The Challenge of Mass Casualty Incident Response Simulation Exercise Design and Creation: A Modified Delphi Study

Abstract

Introduction:A Mass Casualty Incident response (MCI) full scale exercise (FSEx) assures MCI first responder competencies. Simulation and serious gaming platforms (Simulation) have been considered to achieve and maintain first responder competencies with the challenge of the FSEx. The translational science (TS) T0 question: How can students achieve similar MCI competencies through the use of simulation MCI exercises as with a FSEx?Method:Initial TS phase T1: Scoping ReviewA Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review was conducted to develop statements for the TS second phase T2 modified Delphi study. 1320 reference titles and abstracts were reviewed with 215 full articles progressing for full review leading to 97 undergoing data extraction.Second TS stage T2: modified Delphi studyThe database was analyzed and initial draft statements were created. Selected modified Delphi experts were presented with 27 statements with instructions to rank each statement on a seven-point linear numeric scale, where 1 = disagree and 7 = agree. Consensus amongst experts was defined as a standard deviation ≤1.0.Results:After three modified Delphi rounds 19 statements attained consensus and eight did not attain a consensus.Conclusion:The modified Delphi experts agreed that the simultaneous integration of individual duty and incident management skills should be incorporated into simulation MCI exercise design to achieve competencies depending on high physical fidelity to develop the individual’s manual abilities, as well as high conceptual fidelity, to develop the individual’s clinical reasoning and problem-solving skills. MCI simulation exercises can be developed to achieve similar competencies as FSExs incorporating the 19 statements that attained consensus through the TS phases of a scoping review (T1) and modified Delphi study (T2). The TS process should continue with development of these exercises in the T3 implementation stage and then evaluated in the T4 stage.