1. The prehospital part of an exercise training the whole chain of management (organized in collaboration between the Croatian Ministry of Health, the European Society for Trauma & Emergency Surgery and the Croatian Society for Emergency Surgery & Medicine April 2009). At the tables triage teams making decision with regard to priority and treatment before transport under the leadership of the Medical Incident Commander (with radio). In the background,  Chief of Transport (also with radio). The scenario is a terror bomb at a swimming resort with 360 injured and dead and the injuries are the same as at the terror bombing in Madrid. Chief instructor on this position is Bob Dobson (blue shirt) from London Ambulance Service with extensive practical   experience from, scenarios of this kind.
2. A hospital is built up with receiving unit, surgery, intensive care, wards and other critical functions. The resources with regard to available staff och different categories, equipment, surgical theatres, ventilators, beds etc are exactly according to figures in reality."Non-disaster-patients" are illustrated with special cards.
   
3. Instructor candidates train the participants in the MRMI-course in primary and secondary triage in groups, supported and supervised by senior faculty. The aim with this group training is to prepare the participants for the simulation exercises. The training includes the whole chain of the Major Incident Response: Scene, primary and secondary triage, transport, in-hospital management and performance, coordination and command on hospital - and regional level.
   
4. The simulation exercise has started: The first triage team deals with casualties trapped on scene with given times needed for extrication. Decision has to be made what to do or not to do on scene, and with which priority.
   
5. Secondary triage and decision making with regard to treatment on scene: If the trainee decides to indicate treatment of any kind, patient and staff are “frozen” during the time it takes to do that treatment in reality: See timer around the neck of the instructor.
   
6. The load of casualties is heavy: 400 injured and dead after terrorist attack. The injuries are from a real scenario, which makes the exercise realistic.
   
7. High pressure on the transport officer who has to utilize ambulances and helicopters optimally, and also distribute the patients correctly between hospitals in communication with the different hospitals via the Regional Command Centre: Sending patients requiring immediate surgery to a hospital without immediately available theatres will result in mortality.
   
8. Patients arrive to the hospitals, new triage and distribution to available “Major Incident Teams” at the Emergency Department. Also at this position, real times: A blocked team is a blocked team.
   
9. Utilization of diagnostic procedures as CT, which has to be restrictive in this situation, is illustrated.
   
10. Utilization of surgical theatres. Again, real times for all procedures. Need of qualified staff is illustrated
   
11. Available staff, depending on degree of alert. How to handle incoming staff in a big hospital can be a problem in itself, requiring attention and preparation.
   
12. Instructor candidate controls and registers in-hospital management and performance using prepared protocols as a base for the later careful evaluation.
   
13. The Hospital Command Groups are, as in reality, located on another floor than the hospital departments, requiring telephone communication and also equipped with radios. The same is valid for the Regional Command Centre.
   
14. Evaluation of all patients who died after arrival of medical teams, related to both Revised Trauma Score (primary condition) and Injury Severity Score (final diagnosis). Potentially avoidable mortality as well as complications (= result of the performance) is carefully evaluated.
   
15. Instructor candidates are trained to lead evaluation under supervision of senior faculty. This is an important part of the exercise: What can be improved, and how? The participants are given a second chance with two consecutive whole-day simulation exercises, which illustrates how decision making and performance really can be improved by training.