Decision support for medical disasters: Evaluation of the IMPRESS system in the live Palermo demo

Background: In medical disasters, coordination, information flows, and decision making are crucial for response and management. Different factors contribute to thwart the response efforts. Some are due to the coordination of the many agencies active in disaster response. Support tools for gathering and analysing data may support task assignment, resource allocation, and acquisition as well as training at different decision levels (in the field and in command-rooms). Validation of Decision Support Systems (DSS) in simulated contexts, simulating real situations, becomes mandatory. In the framework of testing and validation of the IMPRESS project (and of its INCIMOB and INCIMAG tools), one scenario was planned in Palermo, a city of 700,000 inhabitants in the Mediterranean Area of Southern Italy, simulating the sudden liberation of high concentrations of toxic compounds from a fire in Palermo harbor. Emergency Agencies, a real and a simulated Hospital and operators in the field used the system during the response phase. A group of 20 external Observers participated for evaluation purposes. During a joint debriefing session, ad-hoc questionnaires were administered. IMPRESS was useful in improving the execution of important functions during the DEMO; Users agreed about the advantages of the use of IMPRESS tools for conducting crisis activities. INCIMOB use resulted more problematic from an operational point of view. Shortcomings were detected and criticisms were raised due mainly to the lack of training and direct voice communication. Evaluation of DSS in Emergency medicine can benefit from live exercises to highlight weaknesses in both the response system and decision support.