Uttarakhand is an Indian state in the Himalayan foothills, a favored adventure destination in the country due to abundant natural beauty. However, the terrain has also conferred an increased risk of earthquakes, flash floods, and major road tragedies, resulting in as many as 8 major natural disasters in the state in the preceding 20 years. AIIMS Rishikesh, an autonomous central institute, has been entrusted to build a Level 1 Trauma Center in Uttarakhand, which would help improve the response, coordination, and hence outcome in mass casualty scenarios (MCSs).

As a step toward the achievement of this larger goal, a workshop on MCS and management was conducted by the Department of Trauma Surgery in collaboration with Rambam Hospital, Haifa. We hereby present our template for conducting MCS drills in low resource settings like ours and the lessons learnt.

Process, logistics, limitations, workforce, scheduling, overview, and report of the MCS drill conducted are discussed hereafter.

This template may be replicated by hospitals that intend to conduct similar MCS drills in low resource settings, realizing the real threat of MCS occurrence in our country at anytime.

Mock Code Training is an exercise designed to develop competency in emergency responsiveness. The objectives for this educational intervention were: (1) demonstrate basic airway maneuvers (2) demonstrate basic life support-cardiopulmonary resuscitation (BLS-CPR); (3) demonstrate when and how to call a Code; (4) recognize life-threatening cardiac arrhythmias; (5) initiate relevant cardiac monitoring; and (6) initiate relevant resuscitation based on algorithms.

Drills were conducted monthly on various inpa-tient and outpatient nursing units at the University of Wisconsin Hospital and Clinics. The following data was collected: (1) chime sounded; (2) basic patient assessment; (3) universal precautions; (4) compressions; (5) automated external defibrillator (AED) arrival; (6) unit emergency cart arrival; (7) oxygen administration; (8) code team arrival; (9) Advanced Cardiac Life Support (ACLS) Guidelines; (10) presence of recorder; (11) monitor initiation; (12) advanced airway; (13) intravenous (IV) access; (14) medications; (15) and time resuscitation ended.

The mean results were: (1) action for delivery of compressions = 1 minute, 10 seconds; (2) unit emergency cart arrival = 2 minutes, 15 seconds; (3) oxygen-bag valve mask = 3 minutes, 10 seconds; (4) defibrillation = 7 minutes; (5) code team arrival = 3 minutes, 33 seconds; (6) ACLS Guidelines Initiated = 6 minutes, 13 seconds; (7) monitor initiation = 5 minutes, 33 seconds; (8) advanced airway = 6 minutes; (9) IV access = 3 minutes, 15 seconds; and (10) medication administration = 6 minutes, 30 seconds.

The objective of this study was to determine providers' opinions of SALT Triage after receiving training and using it during a simulated mass-casualty incident.

A survey was conducted of trainees in a disaster course. Trainees were given a-30 minute lecture on SALT (sort, assess, life-saving interventions, treatment and/or transport) Triage and then used it during a drill. After the drill, trainees were asked to complete the survey. Results were analyzed using descriptive statistics.

Thirty trainees (11 medical doctors (MDs), six registered nurses (RNs), eight emergency medical technicians (EMTs), one RN/EMTs, four other) participated in the course. Of these participants, 67% had prior drill experience (mean: 10 drills) and 37% had prior mass-casualty incident experience (mean: four experiences). Prior to the drill: 7% reported that they felt very confident using SALT Triage, 33% were confident, 30% were somewhat confident, and 30% were not confident. After the drill: none reported not feeling confident using SALT Triage, 27% were at the same level of confidence, 73% felt more confident, and none felt less confident. Before the drill: 52% of respondents felt SALT Triage was easier to use than their current disaster triage protocol, 44% felt it was similar, and 4% felt it was more difficult. After the drill: 67% did not change how easy they felt SALT Triage was to use, 26% thought it was easier to use, and 3% thought it was similar.

Providers felt confident using SALT triage after a 30-minute training session and found it was similar or easier to use than their current triage protocol. Using SALT Triage during a drill improved confidence.