Editorial comments-Evaluation of medical command and control using performance indicators during a full-scale major aircraft crash exercise.

Rüter is an important model for getting at the analysis of processes that I recently discussed in the Editor's Corner. 1 The authors identified a list of performance indicators that were used for evaluation of the coordination and control processes used during the responses to a simulated aircraft crash. 2 The indicators selected were obtained from multiple sources. Although all of the indicators used were qualitative, they used scaling of 0, 1, or 2 for each of the indicators to evaluate the level of performance of the participants in coordination and control of the responses. The scores assigned a value of " 0 " indicated that the standard as expressed in the statement was " not met " , " 1 " that the standard was met, but the performance was less than ideal, and " 2 " indicated that the performance not only had achieved the standard but also was accomplished within the designated timeframe. This scaling process of qualitative indicators provided a means for grading the performance. This process facilitated the identification of performance areas that were not in accordance with the perceived standards. Using this tool, they were able to grade performance against benchmarks (expected behaviors) that were assumed from the statements that comprised the indicators used. In addition, they used the cumulative scores as a measure of how well the respective coordination and control operations performed. Thus, they identified that the performance of the Emergency Operations Center in the field was: (1) less than expected; and (2) was not as robust as was the performance exhibited in the hospital Emergency Operations Center. Unfortunately, the authors did not explain what the " approved " level of performance represented or how it had been determined. Some of the indicators may have been crucial to the outcome and the impact of not meeting the standard. Thus, this study demonstrated that areas in need of improvement can be identified using performance standards. It shows that performance can be assessed against standards and that such evaluations can identify some critical points of success and failure. It is a good start and hence, should serve as a model for the conduct of future evaluations that require the use of qualitative indicators. I congratulate the authors for conceiving and performing this important foray into evaluation. They were able to meet the objectives of their study. The study could have been extended and would …