Mass Casualty Incident (MCI) training in a metropolitan university hospital: short-term experience with MAss Casualty SIMulation system MACSIM®



The aim of this study was to test and validate a new hospital Mass Casualty Incident (MCI) training using MACSIM® (MAss Casualty SIMulation) system adapted to the specifications and MCI plan of a single hospital.


The original MCI training format called MACSIM-PEMAF (Piano di Emergenza per il Massiccio Afflusso di Feriti, i.e., hospital disaster plan for massive influx of casualties) was developed for the Italian Society for Trauma and Emergency Surgery (SICUT) in 2016. It uses MACSIM®, a simulation tool for the training and assessment of healthcare professionals in MCI management. Between 2016 and 2018 the course was held several times at a university hospital in the Milan metropolitan area. The MACSIM® tool was used to reproduce different MCI scenarios with actual hospital resources. During the simulations, participants acted in their usual professional functions, testing both the local MCI plan as well as the individuals’ knowledge and skills. Course effectiveness was validated by a pre- and post-curse self-assessment questionnaire.


MACSIM-PEMAF was tested over 7 courses, with a total of 258 participants. Pre- and post-course questionnaires showed a significant improvement for hospital staff in self-reported perceptions of knowledge and skills in MCI management. In total, on a 1–10 scale, all the staff increased their competencies from a value of 4.4 ± 2.5 to 7.5 ± 1.9 (p < 0.001).


MACSIM-PEMAF demonstrated efficacy in fulfilling the requirements of Italian law for PEMAF implementation, testing local resources and resilience, as well as increasing the self-reported perception of the hospital staff ability to respond to a MCI.

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Fig. 1

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Fig. 3



Advanced Trauma Life Support


Emergency Department


European Society for Trauma and Emergency Surgery


Hospital Command Group


Hospital Disaster Manager


Intensive Care Unit


MAss Casualty SIMulation


Mass Casualty Incident


Medical Response to Major Incident


Operating Room


Piano di Emergenza per il Massiccio Afflusso di Feriti (hospital disaster plan for massive influx of casualties)


Italian Society of Trauma and Emergency Surgery


Virtual Reality


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The authors thank Dr. George Formenti-Ujlaki for the English language proofreading.

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All authors read and approved the final manuscript. All authors contributed substantially to its revision.

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Correspondence to Laura Castoldi.

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Castoldi, L., Greco, M., Carlucci, M. et al. Mass Casualty Incident (MCI) training in a metropolitan university hospital: short-term experience with MAss Casualty SIMulation system MACSIM®. Eur J Trauma Emerg Surg (2020).

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  • MCI
  • Emergency response
  • Disaster management
  • Preparedness
  • MRMI