• Users Online: 163
  • Print this page
  • Email this page

Table of Contents
Year : 2018  |  Volume : 19  |  Issue : 2  |  Page : 85-90

Effectiveness of community based mass casualty preparedness program among rural youth and their knowledge, attitude and selected skills towards mass casualty management

1 RN, Manchester, University Hospitals NHS, Manchester, UK
2 Professor, College of Nursing, CMC, Vellore, India
3 Professor, CMC, Vellore, India
4 Lecturer, Dept. of Bio - Statistics, CMC, Vellore, India

Date of Web Publication5-Jun-2020

Correspondence Address:
Login to access the Email id

Source of Support: None, Conflict of Interest: None

Rights and PermissionsRights and Permissions

Mass casualty incidents associated with road traffic accidents have become more frequent during the last decades. Many lives can be saved if the rural youths are trained as first responders in mass casually management. This study was aimed to assess the effectiveness of community based mass casually preparedness program among rural youth on their knowledge, attitude and selected skills towards mass casualty management, using a quasi experimental design. Two villages were conveniently selectedand were allotted to control and experimental group using lot method. From each village 40 youth were randomly selected for the study. Experimental group received community based mass casually preparedness program which included video based teaching and skill demonstration. Knowledge questionnaire, attitude scale and observation checklist on mass casually management was used to collect the data. There was a significant improvement in knowledge (p< .01) and skill (p< .01) among rural youth in experimental group. The findings suggest that equipping rural youth with necessary knowledge and skill for mass casualty management will not only save lives but will also be a ready manpower at the community level.

Keywords: mass casualty incidents, knowledge, attitude, community

How to cite this article:
Daniel JV, Siva R, Ravikumar TS, Mohan VR, Rebekah G. Effectiveness of community based mass casualty preparedness program among rural youth and their knowledge, attitude and selected skills towards mass casualty management. Indian J Cont Nsg Edn 2018;19:85-90

How to cite this URL:
Daniel JV, Siva R, Ravikumar TS, Mohan VR, Rebekah G. Effectiveness of community based mass casualty preparedness program among rural youth and their knowledge, attitude and selected skills towards mass casualty management. Indian J Cont Nsg Edn [serial online] 2018 [cited 2022 Oct 6];19:85-90. Available from: https://www.ijcne.org/text.asp?2018/19/2/85/286095

  Introduction Top

Road traffic accidents are gaining international attention as they are causing increasing morbidity and mortality rates. Road traffic accident is becoming a major cause of death and disability globally. Road traffic injuries are ranked 9th globally among the leading cause of death in 2004 and was estimated to rise to the 3rd place by 2020, unfortunately road traffic accidents have already reached 5th rank (World Health Organization [WHO], 2009).

Low income middle income countries have a higher road traffic fatality rate ranging from 19.5% - 21.9% per 100,000 population. Over 90% of the world’s fatalities on the road occur in low and middle income countries, which have 48% of the worlds registered vehicles (WHO, 2009). Approximately 1.3 million people die each year on the world’s roads, and between 20 and 50 million sustain non- fatal injuries. The Global status report on road safety is the first broad assessment of the road safety situation in 178 countries, using data drawn from a standardized survey (WHO, 2018)

The Global status report on road safety 2013 estimates that more than 2,31, 000 people are killed in road traffic crashes in India every year. Approximately half of all deaths on the country’s roads are among vulnerable road users - motorcyclists, pedestrians and cyclists. A heterogeneous traffic mix that includes high-speed vehicles sharing the road space with vulnerable road users as well as unsafe road infrastructure and vehicles that are in poor condition all contribute to the high fatality rates seen on India’s roads (WHO, 2018). India has 3.3 million kilometers of road network which is the second largest in the world. Roads are the most commonly and extensively used mode for transportation. Roads in India carry nearly 65% freight and 87% passenger traffic. National Highways aggregating 57737 km constitute only 1.7% of total road network but carries about 40% if the road traffic and is the lifeline of the country. The total number of road traffic accident deaths in India in the year 2017 is 1, 47, 649 (Government of India, 2017).

Crime Records Bureau (NCRB) report of 2011, in India, showed that 31.3 % of the road traffic deaths were seen among 15 to 29 years individuals. Transport Research Wing of the Ministry of Road Transport and Highways (MORTH) revealed that of the total road accident casualties, 30.3 % were in the age group of 15-24 yr. Statistics reveal that the vehicle population in Tamil Nadu has been increasing by 10 to 11 % every year (Ministry of Transport, India, 2009).

In Tamil Nadu the road accidents are increasing year by year. The highest road accidents has happened during the year 2016, the increase of accident during the year 2016 comparing 2001 was around 37 %, and it has decreased to 26 % during 2017 due to various steps and road safety measures taken by the Government of Tamil Nadu. During the year 2017, the accidents decreased and thereby it has reduced the fatalities and non-fatalities to some extent. The reduced accidents has made tremendous decrease in the number of persons injured. During the year 2017, it was 74,572 which is around 25 percent decrease comparing the previous year 2016.

WHO (2007) considers mass casualty incidents as a major public health issue which puts the community functioning and health at stake. Both natural and manmade disasters causes excess morbidity and mortality in both predictable and unpredictable ways. Preparedness towards the incidents is considered as the imperative method in handling and managing both the predictable and unpredictable disasters. Community participation has been recognized as an essential element in mass casualty management necessary to reverse the worldwide trend of exponential increase in mass casualty due to road traffic accidents.

WHO (2002) defines community participation as a process by which people are enabled to become actively and genuinely involved in defining the issues of concern to them in making decisions about factors that affect their lives, in formulating and implementing policies, in planning, developing and delivering services and taking action to achieve change.

This study was undertaken with an aim to train and equip young men in selected villages in responding to victims of Mass Casualty Incident (MCI) effectively thereby reducing morbidity and mortality.


  • To assess the knowledge, attitude and selected skills of rural youth regarding mass casualty management
  • To determine the effectiveness of the Community Based Mass Casualty preparedness program on knowledge, attitude and skills of rural youth regarding mass casualty management
  • To determine the association between the knowledge, attitude and selected skills of rural youth and the selected demographic variables
  • To determine the relationship between the knowledge, attitude and selected skills of rural youth on Community Based Mass Casualty preparedness program

  Methods Top

A quasi-experimental (pretest and posttest) research design was adopted for this study. The setting of the study was two villages which were 3.5 km far from each other were selected from 26 rural villages of Arcot block in Vellore district by purposive sampling method since these villages were on the highway (NH 46). The selected two villages were assigned to experimental and control group using lot method. Male youth in these two villages aged between 15 -24 years of age, who were permanent residents of the village were recruited for the study. A sampling frame of all the youth in the villages was prepared after a detailed door to door survey by the investigator. Once the sampling frame was developed, the elements were numbered consecutively. Based on the inclusion and exclusion criteria a total of 40 youth were randomly selected for the study from the control and experimental villages.

The instruments for data collections were developed by the researcher based on literature review and were validated. The first component of the instrument included a socio demographic profile. The second component was a questionnaire on knowledge about mass casualty management and included 20 items with four to eight options as answers. The questionnaire had seven sub sections such as general aspects of mass casualty management, scene safety assessment, role delegation, communication, triage, first aid and transportation. The maximum possible score was 42. The third component included an attitude scale (Likert scale) on mass casualty management and contained 11 items with a maximum score of 22. The fourth component included an observation check list on mass casualty management (communication, triaging, first aid and transportation) with a total of 58 items and maximum possible score of 58.

Data Collection Procedure

Data on pretest knowledge, attitude and selected skills of the rural youth regarding mass casually management was collected from the experimental and control group before administering the Community Based Mass Casualty Preparedness Program. The knowledge and attitude questionnaire was administered individually to each participant at a comfortable place near their residence.

The youth from each study village were requested to assemble in the Panchayat building or in the village high school playground. The skill observation was held in a selected safe, quiet conducive corner of the playground. Three volunteers were selected from the village who were not taking part in the study and were asked to act as victims of road traffic accident. The participants were assessed during skill observation based on the observation checklist prepared by the investigator. Following pre-test the Community Based Mass Casualty Preparedness program was administered to the experimental group on the scheduled days. The first session was through lecture and discussion and video presentation. The video had been prepared and validated by experts in Disaster management. The video content included introduction to mass casualty management, scene safety assessment, role delegation, communication, triaging, first aid and transportation. Skills were demonstrated by the investigator and return demonstration was done by the study participants. After three weeks of interval, from the time of administration of mass casualty preparedness program, the youth from the experimental group was visited at their residential area and data for posttest regarding knowledge and attitude was collected.

Ethical Considerations

Permission to conduct the study was obtained from the Institutional Review Board of the institution. Written consent was obtained from the subjects. Confidentiality was maintained throughout the study.

  Results and Discussion Top

The demographic data of the youth participated in the study revealed that in the experimental group and control group, 26 (65 %) and 20 (50%) youth were in the age group 20 24 respectively. In both groups, 17(42.5%) youth had undergraduate level of education. Thirty five (87.5 %) of the youth in experimental and 40 (100 %) in control group had previous exposure to road accidents (p=0.001). In the experimental group 39 (97.5% ) and 40 (100%) youth from control group have not heard about mass casualty preparedness. One youth from experimental group has heard about mass casualty preparedness from his friends. The occupational background of the youth showed that 19 (47.5%) in experimental group and 22 (55%) in control group were students.

Majority of the youth, that is, 34 (85.0%) in experimental group and 22 (55%) in control had inadequate knowledge. In the experimental group 36 (90%) of the youth and 26 (65%) in control group had inadequate skills regarding mass casualty management. Unfavorable attitude towards mass casualty management was seen in 28 (70%) youth in the experimental group and 30 (75%) in the control group [Figure 1]. Sosada, Zurawiñski, Stepieñ, Makarska, and Myrcik, (2002) evaluated the knowledge of teachers and high school students in Silesia on the principles of first aid. The study revealed that 7 (3.01%) students achieved an excellent result, 57(24.5%) had good result and 168(72.4%) had inadequate level of knowledge which showed that the knowledge of secondary school students and teachers were insufficient to perform basic life support which was similar to the current study reports. In the present study inadequate skills regarding mass casualty management was seen in 36 (90%) and 26 (65%) of the youth in experimental and control group respectively. In the aspect of communication, majority of the youth (95% and 90%) in the experimental and control group respectively had moderately adequate knowledge before the intervention. Skills in triaging, first aid and shifting was found to be inadequate among all the youth in the pretest. In a study where 654 adults (mainly parents) were surveyed on first aid practices such as care of wounds, burns, stings and none answered all questions correctly with roughly half being familiar with 60% of the questions regarding first aid practices (Singer, Gulla, Thode, & Cronin, 2004). In another cross sectional study on current practice and perception of first aid among lay first responders in a rural southern district of India, the findings revealed that 60% had witnessed atleasttwo emergencies in the previous six months and 90 % were aware of the locally available public ambulance number (108). Only half the participants were aware of scene safety, 58 % felt confident to give first aid and 68 % of the participants had knowledge on correct position for transporting victims (Pallavisaiji, Gururaj, & Girish, 2013) The current study as well as evidence from previous studies reveals a lack of knowledge and skill in managing MCI. Contrary to this study Prabu Doss (2006) in his study found 61.1 % of the youth had favorable attitude towards first aid in a community setting.
Figure 1: Pretest Knowledge, Skill, and Attitude among the Youth in Experimental and Control Group

Click here to view
Figure 2: Knowledge, Skill, and Attitude on mass casually management among the youth after the intervention

Click here to view

All the youth in the experimental group had adequate knowledge in posttest. Twenty two (55%) and 18 (45%) youth in control group had inadequate and adequate knowledge respectively in the posttest. All the youth in the experimental group had adequate skill after the intervention whereas Only 34 (85%) in the control group had adequate skill and 6 (15%) had inadequate skill. Favorable attitude was seen in 21 (52.5%) youth in experimental group and 10 (25%) in control group.

There was a significant difference in the mean knowledge (p < .01), skill (p< .01) and attitude (p< .01) scores in the experimental group after the intervention [Table 1]. In the control group the difference in mean scores in knowledge and skill of mass casualty management was not significant [Table 2]. However, the difference in attitude was significant at p< .001 [Table 2]. Introducing the concept of MCI itself could have influenced the attitude. All youth (100%) in experimental group had adequate knowledge in providing first aid and 90% of them in triaging after the training. Adequate skills in triaging and transporting during MCI was observed in all (100%) and in communicating in 97.5% in experimental group after the training showing that the training was very effective and useful in improving knowledge, skills and attitude. Effective communication and wise triaging are important components in mass casually management. Similar to this findings training program on managing multiple casualty incidents was found to increase management. Similar to this findings training program on managing multiple casualty incidents was found to increase post-test knowledge scores of fire fighters, emergency medical service personnel and other first responders specially in the areas of communication and triage in another study (Glow, Colucci, Allington, Noonan, & Hall, 2013) Even a simple table top exercise on mass casualty incident triage showed 90% triage accuracy in the intervention group of doctors and nurses compared to 70% in the control group (Khan, 2018). Education and training has been similarly proven to improve knowledge and skills in providing first aid (Schmidt & Ford, 2003) and in handling disaster or MCI events (Alharbi, 2018) in other studies. Change in attitude although was significant after the training, unfavarouble attitude was still noted in many (47.5%) which needs further exploration.
Table 1: Mean Knowledge, Skills and Attitude levels among Experimental Group Before and After the Community Based Mass Casualty Preparedness Program

Click here to view
Table 2: Mean Knowledge, Skills, and Attitude levels among Control Group in the Pretest and Posttest

Click here to view

Bistaraki (2011) found that there was significant improvement in the knowledge level of the participants after a 5 hour training program on disaster management. The mean score in the post test had increased to 86 (SE: 2) from 44.5(SE: 1.7) (pcO.OOl). The study also found that the mean knowledge score one month after the training was significantly lower than the mean knowledge score immediately after the program. Participants in the control group achieved a score of 40 (SE: 2.4), which was significantly lower than the scores of the intervention group after the course (P < 0.001). A study done by Scott et al. (2006) to assess the skill improvement during emergency terrorism response training found that an interactive simulation enhanced curriculum of terrorism response training for emergency responders can produce significant quantifiable individual and team skill gain. The findings of the current study support the results of the above studies and high lights the importance of short and long term training in mass casualty management.

Significant association was found in the study between occupation and knowledge in the control group. No other associations were found in the study. The reason for this finding might be because the sample size was only 40 in each experimental and control group and the similarity of demographic background of participants. This finding supports the findings of the study by Mahmoud and Elsayd (2013) which records that there was no significant statistical association between the demographic profile and first aid knowledge of the University employees. However in the post test knowledge was associated with education status of the participants.

This study found that there was a strong correlation between knowledge and skill in the experimental group in the post test (r=0.574, ρ =0.000). There was a weak positive correlation between knowledge and attitude during post-test (r=0.338) significant at ρ value 0.033. There was a weak positive correlation between the knowledge and skill in the control group during the pre and post-test.

  Conclusion Top

This study has revealed that the structured teaching program was effective and has brought about positive change in knowledge attitude and skills regarding mass casualty management. There was a favorable level of attitude among the rural youth towards mass casualty preparedness. As proclaimed in any national and international disaster management programme and according to the Sendai framework on disaster risk reduction, capacity building through consistent and continuous training is to be emphasized in all organizations as well as at the community level.

Conflicts of Interest: The authors have declared no conflicts of interest.

  References Top

Alharbi, A. A. (2018). Effect of Mass Casualty Training Program on Prehospital Care Staff in Kuwait. Egyptian Journal of Hospital Medicine, 71(6).  Back to cited text no. 1
Bistaraki, A., Waddington, К., & Galanis, P. (2011). The effectiveness of a disaster training programme for healthcare workers in Greece. International Nursing review, 58(3), 341-346.  Back to cited text no. 2
Glow, S. D., Colucci, V. J., Allington, D. R., Noonan, C. W., & Hall, E. С. (2013). Managing multiple-casualty incidents: A rural medical preparedness training assessment. Prehospital and Disaster Medicine, 28(4), 334-341.  Back to cited text no. 3
Government of India. (2017). Ministry of statistics and programme implementation. Retrieved from http://mospi.nic.in/statistical-year-book- india/2017/207  Back to cited text no. 4
Khan, K. (2018). Tabletop Exercise on Mass Casualty Incident Triage, Does it Work?. Health Science Journal, 12(3).  Back to cited text no. 5
Li, F., Jiang, F., Jin, X., Qiu, Y., & Shen, X. (2012). Pediatric first aid knowledge and attitudes among staff in the preschools of Shanghai, China. BMC pediatrics, 12( 1), 121.  Back to cited text no. 6
Mahmoud HM, Elsayed MS. Designing and Implementing A first Aid Program for Employees of Female Health Colleges at Najran University. International Journal of Advanced Research, 1(9): 269-285.  Back to cited text no. 7
Ministry of Road Transport and Highways. (2009). Road Accidents. Retrieved from http://morth.nic.in /index 1. asp?lang= 1 &linkid=2&lid= 10  Back to cited text no. 8
National Crime Records Bureau. (2011). Accidental Deaths and Suicides in India. Retrieved from http://ncrb.gov.in/  Back to cited text no. 9
Pallavisarji, U., Gururaj, G, & Girish, R. N. (2013). Practice and perception of first aid among lay first responders in a southern district of India. Archives of trauma research, 1(4), 155.  Back to cited text no. 10
Prabudoss, D. (2006). A study to assess the effectiveness of structured teaching programme on knowledge, attitude and skillsfirst aid management among rural youth in Vellore (Unpublished master’s thesis). Tamilnadu Dr. M. G. R. Medical University, India.  Back to cited text no. 11
Sosada, K, Zurawinski, W., Stepien, T., Makarska, J., & Myrcik, D. (2002). Evaluation of the knowledge of teachers and high school students in Silesia on the principles of first aid. Wiadomosci lekarskie, 55(2), 883-889.  Back to cited text no. 12
Schmidt, A. M., & Ford, J. K. (2003). Learning within a learner control training environment: The interactive effects of goal orientation and metacognitive instruction on learning outcomes. Personnel Psychology, 56(2), 405-429.  Back to cited text no. 13
Scott, J. Α., Miller, G T., Barry Issenberg, S., Brotons, A. A., Gordon, D. L., Gordon, M. S., … & Petrusa, E. R. (2006). Skill improvement during emergency response to terrorism training. Prehospital Emergency Care, 10(4), 507-514.  Back to cited text no. 14
Singer, A. J., Gulla, J., Thode, H. C., & Cronin, K. A. (2004). Pediatric first aid knowledge among parents. Pediatric emergency care, 20(12), 808-811.  Back to cited text no. 15
World Health Organsaition. (2002). Community participation in local health ad sustainable development: Approaches and techniques. Retrieved from http://www.euro.who.int/_data/ assets/pdf_file/0013/101065/E78652.pdf  Back to cited text no. 16
World Health Organsiation. (2007). Mass Casualty Management Systems Strategies and guidelines for building health sector capacity. Retrieved from http://www.who.int/hac/techguidance/MCM_guide lines_inside_final.pdf  Back to cited text no. 17
World health organization. (2009). Violence and injury prevention: Global status report on road safety 2009. Retrieved fromhttp://www.who.int/violence_ injury_prevention/road_safety_status/2009/en/  Back to cited text no. 18
World health organsation. (2018). Violence and Injury Prevention: Global status report on road safety. Retrieved from https://www.who.int/violence_ injury_prevention/road_safety_status/report/en/  Back to cited text no. 19


  [Figure 1], [Figure 2]

  [Table 1], [Table 2]


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

  In this article
Results and Disc...
Article Figures
Article Tables

 Article Access Statistics
    PDF Downloaded69    
    Comments [Add]    

Recommend this journal