Evaluation of the decision-making process within the table-top exercise of the Terror and Disaster Surgical Care (TDSC®) course.

PURPOSE: The threat of terror is omnipresent in Europe and the number of attacks worldwide is increasing. The target of attacks in Europe is usually the civilian population. Incalculable dangerous situations at the scene of the event and severe injury patterns such as complex gunshot and explosion injuries with a high number of highly life-threatening people present rescue forces, emergency physicians and subsequently hospitals with medical, organizational as well as tactical and strategic challenges. The Terror and Disaster Surgical Care (TDSC®) course trains clinical decision-makers to meet these challenges of a TerrorMASCAL in the first 24-48 h. METHODS: A table-top exercise was developed for the TDSC® course as a decision training tool, which was prospectively evaluated in six courses. The evaluation took place in 3 courses of the version 1.0, in 3 courses in the further developed version 2.0 to different target values like, e.g., the accuracy of the in-hospital triage. Furthermore, 16 TDSC® course instructors were evaluated. RESULTS: For the evaluation, n = 360 patient charts for version 1.0 and n = 369 for version 2.0 could be evaluated. Overall, the table-top exercise was found to be suitable for training of internal clinical decision makers. Version 2.0 was also able to depict the action and decision-making paths in a stable and valid manner compared to the previous version 1.0. The evaluation of the instructors also confirmed the further value and improvement of version 2.0. CONCLUSION: With this prospective study, the table-top exercise of the TDSC® course was tested for decision stability and consistency of the participants' decision paths. This could be proven for the selected target variables, it further showed an improvement of the training situation. A further development of the table-top exercise, in particular also using digital modules, will allow a further optimization. http://www.bundeswehrkrankenhaus-ulm.de.

Terror and disaster surgical care: training experienced trauma surgeons in decision making for a MASCAL situation with a tabletop simulation game.

BACKGROUND: Mass-casualty incidents, especially in connection with a terrorist attack, can quickly overwhelm the capacities of receiving hospitals. After a mass-casualty terrorist incident, patients often arrive at hospitals in an uncoordinated manner on account of the chaotic situation. Many patients leave the incident site and refer themselves to hospitals independently. Hospital decision makers must, therefore, be able to make quick decisions on diagnostic procedures and treatment for every individual patient and, at the same time, take into consideration available resources. They require decision criteria and aids to properly manage such scenarios. MATERIALS AND METHODS: As part of the preparation of the Terror and Disaster Surgical Care (TDSC®) course, we developed a tabletop simulation game based on a comprehensive and structured review of the literature, the opinions of renowned experts, and the results of specialised conferences. This tabletop simulation game is played four times during each TDSC® course. RESULTS: Our analysis involved 264 of 465 course-participants from 2017 to 2019 and showed that the overall evaluation was very good and that participants grew more positive about the tabletop simulation game during the course. The tabletop simulation game received an average rating of 1.53 (1 = very good, 6 = insufficient). This rating remained consistently high over 19 courses. DISCUSSION: Hospital decision makers must respond to mass-casualty terrorist situations in a defined tactical and strategic approach. Rapid decisions must be made that take into account the special situation and available capacities and resources to maximise the number of survivors even though individual patients may have a poorer functional outcome. As part of the TDSC® course, the tabletop simulation game teaches high-level decision-making algorithms and prepares key hospital personnel for such situations.

Application of table-top exercise in evaluating rescue ability of nursing staff in different stages of coping with public health emergency / 中国实用护理杂志

Objective To analyze the situation of table tennis competitions in emergency public health events, find the possible weak links in the emergency rescue and care work, put forward the hospital in response to emergency public health emergency preparedness plan, health emergency drills and emergency rescue personnel training and so on targeted reference views. Methods A total of four public health emergencies such as traffic accident, mass food poisoning, fire and bird flu were selected as the theme of the competition to simulate the emergency rescue process after the emergency,the examination of each team is divided into pre-hospital disposal and hospital disposal links. Results The score of Crash in Batches was 225.13 ± 8.38, followed by Fire accident 222.78 ± 16.57, Avian Influenza 210.32 ± 11.19, Group Food poisoning 204.80 ± 6.77, the difference was statistically significant (F=8.706,P=0.000). The scores of pre-hospital treatment in all four subjects were109.04±4.80, 108.62±10.12, 98.24±6.95, 101.14± 8.85,lower than those in hospital, which were 116.09±4.79, 114.16±7.61, 106.56±5.31, 109.18±4.24, the difference was statistically significant (t=-6.130--2.338,P＜0.01 or 0.05). Conclusions On the different topics exposed in the desktop exercise competition and the differences between the pre-hospital treatment and the hospital disposal, the nursing managers should strengthen the training and practice of public health emergencies with different themes, and pay attention to the pre-hospital emergency public health emergencies training and rehearsal,the emergency response plans for public health emergencies were revised and improved through the health emergency drills.

Epidemic modeling and Table-top Exercise for Emerging Infectious Diseases in Korea / 한국역학회지

Understanding the spread of infections is of vital importance in the control of epidemics and the development of proper policies toprevent infectious diseases. Theory and techniques have been developed for the study of both the evolution of diseases with individual people and the transmission of infections through populations. From broad theoretical issues to specific practical problems, the mathematical modeling studies of infectious diseases have provided great insight to solve the mechanisms of disease spread and to predict the course of epidemics. Emerging and reemerging infectious diseases have attracted widespread concern in Korea. While preparing the influenza pandemic plan in 2004, we developed a model of the new influenza pandemic to estimate the number of cases and deaths, the shortage of medical resources, and the effect of interventions such as isolation and vaccination. Based on this model, we constructed a possible pandemic scenario of the emerging virus, and designed a table-top exercise for public health officials and related administration staff. On March 30th, 2005, the exercise was performed and the results were evaluated as successful. In the case of bioterrorism, a model of small pox epidemic was developed in 2005 to examine the speed of the disease spread in the population and to evaluate the intervention effects in a Korean city. The simulation results were also helpful to form a guideline to prepare for a small pox epidemic. These two experiments confirmed the usefulness of epidemic modeling in Korea.