Document Type

Master's Culminating Experience

Publication Date



Objective: The purpose of this systemic review of the literature is to determine the best practice with regards to simulating casualties during a disaster response exercise.

Methods: MEDLINE was searched from 1950 till present for the key terms of disaster, simulation, and emergency preparedness. Articles were included which met the following criteria: English language, human subjects, original research using any research design (with or without intervention), and primary focus of disaster preparedness using simulation, virtual reality, or role playing actors.

Results: Of the 386 articles reviewed only 18 met inclusion criteria. The literature is primarily descriptive in nature with regards to simulation in disaster preparedness. Seven articles (38%) were analytical in study design with the rest being observational or descriptive. The populations varied widely among the included articles ranging from participants at a formal training class to medical students to residents and finally nurses and full trained physicians. The majority of studies including the analytical ones used convenience sampling. These articles were assigned a level of evidence and best practice recommendations and conclusions were then determined.

Conclusions: The results show that virtual reality and high-fidelity mannequin based simulation are at least equivalent to the traditional full scale exercise. In addition, both modalities have the advantage of allowing invasive procedures to be performed as well as giving a more realistic time frame experience for the participant. These modalities can be incorporated into future disaster response drills in order to complement each individual modalities strengths and weaknesses.