Enhancing collaboration and education for MCI response: the experience of the Regional Public Company in Lombardy (AREU, Italy)
METHOD: Lombardy is a northern region in Italy and AREU is the pre-hospital emergency public company, born on 2009, that coordinates the EMS response for MCI events and for the disaster response.
The region is one of the most populated in Italy, and the risk analysis showed an high risk related to natural risks, human factor risks, technological and chemical risks.
In the last 9 years, AREU was often involved inside the national disaster response ‘cause of the recent earthquakes in Italy (L’Aquila 2009, Carpi 2012, Amatrice and Norcia 2016, Rigopiano 2017); by the way, on 2015 AREU coordinated the emergency plan for EXPO in Milan, and many times was involved in MCI management for railways events, chemical accidents and support to mass gathering events.
Since 2014, AREU started a cooperation together with CRIMEDIM, a national simulation centre located in Novara (Eastern Piedmont University), one of the excellent simulation center in Italy, and started using a virtual training program of the medical resources that daily work in the pre-hospital emergency system.
The training program, available in a open source platform, was scheduled with a virtual training phase and with a one day residential course phase.
During the virtual and the residential phases the medical resources are tested in scenarios checking: the approach of the rescuers to the MCI scene, the command and control coordination on site, the triage performed, the identification of needs and evacuation priorities of the casualties involved.
During the on line phase and during the residential course both all of the participants are tutored by AREU’s Faculty, and trained to use the ISEE (I-SEE® (Interactive Simulation Exercise for Emergencies) software adopted by AREU training center and Crimedim. During the virtual simulations, few indicators and individual skills are controlled.
During 2017, the software XVR (a 3D simulator) was adopted and introduced inside the residential course, to verify the approach to scene with a tridimensional tool.
RESULTS: after 4 years of training, more than 600 doctors and nurses were trained with ISEE.
In real MCI events the evidence showed that the indicators measured in the theorical training are similar of the real management: logistic skills, command and control chain skills, effective triage, reports timeline and communication skills, are few of the indicators that is possible to control in a virtual training and can be found and measured in real events as well.
The educational and clinical relevance of the case is that the main skills of an MCI management can be measured in a virtual reality and found in real events as well. The field experience become the feedback to modify training programs in the pre-hospital response.
This shows how the cooperation with a research simulation center (Crimedim) can improve the effectiveness of a public company (AREU) in his MCI/Disaster response.
