Healthcare Disaster Response: Improving Training through Computerized Simulation

On June 12,, 2016, staff at Orlando Regional Medical Center (ORMC) put their emergency preparedness training to use.  It is a testament to the staff and leadership of ORMC that within 15 hours, without intervention or assistance from other hospitals, they were able to resume normal operations.  (ORMC, 2016) The trauma team at ORMC worked continually for 30 hours (McKenzie, 2016) to manage the influx of injured. Throughout the crisis, the public was kept informed and leadership at ORMC worked diligently to communicate with families of the injured. Healthcare and emergency response communities will learn much over the next months from the experiences of June 12th, and these lessons will surely be incorporated into community disaster response plans.

Orlando Trauma Surgeons Discuss Chaos After Shooting

Improving Individual Disaster Response Through Supplemental Computerized Mass Casualty Exercises

“History has proven that one of the best ways to prepare for the future is by learning from the past.” (Florida Division of Emergency Management)

Each year, hospitals around the country participate in disaster preparedness exercises, both as individual entities, and in coordination with their greater community. Communities test emergency response plans and resources through live, interdependent modeled simulations.  In situ simulations are thought to provide a sense of realism and to support transfer of skills learned in the simulation to real situations (Gardner, DeMoya, Tinkoff, Brown, Garcia, Miller,…Sachdeva, 2016) supporting their use as training tools.

In my own practice, I’ve noted that large, live mass casualty simulations provide great insight into institutional needs and are effective in training high level incident command staff. These events, however, are limited in their effectiveness as a training tool for front-line staff for the following reasons:

• Staff participation is limited to the day/shift of the event
• Highly trained healthcare staff are asked to overlook their own triage and assessment skills of a healthy volunteer, in favor of written data & moulage
• Monitoring of large scale events does not allow feedback to most individuals about their performance within the simulation

Computerized simulation, modeled from findings of actual events or proposed situations, may provide reasonable remedies for the above challenges. Individual or team participation in a virtual environment immediately resolves the issue of limited staff participation by allowing for flexible delivery across days and shifts. By replacing the live, healthy human with an injured avatar, the healthcare provider no longer needs to override their senses to triage victims. Triage through virtual reality was recently tested and determined to be just as effective as live triage assessment (Luigi Ingrassia, 2015). Finally, in a well designed simulation, learner feedback is built into the environment.  

Simulated training for mass casualty or potential disaster situations should incorporate local possibilities and resources. The example below represents a simulated challenge, for a Level II Trauma Center, of a mass shooting at a music festival nearest the event. All census numbers and resources would be adjustable based on facility. Night shift and day shift situations would require variable adjustment based on availability of additional staff and leadership support during daytime hours.

Mass Casualty Event in 2D Virtual World

• Setting – Level II Trauma Center Community Hospital
• Situation – Call from local Emergency Services announcing multiple gunshot victims from local music festival. Number of victims is undetermined at initiation of the event. Victims arrive by ambulance, police car, and private vehicle in various states of injury.
• Goals – Throughput, effective triage, activation of resources
  • Effective triage of victims to be placed in trauma rooms, treatment rooms, operating suites, minor treatment rooms, or waiting area
  • Activation of appropriate codes
  • Clear communication to staff and community
  • Security of staff and victims
• Avatars – Physicians, Nurses, Leaders, Media Director, Security Officers

Once the simulated environment is created, adjustments to the variables can provide continuing challenges to learners. This capability creates a flexible platform to provide for continual improvement of skills.

Adding computerized, individual or team simulated mass casualty and disaster exercises, such as the example above, to the established practice of large scale, live exercises will allow individual responders to learn and practice their role in these events.

References:

Florida Division of Emergency Management. (2016). Accessed July 2, 2016 at http://www.floridadisaster.org/DEMcom.asp (Links to an external site.) 

Gardner, A. K., DeMoya, M. A., Tinkoff, G. H., Brown, K. M., Garcia, G. D., Miller, G. T., & ... Sachdeva, A. K. (2016). Using simulation for disaster preparedness. Surgery, doi:10.1016/j.surg.2016.03.027 

Luigi Ingrassia, P., Ragazzoni, L., Carenzo, L., Colombo, D., Ripoll Gallardo, A., & Della Corte, F. (2015). Virtual reality and live simulation: a comparison between two simulation tools for assessing mass casualty triage skills. European Journal Of Emergency Medicine : Official Journal Of The European Society For Emergency Medicine,22(2), 121-127.

McKenzie, A. (2016). Pulse shooting: ORMC's trauma surgeons speak out. News 13.Accessed July 2, 2016 at http://orl.mynews13.com/content/news/cfnews13/news/article.html/content/news/articles/cfn/2016/6/17/pulse_shooting_ormc_.html (Links to an external site.)