Latent Safety Threats During Simulated Internal Mass Casualty Incidents: A Multicenter Simulation-Based Systems Testing Study

19/10/2026

AI Summary

Multicentre in situ simulations identified recurrent, high-priority latent safety threats across hospitals, including leadership, patient flow, communication, triage, and system interfaces.
A substantial proportion were classified as high or very high priority, with comparable median FMEA scores across sites.
Mitigation strategies were proposed for about 60-65% of LSTs; prospective tracking and re-simulation are needed to evaluate threat reduction over time.

Disaster Med Public Health Prep. 2026 Oct 19;20:e190. doi: 10.1017/dmp.2026.10476.

ABSTRACT

INTRODUCTION: Internal mass casualty incidents (MCIs) challenge hospital systems by requiring rapid coordination across clinical, operational, and communication domains. Simulation-based clinical systems testing (SbCST) can identify latent safety threats (LSTs), but cross-institutional patterns in internal MCI preparedness remain poorly characterized.

METHODS: We conducted a multicenter simulation-based systems assessment using in situ SbCST and Failure Modes and Effects Analysis (FMEA) during simulated internal MCIs. LSTs were identified through triangulation of structured field observations, facilitator observations, and participant self-report during debriefing. Observations were consolidated through structured review, categorized into system-level domains using the HFMEA (Healthcare Failure Mode and Effect Analysis) framework by multidisciplinary consensus, and prioritized using FMEA with expert scoring followed by consensus reconciliation.

RESULTS: Approximately 75-80 raw observations yielded 53 unique LSTs across 2 hospitals. Recurrent vulnerabilities involved leadership, patient flow, communication, triage, and system interfaces. A substantial proportion were classified as high or very high priority, with comparable median FMEA scores across sites (Site 1: 30 [IQR 24-36]; Site 2: 32 [IQR 24-48]). Mitigation strategies were proposed for approximately 60-65% of LSTs.

CONCLUSION: Multicenter SbCST identified recurrent, high-priority system-level vulnerabilities across 2 hospitals. Prospective tracking of mitigation implementation and re-simulation are needed to determine whether identified threats are reduced over time.

PMID:42894412 | DOI:10.1017/dmp.2026.10476

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