Is all the makeup worth it? Simulated patients in disaster training.

Ingrassia PL, Pigozzi L, Bono M, Ragazzoni L, Della Corte F. Use of Simulated Patients in Disaster Medicine Training: A Systematic Review. Disaster Medicine and Public Health Preparedness. Cambridge University Press; 2021;15(1):99–104.

Context: The present review aims to critically analyze the recent use and the preparation of SPs [simulated patients] in the context of simulation in disaster medicine education."

Methods: Systematic review of disasters (including MCI, catastrophe, and major event) and simulated patients (and standardized patients or live actors)

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Conclusion: SP's are used inconsistently in disaster exercises. Sometimes with makeup, sometimes trained beforehand, sometimes (not often) for the sake of students (more often for practicing professionals), sometimes (not often) involved in debriefing. The authors recommend that SP's be trained and be involved in the education and debriefing of the event.

Despite being such a ubiquitous part of disaster exercises, standardized patients are anything but standard. In research, methods, and outcomes, we actually don't know much about how useful it is to get volunteers to make believe a building has just collapsed on them. Of the 18 studies reviewed, half were case reports so the evidence is not robust. Outcomes as far as skill development, accurate medical interventions, acceptable triage decisions were often not identified. And whether SP's wear makeup, have vital signs, or carry cards describing their injuries and responses is variable.

But what would we do without simulated horrific injuries and moaning volunteers? How would we learn to respond to a disaster? Is all the makeup and moaning worth it? By the evidence, we can't really say. Maybe we would learn just as well without the fake blood...

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