Simulated Mass Casualty Incident Triage Exercise for Training Medical Personnel

Abstract

Audience:The target audience is any medical professional who requires training in mass casualty incident (MCI) triage. This could apply to pre-hospital specialists, nurses, medical students, residents, and physicians.Introduction: Emergency medicine specialists must be able to triage patients quickly, especially in an MCI scenario. The simple triage and rapid treatment (START) system allows providers to categorize patients according to the urgency with which patients must access limited resources. Providers should be comfortable utilizing the START triage system before an MCI or disaster so that they can be prepared to implement it if necessary. This exercise uses simulation and gamification as instructional strategies to encourage knowledge of and comfort with the START triage system for emergency providers.Educational Objectives: By the end of this exercise, learners should be able to (1) recite the basic START patient categories (2) discuss the physical exam signs associated with each START category, (3) assign roles to medical providers in a mass casualty scenario, (4) accurately categorize patients into triage categories: green, yellow, red, and black, and (5) manage limited resources when demand exceeds availability.Educational Methods: Gamification is the use of elements of game design in non-game contexts. 1 Gamification was implemented in this scenario by assigning participants to roles and teams, while creating an engaging, fun, and competitive environment. The exercise also uses low fidelity simulation (without simulation equipment) to encourage learners to practice using the START triage system in a low stakes environment. 2 It is possible for the learners to be divided into two groups that each have the same patients, resources, and objectives. The team that finishes triaging all patients first would be declared the winner. However, in our implementation, we completed the exercise as a single group of learners and patients. SMALLgroupsResearch Methods: Learners were given a survey at the end of implementation and also given the opportunity to discuss feedback with the instructors in a group discussion after completing the exercise. There was no formal assessment completed after the exercise.Results: Informal feedback was collected at the end of the exercise. Residents and medical students all enjoyed the experience. The feedback was overwhelmingly positive. All participants providing feedback stated they would enjoy participating in the exercise again and suggested that it is implemented annually for review of triage topics. We also received informal feedback for suggested changes which we will discuss in this article. An optional, anonymous survey was given to participants at the end of the exercise. There were six responses. Of those surveyed, 100% of participants stated the effectiveness and value of the exercise was outstanding (a rating of five on a scale of one to five). Regarding the quality of the exercise, and whether the participants felt engaged, 100% of responses gave a rating of five. Wh...

Gamification vs. Teaching First Aid: What Is Being Produced by Science in The Area?

“…As leaders in the field of emergency medicine and nursing, these professionals not only respond to acute medical and health situations, but also actively engage in strategic decision-making, resource allocation, and coordination of efforts to ensure an effective and efficient emergency responses (13)(14)(15). This evolving role underscores the comprehensive skill set required of emergency nurses and physicians, positioning them not only as front-line healthcare providers, but also as integral contributors to the broader healthcare infrastructure and to community resilience in times of crisis (8,10,14,16).…”

“…Finally, Rajagopal et al ( 2020) conducted an evaluation of healthcare professionals, including prehospital specialists, nurses, medical students, residents, and physicians, seeking training in mass casualty incident triage (16). The study focused on the Simple Rapid Triage and Treatment (START) system, essential for efficiently categorizing patients in multi-casualty scenarios.…”

“…Gamebased learning integrates game elements into non-game contexts to enhance engagement and improve teaching outcomes. In contrast, simulation-based education encompasses a diverse range of models, including partialtask simulators, screen-based computers, standardized patients, and high-fidelity mannequin simulators (8,16,19,22,23). This variety of tools allows learners to practice clinical skills without compromising patient safety, highlighting the distinct advantages of simulation in medical education (17).…”

“…Simulation serves as a strategic cornerstone in the training of first aid and BLS skills, offering a dynamic and immersive educational platform. This approach transcends conventional instructional methods by creating lifelike scenarios that closely mirror real-life emergencies (11,16,19,22,23). Participants engage in hands-on simulations, enabling them to apply theoretical knowledge in a practical setting.…”

“…The simulation environment allows for the development of critical decision-making skills, honing participants' ability to think quickly and effectively under pressure, a crucial aspect of responding to medical emergencies. Additionally, the interactive nature of these simulations promotes muscle memory and procedural familiarity, ensuring that individuals are better prepared to execute life-saving techniques in real-world situations (8,16,19,22,23). Post-simulation debriefings further enhance the analytical aspect of this training, providing participants with opportunities for self-reflection, constructive feedback, and continuous improvement (8,16,19,22,23).…”