Indicators are used as a benchmark for the quality of disaster response. Desirable attributes of indicators include precision, clear definition, improvement opportunity, unbiased, flexibility, and validity. Due to a lack of universally acceptable, objective indicators, it is currently difficult to gauge improvements in mass casualty preparedness within a hospital.

To describe existing indicators relevant to hospital disaster response, and to explore the use of two new indicators (decanting and chain of command).

A structured literature search in indexed databases was used to identify articles related to the measurement of hospital performance in mass casualties using a matrix technique and snowballing. Relevant websites of disaster management organizations were also reviewed and local disaster management experts were interviewed. Proposed indicators were compared against attributes and some (triage time by category, notification time, time to adequate staff response, preventable deaths, decanting times and chain of command for intensive care unit, and emergency department) were tested and measured in two exercises involving more than 90 staff each, held at two Southeast Queensland hospitals in 2017 and 2018.

Over 50 proposed indicators, including indicators within large sets, were identified. Measurement of some indicators was found to be highly subjective. The decanting and chain-of-command indicators emerged as most useful. Intensive Care Unit required 40 mins to decant beds by 50%, while ED required 25 mins to decant beds by 80%. With regards to the chain of command, ED and triage staff performed best, with 66.7% correctly identifying their immediate supervisor. Overall, staff members were able to correctly identify immediate supervisor better compared to team leaders (59.3% and 40% respectively).

There is a need to narrow down, simplify, and objectify indicators for mass casualty performance. Baseline measurements from actual disasters will provide important comparative data.