title: High-fidelity human patient simulators compared with human actors in an unannounced mass-casualty exercise.
abstract: High-fidelity simulators (HFSs) have been shown to prompt critical actions at a level equal to that of trained human actors (HAs) and increase perceived realism in intrahospital mass-casualty incident (MCI) exercises. For unannounced prehospital MCI exercises, however, no data are available about the feasibility of incorporating HFSs. This case report describes the integration of HFSs in such an unannounced prehospital MCI drill with HAs and provides data about the differences concerning triage, treatment, and transport of HFSs and HAs with identical injury patterns. For this purpose, 75 actors and four high-fidelity simulators were subdivided into nine groups defined by a specific injury pattern. Four HFSs and six HAs comprised a group suffering from traumatic brain injury and blunt abdominal trauma. Triage results, times for transport, and number of diagnostic and therapeutic tasks were recorded. Means were compared by t test or one-way ANOVA. Triage times and results did not differ between actors and simulators. The number of diagnostic (1.25, SD = 0.5 in simulators vs 3.5, SD = 1.05 in HAs; P = .010) and therapeutic tasks (2.0, SD = 1.6 in simulators vs 4.8, SD = 0.4 in HAs; P = .019) were significantly lower in simulators. Due to difficulties in treating and evacuating the casualties from the site of the accident in a timely manner, all simulators died. Possible causal factors and strategies are discussed, with the aim of increasing the utility of simulators in emergency medicine training.
authors.affiliation: 1 Department of Anesthesiology, Klinikum rechts der Isar, Technische Universität München, München, Germany.
authors.forename: Christian M
authors.initials: CM
authors.lastname: Schulz
authors.affiliation: 1 Department of Anesthesiology, Klinikum rechts der Isar, Technische Universität München, München, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Skrzypczak
authors.affiliation: 2 Clinic for Plastic Surgery and Hand Surgery, Klinikum rechts der Isar, Technische Universität München, München, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Raith
authors.affiliation: 1 Department of Anesthesiology, Klinikum rechts der Isar, Technische Universität München, München, Germany.
authors.forename: Dominik
authors.initials: D
authors.lastname: Hinzmann
authors.affiliation: 1 Department of Anesthesiology, Klinikum rechts der Isar, Technische Universität München, München, Germany.
authors.forename: Veronika
authors.initials: V
authors.lastname: Krautheim
authors.affiliation: 1 Department of Anesthesiology, Klinikum rechts der Isar, Technische Universität München, München, Germany.
authors.forename: Fabian
authors.initials: F
authors.lastname: Heuser
authors.affiliation: 1 Department of Anesthesiology, Klinikum rechts der Isar, Technische Universität München, München, Germany.
authors.forename: Valentin
authors.initials: V
authors.lastname: Mayer
authors.affiliation: 1 Department of Anesthesiology, Klinikum rechts der Isar, Technische Universität München, München, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Kreuzer
authors.affiliation: 1 Department of Anesthesiology, Klinikum rechts der Isar, Technische Universität München, München, Germany.
authors.forename: Meike
authors.initials: M
authors.lastname: Himsl
authors.affiliation: 1 Department of Anesthesiology, Klinikum rechts der Isar, Technische Universität München, München, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Holl
authors.affiliation: 1 Department of Anesthesiology, Klinikum rechts der Isar, Technische Universität München, München, Germany.
authors.forename: Christina
authors.initials: C
authors.lastname: Lipp
authors.affiliation: 1 Department of Anesthesiology, Klinikum rechts der Isar, Technische Universität München, München, Germany.
authors.forename: Eberhard F
authors.initials: EF
authors.lastname: Kochs
authors.affiliation: 1 Department of Anesthesiology, Klinikum rechts der Isar, Technische Universität München, München, Germany.
authors.forename: Klaus J
authors.initials: KJ
authors.lastname: Wagner
mesh_terms: D000007:Abdominal Injuries / Q000628:therapy*; D001930:Brain Injuries / Q000628:therapy*; D004189:Disaster Planning; D004632:Emergency Medical Services / Q000458:organization & administration*; D004635:Emergency Medicine / Q000193:education*; D006801:Humans; D054527:Mass Casualty Incidents; D016544:Patient Simulation; D014187:Transportation of Patients; D014218:Triage; D014949:Wounds, Nonpenetrating / Q000628:therapy*