Prehospital and Disaster Medicine

Original Research

Impact of Wireless Electronic Medical Record System on the Quality of Patient Documentation by Emergency Field Responders during a Disaster Mass-Casualty Exercise

Theodore C. Chana1 c1, William G. Griswolda2, Colleen Buonoa1, David Kirsha3, Joachim Lyona4, James P. Killeena1, Edward M. Castilloa1 and Leslie Lenerta1

a1 Department of Emergency Medicine, University of California, San Diego, San Diego, California USA

a2 Department of Computer Science and Engineering, University of California, San Diego, San Diego, California USA

a3 Department of Cognitive Science, University of California, San Diego, San Diego, San Diego, California USA

a4 Center for Work, Technology, and Organization, Stanford University, Palo Alto, California USA


Introduction: The use of wireless, electronic, medical records and communications in the prehospital and disaster field is increasing.

Objective: This study examines the role of wireless, electronic, medical records and communications technologies on the quality of patient documentation by emergency field responders during a mass-casualty exercise.

Methods: A controlled, side-to-side comparison of the quality of the field responder patient documentation between responders utilizing National Institutes of Health-funded, wireless, electronic, field, medical record system prototype (“Wireless Internet Information System for medicAl Response to Disasters” or WIISARD) versus those utilizing conventional, paper-based methods during a mass-casualty field exercise. Medical data, including basic victim identification information, acuity status, triage information using Simple Triage and Rapid Treatment (START), decontamination status, and disposition, were collected for simulated patients from all paper and electronic logs used during the exercise. The data were compared for quality of documentation and record completeness comparing WIISARD-enabled field responders and those using conventional paper methods. Statistical analysis was performed with Fisher’s Exact Testing of Proportions with differences and 95% confidence intervals reported.

Results: One hundred simulated disaster victim volunteers participated in the exercise, 50 assigned to WIISARD and 50 to the conventional pathway. Of those victims who completed the exercise and were transported to area hospitals, medical documentation of victim START components and triage acuity were significantly better for WIISARD compared to controls (overall acuity was documented for 100% vs 89.5%, respectively, difference = 10.5% [95%CI = 0.5–24.1%]). Similarly, tracking of decontamination status also was higher for the WIISARD group (decontamination status documented for 59.0% vs 0%, respectively, difference = 9.0% [95%CI = 40.9–72.0%]). Documentation of disposition and destination of victims was not different statistically (92.3% vs. 89.5%, respectively, difference = 2.8% [95%CI = -11.3–17.3%]).

Conclusions: In a simulated, mass-casualty field exercise, documentation and tracking of victim status including acuity was significantly improved when using a wireless, field electronic medical record system compared to the use of conventional paper methods.

(Received July 12 2010)

(Accepted December 10 2010)

(Revised December 17 2010)


c1 Correspondence: Theodore Chan, MD UCSD DEM 200 West Arbor Drive #8676 San Diego, California 92103 USA E-mail:


Chan TC, Griswold WG, Buono C, Kirsh D, Lyon J, Killeen JP, Castillo EM, Lenert L: Impact of wireless electronic medical record system on the quality of patient documentation by emergency field responders during a disaster mass-casualty exercise. Prehosp Disaster Med 2011;26(4):1–8.