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  1. Article ; Online: Criteria for Deployment of the United States National Guard to Domestic Sudden-Onset Natural Disasters: A Scoping Review.

    Dickason, R Myles / Davis, Terri / Taubman, Cara B / Tin, Derrick / Hata, Ryan / Weinstein, Eric S

    Military medicine

    2024  

    Abstract: Introduction: This study is a scoping review to identify literature pertinent to the question: "What are the criteria for deployment of the United States National Guard (USNG) to domestic sudden-onset natural disasters (SODs)?" As this question relies ... ...

    Abstract Introduction: This study is a scoping review to identify literature pertinent to the question: "What are the criteria for deployment of the United States National Guard (USNG) to domestic sudden-onset natural disasters (SODs)?" As this question relies on factors across many disciplines-legal, medical, technical, cultural-and as there is no foundational body of academic literature or unified governmental or USNG policy addressing this question, a scoping review was designed to identify the body of literature on which further research and policy decisions surrounding this question may be based.
    Materials and methods: On January 23, 2023 a modified PRISMA-ScR search was performed using an online search engine of the following databases: Academic Search Premier, Google Scholar, JSTOR, PubMed, Web of Science, and WorldCat. The inclusion criteria included the involvement of the USNG response to U.S. domestic SOD. Non-SOD results were excluded. Results from all years and of any type of literature were considered and were limited to the English language. First, titles and abstracts were screened by 2 independent reviewers. Then, a full-text review was performed by 2 independent reviewers. Finally, data were extracted from included texts by 2 independent reviewers. A third reviewer resolved any discrepancies at each stage. This study did not require approval of an institutional review board.
    Results: Out of the 886 results identified by the original search, after the complete review process, 34 sources were relevant to the research question. Fifteen criteria for the deployment of the USNG to SODs were identified. Overwhelmed local responders, utility failure, the need for the provision of security, and the need for logistical coordination were the most commonly identified criteria. Hurricanes were the most common SOD addressed in the included literature, and most results were event reports.
    Conclusions: This modified PRISMA-ScR identified a foundation on which elected officials, USNG leadership, and the larger disaster response community may develop policies and disaster response plans to optimize available resources through the activation of the USNG when responding to SODs.
    Language English
    Publishing date 2024-05-03
    Publishing country England
    Document type Journal Article
    ZDB-ID 391061-1
    ISSN 1930-613X ; 0026-4075
    ISSN (online) 1930-613X
    ISSN 0026-4075
    DOI 10.1093/milmed/usae164
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Beirut Explosion: Challenge of Hospital Emergency Preparedness.

    Helou, Mariana / El Osta, Nour / Weinstein, Eric S

    Disaster medicine and public health preparedness

    2022  , Page(s) 1–3

    Abstract: On August 4, 2020, a major explosion took place in Beirut, the capital of Lebanon. Some hospitals in Beirut were destroyed and became nonfunctional, and others were overwhelmed with casualties, with 8643 casualties admitted to emergency departments on ... ...

    Abstract On August 4, 2020, a major explosion took place in Beirut, the capital of Lebanon. Some hospitals in Beirut were destroyed and became nonfunctional, and others were overwhelmed with casualties, with 8643 casualties admitted to emergency departments on that night. The Lebanese American University Medical Center-Rizk Hospital, 2.8 km away from the blast, received an unexpected number of casualties. While a disaster plan was conceived earlier, this hospital's emergency department faced many challenges on that night, and major flaws in their preparedness plan were seen.
    Language English
    Publishing date 2022-07-18
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2375268-3
    ISSN 1938-744X ; 1935-7893
    ISSN (online) 1938-744X
    ISSN 1935-7893
    DOI 10.1017/dmp.2022.115
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Spinal Immobilization in Disasters: A Systematic Review.

    Cuthbertson, Joseph L / Weinstein, Eric S

    Prehospital and disaster medicine

    2020  Volume 35, Issue 4, Page(s) 406–411

    Abstract: In response to the International Liaison Committee on Resuscitation (ILCOR; Niel, Belgium) release of an updated recommendation related to out-of-hospital spinal immobilization (SI) practice in 2015, a systematic review was conducted according to the ... ...

    Abstract In response to the International Liaison Committee on Resuscitation (ILCOR; Niel, Belgium) release of an updated recommendation related to out-of-hospital spinal immobilization (SI) practice in 2015, a systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist of English-language studies published from January 2000 through July 2019 on the use of SI in resource-scarce environments (RSEs). Studies meeting the following criteria were included in the analysis: peer-reviewed statistical studies or reports detailing management of potential traumatic spinal injury in RSE, civilian, and military environments; as well as consensus clinical guidelines, academic center, or professional association protocols or policy statements detailing management of potential traumatic spinal injury in RSE, civilian, and military environments; statistical analysis; and subsequent management of spinal injuries after mass-casualty incidents, in complex humanitarian events or conflict zones, low-to middle-income countries, or prolonged transport times published by government and non-government organizations. Studies excluded from consideration were those not related to a patient with a potential traumatic spinal injury after a mass-casualty incident, in complex humanitarian event or conflict zones, in low-to middle-income countries, or with prolonged transport times.There were one thousand twenty-nine (1029) studies initially identified. After removal of duplicates, nine hundred-nineteen (919) were screened with eight hundred sixty-three (863) excluded. The remaining fifty-six (56) received further review with fourteen (14) selected studies achieving inclusion. The reviewed articles comprised six (6) types of studies and represented research from institutions in seven (7) different countries (Israel, United States, Haiti, Wales, Pakistan, China, and Iran). Thirteen (13) references were case reports/narrative reviews, policy statements, retrospective observational studies, narrative literature reviews, scoping reviews, and one systematic review. The majority of literature describing spinal cord injury was predominantly associated with earthquakes and blast-related disasters. There were no SI evidence-based clinical guidelines (EBG) in RSE. Information was obtained that could be used to formulate statements in a modified Delphi study to present to experts to obtain consensus SI EBG in RSE.
    MeSH term(s) Disasters ; Global Health ; Humans ; Immobilization ; Mass Casualty Incidents ; Practice Guidelines as Topic ; Spinal Injuries/therapy
    Language English
    Publishing date 2020-05-29
    Publishing country United States
    Document type Consensus Development Conference ; Journal Article ; Practice Guideline ; Systematic Review
    ZDB-ID 1025975-2
    ISSN 1945-1938 ; 1049-023X
    ISSN (online) 1945-1938
    ISSN 1049-023X
    DOI 10.1017/S1049023X20000680
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: A T2 Translational Science Modified Delphi Study: Spinal Motion Restriction in a Resource-Scarce Environment.

    Weinstein, Eric S / Cuthbertson, Joseph L / Ragazzoni, Luca / Verde, Manuela

    Prehospital and disaster medicine

    2020  Volume 35, Issue 5, Page(s) 538–545

    Abstract: Introduction: Emerging evidence is guiding changes in prehospital management of potential spinal injuries. The majority of settings related to current recommendations are in resource-rich environments (RREs), whereas there is a lack of guidance on the ... ...

    Abstract Introduction: Emerging evidence is guiding changes in prehospital management of potential spinal injuries. The majority of settings related to current recommendations are in resource-rich environments (RREs), whereas there is a lack of guidance on the provision of spinal motion restriction (SMR) in resource-scarce environments (RSEs), such as: mass-casualty incidents (MCIs); low-middle income countries; complex humanitarian emergencies; conflict zones; and prolonged transport times. The application of Translational Science (TS) in the Disaster Medicine (DM) context was used to develop this study, leading to statements that can be used in the creation of evidence-based clinical guidelines (CGs).
    Objective: What is appropriate SMR in RSEs?
    Methods: The first round of this modified Delphi (mD) study was a structured focus group conducted at the World Association for Disaster and Emergency Medicine (WADEM) Congress in Brisbane Australia on May 9, 2019. The result of the focus group discussion of open-ended questions produced ten statements that were added to ten statements derived from Fischer (2018) to create the second mD round questionnaire.Academic researchers and educators, operational first responders, or first receivers of patients with suspected spinal injuries were identified to be mD experts. Experts rated their agreement with each statement on a seven-point linear numeric scale. Consensus amongst experts was defined as a standard deviation ≤1.0. Statements that were in agreement reaching consensus were included in the final report; those that were not in agreement but reached consensus were removed from further consideration. Those not reaching consensus advanced to the third mD round.For subsequent rounds, experts were shown the mean response and their own response for each of the remaining statements and asked to reconsider their rating. As above, those that did not reach consensus advanced to the next round until consensus was reached for each statement.
    Results: Twenty-two experts agreed to participate with 19 completing the second mD round and 16 completing the third mD round. Eleven statements reached consensus. Nine statements did not reach consensus.
    Conclusions: Experts reached consensus offering 11 statements to be incorporated into the creation of SMR CGs in RSEs. The nine statements that did not reach consensus can be further studied and potentially modified to determine if these can be considered in SMR CGs in RSEs.
    MeSH term(s) Delphi Technique ; Emergency Medical Services ; Focus Groups ; Humans ; Immobilization/standards ; Spinal Injuries/therapy ; Translational Medical Research
    Language English
    Publishing date 2020-07-09
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1025975-2
    ISSN 1945-1938 ; 1049-023X
    ISSN (online) 1945-1938
    ISSN 1049-023X
    DOI 10.1017/S1049023X20000862
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Assessing Hospital Adaptive Resource Allocation Strategies in Responding to Mass Casualty Incidents.

    Faccincani, Roberto / Trucco, Paolo / Nocetti, Claudio / Carlucci, Michele / Weinstein, Eric S

    Disaster medicine and public health preparedness

    2021  , Page(s) 1–9

    Abstract: Background: Hospitals are expected to operate at a high performance level even under exceptional conditions of peak demand and resource disruptions. This understanding is not mature yet and there are wide areas of possible improvement. In particular, ... ...

    Abstract Background: Hospitals are expected to operate at a high performance level even under exceptional conditions of peak demand and resource disruptions. This understanding is not mature yet and there are wide areas of possible improvement. In particular, the fast mobilization and reconfiguration of resources frequently result into the severe disruption of elective activities, worsening the quality of care. This becomes particularly evident during the on-going coronavirus disease 2019 (COVID-19) pandemic. More resilient resource allocation strategies, that is, which adapt to the dynamics of the prevailing circumstance, are needed to maximize the effectiveness of health-care delivery. In this study, a simulation approach was adopted to assess and compare different hospital's adaptive resource allocation strategies in responding to a sudden onset disaster mass casualty incident (MCI).
    Methods: A specific set of performance metrics was developed to take into consideration multiple objectives and priorities and holistically assess the effectiveness of health-care delivery when coping with an MCI event. Discrete event simulation (DES) and system dynamics (SD) were used to model the key hospital processes and the MCI plan.
    Results: In the daytime scenario, during the recovery phase of the disaster, a gradual disengagement of resources from the emergency department (ED) to restart ordinary activities in operating rooms and wards returned the best performance. In the night scenario, the absorption capacity of the ED was evaluated by identifying the current bottleneck and assessment of the benefit of different resource mobilization strategies.
    Conclusions: The present study offers a robust approach, effective strategies and new insights to design more resilient plans to cope with MCIs. It becomes particularly relevant when considering the risk of indirect damage of emergencies, where all the available resources are shifted from the care of the ordinary to the "disaster" patients, like during the on-going COVID-19 pandemic. Future research is needed to widen the scope of the analysis and take into consideration additional resilience capacities such as operational coordination mechanisms among multiple hospitals in the same geographic area.
    Language English
    Publishing date 2021-06-11
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2375268-3
    ISSN 1938-744X ; 1935-7893
    ISSN (online) 1938-744X
    ISSN 1935-7893
    DOI 10.1017/dmp.2021.113
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Prehospital Response Time of the Emergency Medical Service during Mass Casualty Incidents and the Effect of Triage: A Retrospective Study.

    Heemskerk, Johan L / Abode-Iyamah, Kingsley O / Quinones-Hinojosa, Alfredo / Weinstein, Eric S

    Disaster medicine and public health preparedness

    2021  Volume 16, Issue 3, Page(s) 1091–1098

    Abstract: Objective: Prehospital time affects survival in trauma patients. Mass casualty incidents (MCIs) are overwhelming events where medical care exceeds available resources. This study aimed at evaluating the prehospital time during MCIs and investigating the ...

    Abstract Objective: Prehospital time affects survival in trauma patients. Mass casualty incidents (MCIs) are overwhelming events where medical care exceeds available resources. This study aimed at evaluating the prehospital time during MCIs and investigating the effect of triage.
    Methods: A retrospective analysis was performed using Florida's Event Medical Services Tracking and Reporting System database. All patients involved in MCIs during 2018 were accessed, and prehospital time intervals were evaluated and compared to that of non-MCIs. The effect of MCI triage and field triage (Field Triage Criteria) on prehospital time was evaluated.
    Results: In 2018, it was estimated that 2236 unique MCIs occurred in Florida, with a crude incidence of 10.1-10.9/100000 people. 2180 EMS units arrived at the hospital for patient disposition with a median alarm-to-hospital time of 43.74 minutes, significantly longer than non-MCIs (39.15 min;
    Conclusions: MCIs resulted in longer prehospital time intervals than non-MCIs. This finding suggests that additional efforts are needed to reduce the prehospital time for MCI patients. MCI triage and field triage were both associated with shorter alarm-to-hospital times. Widespread use may improve prehospital MCI care.
    MeSH term(s) Humans ; Mass Casualty Incidents ; Triage/methods ; Retrospective Studies ; Reaction Time ; Emergency Medical Services/methods
    Language English
    Publishing date 2021-04-12
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2375268-3
    ISSN 1938-744X ; 1935-7893
    ISSN (online) 1938-744X
    ISSN 1935-7893
    DOI 10.1017/dmp.2021.40
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Assessing Hospital Adaptive Resource Allocation Strategies in Responding to Mass Casualty Incidents.

    Trucco, Paolo / Nocetti, Claudio / Sannicandro, Riccardo / Carlucci, Michele / Weinstein, Eric S / Faccincani, Roberto

    Disaster medicine and public health preparedness

    2021  Volume 16, Issue 3, Page(s) 1105–1115

    Abstract: Objectives: Hospitals are expected to operate at a high-performance level even under exceptional conditions of peak demand and resource disruptions. This understanding is not mature yet, and there are wide areas of possible improvement. In particular, ... ...

    Abstract Objectives: Hospitals are expected to operate at a high-performance level even under exceptional conditions of peak demand and resource disruptions. This understanding is not mature yet, and there are wide areas of possible improvement. In particular, the fast mobilization and reconfiguration of resources frequently result into the severe disruption of elective activities, worsening the quality of care. More resilient resource allocation strategies, ie, which adapt to the dynamics of the prevailing circumstance, are needed to maximize the effectiveness of health-care delivery. In this study, a simulation approach was adopted to assess and compare different hospital's adaptive resource allocation strategies in responding to a mass casualty incident (MCI).
    Methods: A specific set of performance metrics was developed to take into consideration multiple objectives and priorities and holistically assess the effectiveness of health-care delivery when coping with an MCI event. Discrete event simulation (DES) and system dynamics (SD) were used to model the key hospital processes and the MCI plan.
    Results: In the daytime scenario, during the recovery phase of the emergency, a gradual disengagement of resources from the emergency department (ED) to restart ordinary activities in operating rooms and wards, returned the best performance. In the night scenario, the absorption capacity of the ED was evaluated by identifying the current bottleneck and assessment of the benefit of different resource mobilization strategies.
    Conclusions: The present study offers a robust approach, effective strategies, and new insights to design more resilient plans to cope with MCIs. Future research is needed to widen the scope of the analysis and take into consideration additional resilience capacities, such as operational coordination mechanisms, among multiple hospitals in the same geographic area.
    MeSH term(s) Humans ; Mass Casualty Incidents ; Disaster Planning ; Hospitals ; Resource Allocation ; Benchmarking ; Emergency Service, Hospital
    Language English
    Publishing date 2021-05-12
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2375268-3
    ISSN 1938-744X ; 1935-7893
    ISSN (online) 1938-744X
    ISSN 1935-7893
    DOI 10.1017/dmp.2021.62
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Impact of Point-of-Care Ultrasound on Secondary Triage: A Pilot Study.

    Stucchi, Riccardo / Weinstein, Eric S / Ripoll-Gallardo, Alba / Franc, Jeffrey M / Azzaretto, Massimo / Sesana, Giovanni / Della Corte, Francesco / Neri, Luca

    Disaster medicine and public health preparedness

    2022  Volume 17, Page(s) e194

    Abstract: Objectives: In mass casualty scenarios, patients with apparent hemodynamic and respiratory stability might have occult life-threatening injuries. These patients could benefit from more accurate triage methods. This study assessed the impact of point-of- ... ...

    Abstract Objectives: In mass casualty scenarios, patients with apparent hemodynamic and respiratory stability might have occult life-threatening injuries. These patients could benefit from more accurate triage methods. This study assessed the impact of point-of-care ultrasound on the accuracy of secondary triage conducted at an advanced medical post to enhance the detection of patients who, despite their apparent clinically stable condition, could benefit from earlier evacuation to definitive care or immediate life-saving treatment.
    Methods: A mass casualty simulated event consisting of a bomb blast in a remote area was conducted with 10 simulated casualties classified as YELLOW at the primary triage scene; patients were evaluated by 4 physicians at an advanced medical post. Three patients had, respectively, hemoperitoneum, pneumothorax, and hemothorax. Only 2 physicians had sonographic information.
    Results: All 4 physicians were able to suspect hemoperitoneum as a possible critical condition to be managed first, but only physicians with additional sonographic information accurately detected pneumothorax and hemothorax, thus deciding to immediately evacuate or treat.
    MeSH term(s) Humans ; Triage/methods ; Emergency Medical Services/methods ; Pilot Projects ; Hemoperitoneum ; Hemothorax/diagnostic imaging ; Hemothorax/etiology ; Pneumothorax ; Point-of-Care Systems ; Mass Casualty Incidents
    Language English
    Publishing date 2022-04-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2375268-3
    ISSN 1938-744X ; 1935-7893
    ISSN (online) 1938-744X
    ISSN 1935-7893
    DOI 10.1017/dmp.2022.82
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: How to Build the Plane While Flying: VTE/PE Thromboprophylaxis Clinical Guidelines for COVID-19 Patients.

    Costa, Alessandro / Weinstein, Eric S / Sahoo, D Ruby / Thompson, Stanley C / Faccincani, Roberto / Ragazzoni, Luca

    Disaster medicine and public health preparedness

    2020  Volume 14, Issue 3, Page(s) 391–405

    Abstract: Over the years, the practice of medicine has evolved from authority-based to experience-based to evidence-based with the introduction of the scientific process, clinical trials, and outcomes-based data analysis (Tebala GD. Int J Med Sci. 2018;15(12):1397- ...

    Abstract Over the years, the practice of medicine has evolved from authority-based to experience-based to evidence-based with the introduction of the scientific process, clinical trials, and outcomes-based data analysis (Tebala GD. Int J Med Sci. 2018;15(12):1397-1405). The time required to perform the necessary randomized controlled trials, a systematic literature review, and meta-analysis of these trials to then create, accept, promulgate, and educate the practicing clinicians to use the evidence-based clinical guidelines is typically measured in years. When the severe acute respiratory syndrome novel coronavirus-2 (SARS-nCoV-2) pandemic commenced in Wuhan, China at the end of 2019, there were few available clinical guidelines to deploy, let alone adapt and adopt to treat the surge of coronavirus disease 2019 (COVID-19) patients. The aim of this study is to first explain how clinical guidelines, on which bedside clinicians have grown accustomed, can be created in the midst of a pandemic, with an evolving scientific understanding of the pathophysiology of the hypercoagulable state. The second is to adapt and adopt current venous thromboembolism diagnostic and treatment guidelines, while relying on the limited available observational reporting of COVID-19 patients to create a comprehensive clinical guideline to treat COVID-19 patients.
    MeSH term(s) Anticoagulants/therapeutic use ; COVID-19 ; Coronavirus Infections/complications ; Coronavirus Infections/drug therapy ; Fibrin Fibrinogen Degradation Products/analysis ; Guidelines as Topic ; Humans ; Pandemics/statistics & numerical data ; Pneumonia, Viral/complications ; Pneumonia, Viral/drug therapy ; Pre-Exposure Prophylaxis/methods ; Pre-Exposure Prophylaxis/standards ; Pre-Exposure Prophylaxis/statistics & numerical data ; Venous Thromboembolism/drug therapy ; Venous Thromboembolism/etiology ; Venous Thromboembolism/prevention & control
    Chemical Substances Anticoagulants ; Fibrin Fibrinogen Degradation Products ; fibrin fragment D
    Keywords covid19
    Language English
    Publishing date 2020-06-16
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2375268-3
    ISSN 1938-744X ; 1935-7893
    ISSN (online) 1938-744X
    ISSN 1935-7893
    DOI 10.1017/dmp.2020.195
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: The Challenge of Mass Casualty Incident Response Simulation Exercise Design and Creation: A Modified Delphi Study.

    Weinstein, Eric S / Bortolin, Michelangelo / Lamine, Hamdi / Herbert, Teri Lynn / Hubloue, Ives / Pauwels, Sofie / Burke, Rita V / Cicero, Mark X / Dugas, Phoebe O Toups / Oduwole, Elizabeth O / Ragazzoni, Luca / Della Corte, Francesco

    Disaster medicine and public health preparedness

    2023  Volume 17, Page(s) e396

    Abstract: Background: A Mass Casualty Incident response (MCI) full scale exercise (FSEx) assures MCI first responder (FR) competencies. Simulation and serious gaming platforms (Simulation) have been considered to achieve and maintain FR competencies. The ... ...

    Abstract Background: A Mass Casualty Incident response (MCI) full scale exercise (FSEx) assures MCI first responder (FR) competencies. Simulation and serious gaming platforms (Simulation) have been considered to achieve and maintain FR competencies. The translational science (TS) T0 question was asked: how can FRs achieve similar MCI competencies as a FSEx through the use of MCI simulation exercises?
    Methods: T1 stage (Scoping Review): PRISMA-ScR was conducted to develop statements for the T2 stage modified Delphi (mD) study. 1320 reference titles and abstracts were reviewed with 215 full articles progressing for full review leading to 97 undergoing data extraction.T2 stage (mD study): Selected experts were presented with 27 statements derived from T1 data with instruction to rank each statement on a 7-point linear numeric scale, where 1 = disagree and 7 = agree. Consensus amongst experts was defined as a standard deviation ≤ 1.0.
    Results: After 3 mD rounds, 19 statements attained consensus and 8 did not attain consensus.
    Conclusions: MCI simulation exercises can be developed to achieve similar competencies as FSEx by incorporating the 19 statements that attained consensus through the TS stages of a scoping review (T1) and mD study (T2), and continuing to T3 implementation, and then T4 evaluation stages.
    MeSH term(s) Humans ; Consensus ; Delphi Technique ; Emergency Responders ; Exercise ; Mass Casualty Incidents
    Language English
    Publishing date 2023-05-23
    Publishing country United States
    Document type Journal Article ; Review ; Research Support, Non-U.S. Gov't
    ZDB-ID 2375268-3
    ISSN 1938-744X ; 1935-7893
    ISSN (online) 1938-744X
    ISSN 1935-7893
    DOI 10.1017/dmp.2023.71
    Database MEDical Literature Analysis and Retrieval System OnLINE

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