Enhancing emergency response in Somalia: Evaluating the WHO Mass Casualty Management course in trauma hospitals.

Introduction: The ongoing conflict between the Somali National Army and non-state armed actors has led to an increase in mass casualty incidents (MCIs) which burden the fragile Somali healthcare system. Hospitals often become overwhelmed during MCIs, which can lead to increased mortality. To address this gap in mass casualty management (MCM), the WHO developed the MCM course to help hospitals address MCIs through the creation of individualized MCM plans. This study evaluated the effect of the WHO MCM course on participants' knowledge of MCM concepts and self-reported confidence in managing MCIs in trauma hospitals in Somalia. Methods: A prospective pre-post educational study was conducted with healthcare teams from trauma hospitals across Somalia in October 2023. The four-day MCM course utilized lectures and interactive tabletop exercises to introduce MCM concepts, simulate MCI scenarios, and help participants develop MCM plans. Participants' knowledge was assessed using multiple choice pre- and post-tests. Confidence was evaluated using a 4-point Likert scale surveys, feedback forms were used to assess course acceptability. Paired t-tests and Cohen's d were used to analyze pre-post changes. Results: The MCM course was completed by 23 participants from 3 regions across Somalia. They had an average of 8.5 years of clinical experience and 3 years of MCM experience. The mean post-course test scores (78.9%) showed a significant improvement (p<0.001; Cohen's d=1.82) compared to pre-course test scores 47.9% (28%-72%). There was also an improvement in self-reported confidence in the implementation and activation of MCM plans (d=0.49), understanding of MCM roles and responsibilities (d=0.55). The largest gains were in operational readiness (d=1.42), including clearing the emergency unit, documentation, and triage planning. Conclusion: The MCM course improved participant's knowledge of key MCM concepts and self-reported confidence in managing MCIs. Although limited by small sample size and reliance on self-reported outcomes, findings suggest the course may support improved MCM readiness in conflict-affected settings.