Comparative study of a simulated incident with multiple victims and immersive virtual reality.

OBJECTIVES: The main objective of the study is to determine the efficiency in the execution of the START (Simple Triage and Rapid Treatment) triage, comparing Virtual Reality (VR) to Clinical Simulation (CS) in a Mass Casualty Incident (MCI). The secondary objective is to determine the stress produced in the health professionals in the two situations described. MATERIALS: A comparative study on the efficiency and the stress during triage in a MSI was conducted. The basal and post levels of salivary α-amylase (sAA) activity were measured in all the participants before and after the simulation. RESULTS: The percentage of victims that were triaged correctly was 87.65% (SD = 8.3); 88.3% (SD = 9.65) for the Clinical Simulation with Actors (CSA) group and 87.2% (SD = 7.2) for the Virtual Reality Simulation (VRG) group, without any significant differences (p = 0.612) between both groups. The basal sAA was 103.26 (SD = 79.13) U/L with a significant increase (p < 0.001) with respect to the post-simulation levels (182.22, SD = 148.65 U/L). The increase of sAA was 80.70 (SD = 109.67) U/mL, being greater for the CSA group than the VRG group. CONCLUSION: The results show that virtual reality method is as efficient as clinical simulation for training on the execution of basic triage (START model). Also, based on the sAA results, we can attest that clinical simulation creates a more stressful training experience for the student, so that is should not be substituted by the use of virtual reality, although the latter could be used as a complementary activity.

Comparison of the Simple Triage and Rapid Treatment system versus the Prehospital Advanced Triage Model in multiple-casualty events. / Comparación de los sistemas de triaje META y START en un ejercicio simulado de múltiples víctimas.

OBJECTIVES: . The main purpose of this simulation of a multiple-casualty event was to compare the performance of 2 triage methods: the Simple Triage and Rapid Treatment (START) system and the Prehospital Advanced Triage Model (META in its Spanish acronym). The secondary objectives were to analyze times, order of evacuations, and appropriateness of treatments. MATERIAL AND METHODS: Cluster randomized trial that included 16 groups assigned to use either the START system or the META for managing casualties in a simulated event (an airline crash). Each group had 4 members. We recorded times, order of evacuation, and appropriateness of treatment. RESULTS: The mean (SD) evacuation time was 48 minutes and 39 seconds (15 minutes, 52 seconds) in the START arm and 48 minutes and 4 seconds (17 minutes, 21 seconds) in the META arm (P=.829). The patients with greatest need of immediate care were evacuated more quickly in the META arm (31 minutes and 36 seconds [8 minutes, 27 seconds]) than in the START arm (41 minutes and 6 seconds [10 minutes, 39 seconds]) (P=.024). Evacuation of the subgroup of patients requiring emergency surgery was also faster in the META arm (24 minutes and 12 seconds [4 minutes] than in the START arm (44 minutes and 49 seconds [8 minutes, 36 seconds]) (P=.001). Analysis of the order of evacuation under the 2 triage systems revealed that 14 of the first 19 patients evacuated required immediate medical care and 5 of the first 14 evacuated required priority surgical treatment in the START arm. In the META arm, all of the first 14 patients evacuated required immediate medical care and 5 of the first 7 patients evacuated required priority surgical treatment. The rate of appropriate treatment was 92% in the META arm and 63% in the START arm (P=.023). CONCLUSION: Use of the META system might improve prehospital times and the order of evacuation of patients, particularly patients who need immediate medical care or urgent surgery. The META might also increase the likelihood of appropriate treatment in multiple-casualty events.

OBJETIVO: El objetivo principal fue comparar dos sistemas de triaje (Simple Triage and Rapid Treatmet, START vs. Modelo Extrahospitalario de Triaje Avanzado, META) en un mismo incidente simulado de múltiples víctimas (IMV). Los objetivos secundarios fueron analizar los tiempos y el orden de evacuación, y la adecuación del tratamiento. METODO: Ensayo aleatorizado por conglomerados que incluyó 16 grupos de 4 miembros asignados al sistema de triaje START o META en un ejercicio simulado de gestión a las víctimas de un accidente aéreo. Se recogieron los tiempos y el orden de evacuación, y la adecuación del tratamiento. RESULTADOS: El tiempo de evacuación total fue de 48 min 39 s (DE 15 min 52 s) en el grupo START y de 48 min 4 s (DE 17 min 21 s) en el grupo META (p = 0,829). Los pacientes con necesidad de atención inmediata se evacuaron más rápidamente en el grupo META que en el START, tanto en el grupo completo (31 min 36 s [DE 8 min 27 s] vs 41 min 6 s [DE 10 min 39s ]; p = 0,024) como en los que además precisaban tratamiento quirúrgico urgente (24 min 12 s [DE 4 min] vs 44 min 49 s [DE 8 min 36 s]; p = 0,001). El orden de evacuación de pacientes fue: los de necesidad de atención inmediata en las 19 primeras posiciones (14 de 19) y de atención inmediata con prioridad quirúrgica en las 14 primeras posiciones (5 de 14) en el grupo START; y los de necesidad de atención inmediata en las 14 primeras posiciones (14 de 14) y de atención inmediata y con prioridad quirúrgica en las 7 primeras posiciones (5 de 7) en el grupo META. La frecuencia de tratamiento adecuado fue de un 92% en el caso del META y de un 63% en el caso del START (p = 0,023). CONCLUSIONES: El triaje META, en comparación con el START, podría mejorar los tiempos extrahospitalarios y el orden de evacuación de los pacientes, especialmente en el caso de aquellos con necesidad de atención inmediata y de atención inmediata con prioridad quirúrgica, así como la adecuación del tratamiento, en los IMV.

Analysis of performance and stress caused by a simulation of a mass casualty incident.

OBJECTIVE: To determine the stress that is potentially produced in professional health workers due to a mass casualty incident (MCI) simulated exercise, and its relation to prior academic training and the role played in the simulation. METHODS: Observational study of stress in a MCI. For this work, two MCI drills comprised of 40 victims each were conducted. Two randomized groups of 36 students each were created: Master's Students Group (MSG) and Undergraduate Student Group (USG). The role performed by each student (triage or sectorization) was assessed. The stress level was determined by prior and subsequent measurements of alpha-amylase (αA), HR, SBP and DBP. RESULTS: The percentage of victims that were correctly triaged was 88.6%, 91.84% for MSG and 83.76% for the USG (p=0.004). The basal αA was 97,107.50±72,182.67IU/L and the subsequent αA was 136,195.55±90,176.46±IU/L (p<0.001). The baseline HR was 78.74±14.92beats/min and the subsequent HR was 95.65±23.59beats/min (p=0.000). We found significant differences in the αA between students who performed the triage and those who performed sectorization but there were no differences between undergraduate and Masters' students. CONCLUSION: Conducting a simulated exercise caused stress in personnel involved in the MCI, with a greater impact on participants who performed triage, although it was not influenced by their prior academic level. The stress level in our case did not affect or determine the performance of acquired skills.

[Unmanned aerial vehicles: usefulness for victim searches and triage in disasters]. / Utilidad de los vehículos aéreos no tripulados en la búsqueda y triaje de personas en situaciones de catástrofe.

OBJECTIVES: To analyze the influence of drones equipped with thermal cameras for finding victims and aiding triage during disasters. MATERIAL AND METHODS: We carried out a prospective, cross-sectional analysis and 6 experimental simulations, each with 25 victims to locate and triage. Nurses were randomized to a control group or a drone group. Drone-group nurses were given access to images from the thermal cameras 10 minutes before the exercise started. RESULTS: The mean (SD) distance the nurses searched in the control group (1091.11 [146.41] m) was significantly greater than the distance searched by nurses in the drone group (920 [ 71.93] m (P = .0031). The control group found a mean of 66.7% of the victims, a significantly smaller percentage than the drone group's mean of 92% (P = .0001). Triage quality (undertriage and overtriage) was similar in the 2 groups as shown by maneuvers undertaken to open airways and control bleeding. CONCLUSION: Drones with thermal cameras were useful in searching for victims of simulated disasters in this study, although they had no impact on the quality of the nurses' triage.

OBJETIVO: Analizar la influencia del uso de un dron con cámara térmica en la localización y triaje de las víctimas en una situación de catástrofe. METODO: Se ha llevado a cabo un estudio analítico, experimental, prospectivo y transversal, donde se realizaron 6 simulacros de búsqueda de víctimas y triaje (cada uno de ellos con 25 víctimas). De manera aleatoria se hicieron dos grupos: Grupo Control (GC) y Grupo Dron (GD). Los profesionales del GD pudieron disponer de las imágenes de la cámara térmica instalada en un dron 10 minutos antes de comenzar el ejercicio. RESULTADOS: La distancia media recorrida por el GC fue de 1091,11 (DE: 146,41) metros, significativamente mayor (p = 0,0031) que la del GD 920 (DE: 71,93) metros. El porcentaje medio de víctimas encontradas por cada uno de los profesionales del GC fue del 66,7%, significativamente menor (p = 0,0001) que las encontradas por cada uno de los profesionales del GD, que ascendió al 92%. En la calidad del triaje (infra y supratriaje), apertura de la vía aérea y control de hemorragias no se encontraron diferencias entre los dos grupos analizados. CONCLUSIONES: El uso de drones con cámaras térmicas, en condiciones experimentales, es útil en la búsqueda y localización de víctimas en catástrofes, aunque no tiene impacto sobre la calidad del triaje realizado por los profesionales participantes en el estudio.