Learning Under Pressure: Major Incident Simulation Brings Students Together

This blog, written by Yetti Patrick, Senior Lecturer in Paramedic Science at the University of Gloucestershire, showcases how a realistic major incident simulation at the University helped healthcare students develop the teamwork, communication, leadership and clinical decision-making skills needed to respond effectively to mass-casualty emergencies.

Last month, the University of Gloucestershire hosted its annual multi-disciplinary major incident simulation, bringing together paramedic, nursing and sport science students alongside HART paramedics, HEMS clinicians and Emergency Department doctors and nurses for an immersive learning experience.

The scenario saw a vehicle career into a crowded fête, leaving more than 50 casualties requiring immediate assessment and treatment. While simulated, the exercise recreated the pressure and complexity of responding to a real major incident.  The scenario began with sport science students, who were running a stall at the fête, witnessing the incident and becoming the first people on scene. They immediately began triaging casualties until the first student paramedic crew arrived.

Once the student paramedic crew declared METHANE, additional crews were deployed and Ten Second Triage (TST) was quickly carried out. Working together in organised chaos, paramedic and sport science students established a Casualty Clearing Station (CCS) where patients were prioritised before being transported to the simulated hospital. Nursing students in Majors and Minors departments received and managed the incoming casualties, completing the patient journey from pre-hospital care to the Emergency Department.

The exercise provided paramedic students with the opportunity to lead in a challenging pre-hospital environment while remaining within a safe and supported learning setting. Faced with distractions from distressed casualties presenting with injuries ranging from minor wounds to life-threatening emergencies, students had to develop situational awareness, prioritise effectively and make decisions under pressure.

The simulation concluded with a multi-disciplinary debrief involving students, lecturers and experienced clinicians, providing valuable insight into both strengths and areas for improvement.

One of the key learning points focused on communication between ambulance services and hospital teams. Once the major incident had been declared, nursing students/staff reported they received limited information about incoming casualties, making it difficult to prepare. The debrief revealed that hospital staff expected updates via the pre-alert phone, while ambulance crews were communicating casualty information through the Hospital Ambulance Liaison Officer (HALO). This highlighted the importance of understanding communication pathways and the responsibilities of different professional roles during major incidents.

The exercise also tested the effectiveness of TST when used by both non-clinical students (sport science) and paramedic students. Its simplicity proved particularly valuable in a cognitively demanding environment, allowing rapid and dynamic triage decisions. Later in the exercise, the introduction of the Major Incident Triage Tool (MITT) within the Casualty Clearing Station created some confusion, reinforcing the view that continuing with TST alone would provide a clearer and more consistent approach.

Perhaps the greatest benefit of the simulation was the opportunity for students from different disciplines to work together. By experiencing a realistic major incident as one team, participants developed a greater understanding of each other’s roles while strengthening their communication, teamwork and decision-making skills.  Exercises like this prepare future healthcare professionals for the realities of emergency care, building confidence, resilience and collaborative practice. By recreating the challenges of a major incident in a controlled environment, students gain invaluable experience that will help them deliver safe and effective patient care when it matters most.