A mass casualty incident (MCI) is “an event that overwhelms the local healthcare system, where the number of casualties vastly exceeds the local resources and capabilities in a short period of time” [1]. MCIs are increasing in number and severity across the USA and the world [2,3,4,5]. In 2022 alone, there were nearly 400 disaster events worldwide resulting in more than 30,000 deaths [6]. MCIs include natural disasters, pandemics, transportation incidents, acts of terrorism, military actions, and chemical, biological, or radiological events [7].

With the increasing incidence of MCIs in recent decades, there has been a focused interest from the federal government in preparing local resources, including healthcare systems, to respond to disasters [7]. In 2002, the Department of Homeland Security developed specific guidelines for the utilization of disaster exercises or “drills” to assist in preparation for mass casualty events [8]. These drills focus on system-level preparedness and improvement in coordination among all stakeholders.

Emergency medicine physicians serve as the front line of the healthcare system and are increasingly involved in leadership and management in prehospital and emergency medical services (EMS), which includes disaster planning and management. The National Association of EMS Physicians currently reports 77 ACGME-accredited EMS fellowship programs in the USA [9]. Regardless of subspecialty training, emergency medicine physicians are integral to disaster response within and beyond the physical boundaries of the emergency department. Thus, emergency medicine residents should receive focused training to respond in disaster settings [10]. Prior research has indicated that dedicated training improves performance on knowledge exams and in simulation scenarios [11]. Further, healthcare professionals indicate that participating in simulation events and other MCI training exercises improves disaster preparedness on the system level and confidence in the ability to perform their roles on the individual level [12,13,14,15]. Despite this, there is limited data and wide variability in the approach to education for emergency medicine residents and medical students [16].

Currently, didactic lectures, simulation, and hospital-wide training drills are the main educational strategies employed [17,18,19]. Our team realized the opportunity to incorporate educational gamification into the disaster preparedness training. Gamification is simply the “use of game design elements in non-game contexts” and has been exponentially increasing in educational realms [20,21,22,23,24,25,26,27,28,29]. In graduate medical education, we have observed that gamification leads to improved motivation among resident learners [30]. While there have been small-scale (with regard to the amount of resources needed, not the number of participants) exercises incorporating components of gamification in disaster education, there have been no large-scale (higher resource) gamified events utilizing these elements to train emergency medicine residents and students [31, 32].

As the field of disaster medicine continues to grow within the specialty of emergency medicine, there are opportunities for innovation in the way healthcare professionals are trained to provide care in such events. Incorporating large-scale gamified events for MCI training has the potential to motivate learners by creating an interactive and enjoyable method for learning.

Disaster Day 2022 was a collaborative simulation/gamification event involving two ACGME-accredited 3-year, suburban, community-based emergency medicine residency programs in Orlando, Florida. The purpose of this event was to build collaborative relationships, foster physician wellness and networking, and accomplish specific educational goals pertinent to the emergency medicine physician in training.

The event took place on September 15, 2022, aligning with the protected weekly conference time, meaning residents in both programs have mandatory conference attendance when on the majority of rotations within their respective curricula. The overarching educational goal was to familiarize residents and medical students with the processes for pre-hospital care and system coordination for disaster medicine. Learners participated in a variety of live and simulated scenarios involving Simple Triage and Rapid Treatment (START) triage protocol, disaster resource allocation and utilization, field command, trauma resuscitation in resource-limited environments, and online medical control. The theme of the day was “Music Festival,” and each station or scenario was tied to potential catastrophes that could result during the event.

Residents and medical students were divided into 6 equal teams with learners of all levels. Teams rotated through a series of stations, each with three specific educational objectives (see Table 1), and earned points for correct and timely completion of assigned tasks. Prizes were awarded to the winning teams at each of the stations. The stations included (1) Disaster Trivia, a knowledge recall competition between 3 teams simultaneously utilizing “jeopardy”-style quizzing; (2) START Triage, a simulation-based race where learners had to correctly apply the START triage algorithm to patients encountered in a large field; (3) Disaster Sim, a multi-patient simulation where identified team leaders were blindfolded and resources became limited; and (4) MCI Escape Room, a music-festival themed escape room focused on resource allocation, triage, and management of environmental disorders. Each station was facilitated by multiple faculty members from both programs.