title: Teaching mass casualty triage skills using iterative multimanikin simulations.
abstract: OBJECTIVE
  Effective mass casualty triage requires rapid and accurate decision making. First responders need to be trained, but opportunities to practice triage and receive individualized feedback during traditional mass casualty (MC) exercises are uncommon. It was hypothesized that novice learners would improve in speed, accuracy, and self-efficacy after deliberate practice triaging multiple simulated casualties in a MC exercise using high-fidelity manikins.
  
  
  METHODS
  Learners initially developed baseline knowledge of MC triage by listening to four short podcasts and passing a written examination. They then experienced three sequential MC scenarios (A, B, and C) consisting of five manikin simulations each, coupled with individual feedback after each scenario. Students served as their own controls. A triage score (TS) and intervention score (IS) were recorded. For the TS, one point was awarded for each correctly identified main problem, required intervention, and triage category. For the IS, one point was awarded for each correctly applied intervention. Before-and-after surveys measured self-efficacy and reaction to the training.
  
  
  RESULTS
  Twenty-one medical students were enrolled and 20 students passed the examination. The TS and IS improved significantly during scenario B (p < 0.001). Time to complete each scenario decreased significantly from scenario A (8 min 27 sec) to scenario B (6 min 19 sec) (p < 0.001), but not from scenario B to scenario C (5 min 40 sec). Self-efficacy improved significantly after scenario C for prioritizing treatment and resources, identifying high-risk casualties, and learning to be an effective first responder.
  
  
  CONCLUSIONS
  Novice learners demonstrated improved triage and intervention scores, speed, and self-efficacy during an iterative, multimanikin MC training experience.
authors.affiliation: John A. Burns School of Medicine, Telehealth Research Institute, University of Hawaii, Honolulu, Hawaii.
authors.forename: Dale S
authors.initials: DS
authors.lastname: Vincent
authors.forename: Lawrence
authors.initials: L
authors.lastname: Burgess
authors.forename: Benjamin W
authors.initials: BW
authors.lastname: Berg
authors.forename: Kathleen K
authors.initials: KK
authors.lastname: Connolly
mesh_terms: D000704:Analysis of Variance; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D006254:Hawaii; D007722:Health Knowledge, Attitudes, Practice; D006305:Health Status Indicators; D006801:Humans; D008348:Manikins; D054527:Mass Casualty Incidents / Q000706:statistics & numerical data*; D011361:Professional Competence / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013663:Teaching; D014218:Triage / Q000706:statistics & numerical data