Description of MACSIM

Patient cards

The key-component of the system is the patient-card (Fig.1) which is available in two sizes: One bigger (17 x 14 cm) intended for basic training, or to use in field exercises to be attached to figurants, and one smaller (9 x 7.5 cm, magnetized) for simulation exercises.

Fig 1 a Fig 1 a

The MACSIM patient card.

Fig 1 b Fig 1 b

Explanation of symbols and times for different treatments, given on the backside of the big card (basic training) and during simulation exercises available on separate cards.

The card shows age, sex, initial position of the patient and description of the patient´s condition and injuries according to the ATLS-terminology (Airway, Breathing, Circulation, Disability and Exposure). A B C D is illustrated as physiological parameters with all the information needed for the different triage-systems used today. All this information can simply be changed by the instructor: On the bigger cards by movable markers, on the smaller cards by the use of a whiteboard-pen.

 

Fig 2 shows information for the instructor, given on the backside of every small card used for

simulation exercises.

Fig 2 Fig 2

Information for the instructor, given on the backside of every simulation-card (see further the text).

This information includes:

• A complete description of injuries according to final diagnosis, also a base for calculation of

injury severity scores

• Times within certain treatments must be done if the patient not should die (M) or be hit by complications, life-threatening (CL) of leading to impaired function (CF). Treatments are given

by a code system

• The result if the patient should have optimal treatment (R/Opt) in order to identify preventable

deaths/complications

• Times needed for surgery, if considered indicated

• Need of ventilator

• Injury Severity Score (ISS) and Revised Trauma Score (RTS)

 
 

Patient cards for “non-disaster-patients”

At the time for an alert, the health care system is filled with varying numbers of ordinary patients which have to be taken care of, and such patients with critical illness or injuries continue to arrive, adding to the need of triage.

Fig 3 Fig 3

Sets of such patients of different categories are included in the system:

• Ambulatory patients

• Patients needing immediate surgery

• Patients undergoing elective (planned) surgery at the time for alert

• Patients on ventilator

Priority tags

Priority is indicated with movable markers on the cards according to the most commonly used triage-systems (Fig 4):

Fig 4 Fig 4

Priority tags to be applied on the cards, in the colors used in today´s triage systems:

Red: Immediate

Yellow: Urgent, but can wait for a limited time

Green: Shall wait

Blue: Expectant: Severely injured with limited or no prospects of cure

Black: Dead

Treatment symbols

Movable markers with printed labels with text in different colours, indicating different treatments (Fig 5 and 6) for prehospital or hospital use. For each treatment is given the time it takes to do this in reality, based on clinical tests. If the trainee/test-person decides to perform a treatment, the "patient" and the trainee are not allowed to move further until this time has passed. Exercises should always be run with real time.

Fig 5 Fig 5

Movable markers with printed labels indicating different treatments. For treatments dealing with airway label with green text, breathing blue text, circulation red text and stabilisation/bandage black text. For each treatment is given the time it takes to do it in reality. These treatment labels are, as the priority tags, possible to move and re-use an almost unlimited number of times.

Fig 6 a Fig 6 a

The treatment symbols (fig 6 a-e) are available in folders for the scene (for triage teams and ambulance crews, see fig 13) and for the hospitals in different types and numbers, depending on size and type of hospital. Fig 6 a shows airway management, scene.

Fig 6 b Fig 6 b

Ventilatory support, scene.

Fig 6 c Fig 6 c

Circulatory support, scene.

Fig 6 d Fig 6 d

Bandage and stabilization, scene.

Fig 6 e Fig 6 e

Supply of fluids, hospital (adapted to size of hospital).

Fig 6 f Fig 6 f

Blood bank hospital, same as above.

Fig 6 g Fig 6 g

X-ray examinations, hospital.

Fig 6 h Fig 6 h

Planned surgery, hospital.

Staff symbols

The exercises are run with real resources also with regard to staff of different categories (Fig 7). The amount of staff that will be available at different times after an alert is given to the trainee to distribute. Medical staff, rescue service or police cannot perform any of their tasks without access to a sufficient number of staff.

Fig 7 Fig 7

Examples of symbols for staff indicating category and level of competence. Each symbol is 9 x 3.5 cm. Defined numbers, laminated and magnetized, are included in the complete MACSIM-sets (see below).

Command symbols for staff

Symbols indicating staff appointed to take charge at different positions in the process of alert (Fig 8). A clear command structure facilitates this process and secures that all responsibilities are taken on every position according to action cards.

Fig 8 a Fig 8 a

Command symbols indicating 3 levels of command both in the prehospital- and hospital organizations.

Fig 8 b Fig 8 b

Examples of application of the symbols to different categories of staff.

Ambulance- and helicopter symbols

Symbols for civilian and military ambulances and helicopters (Fig 9). Defined numbers of these, laminated and magnetized, are included in the complete MACSIM-sets (see below).

Fig 9 Fig 9

Symbols for ambulances and helicopters, both 15 x 6.5 cm. Military ambulances and helicopters of different sizes are also available.

Signs of different sizes

Laminated and magnetized signs for simulation exercises for prehospital and hospital organizations, 3 different sizes: Small, large and "columns" = several small signs fixed to each other, vertically or horizontally, to facilitate the set- up of scene, transport and hospitals.

Fig 10 Fig 10

Laminated and magnetized signs: Small 8 x 4.5 cm, Large 16 x 4.5 cm and an example of a "column" which can be horizontal or vertical, size depending on function described.

Pouches for hospital wards

Even if hospital beds rarely is a limiting factor for the surge capacity of a hospital, redistribution of patients between wards often has to be done to optimize utilization of bed capacity. The wards are in this system illustrated by magnetized, transparent plastic pouches labeled with signs indicating number of beds (total and present). Disaster patients can be dropped in these pouches depending on space (Fig 11).

Fig 11 Fig 11

Magnetized and labeled, transparent plastic pouches representing hospital wards.

Tabards and arm-badges

Trainee/test-persons with prehospital functions are labeled with tabards indicating their function (markings front and back, Fig 12). Trainee with functions in hospitals or command centers have, as the instructors, arm-badges indicating their function.

Fig 12 a Fig 12 a

Examples on tabards for prehospital staff: Rescue, Police and Medical Incident Commanders, labeled on front and back and fluorescent. Similar tabards are available for Triage Officer (TRO), Ambulance Loading Officer (ALO), Ambulance crew (AMB) and Prehospital Teams MD and Nurse.

Fig 12 b Fig 12 b

Example on arm-badge used by instructors and also by all trainee in hospitals and coordinating units in different colors indicating their functions.

Complete set for courses

Complete sets for courses include:

• All symbols and signs needed for pre-designed scenarios, laminated and magnetized

(patient cards, staff symbols for prehospital and hospital staff, ambulances and

helicopters, signs for prehospital- and hospital organizations)

• Priority tags, treatment labels for prehospital- and hospital use, command symbols

• Tabards for prehospital staff

• Arm-badges for hospital staff and instructors

• Prepared folders for triage-teams, ambulances, hospitals, hospital command groups

and regional command center, including all documents needed (maps, complete

description of resources, standardized disaster plans and action cards)

• Instructor folder with detailed description how to set up and prepare the system,

prepare the trainees for the simulation exercises and running the exercises with predesigned

scenarios

 

Such complete sets will continuously be developed for different scenarios. Available at

present time is the MACSIM start set for terrorist scenarios (MACSTART-T) which has been

used and thoroughly tested in the MRMI courses (see below).

Fig 13 a Fig 13 a

Prepared folders for different functions are included in the complete set for different scenarios. Examples from the MACSTART-T which includes totally 22 different folders (fig 13 a-e). Fig 13 a shows Medical Incident Commander, Regional Command Center with associated functions and Alarm Center/Ambulance Dispatch Center with associated functions. The folders include complete sets of documents: Maps, available resources, disaster plans and action cards.

Fig 13 b Fig 13 b

Folders for hospitals and hospital command groups.

Fig 13 c Fig 13 c

Hospital folders also include treatment symbols for hospitals, adapted to the size and type of hospital.

Fig 13 d Fig 13 d

Folders for Triage Teams and Ambulance crews and Instructor folder.

Fig 13 e Fig 13 e

Folders for Triage Teams and Ambulances include priority-and treatment tags according to their equipment in reality.

The MRMI- textbook

A textbook covering the whole field of knowledge in the MRMI-courses has been produced by the core faculty of the courses and is published by Springer. It can be ordered at orders-hdindividuals@springer.com or telephone (+49) 6221-345-430.

Fig 14 Fig 14

The MRMI-textbook is produced by the core faculty of the MRMI-courses. It includes 400 pages and 180 illustrations in color. The intention is that selected parts (depending on type of course and position) should be read by the trainee before the courses, followed by a pre-test to secure sufficient knowledge to get optimal benefit from the course. This also reduces the need of formal lectures and gives full time for the interactive training.