Development and Validation of a Mass Casualty Conceptual Model

Abstract

Purpose To develop and validate a conceptual model that provides a framework for the development and evaluation of information systems for mass casualty events. Design The model was designed based on extant literature and existing theoretical models. A purposeful sample of 18 experts validated the model. Open-ended questions, as well as a 7-point Likert scale, were used to measure expert consensus on the importance of each construct and its relationship in the model and the usefulness of the model to future research. Methods Computer-mediated applications were used to facilitate a modified Delphi technique through which a panel of experts provided validation for the conceptual model. Rounds of questions continued until consensus was reached, as measured by an interquartile range (no more than 1 scale point for each item); stability (change in the distribution of responses less than 15% between rounds); and percent agreement (70% or greater) for indicator questions. Findings Two rounds of the Delphi process were needed to satisfy the criteria for consensus or stability related to the constructs, relationships, and indicators in the model. The panel reached consensus or sufficient stability to retain all 10 constructs, 9 relationships, and 39 of 44 indicators. Experts viewed the model as useful (mean of 5.3 on a 7-point scale). Conclusions Validation of the model provides the first step in understanding the context in which mass casualty events take place and identifying variables that impact outcomes of care. Clinical Relevance This study provides a foundation for understanding the complexity of mass casualty care, the roles that nurses play in mass casualty events, and factors that must be considered in designing and evaluating information-communication systems to support effective triage under these conditions.

A review of the literature on the validity of mass casualty triage systems with a focus on chemical exposures

“…23 Environmental contextual factors such as the nature of the MCI (natural, technological, unintended or deliberate incident), duration, setting, and size also influence the ability of the responders to care for victims. 24 The multiplicity of triage systems used both within and outside the United States causes confusion. 25 The skill mix and characteristics of the responders and their unfamiliarity with roles, triage systems and tasks influence their ability to gather and process data rapidly, which influences their triage efficiency and healthcare outcomes.…”

“…Successful mass casualty triage depends on clear, accurate, complete, timely, valid, reliable and relevant data 4,26,32 that use common terms understood by all first responders. 4,18 Desirable features of a mass casualty triage system include simplicity, accuracy, reproducibility, rapidity and strong inter-rater reliability. 3,33 The validity, reliability, sensitivity and specificity of the triage system determine victim outcomes.…”

“…66 The majority of systems for MCI response rely on paper triage tags that are attached to the patients. 18 Currently, the amount and type of data collected are not consistent or standardized, 4 and definitions are not universal. The triage of children 81 and victims of chemical, radiological or biological agents have been shown to require different strategies and methods.…”

Gleaning data from disaster: A hospital-based data mining method to study all-hazard triage after a chemical disaster

“…However, there is a paucity of literature evaluating mass casualty triage models and no gold standard for measuring the effectiveness of information decision support data used in response to mass casualty incidents. 1-4 Only one of the triage models currently used for mass casualty triage decision support has been tested under mass casualty conditions and validated by outcome data. 5 Only three studies included assessments of incidents involving chemicals.…”

Nurse Education, Center of Excellence for Remote and Medically Under-Served Areas (CERMUSA)

“…Recent literature reflects on the need to develop and validate mass casualty models so that disaster response remains coordinated and effective (Culley & Effken, 2010). In order to effectively do this, however, we need to better understand the workforce and the competencies required by this workforce.…”