For Doctors in a Hurry
- Researchers investigated how crisis resource management skills affect emergency dispatch center performance during mass casualty incidents.
- The study evaluated twelve high-fidelity mass casualty simulations conducted over nineteen months at a Milan dispatch center.
- Dispatch performance scores averaged 72.9 percent, demonstrating a strong correlation with crisis management scores averaging 73.8 percent (Pearson r=0.78).
- The authors concluded that better crisis resource management skills directly associate with improved emergency dispatch operational performance.
- Training dispatch staff in crisis resource management could optimize coordination and information flow during real mass casualties.
The Cognitive Frontline of Mass Casualty Response
Mass casualty incidents are unpredictable, high-stress events that require rapid, coordinated medical responses to mitigate morbidity and mortality [1]. During these crises, emergency medical dispatch centers serve as the critical first link in the survival chain, managing a sudden influx of complex information while simultaneously coordinating field resources and maintaining situational awareness [2, 3]. Because these events demand rapid decision-making under severe cognitive load, disaster preparedness increasingly relies on high-fidelity simulation to train both technical protocols and nontechnical crisis management skills [4, 5]. While the value of simulation is well-established for frontline clinicians, less is known about how these nontechnical skills impact the operational performance of the dispatchers orchestrating the response from afar. A recent study evaluating dispatch center preparedness now offers fresh insights into this critical dynamic.
Simulating Disaster in the Dispatch Center
In Lombardy, Italy, emergency medical dispatch centers play a crucial role in managing mass casualty incidents. These large-scale events put dispatch staff under severe strain because, in addition to the usual burden of routine emergency calls, operators must handle a massive inflow of information and coordinate the broader incident response. For physicians receiving patients at the hospital doors, the success of field triage and transport relies heavily on how well these dispatchers manage this chaotic influx of data and deploy limited resources. Because technical protocols alone are often insufficient during such chaos, nontechnical abilities, specifically crisis resource management skills, may strongly influence performance. Crisis resource management encompasses the cognitive and interpersonal skills required to effectively utilize all available resources, including communication, situational awareness, and teamwork. To quantify this dynamic, researchers evaluated the performance of the Milan emergency medical dispatch center during a series of simulated mass casualty incidents and measured its correlation with staff crisis resource management skills. To capture realistic data, the investigators conducted twelve high-fidelity simulations over 19 months, creating high-stress scenarios to test the dispatchers' operational capabilities and cognitive resilience.
Quantifying Technical and Nontechnical Proficiency
To objectively assess how well the dispatchers managed the simulated disasters, the researchers measured a set of published key performance indicators, which are standardized metrics used to evaluate operational success. The investigators applied a strict three-tiered scoring system to these operational metrics. Dispatchers received 2 points for a correct and timely action, 1 point for a correct but delayed action, and 0 points for an action not performed or incorrect. To standardize the results across different simulation scenarios, the final key performance indicator score was proportioned to the total obtainable points and converted into a percentage for comparison. Alongside these technical metrics, the study quantified the nontechnical cognitive and interpersonal abilities of the staff. To evaluate these crisis resource management skills, two independent raters utilized the Ottawa Crisis Resource Management Global Rating Scale. This validated assessment tool employs a 1- to 7-point scoring system to grade elements such as leadership, communication, and situational awareness. By employing independent raters and a standardized scale, the researchers aimed to minimize subjective bias when evaluating how effectively the dispatchers coordinated their response efforts under pressure.
Correlation Between Crisis Skills and Operational Success
The analysis of the simulated mass casualty incidents revealed consistent performance across both technical and nontechnical domains. When evaluating objective operational metrics, the average key performance indicator score across scenarios was 72.9 percent (range 45.8 percent to 95.8 percent, standard deviation 15.6). Nontechnical abilities mirrored this level of proficiency. When assessed using the Ottawa Crisis Resource Management Global Rating Scale, the scores averaged 73.8 percent (range 41.7 percent to 100 percent, standard deviation 19.0). To ensure the reliability of these nontechnical assessments, the researchers compared the evaluations of the two independent raters. The Ottawa scale had an interrater agreement of 88.9 percent (κ = 0.66). This kappa value, a statistical measure of interrater reliability, indicates a substantial level of consensus in evaluating the dispatchers' crisis management capabilities. Beyond establishing baseline proficiency, the researchers sought to determine how closely nontechnical skills aligned with objective operational success. The statistical analysis revealed a strong correlation between key performance indicator scores and Ottawa crisis resource management scores (Pearson correlation coefficient = 0.78). This high Pearson coefficient, a metric indicating the strength of a linear relationship between two variables, confirms that better nontechnical skills directly track with better operational execution. Ultimately, the findings showed a strong correlation between the performance of the Milan emergency medical dispatch center during simulated mass casualty incidents and staff crisis resource management skills. For practicing physicians and emergency medical directors, these data underscore a critical operational reality. Training dispatchers in nontechnical crisis management directly supports the technical execution of disaster response protocols, ensuring that field clinicians receive the coordinated support necessary to triage and treat patients effectively during large-scale emergencies.
References
1. Gabbe BJ, Veitch W, Mather A, et al. Review of the requirements for effective mass casualty preparedness for trauma systems. A disaster waiting to happen?. British Journal of Anaesthesia. 2021. doi:10.1016/j.bja.2021.10.038
2. Kedia T, Ratcliff J, O’Connor M, et al. Technologies Enabling Situational Awareness During Disaster Response: A Systematic Review. Disaster Medicine and Public Health Preparedness. 2020. doi:10.1017/dmp.2020.196
3. Hugelius K, Becker J. Common Challenges in the Prehospital Management of Mass-Casualty Incidents: A Systematic Integrative Review. Prehospital and Disaster Medicine. 2024. doi:10.1017/s1049023x24000566
4. Mahdi SS, Jafri HA, Allana R, et al. Systematic review on the current state of disaster preparation Simulation Exercises (SimEx). BMC Emergency Medicine. 2023. doi:10.1186/s12873-023-00824-8
5. Armenia SJ, Thangamathesvaran L, Caine A, King NA, Kunac A, Merchant AM. The Role of High-Fidelity Team-Based Simulation in Acute Care Settings: A Systematic Review. The Surgery Journal. 2018. doi:10.1055/s-0038-1667315
