ReviewFull-scale simulation may be used to train medical students in disaster medicine
Introduction
Estimates indicate that more than 3.4 million people have died over the past quarter century directly due to disasters. Billions of dollars have been spent to rebuild and take care of the communities and people affected by these disasters.1
Disasters can be defined as events in which the number of those affected and injured, and the severity of their injuries, exceed the capacity of available medical resources.2 For disaster management to be effective it must be organized at local, regional, and national level. Moreover international contributions are often necessary as multiple casualties lead to great demands on the available healthcare resources.3 Generally speaking, medical preparedness for disasters can be seen as a “chain of disaster management” with medical care divided into three categories:
On-scene healthcare personnel, transportation and distribution of the injured, and stationary locations such as pre-hospital facilities or general hospitals.2, 3
Therefore, pre-hospital cooperation between medical personnel and valuable participants in emergency care such as the Red Cross is necessary for optimal disaster management.
Disasters are complex events that involve many casualties and environmental factors that are hard to reproduce inside a classroom. Simulation-based training appears to be effective4 and in Denmark medical simulation is an increasing part of the education process for doctors and nurses, especially for those working in the field of anaesthesiology. Simulation training allows clinical situations to be recreated and trained in a controlled environment and can also be used to train teamwork and communication skills.4, 5 Simulations are traditionally performed at simulation centres. However, it is generally recommended to choose a location for simulation depending on the learning possibilities and objectives desired.4 The increased use of medical simulation in both pre- and postgraduate medical training makes the use of simulation in disaster medicine obvious. In disaster medicine it is advantageous to conduct the simulation outside of the simulation centre. Research indicates that students enjoy simulation training and that it can enhance their learning experience.6, 7, 8 Other studies have shown that students are motivated for learning about disaster medicine and that education in disaster medicine can be taught in a reasonable time.7, 9, 10
Recently, the international medical community has identified medical students as a viable resource to be used in response to national and international disasters.6, 9, 11, 12, 13 A 1997 workshop in disaster medicine organized by the European Community Core Group recommended the implementation of a one-week course devoted to disaster medicine in medical schools.11 This recommendation was not implemented in Denmark and today there is still no formal pre- or postgraduate training in disaster medicine for medical students in Denmark. In the United States there is an increasing awareness of including disaster medicine in the medical school curriculum12 and literature from Germany and Sweden describes how a curriculum in disaster medicine has been taught for years.9, 11 Although no published works exists, at the Arctic University of Tromsø in Norway, a week-long course in disaster medicine is a regular part of the medical school curriculum. In Tromsoe, the students help organize and teach an annual disaster medicine course. The fourth year students participate in workshops, attend lectures, and ultimately participate in a one-day disaster simulation. The fifth and sixth year students teach some of these workshops. On the last day there is a simulated disaster where the students participate as figurants and emergency personnel.
Therefore in May 2013 the Students' Society of Anaesthesiology and Traumatology (SATS) in Copenhagen, Denmark hosted a three-day full-scale mass-casualty simulation course in disaster medicine for medical students.
The goal was to increase the students' knowledge about disaster medicine and introduce the concept of triage and decision-making in emergency care. Organizers also wanted to enhance the students' interest in disaster medicine and present and practice the skills necessary not only in disaster medicine but also in everyday clinical practice. A Lickert scale was used to describe the participants' self-assessed capability and confidence in managing the patients during a disaster.10
Section snippets
The course
The course was conducted on a military training facility in Vordingborg in the southern part of Zealand, Denmark. A total of 66 medical students, 62 from SATS and four from the Norwegian sister organization in Tromsoe, participated in the course. The participants were represented from all 12 semesters, thereby ranging from first year to last year medical students.
The course was designed stepwise after the TüPASS model for scenario design.14 First the financial and logistic resources were
Discussion
A group of volunteer medical students from SATS held a three-day disaster medicine course for 66 medical students in Denmark. The course consisted of lectures, workshops, and three full-scale simulations. The course was designed to give participants' an insight into disaster medicine and the basic skills required during a disastrous event. Although exposing students to simulated disaster scenarios cannot mimic “real world” conditions and no evidence has proven that introducing medical students
Acknowledgements
We would like to thank the organizing group behind Trauma Days 2013 for all their time and dedication and the economic support from the Tryg foundation, Østifternes association, FADL, The University of Copenhagen, FALCK, FYA and DASAIM.
Conflict of interest
There is no conflict of interest.
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