Multipatient Disaster Scenario Design Using Mixed Modality Medical Simulation for the Evaluation of Civilian Prehospital Medical Response: A “Dirty Bomb” Case Study

Disasters are defined as events that overwhelm local response capability and present myriad challenges to responding medical personnel.1,2 Prehospital medical providers and hospital personnel can be confronted with a multitude of patients, unusual illnesses or injuries, failure to communicate, poor logistic support, the need for decontamination, and difficulties in perimeter control.3–8 Concurrent demands often lead to task overload and performance failures.9 After-action reports (Rhode Island Disaster Initiative Annotated Bibliography 2002, available at: http://www.ridiproject.org/downloads/ annotated_bibliography.pdf) and disaster literature highlight recurring problem areas.10–16 The potential for a variety of natural and manmade catastrophic events makes health care provider preparation for mass casualty incidents (MCIs) both imperative and challenging. Analysis of disaster response often attributes failure to inadequate preparedness and the inability to follow designated plans.17 Disaster training needs of medical responders may not be adequately represented in current instructional paradigms,18 especially with respect to weapons of mass destruction (WMD) situations (Rhode Island Disaster Initiative Vulnerability Assessment 2002, available at http:// www.ridiproject.org/downloads/vulnerability_assessment.pdf) In the absence of a published standardized methodology,19–22 investigators applied mixed modality medical simulation (SIM) techniques to generate a multipatient WMD disaster scenario and accompanying evaluation tool for education and research purposes. STUDY OBJECTIVES Study investigators aimed to create a repeatable and immersive medical simulation disaster scenario capable of eliciting and recording a representative selection of critical and objectively measurable aspects of on-scene civilian disaster medical response. Combining full-body manikin simulators and professional actors within a high-fidelity environment, the scenario was scheduled to be repeated with trained observers and comprehensive audiovisual systems for systematic collection of prehospital provider participants’ clinical performance data and perceptions of simulation utility.