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A Region-Wide All-Hazard Training Program for Prehospital Mass Casualty Incident Management: A Real-World Case Study

Published online by Cambridge University Press:  01 April 2022

Luca Carenzo
Department of Anesthesia and Intensive Care Medicine, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
Pier Luigi Ingrassia*
Centro di Simulazione (CeSI), Centro Professionale Sociosanitario, Ronchetto, Lugano, Switzerland
Francesco Foti
Agenzia Regionale Emergenza Urgenza (AREU), Milan, Italy
Enzo Albergoni
Agenzia Regionale Emergenza Urgenza (AREU), Milan, Italy
Davide Colombo
Department of Anesthesia and Intensive Care Medicine, Ospedale Ss. Trinità, Borgomanero, Italy CRIMEDIM Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy
Giuseppe Maria Sechi
Agenzia Regionale Emergenza Urgenza (AREU), Milan, Italy
Alberto Zoli
Agenzia Regionale Emergenza Urgenza (AREU), Milan, Italy
Stefano Sironi
Agenzia Regionale Emergenza Urgenza (AREU), Milan, Italy
Corresponding author: Pier Luigi Ingrassia, Email:



We report the development, implementation, and results of a sustainable region-wide mass-casualty management prehospital training program implemented by the Regione Lombardia emergency medical services (EMS) agency AREU in Italy.


The educational program learning objectives are: (1) command and control, communications, and resource management; (2) mass casualty triage and the START triage protocol; (3) on-scene management; (4) Regione Lombardia and AREU Mass Casualty standard operating procedures; and (5) inter-agency communications and relations. For each course edition data on participants’ summative assessment, participants’ feedback and costs were collected.


Between June 26, 2013, and December 31, 2020, a total of 84 editions of the provider training event were delivered, training an overall 1329 prehospital providers; 1239 (93%) passed the summative assessment and were qualified as being operationally “ready.” Regarding participant feedback, the overall program was rated 4.4 ± 0.7 out of 5. The overall cost of running the provider program during the study period was €321 510 (circa US $382 000). The average cost per edition was €3828 and €242 per participant.


We have described a simple yet interactive simulation and blended-learning approach, which has yielded good pass rates, good participant satisfaction, and contained costs to systematically train emergency medical service personnel.

Original Research
© The Author(s), 2022. Published by Cambridge University Press on behalf of Society for Disaster Medicine and Public Health, Inc.

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