Online Optimisation of Casualty Processing in Major Incident Response

Recent emergency response operations to Mass Casualty Incidents (MCIs) have been criticised for a lack of coordination, implying that there is clear potential for response operations to be improved and for corresponding benefits in terms of the health and well-being of those affected by such incidents. In this thesis, the use of mathematical modelling, and in particular optimisation, is considered as a means with which to help improve the coordination of MCI response. Upon reviewing the nature of decision making in MCIs and other disaster response operations in practice, this work demonstrates through an in-depth review of the available academic literature that an important problem has yet to be modelled and solved using an optimisation methodology. This thesis involves the development of such a model, identifying an appropriate task scheduling formulation of the decision problem and a number of objective functions corresponding to the goals of the MCI response decision makers. Efficient solution methodologies are developed to allow for solutions to the model, and therefore to the MCI response operation, to be found in a timely manner. Following on from the development of the optimisation model, the dynamic and uncertain nature of the MCI response environment is considered in detail. Highlighting the lack of relevant research considering this important aspect of the problem, the optimisation model is extended to allow for its use in real-time. In order to allow for the utility of the model to be thoroughly examined, a complementary simulation is developed and an interface allowing for its communication with the optimisation model specified. Extensive computational experiments are reported, demonstrating both the danger of developing and applying optimisation models under a set of unrealistic assumptions, and the potential for the model developed in this work to deliver improvements in MCI response operations

A distributed simulation methodology for large-scale hybrid modelling and simulation of emergency medical services

This thesis was submitted for the award of Doctor of Philosophy and was awarded by Brunel University LondonHealthcare systems are traditionally characterised by complexity and heterogeneity. With the continuous increase in size and shrinkage of available resources, the healthcare sector faces the challenge of delivering high quality services with fewer resources. Healthcare organisations cannot be seen in isolation since the services of one such affects the performance of other healthcare organisations. Efficient management and forward planning, not only locally but rather across the whole system, could support healthcare sector to overcome the challenges. An example of closely interwoven organisations within the healthcare sector is the emergency medical services (EMS). EMS operate in a region and usually consist of one ambulance service and the available accident and emergency (A&E) departments within the coverage area. EMS provide, mainly, pre-hospital treatment and transport to the appropriate A&E units. The life-critical nature of EMS demands continuous systems improvement practices. Modelling and Simulation (M&S) has been used to analyse either the ambulance services or the A&E departments. However, the size and complexity of EMS systems constitute the conventional M&S techniques inadequate to model the system as a whole. This research adopts the approach of distributed simulation to model all the EMS components as individual and composable simulations that are able to run as standalone simulation, as well as federates in a distributed simulation (DS) model. Moreover, the hybrid approach connects agent-based simulation (ABS) and discrete event simulation (DES) models in order to accommodate the heterogeneity of the EMS components. The proposed FIELDS Framework for Integrated EMS Large-scale Distributed Simulation supports the re-use of existing, heterogeneous models that can be linked with the High Level Architecture (HLA) protocol for distributed simulation in order to compose large-scale simulation models. Based on FIELDS, a prototype ABS-DES distributed simulation EMS model was developed based on the London EMS. Experiments were conducted with the model and the system was tested in terms of performance and scalability measures to assess the feasibility of the proposed approach. The yielded results indicate that it is feasible to develop hybrid DS models of EMS that enables holistic analysis of the system and support model re-use. The main contributions of this thesis is a distributed simulation methodology that derived along the process of conducting this project, the FIELDS framework for hybrid EMS distributed simulation studies that support re-use of existing simulation models, and a prototype distributed simulation model that can be potentially used as a tool for EMS analysis and improvement.MATCH Programm

Optimizing emergency preparedness and resource utilization in mass-casualty incidents

This paper presents a response model for the aftermath of a Mass-Casualty Incident (MCI) that can be used to provide operational guidance for regional emergency planning as well as to evaluate strategic preparedness plans. A mixed integer programming (MIP) formulation is proposed for the combined ambulance dispatching, patient-to-hospital assignment, and treatment ordering problem. T he goal is to allocate effectively the limited resources during the response so as to improve patient outcomes, while the objectives are to minimize the overall response time and the total flow time required to treat all patients, in a hierarchical fashion. The model is solved via exact and MIP-based heuristic solution methods. The applicability of the model and the performance of the new methods are challenged on realistic MCI scenarios. We consider the hypothetical case of a terror attack at the New York Stock Exchange in Lower Manhattan with up to 150 trauma patients. We quantify the impact of capacity-based bottlenecks for both ambulances and available hospital beds. We also explore the trade-off between accessing remote hospitals for demand smoothing versus reduced ambulance transportation times

Alcohol, assault and licensed premises in inner-city areas

This report contains eight linked feasibility studies conducted in Cairns during 2010. These exploratory studies examine the complex challenges of compiling and sharing information about incidents of person-to-person violence in a late night entertainment precinct (LNEP). The challenges were methodological as well as logistical and ethical. The studies look at how information can be usefully shared, while preserving the confidentiality of those involved. They also examine how information can be compiled from routinely collected sources with little or no additional resources, and then shared by the agencies that are providing and using the information.Although the studies are linked, they are also stand-alone and so can be published in peer-reviewed literature. Some have already been published, or are ‘in press’ or have been submitted for review. Others require the NDLERF board’s permission to be published as they include data related more directly to policing, or they include information provided by police.The studies are incorporated into the document under section headings. In each section, they are introduced and then presented in their final draft form. The final published form of each paper, however, is likely to be different from the draft because of journal and reviewer requirements. The content, results and implications of each study are discussed in summaries included in each section.Funded by the National Drug Law Enforcement Research Fund, an initiative of the National Drug StrategyAlan R Clough (PhD) School of Public Health, Tropical Medicine and Rehabilitation Sciences James Cook UniversityCharmaine S Hayes-Jonkers (BPsy, BSocSci (Hon1)) James Cook University, Cairns.Edward S Pointing (BPsych) James Cook University, Cairns

Online optimization of casualty processing in major incident response: An experimental analysis

When designing an optimization model for use in mass casualty incident (MCI) response, the dynamic and uncertain nature of the problem environment poses a significant challenge. Many key problem parameters, such as the number of casualties to be processed, will typically change as the response operation progresses. Other parameters, such as the time required to complete key response tasks, must be estimated and are therefore prone to errors. In this work we extend a multi-objective combinatorial optimization model for MCI response to improve performance in dynamic and uncertain environments. The model is developed to allow for use in real time, with continuous communication between the optimization model and problem environment. A simulation of this problem environment is described, allowing for a series of computational experiments evaluating how model utility is influenced by a range of key dynamic or uncertain problem and model characteristics. It is demonstrated that the move to an online system mitigates against poor communication speed, while errors in the estimation of task duration parameters are shown to significantly reduce model utility

Advancing the scientific study of prehospital mass casualty response through a Translational Science process: the T1 scoping literature review stage

PurposeThe European Union Horizon 2020 research and innovation funding program awarded the NIGHTINGALE grant to develop a toolkit to support first responders engaged in prehospital (PH) mass casualty incident (MCI) response. To reach the projects' objectives, the NIGHTINGALE consortium used a Translational Science (TS) process. The present work is the first TS stage (T1) aimed to extract data relevant for the subsequent modified Delphi study (T2) statements.MethodsThe authors were divided into three work groups (WGs) MCI Triage, PH Life Support and Damage Control (PHLSDC), and PH Processes (PHP). Each WG conducted simultaneous literature searches following the PRISMA extension for scoping reviews. Relevant data were extracted from the included articles and indexed using pre-identified PH MCI response themes and subthemes.ResultsThe initial search yielded 925 total references to be considered for title and abstract review (MCI Triage 311, PHLSDC 329, PHP 285), then 483 articles for full reference review (MCI Triage 111, PHLSDC 216, PHP 156), and finally 152 articles for the database extraction process (MCI Triage 27, PHLSDC 37, PHP 88). Most frequent subthemes and novel concepts have been identified as a basis for the elaboration of draft statements for the T2 modified Delphi study.ConclusionThe three simultaneous scoping reviews allowed the extraction of relevant PH MCI subthemes and novel concepts that will enable the NIGHTINGALE consortium to create scientifically anchored statements in the T2 modified Delphi study

Emergencies and Public Health Crisis Management- Current Perspectives on Risks and Multiagency Collaboration

The successful management of emergencies and public health crises depends on adequate measures being implemented at all levels of the emergency chain of action, from policy makers to the general population. It starts with appropriate risk assessment, prevention, and mitigation and continues to prehospital and hospital care, recovery, and evaluation. All levels of action require well-thought out emergency management plans and routines based on established command and control, identified safety issues, functional communication, well-documented triage and treatment policies, and available logistics. All these characteristics are capabilities that should be developed and trained, particularly when diverse agencies are involved. In addition to institutional responses, a robust, community-based disaster response system can effectively mitigate and respond to all emergencies. A well-balanced response is largely dependent on local resources and regional responding agencies that all too often train and operate within “silos”, with an absence of interagency cooperation. The importance of this book issue is its commitment to all parts of emergency and public health crisis management from a multiagency perspective. It aims to discuss lessons learned and emerging risks, introduce new ideas about flexible surge capacity, and show the way it can practice multiagency collaboration

Emergency Management Training and Exercises for Transportation Agency Operations, MTI Report 09-17

Training and exercises are an important part of emergency management. Plans are developed based on threat assessment, but they are not useful unless staff members are trained on how to use the plan, and then practice that training. Exercises are also essential for ensuring that the plan is effective, and outcomes from exercises are used to improve the plan. Exercises have been an important part of gauging the preparedness of response organizations since Civil Defense days when full-scale exercises often included the community. Today there are various types of exercises that can be used to evaluate the preparedness of public agencies and communities: seminars, drills, tabletop exercises, functional exercises, facilitated exercises and full-scale exercises. Police and fire agencies have long used drills and full-scale exercises to evaluate the ability of staff to use equipment, protocols and plans. Transit and transportation agencies have seldom been included in these plans, and have little guidance for their participation in the exercises. A research plan was designed to determine whether urban transit systems are holding exercises, and whether they have the training and guidance documents that they need to be successful. The main research question was whether there was a need for a practical handbook to guide the development of transit system exercises

Evaluation of medical response in disaster preparedness : with special reference to full-scale exercises

Background: Disaster exercises and simulations serves as teaching and training tool for improving medical response in disaster preparedness. Rapid and effective medical response in major incidents is known as a “key phase” to optimise resources, and this requires that management systems have an “all hazards” approach. Decision-making at all levels of management is based on available information and involves allocation of medical resources and triage decisions. Aim: The overall aim of this thesis was to increase our knowledge of the impact of quantitative evaluation of medical response on disaster preparedness. The specific aims were: to increase the ability to learn from full-scale exercises by applying quality indicators at two levels of command and control (I, II); to identify key indicators essential for initial disaster medical response registration (III); to explore ambulance staff attitudes towards practising triage tagging (IV); and to increase our knowledge of the applicability of a technical support system and its potential to provide real-time, overall situation awareness available to those overseeing the medical management of the operation. Methods: Study I, II and V were observational studies based on data collections from full-scale exercises. Templates with measurable performance indicators for evaluation of command and control were used in Study I and II and the same performance indicators combined with outcome indicators was also included in Study II. A consensus method, the Delphi technique, with 30 experts was used in Study III. Study IV used mixed methods, a pre-and post web survey answered by ambulance nurses and physicians (n=57 respectively 57) before and after a time limited strategy with triage tags and three focus groups interviews comprising 21 ambulance nurses and emergency medical technicians. Study V used major two incidents simulations to test the applicability of Radio Frequency Identification (RFID tags) technology and compare it with traditionally paper-based triage tags (n= 20 respectively 20). The quantitative data were analysed using descriptive statistics, and content analysis was used for the qualitative data. Results: The evaluation model exposed several problems occurring in the initial decision-making process that were repeatedly observed (I, II). These results in study II also demonstrated to have a major impact on patient outcome.Out of 17 severely injured patients five respectively seven were at risk for preventable death. A total of 97 statements were generated, of these 77 statements reached experts consensus, and 20 did not (III). Ambulance staffs believe in the usefulness of standardised triage methods, but the sparse application of triage tags at the scene indicates that the tags are not used frequently. Infrequent use in daily practice prevents participants from feeling confident with the triage tool (IV).The Radio Frequency Identification system improved situational awareness in disaster management. Triage information was available at least one hour earlier compared to a paper-based triage system (V). Conclusions: The presented evaluation model can be used in an objective, systematic and reproducible way to evaluate complex medical responses, which is a prerequisite for quality assurance, identification of problems, and the development of disaster preparedness