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Mass Casualty Incident, Training Hospital Staff

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Full Title: Training of Hospital Staff to Respond to a Mass Casualty Incident

April 2004

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Structured Abstract

Objectives: To identify and synthesize evidence on the effectiveness of hospital disaster drills, computer simulations, and tabletop or other exercises in training hospital staff to respond to a mass casualty incident (MCI). This report reviews the methods or tools that have been used to evaluate these types of training activities.

Data Sources: Six electronic databases, including PubMed®, the Cochrane Central Register of Controlled Trials, the Excerpta Medica database (EMBASE), the Educational Research Information Clearinghouse, the specialized Register of Effective Practice and Organization of Care (Cochrane Review Group), and the Research and Development Resource Base in Continuing Medical Education, were used to identify articles. Search terms included mass casualty, disaster, disaster planning, and drill. Additional studies were found by a hand search of references and selected journals.

Review Methods: The search was limited to articles that were written in English, included original human data, and reported on the evaluation of disaster training for hospital staff. The reviewers extracted information on geographic location, MCI type, training intervention, hospital staff targeted, other entities involved, objectives, evaluation methods, and results. Study quality was evaluated in terms of the representativeness of the targeted hospital staff, potential bias and confounding, description of the intervention, assessment of outcomes, and analysis.

Results: Sixteen studies assessed hospital disaster drills for training hospital staff to respond to an MCI, and included lessons learned. The studies had significant limitations in design and evaluation methods. One study addressed computer simulation for training hospital staff to respond to an MCI and identified bottlenecks in patient care, security problems, and other issues. Four studies—covering issues from burn care to a regional, coordinated response to a biological attack—addressed the effectiveness of tabletop or other exercises in training hospital staff to respond to an MCI. The reviewed studies used a variety of methods to evaluate the effectiveness of the training different modalities, and targeted different groups of hospital staff. Internal and external communications were found to be the key to disaster response (e.g., a well-defined incident command center reduced confusion, conference calls were inefficient, and having accurate phone numbers was vital).

Conclusions: Sufficient studies were available to suggest that hospital disaster drills were effective in training hospital staff to respond to an MCI; however, weaknesses in study design limit the strength of these conclusions. Although computer simulations and tabletop and other exercises may have a role in identifying problems in disaster preparedness, the evidence is insufficient to judge their effectiveness in training.

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Training of Hospital Staff to Respond to a Mass Casualty Incident

Evidence-based Practice Center: Johns Hopkins University
Topic Nominator: Agency for Healthcare Research and Quality (AHRQ) and Health Resources and Services Administration (HRSA)

Current as of April 2004


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