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Background: Prehospital and emergency department (ED) providers must be prepared to respond to mass casualty incidents (MCI). However, in the modern era of ED boarding and staffing shortages, prehospital and ED personnel must be prepared to manage high volume and high acuity patients with limited resources. Objectives: Introduce ACGME EMS/Disaster milestones to EM residents and evaluate the response of an academic hospital and community EMS system to a simulated local disaster. Curricular Design: Participants included EM residents, EMS fellows, EM attendings, state and local EMS providers, local simulation/EMT training programs, nurses, ED techs, and security. The cost of the drill was 550. Prehospital participants were drawn to a scene where a terrorist drove a vehicle through a crowd during a parade. Live actor and manikin patients included both adults and pediatrics. Some patients deteriorated, including two that required intubation/surgical airways. Patients were transported by three ambulances, EMS fellow vehicles, and POVs. In the ED, only two resuscitation bays and four rooms on opposite sides of the ED were put in play to simulate surge capacity. Staff improvised by using fast-track beds for yellow patients and a waiting room area for green patients. Some patients decompensated, necessitating procedures and transfer. Effectiveness: All 27 patients were triaged, treated, and transported in 76 minutes. Despite challenges, ED staff were then able to disposition all 27 patients from the ED. Following the drill, a survey was sent to participants using a scale of 1 (worst) to 10 (best). 92% of participants rated their perceived preparedness for a future MCI as ≥ 5 (Fig 1). When asked how well the team worked together, 90% of participants responded ≥ 5 (Fig 2). One area to improve includes communication flow during the event, with 37% of participants rating ≤ 5 (Fig 3). Future drills will test different stressors and focus on communication.
McCafferty et al. (Sun,) studied this question.