High-fidelity human patient simulators compared with human actors in an unannounced mass-casualty exercise.

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.

A tool for immediate and automated assessment of resuscitation skills for a full-scale simulator.

BACKGROUND: For performance assessment during simulation, mostly observers rate the trainees' performance using checklists. Simulator outcome may provide immediate and objective feedback to the participants but requires additional work for the accurate scenario design. High-fidelity simulators are based on physiologic models and store all changes of the simulator conditions during the scenarios and may therefore be used for the assessment of performance. In the present work, the design of a simulator script for the assessment of resuscitation skills using an Emergency Care Simulator (ECS, METI, Sarasota, Florida) is described. FINDINGS: A standardized resuscitation simulator script and a visual basic-based macro were programmed for the immediate and automated extraction of performance-related variables from the log files. The following parameters were assessed: mean cardiac output, time until return of spontaneous circulation, no-flow-time, no-flow-time fraction, the time until the first defibrillation, the number and fraction of indicated and non-indicated defibrillations. Furthermore, mean deviation of defibrillation interval from the 2 minutes interval, the mean interval of defibrillations and the time until the first administration of epinephrine were calculated. As an example, the results of resuscitation efforts according to 2005 guidelines by five teams that consisted of one emergency physician and two paramedics are presented. No data are provided about its validity and reliability. CONCLUSION: The tool can be used to assess adherence to European and American cardiopulmonary resuscitation guidelines (both 2005 and 2010) and to compare simulator outcome if different guidelines are trained and applied according to specific curricula. It represents an example of how simulator outcome can be used for performance assessment and may help to design more complex test-scenarios including the field of critical incidents in anesthesia.