2 Training Emergency Physicians for Mass Casualty Triage during Mass Shooting Events: A New York City- based Pilot Curriculum

Abstract

Recent literature suggests that emergency departments may be underprepared for the influx of “self-referred” patients following a mass shooting event. Following the mass shootings in Orlando and Las Vegas, the Greater New York Hospital Association determined there was a need to increase the preparation of emergency department clinicians for these events in New York. Through a partnership with the Center for Disaster Medicine at New York Medical College an 8-hour, innovative physician-oriented education program was created and piloted at 5 hospitals using a combination of didactics, table-top exercises, live ultrasound scanning, and in-situ high-fidelity simulation. The results of these pilot course deliveries were used to standardized course curricula available to all New York-area hospitals and identify additional educational needs for physicians and other emergency department staff. Didactic content was created using lessons-learned reports, comprehensive literature reviews, and consultation with physician subject matter experts in the area of trauma surgery, disaster medicine, and emergency ultrasound. Hands-on training was created based on lessons-learned consisted of three afternoon break-out sessions including a hospital-specific bed status management exercise to simulate decompressing the ED and critical care units in advance of the arrival of mass casualties, an immersive ED in-situ mass casualty management scenario utilizing high-fidelity trauma simulators and standardized patient actors, and a breakout session on innovative applications of point-of-care ultrasound for triage and clinical decision making using live standardized patients for scanning. Post-course surveys were distributed to participants and survey items aggregated for analysis and curriculum improvement and revision. Didactic content areas showed universal improvement among all pilot sites using Likert confidence scales to evaluate pre-course vs post-course provider self-efficacy. Practical skills and psychomotor evaluations also showed universal improvement following skills practice consistent with current emergency medicine educational literature. Gaps in the pilot course content reported by participants varied by facility but included wanting similar educational content available for non-physician ED clinicians, and wanting to include non-ED physicians, who might “float” to the ED during a mass casualty, to be included in the training. Additionally, physicians at some hospitals had better mastery of POCUS than others. A suggestion was to offer a stand-alone 4-hour course on emergency ultrasound for hospitals who would like to offer this to their ED physicians. Emergency physicians are the leaders of the hospital response to a mass casualty as the primary clinicians responsible for the triage and treatment of victims from out-of-hospital events. Nevertheless, many emergency physicians report not having the opportunity to receive education on new trends and innovations in mass casualty management, which could make them more effective when responding to a disaster. Departments should consider how they might enrich existing preparedness-related CME and leverage their resources in high-fidelity simulation and ultrasound to offer opportunities to practice skills and techniques that are not often utilized during annual in-service training.