Efficacy of critical incident monitoring for evaluating disaster medical readiness and response during the Sydney 2000 Olympic Games.
BACKGROUND
Multiple casualty incidents (MCI) are infrequent events for medical systems. This renders audit and quality improvement of the medical responses difficult. Quality tools and use of such tools for improvement is necessary to ensure that the design of medical systems facilitates the best possible response to MCI.


OBJECTIVE
To describe the utility of incident reporting as a quality monitoring and improvement tool during the deployment of medical teams for mass gatherings and multiple casualty incidents.


METHODS
Voluntary and confidential reporting of incidents was provided by members of the disaster medical response teams during the period of disaster medical team deployment for the 2000 Sydney Olympic Games. Qualitative evaluations were conducted of reported incidents. The main outcome measures included the nature of incident and associated contributing factors, minimization factors, harm potential, and comparison with the post-deployment, cold debriefings.


RESULTS
A total of 53 incidents were reported. Management-based decisions, poor or non-existent protocols, and equipment and communication-related issues were the principal contributing factors. Eighty nine percent of the incidents were considered preventable. A potential for harm to patients and/or team members was documented in 58% of reports, of which 76% were likely to cause at least significant harm. Of equipment incidents, personal protective equipment (33%), medical equipment (27%), provision of equipment (22%), and communication equipment (17%) predominated. Personal protective equipment (50%) was reported as the most frequent occupational health and safety incident followed by fatigue (25%). Pre-deployment planning was the most important factor for future incident impact minimization.


CONCLUSIONS
Incident monitoring was efficacious as a quality tool in identifying incident contributing factors. Incident monitoring allowed for greater systems evaluation. Further evaluation of this quality tool within different disaster settings is required.
Flabouris
Arthas
A
Disaster Medical Response Teams, New South Wales (NSW) Health, Liverpool BC, New South Wales, Australia. Arthas.Flabouris@swsahs.nsw.gov.au
Nocera
Antony
A
Garner
Alan
A
D000846:Anniversaries and Special Events; D003441:Crowding; D004189:Disaster Planning / Q000592:standards*; D004630:Emergencies / Q000453:epidemiology*; D004632:Emergency Medical Services / Q000458:organization & administration* / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D009517:New South Wales / Q000453:epidemiology; D010348:Patient Care Team; D015397:Program Evaluation; D012308:Risk Management / Q000592:standards*; D013177:Sports / Q000706:statistics & numerical data*