8. 13 14 16 Ranse J, Hutton A. Minimum data set for mass gathering health research and evaluation: a 15 For peer review only 16 discussion paper. Prehosp Disaster Med 2012;27:1 8. 17 18 17 Legemaate GA, Burkle FM, Jr., Bierens JJ. The evaluation of research methods during 19 20 21 disaster exercises: applicability for improving disaster health management. Prehosp Disaster 22 23 Med 2012;27:18 26. 24 25 18 Radestad M, Nilsson H, Castren M, et al. Combining performance and outcome indicators 26 27 can be used in a standardized way: a pilot study of two multidisciplinary, full scale major 28 29 30 aircraft exercises. Scand J Trauma Resusc Emerg Med 2012;20:58. 31 32 19 Clarke M. Evidence Aid from the Asian tsunami to the Wenchuan earthquake. J Evid 33 http://bmjopen.bmj.com/ 34 Based Med 2008;1:9 11. 35 36 20 Whiting P, Harbord R, Kleijnen J. No role for quality scores in systematic reviews of 37 38 diagnostic accuracy studies. BMC Med Res Methodol 2005;5:19. 39 40 41 21 Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and 42 on September 30, 2021 by guest. Protected copyright. 43 meta analyses: the PRISMA statement. PLoS Med 2009;6:e1000097. 44 45 22 Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic 46 47 reviews and meta analyses of studies that evaluate health care interventions: explanation and 48 49 50 elaboration. PLoS Med 2009;6:e1000100. 51 52 23 Anderson PB. A comparative analysis of the emergency medical services and rescue 53 54 responses to eight airliner crashes in the United States, 1987 1991. Prehosp Disaster Med 55 56 1995;10:142 53. 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 13 BMJ Open Page 30 of 42 BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 24 Bloch YH, Schwartz D, Pinkert M, et al. Distribution of casualties in a mass casualty 4 5 incident with three local hospitals in the periphery of a densely populated area: lessons 6 7 learned from the medical management of a terrorist attack. Prehosp Disaster Med 8 9 10 2007;22:186 92. 11 12 25 Leiba A, Schwartz D, Eran T, et al. DISAST CIR: Disastrous incidents systematic analysis 13 14 through components, interactions and results: application to a large scale train accident. J 15 For peer review only 16 Emerg Med 2009;37:46 50. 17 18 26 Schwartz D, Bar Dayan Y. Injury patterns in clashes between citizens and security forces 19 20 21 during forced evacuation. Emerg Med J 2008;25:695 8. 22 23 27 Schwartz D, Ostfeld I, Bar Dayan Y. A single, improvised "Kassam" rocket explosion can 24 25 cause a mass casualty incident: a potential threat for future international terrorism? Emerg 26 27 Med J 2009;26:293 8. 28 29 30 28 Raiter Y, Farfel A, Lehavi O, et al. Mass casualty incident management, triage, injury 31 32 distribution of casualties and rate of arrival of casualties at the hospitals: lessons from a 33 http://bmjopen.bmj.com/ 34 suicide bomber attack in downtown Tel Aviv. Emerg Med J 2008;25:225 9. 35 36 29 Pinkert M, Lehavi O, Goren OB, et al. Primary triage, evacuation priorities, and rapid 37 38 primary distribution between adjacent hospitals lessons learned from a suicide bomber attack 39 40 41 in downtown Tel Aviv. Prehosp Disaster Med 2008;23:337 41. 42 on September 30, 2021 by guest. Protected copyright. 43 30 Pinkert M, Leiba A, Zaltsman E, et al. The significance of a small, level 3 'semi 44 45 evacuation' hospital in a terrorist attack in a nearby town. Disasters 2007;31:227 35. 46 47 31 Ingrassia PL, Prato F, Geddo A, et al. Evaluation of medical management during a mass 48 49 50 casualty incident exercise: an objective assessment tool to enhance direct observation. J 51 52 Emerg Med 2010;39:629 36. 53 54 32 Juffermans J, Bierens JJ. Recurrent medical response problems during five recent disasters 55 56 in the Netherlands. Prehosp Disaster Med 2010;25:127 36. 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 14 Page 31 of 42 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 33 Lennquist S. Protocol for Reports from Major Accidents and Disasters in the International 4 5 Journal of Disaster Medicine. Eur J Trauma Emerg Surg 2008;34:486 92. 6 7 34 Gryth D, Radestad M, Nilsson H, et al. Evaluation of medical command and control using 8 9 10 performance indicators in a full scale, major aircraft accident exercise. Prehosp Disaster Med 11 12 2010;25:118 23. 13 14 35 Schwartz D, Pinkert M, Leiba A, et al. Significance of a Level 2, "selective, secondary 15 For peer review only 16 evacuation" hospital during a peripheral town terrorist attack. Prehosp Disaster Med 17 18 2007;22:59 66. 19 20 21 36 Green GB, Modi S, Lunney K, et al. Generic evaluation methods for disaster drills in 22 23 developing countries. Ann Emerg Med 2003;41:689 99. 24 25 37 Kulling P, Birnbaum M, Murray V, et al. Guidelines for reports on health crises and 26 27 critical health events. Prehosp Disaster Med 2010;25:377 83. 28 29 30 38 Ricci E, Pretto E. Assessment of Prehospital and Hospital Response in Disaster. Crit Care 31 32 Clin 1991;7:471 84. 33 http://bmjopen.bmj.com/ 34 39 Ruter A, P. Wiström, T. Performance Indicators for Major Incident Medical Management 35 36 A Possible Tool for Quality Control? Int J Disaster Med 2004;2:52 5. 37 38 40 Lennquist S. Protocol for reports from major accidents and disasters in the International 39 40 41 Journal of Disaster Medicine. Int J Disaster Med 2003;1:79 86. 42 on September 30, 2021 by guest. Protected copyright. 43 41 Lennquist S. Protocol for reports from major accidents and disasters in the International 44 45 Journal of Disaster Medicine. Int J Disaster Med 2004;2:57 64. 46 47 42 Backman K, Albertsson P, Petterson S, et al. Protocol from the coach crash in Ängelsberg, 48 49 50 Sweden January 2003. Int J Disaster Med 2004;2:93 104. 51 52 43 Dami F, Fuchs V, Peclard E, et al. Coordination of emergency medical services for a major 53 54 road traffic accident on a Swiss suburban highway. Eur J Trauma Emerg Surg. 2009;35:265 55 56 70. 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 15 BMJ Open Page 32 of 42 BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 44 Marres GMH, Eijk JVD. Evaluation of admissions to the Major Incident Hospital based on 4 5 standardized protocol. Eur J Trauma Emerg Surg 2011;37:19 29. 6 7 45 Lennquist S. Introduction to the second “Focus on” Disaster and Military Surgery. Eur J 8 9 10 Trauma Emerg Surg 2009;35:199 200. 11 12 46 France JM, Nichols D, Dong S: Increasing emergency medicine residents´ confidence 13 14 in disaster management: use of an Emergency Department simulator and an expedited 15 For peer review only 16 curriculum. Prehosp Disaster Med 2012;27:31 35. 17 18 47 Rüter A, Örtenwall P, Wikström T. Performance indicators for prehospital command and 19 20 21 control in training of medical first responders. Int J Disaster Med 2004;2:89 92. 22 23 48 Rüter A, Wikstrom T. Improved staff procedyre skills lead to improved management 24 25 skills: an observational study in an educational setting. Prehosp Disaster Med 2009;24:376 26 27 379. 28 29 30 49 Rüter A, Nilsson H, Vilkström T. Performance indicators as quality control for testing and 31 32 evaluating hospital management groups: a pilot study. Prehosp Disast Med 2006;21:423 426. 33 http://bmjopen.bmj.com/ 34 50 Rüter A, Vikström A. Indicateurs de performance: De la théorie a la pratique. Approche 35 36 scientifique à propos de la medicine de catastrophe. Urgence Pratique. 2009;93:41 44. 37 38 39 40 41 42 on September 30, 2021 by guest. Protected copyright. 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 16 Page 33 of 42 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 For peer review only 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 http://bmjopen.bmj.com/ 34 35 36 37 38 39 40 41 42 on September 30, 2021 by guest. Protected copyright. 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
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foreach meta ) ) For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 2 Describe sources Describe of funding for systematic the review support and (e.g., other supply of data); role of funders for the systematic review. Provide a a Provide general interpretationof the results thecontext in of other evidence, and implications for future research. Discussstudy limitations at and outcome(e.g., level risk review-level ofand at bias), (e.g., incomplete retrieval of identifiedresearch, reporting bias). Summarizethe main findings the strengthincluding ofevidencefor main each outcome; their consider relevance to Give results ofresults Give additional analyses, if (e.g.,done sensitivity subgroupor analyses, meta-regression Item [see 16]). Present results Present of any assessmentof risk across of (see Itembias studies 15). Present results Present of each meta-analysis done, including confidence intervalsand measures of consistency. For all outcomes Forall considered(benefits harms),or for study: each present, (a) simple summary datafor each groupintervention (b) effectestimates confidence and intervals, forest ideally witha plot. Present Present dataon risk of ofstudy and, each bias ifavailable, outcome any assessmentlevel (see item 12). For each study, Foreach present characteristics for which data extracted were (e.g., study PICOS,follow-upsize, period) and citations. provide the Give numbersGive screened,of studies assessed for eligibility, and includedin the review, reasons with for exclusions at stage, each flow ideally witha diagram. Describe methods Describe of additional analyses (e.g., sensitivity subgroupor analyses, meta-regression),if indicating done, Specify Specify assessment any riskofthat may bias cumulative affectof evidence(e.g., the publication bias,selective studies).reporting within Checklist item item Checklist Describe the Describe methods of handling dataand combining ofresults studies, if done, includingmeasures of consistency I (e.g., key groups key (e.g., healthcare providers, users, and policymakers). For prewhich were peer review only
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PRISMA2009 ChecklistPRISMA 2009 Checklist PRISMA2009 ChecklistPRISMA 2009 Checklist
Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(6): e1000097. From: Funding Funding FUNDING FUNDING Conclusions Limitations Summaryof evidence 24 DISCUSSION DISCUSSION Riskacross of bias studies 22 Synthesisof results Results of Results individual studies 20 Riskstudies within of bias 19 Study characteristics Study 18 Study selection Study RESULTS RESULTS Riskacross of bias studies 15 Section/topic Section/topic Synthesisof results doi:10.1371/journal.pmed1000097 doi:10.1371/journal.pmed1000097 Additional Additional analysis Additional Additional analyses Page 41 of 42 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from Page 42 of . . - statement.org
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Systematic literature review of templates for reporting pre- hospital major incident medical management
ForJournal: peerBMJ Open review only Manuscript ID: bmjopen-2013-002658.R2
Article Type: Research
Date Submitted by the Author: 25-Jun-2013
Complete List of Authors: Fattah, Sabina; Norwegian Air Ambulance Foundation, Department of Research and Development,; University of Tromsø, Anaesthesia and Critical Care Research Group, Faculty of Health Sciences, Rehn, Marius; Norwegian Air Ambulance Foundation, Department of Research and Development; Akershus University Hospital, Department of Anaesthesia and Intensive Care, Reierth, Eirik; University of Tromsø, University Library of Tromsø, Science and Health Library, Wisborg, Torben; University of Tromsø, Anaesthesia and Critical Care Research Group, Faculty of Health Sciences,; Finnmark Health Trust, Hammerfest Hospital, Department of Anaesthesiology and Intensive Care,
Primary Subject Emergency medicine Heading: http://bmjopen.bmj.com/ Secondary Subject Heading: Anaesthesia, Medical management, Evidence based practice
Disaster Medicine, Emergencies, Major Incidents, Mass Casualty Incidents, Keywords: Data Collection, Health Care Management
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1 2 3 Systematic literature review of templates for reporting pre-hospital 4 5 major incident medical management 6 7 8 9 10 Sabina Fattah, MD1, 2. Marius Rehn, Associate professor 1, 3, 4. Eirik Reierth, Dr.scient5. 11 2, 6 12 Torben Wisborg, Professor . 13 14 15 1. DepartmentFor of Research peer and Development, review Norwegian Aironly Ambulance Foundation, 16 17 Drøbak, Norway 18 2. Anaesthesia and Critical Care Research Group, Faculty of Health Sciences, University 19 20 of Tromsø, Tromsø, Norway 21 22 3. Field of Pre hospital Critical Care, Network of Medical Sciences, University of 23 Stavanger, Stavanger, Norway 24 25 4. Department of Anaesthesia and Intensive Care, Akershus University Hospital, 26 27 Lørenskog, Norway 28 5. Science and Health Library, University Library of Tromsø, University of Tromsø, 29 30 Tromsø, Norway 31 32 6. Department of Anaesthesiology and Intensive Care, Hammerfest Hospital, Finnmark 33 Health Trust, Hammerfest, Norway http://bmjopen.bmj.com/ 34 35 36 37 38 Corresponding author: 39 40 Sabina Fattah 41 42 Postal address: P.O box 94, 1448 Drøbak, Norway on September 30, 2021 by guest. Protected copyright. 43 E mail: [email protected] 44 45 Telephone: +47 64 90 44 44 46 47 Fax: +47 64 90 44 45 48 49 50 Keywords: Disaster Medicine, Emergencies, Major Incident, Mass Casualty Incidents, Data 51 52 Collection, Health Care Management. 53 54 55 56 Word count – 2652. 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 1 BMJ Open Page 2 of 39 BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 ABSTRACT 4 5 Objective: To identify and describe the content of templates for reporting pre hospital major 6 incident medical management. 7 8 Design: Systematic literature review according to PRISMA guidelines. 9 10 Data sources: PubMed/Medline, EMBASE, Cinahl, Scopus, and Web of Knowledge. Grey 11 literature was also searched. 12 13 Eligibility criteria for selected studies: Templates published after 1 January 1990 and up to 14 15 19 March 2012.For Non English peer language literature,review except Scandinavian; only literature without an 16 available abstract; and literature reporting only psychological aspects were excluded. 17 18 Results: The main database search identified 8497 articles, among which 8389 were excluded 19 20 based on title and abstract. An additional 96 were excluded based on the full text. The 21 remaining 12 articles were included in the analysis. A total of 107 articles were identified in 22 23 the grey literature and excluded. The reference lists for the included articles identified five 24 25 additional articles. A relevant article published after completing the search was also included. 26 In the 18 articles included in the study, 10 different templates or sets of data are described; 27 28 two methodologies for assessing major incident responses, three templates intended for 29 30 reporting from exercises, two guidelines for reporting in medical journals, two analyses of 31 previous disasters, and one Utstein Style template. 32 33 Conclusion: More than one template exists for generating reports. The limitations of the http://bmjopen.bmj.com/ 34 35 existing templates involve internal and external validity, and none of them have been tested 36 for feasibility in real life incidents. 37 38 Trial registration: The review is registered in PROSPERO (registration number: 39 40 CRD42012002051). 41
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1 2 3 ARTICLE SUMMARY 4 5 Article focus: 6 Identify templates that enable systematic and uniform reporting of pre hospital major incident 7 8 medical management. 9 10 Appraise the data fields in the included templates regarding internal and external validity. 11 Key messages: 12 13 Templates for reporting major incident medical management exist in different formats, but 14 15 none have beenFor tested for peer feasibility. review only 16 A template for generating reports from the pre hospital phase with clearly defined data 17 18 variables enabling comparative analysis is needed. 19 20 21 Strengths and limitations of the study: 22 23 A systematic review following the PRISMA guidelines. 24 25 The protocol was published and deviations from protocol are revealed in the study report. 26 Only English and Scandinavian language literature was included. 27 28 29 30 The original protocol of the study 31 32 The study protocol is available in BMJ Open [1]. 33 http://bmjopen.bmj.com/ 34 35 INTRODUCTION 36 37 Major incidents, such as natural disasters, accidents, and terrorist attacks, affect millions of 38 lives each year. In 2011, natural disasters alone killed more than 30,000 people and injured 39 40 244 million people worldwide. The 332 natural disasters in 2011 caused the highest economic 41 42 damage ever recorded; Asia was the continent most often hit, followed by the Americas, on September 30, 2021 by guest. Protected copyright. 43 Africa, Europe, and Oceania. This regional distribution of disaster resembles the profile 44 45 observed from 2001 to 2010. Over the last decade, China, the United States, the Philippines, 46 47 India, and Indonesia were the five countries most frequently hit by natural disasters [2]. 48 49 50 51 52 Although disaster medicine can be traced back to the Middle Ages, it has become a distinct 53 54 scientific discipline in only the last 60 years [3]. An evolving trend in disaster medicine calls 55 for improved reporting of major incidents in order to increase the level of science within this 56 57 field [4 9]. Previous expert group processes defined uniform data sets for reporting in both 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 3 BMJ Open Page 4 of 39 BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 emergency medicine in general [10, 11] and in disaster medicine specifically [12, 13]. These 4 5 templates were designated as Utstein style templates after the Norwegian monastery where 6 they were developed. Qualitative research methods have also been used to identify areas 7 8 within pre hospital critical care and major incident management that require further research 9 10 [14, 15]. A recent review identified data from mass gatherings as non uniform and called for 11 consistent data to enable future research [16]. The importance of evaluating disaster exercises 12 13 using pre defined, high quality data has also been discussed as a potential for improving 14 15 disaster healthFor management peer [17] and for reviewcomparing outcomes fromonly different exercises [18]. 16 The analysis of standardized data from previous incidents can allow decision makers to make 17 18 well informed decisions [19]. 19 20 21 22 This systematic review was designed to identify and describe the content of templates for 23 24 reporting pre hospital major incident medical management. The questions being asked in this 25 26 systematic review were: which data are reported in the existing templates (data extraction), 27 and are the templates internally and externally valid with regards to the methodology with 28 29 which they were developed and the data they are reporting (quality appraisal)? The need for a 30 31 template for uniform reporting was assessed based on the findings. To the best of our 32 knowledge, no similar studies have been performed or registered in the Cochrane or Prospero 33 http://bmjopen.bmj.com/ 34 databases. 35 36 37 38 METHODS 39 40 Search strategy 41 42 A systematic literature search was performed to identify templates published after 1 January on September 30, 2021 by guest. Protected copyright. 43 1990 and up to 19 March 2012 [1]. The controlled vocabulary of Medical Subject Headings 44 45 (MeSH) from PubMed, including subheadings, publication types, and supplementary 46 47 concepts, was used. The search was performed between 24 February 2012 and 19 March 48 2012. A systematic search of the grey literature was performed 25 29 June 2012. 49 50 51 52 In the main database search, three sets of entry terms were applied and combined (figure 1). 53 The first set of entry terms describes major incidents. The second set of entry terms describes 54 55 templates. In addition to the MeSH terms in the first two sets, a third set of entry terms with 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 4 Page 5 of 39 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 free search phrases was included. For the grey literature search, only two sets of entry terms 4 5 were combined [1]. 6 7 8 9 Inclusion criteria 10 − Templates reporting pre hospital major incident medical management. 11 12 − Templates published after 1 January 1990 (inclusive) and until the date of the 13 14 literature search. 15 For peer review only 16 17 18 Exclusion criteria 19 20 − All non English language literature, except Scandinavian. 21 − Literature without an available abstract. 22 23 − Literature reporting only psychological aspects. 24 25 26 27 Deviations from protocol in search strategy 28 29 Combining the three sets of entry terms resulted in 225 individual searches in each database. 30 31 If any of these individual searches returned more than 700 results, the search was performed 32 again with a fourth entry term (disaster prevention) using the Boolean operator AND (figure 33 http://bmjopen.bmj.com/ 34 1). 35 36 37 In Scopus, two entry terms, “questionnaires” and “learning”, were excluded due to a large 38 39 number of irrelevant results, and all searches were limited to the subject areas of life sciences, 40 41 health sciences, and physical sciences. Searches in Scopus were further limited to article title, on September 30, 2021 by guest. Protected copyright. 42 abstract, and keywords. In Web of Knowledge (ISI), all searches were limited to articles and 43 44 reviews. The term “disaster prevention” was used to refine and decrease the number of search 45 46 results in four of the individual searches performed in this database. ProQuest Research 47 Library was excluded as it returned too many irrelevant results and the most relevant subjects 48 49 were covered by the searches performed in PubMed/Medline, Web of Knowledge, and 50 51 Scopus. 52 53 54 The grey literature databases revealed a broad range of quality and searchability. The System 55 56 for Information on Grey Literature in Europe (OpenSIGLE) was excluded due to the need to 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 5 BMJ Open Page 6 of 39 BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 order the documents from the original source or a library. Only the document title was 4 5 available on the web page, making it difficult to determine which documents to order. 6 7 8 Deviations in the search strategy were necessary in order to make the systematic literature 9 10 review feasible, as a larger number of findings might have made completion of the study 11 impossible. 12 13 14 Search findings 15 The search wasFor performed peer according to thereview deviations described only above. A total of 10,136 16 17 results from each individual database search were sent to Endnote X5 (Thomson Reuters, 18 19 NY, USA). After removing duplicates, the number of results was 8,497. The grey literature 20 search returned 107 results (figure 2). A total of 18 articles were included for data extraction 21 22 and quality appraisal. 23 24 25 26 Analysis of identified literature 27 One author scanned the titles and abstracts of the identified literature. Literature not 28 29 complying with the inclusion criteria was excluded. The full text was obtained for uncertain 30 articles, and inclusion was subject to consensus among three of the authors. Data analysis was 31 32 done according to PICOS methodology (Participants, Interventions, Comparisons, Outcomes, 33 http://bmjopen.bmj.com/ 34 Study design) as described in PRISMA guidelines [21, 22]. In this case the participants were 35 36 all the identified templates for reporting major incident medical management. Our 37 intervention, comparisons and outcomes were carried out using the data extraction and quality 38 39 appraisal variables described in methods and depicted in Figures 3 and 4. From each template 40 41 34 data items were extracted according to a pre defined set of questions described in the study on September 30, 2021 by guest. Protected copyright. 42 protocol [1] (figure 3). These data were classified into four categories: demographics, incident 43 44 characteristics, system characteristics, and descriptors of patient characteristics. After data 45 46 extraction quality appraisal was conducted using a checklist [20] designed by the authors 47 prior to data collection [1] (figure 4). This checklist was based on authors’ assumptions of the 48 49 data relevant to report in a template. One author performed data extraction and quality 50 51 appraisal; the results were checked by a second author. The contact authors of articles that 52 provided an e mail address were asked whether the template had been used in real life 53 54 incidents. The reference lists of the included literature were scanned and relevant literature 55 56 included. A quantitative synthesis (meta analysis) was not performed. The Preferred 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 6 Page 7 of 39 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines were 4 5 followed [21, 22]. 6 7 8 9 10 Deviations from protocol regarding quality appraisal 11 The study protocol proposed to appraise whether the medical outcomes predicted by the 12 13 templates were valid and to evaluate the outcome of using the templates. Both of these 14 questions proved difficult to answer and were removed from the appraisal. 15 For peer review only 16 17 18 RESULTS 19 20 A total of 12 articles were included from the main database search [23 34], five articles were 21 identified from the literature lists of included articles [35 39], and one relevant article was 22 23 published after the literature search was completed [13] (figure 2). The total 18 articles 24 25 included 10 different templates or guidelines for reporting (table 1). 26 27 28 Table 1 An overview of included literature. 29 30 31 32 33 http://bmjopen.bmj.com/ 34 35 36 37 38 39 40 41 42 on September 30, 2021 by guest. Protected copyright. 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 7 BMJ Open Page 8 of 39 BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 4 5 Data extraction 6 The results of data extraction are shown in Figure 3. In addition under each of the four 7 8 categories other information that was not extracted by the pre defined questions was 9 10 registered. Six of the 10 templates contained other pre event information, such as climate, 11 child mortality rate, and descriptions of hazards. Seven of the 10 templates contained other 12 13 incident information, such as a description of the incident. All templates included more 14 15 system characteristicsFor than peer what we extracted, review including on site only medical care, distribution of 16 casualties, independent action by medical disaster response personnel, continuation of day to 17 18 day care, decision flow and information management. Seven templates contained other 19 20 descriptors of patient characteristics, such as different triage systems used, description of 21 psychological reactions, and morbidity using hospital data. 22 23 24 25 Quality appraisal 26 27 The appraisal using a pre defined checklist is shown in Figure 4. The first five questions 28 29 regarding internal validity indicated that two of the templates contained none of the data we 30 were looking for, four templates contained one of the data items we found relevant, and the 31 32 remaining four templates included three or more data items included on our list of desirable 33 http://bmjopen.bmj.com/ 34 information. The 11 items regarding external validity were also heterogeneous in regarding to 35 which and how many of the items each template contained. 36 37 38 39 40 Use of templates 41
We succeeded in contacting the authors of seven templates. According to the authors, five of on September 30, 2021 by guest. Protected copyright. 42 43 these templates [24 30, 31, 33 35, 37, 39] were used in other publications and one [13] is 44 45 currently being used to retrospectively evaluate disaster management. One has not been used 46 in other publications [32]. DISAST CIR [24 30, 35] is routinely used to report each mass 47 48 casualty incident in the registry of the Israeli Defence Force Home Front and Ministry of 49 50 Health. Guidelines for reporting health crises and critical health events [37] have been used to 51 report international disasters, but these publications were not available as official publications 52 53 at the time of correspondence with the authors. The protocol for reports of major accidents 54 55 and disasters [33] was published previously in the International Journal of Disaster Medicine 56 [40, 41] and used for a report in this journal [42]. It has also been used in the European 57 58 Journal of Trauma and Emergency Surgery [43, 44] and mentioned in an editorial in the same 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 8 Page 9 of 39 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 journal [45]. Two of the templates [31, 34, 39] are routinely used for reporting from exercises. 4 5 Data on medical management during a mass casualty incident exercise [31] is normally used 6 to assess the health care system in mass casualty incident simulation and exercise. An online 7 8 registry for the health care system is designed using this instrument. Performance indicators 9 10 for major incident medical management [34, 39] has also been used in additional publications 11 [18, 46 50]. For the three publications lacking author e mail [23, 36, 38] we were unable to 12 13 attain information of whether they have been used. 14 15 For peer review only 16 17 DISCUSSION 18 We identified 10 templates for reporting pre hospital major incident medical management that 19 20 were heterogeneous with regards to the data they reported. The quality appraisal revealed that, 21 22 for most of the templates, the methodology for developing them was not clearly explained. In 23 addition, the data variables were not clearly defined for all templates, and the rationale for 24 25 choosing the data variables was only explained for half of the templates. Only three of the 26 27 articles describe the handling of missing data and two depict whether an ethics committee 28 approved the templates. All of these factors are important for internal validity, but the results 29 30 were also heterogeneous for external validity. We chose to interpret that the template were 31 32 developed in the regions affiliated with the authors, though this was not specified. Only two 33 templates stated in which region they were intended to be used. None of the articles discussed http://bmjopen.bmj.com/ 34 35 the clinical credibility of the template, and no feasibility studies have been performed. In all 36 37 cases, the use of the template as a tool for evaluation was mentioned. 38 39 40 Data extraction and quality appraisal variables were based on the authors assumptions on 41 42 what is important in a template for reporting major incident medical management. Data on September 30, 2021 by guest. Protected copyright. 43 variables for reporting should be uniformly defined in order to improve research and allow 44 45 analysis of data; this is the ideological basis for several previous projects to standardize data 46 47 for scientific use [10 13]. We also believe it is important that templates are pre approved by 48 ethics committees to allow immediate reporting and rapid dissemination of data on the 49 50 potential for improvement. For a template to be used, it needs to be both clinically credible 51 52 and feasible. Ideally, if a template is to be used in a specific region, it ought to be developed 53 together with experts from that region; if this is not possible, feasibility studies regarding 54 55 regional differences could be performed. Reporting should be done by representatives with in 56 57 depth local knowledge and directly involved in responding to or managing the major incident. 58 The ultimate goal of reporting is that an evaluation of the response be undertaken to identify 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 9 BMJ Open Page 10 of 39 BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 areas for improvement, enabling those responsible in similar settings to improve their 4 5 preparedness. For this kind of evaluation to occur, comparable, standardized reports that 6 allow for research need to be published. Thus far, reporting on the scale needed for 7 8 comparisons has not been achieved. 9 10 11 Limitations 12 13 Not all of the included literature was intended for prospectively reporting real life incidents. 14 15 However, in Fororder to not peeroverlook potentially review relevant aspects ofonly major incident reporting, the 16 literature aimed to report from exercises [31, 34, 36, 39] and literature using a systematic 17 18 method for reporting in general were included [23, 32]. A clear weakness was that templates 19 20 may exist in other languages than those included. We invite others to identify these templates. 21 Only literature in which an abstract was available was included, with more that 8000 articles 22 23 identified in the search, reviewing full articles at the initial stage was not feasible. Another 24 25 limitation was that only one author performed the initial review of the literature for inclusion. 26 One author performed data extraction and the appraisal and a second author checked the 27 28 results, but this can still allow room for subjective interpretations of the content of the 29 30 templates. The aim of the appraisal was to systematically extract information that the authors 31 thought would be important for reporting major incident medical management. However, 32 33 neither the data extraction nor the quality appraisal represents a validated set of data or gold http://bmjopen.bmj.com/ 34 35 standard. 36 37 38 39 40 CONCLUSIONS 41 42 Our findings show that more than one template exists for generating reports from the medical on September 30, 2021 by guest. Protected copyright. 43 management of major incidents. Limitations are present in the existing templates regarding 44 45 internal and external validity, and none of them have been tested for feasibility in real life 46 47 incidents. Uniform reporting can allow the analysis and comparison of medical management 48 for different major incidents and identify areas that need improvement. Indirectly, this 49 50 information can lead to better resource use and improved outcomes for patients and society. 51 52 The identified templates may be used as a basis for designing a template that is specifically 53 aimed at pre hospital medical care and at generating reports in such a quantity that 54 55 comparative analysis can be performed. The work to create such a template seems warranted 56 57 and is now underway. 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 10 Page 11 of 39 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 Authors’ contributions 4 5 SF, MR, and TW conceived the idea and designed the study. ER designed and conducted the 6 search strategy for the literature search. SF screened the identified literature. TW, MR, and SF 7 8 considered the eligibility of uncertain literature. SF performed data extraction and quality 9 10 analysis of the included literature. TW and MR checked these results and were mentors in the 11 process. SF, MR, ER, and TW approved the final version of the manuscript. 12 13 14 15 Competing interestsFor peer review only 16 17 The authors declare no competing interests. 18 19 20 Funding 21 22 The Norwegian Air Ambulance employs SF and MR as research fellows. ER and TW 23 received departmental funding only. No additional funding was obtained. 24 25 26 27 Figure legends 28 29 Figure 1 Search strategy. The two first sets of entry terms consisted of 15 terms each, and the 30 third set of eight free search phrases. Combining these three sets resulted in 225 individual 31 32 searches in each database. *If any of the individual searches returned more than 700 results, 33 http://bmjopen.bmj.com/ 34 the search was performed again with a fourth entry term (disaster prevention) using the 35 Boolean operator AND. 36 37 Figure 2 Flow diagram depicting the different stages of the systematic literature review. 38 39 Figure 3 Data extraction from included literature. : yes, : no, ?: unclear, : not for all 40 incidents, π: only date, Ф: only scaling up. MI = major incident. 41 42 Figure 4 Quality appraisal of the included literature. : yes, : no, ?: unclear, *: study is on on September 30, 2021 by guest. Protected copyright. 43 44 going. 45 46 47 48 REFERENCES 49 50 1 Fattah S, Rehn M, Reierth E, et al. Templates for reporting pre hospital major incident 51 52 medical management: systematic literature review. BMJ Open 2012;2:e001082. 53 54 55 2 Guha Sapir D, Vos F, Below R, et al. Annual Disaster Statistical Review 2011: The 56 57 Numbers and Trends. Centre for Research on the Epidemiology of Disasters, Brussels, 2012. 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 11 BMJ Open Page 12 of 39 BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 http://cred.be/sites/default/files/2012.07.05.ADSR_2011.pdf (accessed 31.03.2013). 4 5 3 Dara SI, Ashton RW, Farmer JC, et al. Worldwide disaster medical response: An historical 6 7 perspective. Crit Care Med 2005;33:S2 S6. 8 9 10 4 Bradt DA, Aitken P. Disaster medicine reporting: the need for new guidelines and the 11 12 CONFIDE statement. Emerg Med Australas 2010;22:483 7. 13 14 5 Stratton SJ. Use of structured observational methods in disaster research: "Recurrent 15 For peer review only 16 medical response problems in five recent disasters in the Netherlands". Prehosp Disaster Med 17 18 2010;25:137 8. 19 20 21 6 Stratton SJ. The Utstein style Template for uniform data reporting of acute medical 22 23 response in disasters. Prehosp Disaster Med 2012;27:219. 24 25 7 Castren M, Hubloue I, Debacker M. Improving the science and evidence for the medical 26 27 management of disasters: Utstein style. Eur J Emerg Med 2012;19:275 6. 28 29 30 8 Lockey DJ. The shootings in Oslo and Utoya island July 22, 2011: lessons for the 31 32 International EMS community. Scand J Trauma Resusc Emerg Med 2012;20:4. 33 http://bmjopen.bmj.com/ 34 9 Lennquist S. Introduction to the third "Focus on" issue specially devoted to papers within 35 36 the field of the ESTES section for Disaster and Military Surgery. Eur J Trauma Emerg Surg 37 38 2011;37:1 2. 39 40 41 10 Langhelle A, Nolan J, Herlitz J, et al. Recommended guidelines for reviewing, reporting, 42 on September 30, 2021 by guest. Protected copyright. 43 and conducting research on post resuscitation care: the Utstein style. Resuscitation 44 45 2005;66:271 83. 46 47 11 Ringdal KG, Coats TJ, Lefering R, et al. The Utstein template for uniform reporting of 48 49 50 data following major trauma: a joint revision by SCANTEM, TARN, DGU TR and RITG. 51 52 Scand J Trauma Resusc Emerg Med 2008;16:7. 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 12 Page 13 of 39 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 12 Sundnes KO. Health disaster management: guidelines for evaluation and research in the 4 5 Utstein style: executive summary. Task Force on Quality Control of Disaster Management. 6 7 Prehosp Disaster Med 1999;14:43 52. 8 9 10 13 Debacker M, Hubloue I, Dhondt E, et al. Utstein style template for uniform data reporting 11 12 of acute medical response in disasters. PLoS Curr 2012;4:e4f6cf3e8df15a. 13 14 14 Fevang E, Lockey D, Thompson J, et al. The top five research priorities in physician 15 For peer review only 16 provided pre hospital critical care: a consensus report from a European research collaboration. 17 18 Scand J Trauma Resusc Emerg Med 2011;19:57. 19 20 21 15 Mackway Jones K, Carley S. An international expert delphi study to determine research 22 23 needs in major incident management. Prehosp Disaster Med 2012;27:351 8. 24 25 16 Ranse J, Hutton A. Minimum data set for mass gathering health research and evaluation: a 26 27 discussion paper. Prehosp Disaster Med 2012;27:1 8. 28 29 30 17 Legemaate GA, Burkle FM, Jr., Bierens JJ. The evaluation of research methods during 31 32 disaster exercises: applicability for improving disaster health management. Prehosp Disaster 33 http://bmjopen.bmj.com/ 34 Med 2012;27:18 26. 35 36 18 Radestad M, Nilsson H, Castren M, et al. Combining performance and outcome indicators 37 38 can be used in a standardized way: a pilot study of two multidisciplinary, full scale major 39 40 41 aircraft exercises. Scand J Trauma Resusc Emerg Med 2012;20:58. 42 on September 30, 2021 by guest. Protected copyright. 43 19 Clarke M. Evidence Aid from the Asian tsunami to the Wenchuan earthquake. J Evid 44 45 Based Med 2008;1:9 11. 46 47 20 Whiting P, Harbord R, Kleijnen J. No role for quality scores in systematic reviews of 48 49 50 diagnostic accuracy studies. BMC Med Res Methodol 2005;5:19. 51 52 21 Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and 53 54 meta analyses: the PRISMA statement. PLoS Med 2009;6:e1000097. 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 13 BMJ Open Page 14 of 39 BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 22 Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic 4 5 reviews and meta analyses of studies that evaluate health care interventions: explanation and 6 7 elaboration. PLoS Med 2009;6:e1000100. 8 9 10 23 Anderson PB. A comparative analysis of the emergency medical services and rescue 11 12 responses to eight airliner crashes in the United States, 1987 1991. Prehosp Disaster Med 13 14 1995;10:142 53. 15 For peer review only 16 24 Bloch YH, Schwartz D, Pinkert M, et al. Distribution of casualties in a mass casualty 17 18 incident with three local hospitals in the periphery of a densely populated area: lessons 19 20 21 learned from the medical management of a terrorist attack. Prehosp Disaster Med 22 23 2007;22:186 92. 24 25 25 Leiba A, Schwartz D, Eran T, et al. DISAST CIR: Disastrous incidents systematic analysis 26 27 through components, interactions and results: application to a large scale train accident. J 28 29 30 Emerg Med 2009;37:46 50. 31 32 26 Schwartz D, Bar Dayan Y. Injury patterns in clashes between citizens and security forces 33 http://bmjopen.bmj.com/ 34 during forced evacuation. Emerg Med J 2008;25:695 8. 35 36 27 Schwartz D, Ostfeld I, Bar Dayan Y. A single, improvised "Kassam" rocket explosion can 37 38 cause a mass casualty incident: a potential threat for future international terrorism? Emerg 39 40 41 Med J 2009;26:293 8. 42 on September 30, 2021 by guest. Protected copyright. 43 28 Raiter Y, Farfel A, Lehavi O, et al. Mass casualty incident management, triage, injury 44 45 distribution of casualties and rate of arrival of casualties at the hospitals: lessons from a 46 47 suicide bomber attack in downtown Tel Aviv. Emerg Med J 2008;25:225 9. 48 49 50 29 Pinkert M, Lehavi O, Goren OB, et al. Primary triage, evacuation priorities, and rapid 51 52 primary distribution between adjacent hospitals lessons learned from a suicide bomber attack 53 54 in downtown Tel Aviv. Prehosp Disaster Med 2008;23:337 41. 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 14 Page 15 of 39 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 30 Pinkert M, Leiba A, Zaltsman E, et al. The significance of a small, level 3 'semi 4 5 evacuation' hospital in a terrorist attack in a nearby town. Disasters 2007;31:227 35. 6 7 31 Ingrassia PL, Prato F, Geddo A, et al. Evaluation of medical management during a mass 8 9 10 casualty incident exercise: an objective assessment tool to enhance direct observation. J 11 12 Emerg Med 2010;39:629 36. 13 14 32 Juffermans J, Bierens JJ. Recurrent medical response problems during five recent disasters 15 For peer review only 16 in the Netherlands. Prehosp Disaster Med 2010;25:127 36. 17 18 33 Lennquist S. Protocol for Reports from Major Accidents and Disasters in the International 19 20 21 Journal of Disaster Medicine. Eur J Trauma Emerg Surg 2008;34:486 92. 22 23 34 Gryth D, Radestad M, Nilsson H, et al. Evaluation of medical command and control using 24 25 performance indicators in a full scale, major aircraft accident exercise. Prehosp Disaster Med 26 27 2010;25:118 23. 28 29 30 35 Schwartz D, Pinkert M, Leiba A, et al. Significance of a Level 2, "selective, secondary 31 32 evacuation" hospital during a peripheral town terrorist attack. Prehosp Disaster Med 33 http://bmjopen.bmj.com/ 34 2007;22:59 66. 35 36 36 Green GB, Modi S, Lunney K, et al. Generic evaluation methods for disaster drills in 37 38 developing countries. Ann Emerg Med 2003;41:689 99. 39 40 41 37 Kulling P, Birnbaum M, Murray V, et al. Guidelines for reports on health crises and 42 on September 30, 2021 by guest. Protected copyright. 43 critical health events. Prehosp Disaster Med 2010;25:377 83. 44 45 38 Ricci E, Pretto E. Assessment of Prehospital and Hospital Response in Disaster. Crit Care 46 47 Clin 1991;7:471 84. 48 49 50 39 Ruter A, P. Wiström, T. Performance Indicators for Major Incident Medical Management 51 52 A Possible Tool for Quality Control? Int J Disaster Med 2004;2:52 5. 53 54 40 Lennquist S. Protocol for reports from major accidents and disasters in the International 55 56 Journal of Disaster Medicine. Int J Disaster Med 2003;1:79 86. 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 15 BMJ Open Page 16 of 39 BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 41 Lennquist S. Protocol for reports from major accidents and disasters in the International 4 5 Journal of Disaster Medicine. Int J Disaster Med 2004;2:57 64. 6 7 42 Backman K, Albertsson P, Petterson S, et al. Protocol from the coach crash in Ängelsberg, 8 9 10 Sweden January 2003. Int J Disaster Med 2004;2:93 104. 11 12 43 Dami F, Fuchs V, Peclard E, et al. Coordination of emergency medical services for a major 13 14 road traffic accident on a Swiss suburban highway. Eur J Trauma Emerg Surg. 2009;35:265 15 For peer review only 16 70. 17 18 44 Marres GMH, Eijk JVD. Evaluation of admissions to the Major Incident Hospital based on 19 20 21 standardized protocol. Eur J Trauma Emerg Surg 2011;37:19 29. 22 23 45 Lennquist S. Introduction to the second “Focus on” Disaster and Military Surgery. Eur J 24 25 Trauma Emerg Surg 2009;35:199 200. 26 27 46 France JM, Nichols D, Dong S: Increasing emergency medicine residents´ confidence 28 29 30 in disaster management: use of an Emergency Department simulator and an expedited 31 32 curriculum. Prehosp Disaster Med 2012;27:31 35. 33 http://bmjopen.bmj.com/ 34 47 Rüter A, Örtenwall P, Wikström T. Performance indicators for prehospital command and 35 36 control in training of medical first responders. Int J Disaster Med 2004;2:89 92. 37 38 48 Rüter A, Wikstrom T. Improved staff procedyre skills lead to improved management 39 40 41 skills: an observational study in an educational setting. Prehosp Disaster Med 2009;24:376 42 on September 30, 2021 by guest. Protected copyright. 43 379. 44 45 49 Rüter A, Nilsson H, Vilkström T. Performance indicators as quality control for testing and 46 47 evaluating hospital management groups: a pilot study. Prehosp Disast Med 2006;21:423 426. 48 49 50 50 Rüter A, Vikström A. Indicateurs de performance: De la théorie a la pratique. Approche 51 52 scientifique à propos de la medicine de catastrophe. Urgence Pratique 2009;93:41 44. 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 16 Page 17 of 39 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 For peer review only 16 17 18 19 Figure 1. Search strategy. The two first sets of entry terms consisted of 15 terms each, and the third set of 20 eight free search phrases. Combining these three sets resulted in 225 individual searches in each 21 database. *If any of the individual searches returned more than 700 results, the search was performed 22 again with a fourth entry term (disaster prevention) using the Boolean operator AND. 23 221x76mm (300 x 300 DPI) 24 25 26 27 28 29 30 31 32 33 http://bmjopen.bmj.com/ 34 35 36 37 38 39 40 41 42 on September 30, 2021 by guest. Protected copyright. 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 18 of 39 BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 For peer review only 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 Figure 2. PRISMA flow diagram depicting the different stages of the systematic literature review. 31 280x191mm (300 x 300 DPI) 32 33 http://bmjopen.bmj.com/ 34 35 36 37 38 39 40 41 42 on September 30, 2021 by guest. Protected copyright. 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 19 of 39 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 For peer review only 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 Figure 3 Data extraction from included literature. ✔: yes, ✕: no, ?: unclear, : not for all incidents, π: only 31 date, Ф: only scaling up. MI = major incident. 32 272x187mm (300 x 300 DPI) 33 http://bmjopen.bmj.com/ 34 35 36 37 38 39 40 41 42 on September 30, 2021 by guest. Protected copyright. 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 20 of 39 BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 For peer review only 16 17 18 19 20 21 22 23 24 25 26 27 28 29 Figure 4 Quality appraisal of the included literature. ✔: yes, ✕: no, ?: unclear, *: study is on going. 30 268x172mm (300 x 300 DPI) 31 32 33 http://bmjopen.bmj.com/ 34 35 36 37 38 39 40 41 42 on September 30, 2021 by guest. Protected copyright. 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
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For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml registration registration informationincluding registration number. State the State principal summarymeasures (e.g., risk ratio,means). difference in Describe methods Describe used for assessing risk studies of of bias individual (including specification of this whether was the study at done outcomeor andhow this level), information be usedto is in any datasynthesis. List and define List variables all for data which sought were (e.g., PICOS,fundingsources) any assumptionsand and simplificationsmade. Describe method Describe of dataextraction from reports(e.g., forms, piloted inindependently, duplicate) and any processes forand confirming obtaining datafrom investigators. State the State process for studies selecting (i.e., screening, eligibility, includedin systematic and,if review, applicable, includedin the meta Present full electronicPresent search strategyfor least one at database, including limits any used, such that it could be repeated. Describe all Describe information sources databases (e.g., of with dates coverage, contact study with authors to identify studies) additional in the search and datelast searched. Specify study Specify characteristics PICOS, (e.g., length of follow - Indicate Indicate review if a protocolexists, if andcan it where Webaccessed (e.g.,be address), and, if available, provide Provide anProvide statement explicit of questions being addressedwithreference to participants, interventions,comparisons, outcomes,study and (PICOS). design Describe the Describe rationale for review inthe the context of what already is known. Provide a structured a Provide summary including, asapplicable: background; objectives;datasources; study eligibilitycriteria, participants,and interventions; study appraisal and synthesis methods; results; limitations;conclusions and implicationsoffindings; key systematic registration review number. Identify the Identify report systematic asa meta-analysis, review, both.or Checklist item item Checklist For peer review language, publicationstatus) ascriteria used for eligibility, rationale. giving only
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Summarymeasures Riskindividual in of bias studies Data Data items Data collection Data process 10 Study selection Study Search Search Information sourcesInformation Eligibility criteria Eligibility Protocol and registrationProtocol 5 METHODS METHODS Objectives Objectives Rationale Rationale INTRODUCTION INTRODUCTION Structuredsummary ABSTRACT ABSTRACT Title Title TITLE TITLE Section/topic Section/topic Page 21 of 39 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60
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foreach meta ) ) For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 2 Describe sources Describe of funding for systematic the review support and (e.g., other supply of data); role of funders for the systematic review. Provide a a Provide general interpretationof the results thecontext in of other evidence, and implications for future research. Discussstudy limitations at and outcome(e.g., level risk review-level ofand at bias), (e.g., incomplete retrieval of identifiedresearch, reporting bias). Summarizethe main findings the strengthincluding ofevidencefor main each outcome; their consider relevance to Give results ofresults Give additional analyses, if (e.g.,done sensitivity subgroupor analyses, meta-regression Item [see 16]). Present results Present of any assessmentof risk across of (see Itembias studies 15). Present results Present of each meta-analysis done, including confidence intervalsand measures of consistency. For all outcomes Forall considered(benefits harms),or for study: each present, (a) simple summary datafor each groupintervention (b) effectestimates confidence and intervals, forest ideally witha plot. Present Present dataon risk of ofstudy and, each bias ifavailable, outcome any assessmentlevel (see item 12). For each study, Foreach present characteristics for which data extracted were (e.g., study PICOS,follow-upsize, period) and citations. provide the Give numbersGive screened,of studies assessed for eligibility, and includedin the review, reasons with for exclusions at stage, each flow ideally witha diagram. Describe methods Describe of additional analyses (e.g., sensitivity subgroupor analyses, meta-regression),if indicating done, Specify Specify assessment any riskofthat may bias cumulative affectof evidence(e.g., the publication bias,selective studies).reporting within Checklist item item Checklist Describe the Describe methods of handling dataand combining ofresults studies, if done, includingmeasures of consistency I (e.g., key groups key (e.g., healthcare providers, users, and policymakers). For prewhich were peer review only
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Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(6): e1000097. From: Funding Funding FUNDING FUNDING Conclusions Limitations Summaryof evidence 24 DISCUSSION DISCUSSION Riskacross of bias studies 22 Synthesisof results Results of Results individual studies 20 Riskstudies within of bias 19 Study characteristics Study 18 Study selection Study RESULTS RESULTS Riskacross of bias studies 15 Section/topic Section/topic Synthesisof results doi:10.1371/journal.pmed1000097 doi:10.1371/journal.pmed1000097 Additional Additional analysis Additional Additional analyses 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from . . - statement.org
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For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml For peer review only PRISMA2009 ChecklistPRISMA 2009 Checklist PRISMA2009 ChecklistPRISMA 2009 Checklist Page 23 of 39 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 BMJ Open Page 24 of 39 BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 Systematic literature review of templates for reporting pre-hospital 4 5 major incident medical management 6 7 8 9 10 Sabina Fattah, MD1, 2. Marius Rehn, Associate professor 1, 3, 4. Eirik Reierth, Dr.scient5. 11 2, 6 12 Torben Wisborg, Professor . 13 14 15 1. DepartmentFor of Research peer and Development, review Norwegian Aironly Ambulance Foundation, 16 17 Drøbak, Norway 18 2. Anaesthesia and Critical Care Research Group, Faculty of Health Sciences, University 19 20 of Tromsø, Tromsø, Norway 21 22 3. Field of Pre hospital Critical Care, Network of Medical Sciences, University of 23 Stavanger, Stavanger, Norway 24 25 4. Department of Anaesthesia and Intensive Care, Akershus University Hospital, 26 27 Lørenskog, Norway 28 5. Science and Health Library, University Library of Tromsø, University of Tromsø, 29 30 Tromsø, Norway 31 32 6. Department of Anaesthesiology and Intensive Care, Hammerfest Hospital, Finnmark 33 Health Trust, Hammerfest, Norway http://bmjopen.bmj.com/ 34 35 36 37 38 Corresponding author: 39 40 Sabina Fattah 41 42 Postal address: P.O box 94, 1448 Drøbak, Norway on September 30, 2021 by guest. Protected copyright. 43 E mail: [email protected] 44 45 Telephone: +47 64 90 44 44 46 47 Fax: +47 64 90 44 45 48 49 50 Keywords: Disaster Medicine, Emergencies, Major Incident, Mass Casualty Incidents, Data 51 52 Collection, Health Care Management. 53 54 55 56 Word count – 2652. 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 1 Page 25 of 39 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 ABSTRACT 4 5 Objective: To identify and describe the content of templates for reporting pre hospital major 6 incident medical management. 7 8 Design: Systematic literature review according to PRISMA guidelines. 9 10 Data sources: PubMed/Medline, EMBASE, Cinahl, Scopus, and Web of Knowledge. Grey 11 literature was also searched. 12 13 Eligibility criteria for selected studies: Templates published after 1 January 1990 and up to 14 15 19 March 2012.For Non English peer language literature,review except Scandinavian; only literature without an 16 available abstract; and literature reporting only psychological aspects were excluded. 17 18 Results: The main database search identified 8497 articles, among which 8389 were excluded 19 20 based on title and abstract. An additional 96 were excluded based on the full text. The 21 remaining 12 articles were included in the analysis. A total of 107 articles were identified in 22 23 the grey literature and excluded. The reference lists for the included articles identified five 24 25 additional articles. A relevant article published after completing the search was also included. 26 In the 18 articles included in the study, 10 different templates or sets of data are described; 27 28 two methodologies for assessing major incident responses, three templates intended for 29 30 reporting from exercises, two guidelines for reporting in medical journals, two analyses of 31 previous disasters, and one Utstein Style template. 32 33 Conclusion: More than one template exists for generating reports. The limitations of the http://bmjopen.bmj.com/ 34 35 existing templates involve internal and external validity, and none of them have been tested 36 for feasibility in real life incidents. 37 38 Trial registration: The review is registered in PROSPERO (registration number: 39 40 CRD42012002051). 41
on September 30, 2021 by guest. Protected copyright. 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 2 BMJ Open Page 26 of 39 BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 ARTICLE SUMMARY 4 5 Article focus: 6 Identify templates that enable systematic and uniform reporting of pre hospital major incident 7 8 medical management. 9 10 Appraise the data fields in the included templates regarding internal and external validity. 11 Key messages: 12 13 Templates for reporting major incident medical management exist in different formats, but 14 15 none have beenFor tested for peer feasibility. review only 16 A template for generating reports from the pre hospital phase with clearly defined data 17 18 variables enabling comparative analysis is needed. 19 20 21 Strengths and limitations of the study: 22 23 A systematic review following the PRISMA guidelines. 24 25 The protocol was published and deviations from protocol are revealed in the study report. 26 Only English and Scandinavian language literature was included. 27 28 29 30 The original protocol of the study 31 32 The study protocol is available in BMJ Open [1]. 33 http://bmjopen.bmj.com/ 34 35 INTRODUCTION 36 37 Major incidents, such as natural disasters, accidents, and terrorist attacks, affect millions of 38 lives each year. In 2011, natural disasters alone killed more than 30,000 people and injured 39 40 244 million people worldwide. The 332 natural disasters in 2011 caused the highest economic 41 42 damage ever recorded; Asia was the continent most often hit, followed by the Americas, on September 30, 2021 by guest. Protected copyright. 43 Africa, Europe, and Oceania. This regional distribution of disaster resembles the profile 44 45 observed from 2001 to 2010. Over the last decade, China, the United States, the Philippines, 46 47 India, and Indonesia were the five countries most frequently hit by natural disasters [2]. 48 49 50 51 52 Although disaster medicine can be traced back to the Middle Ages, it has become a distinct 53 54 scientific discipline in only the last 60 years [3]. An evolving trend in disaster medicine calls 55 for improved reporting of major incidents in order to increase the level of science within this 56 57 field [4 9]. Previous expert group processes defined uniform data sets for reporting in both 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 3 Page 27 of 39 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 emergency medicine in general [10, 11] and in disaster medicine specifically [12, 13]. These 4 5 templates were designated as Utstein style templates after the Norwegian monastery where 6 they were developed. Qualitative research methods have also been used to identify areas 7 8 within pre hospital critical care and major incident management that require further research 9 10 [14, 15]. A recent review identified data from mass gatherings as non uniform and called for 11 consistent data to enable future research [16]. The importance of evaluating disaster exercises 12 13 using pre defined, high quality data has also been discussed as a potential for improving 14 15 disaster healthFor management peer [17] and for reviewcomparing outcomes fromonly different exercises [18]. 16 The analysis of standardized data from previous incidents can allow decision makers to make 17 18 well informed decisions [19]. 19 20 21 22 This systematic review was designed to identify and describe the content of templates for 23 24 reporting pre hospital major incident medical management. The questions being asked in this 25 26 systematic review were: which data are reported in the existing templates (data extraction), 27 and are the templates internally and externally valid with regards to the methodology with 28 29 which they were developed and the data they are reporting (quality appraisal)? The need for a 30 31 template for uniform reporting was assessed based on the findings. To the best of our 32 knowledge, no similar studies have been performed or registered in the Cochrane or Prospero 33 http://bmjopen.bmj.com/ 34 databases. 35 36 37 38 METHODS 39 40 Search strategy 41 42 A systematic literature search was performed to identify templates published after 1 January on September 30, 2021 by guest. Protected copyright. 43 1990 and up to 19 March 2012 [1]. The controlled vocabulary of Medical Subject Headings 44 45 (MeSH) from PubMed, including subheadings, publication types, and supplementary 46 47 concepts, was used. The search was performed between 24 February 2012 and 19 March 48 2012. A systematic search of the grey literature was performed 25 29 June 2012. 49 50 51 52 In the main database search, three sets of entry terms were applied and combined (figure 1). 53 The first set of entry terms describes major incidents. The second set of entry terms describes 54 55 templates. In addition to the MeSH terms in the first two sets, a third set of entry terms with 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 4 BMJ Open Page 28 of 39 BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 free search phrases was included. For the grey literature search, only two sets of entry terms 4 5 were combined [1]. 6 7 8 9 Inclusion criteria 10 − Templates reporting pre hospital major incident medical management. 11 12 − Templates published after 1 January 1990 (inclusive) and until the date of the 13 14 literature search. 15 For peer review only 16 17 18 Exclusion criteria 19 20 − All non English language literature, except Scandinavian. 21 − Literature without an available abstract. 22 23 − Literature reporting only psychological aspects. 24 25 26 27 Deviations from protocol in search strategy 28 29 Combining the three sets of entry terms resulted in 225 individual searches in each database. 30 31 If any of these individual searches returned more than 700 results, the search was performed 32 again with a fourth entry term (disaster prevention) using the Boolean operator AND (figure 33 http://bmjopen.bmj.com/ 34 1). 35 36 37 In Scopus, two entry terms, “questionnaires” and “learning”, were excluded due to a large 38 39 number of irrelevant results, and all searches were limited to the subject areas of life sciences, 40 41 health sciences, and physical sciences. Searches in Scopus were further limited to article title, on September 30, 2021 by guest. Protected copyright. 42 abstract, and keywords. In Web of Knowledge (ISI), all searches were limited to articles and 43 44 reviews. The term “disaster prevention” was used to refine and decrease the number of search 45 46 results in four of the individual searches performed in this database. ProQuest Research 47 Library was excluded as it returned too many irrelevant results and the most relevant subjects 48 49 were covered by the searches performed in PubMed/Medline, Web of Knowledge, and 50 51 Scopus. 52 53 54 The grey literature databases revealed a broad range of quality and searchability. The System 55 56 for Information on Grey Literature in Europe (OpenSIGLE) was excluded due to the need to 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 5 Page 29 of 39 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 order the documents from the original source or a library. Only the document title was 4 5 available on the web page, making it difficult to determine which documents to order. 6 7 8 Deviations in the search strategy were necessary in order to make the systematic literature 9 10 review feasible, as a larger number of findings might have made completion of the study 11 impossible. 12 13 14 Search findings 15 The search wasFor performed peer according to thereview deviations described only above. A total of 10,136 16 17 results from each individual database search were sent to Endnote X5 (Thomson Reuters, 18 19 NY, USA). After removing duplicates, the number of results was 8,497. The grey literature 20 search returned 107 results (figure 2). A total of 18 articles were included for data extraction 21 22 and quality appraisal. 23 24 25 26 Analysis of identified literature 27 One author scanned the titles and abstracts of the identified literature. Literature not 28 29 complying with the inclusion criteria was excluded. The full text was obtained for uncertain 30 articles, and inclusion was subject to consensus among three of the authors. Data analysis was 31 32 done according to PICOS methodology (Participants, Interventions, Comparisons, Outcomes, 33 http://bmjopen.bmj.com/ 34 Study design) as described in PRISMA guidelines [21, 22]. In this case the participants were 35 36 all the identified templates for reporting major incident medical management. Our 37 intervention, comparisons and outcomes were carried out using the data extraction and quality 38 39 appraisal variables described in methods and depicted in Figures 3 and 4. From each template 40 41 34 data items were extracted according to a pre defined set of questions described in the study on September 30, 2021 by guest. Protected copyright. 42 protocol [1] (figure 3). These data were classified into four categories: demographics, incident 43 44 characteristics, system characteristics, and descriptors of patient characteristics. After data 45 46 extraction quality appraisal was conducted using a checklist [20] designed by the authors 47 prior to data collection [1] (figure 4). This checklist was based on authors’ assumptions of the 48 49 data relevant to report in a template. One author performed data extraction and quality 50 51 appraisal; the results were checked by a second author. The contact authors of articles that 52 provided an e mail address were asked whether the template had been used in real life 53 54 incidents. The reference lists of the included literature were scanned and relevant literature 55 56 included. A quantitative synthesis (meta analysis) was not performed. The Preferred 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 6 BMJ Open Page 30 of 39 BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines were 4 5 followed [21, 22]. 6 7 8 9 10 Deviations from protocol regarding quality appraisal 11 The study protocol proposed to appraise whether the medical outcomes predicted by the 12 13 templates were valid and to evaluate the outcome of using the templates. Both of these 14 questions proved difficult to answer and were removed from the appraisal. 15 For peer review only 16 17 18 RESULTS 19 20 A total of 12 articles were included from the main database search [23 34], five articles were 21 identified from the literature lists of included articles [35 39], and one relevant article was 22 23 published after the literature search was completed [13] (figure 2). The total 18 articles 24 25 included 10 different templates or guidelines for reporting (table 1). 26 27 28 Table 1 An overview of included literature. 29 30 31 32 33 http://bmjopen.bmj.com/ 34 35 36 37 38 39 40 41 42 on September 30, 2021 by guest. Protected copyright. 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 7 Page 31 of 39 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 4 5 Data extraction 6 The results of data extraction are shown in Figure 3. In addition under each of the four 7 8 categories other information that was not extracted by the pre defined questions was 9 10 registered. Six of the 10 templates contained other pre event information, such as climate, 11 child mortality rate, and descriptions of hazards. Seven of the 10 templates contained other 12 13 incident information, such as a description of the incident. All templates included more 14 15 system characteristicsFor than peer what we extracted, review including on site only medical care, distribution of 16 casualties, independent action by medical disaster response personnel, continuation of day to 17 18 day care, decision flow and information management. Seven templates contained other 19 20 descriptors of patient characteristics, such as different triage systems used, description of 21 psychological reactions, and morbidity using hospital data. 22 23 24 25 Quality appraisal 26 27 The appraisal using a pre defined checklist is shown in Figure 4. The first five questions 28 29 regarding internal validity indicated that two of the templates contained none of the data we 30 were looking for, four templates contained one of the data items we found relevant, and the 31 32 remaining four templates included three or more data items included on our list of desirable 33 http://bmjopen.bmj.com/ 34 information. The 11 items regarding external validity were also heterogeneous in regarding to 35 which and how many of the items each template contained. 36 37 38 39 40 Use of templates 41
We succeeded in contacting the authors of seven templates. According to the authors, five of on September 30, 2021 by guest. Protected copyright. 42 43 these templates [24 30, 31, 33 35, 37, 39] were used in other publications and one [13] is 44 45 currently being used to retrospectively evaluate disaster management. One has not been used 46 in other publications [32]. DISAST CIR [24 30, 35] is routinely used to report each mass 47 48 casualty incident in the registry of the Israeli Defence Force Home Front and Ministry of 49 50 Health. Guidelines for reporting health crises and critical health events [37] have been used to 51 report international disasters, but these publications were not available as official publications 52 53 at the time of correspondence with the authors. The protocol for reports of major accidents 54 55 and disasters [33] was published previously in the International Journal of Disaster Medicine 56 [40, 41] and used for a report in this journal [42]. It has also been used in the European 57 58 Journal of Trauma and Emergency Surgery [43, 44] and mentioned in an editorial in the same 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 8 BMJ Open Page 32 of 39 BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 journal [45]. Two of the templates [31, 34, 39] are routinely used for reporting from exercises. 4 5 Data on medical management during a mass casualty incident exercise [31] is normally used 6 to assess the health care system in mass casualty incident simulation and exercise. An online 7 8 registry for the health care system is designed using this instrument. Performance indicators 9 10 for major incident medical management [34, 39] has also been used in additional publications 11 [18, 46 50]. For the three publications lacking author e mail [23, 36, 38] we were unable to 12 13 attain information of whether they have been used. 14 15 For peer review only 16 17 DISCUSSION 18 We identified 10 templates for reporting pre hospital major incident medical management that 19 20 were heterogeneous with regards to the data they reported. The quality appraisal revealed that, 21 22 for most of the templates, the methodology for developing them was not clearly explained. In 23 addition, the data variables were not clearly defined for all templates, and the rationale for 24 25 choosing the data variables was only explained for half of the templates. Only three of the 26 27 articles describe the handling of missing data and two depict whether an ethics committee 28 approved the templates. All of these factors are important for internal validity, but the results 29 30 were also heterogeneous for external validity. We chose to interpret that the template were 31 32 developed in the regions affiliated with the authors, though this was not specified. Only two 33 templates stated in which region they were intended to be used. None of the articles discussed http://bmjopen.bmj.com/ 34 35 the clinical credibility of the template, and no feasibility studies have been performed. In all 36 37 cases, the use of the template as a tool for evaluation was mentioned. 38 39 40 Data extraction and quality appraisal variables were based on the authors assumptions on 41 42 what is important in a template for reporting major incident medical management. Data on September 30, 2021 by guest. Protected copyright. 43 variables for reporting should be uniformly defined in order to improve research and allow 44 45 analysis of data; this is the ideological basis for several previous projects to standardize data 46 47 for scientific use [10 13]. We also believe it is important that templates are pre approved by 48 ethics committees to allow immediate reporting and rapid dissemination of data on the 49 50 potential for improvement. For a template to be used, it needs to be both clinically credible 51 52 and feasible. Ideally, if a template is to be used in a specific region, it ought to be developed 53 together with experts from that region; if this is not possible, feasibility studies regarding 54 55 regional differences could be performed. Reporting should be done by representatives with in 56 57 depth local knowledge and directly involved in responding to or managing the major incident. 58 The ultimate goal of reporting is that an evaluation of the response be undertaken to identify 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 9 Page 33 of 39 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 areas for improvement, enabling those responsible in similar settings to improve their 4 5 preparedness. For this kind of evaluation to occur, comparable, standardized reports that 6 allow for research need to be published. Thus far, reporting on the scale needed for 7 8 comparisons has not been achieved. 9 10 11 Limitations 12 13 Not all of the included literature was intended for prospectively reporting real life incidents. 14 15 However, in Fororder to not peeroverlook potentially review relevant aspects ofonly major incident reporting, the 16 literature aimed to report from exercises [31, 34, 36, 39] and literature using a systematic 17 18 method for reporting in general were included [23, 32]. A clear weakness was that templates 19 20 may exist in other languages than those included. We invite others to identify these templates. 21 Only literature in which an abstract was available was included, with more that 8000 articles 22 23 identified in the search, reviewing full articles at the initial stage was not feasible. Another 24 25 limitation was that only one author performed the initial review of the literature for inclusion. 26 One author performed data extraction and the appraisal and a second author checked the 27 28 results, but this can still allow room for subjective interpretations of the content of the 29 30 templates. The aim of the appraisal was to systematically extract information that the authors 31 thought would be important for reporting major incident medical management. However, 32 33 neither the data extraction nor the quality appraisal represents a validated set of data or gold http://bmjopen.bmj.com/ 34 35 standard. 36 37 38 39 40 CONCLUSIONS 41 42 Our findings show that more than one template exists for generating reports from the medical on September 30, 2021 by guest. Protected copyright. 43 management of major incidents. Limitations are present in the existing templates regarding 44 45 internal and external validity, and none of them have been tested for feasibility in real life 46 47 incidents. Uniform reporting can allow the analysis and comparison of medical management 48 for different major incidents and identify areas that need improvement. Indirectly, this 49 50 information can lead to better resource use and improved outcomes for patients and society. 51 52 The identified templates may be used as a basis for designing a template that is specifically 53 aimed at pre hospital medical care and at generating reports in such a quantity that 54 55 comparative analysis can be performed. The work to create such a template seems warranted 56 57 and is now underway. 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 10 BMJ Open Page 34 of 39 BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 Authors’ contributions 4 5 SF, MR, and TW conceived the idea and designed the study. ER designed and conducted the 6 search strategy for the literature search. SF screened the identified literature. TW, MR, and SF 7 8 considered the eligibility of uncertain literature. SF performed data extraction and quality 9 10 analysis of the included literature. TW and MR checked these results and were mentors in the 11 process. SF, MR, ER, and TW approved the final version of the manuscript. 12 13 14 15 Competing interestsFor peer review only 16 17 The authors declare no competing interests. 18 19 20 Funding 21 22 The Norwegian Air Ambulance employs SF and MR as research fellows. ER and TW 23 received departmental funding only. No additional funding was obtained. 24 25 26 27 Figure legends 28 29 Figure 1 Search strategy. The two first sets of entry terms consisted of 15 terms each, and the 30 third set of eight free search phrases. Combining these three sets resulted in 225 individual 31 32 searches in each database. *If any of the individual searches returned more than 700 results, 33 http://bmjopen.bmj.com/ 34 the search was performed again with a fourth entry term (disaster prevention) using the 35 Boolean operator AND. 36 37 Figure 2 Flow diagram depicting the different stages of the systematic literature review. 38 39 Figure 3 Data extraction from included literature. : yes, : no, ?: unclear, : not for all 40 incidents, π: only date, Ф: only scaling up. MI = major incident. 41 42 Figure 4 Quality appraisal of the included literature. : yes, : no, ?: unclear, *: study is on on September 30, 2021 by guest. Protected copyright. 43 44 going. 45 46 47 48 REFERENCES 49 50 1 Fattah S, Rehn M, Reierth E, et al. Templates for reporting pre hospital major incident 51 52 medical management: systematic literature review. BMJ Open 2012;2:e001082. 53 54 55 2 Guha Sapir D, Vos F, Below R, et al. Annual Disaster Statistical Review 2011: The 56 57 Numbers and Trends. Centre for Research on the Epidemiology of Disasters, Brussels, 2012. 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 11 Page 35 of 39 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 http://cred.be/sites/default/files/2012.07.05.ADSR_2011.pdf (accessed 31.03.2013). 4 5 3 Dara SI, Ashton RW, Farmer JC, et al. Worldwide disaster medical response: An historical 6 7 perspective. Crit Care Med 2005;33:S2 S6. 8 9 10 4 Bradt DA, Aitken P. Disaster medicine reporting: the need for new guidelines and the 11 12 CONFIDE statement. Emerg Med Australas 2010;22:483 7. 13 14 5 Stratton SJ. Use of structured observational methods in disaster research: "Recurrent 15 For peer review only 16 medical response problems in five recent disasters in the Netherlands". Prehosp Disaster Med 17 18 2010;25:137 8. 19 20 21 6 Stratton SJ. The Utstein style Template for uniform data reporting of acute medical 22 23 response in disasters. Prehosp Disaster Med 2012;27:219. 24 25 7 Castren M, Hubloue I, Debacker M. Improving the science and evidence for the medical 26 27 management of disasters: Utstein style. Eur J Emerg Med 2012;19:275 6. 28 29 30 8 Lockey DJ. The shootings in Oslo and Utoya island July 22, 2011: lessons for the 31 32 International EMS community. Scand J Trauma Resusc Emerg Med 2012;20:4. 33 http://bmjopen.bmj.com/ 34 9 Lennquist S. Introduction to the third "Focus on" issue specially devoted to papers within 35 36 the field of the ESTES section for Disaster and Military Surgery. Eur J Trauma Emerg Surg 37 38 2011;37:1 2. 39 40 41 10 Langhelle A, Nolan J, Herlitz J, et al. Recommended guidelines for reviewing, reporting, 42 on September 30, 2021 by guest. Protected copyright. 43 and conducting research on post resuscitation care: the Utstein style. Resuscitation 44 45 2005;66:271 83. 46 47 11 Ringdal KG, Coats TJ, Lefering R, et al. The Utstein template for uniform reporting of 48 49 50 data following major trauma: a joint revision by SCANTEM, TARN, DGU TR and RITG. 51 52 Scand J Trauma Resusc Emerg Med 2008;16:7. 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 12 BMJ Open Page 36 of 39 BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 12 Sundnes KO. Health disaster management: guidelines for evaluation and research in the 4 5 Utstein style: executive summary. Task Force on Quality Control of Disaster Management. 6 7 Prehosp Disaster Med 1999;14:43 52. 8 9 10 13 Debacker M, Hubloue I, Dhondt E, et al. Utstein style template for uniform data reporting 11 12 of acute medical response in disasters. PLoS Curr 2012;4:e4f6cf3e8df15a. 13 14 14 Fevang E, Lockey D, Thompson J, et al. The top five research priorities in physician 15 For peer review only 16 provided pre hospital critical care: a consensus report from a European research collaboration. 17 18 Scand J Trauma Resusc Emerg Med 2011;19:57. 19 20 21 15 Mackway Jones K, Carley S. An international expert delphi study to determine research 22 23 needs in major incident management. Prehosp Disaster Med 2012;27:351 8. 24 25 16 Ranse J, Hutton A. Minimum data set for mass gathering health research and evaluation: a 26 27 discussion paper. Prehosp Disaster Med 2012;27:1 8. 28 29 30 17 Legemaate GA, Burkle FM, Jr., Bierens JJ. The evaluation of research methods during 31 32 disaster exercises: applicability for improving disaster health management. Prehosp Disaster 33 http://bmjopen.bmj.com/ 34 Med 2012;27:18 26. 35 36 18 Radestad M, Nilsson H, Castren M, et al. Combining performance and outcome indicators 37 38 can be used in a standardized way: a pilot study of two multidisciplinary, full scale major 39 40 41 aircraft exercises. Scand J Trauma Resusc Emerg Med 2012;20:58. 42 on September 30, 2021 by guest. Protected copyright. 43 19 Clarke M. Evidence Aid from the Asian tsunami to the Wenchuan earthquake. J Evid 44 45 Based Med 2008;1:9 11. 46 47 20 Whiting P, Harbord R, Kleijnen J. No role for quality scores in systematic reviews of 48 49 50 diagnostic accuracy studies. BMC Med Res Methodol 2005;5:19. 51 52 21 Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and 53 54 meta analyses: the PRISMA statement. PLoS Med 2009;6:e1000097. 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 13 Page 37 of 39 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 22 Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic 4 5 reviews and meta analyses of studies that evaluate health care interventions: explanation and 6 7 elaboration. PLoS Med 2009;6:e1000100. 8 9 10 23 Anderson PB. A comparative analysis of the emergency medical services and rescue 11 12 responses to eight airliner crashes in the United States, 1987 1991. Prehosp Disaster Med 13 14 1995;10:142 53. 15 For peer review only 16 24 Bloch YH, Schwartz D, Pinkert M, et al. Distribution of casualties in a mass casualty 17 18 incident with three local hospitals in the periphery of a densely populated area: lessons 19 20 21 learned from the medical management of a terrorist attack. Prehosp Disaster Med 22 23 2007;22:186 92. 24 25 25 Leiba A, Schwartz D, Eran T, et al. DISAST CIR: Disastrous incidents systematic analysis 26 27 through components, interactions and results: application to a large scale train accident. J 28 29 30 Emerg Med 2009;37:46 50. 31 32 26 Schwartz D, Bar Dayan Y. Injury patterns in clashes between citizens and security forces 33 http://bmjopen.bmj.com/ 34 during forced evacuation. Emerg Med J 2008;25:695 8. 35 36 27 Schwartz D, Ostfeld I, Bar Dayan Y. A single, improvised "Kassam" rocket explosion can 37 38 cause a mass casualty incident: a potential threat for future international terrorism? Emerg 39 40 41 Med J 2009;26:293 8. 42 on September 30, 2021 by guest. Protected copyright. 43 28 Raiter Y, Farfel A, Lehavi O, et al. Mass casualty incident management, triage, injury 44 45 distribution of casualties and rate of arrival of casualties at the hospitals: lessons from a 46 47 suicide bomber attack in downtown Tel Aviv. Emerg Med J 2008;25:225 9. 48 49 50 29 Pinkert M, Lehavi O, Goren OB, et al. Primary triage, evacuation priorities, and rapid 51 52 primary distribution between adjacent hospitals lessons learned from a suicide bomber attack 53 54 in downtown Tel Aviv. Prehosp Disaster Med 2008;23:337 41. 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 14 BMJ Open Page 38 of 39 BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 30 Pinkert M, Leiba A, Zaltsman E, et al. The significance of a small, level 3 'semi 4 5 evacuation' hospital in a terrorist attack in a nearby town. Disasters 2007;31:227 35. 6 7 31 Ingrassia PL, Prato F, Geddo A, et al. Evaluation of medical management during a mass 8 9 10 casualty incident exercise: an objective assessment tool to enhance direct observation. J 11 12 Emerg Med 2010;39:629 36. 13 14 32 Juffermans J, Bierens JJ. Recurrent medical response problems during five recent disasters 15 For peer review only 16 in the Netherlands. Prehosp Disaster Med 2010;25:127 36. 17 18 33 Lennquist S. Protocol for Reports from Major Accidents and Disasters in the International 19 20 21 Journal of Disaster Medicine. Eur J Trauma Emerg Surg 2008;34:486 92. 22 23 34 Gryth D, Radestad M, Nilsson H, et al. Evaluation of medical command and control using 24 25 performance indicators in a full scale, major aircraft accident exercise. Prehosp Disaster Med 26 27 2010;25:118 23. 28 29 30 35 Schwartz D, Pinkert M, Leiba A, et al. Significance of a Level 2, "selective, secondary 31 32 evacuation" hospital during a peripheral town terrorist attack. Prehosp Disaster Med 33 http://bmjopen.bmj.com/ 34 2007;22:59 66. 35 36 36 Green GB, Modi S, Lunney K, et al. Generic evaluation methods for disaster drills in 37 38 developing countries. Ann Emerg Med 2003;41:689 99. 39 40 41 37 Kulling P, Birnbaum M, Murray V, et al. Guidelines for reports on health crises and 42 on September 30, 2021 by guest. Protected copyright. 43 critical health events. Prehosp Disaster Med 2010;25:377 83. 44 45 38 Ricci E, Pretto E. Assessment of Prehospital and Hospital Response in Disaster. Crit Care 46 47 Clin 1991;7:471 84. 48 49 50 39 Ruter A, P. Wiström, T. Performance Indicators for Major Incident Medical Management 51 52 A Possible Tool for Quality Control? Int J Disaster Med 2004;2:52 5. 53 54 40 Lennquist S. Protocol for reports from major accidents and disasters in the International 55 56 Journal of Disaster Medicine. Int J Disaster Med 2003;1:79 86. 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 15 Page 39 of 39 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2013-002658 on 1 August 2013. Downloaded from
1 2 3 41 Lennquist S. Protocol for reports from major accidents and disasters in the International 4 5 Journal of Disaster Medicine. Int J Disaster Med 2004;2:57 64. 6 7 42 Backman K, Albertsson P, Petterson S, et al. Protocol from the coach crash in Ängelsberg, 8 9 10 Sweden January 2003. Int J Disaster Med 2004;2:93 104. 11 12 43 Dami F, Fuchs V, Peclard E, et al. Coordination of emergency medical services for a major 13 14 road traffic accident on a Swiss suburban highway. Eur J Trauma Emerg Surg. 2009;35:265 15 For peer review only 16 70. 17 18 44 Marres GMH, Eijk JVD. Evaluation of admissions to the Major Incident Hospital based on 19 20 21 standardized protocol. Eur J Trauma Emerg Surg 2011;37:19 29. 22 23 45 Lennquist S. Introduction to the second “Focus on” Disaster and Military Surgery. Eur J 24 25 Trauma Emerg Surg 2009;35:199 200. 26 27 46 France JM, Nichols D, Dong S: Increasing emergency medicine residents´ confidence 28 29 30 in disaster management: use of an Emergency Department simulator and an expedited 31 32 curriculum. Prehosp Disaster Med 2012;27:31 35. 33 http://bmjopen.bmj.com/ 34 47 Rüter A, Örtenwall P, Wikström T. Performance indicators for prehospital command and 35 36 control in training of medical first responders. Int J Disaster Med 2004;2:89 92. 37 38 48 Rüter A, Wikstrom T. Improved staff procedyre skills lead to improved management 39 40 41 skills: an observational study in an educational setting. Prehosp Disaster Med 2009;24:376 42 on September 30, 2021 by guest. Protected copyright. 43 379. 44 45 49 Rüter A, Nilsson H, Vilkström T. Performance indicators as quality control for testing and 46 47 evaluating hospital management groups: a pilot study. Prehosp Disast Med 2006;21:423 426. 48 49 50 50 Rüter A, Vikström A. Indicateurs de performance: De la théorie a la pratique. Approche 51 52 scientifique à propos de la medicine de catastrophe. Urgence Pratique 2009;93:41 44. 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 16