title: Making disaster care count: consensus formulation of measures of effectiveness for natural disaster acute phase medical response.
abstract: BACKGROUND
  No standard exists for provision of care following catastrophic natural disasters. Host nations, funders, and overseeing agencies need a method to identify the most effective interventions when allocating finite resources. Measures of effectiveness are real-time indicators that can be used to link early action with downstream impact.
  
  
  OBJECTIVE
  Group consensus methods can be used to develop measures of effectiveness detailing the major functions of post natural disaster acute phase medical response.
  
  
  METHODS
  A review of peer-reviewed disaster response publications (2001-2011) identified potential measures describing domestic and international medical response. A steering committee comprised of six persons with publications pertaining to disaster response, and those serving in leadership capacity for a disaster response organization, was assembled. The committee determined which measures identified in the literature review had the best potential to gauge effectiveness during post-disaster acute-phase medical response. Using a modified Delphi technique, a second, larger group (Expert Panel) evaluated these measures and novel measures suggested (or "free-texted") by participants for importance, validity, usability, and feasibility. After three iterations, the highest rated measures were selected.
  
  
  RESULTS
  The literature review identified 397 measures. The steering committee approved 116 (29.2%) of these measures for advancement to the Delphi process. In Round 1, 25 (22%) measures attained >75% approval and, accompanied by 77 free-text measures, graduated to Round 2. There, 56 (50%) measures achieved >75% approval. In Round 3, 37 (66%) measures achieved median scores of 4 or higher (on a 5-point ordinal scale). These selected measures describe major aspects of disaster response, including: Evaluation, Treatment, Disposition, Public Health, and Team Logistics. Of participants from the Expert Panel, 24/39 (63%) completed all rounds. Thirty-three percent of these experts represented international agencies; 42% represented US government agencies.
  
  
  CONCLUSIONS
  Experts identified response measures that reflect major functions of an acute medical response. Measures of effectiveness facilitate real-time assessment of performance and can signal where practices should be improved to better aid community preparedness and response. These measures can promote unification of medical assistance, allow for comparison of responses, and bring accountability to post-disaster acute-phase medical care. This is the first consensus-developed reporting tool constructed using objective measures to describe the functions of acute phase disaster medical response. It should be evaluated by agencies providing medical response during the next major natural disaster.
authors.affiliation: 1Baylor College of Medicine,Department of Pediatrics,Section of Emergency Medicine,Houston,TexasUSA.
authors.forename: Rajesh K
authors.initials: RK
authors.lastname: Daftary
authors.affiliation: 1Baylor College of Medicine,Department of Pediatrics,Section of Emergency Medicine,Houston,TexasUSA.
authors.forename: Andrea T
authors.initials: AT
authors.lastname: Cruz
authors.affiliation: 3US Naval Medical Research Unit No. 6,Lima,Peru.
authors.forename: Erik J
authors.initials: EJ
authors.lastname: Reaves
authors.affiliation: 4Harvard Humanitarian Initiative,Harvard School of Public Health,Cambridge,MassachusettsUSA.
authors.forename: Frederick M
authors.initials: FM
authors.lastname: Burkle
authors.affiliation: 5Critical Care & Infectious Diseases Mount Sinai Hospital & University Health Network,Toronto,OntarioCanada.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Christian
authors.affiliation: 2The George Washington University School of Medicine and Health Sciences,Department of Pediatrics and Emergency Medicine,Washington,D.C.USA.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Fagbuyi
authors.affiliation: 8Department of Health and Human Services,Office of the Assistant Secretary of Preparedness and Response,Washington,DCUSA.
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Garrett
authors.affiliation: 9Baylor College of Medicine,Department of Emergency Medicine,Houston,TexasUSA.
authors.forename: G Bobby
authors.initials: GB
authors.lastname: Kapur
authors.affiliation: 1Baylor College of Medicine,Department of Pediatrics,Section of Emergency Medicine,Houston,TexasUSA.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Sirbaugh
mesh_terms: D002170:Canada; D032921:Consensus; D003697:Delphi Technique; D004189:Disaster Planning / Q000592:standards*; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D011050:Policy Making; D014481:United States