MACSIM ®

MACSIM can be used for education and training in traumatology and major incident response on all levels:

• Basic training in traumatology on prehospital and/or hospital level

• Basic training in major incident response on prehospital and/or hospital level

• Advanced training in major incident response on prehospital and/or hospital level

Basic training in traumatology

This can be done by using the big patient cards just as a group training where the trainee propose diagnosis and treatment based on the information on the card. The instructor has access to the complete information on final diagnosis, necessary treatments and outcome given for each card. This is valuable both in the prehospital and hospital setting.

Basic training in major incident response

This can be done in the same way as above with group training where the trainee also can perform triage using different methods and decide priority based on a given scenario.

The cards can also be attached to figurants in a field exercise. They can then replace the old fashioned painting of injuries, which regardless of efforts never can be realistic and actually gives less information than the cards. The figurants can easily learn to act according to the card. This makes possible rapid rotation of trainee during practical exercises so everyone gets the opportunity both to train and be figurant.

Advanced training in major incident response

This requires more equipment and more instructors, but can on the other give much more information and learning than a practical field exercise – with less work and for smaller costs.

When setting up such an exercise, it is recommended to start with using a complete, standardized course package and run the scenarios included in this package, preferably with the help of instructors trained for the system (a list of trained international instructors can be required from us using the address below). After this, the exercise can easily be adapted to your own organization and your own language.

An example of such a complete course-package is the MACSIM start package for terrorist scenarios (MACSTART- T) which has been used for the MRMI-courses (Medical Response to Major Incidents).

The MRMI-course is a strictly standardized course under protected name (as the ATLS or MIMMS) and running a course under this name requires permission from the MRMIassociation (www.mrmi.org) and also fulfilling of certain criteria. The MACSTART-T package is a prerequisite for organizing MRMI-courses but can also be used for other forms of training and testing of organizations.

An example of how to design a course on this level is described in fig 15. The figure illustrates a course for training of the whole chain of response simultaneously, based on 4 hospitals, the same model as has been used in the MRMI-courses. When application of this model to your local organization, the number of hospitals can be reduced or extended (up to an unlimited amount). It is however recommended not to run this model with less than 3 hospitals as a minimum to train inter-hospital communication.

The center of the figure represents the prehospital part the scene which requires a bigger room with space for 8 magnetic whiteboards 200 x 120 cm, minimum 3 of them on wheels and magnetic on both sides. In addition, there should be space for two parallel triage-lines between the "scene" and the transport boards. This room is also illustrated live on figures 17-20 below. The "scene" is illustrated by 3 boards showing the exterior appearance (of for example a building) on the front, and the interior appearance (to which the trainee not have immediate access) on the backsides. Example of transport board for helicopters and ambulances see fig 20 below.

On distance from the scene are located the rooms for hospitals (see fig 21 below), one board for a smaller and 2 -3 boards for a bigger hospital. On distance from these are the rooms for hospital command centers (HCC) and also the rooms for the regional coordination (RCC) and ambulance dispatch (ADC) centers, 2-3 boards per room (fig 25). The minimum number of magnetic whiteboards for a set- up of this size is 20, minimum 6 of these mobile on wheels and minimum 3 of these magnetic on both sides. It is a big advantage to have all 20 mobile on wheels since they can then be constantly prepared for use.

As in reality, communication from the scene to RMC, ADC and HCG:s requires radio sets, the other communication is by telephone and requires minimum 1-2 telephones in each room.

The exercise is run with real time without breaks (nutrition of participating staff is done by catering as in reality) and does not stop until all patients are under treatment in hospitals. The type and distribution of injuries is based on real scenarios. It is recommended to use a number of casualties high enough to identify the critical limit for the capacity of the different units.

Liberal time is devoted to evaluation where the trainees are given feedback on all identified mistakes. The experiences show that the trainee, when possible, always should have a chance to have a second exercise in direct connection to the first one to be able to correct mistakes.

Since the system was launched 2009, 8 MRMI courses based on this system have been organized in 5 different countries and with totally 451 participants:

The courses have been carefully evaluated and the educational model validated by:

• Pre- and post- course surveys where the trainee have marked their perceived capacity for different functions before and after the course

• Pre- and post-course triage tests

The results show significant improvements of these criteria supporting the accuracy of the model.

Lennquist Montán K, Bemelman M, Dobson B, Boris Hreckovski, Philipp Fischer, Amir Khorram-Manesh, Carl Montan, Per Örtenwall, Sten Lennquist: ESTES postgraduate training in medical response to major incidents (MRMI) - Experiences from the first five courses. Eur J Trauma Emerg Surg 2011;Suppl 1; s52