Skip to main content Accessibility help

The Evaluation of Research Methods during Disaster Exercises: Applicability for Improving Disaster Health Management

  • G.A. Guido Legemaate (a1), Frederick M Burkle (a2) and Joost J.L.M. Bierens (a3)


Introduction: The objective of this study was to investigate whether disaster exercises can be used as a proxy environment to evaluate potential research instruments designed to study the application of medical care management resources during a disaster.

Methods: During an 06 April 2005 Ministerial-level exercise in the Netherlands, three functional areas of patient contact were assessed: (1) Command and Control, through the application of an existing incident management system questionnaire; (2) patient flow and quality of patient distribution, through registration of data from prehospital casualty collection points, ambulances, and participating trauma centers (with inclusion of data in a flow chart); and (3) hospital coping capacity, through timed registration reports from participating trauma centers.

Results: The existing incident management system questionnaire used for evaluating Command and Control during a disaster exercise would benefit from minor adaptations and validation that could not be anticipated in the exercise planning stage. Patient flow and the quality of patient distribution could not be studied during the exercise because of inconsistencies among data, and lack of data from various collection points. Coping capacity was better measured by using 10-minute rather than one hour time intervals, but provided little information regarding bottlenecks in surge capacity.

Conclusion: Research instruments can be evaluated and improved when tested during a disaster exercise. Lack of data recovery hampers disaster research even in the artificial setting of a national disaster exercise. Providers at every level must be aware that proper data collection is essential to improve the quality of health care during a disaster, and that predisaster cooperation is crucial to validate patient outcomes. These problems must be addressed pre-exercise by stakeholders and decision-makers during planning, education, and training. If not, disaster exercises will not meet their full potential.


Corresponding author

Correspondence: G.A.G. Legemaate, MSc Fire Department Amsterdam-Amstelland Department of Crisis ManagementPostbox 92171 1090 AD Amsterdam The Netherlands E-mail:


Hide All
Sundnes, KO, Birnbaum, ML (eds): Health disaster management: guidelines for evaluation and research in the Utstein style. Prehosp Disaster Med 2003;17:Suppl 3:1177.
Green, GB, Modi, S, Lunney, K et al. , : Generic evaluation methods for disaster drills in developing countries. Ann Emerg Med 2003;41:5:689699.
Kulling, P, Birnbaum, M, Murray, V et al. , : Guidelines for reports on health crises and critical health events. Prehosp Disaster Med 2010;25;4:377383.
Harten van, SM, Bierens, JJLM, Welling, L et al. , : The Volendam fire: lessons learned from disaster research. Prehosp Disaster Med 2006;21:5:303309.
Ministry of the Interior and Kingdom Relations. Bonfire: The Netherlands can withstand Terrorist Threat. Available at: in Dutch. Accessed 18 November 2011.
Jamieson, S: Likert scales: How to (ab)use them. Med Educ 2004;38:12121218.
Thomas, TL, Hsu, EB, Kim, HK et al. , : The incident command system in disasters: Evaluation methods for a hospital-based exercise. Prehosp Disaster Med 2005;20:1:1423.
Dib, JE, Naderi, S, Sheridan, IA et al. , : Analysis and applicability of the Dutch EMS system into countries developing EMS systems. J Emerg Med 2006;30:111115.
Juffermans, JHM, Bierens, JJLM: Recurrent medical response problems during five recent disasters in the Netherlands. Prehosp Disaster Med 2010;25:127136.
Welling, L, Harten van, SM, Patka, P et al. , : Medical management after indoors fires: A review. Burns 2005;31:6:673678.
Debacker, MAM, Bierens, JJLM, Rampengeneeskunde (Disaster Medicine). In: Codex Medicus Online. Available at in Dutch. Accessed 18 November 2011.
Arnold, JL, Paturas, J, Rodoplu, Ű: Measures of effectiveness of hospital incident command system performance. Prehosp Disaster Med 2005;20:3:202205.
Paris, PM, Stewart, RD, Pelton, GH: Triage success in disasters: Dynamic patient-tracking cards. Am J Emerg Med 1985;3:4:323326.
Joy, TL, Kemp, HN: Managing the hurricane Katrina disaster in the Midwest. J Trauma Nurs 2007;14:270272.
Walderhaug, S, Meland, PH, Mikalsen, M et al. , : Evacuation support system for improved medical documentation and information flow in the field. Int J Med Inform 2007;77:2:137151.


The Evaluation of Research Methods during Disaster Exercises: Applicability for Improving Disaster Health Management

  • G.A. Guido Legemaate (a1), Frederick M Burkle (a2) and Joost J.L.M. Bierens (a3)


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed