From Simulations to the Scene: Mobile Training for Life-Saving Trauma Interventions in Mass Casualty Events

Summary: During the October 7, 2023, massacre in Israel, a large number of communities in multiple locations were attacked simultaneously. Many of these were cut off from help, resulting in delays in the evacuation of patients from the field to higher levels of care. This has highlighted the need for capacity building among first responders in performing life-saving procedures to victims of trauma, as well as managing mass casualty incidents before the arrival of ambulance paramedics. Three types of first responders were identified as providing crucial trauma care in these circumstances: the Army medical corps, local, community-based security teams, and medical staff in peripheral hospitals. To streamline training across a large geographical area, a mobile emergency medical training unit was established to bring expertise and the equipment to first responders nationwide. This is the first mobile simulation unit in Israel run exclusively and voluntarily by Emergency Physicians. Providers benefit from being trained and drilled together as a team on familiar ground through high-fidelity simulations. To date, over 100 workshops have been completed, training more than 3,000 medical personnel. Following the MARCH principles of trauma care, prioritized skills include hemorrhage control and airway management, prevention of hypothermia and expedient evacuation, and the integration of these into the assessment and care of both the individual trauma patient as well as multiple victims in mass casualty events. The workshops are modular and adapted to the professional level and requirements of the participants. To evaluate the efficacy of the workshops, pre- and post-workshop knowledge, proficiency, and confidence levels are continuously assessed at a programmatic level through surveys and qualitative methods. Mobile simulation units run by Emergency Physicians likely offer uniform, high-level emergency trauma care training to a wide spectrum of providers in their native environment.