Prehospital and Disaster Medicine

Original Research

Evaluation of Medical Command and Control Using Performance Indicators in a Full-Scale, Major Aircraft Accident Exercise

Dan Grytha1 c1, Monica Rådestada1, Heléne Nilssona2, Ola Nerfa1, Leif Svenssona1, Maaret Castréna1 and Anders Rütera2

a1 Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm Prehospital Centre, Stockholm, Sweden

a2 Centre for Teaching and Research in Disaster Medicine and Traumatology, Linköping University, Linköping, Sweden


Introdution: Large, functional, disaster exercises are expensive to plan and execute, and often are difficult to evaluate objectively. Command and control in disaster medicine organizations can benefit from objective results from disaster exercises to identify areas that must be improved.

Objective: The objective of this pilot study was to examine if it is possible to use performance indicators for documentation and evaluation of medical command and control in a full-scale major incident exercise at two levels: (1) local level (scene of the incident and hospital); and (2) strategic level of command and control. Staff procedure skills also were evaluated.

Methods: Trained observers were placed in each of the three command and control locations. These observers recorded and scored the performance of command and control using templates of performance indicators. The observers scored the level of performance by awarding 2, 1, or 0 points according to the template and evaluated content and timing of decisions. Results from 11 performance indicators were recorded at each template and scores >11 were considered as acceptable.

Results: Prehospital command and control had the lowest score. This also was expressed by problems at the scene of the incident. The scores in management and staff skills were at the strategic level 15 and 17, respectively; and at the hospital level, 17 and 21, respectively.

Conclusions: It is possible to use performance indicators in a full-scale, major incident exercise for evaluation of medical command and control. The results could be used to compare similar exercises and evaluate real incidents in the future.

(Received May 26 2009)

(Accepted June 15 2009)

(Revised July 13 2009)


c1 Department of Clinical Science and Education, Södersjukhuset Karolinska Institutet Stockholm Prehospital Centre S-118 83 Stockholm Sweden E-mail:

Gryth D, Rådestad M, Nilsson H, Nerf O, Svensson L, Castrén M, Rüter A: Evaluation of medical command and control using performance indicators in a full-scale, major aircraft accident exercise. Prehosp Disaster Med 2010;25(2):118-124.