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This review analyzes EMT preparedness and self-reported confidence levels in managing out-of-hospital mass casualty incidents.

July 11, 2026

Assessment of Emergency Medical Technician (EMT) Preparedness and Confidence in Managing Out of Hospital Mass Casualty Incidents: A Systematic Review

HAHiba Khalid AlshareefKing Saud Medical City AAAbdulaziz AlrabiahKing Khalid University Hospital

Key Points

This review analyzes EMT preparedness and self-reported confidence levels in managing out-of-hospital mass casualty incidents.
Conducted a systematic review adhering to PRISMA guidelines, reviewing articles published from 2010 to present.
Data gathered from multiple databases including PubMed, MEDLINE, and Scopus focusing on EMT preparedness and confidence.
Quality assessment performed by two independent reviewers with qualitative data synthesis.
Identified significant gaps in preparedness, particularly in interagency coordination and role-specific training.
A national assessment in Saudi Arabia revealed a median benchmark score of 60% for prehospital MCI preparedness.
Simulation studies demonstrated that innovative training methods, such as gamification and VR, improved preparedness and confidence.

Abstract

Background: Mass casualty incidents (MCIs) place significant stress on Emergency Medical Services (EMS) and frontline Emergency Medical Technicians (EMTs) due to high patient demand and resource constraints. Effective prehospital MCI management is dependent on EMT preparedness, which includes the necessary knowledge, skills, and organizational structures. In addition to objective skills, professional self-confidence is critical for performance under high stress. The purpose of this systematic review was to analyze current literature regarding the preparedness levels and self-reported confidence of EMTs in managing out-of-hospital MCIs. Methods: This systematic review was conducted in accordance with PRISMA guidelines, searching databases including PubMed, MEDLINE, and Scopus for original articles from 2010 to the present. The research focused on EMTs and other prehospital providers concerning preparedness (knowledge, training, drills) and confidence. Study selection and quality assessment were performed by two independent reviewers, and the data was analyzed using a qualitative synthesis. Results: Ten original studies were included in the review. Findings indicated significant gaps in system preparedness, mainly concerning interagency coordination, surge capacity, and role-specific training. A national assessment in Saudi Arabia showed a median benchmark score of 60% for prehospital MCI preparedness. Simulation studies highlighted the decline in triage skills over time, which suggest the need for annual refresher training. Training interventions, mainly scenario-based methods like gamification and immersive virtual reality (VR), were shown to increase perceived preparedness and self-reported confidence of participants. Conclusion: EMTs and EMS systems show moderate levels of MCI preparedness, but deficiencies still in coordination, surge capacity, and sustained skill retention. Active, scenario based training, especially using innovative technologies like VR, is effective in improvement of objective performance and professional confidence in managing prehospital MCIs.

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