60 Seconds to Survival

KET Coalition member Angie Bowen has served the healthcare community of East Tennessee and been an active member of the KET Coalition for many years. Angie has 26 years of emergency nursing experience and has held multiple leadership roles in the emergency response setting.  Before joining  REAC/TS, she served as the EMSC (Emergency Medical Services for Children) Regional Coordinator and the Trauma Coordinator at East Tennessee Children’s Hospital in Knoxville. She has also worked in the pre-hospital setting in both EMS and rescue capacities for 29 years.

Before leaving East Tennessee Children’s hospital, Angie partnered with pediatric specialists across the nation to pilot a study for pre-hospital providers: 60 Seconds to Survival.Since that time, this work has been ongoing, and the study was recently published in the American Journal of Disaster Medicine. A summary of the study results are below. We’re proud of the many accomplishments our Coalitions partners make in not only our community, but across the nation!


Disaster triage training for emergency medical service (EMS) providers is not standardized. Simulation training is costly and time-consuming. In contrast, educational video games enable low-cost and more time-efficient standardized training. We hypothesized that players of the video game “60 Seconds to Survival” (60S) would have greater improvements in disaster triage accuracy compared to control subjects who did not play 60S.


Participants recorded their demographics and highest EMS training level and were randomized to play 60S (intervention) or serve as controls. At baseline, all participants completed a live school-shooting simulation in which manikins and standardized patients depicted 10 adult and pediatric victims. The intervention group then played 60S at least three times over the course of 13 weeks (time 2). Players triaged 12 patients in three scenarios (school shooting, house fire, tornado), and received in-game performance feedback. At time 2, the same live simulation was conducted for all participants. Controls had no disaster training during the study. The main outcome was improvement in triage accuracy in live simulations from baseline to time 2. Physicians and EMS providers predetermined expected triage level (RED/YELLOW/GREEN/BLACK) via modified Delphi method.


There were 26 participants in the intervention group and 21 in the control group. There was no difference in gender, level of training, or years of EMS experience (median 5.5 years intervention, 3.5 years control, p = 0.49) between the groups. At baseline, both groups demonstrated median triage accuracy of 80 percent (IQR 70-90 percent, p = 0.457). At time 2, the intervention group had a significant improvement from baseline (median accuracy = 90 percent [IQR: 80-90 percent], p = 0.005), while the control group did not (median accuracy = 80 percent [IQR:80-95], p = 0.174). However, the mean improvement from baseline was not significant between the two groups (difference = 6.5, p = 0.335).


The intervention demonstrated a significant improvement in accuracy from baseline to time 2 while the control did not. However, there was no significant difference in the improvement between the intervention and control groups. These results may be due to small sample size. Future directions include assessment of the game’s effect on triage accuracy with a larger, multisite site cohort and iterative development to improve 60S.

For more information on this pilot project: https://www.ncbi.nlm.nih.gov/pubmed/29136270

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