Preparing medical first responders for crises: a systematic literature review of disaster training programs and their effectiveness

Abstract

Background Adequate training and preparation of medical first responders (MFRs) are essential for an optimal performance in highly demanding situations like disasters (e.g., mass accidents, natural catastrophes). The training needs to be as effective as possible, because precise and effective behavior of MFRs under stress is central for ensuring patients’ survival and recovery. This systematic review offers an overview of scientifically evaluated training methods used to prepare MFRs for disasters. It identifies different effectiveness indicators and provides an additional analysis of how and to what extent the innovative training technologies virtual (VR) and mixed reality (MR) are included in disaster training research. Methods The systematic review was conducted according to the PRISMA guidelines and focused specifically on (quasi-)experimental studies published between January 2010 and September 2021. The literature search was conducted via Web of Science and PubMed and led to the inclusion of 55 articles. Results The search identified several types of training, including traditional (e.g., lectures, real-life scenario training) and technology-based training (e.g., computer-based learning, educational videos). Most trainings consisted of more than one method. The effectiveness of the trainings was mainly assessed through pre-post comparisons of knowledge tests or self-reported measures although some studies also used behavioral performance measures (e.g., triage accuracy). While all methods demonstrated effectiveness, the literature indicates that technology-based methods often lead to similar or greater training outcomes than traditional trainings. Currently, few studies systematically evaluated immersive VR and MR training. Conclusion To determine the success of a training, proper and scientifically sound evaluation is necessary. Of the effectiveness indicators found, performance assessments in simulated scenarios are closest to the target behavior during real disasters. For valid yet inexpensive evaluations, objectively assessible performance measures, such as accuracy, time, and order of actions could be used. However, performance assessments have not been applied often. Furthermore, we found that technology-based training methods represent a promising approach to train many MFRs repeatedly and efficiently. These technologies offer great potential to supplement or partially replace traditional training. Further research is needed on those methods that have been underrepresented, especially serious gaming, immersive VR, and MR.

NextGen Training for Medical First Responders: Advancing Mass-Casualty Incident Preparedness through Mixed Reality Technology

“…Baetzner et al [5] highlight significant challenges in current MCI training, which is supported by the feedback received. Two critical areas of limitations have been identified: a lack of realism in training scenarios and inadequate post-training evaluation.…”

“…However, it presents challenges related to resources and evaluation [4]. Research reveals inadequate MCI scenario training, leading to MFRs feeling unprepared, potentially affecting their response to disasters and patient safety [5].…”

Do negative cognitions influence first responders’ coping and attitudes toward others?

“…First responders can include emergency medical technicians, police officers, firefighters, and paramedics. There are specialized trainings available for first responders to help them navigate and ensure the safety of themselves and the populations they work with effectively (Baetzner et al, 2022; Szeto et al, 2019). Populations served can include survivors of disasters, including assault or violent crimes or at-risk populations, including those with mental health concerns or physical disabilities, all of whom may require specialized assistance that accounts for their more specific needs (PUBLIC HEALTH WORKBOOK to Define, Locate, and Reach Special, Vulnerable, and At-Risk Populations in an Emergency, n.d.; Reaching At-Risk Populations in an Emergency|CDC, 2021; SAMHSA, 2018).…”

Exploring objective measures for assessing team performance in healthcare: an interview study

“…Team performance outcomes focus on results, such as treatment and patient condition. To assess training benefits, medical training studies usually focus on reporting outcomes such as triage accuracy, time to triage, and occasionally administer the perceived benefits from participants (e.g., Luigi Ingrassia et al, 2015 ; Dittmar et al, 2018 ; Baetzner et al, 2022 ). Team researchers typically use the same measures, often assessing time intervals during medical processes, such as decision or execution latency ( Burtscher et al, 2011 ), percentage of hands-on time during resuscitations ( Tschan et al, 2009 ), or durations required to complete a specific task ( Tschan et al, 2009 ).…”