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Table 1 Overview of included studies

From: Preparing medical first responders for crises: a systematic literature review of disaster training programs and their effectiveness

First author, year

Study design

N1

Professions

Training content

Training methods

Duration, timespan

Effectiveness indicators

Effectiveness confirmation

Aghababaeian, 2013 [58]

Non-RCT (pre-post)

144

Paramedics, EMTs

Triage

IG: Educational video

CG: Real-life scenario

0.5 h, 1 day

Basic knowledge test

No sign. difference between groups

Applied knowledge test (triage accuracy)

IG partially better than CG

Alenyo, 2018 [77]

Single group, pre-post

129

Emergency medical service providers

General disaster management

Not specified

NA, NA

Applied knowledge test (triage accuracy)

Yes

Alim, 2015 [78]

Single group, pre-post

309

Nursing students

General disaster management

Not sufficiently clear (“in-class training”)

8 h, 1 day

Basic knowledge test

Yes

Aluisio, 2016 [79]

Single group, pre-post

12

Physicians, nurses

Lower extremity regional anesthesia for earthquake victims

Discussion-based training, practical skills

5.25 h, 1 day

Basic knowledge test

Yes

Andreatta, 2010 [25]

Stratified RCT (pre-post)

15

Physicians

Triage

IG: Lecture, VR with CAVE

CG: Lecture, real-life scenario

NA, 1 day

Basic knowledge test

CG better than IG (effect sizes only)

Observed performance with a self-developed instrument to compose an overall performance score during real-life / VR simulation (e.g., ensure safety on scene, call for additional help, accuracy)

IG better than CG (effect sizes only)

Andreatta, 2015 [34]

Non-RCT (pre-post)

204

Nurses, paramedics, medical students

Cholinergic crisis management

IG (use of virtual animal model): Discussion-based training, real-life scenario, computer-based learning

CG (use of virtual human model): Discussion-based training, real-life scenario, computer-based learning

4 h, 1 day

Basic knowledge test

For all indicators: Yes, for both groups (no sign. difference between groups)

Observed performance with a previously validated instrument [80] to compose an overall performance score during real-life simulation (multiple performance dimensions associated with managing a nerve agent casualty)

Self-reports of self-efficacy and state affect

Bajow, 2016 [63]

Single group, pre-post

29

Medical students

General disaster management

Lecture, discussion-based training, real-life scenario, VR on screen, educational video, debriefing, field visit

53 h, 2 weeks

Basic knowledge test

Yes

Betka, 2021 [49]

Single group, pre-post

17

Medical students, nursing students2

General disaster management

Discussion-based training, computer-based learning

NA, NA

Self-rep. interprofessional collaborative competencies

Partially confirmed

Self-rep. disaster management competence

Yes

Self-rep. self-confidence in managing disasters

Partially confirmed

Chan, 2010 [71]

Single group, pre-post

138

Nursing students

General disaster management

Lecture, discussion-based training, practical skills, field visit

NA, 2 weeks

Self-rep. competence in disaster nursing

Yes

Chandra, 2014 [52]

Single group, pre-post

76

Professional volunteers

Psychological first aid

Lecture, discussion-based training, educational video

2 h

1 day

Basic knowledge test

No

Self-rep. capability in using psychological first aid

Yes

Chou, 2021 [53]

Single group, pre-post

48

Medical students

General disaster management

Lecture, discussion-based training, real-life scenario

NA, 2 days

Basic knowledge test

Partially confirmed

Self-rep. willingness to pursue further training

No

Interest in disaster training

No

Cicero, 2012 [26]

Single group, pre-post

50

Physicians

Triage

Lecture, real-life scenario, debriefing

3.5 h, 5 months

Observed triage performance during real-life simulation (accuracy)

Yes

Cicero, 2017 [27]

Single group, pre-post

261

Paramedics, EMTs, paramedic students

Triage

Real-life scenario, debriefing, computer-based learning

5 h, 6.5 months

Observed triage performance during real-life simulation (accuracy)

Yes

Cowling, 2021 [45]

Single group, pre-post

26

EMTs in training

General disaster management

Real-life scenario, debriefing

NA, 1 day

Basic knowledge test

No

Self-rep. knowledge

Yes

Self-rep. confidence in managing a structural collapse scenario

Yes

Cuttance, 2017 [57]

RCT (only post)

292

Paramedics

Triage

IG1: lecture, other (aid memoire)

IG2: lecture

IG3: other (aid memoire)

CG: no intervention

NA, NA

Applied knowledge test (triage accuracy)

Yes, all IGs improved with the greatest improvements in IG1 and IG3

Dittmar, 2018 [28]

Single group, pre-post

19

Paramedics2

Triage

Lecture

0.75 h, 1 day

Observed triage performance during real-life simulation (time + accuracy + overall performance score assessed with a self-developed instrument that incorporated e.g., accuracy, time, airway handling and bleeding control measures)

Yes

Edinger, 2019 [81]

Single group, pre-post

19

Emergency medical service providers

Interacting with individuals with developmental disabilities during disaster response

Computer-based learning

1 h, 1 day

Basic knowledge test

Partially confirmed

Self-rep. self-efficacy for caring for developmentally disabled individuals

Yes

Farra, 2013 [61]

RCT (pre-post)

47

Nursing students

General disaster management

IG: computer-based learning, VR on screen

CG: computer-based learning

NA, NA

Basic knowledge test

IG partially better but CG improved as well (within-group effect of CG not tested for significance)

Fernandez-Pacheco, 2017 [60]

Single group, pre-post

35

Nursing students

Triage

Debriefing with video

NA, NA

Change in self-perception (number of behaviors, moments, thoughts, feelings, strengths + weaknesses being described)

Partially confirmed

Foronda, 2016 [62]

Single group, pre-post

6

Nursing students

Triage

Lecture, VR on screen, debriefing

1.25, 1 day

Applied knowledge test (triage accuracy)

No

Furseth, 2016 [50]

Non-RCT (pre-post)

189

Nursing students, paramedic students

General disaster management

IG with a training focus on handoff communication: lecture, real-life scenario, debriefing

CG: lecture, real-life scenario, debriefing

NA, 1 day

Self-rep. attitude towards Interprofessional education and interprofessional healthcare teams

For all indicators: IG partially better

Self-rep. confidence

Satisfaction with the training

Greco, 2019 [47]

Single group, pre-post

90

Nursing students

Triage

Real-life scenario, debriefing

NA, NA

Self-rep. ethical reasoning confidence

Yes

perceived importance of ethical reasoning

Huh, 2019 [41]

RCT (pre-post)

60

Nursing students

General disaster management

IG: Lecture, discussion-based training, practical skills, educational video

CG: No intervention

8 h, 4 weeks

Basic knowledge test

For both indicators: Yes

Self-rep. disaster readiness

Hutchinson, 2011 [82]

Single group, pre-post

81

Nursing students

General disaster management

Lecture, discussion-based training, real-life scenario, educational video, computer-based learning

NA, NA

Basic knowledge test

Partially confirmed

Ingrassia, 2015 [29]

RCT (pre-post) cross-over design

56

Medical students

Triage

IG: Lecture, VR on screen

CG: Lecture, real-life scenario training

NA, 3 days

Triage performance observed during real-life/virtual simulation (accuracy of triage decisions and of decisions about the need for lifesaving treatments + time)

No sign. difference between groups but both groups improved significantly

Ingrassia, 2014 [83]

Single group, pre-post

524

Medical students

General disaster management

Discussion-based training, computer-based learning, debriefing

47 h, 1 month

Basic knowledge test

For both indicators: Yes

Applied knowledge test (triage accuracy)

James, 2021 [84]

Single group, pre-post

34

Nursing students

General disaster management

Real-life scenario, debriefing

4 h, 1 day

Self-rep. attitudes towards teamwork in training

Yes

Jones, 2014 [43]

Single group, pre-post

224

Paramedics, EMTs

Active shooter incident response

Lecture, real-life scenario

4 h, 1 day

Self-rep. preparedness and attitudes towards active shooter incident response

Yes (but only descriptive statistics)

Kim, 2020 [55]

Single group, pre-post

34

Nursing students

General disaster management

Lecture, discussion-based training, real-life scenario, debriefing

3 h, 1 day

Self-rep. attitudes towards responding to MCIs

Yes

Knight, 2010 [30]

Non-RCT (only post)

91

Physicians, nurses, paramedics

Triage

IG: lecture, serious gaming with VR on screen

CG: lecture, discussion-based training

NA, NA

Observed triage performance during real-life simulation (triage accuracy + compliance with the correct procedure + time)

Accuracy: IG better than CG, step accuracy: IG partially better, time: no sign. difference between groups

Koca, 2020 [42]

RCT (pre-post)

235

Nursing students

General disaster management

IG: computer-based learning

CG: no intervention

11 h, 2 weeks

Self-reports of preparedness and self-efficacy

Yes

Koutitas, 2021 [38]

RCT (only post)

30

EMTs

Familiarization with the ambulance bus (AMBUS)

IG1: lecture, VR with HMD

IG2: lecture, AR with a head-mounted display

CG: lecture, field visit

NA, 1 week

Observed performance in a real ambulance bus (orientation in ambulance bus; accuracy + time + overall performance score calculated from accuracy and time)

Yes, for both IGs with better results in IG1 (only descriptive statistics reported)

Kuhls, 2017 [48]

Single group, pre-post

78

Physicians, nurses2

General disaster management

Not specified

8 h, 1 day

Self-rep. confidence to manage disaster scenarios

Yes

Lampi, 2013 [85]

Single group, pre-post

153

Physicians

Trauma life support

Lecture, discussion-based training, practical skills

NA, NA

Applied knowledge test (triage accuracy)

No

Lennquist Montán, 2015 [86]

Single group, pre-post

83

Emergency medical services providers2

General disaster management

Discussion-based training

NA, 3 days

Self-rep. knowledge

For both indicators: Yes

Self-rep. skills

Ma, 2021 [24]

RCT (pre-post)

104

Nursing students

General disaster management

IG: screen-based serious gaming

CG: discussion-based training, real-life scenario, practical skills, debriefing

2 h, NA

Self-rep. competence in disaster nursing

IG better than CG

Merlin, 2010 [54]

Single group, pre-post

46

Medical students

General disaster management

Lecture, practical skills, field visit/clerkship

34.5 h, 4 weeks

Self-rep. knowledge

For both indicators: Yes

Self-rep. opinions about prehospital issues

Mills, 2020 [31]

RCT (only post)

cross-over design

29

Paramedic students

Triage

IG: VR with HMD

CG: real-life scenario

NA, 1 day

Triage performance (accuracy) during real-life/VR simulation

No sign. difference between groups

Immersion (via heart-rate and self-rep.)

Greater immersion in real-life training

Learning satisfaction

No sign. difference between groups

Motola, 2015 [35]

RCT (pre-post)

91

Paramedics

Managing CBRNE incidents

IG: Educational video

Waiting CG: no intervention

NA, NA

Basic knowledge test

Yes

Observed performance in treating a CBRNE patient (overall performance score assessed with an instrument based on a previous study; [87])

Partially confirmed

Paddock, 2015 [37]

Stratified RCT (pre-post)

36

Physicians, nurses, paramedics, EMTs

Prehospital focused assessment with sonography in trauma

IG1: Educational video, computer-based learning

CG: Educational video, practical skills

IG2: Both of the trainings above

4 h, 1 day

Basic knowledge test

No sign. difference between groups but all trainings led to significant improvement

Observed sonography performance (overall performance scores for image acquisition and interpretation assessed with a self-developed instruments)

no sign. difference between groups

Phattaharapornjaroen, 2020 [88]

Single group, pre-post

52

Physicians

General disaster management

Discussion-based training

NA, 2 days

Self-rep. knowledge

Yes

Pollard, 2015 [89]

Single group, pre-post

41

Medical students

General disaster management

Lecture, real-life scenario, computer-based learning

NA, 8 months

Basic knowledge test

Yes

Pouraghaei, 2017 [36]

Single group, pre-post

205

EMTs

Triage

Lecture, discussion-based training

2 h, 1 day

Basic knowledge test

For all indicators: Yes

Applied knowledge test (triage accuracy)

Observed performance of managing the jaw trust airway maneuver (overall performance score via expert evaluations of success vs. failure)

Ripoll-Gallardo, 2020 [40]

Single group, pre-post

8

Physicians

General disaster management

Discussion-based training, real-life scenario, educational videos, computer-based learning, field visits

NA, 6 months

Basic knowledge test

Yes

Observed performance in real-life simulation in a low-resource emergency room (overall performance score assessed with the TIGR [90])

Yes

Self-rep. attitude towards disaster management domains

No

Rivkind, 2015 [91]

Single group, pre-post

3093

Medical students

Trauma management

Lecture, discussion-based training, real-life scenario, practical skills, educational video, computer-based learning, debriefing

77 h, 2 weeks

Basic knowledge test

Yes

Saiboon, 2021 [92]

Single group, pre-post

168

Medical students

General disaster management

Educational video

0.5 h, 7 days

Basic knowledge test

Yes

Scott, 2010 [51]

Single group, pre-post

61

Medical students

General disaster management

Lecture, real-life scenario

3 h, 1 day

Basic knowledge test

Yes (but only descriptive statistics)

Self-rep. knowledge

Sena, 2021 [46]

Single group, pre-post

22

Physicians

General disaster management

Lecture, discussion-based training, debriefing

2 h, 1 day

Basic knowledge test

No

Self-rep. confidence

Yes

Perceived importance of disaster medicine training

No

Smith, 2015 [64]

Single group, pre-post

65

Nursing students

Nursing leadership skills in disaster response

Lecture, discussion-based training, real-life scenario, VR on screen with movement tracking via webcam

8 h, 1 day

Self-rep. self-efficacy

Yes

Unver, 2018 [44]

Single group, pre-post

87

Nursing students

General disaster management

Lecture, real-life scenario, debriefing

NA, 8 weeks

Self-rep. disaster preparedness

Yes

Wiese, 2021 [59]

Non-RCT (pre-post), cross-over design

80

Nursing students

General disaster management

IG: computer-based learning

CG: practical skills, debriefing

NA, NA

Basic knowledge test

IG better than CG

Perceptions about learning

No sign. difference between groups

Xia, 2020 [56]

RCT (pre-post)

63

Nursing students

General disaster management

IG: lecture, discussion-based training, real-life scenario, educational video, debriefing

CG: No intervention

7 h, NA

Basic knowledge test

Partially confirmed

Self-rep. attitude (one score combining attitudes towards the training, towards disaster preparedness and family disaster preparation)

No sign. difference between groups

Yanagawa, 2018 [32]

Non-RCT (only post)

63

EMTs

General disaster management

IG: Lecture, real-life scenario, practical skills

CG: No intervention

NA, 1 day

Observed performance of whole team during real-life simulation (accuracy + overall performance score assessed with a self-developed instrument)

No

Zhang, 2021 [39]

RCT (pre-post)

120

Nurses

General disaster management

IG: VR on screen, discussion-based training, real-life scenario

CG: Lecture, discussion-based training, real-life scenario, practical skills

48 h, 3 months

Basic knowledge test

For all indicators: IG better than CG; CG improved as well but within-group effects not tested for significance

Observed performance during real-life simulation (overall performance score assessed with the self-developed emergency care capability rating scale)

Observed performance in technical skills (overall performance score assessed with a self-developed instrument)

Self-rep. disaster preparedness

Zheng, 2020 [33]

RCT (pre-post)

103

Medical students

Triage

IG: Lecture, discussion-based training

CG: Lecture

NA, 3 weeks

Basic knowledge test

IG better than CG

Observed triage performance (accuracy + time) during real-life simulation

No sign. difference between groups

Satisfaction with training

IG partially better than CG

  1. Sign. = significant, CG = control group, IG = intervention group, HMD = head-mounted display; Self-rep. = self-reported
  2. 1Number of participants in analyses
  3. 2Only referring to relevant subsample as there were separate analyses reported
  4. 3Number refers to trainees from the years 2010–2012