Ordering the Disorder: Preparing Paramedics for Unexpected and Unsafe Mass Casualty Incidents

Mass Casualty Incidents (MCI) occur when the number of patients in an incident exceed the number of available resources, require a multi-disciplinary approach and are protracted; fortunately, they are rare. When they do occur, first responders –including paramedics, police and fire fighters - must respond instantly and effectively. This article introduces research on use of an MCI simulation as the capstone subject for a degree program preparing student paramedics for the disorder and chaos of their first MCI. The University of Tasmania’s (UTAS) Sydney campus ran three iterations of an MCI simulation for students in the Bachelor of Paramedic Practice degree. The MCI required paramedics to respond to a gas explosion involving mass casualties in a public setting - using 30 moulage enhanced (makeup-based mock injuries) simulated patients in varying degrees of distress. The MCI scenario was specifically designed as an immersive experience within which participants could review their current capabilities. This article reflects on the impact of the third iteration, drawing on post event interviews to review experiences occurring during/after such large scale, complex, stress-inducing simulations. Fidelity to conditions in real MCIs was elevated through use of intrusive noise, simulated patients and live radio communications. The impact on participants – both facilitators and students as patients or paramedics – has been long lasting. Future research will consider the extent to which the effect of emotional engagement and skills acquisition persist and re-surface long after the event is over.