Comparison of Computerized Patients versus Live Moulaged Actors for a Mass-casualty Drill.
BACKGROUND
Multiple modalities for simulating mass-casualty scenarios exist; however, the ideal modality for education and drilling of mass-casualty incident (MCI) triage is not established. Hypothesis/Problem Medical student triage accuracy and time to triage for computer-based simulated victims and live moulaged actors using the pediatric version of the Simple Triage and Rapid Treatment (JumpSTART) mass-casualty triage tool were compared, anticipating that student performance and experience would be equivalent.


METHODS
The victim scenarios were created from actual trauma records from pediatric high-mechanism trauma presenting to a participating Level 1 trauma center. The student-reported fidelity of the two modalities was also measured. Comparisons were done using nonparametric statistics and regression analysis using generalized estimating equations.


RESULTS
Thirty-three students triaged four live patients and seven computerized patients representing a spectrum of minor, immediate, delayed, and expectant victims. Of the live simulated patients, 92.4% were given accurate triage designations versus 81.8% for the computerized scenarios (P=.005). The median time to triage of live actors was 57 seconds (IQR=45-66) versus 80 seconds (IQR=58-106) for the computerized patients (P<.0001). The moulaged actors were felt to offer a more realistic encounter by 88% of the participants, with a higher associated stress level.


CONCLUSIONS
While potentially easier and more convenient to accomplish, computerized scenarios offered less fidelity than live moulaged actors for the purposes of MCI drilling. Medical students triaged live actors more accurately and more quickly than victims shown in a computerized simulation.
1Department of Emergency Medicine,University of Southern California,Keck School of Medicine,Los Angeles,CaliforniaUSA.
Ilene
I
Claudius
2Department of Emergency Medicine,Harbor-University of California-Los Angeles Medical Center,Torrance,CaliforniaUSA.
Amy
A
Kaji
1Department of Emergency Medicine,University of Southern California,Keck School of Medicine,Los Angeles,CaliforniaUSA.
Genevieve
G
Santillanes
3Department of Pediatrics,Yale School of Medicine,New Haven,ConnecticutUSA.
Mark
M
Cicero
2Department of Emergency Medicine,Harbor-University of California-Los Angeles Medical Center,Torrance,CaliforniaUSA.
J Joelle
JJ
Donofrio
2Department of Emergency Medicine,Harbor-University of California-Los Angeles Medical Center,Torrance,CaliforniaUSA.
Marianne
M
Gausche-Hill
4Department of Emergency Medicine,Children's Hospital Los Angeles,Los Angeles,CaliforniaUSA.
Saranya
S
Srinivasan
4Department of Emergency Medicine,Children's Hospital Los Angeles,Los Angeles,CaliforniaUSA.
Todd P
TP
Chang
D002648:Child; D002675:Child, Preschool; D003198:Computer Simulation; D004189:Disaster Planning / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D054527:Mass Casualty Incidents; D016544:Patient Simulation; D010372:Pediatrics; D018709:Statistics, Nonparametric; D014218:Triage / Q000379:methods*
MCI mass-casualty incident; START Simple Triage and Rapid Treatment; VAS visual analogue scale; emergency department; mass-casualty incident; triage