100 Development of a Peer Assessment Tool to Evaluate Preparedness for Large Mass Casualty Incidents in the United States Yields Critical Lessons

Abstract

Geopolitical changes and increases in manmade and natural mass casualty incidents (MCIs) make preparation for such events more critical. The objective of this study is to understand those preparedness activities that are most effective in securing a successful response to MCIs. To achieve this goal, RAND was commissioned by the Department of Health and Human Services/Office of the Assistant Secretary for Preparedness and Response (HHS/ASPR) to develop a peer assessment tool that was pilot-tested in three communities across the United States that had recently experienced an incident. An interview protocol was developed based on a literature review of past domestic and international MCIs, after action reports from previous domestic incidents, expert opinion, and previous RAND post-incident evaluation tools. The protocol, designed for use by peer assessors, was pilot-tested in three communities that had recently experienced MCIs and sought to elicit successes, challenges, innovative adaptations, lessons for other communities, and related recommendations. Use of this tool identified key preparedness activities in the areas of: scene management, communication, patient transfer optimization; receiving hospital actions, receiving ED actions, emergency operation center actions, interfacing with law enforcement and state or federal agencies, patient identification and family reunification, interfacing with the media; incorporation of mental health needs, inter-organizational relationship building; and preparedness investment. Based on peer-assessor and pilot-site feedback, use of this tool was deemed feasible with low burden on sites. The results of these pilots, and the use of this tool following future incidents, can be used to create a de-identified database of best practices for disaster preparation, inform preparedness policy, improve response, and guide federal preparedness investments.