PS2-07: A COMPREHENSIVE MASS CASUALTY INCIDENT (MCI) CURRICULUM FOR MEDICAL STUDENTS COMBINING DIDACTICS, BLEEDING CONTROL SKILLS AND SIMULATION.
Devashish J Anjaria, MD, Brad Chernock, Kurun Partap S Oberoi, MD, Wissam Nasser, Anastasia Kunac, MD; Rutgers - New Jersey Medical School

Background:  Mass casualty incidents, both conventional and terrorist, are unfortunately becoming more common in the US.  Despite this, medical school curricula do not address the principles and challenges in triaging and treating patients during a MCI.  We implemented a MCI curriculum for medical students during the third year surgery clerkship which includes didactic knowledge, bleeding control (BCON) skills as well as a novel tabletop MCI simulation to give experience with triage and emergency care principles during a MCI.

Methods:  A three part MCI curriculum was created for the third year surgery clerkship and delivered at orientation, comprised of an initial 30-minute didactic session, the ACS BCON course and a tabletop simulation of a mass shooting.  For the simulation, students worked in groups to assess patients in a multi-staged triage and treatment simulation, needing to accurately triage patients using START triage criteria and identify treatment of life threatening conditions prior to advancing the patient to the next tier of care.  In addition to assessment of the accuracy of triage and care, students were evaluated for retention of BCON skills at the end of the clerkship.  Student satisfaction with the curriculum was evaluated by survey.

Results:  To date 100, students have completed the curriculum.  88% reported having no prior MCI training.  Assessing accuracy of triage in the simulation, students had appropriate triage rate of 85%, undertriage rate of 6% and overtriage at 9%.  Students scored the simulation ≥ 4 on a 5 point Likert scale with a mean of 4.76 in value and effectiveness of understanding MCI care.  After 8 weeks, 64 students completed the BCON retention assessment and 92% were able to successfully demonstrate effective wound packing, 92% successful tourniquet application and 86% effective direct pressure. 78% of the students successfully demonstrated all three BCON skills. 

Conclusion:  This represents a reproducible MCI curriculum including simulation that can be implemented at any medical school.  Students demonstrated triage success comparable to published standards and high retention and successful demonstration of BCON skills.  The demands and principles of MCI care is applicable across specialties and therefore training should be incorporated into medical school curricula.