title: Mass-casualty triage training for international healthcare workers in the Asia-Pacific region using manikin-based simulations.
abstract: BACKGROUND
  More than half of the world's disasters occur in the Asia-Pacific region. A simulation-based exercise to teach healthcare workers prehospital triage, tagging, and treatment methods was used to link disaster management theory to practice with a student-centered, hands-on educational activity. Various strategies for teaching disaster health education have been advocated, and best-practice disaster education models continue to be sought.
  
  
  METHODS
  A manikin-based, primary triage and treatment course was adapted for international healthcare providers in the Asia-Pacific region using symbolic representations of triage categories and physical findings. The pedagogical construct that was used was an interactive, formative assessment in which faculty members mediated learner information gathering and interpretation during four simulation scenarios. After establishing a multi-casualty disaster context, a wireless, audience response system anonymously collected learner responses to four clinical situations: (1) leg wound (hemorrhagic shock/immediate); (2) chest wound (tension pneumothorax/immediate); (3) head wound (traumatic brain injury/expectant); and (4) limb trauma (leg fracture/delayed).
  
  
  RESULTS
  There were 182 healthcare providers from eight Asia-Pacific countries (including the US) that participated in four simulation seminars. The simulation sessions were successfully tailored to groups of learners that varied in size and professional composition. Expectant and delayed triage categories posed the greatest challenge to learners. In one of two groups that were queried, learner self-confidence in applying principles of triage and treatment improved significantly. At the conclusion of the simulation sessions, learners strongly agreed that manikin-based simulation improved their understanding of triage, and should be used to teach principles of primary triage and treatment.
  
  
  CONCLUSIONS
  Simulation training represents an opportunity to engage learners regardless of language and cultural barriers. Simulation-based training can be effective in introducing healthcare professionals to principles of primary triage and treatment in an effective and culturally sensitive manner. The characteristics of the course with respect to planned formative assessment and culturally competent scholarship were reviewed.
authors.affiliation: John A Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 96813, USA. dvincent@hawaii.edu
authors.forename: Dale S
authors.initials: DS
authors.lastname: Vincent
authors.forename: Benjamin W
authors.initials: BW
authors.lastname: Berg
authors.forename: Keiichi
authors.initials: K
authors.lastname: Ikegami
mesh_terms: D001208:Asia; D019985:Benchmarking; D004522:Educational Status; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006254:Hawaii; D006801:Humans; D007391:International Cooperation; D008348:Manikins; D054527:Mass Casualty Incidents; D017145:Models, Educational; D010140:Pacific Ocean; D010865:Pilot Projects; D011361:Professional Competence; D014218:Triage / Q000458:organization & administration*; D014481:United States