COVID-19 Resurgence Mass Casualty Incident Simulation Steven Bolger, Daniel Weinick, Yasamin Soltanianzadeh, Heidi Baer, Joshua McHugh, Daniel Satnick, Edmund Hsu Mount Sinai Morningside and West
PURPOSE:
METHODS:
As part of orientation for the incoming emergency medicine interns, the Divisions of Simulation and EMS and Disaster Preparedness collaborated to teach basic principles of emergency preparedness through an insitu simulation of a mass casualty incident (MCI) related to COVID-19 resurgence in New York City. The objective of this MCI simulation was to provide an opportunity for the interns to learn the principles of disaster preparedness through a simulated MCI case using the resources available in the Emergency Department at Mount Sinai West.
The incoming emergency medicine interns were introduced to MCI operations through a morning didactic session hosted by the EMS and Disaster Preparedness Division. This session included a discussion of the varying MCI levels and principles of adapting to a new triage system and delegating tasks. The interns then participated in two focused insitu MCI simulation sessions in the context of a resurgence of patients with respiratory distress secondary to COVID19. The scenarios involved a nursing home alerting the emergency department to a large number of residents with signs of respiratory distress.
An anonymous 10-question survey was then distributed to the interns to collect data regarding performance during the first and second simulation sessions. We used a Likert scale from 1 (needs improvement) to 5 (exceeds expectation) to assess communication between providers, how appropriately patients were triaged and dispositioned, and how appropriately patients with respiratory distress were acutely managed. RESULTS: We found an increase in the numeric rating of communication between providers comparing the first and second simulation sessions from 3.3 to 4.3. We similarly found an increase in the numeric scale regarding how appropriately patients were triaged between low acuity non-isolation, high acuity non-isolation, low acuity isolation, and high acuity isolation between the first and second simulation sessions from 3.6 to 4.0.
We also found an increase regarding how appropriately patients were dispositioned between the first and second cases from 3.6 to 4.1. We did not find a numeric difference in how appropriately the patients with respiratory distress were intervened upon with critical actions. We also found that 12 patients were triaged in the first simulation session compared to 14 in the second simulation session which is likely due to a more organized and systematic MCI response. CONCLUSIONS: We created a brief learning session followed by an in-situ simulation of an MCI involving COVID-19 resurgence with an objective of allowing interns to understand basic MCI principles and use their newfound knowledge to implement existing MCI protocols and develop an organized response. Overall, we found that in-situ simulation is an effective method of allowing interns to improve communication skills and appropriately triage and disposition patients during an MCI.
