Nationwide Program for training nurses in MCI Triage: the impact of three different type

of simulation

Ragazzoni L, Ingrassia PL, Sabatini E, Sabbatini S, Di Matteo L, Troiano H, Polcini F, Picone C, Petrini F, Della Corte F.

BACKGROUND• Several studies assessed the

effects of training and teaching in Disaster Medicine using simulation systems on medical skills.

• Anyhow stress responses in a simulated scenario and the relationship between stress reactivity and medical performance have been studied rarely.

Simulated Scenario

Medical Performance

Stress Responses

Stress Reactivity

BACKGROUND

Rea l i s m

Effective

Effective

Effective

Stressful Situation

Stressful Situation

Stressful Situation

?

Table-top exercises and Virtual Reality simulation are establishing to be equally effective compared to the Live Simulation but it is common to think that the high degree of realism achieved by drills produces a more stressful situation for the participants compare to the other.

Table-top exercises and Virtual Reality simulation are establishing to be equally effective compared to the Live Simulation but it is common to think that the high degree of realism achieved by drills produces a more stressful situation for the participants compare to the other.

Table-top

Virtual Reality

Live Simulation

THE aim OF THIS STUDY

to compare the impact on

physiologic stress

response of three

different simulation-based

methods for training

nurses in mass casualty

triage

Table-top

Virtual Reality

Live Simulation

Stress Reactivity

TriagePerformance

METHODS

• A prospective randomized controlled longitudinal study was designed

• 51 nurses enrolled in an Italian first-level Master on principles of Disaster Preparedness and Management were randomized in three group

• aiming at triaging 10 victims in a limited period of time (5 min) using the Simple Triage and Rapid Treatment (START) algorithm

METHODS20-min lecture about MCI Triage

Group 1 Group 2 Group 3

Table-top Exercise

Virtual Reality Simulation Live Scenario

The simulation environment and the victims’ clinical conditions were identical in the three different simulations

(17 nurses)(17 nurses) (17 nurses)

(51 nurses)

METHODS

• Heart rate and blood pressure were recorded just before and after the simulations

• The groups’ ability to manage the simulated triage scenario was then compared (times and triage accuracy)

• One-way analysis of variance (ANOVA) for each student was used

RESULTS

• There was no difference in triage accuracy during the three exercises (average 7.56±1.23)

• There was a marked difference in time to complete triage

Times and triage accuracy

• Both G1 and G2 in the TT and VR used all the time they had available to

complete triage (5 minutes)

• G3 participating in the LS completed the triage operation in an average

of 3.3±0.5 minutes

RESULTSPsysiological Stress

Parameters

There was no difference in heart rate before and after the three simulations

Table-top

Virtual Reality

Live Scenario

Group 1

Group 2

Group 3

Average Hearth (p =0.54)

Before After

85 bpm

85 bpm

82 bpm

80 bpm

80 bpm

76 bpm

RESULTS

Interestingly systolic blood pressure, which was not significantly different before the exercises (p=0.23) showed a marked increase in G2 (p<0.05)and in G3 (p<0.01)

Table-top

Virtual Reality

Live Scenario

Group 1

Group 2

Group 3

Systolic Blood Pressure

Before After

123 mmHg

127mmHg

125 mmHg

130 mmHg

121 mmHg

139 mmHg

(p= 0.73)

(p< 0.05)

(p< 0.01)

Psysiological Stress Parameters

Conclusion

the LS and VR had an increased physiologic stress levels, as measured by systolic blood pressure

Table-top

Virtual Reality

Live Simulation

compared with TT

This results could be

explained by the high

degree of realism

achieved by VR and

LS compared to TT.

CONCLUSION

Stress Reactivity

TriagePerformance

Instead such a stress reactivity

reported would seem to have no

impact in improving or decreasing

triage performance.

Although nurses were exposed to a

training session, the lack of

familiarity with the new simulation

tools could be the reason of the

higher time to complete TT and VR.

CONCLUSION

The data represents only

an initial report of a

future nationwide study

that will include all the

180 nurses enrolled into

the Master.