Evaluation of Medical Management During a Mass Casualty Incident Exercise: An Objective Assessment Tool to Enhance Direct Observation

Radio Records’ Analysis: During the post-exercise analysis, communications were sorted into eight categories: asking for support, answering a request, reporting position, requesting assistance, commanding, waiting for instructions, giving information, and other. A diagram of points and lines representing relations among rescuers to display position of power and lines of communication was plotted.Anecdotal observations. These images were integrated into the CITE Explorer® software package (VLS System AB, Linkoping, Sweden), which allowed a time-synchronized discrete event representation of rescue operations.Statistical Analysis: Contingency table tests were used to compare the mean triage classes. Non-parametric were used to compare the triage delay, evacuation time from crash area, and collecting area between triage categories. The appropriateness of the triage and the evacuation priorities were evaluated to reveal any significant statistical differences between planned and assigned triage color code and delay time. Treatment means were also analyzed statistically to point out different levels of efficiency. The further division of incorrect maneuvers into categories of overtreatment and under-treatment, and their comparison, was viewed as an index of available resources in a particular situation.

An evaluation tool comprising three data fields (triage, clinical maneuvers, and radio usage), accompanied by direct anecdotal observational methods, was used to evaluate a large functional mass casualty incident exercise.

triage delay; evacuation time from crash area, and collecting area between triage categories; the appropriateness of the triage; the evacuation priorities; treatment means; how well missions and critical tasks are carried out

Victims: 112 simulated adult victims (medical students), 29% severe traumatic injuries, 10% Primarily chemical inhalation injuries, 7% combined traumatic and chemical injuries, 45% with minor injuries including psychological trauma, 9% non-salvageable. The victims were prepared for the exercise by donning appropriate attire and make-up. The students were given detailed instructions in a separate course regarding their roles as victims. Each student was given a set of dynamic casualty cards that were inserted in a transparent envelope and safely attached to a lanyard to be worn around the mock victim’s neck. Setting: A conventional explosive blast in a two-story building was simulated in Casalvolone, Italy. Patient distribution within the building by Simple Triage and Rapid Treatment. Student medical responders were assigned roles within the exercise that were commensurate with their previous experience.During the exercise, the local fire brigade, emergency medical services (EMS), police, and civil protection acted in their usual capacities. However, none of these agencies had been previously informed of the scenario.Triage: Before the exercise, patients were assigned ideal triage scores according to the START criteria.Treatment maneuvers. In the clinical scenario, patients received mandatory maneuvers of four different subtypes, performed by the medical responders, which would be necessary parts of patient treatment.Radio usage: Two radio channels were available for participant usage. The first channel was used for medical coordination and connected the on-site medical officer with the dispatch center, first responder, secondary triage officer, command post medical officer, and fire brigade. The second channel was used for evacuation and connected dispatch, the AMP commander, the fire brigade, and the supporting hospital and the ambulances.

Seven trained observers, located at designated areas at the exercise site, recorded their observations of medical management in the simulation on structured evaluation forms. Three observers were physicians with experience in disaster management and four were medical students with a special interest in disaster medicine. The observers had participated in the organization of the exercise and design of the evaluation forms.All radio traffic was digitally recorded, with each communication being time-stamped.Anecdotal observations: Digital photographs and video recordings were used extensively to document the progress of the exercise.

Although much attention was given to making the scenario as realistic as possible, the scenario was still a simulation.The degree to which human performance during the simulation mimics behavior in a true disaster is unknown. The present evaluation system is also limited to markers of individual human performance, and does not evaluate equipment, information systems, or even patient management protocols.A three-part tool (triage, medical maneuvers, and radio usage) can provide a method to evaluate functional mass casualty incident exercises, and is easily implemented. For the best results, it should be used in conjunction with direct observation. The evaluation tool has great potential as a reproducible and internationally recognized tool for evaluating disaster management exercises.

Seventeen medical responders managed 112 victims of a simulated building explosion. Although 81% of the patients were assigned the appropriate triage codes, evacuation from the site did not follow in priority. Required maneuvers were performed correctly in 85.2% of airway maneuvers and 78.7% of breathing maneuvers, however, significant under-treatment occurred, possibly due to equipment shortages. Extensive use of radio communication was documented. In evaluating this tool, the structured markers were informative, but further information provided by direct observation was invaluable.Data communication played a pivotal role in disaster and MCI response. An accurate and objective method for evaluation of exercises would allow the determination of strengths and weaknesses in the disaster response; and ultimately provides the data needed for improvement of the response system.

To describe a simple and objective method to assess medical performance during functional mass casualty incident exercise events.