Determining surgical surge capacity with a hybrid simulation exercise.

Area of Science:

• Emergency Medicine
• Disaster Preparedness
• Healthcare Simulation

Background:

• Mass casualty incident (MCI) exercises are crucial for testing surgical surge capacity.
• Traditional table-top exercises (TTX) and full-scale exercises (FSX) have limitations in assessing organizational capabilities.
• A hybrid exercise model combining TTX and FSX offers a potential solution for comprehensive evaluation.

Purpose of the Study:

• To evaluate the feasibility of a hybrid TTX/FSX exercise for assessing an organization's capability and structure.
• To determine the effectiveness of a hybrid simulation in identifying areas for improvement in MCI response.

Main Methods:

• A hybrid MCI simulation was conducted at a level 1 trauma center, involving 103 simulated casualties over 4 hours.
• The simulation incorporated moulaged figurants and simulation cards, tracking patient flow from registration and triage to hospital-wide treatment.
• Observers monitored procedural adequacy, realistic timing, and resource utilization, with average emergency department time as the primary endpoint.

Main Results:

• The hospital successfully managed the patient flow without system collapse.
• Adequate operating theatre, ICU, and ward bed capacity was maintained throughout the exercise.
• The hybrid exercise identified specific response details not observed in previous TTX.

Conclusions:

• Full-scale exercises (FSX) are valuable for MCI management training and evaluation.
• Hybrid simulations combining FSX and TTX can optimize resource utilization.
• This approach allows for more frequent exercises with comparable organizational benefits, enhancing preparedness.