Mobile medical units often serve as extensions of main health facilities to reach patients when they are at most risk. These high-tech units act as mini-hospitals to provide definitive life-saving emergency and/or post disaster response for many needs-based functions, including disaster response, large-scale recreational events, support in mass casualties, or replacing lost ambulatory or emergency room service capacity in case of emergency department closures [1–5].

During the 2010 Vancouver Winter Games, mobile surgical services and medical support for athletes and officials were provided on-site at the Whistler Athlete Village by the Mobile Medical Unit/Polyclinic (MMU/PC). The MMU/PC was designed to provide definitive life-saving care for persons in the event that injury severity, transportation, or weather disruption would prohibit immediate triage and transport to larger care facilities as well as to provide surge capacity in the event of a mass or multi-casualty situation.

The MMU is a 15.9-metre tractor-trailer, which can expand to a 90-square-metre unit with up to 12 beds (Figures 1 and 2). Our configuration included four resuscitation bay/critical care beds, a single table operating room and two non-monitored holding beds. The unit was supported with a secondary trailer stocked with 72 hours worth of medical/surgical supplies and other equipment. The MMU had self-contained back up diesel generators, an O₂ concentrator, IMIT connectivity, and lab and diagnostic support services.

As these are highly sophisticated and specialized units it is necessary to provide equally sophisticated and specialized training in order to make the users comfortable and familiar with the environment. It has been shown that simulation based trainings have demonstrated significant impact on teamwork competencies such as communication, role clarity, situation awareness and leadership as well as clinical knowledge and skills [6, 7]. An education framework was established early in the planning process to ensure all medical staff and contractors received hands-on training to prepare for efficient and effective patient care and flow while working in the MMU. This training program was coordinated by a joint education committee between Canadian Forces Trauma Training Centre (West) (CFTTC (W))^a and the Vancouver Coastal Health (VCH) section of Learning and Development at Vancouver General Hospital (VGH) with close collaboration from the Public Health Agency of Canada (PHAC), National Office of Health Emergency Response Teams (NOHERT) and Vancouver Olympic Committee (VANOC).

Validation and participant satisfaction studies can help link field performance to training context [8, 9]. The feedback gained from these measures can be used to synchronize the training objectives with trainees’ area of expertise to make the training “more targeted” [10]. The purpose of this study was to survey the satisfaction of the clinical staff that completed the MMU/PC training in attempt to assess the impact of the education and training program provided to health care providers who supported the MMU during the Games.

To assess the applicability of medical training in the actual practice field, the impact of training should be questioned in several territories such as clinical skills, performing procedures, patient management, ethicolegal responsibilities, team performance and communication skills [12, 13]. Our multi-phase MMU/PC training, that covered a diverse array of areas, was found to be beneficial in the perspective of the participants for preparing personnel for the 2010 Winter Games. The uniqueness of this training program was a four-phase education and training curriculum designed to foster the performance of a high functioning interdisciplinary team.

Although our evaluation did not include a controlled clinical trial design, it provides valuable information on the perspective of clinical staff that completed the different training models developed for the curriculum. In particular this survey demonstrates strong support for incorporating simulation training when preparing ad hoc clinical training programs. These findings add additional support to the literature on the utility of simulation training programs on teamwork competencies [14]. The study also provides new information on how to structure training programs for preparing clinicians to work within mobile medical environments.

We had a favorable response rate and good representation of among the clinical professionals who participated in this training program. Over 75% of the participants had more than 5 years work experience and 55% had experience working in large scale events, indicating that the Whistler Olympic Village recruitment strategy specifically targeted individuals with experience working in large-scale events and experience in trauma. The fact that the ‘more experienced’ groups rated the training favorably does provide an indication that the structure of the training program was useful and of benefit to the participants.

This feedback is important given the many potential situations where ad hoc clinical teams might form, from potential epidemic outbreaks, to terrorist threats, to natural disasters. Since the 2010 Games, daily simulation has become a standing operation procedure for current MMU deployments in effort to keep our new and constantly changing teams up to speed on working in these types of clinical environments. Subsequent deployments have ranged from staging at small stage events, including the BMX Supercross World Cup in Abbotsford, BC in 2012, to outreach programs across the province, to providing Emergency Department support over a 10-day period during the 2012 flooding of the Surrey Memorial Hospital. Many of the original teaching staff attached to the MMU during the 2010 Games subsequently became staff for the MMU as a provincial resource. We continue to build on the original ‘just in time’ training curriculum to help train and prepare the medical teams prior to deployment. These ongoing sessions are helping to re-shape the curriculum, taking lessons learned from previous deployments and immediately updating lesson plans and performance objectives.

At the time of the Games, we had little experience in the MMU. Knowing what we do now about the strengths and weaknesses of the unit and support trailer and from experience with the Games and other deployments we would recommend holding more simulation exercises of casualties for future training sessions. In addition, to optimize learning for all clinical staff we would have the MMU wired for video broadcast of simulations. We recently did this at an emergency medical conference, allowing hundreds of people to watch the small teams function in the unit. For education and training purposes, the benefit of the video stream would be the increased observation opportunities for clinical staff as they watched teams practice, thus affording another opportunity to gain experience for working within the MMU.

These results should be viewed within the context of some important limitations. Firstly, although the survey responses imply that the training program developed for the 2010 Games was effective, we do not present any clinical outcome data that can additionally confirm or deny the appropriateness of the training. Access to this data was not feasible due to ownership and privacy stipulations of the medical records for all persons treated in the MMU during the 2010 games. One approach for future training evaluation programs would be to hold pre and post training surveys, thereby linking the training and performance objectives to outcome measures such as patient satisfaction, complications, or functional outcomes. Similarly, future assessments could be derived using pre- and post-test knowledge and confidence tests and surveys followed by post-deployment validation surveys. For example, an external reviewer observing team performance for error rates with simulation patients and treatment algorithms.

One of the legacy goals of the MMU/PC is to maintain an annual clinical training program whereby portions of the training delivered during the 2010 Winter Games will be replicated. Within a Canadian context, British Columbia is the only province with this type of service facility. Thus, it offers an opportunity to improve the preparedness of Canadian clinical personnel who may later work in austere environments either in Canada or abroad. The level of satisfaction from participants of the training program is encouraging as it provides a foundation to structure future training clinical training programs for working in MMU environments.

^aCFTTC(W) contribution with the permission of the Minister of National Defense.