Disaster Triage and Response in Multiple Simulated Critical Access Hospital Settings in Natural Disaster in Emergency Medicine Residents, Students, Nursing, Pharmacist and EMS Agencies

Introduction: Mass casualty incidents (MCIs), including natural disasters, pandemics, multi-vehicle traffic accidents, and mass shooting events, are rare but are becoming a more routine encounter in emergency medicine. Training emergency medicine physicians for these events can be difficult given the incontinence of involvement during residency. Tools such as SALT (Sort, Assess, Lifesaving-interventions, Treat/Transport) triage have been developed to standardize response to MCIs, but can only be prepared to a degree of preparation. One way to improve training and education is through simulation, which provides a risk-free environment that can improve knowledge, clinical skills, and comfort with rare scenarios. Methods: Surveys were obtained regarding familiarity and comfort with concepts and confidence in MCI management. A pre-survey was obtained before a 2-hour education, followed by a 2-hour disaster simulation with participants running EMS response, critical access hospitals with limited resources, and a tertiary referral center. Post survey data was collected following the education and simulation. Surveys were collected on Qualtrics using the Likert scale (1-5) with pre- and post-survey averages. Results: All covered areas of training with familiarity and comfort in concepts improved by an average of 1.2 and 1.3 points, with the largest improvement seen on SALT Triaging (1.7, 1.8), Dry Decontamination (1.4, 1.6), and Wet-Decontamination (1.4, 1.6). Confidence metrics improved by an average of 1 point, with the largest improvements in Role Assigning (1.18) and Transfer Decisions (1.11). Conclusion: Our education and simulation event led to a modest increase in comfort for MCIs. Health systems surge planning, hospital-staging, and SALT triaging had the most improvement in both familiarity and comfort, with averages of 1.4, 1.4, and 1.75 points, respectively. There was also improvement in confidence for resource distribution, role assigning, and transfer decisions. This reinforces that simulation events are an effective way of educating in a risk-free environment, especially for rare health care practices.