| Popis: |
Increasing scrutiny of the role and actions of emergency responders in the aftermath of mass casualty events continues to elicit the need for changes and advances in terms of treatment and care. Despite improvements in some areas, there is a growing concern relating to the identification of incapacitated patients who are unable to provide any identifying details. The use of visual identification and the reliance on personal effects within the vicinity of victims, both living and deceased, has resulted in mistaken identification in a number of major incidents internationally. There is a misguided emphasis on the identification of the deceased over that of the living incapacitated victim. This research examines the practicalities of using scientific methods for identification of the deceased, such as those used in INTERPOL’s Disaster Victim Identification (DVI) process, and questions whether they should be broadened to include those who are incapacitated and unable to confirm their own identity. The study uses qualitative ethnographic analysis, triangulating observation of two large mass casualty and fatality exercises, interviews with front-line responders and subject-matter experts and corresponding documentation and fieldnotes to critically examine the challenges, barriers and solutions to determining an unconscious patient’s identity. In addition, analysis of previous cases of identification errors was carried out using Turner’s Incubation Theory as a basis for understanding the causative factors. This thesis establishes that despite the growing number of these cases, and the successful implementation of DVI techniques with the incapacitated in the aftermath of two recent terrorist attacks, lessons are not being learned. There remains a resistance to organisational learning from a crisis and an unwillingness to change practices that are no longer sufficient or relevant. Ultimately, the application of DVI on its own to resolve identification issues is insufficient. The empirical evidence established as a result of this study demonstrates that successful implementation of DVI requires better awareness of these issues, including the latent failures present in the Incubation Period. Perceived barriers, including questions over the legal viability of DVI when used with the living, will need to be overcome. This can be achieved through awareness, planning and training and ultimately steered by effective strategic leadership with a desire to improve the culture of emergency response across an organisation. Failure to adopt this strategy alongside the application of DVI will result in harms, not only to victims and their families as a result of identification errors, but importantly to the responders themselves. If organisations fail in their duty to plan for and respond to mass casualty incidents involving unidentified and unknown incapacitated patients, the responders themselves will become victims of psychosocial stress and harm. |
