Cicero Mark X, Whitfill Travis, Munjal Kevin, Madhok Manu, Diaz Maria Carmen G, Scherzer Daniel J, Walsh Barbara M, Bowen Angela, Redlener Michael, Goldberg Scott A, Symons Nadine, Burkett James, Santos Joseph C, Kessler David, Barnicle Ryan N, Paesano Geno, Auerbach Marc A
Departments of Pediatrics and Emergency Medicine, Yale School of Medicine, New Haven, Connecticut.
Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut.
Am J Disaster Med. 2017 Spring;12(2):75-83. doi: 10.5055/ajdm.2017.0263.
Disaster triage training for emergency medical service (EMS) providers is not standardized. Simulation training is costly and time-consuming. In contrast, educational video games enable low-cost and more time-efficient standardized training. We hypothesized that players of the video game "60 Seconds to Survival" (60S) would have greater improvements in disaster triage accuracy compared to control subjects who did not play 60S.
Participants recorded their demographics and highest EMS training level and were randomized to play 60S (intervention) or serve as controls. At baseline, all participants completed a live school-shooting simulation in which manikins and standardized patients depicted 10 adult and pediatric victims. The intervention group then played 60S at least three times over the course of 13 weeks (time 2). Players triaged 12 patients in three scenarios (school shooting, house fire, tornado), and received in-game performance feedback. At time 2, the same live simulation was conducted for all participants. Controls had no disaster training during the study. The main outcome was improvement in triage accuracy in live simulations from baseline to time 2. Physicians and EMS providers predetermined expected triage level (RED/YELLOW/GREEN/BLACK) via modified Delphi method.
There were 26 participants in the intervention group and 21 in the control group. There was no difference in gender, level of training, or years of EMS experience (median 5.5 years intervention, 3.5 years control, p = 0.49) between the groups. At baseline, both groups demonstrated median triage accuracy of 80 percent (IQR 70-90 percent, p = 0.457). At time 2, the intervention group had a significant improvement from baseline (median accuracy = 90 percent [IQR: 80-90 percent], p = 0.005), while the control group did not (median accuracy = 80 percent [IQR:80-95], p = 0.174). However, the mean improvement from baseline was not significant between the two groups (difference = 6.5, p = 0.335).
The intervention demonstrated a significant improvement in accuracy from baseline to time 2 while the control did not. However, there was no significant difference in the improvement between the intervention and control groups. These results may be due to small sample size. Future directions include assessment of the game's effect on triage accuracy with a larger, multisite site cohort and iterative development to improve 60S.
针对紧急医疗服务（EMS）提供者的灾难分诊培训尚未标准化。模拟培训成本高昂且耗时。相比之下，教育视频游戏能够提供低成本且更具时间效率的标准化培训。我们假设，与未玩过《60秒求生》（60S）的对照组受试者相比，玩这款视频游戏的玩家在灾难分诊准确性方面会有更大提升。
参与者记录了他们的人口统计学信息和最高EMS培训水平，并被随机分配去玩60S（干预组）或作为对照组。在基线时，所有参与者完成了一次校园枪击现场模拟，其中人体模型和标准化病人模拟了10名成人和儿童受害者。干预组随后在13周内至少玩三次60S（时间点2）。玩家在三种场景（校园枪击、房屋火灾、龙卷风）中对12名患者进行分诊，并收到游戏内的表现反馈。在时间点2，对所有参与者进行了相同的现场模拟。对照组在研究期间没有接受灾难培训。主要结果是从基线到时间点2的现场模拟中分诊准确性的提高。医生和EMS提供者通过改良德尔菲法预先确定预期的分诊级别（红色/黄色/绿色/黑色）。
干预组有26名参与者，对照组有21名。两组在性别、培训水平或EMS工作年限方面没有差异（干预组中位数为5.5年，对照组为3.5年，p = 0.49）。在基线时，两组的分诊准确性中位数均为80%（四分位间距70 - 90%，p = 0.457）。在时间点2，干预组较基线有显著提高（准确性中位数 = 90% [四分位间距：80 - 90%]，p = 0.005），而对照组没有（准确性中位数 = 80% [四分位间距：80 - 95%]，p = 0.174）。然而，两组从基线开始的平均提高幅度没有显著差异（差值 = 6.5，p = 0.335）。
干预组从基线到时间点2的准确性有显著提高，而对照组没有。然而，干预组和对照组在提高幅度上没有显著差异。这些结果可能是由于样本量较小。未来的方向包括评估该游戏对更大规模、多地点队列的分诊准确性的影响，以及进行迭代开发以改进60S。
