Teaching medical care in mass casualty incidents through advanced clinical simulation

The threat of intentional mass casualty incidents remains high, making healthcare response a priority. The Hartford Consensus and the THREAT protocol (Threat suppression, Hemorrhage control, Rapid Extrication to safety, Assessment by medical providers, Transport to definitive care) establish recommended actions. A key objective is training civilians as "immediate responders" for hemorrhage control. However, this emergency care training is often limited in medical schools. Francisco de Vitoria University incorporates clinical simulation, including emergency medicine content in the fifth year. This study aims to assess learning outcomes from an activity designed to familiarize students with the Hartford Consensus and THREAT protocol.

Simulation Activity Development: Students gathered in an enclosed area. Basic principles of action during a terrorist attack were explained. A simulated attack unfolded, requiring students to escape, hide, or fight, and assist victims according to protocol. Wounded individuals were transported to a meeting point for a debriefing, followed by a final group meeting.

Students completed a questionnaire at the beginning and end of the activity, including technical and subjective questions about perceived preparedness. Statistical analysis used the Chi-square test to compare response frequencies. 112 fifth-year medical students completed the online questionnaire.

Seventy-one pre-activity and 41 post-activity questionnaires were completed. Perceived preparedness significantly improved: initially, 66.2% felt "no" prepared, which decreased to 4.9% after the activity (p < 0.001). Correct responses to "first thing to do in an attack" increased from 19.4% to 92.7% (p < 0.001). Understanding "improvised means" rose from 85.9% to 100% (p = 0.042). No statistically significant differences were observed for more technical questions like hemorrhage or cardiac arrest.

Teaching through simulated environments offers undeniable learning benefits. While curriculum integration faces, simulation is a valuable tool in emergency training. Our cost-effective instructional methods proved successful, as shown by survey data. These engaging experiences facilitate knowledge acquisition. Replicating real-life conditions helps students appreciate inherent challenges. We conclude that using a simulated environment at the undergraduate level to train students as first responders in mass casualty incidents is an effective educational strategy.