Claudius Ilene, Kaji Amy, Santillanes Genevieve, Cicero Mark, Donofrio J Joelle, Gausche-Hill Marianne, Srinivasan Saranya, Chang Todd P
1Department of Emergency Medicine,University of Southern California,Keck School of Medicine,Los Angeles,CaliforniaUSA.
2Department of Emergency Medicine,Harbor-University of California-Los Angeles Medical Center,Torrance,CaliforniaUSA.
Prehosp Disaster Med. 2015 Oct;30(5):438-42. doi: 10.1017/S1049023X15004963. Epub 2015 Aug 12.
Multiple modalities for simulating mass-casualty scenarios exist; however, the ideal modality for education and drilling of mass-casualty incident (MCI) triage is not established. Hypothesis/Problem Medical student triage accuracy and time to triage for computer-based simulated victims and live moulaged actors using the pediatric version of the Simple Triage and Rapid Treatment (JumpSTART) mass-casualty triage tool were compared, anticipating that student performance and experience would be equivalent.
The victim scenarios were created from actual trauma records from pediatric high-mechanism trauma presenting to a participating Level 1 trauma center. The student-reported fidelity of the two modalities was also measured. Comparisons were done using nonparametric statistics and regression analysis using generalized estimating equations.
Thirty-three students triaged four live patients and seven computerized patients representing a spectrum of minor, immediate, delayed, and expectant victims. Of the live simulated patients, 92.4% were given accurate triage designations versus 81.8% for the computerized scenarios (P=.005). The median time to triage of live actors was 57 seconds (IQR=45-66) versus 80 seconds (IQR=58-106) for the computerized patients (P<.0001). The moulaged actors were felt to offer a more realistic encounter by 88% of the participants, with a higher associated stress level.
While potentially easier and more convenient to accomplish, computerized scenarios offered less fidelity than live moulaged actors for the purposes of MCI drilling. Medical students triaged live actors more accurately and more quickly than victims shown in a computerized simulation.
存在多种模拟大规模伤亡场景的方式；然而，大规模伤亡事件（MCI）分诊教育与演练的理想方式尚未确立。假设/问题 比较了医学生使用儿科版简易分诊与快速治疗（JumpSTART）大规模伤亡分诊工具对基于计算机模拟的受害者和现场模拟演员进行分诊的准确性和分诊时间，预计学生的表现和体验将相当。
受害者场景根据一家参与研究的一级创伤中心收治的儿科高机制创伤的实际创伤记录创建。还测量了学生报告的两种方式的逼真度。使用非参数统计和广义估计方程进行回归分析。
三十三名学生对四名现场患者和七名计算机模拟患者进行了分诊，这些患者代表了从轻伤、紧急、延迟和预期受害者的一系列情况。在现场模拟患者中，92.4%被给予了准确的分诊指定，而计算机模拟场景为81.8%（P = 0.005）。现场演员的中位分诊时间为57秒（四分位间距 = 45 - 66），而计算机模拟患者为80秒（四分位间距 = 58 - 106）（P < 0.0001）。88%的参与者认为模拟演员提供了更真实的体验，且压力水平更高。
虽然计算机模拟场景可能更容易且更方便实现，但就MCI演练而言，其逼真度低于现场模拟演员。医学生对现场演员的分诊比对计算机模拟中的受害者更准确、更快。
