title: Simulation in a disaster drill: comparison of high-fidelity simulators versus trained actors.
abstract: OBJECTIVE
  High-fidelity patient simulation provides lifelike medical scenarios with real-time stressors. Mass casualty drills must construct a realistic incident in which providers care for multiple injured patients while simultaneously coping with numerous stressors designed to tax an institution's resources. This study compared the value of high-fidelity simulated patients with live actor-patients.
  
  
  METHODS
  A prospective cohort study was conducted during two mass casualty drills in December 2006 and March 2007. The providers' completion of critical actions was tested in live actor-patients and simulators. A posttest survey compared the participants' perception of "reality" between the simulators and live actor victims.
  
  
  RESULTS
  The victims (n = 130) of the mass casualty drill all had burn-, blast-, or inhalation-related injuries. The participants consisted of physicians, residents, medical students, clerks, and paramedics. The authors compared the team's execution of the 136 critical actions (17 critical actions x 8 scenarios) between the simulators and the live actor-patients. Only one critical action was missed in the simulator group and one in the live actor group, resulting in a miss rate of 0.74% (95% confidence interval [CI] = 0.01% to 4.5%). All questionnaires were returned and analyzed. The vast majority of participants disagreed or strongly disagreed that the simulators were a distraction from the disaster drill. More than 96% agreed or strongly agreed that they would recommend the simulator as a training tool. The mean survey scores for all participants demonstrated agreement that the simulators closely mimicked real-life scenarios, accurately represented disease states, and heightened the realism of patient assessment and treatment options during the drill with the exception of nurse participants, who agreed slightly less strongly.
  
  
  CONCLUSIONS
  This study demonstrated that simulators compared to live actor-patients have equivalent results in prompting critical actions in mass casualty drills and increase the perceived reality of such exercises.
authors: Center for Advanced Clinical Skills Lab, University of South Florida, Tampa, FL, USA. bpgillett@earthlink.net
authors: Brian
authors: B
authors: Gillett
authors: Brad
authors: B
authors: Peckler
authors: Richard
authors: R
authors: Sinert
authors: Cherie
authors: C
authors: Onkst
authors: Spencer
authors: S
authors: Nabors
authors: Steven
authors: S
authors: Issley
authors: Christopher
authors: C
authors: Maguire
authors: Sagar
authors: S
authors: Galwankarm
authors: Bonnie
authors: B
authors: Arquilla
mesh_terms: D003198:Computer Simulation; D004189:Disaster Planning / Q000379:methods*; D004632:Emergency Medical Services / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000458:organization & administration; D006801:Humans; D054527:Mass Casualty Incidents; D016544:Patient Simulation; D011446:Prospective Studies