Hostname: page-component-8448b6f56d-tj2md Total loading time: 0 Render date: 2024-04-16T04:53:23.069Z Has data issue: false hasContentIssue false

A Region-Wide All-Hazard Training Program for Prehospital Mass Casualty Incident Management: A Real-World Case Study

Published online by Cambridge University Press:  01 April 2022

Luca Carenzo
Affiliation:
Department of Anesthesia and Intensive Care Medicine, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
Pier Luigi Ingrassia*
Affiliation:
Centro di Simulazione (CeSI), Centro Professionale Sociosanitario, Ronchetto, Lugano, Switzerland
Francesco Foti
Affiliation:
Agenzia Regionale Emergenza Urgenza (AREU), Milan, Italy
Enzo Albergoni
Affiliation:
Agenzia Regionale Emergenza Urgenza (AREU), Milan, Italy
Davide Colombo
Affiliation:
Department of Anesthesia and Intensive Care Medicine, Ospedale Ss. Trinità, Borgomanero, Italy CRIMEDIM Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy
Giuseppe Maria Sechi
Affiliation:
Agenzia Regionale Emergenza Urgenza (AREU), Milan, Italy
Alberto Zoli
Affiliation:
Agenzia Regionale Emergenza Urgenza (AREU), Milan, Italy
Stefano Sironi
Affiliation:
Agenzia Regionale Emergenza Urgenza (AREU), Milan, Italy
*
Corresponding author: Pier Luigi Ingrassia, Email: pierluigi.ingrassia@edu.ti.ch.

Abstract

Objective:

We report the development, implementation, and results of a sustainable region-wide mass-casualty management prehospital training program implemented by the Regione Lombardia emergency medical services (EMS) agency AREU in Italy.

Methods:

The educational program learning objectives are: (1) command and control, communications, and resource management; (2) mass casualty triage and the START triage protocol; (3) on-scene management; (4) Regione Lombardia and AREU Mass Casualty standard operating procedures; and (5) inter-agency communications and relations. For each course edition data on participants’ summative assessment, participants’ feedback and costs were collected.

Results:

Between June 26, 2013, and December 31, 2020, a total of 84 editions of the provider training event were delivered, training an overall 1329 prehospital providers; 1239 (93%) passed the summative assessment and were qualified as being operationally “ready.” Regarding participant feedback, the overall program was rated 4.4 ± 0.7 out of 5. The overall cost of running the provider program during the study period was €321 510 (circa US $382 000). The average cost per edition was €3828 and €242 per participant.

Conclusions:

We have described a simple yet interactive simulation and blended-learning approach, which has yielded good pass rates, good participant satisfaction, and contained costs to systematically train emergency medical service personnel.

Type
Original Research
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of Society for Disaster Medicine and Public Health, Inc.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Catlett, CL, Jenkins, JL, Millin, MG. Role of emergency medical services in disaster response: resource document for the National Association of EMS Physicians position statement. Prehosp Emerg Care. 2011;15(3):420-425.CrossRefGoogle ScholarPubMed
Gamberini, L, Imbriaco, G, Ingrassia, PL, et al. Logistic red flags in mass-casualty incidents and disasters: a problem-based approach. Prehosp Disaster Med. Published online February 3, 2022. doi: 10.1017/S1049023X22000188 CrossRefGoogle ScholarPubMed
Oldenburger, D, Baumann, A, Banfield, L. Characteristics of medical teams in disaster. Prehosp Disaster Med. 2017;32(2):195-200. doi: 10.1017/S1049023X16001461 CrossRefGoogle ScholarPubMed
Clawson, A, Menachemi, N, Kim, U, Brooks, RG. Are we ready for terrorism? Emergency medical technicians’ and paramedics’ training and self-perceived competence since September 11. Am J Disaster Med. 2007;2(1):26-32.CrossRefGoogle ScholarPubMed
Subbarao, I, Lyznicki, JM, Hsu, EB, et al. A consensus-based educational framework and competency set for the discipline of disaster medicine and public health preparedness. Disaster Med Public Health Prep. 2008;2(1):57-68. doi: 10.1097/DMP.0b013e31816564af CrossRefGoogle ScholarPubMed
Schultz, CH, Koenig, KL, Whiteside, M, Murray, R; National Standardized All-Hazard Disaster Core Competencies Task Force. Development of national standardized all-hazard disaster core competencies for acute care physicians, nurses, and EMS professionals. Ann Emerg Med. 2012;59(3):196208.e1. doi: 10.1016/j.annemergmed.2011.09.003 CrossRefGoogle ScholarPubMed
Fernandez, AR, Studnek, JR, Margolis, GS, et al. Disaster preparedness of nationally certified emergency medical services professionals. Acad Emerg Med. 2011;18(4):403-412. doi: 10.1111/j.1553-2712.2011.01030.x CrossRefGoogle ScholarPubMed
Fischer, P, Wafaisade, A, Bail, H, et al. Civil protection and disaster medicine in Germany today. Langenbecks Arch Surg. 2011;396(4):523-528. doi: 10.1007/s00423-011-0767-x CrossRefGoogle ScholarPubMed
Sarin, RR, Biddinger, P, Brown, J, et al. Core Disaster Medicine Education (CDME) for emergency medicine residents in the United States. Prehosp Disaster Med. 2019;34(5):473-480. doi: 10.1017/S1049023X19004746 CrossRefGoogle ScholarPubMed
Carenzo, L, Bazurro, S, Colombo, D, et al. An island-wide disaster drill to train the next generation of anesthesiologists: the SIAARTI Academy experience. Disaster Med Public Health Prep. 2020;1-4. doi: 10.1017/dmp.2019.163 AQ: Please provide volume or online published dateGoogle ScholarPubMed
Rehn, M, Davies, G, Smith, P, Lockey, DJ. Structure of rapid response car operations in an urban trauma service. Air Med J. 2016;35(3):143-147. doi: 10.1016/j.amj.2015.12.015 CrossRefGoogle Scholar
Della Corte, F, Hubloue, I, Ripoll Gallardo, A, et al. The European Masters Degree in Disaster Medicine (EMDM): a decade of exposure. Front Public Health. 2014;2:49. doi: 10.3389/fpubh.2014.00049 CrossRefGoogle ScholarPubMed
Delooz, H, Debacker, M, Moens, G, Johannik, K; I SEE Partnership. European survey on training objectives in disaster medicine. Eur J Emerg Med. 2007;14(1):25-31. doi: 10.1097/01.mej.0000224432.43999.87 CrossRefGoogle ScholarPubMed
Levin, HM, McEwan, OJ. Cost-effectiveness analysis: methods and applications. 2nd ed. Thousand Oaks, CA: Sage; 2001.Google Scholar
Levin, HM. Waiting for Godot: cost-effectiveness analysis in education. New Dir Eval. 2001;90:55-68. doi: 10.1002/ev.12.CrossRefGoogle Scholar
Zendejas, B, Wang, AT, Brydges, R, et al. Cost: the missing outcome in simulation-based medical education research: a systematic review. Surgery. 2013;153(2):160-176. doi: 10.1016/j.surg.2012.06.025 CrossRefGoogle ScholarPubMed
Rodriguez-Paz, JM, Kennedy, M, Salas, E, et al. Beyond “see one, do one, teach one”: toward a different training paradigm. Postgrad Med J. 2009;85(1003):244-249. doi: 10.1136/qshc.2007.023903 CrossRefGoogle Scholar
Risavi, BL, McLaughlin, B, Stuart, D, et al. The effectiveness of a formal curriculum in teaching mass casualty management. J Emerg Manag. 2020;18(5):411-424. doi: 10.5055/jem.2020.0489 Google ScholarPubMed
Kogan, JR, Shea, JA. Course evaluation in medical education. Teach Teach Educ. 2007;23(3):251-264. doi: 10.1016/j.tate.2006.12.020 CrossRefGoogle Scholar
Walsh, K, Levin, H, Jaye, P, Gazzard, J. Cost analyses approaches in medical education: there are no simple solutions. Med Educ. 2013;47(10):962-968. doi: 10.1111/medu.12214 CrossRefGoogle ScholarPubMed
Lin, Y, Cheng, A, Hecker, K, et al. Implementing economic evaluation in simulation-based medical education: challenges and opportunities. Med Educ. 2018;52(2):150-160. doi: 10.1111/medu.13411 CrossRefGoogle ScholarPubMed
Shreve, CM, Kelman, I. Does mitigation save? Reviewing cost-benefit analyses of disaster risk reduction. Int J Disaster Risk Reduct. 2014;10:213-235. doi: 10.1016/j.ijdrr.2014.08.004 CrossRefGoogle Scholar
Kousky, C, Ritchie, L, Tierney, K, Lingle, B. Return on investment analysis and its applicability to community disaster preparedness activities: calculating costs and returns. Int J Disaster Risk Reduct. 2019;41:101296. doi: 10.1016/j.ijdrr.2019.101296 CrossRefGoogle Scholar
Faccincani, R, Stucchi, R, Carlucci, M, et al. Evaluation of interaction between emergency medical system and hospital network during a train derailment in Milan. Disaster Med Public Health Prep. Published online February 15, 2021. doi: 10.1017/dmp.2020.410 Google Scholar
Spina, S, Marrazzo, F, Migliari, M, et al. The response of Milan’s Emergency Medical System to the COVID-19 outbreak in Italy. Lancet. 2020;395(10227):e49-e50. doi: 10.1016/S0140-6736(20)30493-1 CrossRefGoogle Scholar
Marrazzo, F, Spina, S, Pepe, PE, et al. Rapid reorganization of the Milan metropolitan public safety answering point operations during the initial phase of the COVID-19 outbreak in Italy. J Am Coll Emerg Phys Open. 2020;1(6):1240-1249. doi: 10.1002/emp2.12245 Google ScholarPubMed
Fagoni, N, Perone, G, Villa, GF, et al. The Lombardy Emergency Medical System faced with COVID-19: the impact of out-of-hospital outbreak. Prehosp Emerg Care. 2021;25(1):1-7. doi: 10.1080/10903127.2020.1824051 CrossRefGoogle ScholarPubMed
Perlini, S, Canevari, F, Cortesi, S, et al. Emergency department and out-of-hospital emergency system (112-AREU 118) integrated response to coronavirus disease 2019 in a northern Italy centre. Intern Emerg Med. 2020;15(5):825-834. doi: 10.1007/s11739-020-02390-4 CrossRefGoogle Scholar
Sechi, GM, Migliori, M, Dassi, G, et al. Business intelligence applied to emergency medical services in the Lombardy region during SARS-CoV-2 epidemic. Acta Biomed. 2020;91(2):39-44. doi: 10.23750/abm.v91i2.9557 Google ScholarPubMed
Risavi, BL, Terrell, MA, Lee, W, Holsten, DL Jr Prehospital mass-casualty triage training-written versus moulage scenarios: how much do EMS providers retain? Prehosp Disaster Med. 2013;28(3):251-256. doi: 10.1017/S1049023X13000241 CrossRefGoogle ScholarPubMed
Dittmar, MS, Wolf, P, Bigalke, M, et al. Primary mass casualty incident triage: evidence for the benefit of yearly brief re-training from a simulation study. Scand J Trauma Resusc Emerg Med. 2018;26(1):35. doi: 10.1186/s13049-018-0501 CrossRefGoogle ScholarPubMed