Can Live-Actor Patients in a Mass Casualty Incident Exercise Benefit as Exercise Players?

OBJECTIVES: In a mass casualty incident (MCI) exercise, live-actor patients (LAPs) simulated different scenarios in the exercise. This study compared the benefit to LAPs with that to exercise players (EPs) and nonparticipants (NPs). METHODS: An MCI exercise was conducted in 2018. Emergency department (ED) nurses were assigned as EPs, LAPs, or NPs and asked to attend a pre-exercise lecture. A pre-exercise survey evaluated all ED nurses' background, confidence level, and knowledge of MCI management. Knowledge assessment included disaster medicine knowledge (DMK) and on emergency operation plan familiarity (EOPF). The same survey was conducted again after the exercise. A paired t-test was used to analyze the difference before and after the exercise in the 3 groups. RESULTS: Twenty-nine ED nurses completed both surveys. Confidence improved significantly for both the EP and LAP groups. The DMK of the LAP group improved significantly. EOPF also improved significantly for all 3 groups. A comparison of the improvement levels showed no significant difference between the EP and LAP groups for confidence, DMK, and EOPF. CONCLUSIONS: ED nurses can benefit from participating as LAPs in full-scale MCI exercises. Having ED nurses act as LAPs makes it possible to train more staff in 1 exercise.

Preparation of Medical Supply for Prehospital Emergencies and Disasters: An Internet-Based Simulation Drill.

Background: Mass casualties caused by natural disasters and man-made events may overwhelm local emergency medical services and healthcare systems. Logistics is essential to a successful emergency medical response. Drills have been used in disaster preparedness to validate plans, policies, procedures, and agreements, and identify resource gaps. The application of the internet to facilitate the conduct of exercise was still limited. This study aimed to investigate the optimal preparation of medical supplies by medical emergency response teams (MERTs) during emergencies and disasters using an internet-based drill. Methods: An internet-based drill based on real-life mass casualty incidents (MCIs) was developed and conducted in Taiwan from June 2017 to July 2018. The drill involved an MCI with 50 events delivered under two scenarios: (1) reduced transfer capacity and well-functioning local healthcare facilities (emergency module); (2) severely reduced transfer capacity and dysfunctional local healthcare facilities (disaster module). For each event, medical supplies commonly prepared by local MERTs in Taiwan were listed in structured questionnaires and participants selected the supplies they would use. Results: Forty-three senior medical emergency responders participated in the survey (responding rate of 47.3%). Resuscitation-related supplies increased from emergency to disaster module (e.g., intubation from 9.1% to 13.9%; dopamine from 3.2% to 5.0%; all p < 0.001). In the subgroup analysis of events with life-threatening injuries, the utilization of resuscitation-related supplies (e.g., intubation from 46.6% to 65.3%; p < 0.001) remained higher in the disaster than in the emergency module. Compared to emergency medical technicians, physicians and nurses are more likely to use intravenous/intramuscular analgesics. Conclusions: The severity of scenarios and the professional background of emergency responders have a different utilization of medical supplies in the simulation drill. The internet-based drill may contribute to optimizing the preparedness of medical response to prehospital emergencies and disasters.

Who Can Be the Standardized Patient in Disaster Medical Full-Scale Exercise, Freshman, or Professional?

Background: Disasters cannot be predicted, so being well-prepared is important before a disaster strike. Good preparation needs constant practice and improvement, and full-scale exercise can provide both. The standardized patients (SPs) in a full-scale exercise to simulate patients are vital because they can provide realistic effects to exercise participants. However, there was no literature about who is capable of being an SP. We investigated the relationship between the SPs' current occupation and previous experience with their fidelity and participants' performance. Methods: Three identically designed full-scale exercises were conducted for three different emergency medical teams (EMTs) with the scenario of post-earthquake mass casualty incidents. Forty SPs were used in each exercise. Exercise objective and detail scenario were told to the SPs before exercise, and mock wound makeup was applied to the SPs. Each SP's occupation and previous experience were recorded before exercise. The SP's previous experience was defined as previous exercise experience and previous disaster medicine education. The SPs' fidelity (SPF) was rated using a 5-point Likert scale (1 = poor and 5 = excellent). The participants' performance (PP) was also rated using a 5-point Likert scale (1 = poor and 5 = excellent) according to the accuracy of each SP's triage result and management. The SPF and the PP were evaluated by clinicians with disaster medicine specialties using the same standard. The relationship between the SPs' occupation and the SPF along with occupation, and the PP were analyzed by analysis of variance (ANOVA). The data of the SPF and the PP in the SP groups divided by previous experience were analyzed by the Student's t -test. Results: The SPs' occupations were medical student, nurse, physician, and members of EMT. There was no significant difference in the SPF and the PP between occupations ( p = 0.382 and 0.416, respectively). Both the experienced and the inexperienced SP groups show no significant difference in the SPF ( p = 0.339). Significantly better PP was noted in the inexperienced SP group ( p < 0.001). Conclusions: The SPs' background does not influence the performance of either SPs or exercise participants. We proposed that the success of using freshmen as SPs in full-scale exercise depends on the pre-exercise design and the SP instruction and training.

The Effectiveness of Functional Exercises for Teaching Method Disaster Medicine to Medical Students.

Introduction Functional exercises are effective for testing disaster management training. Previously, we found that functional exercises promote student engagement and improve the perception of learning after exercise. Objective The study objective is to investigate whether functional exercise is effective for teaching disaster medicine. Methods Students who partook in a two-day course of disaster medicine were recruited. The course consisted of lectures and workshops followed by a half-day functional exercise and was designed based on four core competency domains which included major disaster medicine concepts. After the lectures and workshops, participants completed a test to assess their knowledge of the core competency domains and a questionnaire to evaluate their willingness to pursue further training and participate in a disaster medical assistance team (DMAT) and their interest in disaster exercises. The functional exercise involved the scenario of an earthquake and mass-casualty incident and participants acted as DMAT members in the exercise. A post-exercise debrief was conducted by the evaluators to discuss performance and evaluate the results of the exercise. Participants then completed the same tests and questionnaires as before the exercise. Results Ninety-seven students were recruited, 72 of which were medical students. Pre- and post-exercise tests and questionnaires were completed by 48. We found disaster scene safety knowledge to be significantly improved after the functional exercise. Students' willingness for further training and participation in a DMAT as well as their interest in disaster training was high before and after the exercise. Conclusion Disaster scene safety is a vital element of disaster medicine training but it is difficult to teach. Functional exercises represent a good tool for this purpose and can maintain enthusiasm for learning and participating in disaster medicine-related activities.

The Value of Functional Exercise in Pediatric Mass- Casualty Incident Training.

BACKGROUND: Hospital staff in Taiwan practice mass casualty incident (MCI) management through full-scale exercise (FSE). However, FSE is generally resource-intensive and time-consuming. As an alternative, functional exercise (FE) may be more cost-effective with a similar effect in certain aspects. Hence, we aimed to evaluate the FE value in MCI training. We investigated whether FE can increase the familiarity of pediatric MCI response and the effect in different groups. METHODS: A new emergency operation plan (EOP) of nontraumatic pediatric MCI was developed in 2018 for our Children's Hospital. An FE was conducted to assess the plan. In addition to the emergency department staff, head nurses, supervisors, and physicians of Children's Hospital also participated in the exercise. Pre- and post-exercise questionnaires were designed, and participants were asked to evaluate their familiarity with pediatric MCI response pre- and post-exercise. Participants' reading experience of the new EOP, previous training level, occupation position, and whether they were using a computer during the exercise were also noted in the questionnaires. Data were analyzed using paired t-test and Fisher's exact test. RESULTS: Among 49 participants, 16 participants completed the pre- and post-exercise questionnaires. The post-exercise familiarity score was found to be significantly higher than that of pre-exercise (p < 0.05). There were no significant differences among the relationships between familiarity increase and participants' reading experience of the new EOP, previous training level, occupation position, and whether they were using a computer during the exercise. CONCLUSIONS: FE can significantly increase the familiarity of the hospital staff with pediatric MCI response and may be applied as a new training method of hospital disaster preparedness.

Review of Medical Response in 2015 TransAsia Airways Flight 235 Aircraft Crash.

TransAsia Airways Flight 235 was a domestic flight that crashed into the Keelung River on February 4, 2015, about several minutes after take-off from Taipei Songshan Airport. There were 53 passengers and five crew members on board, however, only 15 of them survived. Twenty-seven casualties were sent to eight nearby hospitals. All of them were sent by ambulances of fire departments. Among 27 casualties, 10 experienced traumatic out-of-hospital cardiac arrest and the remaining 17 had traumatic injuries or hypothermia. The accident revealed several important issues regarding disaster medical response in Taiwan. First, compared to previous aircraft crash accidents in Taiwan, the search and rescue process was much more difficult because the airplane had fallen into the middle of a river. It was much more like a river rescue than an aircraft crash. Responders could not reach the casualties and provide care initially due to lack of proper equipment needed to cross the river. Second, the airplane crashed right on the border between two cities, the "command and communication" issue was also confused in the beginning. Third, the role of the disaster medical assistant team (DMAT) in Taiwan should be re-evaluated, including various protocols and standard procedures for dispatch, task, cooperation, staff training and logistics. By reviewing the response, we hope we can improve our system for the challenges in the future.