JMIR Publications

ABSTRACT

Background:

Major incidents correspond to any situation where the location, number, severity or type of casualties requires extraordinary resources. Major incident management must be efficient to save as many lives as possible. All paramedics and emergency medical technicians may unexpectedly have to respond to such incidents. Regular training is therefore mandatory. Those training are usually based on simulations. But most simulations are limited by the fact that simulated patients do not evolve during the simulation, regardless of the time elapsed and treatment decisions. Therefore, most simulations fail to incorporate the critical temporal effect of decision-making.

Objective:

To develop and validate a simplified yet realistic physiological model capable of simulating the real-time evolution of several casualties.

Methods:

A modified version of the user-centered design framework was used to define the development process of the physiological model. This framework is based on the five modes of design thinking (empathize, define, ideate, prototype, and test), with the addition of a knowledge base mode, and a validation phase. To determine whether the developed model was clinically realistic, 15 experienced professionals of emergency medical services participated in the validation phase. They were asked to rate clinical and physiological parameters according to a 5-point Likert scale ranging from 1 (impossible) to 5 (absolutely realistic).

Results:

A collaborative development team including professionals from emergency medical services and computer scientists led to the development of the HUMAn model (Human is an Uncomplicated Model of Anatomy). The team agreed on the most important feature of the model: clinically realistic, includes all the elements required to compute the evolution of prehospital vital signs, simple enough to allow real-time computation for several simulated patients on regular computers or tablets. Iterations led to the development of a heart-lung-brain interaction model coupled to functional blocks representing the main anatomical body parts. These blocks enabled the management of neurovascular elements used to provide neurological information and to create hemorrhages at different levels with different blood flows. In the validation phase, professionals from emergency medical services assessed nine simulated patients presenting pathologies devised to test the different systems and their interactions. Initial and final states of all patients had a median rating of 5 (absolutely realistic) for both clinical and physiological parameters.

Conclusions:

A simplified model of trauma patient evolution was successfully created and deemed clinically realistic by experienced clinicians. This model should now be included in computer-based simulations and its impact on the teaching of major incident management assessed through randomized trials.