title: Development and evaluation of a new simulation model for interactive training of the medical response to major incidents and disasters.
abstract: OBJECTIVE
  The need for and benefit of simulation models for interactive training of the response to major incidents and disasters has been increasingly recognized during recent years. One of the advantages with such models is that all components of the chain of response can be trained simultaneously. This includes the important communication/coordination between different units, which has been reported as the most common cause of failure. Very few of the presently available simulation models have been suitable for the simultaneous training of decision-making on all levels of the response. In this study, a new simulation model, originally developed for the scientific evaluation of methodology, was adapted to and developed for the postgraduate courses in Medical Response to Major Incidents (MRMI) organized under the auspices of the European Society for Trauma and Emergency Surgery (ESTES). The aim of the present study was to describe this development process, the model it resulted in, and the evaluation of this model.
  
  
  METHODS
  The simulation model was based on casualty cards giving all information normally available for the triage and primary management of traumatized patients. The condition of the patients could be changed by the instructor according to the time passed since the time of injury and treatments performed. Priority of the casualties as well as given treatments could be indicated on the cards by movable markers, which also gave the time required for every treatment. The exercises were run with real consumption of time and resources for all measures performed. The magnetized cards were moved by the trainees through the scene, through the transport lines, and through the hospitals where all functions were trained. For every patient was given the definitive diagnosis and the times within certain treatments had to be done to avoid preventable mortality and complications, which could be related to trauma-scores.
  
  
  RESULTS
  The methodology was tested in nine MRMI courses with a total of 470 participants. Based on continuous evaluations and accumulated experience, the setup of the simulation was step-wise adjusted to the present model, including also collaborating agencies such as fire and rescue services as well as the police, both on-scene and on superior command levels. The accuracy of the simulation cards for this purpose was evaluated as "very good" by 63 % of the trainees and as "good" by 33 %, the highest two of the six given alternatives. The participants' ranking of the extent that the course increased their competencies related to the given objectives on a 1-5 scale for prehospital staff had an average value of 4.25 ± 0.77 and that for hospital staff had an average value of 4.25 ± 0.72. The accuracy of the course for the training of major incident response on a 1-5 scale by prehospital staff was evaluated as 4.35 ± 0.73 and that by hospital staff as 4.30 ± 0.74.
  
  
  CONCLUSIONS
  The simulation system tested in this study could, with adjustments based on accumulated experience and evaluations, be developed into a tool for the training of major incident response meeting the specific demands on such training based on recent experiences from major incidents and disasters. Experienced trainees in several courses evaluated the methodology to be accurate for this training, markedly increasing their perceived knowledge and skills in fields of importance for a successful outcome of the response to a major incident.
authors.affiliation: Department of Surgery, Institute of Clinical Sciences, Center for Prehospital and Disaster Medicine, University of Gothenburg, Göteborg, Sweden. lennquist@hotmail.com.|, Åsevägen 1, 182 39, Danderyd, Sweden. lennquist@hotmail.com.
authors.forename: K
authors.initials: K
authors.lastname: Lennquist Montán
authors.affiliation: Department of Surgery, General Hospital Slavonski Brod, Croatian Urgent Medicine and Surgery Association, Slavonski Brod, Croatia.
authors.forename: B
authors.initials: B
authors.lastname: Hreckovski
authors.affiliation: Hanover Associates, Teddington, UK.
authors.forename: B
authors.initials: B
authors.lastname: Dobson
authors.affiliation: Department of Surgery, Institute for Clinical Sciences, University of Gothenburg, Göteborg, Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Örtenwall
authors.affiliation: Department of Vascular Surgery, Karolinska Institutet, Solna, Sweden.
authors.forename: C
authors.initials: C
authors.lastname: Montán
authors.affiliation: Department of Surgery, Institute of Clinical Sciences, Center for Prehospital and Disaster Medicine, University of Gothenburg, Göteborg, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Khorram-Manesh
authors.affiliation: University of Linköping, Linköping, Sweden.
authors.forename: S
authors.initials: S
authors.lastname: Lennquist
keywords: Disaster; MACSIM; MRMI; Major incident; Mass-casualty; Simulation; Training
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