Abstract / Summary
Abstract Background Hospitals play a central role in managing trauma-related mass casualty incidents (MCIs), and full-scale simulation exercises (FSSEs) are widely used to test institutional preparedness. This study aimed to assess the structure and execution of a trauma-related disaster drill, identify systemic gaps in triage, communication, and patient disposition, and analyze the operational flow of the hospital incident command system (HICS). Methods A multimethod retrospective study was conducted at a tertiary-care hospital following a full-scale trauma disaster drill simulating a two-bus collision with approximately 100 casualties. A standardized five-domain checklist was scored independently by three observers, and inter-rater agreement was assessed using Fleiss' kappa. Time-motion analysis tracked five simulated patients from arrival to disposition. HICS activation and role performance were mapped using a swim lane process-flow analysis and compared against expected protocol benchmarks. Qualitative data were analyzed thematically. Results Inter-rater reliability across checklist domains was moderate to good (overall Fleiss' kappa = 0.558). Triage was initiated without measurable delay from patient arrival, but downstream processes were slower. HICS activation (14 minutes 52 seconds) and triage-officer assignment (16.8 minutes) both exceeded protocol benchmarks, while siren activation (29 minutes 56 seconds) and initial patient triage were within expected limits. Thematic analysis of interviews identified four major domains of concern: planning constraints, communication gaps, resource/logistical barriers, and team role confusion. Conclusions Frontline clinical response, particularly triage, was a consistent strength, but systemic inefficiencies in communication infrastructure, command coordination, and resource logistics represent the principal barriers to optimal mass casualty response.