Mass Casualty Mini Drills on Trauma Surgery Department Staff Knowledge: An Educational Improvement Study

Abstract

Background: Over the last decade, the United States has witnessed an increase in mass casualty incidents (MCIs). The outcome of an MCI depends upon hospital preparedness, yet many hospitals are unfamiliar with their facility MCI procedure. Educational training drills may be one method to improve staff knowledge of policy and procedure. Objective: This study aimed to improve knowledge gained through educational MCI mini drills of institutional mass casualty policy and procedure in surgery department staff at a level II trauma center. Methods: A pre-/posttest design was utilized. The hospital implemented MCI mini training drills as a quality improvement project using Plan-Do-Study-Act iterative cycles with prospective data collection. Knowledge scores were measured using a 12-item surgery department MCI policy and procedure questionnaire that was developed by the author and leadership. Results: A one-way analysis of covariance analysis in participants that mini drilled more than once indicated significant effect on mean cycle score differences among three cycles F (2,21) = 12.96, p = .00. Multiple comparison using Games–Howell indicated the mean score for Cycle 4 (M = 96.15, SD = 6.54) was significantly different from Cycle 3 (M = 59.71, SD = 25.15). Gender, shift, and credentials of participants influenced knowledge improvement. Conclusion: Implementation of hospital MCI mini drills improved staff knowledge of institutional mass casualty policy and procedure in the surgery department and may be applied to surgery departments with similar policy, procedure, and participant characteristics. Hospital mass casualty response education and preparation is essential to saving lives.

Review of the requirements for effective mass casualty preparedness for trauma systems. A disaster waiting to happen?

“…51,52 Repeated paper-based mini-drills have been shown to increase participant knowledge of institutional disaster policy and procedures, potentially improving preparedness for MCIs. 53 Nevertheless, tabletop simulations cannot fully replace real-world multicentre, multi-organisational drills. 48,54 Large-scale drills commonly include multiple trauma centres, regional hospitals, law enforcement, defence force, and emergency services, and provide a unique opportunity to stress and evaluate existing protocols.…”

“…Conversely, 58% of trauma centres in Australia, Canada, England, and NZ had activated their disaster plan (32% in the past 2 yr); 79% reported conducting a practice drill for an MCI and 48% had completed a multi-agency real-world exercise in the past 2 yr. 13 Regardless of methodological choice, recommendations outlined as a result of training exercises should be acted upon in a timely way and then tested to ensure that improvements have been effective. 18,53 Skryabina and colleagues 57 found that deficiencies in emergency plans, procedures, resources, and communications identified through simulation exercises were often not integrated into an updated emergency plan. Gabbe and colleagues 13 reported that most (50/52) centres in Australia, Canada, England, and NZ that had undertaken a practice drill had reported the findings, and 80% of the time, the findings were incorporated in the revised disaster plan.…”