Reframing disaster simulation as a translational systems intervention: a design-based comparative analysis of MRMI and the Emergo Train System (ETS)

Abstract Background Disaster simulation is central to emergency preparedness; however, many simulation designs insufficiently represent disasters as prolonged, system-disruptive, and ethically complex events. Exercises frequently emphasize mass-casualty throughput, rely on simplified assumptions, and evaluate success primarily in terms of task completion rather than system performance and organizational learning. This study examines how disaster simulation design shapes preparedness outcomes and explores how simulation may be reframed as a translational systems intervention. Methods A qualitative design-based research approach was used to conduct an inductive comparative framework analysis of two established disaster simulation paradigms: Medical Response to Major Incident (MRMI) and the Emergo Train System (ETS). Documentary sources included curricula, instructional materials, scenario templates, published evaluations, disaster evidence literature, and World Health Organization Emergency Medical Team standards. Simulation design features were extracted and compared using constant comparative analysis, and the findings were subsequently interpreted through socio-technical systems and resilience engineering perspectives. Results Four recurrent design-level tensions were identified using harmonized terminology: (1) divergent disaster conceptualization (governable surge versus unstable system disruption); (2) fidelity emphasis imbalance (cognitive versus behavioral realism); (3) incident-centric temporal framing; and (4) inconsistent translation into organizational learning. Published evaluation reports suggest that MRMI may support governance alignment and coordinated surge reasoning, whereas ETS may provide greater operational realism and more opportunities to expose teamwork under stress. Neither paradigm alone appears to fully address all design requirements relevant to sustained disaster-level system resilience. Conclusions MRMI and ETS appear complementary but individually incomplete. A staged hybrid architecture integrating governance modeling, operational stress testing, longitudinal degradation modeling, and structured reflective translation is proposed as a design-oriented framework. This framework may help position disaster simulation as a translational systems intervention that connects exercise performance to potentially measurable organizational preparedness and system resilience, while still requiring empirical validation in practical settings.