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Making Disaster Care Count: Consensus Formulation of Measures of Effectiveness for Natural Disaster Acute Phase Medical Response

Published online by Cambridge University Press:  16 September 2014

Rajesh K. Daftary ,
Andrea T. Cruz ,
Erik J. Reaves ,
Frederick M. Burkle Jr. ,
Michael D. Christian ,
Daniel B. Fagbuyi ,
Andrew L. Garrett ,
G. Bobby Kapur  and
Paul E. Sirbaugh
Rajesh K. Daftary*
Affiliation:
Baylor College of Medicine, Department of Pediatrics, Section of Emergency Medicine, Houston, TexasUSA The George Washington University School of Medicine and Health Sciences, Department of Pediatrics and Emergency Medicine, Washington, D.C.USA
Andrea T. Cruz
Affiliation:
Baylor College of Medicine, Department of Pediatrics, Section of Emergency Medicine, Houston, TexasUSA
Erik J. Reaves
Affiliation:
US Naval Medical Research Unit No. 6, Lima, Peru
Frederick M. Burkle Jr.
Affiliation:
Harvard Humanitarian Initiative, Harvard School of Public Health, Cambridge, MassachusettsUSA
Michael D. Christian
Affiliation:
Critical Care & Infectious Diseases Mount Sinai Hospital & University Health Network, Toronto, OntarioCanada Royal Canadian Air Force, National Defence, Canada Faculty of Medicine and Dalla Lana School of Public Health, University of Toronto, OntarioCanada
Daniel B. Fagbuyi
Affiliation:
The George Washington University School of Medicine and Health Sciences, Department of Pediatrics and Emergency Medicine, Washington, D.C.USA
Andrew L. Garrett
Affiliation:
Department of Health and Human Services, Office of the Assistant Secretary of Preparedness and Response, Washington, DCUSA
G. Bobby Kapur
Affiliation:
Baylor College of Medicine, Department of Emergency Medicine, Houston, TexasUSA
Paul E. Sirbaugh
Affiliation:
Baylor College of Medicine, Department of Pediatrics, Section of Emergency Medicine, Houston, TexasUSA City of Houston, Emergency Medical Services, TexasUSA
*
Correspondence: Rajesh K. Daftary, MD George Washington University School of Medicine Department of Pediatrics Division of Emergency Medicine 111 Michigan Ave, NW Washington, DC 20010 USA E-mail rajdaftary@gmail.com
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Abstract

Introduction

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.

Hypothesis

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.

Conclusion

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.

DaftaryRK, CruzAT, ReavesEJ, BurkleFMJr, ChristianMD, FagbuyiDB, GarrettAL, KapurGB, SirbaughPE. Making Disaster Care Count: Consensus Formulation of Measures of Effectiveness for Natural Disaster Acute Phase Medical Response. Prehosp Disaster Med. 2014;29(5):1-7.

Keywords

disasterdisaster epidemiologydisaster medicinedisaster reliefmeasures of effectiveness
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 29 , Issue 5 , October 2014 , pp. 461 - 467
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2014 

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Appendix A

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Appendix B

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Appendix C

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