Improving Emergency Medicine Residents' Comfort in Responding to Mass Casualty Incidents: A Cost-Effective Exercise...

Mass casualty incidents present significant challenges to healthcare systems, necessitating effective triage and response from emergency personnel. Unfortunately, emergency medicine residents have reported discomfort with disaster preparation and lack of confidence at the prospect of responding to large-scale mass casualty incidents. Mass casualty preparation exercises are often costly, time-consuming to plan, and resource prohibitive, complicating disaster training initiatives for emergency medicine residency programs. We implemented and evaluated a novel training exercise geared toward improving resident comfort levels in utilizing the START (Simple Triage and Rapid Treatment) and JumpSTART triage algorithms that incorporated easily acquired materials and required limited faculty time commitment.

We staged two small-scale mass casualty exercises in May 2023 and December 2024 utilizing moulaged dolls and props designed to mimic a disaster scene. Dolls were equipped with QR codes linked to short vignettes including vital signs and relevant clinical information. Residents were instructed to assign a triage designation based on the information provided and input their response into Google Forms. Once submitted, participants received immediate feedback regarding the accuracy of their response, along with an explanation of why they were or were not correct.

A total of thirteen residents for the first, and twelve residents for the second exercise implementation participated, completing pre- and post-intervention surveys to evaluate their comfort with mass casualty scenarios using the START triage system. Results indicated a 66% increase (first implementation) and 55% increase (second implementation) in the likelihood of residents feeling "mostly" or "very" comfortable post-exercise. Participants rated the teaching quality and instructional tools as "excellent".

Resident confidence in responding to mass casualty incidents improved post-exercise via the use of a cost-effective and easily replicable mass casualty triage training model, circumventing the need for costly simulation equipment and extensive faculty involvement.