The game was designed iteratively over the course of 8 months, with feedback from EMS providers demographically similar to the target participants. These actions and assessments are based on the JumpSTART algorithm. To ensure that players are learning the JumpSTART triage algorithm and not simply memorizing the expected triage level for each patient, a threshold number of correct actions and assessments must be completed. Each scenario has 12 patients, and there are a variety of patient injuries and presentations in each scenario. Those scenarios are 1) school shooting, 2) multiple‐family house fire, and 3) tornado. ![]() ![]() Players encounter a different scenario each time they play. Each simulation had victims with similar distribution of injuries by type (e.g., head injury, hemorrhagic shock from appendicular injury) and age distribution. 20 For each scenario, the player has up to 9 minutes to triage 12 patients, with children and adults among the victims. These scenarios were based on a previously described live simulation disaster triage curriculum and adapted for the screen‐based simulation. The game has three scenarios, presented in this order: 1) a mass shooting at a high school, 2) a multiple‐family house fire, and 3) a shopping mall struck by a tornado. Sound Web Solutions (Coventry, CT) designed the software, and MEA Mobile (New Haven, CT) designed the graphics. Prior to this investigation, the authors developed the content and objectives for 60S, a disaster triage video game. The human investigations committee of the principal investigator's institution approved the study, as did the institutional review board of other enrollment sites. Enrollment sites represented urban and rural EMS sponsor hospitals and agencies, predominantly, but not exclusively, in the Northeast, South, and Midwest of the United States. Participants were recruited from 21 EMS agencies across 12 states. This was a prospective cohort study of EMS personnel completing a screen‐based simulation intervention that aimed to improve disaster triage skills. Further, we theorized that these improvements would be observed across a range of learners, regardless of enrollment site, learner age, sex, or level of EMS training (e.g., emergency medical technician, paramedic). We hypothesized that the video game 60 Seconds to Survival (60S) would be associated with in‐game improvements in triage accuracy over time. 15 In other health care disciplines, video games have been shown to improve procedural skills, 16, 17 have been associated with improvements in communication, 18 and have yielded changes in risk taking behavior among patients. 14 The ability to access these simulations or games on any device with access to the Internet enables low‐cost, time‐efficient, and generalizable standardized training. 12, 13 Screen‐based simulations are defined by the Society for Simulation in Healthcare as computer‐generated video game simulators that create scenarios that require real‐time decision making in a virtual environment. 10, 11 Thus, temporal placement of training close to mass casualty events is not feasible. Finally, although disasters are high‐stakes events, their frequency is low. 5, 6 Simulation training using manikins and/or actors, while known to yield more durable and clinically meaningful educational outcomes than didactic training, 7, 8, 9 is more costly and time‐consuming to deliver to large numbers of learners. ![]() For example, EMS schedules are erratic and prone to change, making multipart curricula difficult to complete. 2, 3, 4 Several factors compound the problem of delivering quality disaster education to EMS providers. 1 Disaster triage training for EMS providers is unstandardized with few national or regional courses in wide use. Emergency medical services (EMS) providers are often the first health care providers to render care in these high‐stakes, low‐frequency events. Disasters are events that overwhelm available health care resources.
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