60 seconds to survival: A pilot study of a disaster triage video game for prehospital providers

Mark X. Cicero, MD; Travis Whitfill, MPH; Kevin Munjal, MD; Manu Madhok, MD, MPH; Maria Carmen G. Diaz, MD; Daniel J. Scherzer, MD; Barbara M. Walsh, MD; Angela Bowen, RN, BSN, CPEN, NREMT-P; Michael Redlener, MD; Scott A. Goldberg, MD, MPH; Nadine Symons, MD; James Burkett, DHSc, PA-C, DFAAPA; Joseph C. Santos, MPH, NREMT; David Kessler, MD, MSc, RDMS; Ryan N. Barnicle, MD, MEd; Geno Paesano, NREMT-P; Marc A. Auerbach, MD, MSc

doi:10.5055/ajdm.2017.0263

Authors

Mark X. Cicero, MD
Travis Whitfill, MPH
Kevin Munjal, MD
Manu Madhok, MD, MPH
Maria Carmen G. Diaz, MD
Daniel J. Scherzer, MD
Barbara M. Walsh, MD
Angela Bowen, RN, BSN, CPEN, NREMT-P
Michael Redlener, MD
Scott A. Goldberg, MD, MPH
Nadine Symons, MD
James Burkett, DHSc, PA-C, DFAAPA
Joseph C. Santos, MPH, NREMT
David Kessler, MD, MSc, RDMS
Ryan N. Barnicle, MD, MEd
Geno Paesano, NREMT-P
Marc A. Auerbach, MD, MSc

DOI:

https://doi.org/10.5055/ajdm.2017.0263

Keywords:

serious video games, disaster triage, pediatrics, paramedics, emergency medical technicians, curriculum evaluation

Abstract

Introduction: Disaster triage training for emergency medical service (EMS) providers is not standardized. Simulation training is costly and time-consuming. In contrast, educational video games enable low-cost and more time-efficient standardized training. We hypothesized that players of the video game “60 Seconds to Survival” (60S) would have greater improvements in disaster triage accuracy compared to control subjects who did not play 60S.

Methods: Participants recorded their demographics and highest EMS training level and were randomized to play 60S (intervention) or serve as controls. At baseline, all participants completed a live school-shooting simulation in which manikins and standardized patients depicted 10 adult and pediatric victims. The intervention group then played 60S at least three times over the course of 13 weeks (time 2). Players triaged 12 patients in three scenarios (school shooting, house fire, tornado), and received in-game performance feedback. At time 2, the same live simulation was conducted for all participants. Controls had no disaster training during the study. The main outcome was improvement in triage accuracy in live simulations from baseline to time 2. Physicians and EMS providers predetermined expected triage level (RED/YELLOW/GREEN/BLACK) via modified Delphi method.

Results: There were 26 participants in the intervention group and 21 in the control group. There was no difference in gender, level of training, or years of EMS experience (median 5.5 years intervention, 3.5 years control, p = 0.49) between the groups. At baseline, both groups demonstrated median triage accuracy of 80 percent (IQR 70-90 percent, p = 0.457). At time 2, the intervention group had a significant improvement from baseline (median accuracy = 90 percent [IQR: 80-90 percent], p = 0.005), while the control group did not (median accuracy = 80 percent [IQR:80-95], p = 0.174). However, the mean improvement from baseline was not significant between the two groups (difference = 6.5, p = 0.335).

Conclusion: The intervention demonstrated a significant improvement in accuracy from baseline to time 2 while the control did not. However, there was no significant difference in the improvement between the intervention and control groups. These results may be due to small sample size. Future directions include assessment of the game's effect on triage accuracy with a larger, multisite site cohort and iterative development to improve 60S.

Author Biographies

Mark X. Cicero, MD

Departments of Pediatrics and Emergency Medicine, Yale School of Medicine, New Haven, Connecticut

Travis Whitfill, MPH

Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut

Kevin Munjal, MD

Emergency Medicine, Mount Sinai Medical Center, New York, New York

Manu Madhok, MD, MPH

Pediatrics, Children's Minnesota Minneapolis Hospital, Saint Paul, Minnesota

Maria Carmen G. Diaz, MD

Pediatrics, A. I. DuPont Hospital for Children, Wilmington, Delaware

Daniel J. Scherzer, MD

Pediatrics, Nationwide Children's Hospital, Columbus, Ohio

Barbara M. Walsh, MD

Associate Professor of Pediatrics, Division of Pediatric Emergency Medicine; Director, Pediatric Emergency Medicine Simulation Program, Hofstra School of Medicine, Cohen’s Children’s Medical Center, New Hyde Park, New York

Angela Bowen, RN, BSN, CPEN, NREMT-P

Radiation Emergency Assistance Center/Training Site (REAC/TS), Oak Ridge, Tennessee

Michael Redlener, MD

Department of Emergency Medicine, Mount Sinai St. Luke's, New York, New York

Scott A. Goldberg, MD, MPH

Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts

Nadine Symons, MD

Pediatrics, Le Bonheur Children's Hospital, Memphis, Tennessee

James Burkett, DHSc, PA-C, DFAAPA

Director, Advanced Physician Assistant Degree Program, Arizona School of Health Sciences, Mesa, Arizona

Joseph C. Santos, MPH, NREMT

Emergency Medical Services for Children, Baylor College of Medicine, Houston, Texas

David Kessler, MD, MSc, RDMS

Pediatrics, Columbia School of Medicine, New York, New York

Ryan N. Barnicle, MD, MEd

Medical School, Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, Connecticut

Geno Paesano, NREMT-P

Sponsor Hospital Program, Yale New Haven Hospital, New Haven, Connecticut

Marc A. Auerbach, MD, MSc

Departments of Pediatrics and Emergency Medicine, Yale School of Medicine, New Haven, Connecticut

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