Introduction Medical simulation is a well-recognized tool for educational, training and evaluative purposes and can be a useful method to assess performance, test plans and guidelines and investigate the hu- man factor 1-3 . Full scale exercises (FSE), are the best way to evaluate efficiency and efficacy of sys- tem response and represent the gold standard for simulation 4 . A systematic debriefing is needed to identify specific strengths and weaknesses of a given system's response, in order to improve per- formance and to assess the impact of education and training on healthcare personnel. Unfortu- nately, to date there is no standardized method to evaluate data collected through an FSE. Previously developed semi-quantitative drill evaluation tools were able to improve the efficacy and benefits of simulation 5 . We improved one of such tools, the Disaster Simulation Suite (DSS) (iNovaria, Novara, Italy) by adding the possibility to create standard- ized victims and to formulate a more precise defi- nition of performance indicators (PI), time frames and skill recordings. This study aims to describe the DSS and to evaluate its use during a similar FSE replicated in two different occasions. The healthcare providers involved in the FSE had different educational background in MCI management. The hypothesis is that the DSS would allow to detect differences between the two groups during event manage- ment, reflecting the level of education and train- ing of the participants 6 . Emergencias 2013; 25: 459-466 459 ORIGINAL ARTICLE Impact of training in medical disaster management: a pilot study using a new tool for live simulation PIER LUIGI INGRASSIA 1 , DAVIDE COLOMBO 1 , FEDERICO LORENZO BARRA 1 , LUCA CARENZO 1 , JEFFREY FRANC 2 , FRANCESCO DELLA CORTE 1 1 CRIMEDIM Research Center in Disaster and Emergency Medicine, Department of Translational Medicine, Università del Piemonte Orientale “A. Avogadro”, Novara, Italy. 2 University of Alberta, Edmonton, Canada. Objectives: The aim of this study was to test a new disaster simulation suite (DSS), evaluating its application during the same type of full-scale exercise on 2 different occasions. Our hypothesis was that the system would allow us to detect differences between trained and nontrained physicians during event management. Methods: Players (physicians) were classed as trained or nonrained based on their background in disaster medicine training. We simulated the collapse of a ceiling structure in a crowded room. Using the DSS, we electronically collected data relative to key prehospital and hospital times, triage accuracy, command-and-control and prehospital treatment accuracy. Results: No usability problems arose during either simulation. Trained physicians were faster than nontrained physicians in dispatching the victims from scene to hospital (median [interquartile range] times, 67.5 [50.0-111.0] vs 145.0 [110.0-150.0] minutes, P<.001); trained physicians also treated and discharged more patients in the emergency department (32/38 vs 14/31, P<.001) and performed better on command-and-control items (31/44 vs 17/44 for trained and nontrained players respectively, P<.05). No differences were found as regards triage or prehospital treatment accuracy. Conclusions: Using the DSS in 2 comparable scenarios allowed us to identify differences in mass casualty responses of trained and nontrained physicians. These results may reflect some of the specific objectives of disaster medicine training oriented to the organizational management of health crises rather than to the clinical management of injuries. [Emergencias 2013;25:459-466] Keywords: Training, case management. Disasters. Simulations. CORRESPONDENCE: Francesco Della Corte CRIMEDIM Research Center in Disaster and Emergency Medicine Via Solaroli, 17 28100 Novara, Italy E-mail: dellacorte.f@gmail.com RECEIVED: 19-4-2012 ACCEPTED: 17-7-2012 CONFLICT OF INTEREST: The authors declare no conflict of interest in relation with the present article.