Resilience Training of Regional Medical Command and Control

Abstract

Introduction:Resilience is often described as a desirable holistic approach to disaster preparedness. However, the term has a wide variety of meanings and is hard to operationalize and implement in disaster management. A goal for the EU H2020 project DARWIN was to operationalize resilience for incident management teams.Aim:To test the resilience operationalization by analyzing command team behaviors in a major incident exercise and trace observations to resilience theory.Methods:A regional medical command and control team (n=11) was observed when performing in a functional simulation exercise of a mass casualty incident (300 injured, 1800 uninjured) following the collision of a cruise ship and an oil tanker close to the Swedish coast. Audio and video recordings of behaviors and communications were reviewed for resilient behaviors based on the DARWIN guidelines using the “resilience markers for small teams” framework (Furniss et al., 2011).Results:A total of 121 observed instances of resilient behaviors were found in the material. In 95 cases (79%) the observed behaviors followed a priori hypothesized connections between resilient strategies and general markers. Certain marker-strategy combinations occurred frequently, such as 18 observations where the strategy “understand crucial assumptions” occurred together with the marker “adapting to expected and unexpected events.”Discussion:Resilience has the potential to contribute to a more holistic disaster management approach. The findings that the observations, in general, correspond to the expected relationship between theoretical concretization and contextualization supports the DARWIN effort to operationalize resilience theory. This is a prerequisite for developing observational protocols for training and further studies of resilient behaviors in disaster management teams.