Managing Multiple-Casualty Incidents: A Rural Medical Preparedness Training Assessment

• Published in: Prehospital and disaster medicine 2013-08, Vol.28 (4), p.334-341
• Main Authors: Glow, Steven D., Colucci, Vincent J., Allington, Douglas R., Noonan, Curtis W., Hall, Earl C.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Bioterrorism; Causality; Communications; Computer Simulation; Disaster Planning - methods; Emergency medical services; Emergency Medical Technicians - education; Emergency preparedness; Emergency Responders - education; Emergency Service, Hospital - manpower; Emergency Service, Hospital - organization & administration; Female; Firefighters; Firefighters - education; Health services; Health technology assessment; Humans; Male; Manpower; Mass Casualty Incidents; Middle Aged; Models, Educational; Montana; Original Research; Personnel, Hospital - education; Police; Police - education; Program Evaluation; Rural areas; Training; Young Adult
• ISSN: 1049-023X; 1945-1938
• DOI: 10.1017/S1049023X13000423

The objectives of this study were to develop a novel training model for using mass-casualty incident (MCI) scenarios that trained hospital and prehospital staff together using Microsoft Visio, images from Google Earth and icons representing first responders, equipment resources, local hospital emergency department bed capacity, and trauma victims. The authors also tested participants' knowledge in the areas of communications, incident command systems (ICS), and triage. Participants attended Managing Multiple-Casualty Incidents (MCIs), a one-day training which offered pre- and post-tests, two one-hour functional exercises, and four distinct, one-hour didactic instructional periods. Two MCI functional exercises were conducted. The one-hour trainings focused on communications, National Incident Management Systems/Incident Command Systems (NIMS/ICS) and professional roles and responsibilities in NIMS and triage. The trainings were offered throughout communities in western Montana. First response resource inventories and general manpower statistics for fire, police, Emergency Medical Services (EMS), and emergency department hospital bed capacity were determined prior to MCI scenario construction. A test was given prior to and after the training activities. A total of 175 firefighters, EMS, law enforcement, hospital personnel or other first-responders completed the pre- and post-test. Firefighters produced higher baseline scores than all other disciplines during pre-test analysis. At the end of the training all disciplines demonstrated significantly higher scores on the post-test when compared with their respective baseline averages. Improvements in post-test scores were noted for participants from all disciplines and in all didactic areas: communications, NIMS/ICS, and triage. Mass-casualty incidents offer significant challenges for prehospital and emergency room workers. Fire, Police and EMS personnel must secure the scene, establish communications, define individuals' roles and responsibilities, allocate resources, triage patients, and assign transport priorities. After emergency department notification and in advance of arrival, emergency department personnel must assess available physical resources and availability and type of manpower, all while managing patients already under their care. Mass-casualty incident trainings should strengthen the key, individual elements essential to well-coordinated response such as communications, incident management system