Mass Casualty Incident Commander Decision-Making Models: Novice vs. Expert Decision Making

Introduction: Managing a mass-casualty incident (MCI) challenges commanders in the pre-hospital phase. Exploring the differences between the decision-making processes of novice and expert commanders can reveal how to improve training. This study aims to compare the decision-making processes between paramedic students and veteran paramedics. Methods: Data from eight MCI field simulations of paramedic students with no experience, and one simulation of a veteran paramedic were collected. Results: In the first phase of the simulation, both the students and the veteran paramedic followed the MCI protocol. From the second phase, the paramedic students mostly responded to received cues, while the veteran paramedic initiated actions without preliminary cues. Discussion: The veteran paramedic initiates actions and utilizes "considered" decision-making process earlier than the students, that frequently acted in response to cues. Although these results are based on a small sample, this study indicates a difference between novice and expert commanders’ decision-making processes.