Evaluation of the decision-making process within the table-top exercise of the Terror and Disaster Surgical Care (TDSC®) course

Gerhard Achatz; Alexander Reckziegel; Benedikt Friemert; Markus Blätzinger; Simone Hinz-Bauer; Axel Franke; Dan Bieler; Thomas Paffrath; Patrick Hoth; Deployment, Disaster, Tactical Surgery Section of the German Trauma Society

doi:10.1007/s00068-022-02217-1

Evaluation of the decision-making process within the table-top exercise of the Terror and Disaster Surgical Care (TDSC^®) course

Eur J Trauma Emerg Surg. 2023 Apr;49(2):607-617. doi: 10.1007/s00068-022-02217-1. Epub 2023 Feb 15.

Affiliations

¹ Department for Trauma Surgery and Orthopaedics, Reconstructive and Septic Surgery, Sportstraumatology / Trauma Research Group, German Armed Forces Hospital Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany. GerhardAchatz@Bundeswehr.org.
² Department for Trauma Surgery and Orthopaedics, Reconstructive and Septic Surgery, Sportstraumatology / Trauma Research Group, German Armed Forces Hospital Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany.
³ AUC-Academy for Trauma Surgery GmbH, Munich, Wilhelm-Hale-Straße 46B, 80639, Munich, Germany.
⁴ Department for Trauma Surgery and Orthopaedics, Reconstructive and Hand Surgery, Burn Medicine, German Armed Forces Central Hospital Koblenz, Rübenacher Straße 170, 56072, Koblenz, Germany.
⁵ Department of Orthopaedics and Trauma Surgery, Heinrich Heine University Hospital Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
⁶ Department for Trauma Surgery, Krankenhaus der Augustinerinnen, Jacobstr. 27-31, 50678, Cologne, Germany.

Abstract

Purpose: The threat of terror is omnipresent in Europe and the number of attacks worldwide is increasing. The target of attacks in Europe is usually the civilian population. Incalculable dangerous situations at the scene of the event and severe injury patterns such as complex gunshot and explosion injuries with a high number of highly life-threatening people present rescue forces, emergency physicians and subsequently hospitals with medical, organizational as well as tactical and strategic challenges. The Terror and Disaster Surgical Care (TDSC^®) course trains clinical decision-makers to meet these challenges of a TerrorMASCAL in the first 24-48 h.

Methods: A table-top exercise was developed for the TDSC^® course as a decision training tool, which was prospectively evaluated in six courses. The evaluation took place in 3 courses of the version 1.0, in 3 courses in the further developed version 2.0 to different target values like, e.g., the accuracy of the in-hospital triage. Furthermore, 16 TDSC^® course instructors were evaluated.

Results: For the evaluation, n = 360 patient charts for version 1.0 and n = 369 for version 2.0 could be evaluated. Overall, the table-top exercise was found to be suitable for training of internal clinical decision makers. Version 2.0 was also able to depict the action and decision-making paths in a stable and valid manner compared to the previous version 1.0. The evaluation of the instructors also confirmed the further value and improvement of version 2.0.

Conclusion: With this prospective study, the table-top exercise of the TDSC^® course was tested for decision stability and consistency of the participants' decision paths. This could be proven for the selected target variables, it further showed an improvement of the training situation. A further development of the table-top exercise, in particular also using digital modules, will allow a further optimization. http://www.bundeswehrkrankenhaus-ulm.de.

Keywords: Decision-making; Disaster; Evaluation; Preparedness; Simulation game; Table-top exercise; Terror.

MeSH terms

Disaster Planning*
Disasters*
Humans
Prospective Studies
Triage
Wounds, Gunshot* / surgery