title: Creation and Delphi-method refinement of pediatric disaster triage simulations.
abstract: OBJECTIVE
  There is a need for rigorously designed pediatric disaster triage (PDT) training simulations for paramedics. First, we sought to design three multiple patient incidents for EMS provider training simulations. Our second objective was to determine the appropriate interventions and triage level for each victim in each of the simulations and develop evaluation instruments for each simulation. The final objective was to ensure that each simulation and evaluation tool was free of bias toward any specific PDT strategy.
  
  
  METHODS
  We created mixed-methods disaster simulation scenarios with pediatric victims: a school shooting, a school bus crash, and a multiple-victim house fire. Standardized patients, high-fidelity manikins, and low-fidelity manikins were used to portray the victims. Each simulation had similar acuity of injuries and 10 victims. Examples include children with special health-care needs, gunshot wounds, and smoke inhalation. Checklist-based evaluation tools and behaviorally anchored global assessments of function were created for each simulation. Eight physicians and paramedics from areas with differing PDT strategies were recruited as Subject Matter Experts (SMEs) for a modified Delphi iterative critique of the simulations and evaluation tools. The modified Delphi was managed with an online survey tool. The SMEs provided an expected triage category for each patient. The target for modified Delphi consensus was ≥85%. Using Likert scales and free text, the SMEs assessed the validity of the simulations, including instances of bias toward a specific PDT strategy, clarity of learning objectives, and the correlation of the evaluation tools to the learning objectives and scenarios.
  
  
  RESULTS
  After two rounds of the modified Delphi, consensus for expected triage level was >85% for 28 of 30 victims, with the remaining two achieving >85% consensus after three Delphi iterations. To achieve consensus, we amended 11 instances of bias toward a specific PDT strategy and corrected 10 instances of noncorrelation between evaluations and simulation.
  
  
  CONCLUSIONS
  The modified Delphi process, used to derive novel PDT simulation and evaluation tools, yielded a high degree of consensus among the SMEs, and eliminated biases toward specific PDT strategies in the evaluations. The simulations and evaluation tools may now be tested for reliability and validity as part of a prehospital PDT curriculum.
authors.forename: Mark X
authors.initials: MX
authors.lastname: Cicero
authors.forename: Linda
authors.initials: L
authors.lastname: Brown
authors.forename: Frank
authors.initials: F
authors.lastname: Overly
authors.forename: Jorge
authors.initials: J
authors.lastname: Yarzebski
authors.forename: Garth
authors.initials: G
authors.lastname: Meckler
authors.forename: Susan
authors.initials: S
authors.lastname: Fuchs
authors.forename: Anthony
authors.initials: A
authors.lastname: Tomassoni
authors.forename: Richard
authors.initials: R
authors.lastname: Aghababian
authors.forename: Sarita
authors.initials: S
authors.lastname: Chung
authors.forename: Andrew
authors.initials: A
authors.lastname: Garrett
authors.forename: Daniel
authors.initials: D
authors.lastname: Fagbuyi
authors.forename: Kathleen
authors.initials: K
authors.lastname: Adelgais
authors.forename: Ran
authors.initials: R
authors.lastname: Goldman
authors.forename: James
authors.initials: J
authors.lastname: Parker
authors.forename: Marc
authors.initials: M
authors.lastname: Auerbach
authors.forename: Antonio
authors.initials: A
authors.lastname: Riera
authors.forename: David
authors.initials: D
authors.lastname: Cone
authors.forename: Carl R
authors.initials: CR
authors.lastname: Baum
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003198:Computer Simulation; D003697:Delphi Technique; D054597:Disaster Medicine / Q000193:education*; D004632:Emergency Medical Services / Q000379:methods / Q000592:standards*; D004634:Emergency Medical Technicians / Q000193:education*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008348:Manikins; D054527:Mass Casualty Incidents; D016544:Patient Simulation; D010372:Pediatrics / Q000193:education*; D014218:Triage / Q000379:methods / Q000592:standards*