Skip to main content

Terror and disaster surgical care: training experienced trauma surgeons in decision making for a MASCAL situation with a tabletop simulation game

Abstract

Background

Mass-casualty incidents, especially in connection with a terrorist attack, can quickly overwhelm the capacities of receiving hospitals. After a mass-casualty terrorist incident, patients often arrive at hospitals in an uncoordinated manner on account of the chaotic situation. Many patients leave the incident site and refer themselves to hospitals independently. Hospital decision makers must, therefore, be able to make quick decisions on diagnostic procedures and treatment for every individual patient and, at the same time, take into consideration available resources. They require decision criteria and aids to properly manage such scenarios.

Materials and methods

As part of the preparation of the Terror and Disaster Surgical Care (TDSC®) course, we developed a tabletop simulation game based on a comprehensive and structured review of the literature, the opinions of renowned experts, and the results of specialised conferences. This tabletop simulation game is played four times during each TDSC® course.

Results

Our analysis involved 264 of 465 course–participants from 2017 to 2019 and showed that the overall evaluation was very good and that participants grew more positive about the tabletop simulation game during the course. The tabletop simulation game received an average rating of 1.53 (1 = very good, 6 = insufficient). This rating remained consistently high over 19 courses.

Discussion

Hospital decision makers must respond to mass-casualty terrorist situations in a defined tactical and strategic approach. Rapid decisions must be made that take into account the special situation and available capacities and resources to maximise the number of survivors even though individual patients may have a poorer functional outcome. As part of the TDSC® course, the tabletop simulation game teaches high-level decision-making algorithms and prepares key hospital personnel for such situations.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. Friemert B, et al. Treatment strategies for mass casualty incidents and terrorist attacks in trauma and vascular surgery: presentation of a treatment concept. Chirurg. 2017;88(10):856–62.

    CAS  PubMed  Article  Google Scholar 

  2. Franke A, et al. Preclinical and intrahospital management of mass casualties and terrorist incidents. Chirurg. 2017;88(10):830–40.

    CAS  PubMed  Article  Google Scholar 

  3. Franke A, et al. The first aid and hospital treatment of gunshot and blast injuries. Dtsch Arztebl Int. 2017;114(14):237–43.

    PubMed  PubMed Central  Google Scholar 

  4. von Lubken F, et al. Update on gunshot wounds to extremities. Unfallchirurg. 2018;121(1):59–72.

    Article  Google Scholar 

  5. de Ceballos JP, et al. 11 March 2004: the terrorist bomb explosions in Madrid, Spain–an analysis of the logistics, injuries sustained and clinical management of casualties treated at the closest hospital. Crit Care. 2005;9(1):104–11.

    PubMed  Article  Google Scholar 

  6. Haug CJ. Report from Paris. N Engl J Med. 2015;373(27):2589–93.

    PubMed  Article  Google Scholar 

  7. Franke A, et al. ATLS(R) and TDSC(R): how it fits together: a treatment concept for mass casualty and terrorist-related mass casualty situations, life-threatening and special scenarios. Unfallchirurg. 2019;5:1.

    Google Scholar 

  8. Gauthier A, et al. Board games for health: a systematic literature review and meta-analysis. Games Health J. 2019;8(2):85–100.

    PubMed  Article  Google Scholar 

  9. Bratton SR, Rhine D, Jones TL. The efficacy of play therapy with children: a meta-analytic review of treatment outcomes. Prof Psychol Res Pract. 2005;36:376–90.

    Article  Google Scholar 

  10. Wilde J. The effects of the Let’s Get Rational board game on rational thinking, depression, and self-acceptance in adolescents. J Ration Cogn Ther. 1994;12:189–96.

    Article  Google Scholar 

  11. Bochennek K, et al. More than mere games: a review of card and board games for medical education. Med Teach. 2007;29(9):941–8.

    PubMed  Article  Google Scholar 

  12. Burke B. Gamify: how gamification motivates people to do extraordinary things. Brookline, MA: Bibliomotion; 2014.

    Google Scholar 

  13. Sailer MH, Mayr JU, Mandl SKH. How gamification motivates: an experimental study of the effects of specific game design elements on psychological need satisfaction. Comput Hum Behav. 2017;69:371–80.

    Article  Google Scholar 

  14. Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol. 2000;55(1):68–78.

    CAS  PubMed  Article  Google Scholar 

  15. Ryan RM, Deci EL. Intrinsic and extrinsic motivations: classic definitions and new directions. Contemp Educ Psychol. 2000;25(1):54–67.

    CAS  PubMed  Article  Google Scholar 

  16. Tepe A. Games as a teaching method in social science education. Curr Issu. 2017;10(4):241–9.

    Google Scholar 

  17. Lennquist Montan K, et al. Development and evaluation of a new simulation model for interactive training of the medical response to major incidents and disasters. Eur J Trauma Emerg Surg. 2014;40(4):429–43.

    CAS  PubMed  Article  Google Scholar 

  18. Sailer M, Hense J, Mandl H, Klevers M. Psychological perspectives on motivation through gamification. Inter Design Arch J. 2013;19:28–37.

    Google Scholar 

  19. Werbach K, Hunter D. For the win: how game thinking can revolutionize your business 2012. Philadelphia: Wharton Digital Press; 2012.

    Google Scholar 

  20. Burguillo JC. Using game theory and competition-based learning to stimulate student motivation and performance. Comput Educ. 2010;55(2):566–75.

    Article  Google Scholar 

  21. Sailer M. Die Wirkung von Gamification auf Motivation und Leistung: Empirische Studien im Kontext manueller Arbeitsprozesse. Wiesbaden: Springer; 2016.

    Book  Google Scholar 

  22. German Trauma Society. Whitebook Medical Care of the Severely Injured. 3rd revised, updated and expanded version. 2019. https://www.dgu-online.de/fileadmin/published_content/5.Qualitaet_und_Sicherheit/PDF/2019_DGU_Weissbuch_Schwerverletztenversorgung_Vorabdruck.pdf.

Download references

Author information

Authors and Affiliations

Authors

Consortia

Corresponding author

Correspondence to Gerhard Achatz.

Ethics declarations

Conflict of interest

Friemert B, Achatz G, Franke A and Bieler D are developers of the TDSC – Course and are active as Course-Directors or -Instructors in this Course. Pafrath T is Instructor in the TDSC – Course, Hofmann M is didactic advisor for the TDSC – Course, Blätzinger M and Hinz-Bauer S are members of AUC – Academy for Traume Surgery GmbH and organizer and operator of the TDSC – Course. Trentzsch H created, designed and conseptualized the simulation game in close cooperation with the developers of the TDSC – Course and the didactic advisor.

Ethical statement

For this study, there were no test or experiments to humans or animals.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Achatz, G., Friemert, B., Trentzsch, H. et al. Terror and disaster surgical care: training experienced trauma surgeons in decision making for a MASCAL situation with a tabletop simulation game. Eur J Trauma Emerg Surg 46, 717–724 (2020). https://doi.org/10.1007/s00068-020-01441-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00068-020-01441-x

Keywords

  • Terror
  • Disaster
  • Preparedness
  • Decision making
  • Table-top-Exercise
  • Simulation
  • Game