Dispatch center performance and crisis resource management skills in mass casualty incidents: a prehospital simulation study preparing for 2026 Milan-Cortina Olympics

BACKGROUND: In Lombardy (Italy), Emergency Medical Dispatch Centers (EMDCs) play a crucial role in Mass Casualty Incidents (MCIs). These events put the staff under strain because, in addition to the usual burden of emergency calls, there is also the need to handle the inflow of information and coordinate the incident response. Crisis Resource Management (CRM) skills may strongly influence performance during complex situations. This study evaluates the performance of the Milan EMDC during a series of simulated MCIs and its correlation with staff CRM skills. METHODS: Twelve high-fidelity simulations were conducted over 19 months. A set of published Key Performance Indicators (KPIs) was measured as follows: 2 points (correct and timely action), 1 point (correct but delayed action), and 0 points (action not performed or incorrect). The score was then proportioned to the total obtainable and converted into a percentage for comparison. The Ottawa CRM Global Rating Scale (1- to 7-point scoring) was used by two independent raters to evaluate CRM skills. RESULTS: The average KPI score across scenarios was 72.9% (45.8%-95.8%, SD 15.6). The Ottawa scale averaged 73.8% (41.7%-100%, SD 19.0), with an interrater agreement of 88.9% (κ = 0.66). A strong correlation between KPI and Ottawa CRM scores was found (Pearson correlation coefficient = 0.78). CONCLUSIONS: Our findings showed a strong correlation between the performance of the Milan EMDC during simulated MCIs and staff CRM skills.