title: Mass casualty incident training in a resource-limited environment.
abstract: BACKGROUND
  A mass casualty incident (MCI) occurs when a disaster involves a large number of injured people, overwhelming the capacity of local emergency medical services. This article describes the planning and execution of a MCI workshop created for use in Sierra Leone, a low-income country.
  
  
  METHODS
  Surgeons OverSeas (SOS), an international non-governmental organization, partnered with the Sierra Leone Office of National Security and Connaught Hospital to develop a 2-day MCI workshop designed to meet needs specific to their resource-limited environment. Pre- and post-course questionnaires were completed. Day 1 consisted of didactic teaching focused on triage principles, resource deployment, communication/operations and tabletop drills. On day 2 a mock MCI with performance assessments by independent observers was staged, followed by post-event debriefing.
  
  
  RESULTS
  Pre-course questionnaires identified the following deficits: lack of triage training (29 per cent), and transportation (19 per cent) and communication (17 per cent) shortfalls. Only 11 per cent could define MCI. During the drill, on-scene and hospital triage was accurate in 28 (93 per cent) and 23 (77 per cent) of 30 casualties respectively. Systematic deficiencies identified included: transport issues, no accurate system for tracking victims, and undersized triage areas. Participants identified interagency coordination (63 of 136 responses; 46·3 per cent) and triage (32 of 136; 23·5 per cent) as the most valuable lessons learned.
  
  
  CONCLUSIONS
  Pre-existing MCI programmes based on first-world logistics do not account for challenges encountered when caring for casualties in resource-constrained settings. Logistical training, rather than medical skills or knowledge, was identified as the educational priority.
authors.affiliation: Surgeons OverSeas (SOS), New York, New York 10003, USA.
authors.forename: J J
authors.initials: JJ
authors.lastname: Leow
authors.forename: S I
authors.initials: SI
authors.lastname: Brundage
authors.forename: A L
authors.initials: AL
authors.lastname: Kushner
authors.forename: T B
authors.initials: TB
authors.lastname: Kamara
authors.forename: E
authors.initials: E
authors.lastname: Hanciles
authors.forename: A
authors.initials: A
authors.lastname: Muana
authors.forename: M M
authors.initials: MM
authors.lastname: Kamara
authors.forename: K S
authors.initials: KS
authors.lastname: Daoh
authors.forename: T P
authors.initials: TP
authors.lastname: Kingham
mesh_terms: D003479:Curriculum; D003906:Developing Countries; D004189:Disaster Planning / Q000458:organization & administration*; D004501:Education, Medical / Q000379:methods*; D004635:Emergency Medicine / Q000193:education*; D006801:Humans; D054527:Mass Casualty Incidents; D012807:Sierra Leone; D013663:Teaching / Q000379:methods; D014218:Triage / Q000458:organization & administration*