The Delphi technique is a unique survey method that involves an iterative process to gain consensus when consensus is challenging to establish and is widely used in Disaster Medicine research. Participants typically rate a variety of statements using a specified rating scale. The survey is repeated for several rounds, and at each round statements that do not reach a predefined level of consensus are advanced to the next round while giving the participants information about the responses of other participants for their comparison. The final statements are then ranked in order of the average rating. The statistical methods to analyze Delphi studies are not well described. This study investigates the use of a 1 to 7 linear rating scale along with parametric summary statistics for assessment of consensus and ranking of statements.

A study set of 9297 individual ratings on the 1 to 7 scale were obtained from previously performed Delphi studies and used to create 490,000 simulated Delphi ratings with various numbers of participants.

While the overall distribution of ratings was strongly left skewed the sampling distribution was near normally distributed for studies with five or more participants. The average difference between the standard deviation and interquartile range was -0.26/7. The overall risk of falsely concluding consensus using the standard deviation as a summary statistic was 7.3% when compared to using the interquartile range. The average difference between mean and median was -0.20/7. The risk of falsely ranking the statements by a value of 0.5 or more was near zero for all sample sizes when the mean was compared to the median.

This study suggests that the use of the 1 to 7 linear rating scale in combination with the parametric summary statistics of standard deviation and mean is a valid method to analyze ratings from Delphi studies.

Asymmetric warfare and the reaction to its threats have implications in the way far-forward medical assistance is provided in such settings. Investments in far-forward emergency resuscitation and stabilization can contribute to saving lives and increase the resilience of health systems. Thus, it is proposed to extend the use of the Haddon Matrix to determine a set of strategies to better understand and prioritize activities to prepare for and set-up frontline care in the form of Trauma Stabilization Points (TSPs).

An expert consensus methodology was used to achieve the research aim. A small subject matter experts’ group was convened to create and validate the content of the Haddon Matrix.

The result of the expert group consultations presented an overview of TSP Preparedness and Operational Readiness activities within a Haddon Matrix framework. Main strategies to be adopted within the cycle from pre- to post-event had been identified and presented considering the identified opportunities in the context of the possibility of implementation. Of particular importance was the revision of a curriculum that fits the civilian medical system and facilitates its adaptation to the context and available resources.

The new framework to enhance frontline care preparedness and response using the Haddon Matrix facilitated the identification of a set of strategies to support frontline health care workers in a more efficient manner. Since the existing approach and tools are insufficient for modern warfare, additional research is needed.