Open Access Open Access  Restricted Access Subscription or Fee Access

High-fidelity multiactor emergency preparedness training for patient care providers

Lancer A. Scott, MD, P. Tim Maddux, BS, Jennifer Schnellmann, PhD, ELS, Lauren Hayes, BS, Jessica Tolley, BS, Amy E. Wahlquist, MS


Background: Providing comprehensive emergency preparedness training (EPT) for patient care providers is important to the future success of emergency preparedness operations in the United States. Disasters are rare, complex events involving many patients and environmental factors that are difficult to reproduce in a training environment. Few EPT programs possess both competency-driven goals and metrics to measure life-saving performance during a multiactor simulated disaster.
Methods: The development of an EPT curriculum for patient care providers—provided first to medical students, then to a group of experienced disaster medical providers—that recreates a simulated clinical disaster using a combination of up to 15 live actors and six high-fidelity human simulators is described. Specifically, the authors detail the Center for Health Professional Training and Emergency Response’s (CHPTER’s) 1-day clinical EPT course including its organization, core competency development, medical student self-evaluation, and course assessment.
Results: Two 1-day courses hosted by CHPTER were conducted in a university simulation center. Students who completed the course improved their overall knowledge and comfort level with EPT skills.
Conclusions: The authors believe this is the first published description of a curriculum method that combines high-fidelity, multiactor scenarios to measure the life-saving performance of patient care providers utilizing a clinical disaster scenario with >10 patients at once. A larger scale study, or preferably a multicenter trial, is needed to further study the impact of this curriculum and its potential to protect provider and patient lives.


high-fidelity simulation, simulator, simulation, performance, performance-based, emergency preparedness, disaster medicine, disaster training, training, medical trainee, medical student, health professional, healthcare worker, first responder, emergency m

Full Text:



Tokuda Y, Kikuchi M, Takahashi O, et al.: Prehospital management of sarin nerve gas terrorism in urban settings: 10 years of progress after the Tokyo subway sarin attack. Resuscitation. 2006; 68(2): 193-202.

Barkemeyer BM: Practicing neonatology in a blackout: The University Hospital NICU in the midst of Hurricane Katrina: Caring for children without power or water. Pediatrics. 2006; 117(5 Pt 3): S369-S374.

Currier M, King DS,Wofford MR, et al.: A Katrina experience: Lessons learned. Am J Med. 2006; 119(11): 986-992.

Edwards TD,Young RA, Lowe AF: Caring for a surge of Hurricane Katrina evacuees in primary care clinics. Ann Fam Med. 2007; 5(2): 170-174.

Hamm LL: Personal observations and lessons from Katrina. Am J Med Sci. 2006; 332(5): 245-250.

Kline DG: Inside and somewhat outside Charity. J Neurosurg. 2007; 106(1): 180-188.

Leder HA, Rivera P: Six days in Charity Hospital: Two doctors’ ordeal in Hurricane Katrina. Compr Ther. 2006; 32(1): 2-9.

Ciraulo DL, Frykberg ER, Feliciano DV, et al.: A survey assessment of the level of preparedness for domestic terrorism and mass casualty incidents among Eastern Association for the Surgery of Trauma members. J Trauma. 2004; 56(5): 1033-1039; discussion 1039-1041.

Bartley BH, Stella JB, Walsh LD: What a disaster?! Assessing utility of simulated disaster exercise and educational process for improving hospital preparedness. Prehosp Disaster Med. 2006; 21(4): 249-255.

Galante JM, Jacoby RC, Anderson JT: Are surgical residents prepared for mass casualty incidents? J Surg Res. 2006; 132(1): 85-91.

Martin SD, Bush AC, Lynch JA: A national survey of terrorism preparedness training among pediatric, family practice, and emergency medicine programs. Pediatrics. 2006; 118(3): e620-e626.

Miller GT, Scott JA, Issenberg SB, et al.: Development, implementation and outcomes of a training program for responders to acts of terrorism. Prehosp Emerg Care. 2006; 10(2): 239-246.

Scott JA, Miller GT, Issenberg SB, et al.: Skill improvement during emergency response to terrorism training. Prehosp Emerg Care. 2006; 10(4): 507-514.

Sklar DP, Richards M, Shah M, et al.: Responding to disasters: Academic medical centers’ responsibilities and opportunities. Acad Med. 2007; 82(8): 797-800.

Coico R, Kachur E, Lima V, et al.: Guidelines for preclerkship bioterrorism curricula. Acad Med. 2004; 79(4): 366-375.

American College of Emergency Physicians:Task Force of Health Care and Emergency Services Professional on Preparedness for Nuclear, Biological and Chemical Incidents, Executive Summary, 2001.

American Association of Medical Colleges: Training Future Physicians About Weapons of Mass Destruction. Report of the Expert Panel on Bioterrorism Education, 2008.

Institute of Medicine Committee: Hospital-Based Emergency Care: At the Breaking Point. Institute of Medicine Committee on the Future of Emergency Care in the US Health System.Washington, DC: National Academies Press, 2006.

Scott LA, Carson DS, Greenwell IB: Disaster 101: A novel approach to disaster medicine training for health professionals. J Emerg Med. 2010; 39(2): 220-226.

Association of American Medical Colleges: Number of US Medical Schools Teaching Selected Topics 2004-2005, 2005.

Rico E, Trepka M, Zhang G, et al.: Knowledge and attitudes about bioterrorism and smallpox: A survey of physicians and nurses. Epidemiol Mon Rep. 2002; 3: 1-7.

Lanzilotti SS, Galanis D, Leoni N, et al.: Hawaii medical professionals assessment. Hawaii Med J. 2002; 61(8): 162-173.

Gershon RR, Canton AN, Magda LA, et al.:Web-based training on weapons of mass destruction response for emergency medical services personnel. Am J Disaster Med. 2009; 4(3): 153-161.

Chen J,Wilkinson D, Richardson RB, et al.: Issues, considerations and recommendations on emergency preparedness for vulnerable population groups. Radiat Prot Dosimetry. 2009; 134(3-4): 132-135.

Subbarao I, Lyznicki JM, Hsu EB, et al.: A consensus-based educational framework and competency set for the discipline of disaster medicine and public health preparedness. Disaster Med Public Health Prep. 2008; 2(1): 57-68.

Williams J, Nocera M, Casteel C: The effectiveness of disaster training for health care workers: A systematic review. Ann Emerg Med. 2008; 52(3): 211-222, 222 e211-212.

Hsu EB, Jenckes MW, Catlett CL, et al.: Training of Hospital Staff to Respond to a Mass Casualty Incident. Evidence Report/ Technology Assessment Number 95. Johns Hopkins University Evidence-based Practice Center under Contract No. 290-02-0018. 2004: 1-3.

Improving Patient Safety Through Simulation Research. 2004. Available at Accessed March 2, 2012.

Scott LA: Disaster 101: A novel approach to health care students’ disaster medicine and emergency preparedness training. Disaster Med Public Health Prep. 2009; 3(3): 139-140.

Barbera JA, Yeatts DJ, Macintyre AG: Challenge of hospital emergency preparedness: Analysis and recommendations. Disaster Med Public Health Prep. 2009; 3(2 Suppl): S74-S82.

The George Washington University Institute for Crisis Disaster and Risk Management: VHA-EMA Certification Program, Healthcare Emergency Management Professional Certification Program, Final Program Recommendations, Deliverable November 9, 2007.

Subbarao I, Bond WF, Johnson C, et al.: Using innovative simulation modalities for civilian-based, chemical, biological, radiological, nuclear, and explosive training in the acute management of terrorist victims: A pilot study. Prehosp Disaster Med. 2006; 21(4): 272-275.

Cosgrove SE, Jenckes MW,Wilson LM, et al.:Tool for Evaluating Core Elements of Hospital Disaster Drills. Agency for Healthcare Research and Quality Web site, publication 08-0019. 2008.Available at Accessed April 25, 2012.

King HB, Battles J, Baker DP, et al.: Team STEPPS: Team Strategies and Tools to Enhance Performance and Patient Safety (Performance and Tools). Aug 2008: 3.

Markenson D, DiMaggio C, Redlener I: Preparing health professions students for terrorism, disaster, and public health emergencies: Core competencies. Acad Med. 2005; 80(6): 517-526.

Bloom B, Engelhart M, Furst E, et al.: Taxonomy of Educational Objectives: The Classification of Educational Goals. New York: Longmans, Green, 1956.

Krathwohl D, Bloom B, Masia B: Taxonomy of Educational Objectives; the Classification of Educational Goals. New York: Longman, Green, 1964.

Smith P, Ragan T: Instructional Design. 2nd ed. New York: John Wiley & Sons, Inc, 1999.

Scott L, Ross A, Schnellmann J, et al.: Surge Capacity: CHPTER and the South Carolina Healthcare Worker Preparedness. J S C Med Soc. 2011; 107: 74-77.

Diehr P, Martin D, Koepsell T, et al.: Breaking the matches in a paired t-test for community interventions when the number of pairs is small. Stat Med. 1995; 14: 1491-1504.

Ruhe DS, Byfield GV: Audiovisual aids for disaster and military medicine in the medical schools. J Med Educ. 1954; 29(8 1): 59-62.

Kohn LT, Corrigan J, Donaldson MS: To Err is Human: Building a Safer Health System.Washington, DC: National Academy Press, 2000.

Howard SK, Gaba DM, Fish KJ, et al.: Anesthesia crisis resource management training: Teaching anesthesiologists to handle critical incidents. Aviat Space Environ Med. 1992; 63(9): 763-770.

Wiener EL, Kanki BG, Helmreich RL: Cockpit Resource Management. San Diego: Academic Press, 1993.

Murray DJ, Boulet JR, Kras JF, et al.: Acute care skills in anesthesia practice: A simulation-based resident performance assessment. Anesthesiology. 2004; 101(5): 1084-1095.

Wayne DB, Didwania A, Feinglass J, et al.: Simulation-based education improves quality of care during cardiac arrest team responses at an academic teaching hospital: A case-control study. Chest. 2008; 133(1): 56-61.

Wayne DB, Butter J, Siddall VJ, et al.: Mastery learning of advanced cardiac life support skills by internal medicine residents using simulation technology and deliberate practice. J Gen Intern Med. 2006; 21(3): 251-256.

Rosenthal ME, Adachi M, Ribaudo V, et al.: Achieving housestaff competence in emergency airway management using scenario based simulation training: Comparison of attending vs housestaff trainers. Chest. 2006; 129(6): 1453-1458.

Tsai TC, Harasym PH, Nijssen-Jordan C, et al.: Learning gains derived from a high-fidelity mannequin-based simulation in the pediatric emergency department. J Formos Med Assoc. 2006; 105(1): 94-98.

Shavit I, Keidan I, Hoffmann Y, et al.: Enhancing patient safety during pediatric sedation: The impact of simulation-based training of nonanesthesiologists. Arch Pediatr Adolesc Med. 2007; 161(8): 740-743.

DeVita MA, Schaefer J, Lutz J, et al.: Improving medical emergency team (MET) performance using a novel curriculum and a computerized human patient simulator. Qual Saf Health Care. 2005; 14(5): 326-331.

Franc-Law J, Ingrassia P, Ragazzoni L, et al.: The effectiveness of training with an emergency department simulator on medical student performance in a simulated disaster. CJEM. 2010; 12(1): 27-32.

Gordon JA, Shaffer DW, Raemer DB, et al.: A randomized controlled trial of simulation-based teaching versus traditional instruction in medicine: A pilot study among clinical medical students. Adv Health Sci Educ Theory Pract. 2006; 11(1): 33-39.

Morgan PJ, Cleave-Hogg D, Desousa S, et al.: Applying theory to practice in undergraduate education using high fidelity simulation. Med Teach. 2006; 28(1): e10-e15.

Ten Eyck RP, Tews M, Ballester JM: Improved medical student satisfaction and test performance with a simulation-based emergency medicine curriculum: A randomized controlled trial. Ann Emerg Med. 2009; 54(5): 684-691.

Wong G, Jenkins C,Yao TJ, et al.: A trend toward improved learning of cardiovascular pathophysiology in medical students from using a human patient simulator: Results of a pilot study. Adv Physiol Educ. 2007; 31(4): 372.

Small SD,Wuerz RC, Simon R, et al.: Demonstration of highfidelity simulation team training for emergency medicine. Acad Emerg Med. 1999; 6(4): 312-323.

Reznek M, Smith-Coggins R, Howard S, et al.: Emergency medicine crisis resource management (EMCRM): Pilot study of a simulation- based crisis management course for emergency medicine. Acad Emerg Med. 2003; 10(4): 386-389.

Kobayashi L, Shapiro MJ, Gutman DC, et al.: Multiple encounter simulation for high-acuity multipatient environment training. Acad Emerg Med. 2007; 14(12): 1141-1148.

Andreatta PB, Maslowski E, Petty S, et al.:Virtual reality triage training provides a viable solution for disaster-preparedness. Acad Emerg Med. 2010; 17(8): 870-876.

Eaves RH, Flagg AJ: The U.S. Air Force pilot simulated medical unit: A teaching strategy with multiple applications. J Nurs Educ. 2001; 40(3): 110-115.

Decker SI, Galvan TJ, Sridaromont K: Integrating an exercise on mass casualty response into the curriculum. J Nurs Educ. 2005; 44(7): 339-340.

Vincent DS, Burgess L, Berg BW, et al.: Teaching mass casualty triage skills using iterative multimanikin simulations. Prehosp Emerg Care. 2009; 13(2): 241-246.

Coule PL, Schwartz RB: The national disaster life support programs: A model for competency-based standardized and locally relevant training. J Public Health Manag Pract. 2009; 15(2 Suppl): S25-S30.

Fritz PZ, Gray T, Flanagan B: Review of mannequin-based highfidelity simulation in emergency medicine. Emerg Med Australas. 2008; 20(1): 1-9.

LeRoy Heinrichs W, Youngblood P, Harter PM, et al.: Simulation for team training and assessment: Case studies of online training with virtual worlds.World J Surg. 2008; 32(2): 161-170.

Schumacher J, Runte J, Brinker A, et al.: Respiratory protection during high-fidelity simulated resuscitation of casualties contaminated with chemical warfare agents. Anaesthesia. 2008; 63(6): 593- 598.

Kyle RR, Via DK, Lowy RJ, et al.: A multidisciplinary approach to teach responses to weapons of mass destruction and terrorism using combined simulation modalities. J Clin Anesth. 2004; 16(2): 152-158.

Lerner E, Schwartz R, Coule P, et al.: Use of SALT triage in a simulated mass-casualty incident. Prehosp Emerg Care. 2010; 14: 21-25.

Summerhill EM, Mathew MC, Stipho S, et al.: A simulationbased biodefense and disaster preparedness curriculum for internal medicine residents. Med Teach. 2008; 30(6): e145-e151.

Gillett B, Peckler B, Sinert R, et al.: Simulation in a disaster drill: Comparison of high-fidelity simulators versus trained actors. Acad Emerg Med. 2008; 15(11): 1144-1151.

Wallace D, Gillett B, Wright B, et al.: Randomized controlled trial of high fidelity patient simulators compared to actor patients in a pandemic influenza drill scenario. Resuscitation. 2010; 81(7): 872- 876.

Kaji AH, Coates W, Fung CC: A disaster medicine curriculum for medical students. Teach Learn Med. 2010; 22(2): 116-122.

Van Sickle D,Wenck MA, Belflower A, et al.: Acute health effects after exposure to chlorine gas released after a train derailment. Am J Emerg Med. 2009; 27(1): 1-7.

Wenck MA, Van Sickle D, Drociuk D, et al.: Rapid assessment of exposure to chlorine released from a train derailment and resulting health impact. Public Health Rep. 2007; 122(6): 784-792.

Ball LJ, Dworak J: Disaster in Graniteville. S C Nurse. 2005; 12(2): 1.

Buckley RL, Hunter CH, Addis RP, et al.: Modeling dispersion from toxic gas released after a train collision in Graniteville, SC. J Air Waste Manag Assoc. 2007; 57(3): 268-278.

Mitchell J, Edmonds A, Cutter S, et al.: Evacuation Behavior in Response to the Graniteville, South Carolina, Chlorine Spill. University of South Carolina, 2005.

Centers for Disease Control: Public Health Consequences from Hazardous Substances Acutely Released During Rail Transit— South Carolina, 2005; Selected States, 1999-2004. Morb Mortal Wkly Rep. 2005; 54: 64-67.



  • There are currently no refbacks.