Educational Interventions to Improve Preparedness for Mass Casualty Incidents and Armed Conflict: A Systematic Review

Mass casualty incidents (MCIs), terrorist attacks, and armed conflicts place significant demands on healthcare systems and require rapid triage, effective teamwork, and life-saving interventions under resource-limited conditions. Training and educational programs are widely implemented to improve disaster preparedness among healthcare providers, but the measurable effectiveness of these interventions remains unclear. This systematic review aimed to evaluate the effectiveness of educational interventions on measurable preparedness outcomes among healthcare professionals.

A systematic review was conducted in accordance with PRISMA guidelines. Medline (Ovid), Embase, Web of Science Core Collection, Cochrane CENTRAL, and Google Scholar were used. Studies evaluating pre- and post-intervention outcomes following educational or training interventions for MCIs or war-related scenarios were included. Outcomes of interest included knowledge, clinical skills performance, and triage accuracy.

A total of 1,836 records were identified, of which 42 studies met the inclusion criteria. Most studies used single-group pre-post designs (n = 32, 76%), while 6 were randomized controlled trials (14%) and 4 were controlled non-randomized studies (10%). Educational interventions included course-based training, simulation-based training, e-learning, and blended learning approaches. The majority of studies reported significant improvements in knowledge (14/15 studies), hands-on clinical skills (13/14 studies), and triage performance (6/7 studies) following training. Only 4 studies assessed long-term retention.

Educational interventions improve preparedness for mass casualty incidents and war-related scenarios. Simulation-based and multidisciplinary training appear most effective. However, the certainty of evidence quality remains limited. Preparedness should therefore be viewed as a continuous process requiring repeated training, objective evaluation, and stronger civil-military collaboration.