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Schulz F, Nguyen Q, Baetzner A, Sjöberg D, Gyllencreutz L. Exploring medical first responders' perceptions of mass casualty incident scenario training: a qualitative study on learning conditions and recommendations for improvement. BMJ Open 2024; 14:e084925. [PMID: 38991686 PMCID: PMC11243206 DOI: 10.1136/bmjopen-2024-084925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2024] Open
Abstract
OBJECTIVE Despite participating in scenario training, many medical first responders (MFRs) perceive themselves as inadequately prepared to respond to mass casualty incidents (MCIs). The objective of this study was to conduct a comprehensive examination of traditional MCI scenario training methods, focusing on their inherent strengths and limitations. An investigation into the perceptions of MFRs who had participated in MCI scenario training was carried out to identify potential areas for improvement and provide recommendations for refining MCI training protocols. DESIGN Qualitative inductive approach using semistructured interviews that took place between October 2021 and February 2022. Data were analysed with qualitative content analysis. SETTING MCI scenario training involving four organisations (three emergency medical services and one search-and-rescue organisation) tasked with responding to MCIs, collectively representing four European Union countries. PARTICIPANTS 27 MFRs (17 emergency medical services personnel and 10 search-and-rescue volunteers) were recruited to participate in the study. RESULTS Two categories and seven associated subcategories (shown in parentheses) were identified as influencing the learning outcomes for MFRs: Training in a context mirroring real-world incidents (conducting incident scene risk assessment, realistic representation in casualties, incorporating scenario variety into the curriculum, interagency collaboration, role alignment when training incident site management) and use of a pedagogical framework (allowing for mistakes, the importance of post-training evaluation). CONCLUSIONS This study reaffirms the value of traditional MCI scenario training and identifies areas for enhancement, advocating for realistic scenarios, interagency collaboration, improved incident site management skills and thorough post-training evaluation. It suggests a shift in MCI training conceptualisation and delivery. The potential of virtual reality technologies as a valuable addition to training methods is explored, with a note on the need for further research to ascertain the long-term effectiveness of these technologies. However, the selection of a training method should consider programme goals, target population and resources.
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Affiliation(s)
- Fredrik Schulz
- Department of Nursing, Umeå University, Umea, Sweden
- Department of Diagnostics and Intervention, Umeå University, Umea, Sweden
| | - Quynh Nguyen
- Center for Technology Experience, Austrian Institute of Technology GmbH, Wien, Austria
- Department for Artificial Intelligence and Human Interfaces, Paris Lodron University of Salzburg, Salzburg, Austria
| | - Anke Baetzner
- Institute of Sports and Sports Sciences, Heidelberg University, Heidelberg, Germany
| | | | - Lina Gyllencreutz
- Department of Nursing, Umeå University, Umea, Sweden
- Department of Diagnostics and Intervention, Umeå University, Umea, Sweden
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Ugelvik KS, Thomassen Ø, Braut GS, Geisner T, Sjøvold JE, Agri J, Montan C. Evaluation of prehospital preparedness for major incidents on a national level, with focus on mass casualty incidents. Eur J Trauma Emerg Surg 2024; 50:945-957. [PMID: 38117294 DOI: 10.1007/s00068-023-02386-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/21/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE To investigate prehospital preparedness work for Mass Casualty Incidents (MCI) and Major Incidents (MI) in Norway. METHOD A national cross-sectional descriptive study of Norway's prehospital MI preparedness through a web-based survey. A representative selection of Rescue and Emergency Services were included, excluding Non-Governmental Organisations and military. The survey consisted of 59 questions focused on organisation, planning, education/training, exercises and evaluation. RESULTS Totally, 151/157 (96%) respondents answered the survey. The results showed variance regarding contingency planning for MCI/MI, revisions of the plans, use of national triage guidelines, knowledge requirements, as well as haemostatic and tactical first aid skills training. Participation in interdisciplinary on-going life-threatening violence (PLIVO) exercises was high among Ambulance, Police and Fire/Rescue Emergency Services. Simulations of terrorist attacks or disasters with multiple injured the last five years were reported by 21/151 (14%) on a regional level and 74/151 (48%) on a local level. Evaluation routines after MCI/MI events were reported by half of the respondents (75/151) and 70/149 (47%) described a dedicated function to perform such evaluation. CONCLUSION The study indicates considerable variance and gaps among Prehospital Rescue and Emergency Services in Norway regarding MCI/MI preparedness work, calling for national benchmarks, minimum requirements, follow-up routines of the organisations and future reassessments. Implementation of mandatory PLIVO exercises seems to have contributed to interdisciplinary exercises between Fire/Rescue, Police and Ambulance Emergency Service. Repeated standardised surveys can be a useful tool to assess and follow-up the MI preparedness work among Prehospital Rescue and Emergency Services at a national, regional and local level.
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Affiliation(s)
- Kristina Stølen Ugelvik
- University of Bergen, Bergen, Norway.
- Regional Trauma Centre, Haukeland University Hospital, Bergen, Norway.
| | - Øyvind Thomassen
- University of Bergen, Bergen, Norway
- HEMS, Haukeland University Hospital, Bergen, Norway
- Norwegian Air Ambulance Foundation, Oslo, Norway
| | - Geir Sverre Braut
- Stavanger University Hospital, Stavanger, Norway
- Western Norway University of Applied Sciences, Stavanger, Norway
| | - Thomas Geisner
- Gastrosurgical Department, Haukeland University Hospital, Bergen, Norway
| | | | - Joakim Agri
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Carl Montan
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Hu H, Lai X, Yan L. Training nurses in an international emergency medical team using a serious role-playing game: a retrospective comparative analysis. BMC MEDICAL EDUCATION 2024; 24:432. [PMID: 38649943 PMCID: PMC11034038 DOI: 10.1186/s12909-024-05442-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 04/17/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Although game-based applications have been used in disaster medicine education, no serious computer games have been designed specifically for training these nurses in an IEMT setting. To address this need, we developed a serious computer game called the IEMTtraining game. In this game, players assume the roles of IEMT nurses, assess patient injuries in a virtual environment, and provide suitable treatment options. METHODS The design of this study is a retrospective comparative analysis. The research was conducted with 209 nurses in a hospital. The data collection process of this study was conducted at the 2019-2020 academic year. A retrospective comparative analysis was conducted on the pre-, post-, and final test scores of nurses in the IEMT. Additionally, a survey questionnaire was distributed to trainees to gather insights into teaching methods that were subsequently analyzed. RESULTS There was a significant difference in the overall test scores between the two groups, with the game group demonstrating superior performance compared to the control group (odds ratio = 1.363, p value = 0.010). The survey results indicated that the game group exhibited higher learning motivation scores and lower cognitive load compared with the lecture group. CONCLUSIONS The IEMT training game developed by the instructor team is a promising and effective method for training nurses in disaster rescue within IEMTs. The game equips the trainees with the necessary skills and knowledge to respond effectively to emergencies. It is easily comprehended, enhances knowledge retention and motivation to learn, and reduces cognitive load.
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Affiliation(s)
- Hai Hu
- Emergency Management Office of West China Hospital, Sichuan University, The street address: No. 37. Guoxue Road, Chengdu City, Sichuan Province, China.
- China International Emergency Medical Team (Sichuan), Chengdu City, Sichuan Province, China.
- Emergency Medical Rescue Base, Sichuan University, Chengdu City, Sichuan Province, China.
| | - Xiaoqin Lai
- China International Emergency Medical Team (Sichuan), Chengdu City, Sichuan Province, China
- Day Surgery Center, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China
- Department of Thoracic Surgery, West China Tianfu Hospital, Sichuan University, Chengdu City, Sichuan Province, China
| | - Longping Yan
- West China School of Nursing, Sichuan University, Chengdu City, Sichuan Province, China
- West China School of Public Health, Sichuan University, Chengdu, Sichuan, China
- West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
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Gangadharan M, Hayanga HK, Greenberg R, Schwengel D. A Call to Action: Why Anesthesiologists Must Train, Prepare, and Be at the Forefront of Disaster Response for Mass Casualty Incidents. Anesth Analg 2024; 138:893-903. [PMID: 38109852 DOI: 10.1213/ane.0000000000006719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
Disasters, both natural and man-made, continue to increase. In Spring 2023, a 3-hour workshop on mass casualty incidents was conducted at the Society for Pediatric Anesthesia-American Academy of Pediatrics Annual conference. The workshop used multiple instructional strategies to maximize knowledge transfer and learner engagement including minididactic sessions, problem-based learning discussions in 3 tabletop exercises, and 2 30-minute disaster scenarios with actors in a simulated hospital environment. Three themes became evident: (1) disasters will continue to impact hospitals and preparation is imperative, (2) anesthesiologists are extensively and comprehensively trained and their value is often underestimated as mass casualty incident responders, and (3) a need exists for longitudinal disaster preparedness education and training over the course of a career. In this special article, we have sought to further define the problem and evidence, the capacity of anesthesiologists as leaders in disaster preparedness, and the rationale for preparation with current best practices to guide how best to move forward.
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Affiliation(s)
- Meera Gangadharan
- From the Department of Anesthesiology, Critical Care and Pain Medicine, UT Houston, McGovern Medical School, Houston, Texas
| | - Heather K Hayanga
- Department of Anesthesiology, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Robert Greenberg
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Deborah Schwengel
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, Maryland
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Sansregret A, Garber A, Freire-Lizama T, Monton L, Mueller V, Papalia N, Ruiter PJA, Shore EM, Suri M. Consensus Statement No. 434: Simulation in Obstetrics and Gynaecology. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:214-226.e1. [PMID: 37055148 DOI: 10.1016/j.jogc.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
OBJECTIVE To provide a comprehensive and current overview of the evidence for the value of simulation for education, team training, patient safety, and quality improvement in obstetrics and gynaecology, to familiarize readers with principles to consider in developing a simulation program, and to provide tools and references for simulation advocates. TARGET POPULATION Providers working to improve health care for Canadian women and their families; patients and their families. OUTCOMES Simulation has been validated in the literature as contributing to positive outcomes in achieving learning objectives, maintaining individual and team competence, and enhancing patient safety. Simulation is a well-developed modality with established principles to maximize its utility and create a safe environment for simulation participants. Simulation is most effective when it involves interprofessional collaboration, institutional support, and regular repetition. BENEFITS, HARMS, AND COSTS This modality improves teamwork skills, patient outcomes, and health care spending. Upholding prescribed principles of psychological safety when implementing a simulation program minimizes harm to participants. However, simulation can be an expensive tool requiring human resources, equipment, and time. EVIDENCE Articles published between 2003 and 2022 were retrieved through searches of Medline and PubMed using the keywords "simulation" and "simulator." The search was limited to articles published in English and French. The articles were reviewed for their quality, relevance, and value by the SOGC Simulation Working Group. Expert opinion from relevant seminal books was also considered. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations). INTENDED AUDIENCE All health care professionals working to improve Canadian women's health, and relevant stakeholders, including granting agencies, physician/nursing/midwifery colleges, accreditation bodies, academic centres, hospitals, and training programs. RECOMMENDATIONS
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Sansregret A, Garber A, Freire-Lizama T, Monton L, Mueller V, Papalia N, Ruiter PJA, Shore EM, Suri M. Déclaration de consensus n o 434 : Simulation en obstétrique et gynécologie. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:227-240.e1. [PMID: 37055149 DOI: 10.1016/j.jogc.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
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Pfenninger EG, Villhauer S, Königsdorfer M. [Hospital disaster planning in south-western Germany. A survey of 214 clinics]. Notf Rett Med 2022:1-10. [PMID: 35991807 PMCID: PMC9380686 DOI: 10.1007/s10049-022-01065-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2022] [Indexed: 11/24/2022]
Abstract
Background Due to legal regulations in Germany, public acute and emergency (A&E) hospitals-along with responsible authorities, emergency medical services, and other institutions such as the state medical associations-are committed to participate in civil protection. This participation includes the need to create and update emergency plans for external and internal crises and to take part in disaster drills. In fact, so far there is only little literature to prove whether and to what extent hospitals fulfill their obligations on this topic. Objectives Using a standardized survey, the state of emergency planning in hospitals in Baden-Wuerttemberg was evaluated. Materials and methods Based on a listing provided by the Hospital Society of Baden-Wuerttemberg (BWKG), all 214 hospitals in Baden-Wuerttemberg were identified. The standardized questionnaire inquired about specific characteristics of the emergency plan, the availability and knowledge of this plan by the hospital workforce and other local institutions that take part in civil protection and, finally, participation in disaster drills were queried. Results Of the 214 hospitals in Baden-Wuerttemberg, 135 (63%) provided information using the questionnaire. Except for one hospital, all other clinics indicated having a special emergency plan ready. In most cases (79.3%), both external (e.g., mass casualty incidents) and internal (e.g., fire, failure of technical equipment) crises are covered. In the vast majority of cases (94%), the hospitals also indicated that they regularly update their emergency plan, whereby the frequency of updates varied markedly. Three quarters of the hospitals said that they also regularly simulate the use of the emergency plan in disaster drills. In two thirds of the cases, external forces such as emergency medical services or the fire department also take part in these drills along with the hospitals themselves. In some cases, knowledge gained from the drills was incorporated into the emergency plan or led to improvements in staff training. Conclusions The willingness of public hospitals to establish comprehensive disaster planning and to take part in related drills seems to have improved noticeably in recent years. However, there is still the need for improvement in keeping the concepts up to date at some hospitals. Especially smaller hospitals showed deficits in emergency planning, particularly concerning preparedness for internal crises, resulting from failure of technical equipment. More regular drills should be used to test existing concepts and to familiarize employees with the processes on a routine basis.
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Affiliation(s)
- Ernst G. Pfenninger
- Stabsstelle Katastrophenschutz, Universitätsklinikum Ulm, Albert-Einstein-Allee 29, 89081 Ulm, Deutschland
| | - Sabine Villhauer
- Stabsstelle Katastrophenschutz, Universitätsklinikum Ulm, Albert-Einstein-Allee 29, 89081 Ulm, Deutschland
| | - Manuel Königsdorfer
- Stabsstelle Katastrophenschutz, Universitätsklinikum Ulm, Albert-Einstein-Allee 29, 89081 Ulm, Deutschland
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Ulm, Ulm, Deutschland
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Widya S, Hewitson R, Patel T, Roland D, Dadnam C. Fifteen-minute consultation: An overview of major incidents. Arch Dis Child Educ Pract Ed 2022:archdischild-2022-323785. [PMID: 35705326 DOI: 10.1136/archdischild-2022-323785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 05/27/2022] [Indexed: 11/04/2022]
Abstract
Major incidents are rare but require a large amount of preparation, co-ordination and communication across different emergency services and specialities. This ensures that casualties are efficiently managed within the constraints of limited clinical resources. This article aims to provide a brief understanding of what constitutes as a major incident, how it is declared and the chain of command in communication and action, focusing specifically on the paediatric process. It also aims to highlight important considerations that could potentially be missed (eg, the mental health impact, forensic evidence and so on).
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Affiliation(s)
- Stefani Widya
- General Paediatrics, Leicester Royal Infirmary, Leicester, UK
| | - Rebecca Hewitson
- Paediatric Emergency Department, Cardiff and Vale University Healthboard, Cardiff, UK
| | - Tulsi Patel
- Paediatric Emergency Department, Leicester Royal Infirmary, Leicester, UK
| | - Damian Roland
- Paediatric Emergency Department, Leicester Royal Infirmary, Leicester, UK
| | - Christopher Dadnam
- Paediatric Emergency Department, Leicester Royal Infirmary, Leicester, UK
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Development and Evaluation of Innovative and Practical Table-top Exercises Based on a Real Mass-Casualty Incident. Disaster Med Public Health Prep 2022; 17:e200. [PMID: 35575292 DOI: 10.1017/dmp.2022.95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE The aim of this work was to develop a table-top exercise (TTX) program for mass-casualty incident (MCI) response based on a real incident to evaluate the program. METHODS The TTX program was developed based on the 8 TTX design steps. Convenience sampling was adopted to recruit recently graduated physicians in China. After the TTX training, the participants completed a self-designed questionnaire, as well as the Simulation Design Scale (SDS) and Educational Practices in Simulation Scale (EPSS). RESULTS In total, 148 valid questionnaires were collected. The difficulty score of the TTX program was 3.69 ± 0.8. The participants evaluated the program highly, with a score of 4.72 ± 0.54 out of 5. Both the SDS and the EPSS had average scores higher than 4.5. Guided reflection/feedback (M = 4.68, SD = 0.41) and fidelity (M =4.66, SD = 0.57) were the 2 highest-rated SDS subscales. For the EPSS, diverse ways of learning and collaboration were the 2 highest-rated subscales. Multivariate stepwise regression analysis showed that the participants' evaluations of the TTX training course were related to the EPSS score, the difficulty rating, the evaluation of the instructional props, and the degree of participant involvement (F = 24.385, P < 0.001). CONCLUSIONS A TTX program for MCIs was developed based on the 2014 Shanghai New Year Crush. The TTX kit is practical and sophisticated, and it provides an effective strategy for MCI training.
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Mass casualty medicine: time for a 21st century refresh. Br J Anaesth 2021; 128:e65-e67. [PMID: 34949438 DOI: 10.1016/j.bja.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/01/2021] [Accepted: 12/05/2021] [Indexed: 11/20/2022] Open
Abstract
Mass casualty events are on the rise globally, as we face increasing pressures from scarcity of resources, population growth, systemic inequalities, geopolitical instabilities, and polarised discourse. Although they are rare events for an individual practitioner, they are going to happen to someone, somewhere, this week, this month, this year. And whilst they are often the last consideration for healthcare systems under constant pressures from daily routine work, individuals, departments, hospitals, and systems have to step up effectively in times of crisis. Failure to do so can lead to suboptimal outcomes for casualties, and even perceived failures can have crippling consequences on staff, families, and communities for years.
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