Impact of training in medical disaster management: a pilot study using a new tool for live simulation

Objectives: The aim of this study was to test a new disaster simulation suite (DSS), evaluating its application during the same type of full-scale exercise on 2 different occasions. Our hypothesis was that the system would allow us to detect differences between trained and nontrained physicians during event management. Methods: Players (physicians) were classed as trained or nonrained based on their background in disaster medicine training. We simulated the collapse of a ceiling structure in a crowded room. Using the DSS, we electronically collected data relative to key prehospital and hospital times, triage accuracy, command-and-control and prehospital treatment accuracy. Results: No usability problems arose during either simulation. Trained physicians were faster than nontrained physicians in dispatching the victims from scene to hospital (median [interquartile range] times, 67.5 [50.0-111.0] vs 145.0 [110.0-150.0] minutes, P<.001); trained physicians also treated and discharged more patients in the emergency department (32/38 vs 14/31, P<.001) and performed better on command-and-control items (31/44 vs 17/44 for trained and nontrained players respectively, P<.05). No differences were found as regards triage or prehospital treatment accuracy. Conclusions: Using the DSS in 2 comparable scenarios allowed us to identify differences in mass casualty responses of trained and nontrained physicians. These results may reflect some of the specific objectives of disaster medicine training oriented to the organizational management of health crises rather than to the clinical management of injuries.