Value of a Ludic Simulation in Training First Responders to Manage Blast Incidents

Background

Common errors made by responders to explosive blast incidents include entering the scene too early or getting too close before the scene is cleared, gaining access without securing egress (blocked exits), failing to triage (treating/transporting in order of encounter), increasing risk to casualties by moving them to unsafe triage/treatment areas, and improperly assessing and/or treating casualties. Managing victims of an explosive blast event requires switching to a mode of operations that may differ substantially from standard management guidelines, and that switch must be automatic and smooth. Additional considerations specific to blast events include the possible risk of secondary attacks, different patterns of injury, and the fact that visual triage alone is insufficient.

Current training for blast response is primarily delivered via lecture and PowerPoint presentation, sometimes with practice sessions on human patient simulators (manikins). Although this is clearly insufficient to convey a sense of the reality of a mass-casualty incident, staging large-scale exercises is costly, time- and resource-intensive, and logistically challenging. Further, objective criteria of success and failure are rarely defined or imposed.