Stress and ETS: Measuring the neuroendocrine stress response of participants in a hospital disaster response simulation.

Disaster simulations are the traditional method of assessing hospital disaster
preparedness. Some studies have suggested that Mass-Casualty Incident (MCI)
training can be effective in training hospital staff. However, hard evidence of
the effectiveness of MCI training is limited.
It can be hypothesized that stress is a crucial element of MCI training. The
experience with stressful (training) situations may aid adequate behavior
during real MCI situations. Furthermore, there may be a large difference
between different MCI training methods in the level of stress experienced by
the participants. Factors that introduce stress in MCI training may be
maintaining an actual time frame and warranting the continuity of the
patientflow. However, there is no evidence available on stress responses in MCI
training participants or the factors that may be of influence.
The Emergo Train System (ETS) is a training and simulation method for the
medical response to disasters and major accidents. It is a *real time* training
method in which the continuity if the patientflow depends on the weakest link
in the chain that follows triage. These factors are expected to impose stress
to the trainees which may be comparable to real disaster situations.

The primary objective is to evaluate the neuro-endocrine stress response during
ETS training.
The secondary objectives are to assess whether chronic stress, individual
sensitivity and personal experience with trauma or disaster medicine are
predictive factors for the individual stress response during an ETS training.

Observational study

Subjects will take part in the ETS training regardless of this study. The
interventions are non-invasive and will not cause any risk. Wearing the Polar*
heart rate monitor, answering a questionnaire and donating saliva shortly
before, during and after the training will cause a minimal inconvenience for
the subjects; however, it is not harmful. Measuring the baseline saliva
cortisol secretion on a random day before the ETS training is necessary to
determine the extent of elevation of the cortisol level during the training.
Following the protocol for baseline measurement of the saliva cortisol level
might be a small burden for these healthy medical professionals