THE ROLE OF SIMULATION-BASED TRAINING IN PREPARING HEALTHCARE PROFESSIONALS TO MANAGE CRITICAL INCIDENTS DURING STRATEGIC MEDICAL EVACUATION

Abstract

Background: Strategic medical evacuation (SME) of wounded service members and critically ill patients is an integral component of modern military medical support systems during armed conflicts. Long-distance transport of critically ill patients carries a substantial risk of critical incidents and requires healthcare professionals to possess advanced clinical competencies and rapid decision-making skills under challenging conditions. Environmental factors such as noise, vibration, confined working space, and other transport-related stressors may compromise the performance of medical equipment, lead to displacement of drains and catheters, impair patient monitoring, and contribute to adverse events. Previous studies have shown that a considerable proportion of transport-related critical incidents are potentially preventable through appropriate staff training. Simulation-based education combined with structured debriefing has emerged as an effective educational approach for developing both technical and non-technical competencies. Objective: To evaluate the impact of simulation-based training on the preparedness of healthcare professionals to manage critical incidents during SME of wounded and critically ill patients. Methods: A prospective questionnaire-based study was conducted after completion of a two-day simulation course entitled "Patient Transport Management" between November 2025 and March 2026. Participants included anaesthesiology and intensive care residents as well as physicians from other specialties involved in interfacility patient transport. The training program consisted of didactic lectures, hands-on training using a Type C emergency ambulance, and six high-fidelity simulation scenarios involving critical incidents during SME. Training effectiveness was evaluated using an anonymous post-course questionnaire, and the data were analyzed using descriptive statistics. Results: A total of 25 questionnaires were analysed. Most participants reported increased confidence in their clinical skills (92 %), improved self-reported preparedness to manage emergency situations during patient transport (92 %), and enhanced ability to identify gaps in their knowledge and skills (96 %). All participants rated simulation-based education as more effective than traditional educational methods and reported that structured debriefing significantly improved knowledge retention and facilitated error recognition and correction. Furthermore, all respondents (100 %) recognized debriefing as an essential component of simulation-based education. Conclusions: Simulation-based education is an effective approach for preparing healthcare professionals to manage critical incidents during SME. The use of realistic clinical scenarios, specialized transport equipment, and structured debriefing enhances practical skills, increases clinicians' confidence, and strengthens preparedness for the transport of critically ill patients. Standardized checklists provide a structured approach to patient assessment during transport, whereas debriefing following each simulation scenario promotes reflective practice, strengthens clinical reasoning, and may ultimately reduce the incidence of medical errors during real-world patient transport.