Code Triage: A Mass Casualty Simulation Board Game

Graduate medical education, once primarily rooted in textbooks and basic didactics, has advanced along with the technologies of the twenty-first century; there is now more emphasis on simulation-based training, role-play, and even virtual reality as active learning opportunities for resident trainees. Mass casualty incidents in the ED, while rare, spark a unique challenge to operations, roles, and logistics of care in the Emergency Department.

The goal of this game is to provide interactive training and preparation to ED staff and residents in the form of a board game. To evaluate whether playing a triage-and-treat style board game that simulates ED management of a MCI improves disaster medicine knowledge and preparedness for handling an MCI for EM providers at varying professional and/or training levels.

A prospective observational study of emergency medicine residents and students who participated in a 1 hour simulation-based activity consisting of a pre-game survey, active gameplay period followed by a debrief discussion, and a post-game survey will be performed. The pre- and post- survey will then be analyzed for significance and learner thoughts of improvement.

We will measure the pre- and post- performances regarding basic disaster medicine, triage concepts, and subjective preparedness for ED MCI management for the participants of this study to determine its usability as an interactive learning tool. Additionally, this game will allow a starting point to transition into AI/computer software that can be made customizable to individual ED’s program-specific needs, space limitations, and resources to allow Emergency Department specific training for staff and residents.

This is a game to enhance emergency medicine providers’ ability to respond to a mass casualty incident within the confines of the hospital. This gamifies disaster medicine learning into a tangible overview of all of the working parts of an MCI and its effects on hospital operations. Each standard session will be 1 hour long, including brief pre- and post- surveys completed by each participant, and interactive gameplay in between. As an SAEM tabletop/interactive presentation, the sessions will be shortened accordingly to allow for potential time constraints. The physical game board will be set up, and groups of 2-8 participants will have allotted time to be informed of the impending mass casualty scenario for their hospital, make the necessary preparations and role assignments, and then run through the gameplay of trying to appropriately triage, treat, and determine final dispositions of as many patients as possible within the time frame. There will be a set scoring system to provide an objective measurement of each group's performance in managing the mass casualty (a local food truck explosion at a nearby college football tailgate). For example, each group will earn points based on the amount of patients “correctly” triaged and dispositioned, whether discharged, admitted, or sent to the OR. They will lose points for grossly mis-triaged patients or for critical patients left waiting to be triaged. There will be a brief informative discussion after the gameplay to review fundamentals of disaster medicine/mass casualty preparedness and discuss opportunities for improvement. We intend to utilize the data collected from the surveys to determine the feasibility of this game as a learning tool, especially for residents in emergency medicine, to provide hands-on education for a topic that is not always a common real-life experience depending on where one does their training, but is nonetheless fundamental in training as an EM provider.