Comparison of two disaster drills' management performed by trained and not-trained students: key times evaluation

Introduction The aim of this report is to compare two disaster exercises' management of students with different backgrounds. To our knowledge nobody has ever compared two exercises, probably because of the difficulty in their evaluation. We implemented a tool for an objective evaluation [1] and we used it for this purpose. Methods Both drills represented a ceiling collapse over a crowded room with a similar amount of casualties and similar severity index. The START triage system was used. The trained students (T) were attending the European Master in Disaster Medicine (EMDM), while the not-trained students (NT) were at the beginning of an introductory course in disaster medicine. During the exercises we recorded key victim-provider interaction times [2] using victim-based data collection. Each victim had their own data card to record triage and time information. Results In this preliminary report we present data regarding the scene length of stay (LOS) and triage to collecting area/advanced medical post time (T-AMP). The LOS was 67.5 (50.0 to 111.0) minutes (25 to 75 IQR) for T as compared with 145.0 (110.0 to 150.0) minutes (25 to 75 IQR) for NT (P < 0.001). Stratification according to assigned triage code showed no difference for high-priority codes (reds and yellows) as opposed to the green code (55.0 (47.0 to 75.0) minutes for T vs 145.0 (141.0 to 155.0) minutes for NT with P < 0.01). T-AMP was 10.0 (3.0 to 34.5) minutes for T as compared with 63.5 (19.5 to 104.3) minutes for NT (P < 0.001). Stratification according to triage code showed no difference for red codes between T and NT but showed a difference for yellow codes (36.5 (15.0 to 82.0) vs 71.0 (30.0 to 99.0) minutes) and green codes (7.0 (3.0 to 12.0) vs 85.0 (17.3 to 115.0) minutes) with P < 0.01. Conclusions Both teams evacuated red codes before the yellow ones in similar time. T-AMP was shorter considering global, yellow and green codes for T as opposed to NT. Global and green LOS was also shorter in the T group as opposed to NT. Training seems to influence global exercise management, less affecting red codes but with an impact on yellow and green evacuation strategies

Virtual reality and live scenario simulation: options for training medical students in mass casualty incident triage

Introduction Multicasualty triage is the process of establishing the priority of care among casualties in disaster management. Recent mass casualty incidents (MCI) revealed that health personnel are unfamiliar with the triage protocols. The objective of this study is to compare the relative impact of two simulation-based methods for training medical students in mass casualty triage using the Simple Triage and Rapid Treatment (START) algorithm. Methods A prospective randomized controlled longitudinal study. Medical students enrolled in the emergency medicine course were randomized into two groups (A and B). On day 1, group A students were exposed to a virtual reality (VR) scenario and group B students were exposed to a live scenario (LS), both exercises aiming at triaging 10 victims in a limited period of time (30 seconds/victim). On day 2 all students attended a 2-hour lecture about medical disaster management and START. On day 3 group A and B students were exposed to a LS and to a VR scenario respectively. The vital signs and clinical condition of the 10 victims were identical in the two scenarios. Ability of the groups to manage a simulated triage scenario was then compared (times and triage accuracy). Results Groups A and B were composed of 25 and 28 students respectively. During day 1 group A LS triage accuracy was 58%, while the average time to assess all patients was 4 minutes 28 seconds. The group B VR scenario triage accuracy was 52%, while the average time to complete the assessment was 5 minutes 18 seconds. During day 3 the triage accuracy for group A VR simulation was 92%, while the average time was 3 minutes 53 seconds. Group B triage accuracy during the LS was 84%, with an average time of 3 minutes 25 seconds. Triage scores improved significantly during day 3 (P < 0.001) in the two groups. The time to complete each scenario decreased significantly from day 1 to day 3. Conclusions The study demonstrates that the training course generates significant improvement in triage accuracy and speed. It also reveals that VR simulation compared to live exercises has equivalent results in prompting critical decisions in mass casualty drills. In the beginning the average time to complete the VR scenario was higher than the LS. This could be due to the fact that on day 1 very detailed VR victims created a higher challenge for untaught students. However, the higher triage accuracy recorded at the end of day 3 in VR could be explained by a lower stress level compared to the LS, which could be creating a more stressful environment in taught students

Evaluation of a new community-based curriculum in disaster medicine for undergraduates

BACKGROUND: Nowadays, many medical schools include training in disaster medicine in undergraduate studies. This study evaluated the efficacy of a disaster medicine curriculum recently designed for Saudi Arabian medical students. METHODS: Participants were 15 male and 14 female students in their fourth, fifth or sixth year at Jazan University Medical School, Saudi Arabia. The course was held at the Research Center in Emergency and Disaster Medicine and Computer Sciences Applied to the Medical Practice in Novara, Italy. RESULTS: The overall mean score on a test given before the course was 41.0 % and it increased to 67.7 % on the post-test (Wilcoxon test for paired samples: z = 4.71, p < 0.0001). There were no significant differences between the mean scores of males and females, or between students in their fourth, fifth or sixth year of medical school. CONCLUSIONS: These results show that this curriculum is effective for teaching disaster medicine to undergraduate medical students. Adoption of this course would help to increase the human resources available for dealing with disaster situations

Hospitals Disaster Preparedness during Arab Spring in Yemen.

Objective: The objective of this paper is to assess the hospitals preparedness for emergency using WHO standards. Method: This is a cross-sectional study, consisted of site visit, questionnaire survey, 16 health facilities were included. The WHO standard for emergency preparedness of health facilities was used to evaluate and assess the hospitals preparedness of health facilities. Result: 13 hospitals were responded. They scored below average in all measure >75%), while above average score was in 7 out 9 nine measure with a range of 8%-25%. Un acceptable below average was noted in two measures only. Discussion: The biggest challenge facing the hospitals in their emergency intervention is the lack of pre-emergency and emergency preparedness plans as well as the coordination of the hospitals response mechanisms. Conclusion: The studied hospitals presently are far from international disasters preparedness protocols. That necessitates improvements in emergency preparedness, as well as in physician skills for injury management

E-learning e alta formazione in medicina dei disastri: l\u2019esperienza dello European Master in Disaster Medicine

Lo European Master in Disaster Medicine \ue8 un corso di alta formazione in Medicina delle Catastrofi erogato in e-learning e frequentato da discenti provenienti da tutto il mondo. Il programma comprende 1) una fase a distanza articolata in pi\uf9 sezioni, ciascuna guidata da un membro del corpo docente, basata sull\u2019apprendimento per risoluzione di problemi e completata da attivit\ue0 collaborative in gruppo; 2) un corso residenziale di due settimane, dove gli studenti interagiscono con i docenti in dibattiti, verificano la capacit\ue0 di applicare quanto appreso a distanza, svolgono esercizi di simulazione virtuale e dal vivo; 3) la compilazione di una tesi e 4) un esame finale on-line. Gli sviluppi tecnologici pi\uf9 interessanti che caratterizzano questo corso internazionale vanno nella direzione del game-based learning, ovvero lo sviluppo di ambienti virtuali che permettono di costruire scenari di grandi incidenti, di definire piani di emergenza per gli ospedali dell\u2019area, e di simulare uno scenario di incidente ipotizzato, allo scopo di valutare la risposta all\u2019emergenza e la validit\ue0 dei piani elaborati dai discenti