Resilience in medical incident command

Sammanfattning

Background: Natural and manmade disasters are becoming more common and are creating increasingly complex response challenges. In Sweden, the responsibility for disaster management and disaster preparedness lies with the regions. Disaster preparedness includes the provision of training and exercises in medical command and control to establish the ability to create surge capacity. Resilience can serve as a theoretical perspective to identify crucial capabilities for managing disasters and can be defined within the domain of disaster medicine, as the ability to withstand, absorb, and react to the impact of disasters while preserving and augmenting essential health services, and subsequently recovering to the system’s original state or adapting to a new one. Research on resilience in medical command and control may contribute to evidence-based teaching and training for medical incident command. The aim of this thesis is to contribute to new knowledge about resilience in medical command and control and how to implement resilience in disaster management teaching and training.  Methods: This thesis is based on four studies using a mix of qualitative and qualitative methods with both deductive and inductive approaches. In study I, a within-group pretest–posttest design was used to examine 13 head nurses´ general and specific self-efficacy before and after an intervention of three short computer-based simulation exercises. Study II was a case study focusing on a regional medical incident command taking part in a capability development program combining education, training, and exercises. In study III, an experienced medical incident command participated in a functional exercise and behaviors were captured through observations, video, and audio recordings. Using the markers and strategies analytic framework, observable behavior that exemplified resilient practice were identified. Study IV was a semi-structured, retrospective, in-depth interview study with an inductive design relying on the Critical Decision Method   Results: Study I showed an increase in head nurses´ general but not specific self-efficacy. They also exhibited improved management skills, as indicated by shorter time-to-treatment for both trauma patients and in-hospital patients in the last exercise. Study II offers an example of how a resilience concept can be introduced to, contextualized, and operationalized with medical incident command personnel through a combination of education, training, and exercises. Study III shows an empirical link from resilience concepts to observable behaviors during an exercise in medical command and control. Study IV identified factors affecting decision-making in medical command and control during the early phase of COVID-19.  Conclusions: The results contribute valuable insights to the understanding of challenges, strategies, education, and training methods related to resilience in medical command and control.