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60 seconds to survival: A pilot study of a disaster triage video game for prehospital providers

Mark X. Cicero, MD, Travis Whitfill, MPH, Kevin Munjal, MD, Manu Madhok, MD, MPH, Maria Carmen G. Diaz, MD, Daniel J. Scherzer, MD, Barbara M. Walsh, MD, Angela Bowen, RN, BSN, CPEN, NREMT-P, Michael Redlener, MD, Scott A. Goldberg, MD, MPH, Nadine Symons, MD, James Burkett, DHSc, PA-C, DFAAPA, Joseph C. Santos, MPH, NREMT, David Kessler, MD, MSc, RDMS, Ryan N. Barnicle, MD, MEd, Geno Paesano, NREMT-P, Marc A. Auerbach, MD, MSc


Introduction: Disaster triage training for emergency medical service (EMS) providers is not standardized. Simulation training is costly and time-consuming. In contrast, educational video games enable low-cost and more time-efficient standardized training. We hypothesized that players of the video game “60 Seconds to Survival” (60S) would have greater improvements in disaster triage accuracy compared to control subjects who did not play 60S.

Methods: Participants recorded their demographics and highest EMS training level and were randomized to play 60S (intervention) or serve as controls. At baseline, all participants completed a live school-shooting simulation in which manikins and standardized patients depicted 10 adult and pediatric victims. The intervention group then played 60S at least three times over the course of 13 weeks (time 2). Players triaged 12 patients in three scenarios (school shooting, house fire, tornado), and received in-game performance feedback. At time 2, the same live simulation was conducted for all participants. Controls had no disaster training during the study. The main outcome was improvement in triage accuracy in live simulations from baseline to time 2. Physicians and EMS providers predetermined expected triage level (RED/YELLOW/GREEN/BLACK) via modified Delphi method.

Results: There were 26 participants in the intervention group and 21 in the control group. There was no difference in gender, level of training, or years of EMS experience (median 5.5 years intervention, 3.5 years control, p = 0.49) between the groups. At baseline, both groups demonstrated median triage accuracy of 80 percent (IQR 70-90 percent, p = 0.457). At time 2, the intervention group had a significant improvement from baseline (median accuracy = 90 percent [IQR: 80-90 percent], p = 0.005), while the control group did not (median accuracy = 80 percent [IQR:80-95], p = 0.174). However, the mean improvement from baseline was not significant between the two groups (difference = 6.5, p = 0.335).

Conclusion: The intervention demonstrated a significant improvement in accuracy from baseline to time 2 while the control did not. However, there was no significant difference in the improvement between the intervention and control groups. These results may be due to small sample size. Future directions include assessment of the game's effect on triage accuracy with a larger, multisite site cohort and iterative development to improve 60S.


serious video games, disaster triage, pediatrics, paramedics, emergency medical technicians, curriculum evaluation

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