editorial · Frontiers in Disaster and Emergency Medicine
This commentary examines the D2PuLs simulation platform, a digital environment designed for mass-casualty incident training. The system integrates dynamic patient physiology, configurable prehospital and hospital scenarios, hybrid use alongside physical manikins, and data-supported debriefing. While traditional training relies on static cards, dynamic simulations better reflect patient deterioration, resource allocation, and competing pressures. Initial field tests involving 13 clinical participants, including seven nurses, focused on feasibility, technical delivery, usability, and self-assessed learning. However, because trial findings grouped all clinical participants together, distinct impacts on nursing roles remain unmeasured. Nursing and medical personnel have different responsibilities and learning needs during major incidents. Future trials need role-specific learning objectives and evaluations to establish whether the system improves clinical performance and patient safety beyond current feasibility findings.
Mass-casualty incidents place intense demands on healthcare teams. Digital simulation tools that model real-time patient deterioration can improve preparedness, but training platforms must be thoroughly assessed. Clarifying how different professions, such as nurses and doctors, interact with these systems ensures training reflects actual clinical responsibilities and improves emergency readiness.
The technology is an applied training platform combining digital simulation software with physical manikins for emergency and healthcare organisations. It currently sits at an applied feasibility stage, having undergone small-scale technical and usability field testing. Moving towards broader operational deployment will require targeted clinical trials that demonstrate verified improvements in interprofessional performance and patient safety outcomes.
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A commentary on Konrad R, Pfadenhauer T, Eckenweber L, Banahovschi A, Braun C, Reuter T, Popp S, Engelen C, Baierl L, Soy M and Bauer C (2026) Digital cross-sectoral training with dynamic patient and situation simulation in the context of mass casualty incidents-insights from the research projects D2PuLs and D2PuLs PRO. Front. Disaster Emerg. Med. 4:1756349. doi: 10.3389/femer.2026.1756349. Konrad et al. describe a modular digital simulation environment that combines dynamic patient physiology, configurable clinical and prehospital scenarios, hybrid use with manikins, and data-supported debriefing for mass-casualty incident training (1). This is a valuable advance because it makes deterioration, competing demands, and resource allocation more visible than static patient cards. The evidence is nevertheless preliminary: the reported field tests primarily addressed feasibility, usability, technical implementation, organizational process, and self-assessed learning rather than observed clinical performance or patient-safety outcomes (1). A nursing-focused extension should therefore build on the platform's demonstrated feasibility while avoiding claims of established effectiveness.The clinical field trial included 13 participants, of whom seven had nursing qualifications: six with specialist training in emergency, anesthesia, or intensive care and one with general nursing preparation (1). However, evaluation results were presented for the clinical group as a whole. This aggregation limits interpretation because nursing and medical participants may have different responsibilities, learning needs, interface risks, and performance expectations. Future D2PuLs evaluations should define professionspecific learning objectives before each scenario and report outcomes by role, while preserving interprofessional team measures. examine what happened, why it happened, and which system conditions shaped performance. Evidence-77 based debriefing standards emphasize planned reflection and a safe learning environment (8,9). 78In conclusion, D2PuLs offers a promising and adaptable foundation, but its nursing value will depend 79 on making nursing roles, objectives, and outcomes explicit. The appropriate next claim is not that patient 80 safety has already improved, but that platform provides preliminary feasibility evidence and a testable 81 opportunity to strengthen nursing and interprofessional performance across the mass-casualty care 82 pathway. 83
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DOI: 10.3389/femer.2026.1931354
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