Abstract
BACKGROUND: Hospital-based simulations are vital for disaster preparedness. Anxiety and other emotions may affect hospital staff by influencing non-technical skills. We investigated self-reported emotional and organizational factors among hospital professionals during a large-scale disaster simulation. METHODS: We conducted a cross-sectional study using a self-reported web survey administered after a large-scale in-hospital fire simulation at a level 1 trauma center. The primary outcome was self-reported anxiety intensity during the exercise on a 0 to 10 numerical rating scale. We compared anxiety levels between staff working in emergency versus non-emergency settings and performed a cluster analysis to identify participant profiles based on emotional and organizational perceptions. RESULTS: Of 89 participants, 72 (80.9%) completed the survey. Emergency professionals reported significantly higher anxiety during the exercise (median 3 [1-5] versus 1.5 [0-3] for non-emergency professionals; p = 0.01). Exploratory cluster analysis suggested three distinct professional profiles: Cluster 1 (n = 19; 26.4%) included non-emergency staff with limited experience, characterized by lower enthusiasm and increased communication difficulty; Cluster 2 (n = 28; 38.9%) comprised experienced emergency professionals with high enthusiasm and low negative emotions; and Cluster 3 (n = 25; 34.7%) was composed predominantly of non-emergency staff with general but limited large-scale simulation experience and reported higher negative emotions despite a high level of preparedness. Perceived safety was significantly associated with increased odds of institutional trust (OR = 1.55; 95% CI [1.11-2.16]; p = 0.009). CONCLUSIONS: Emergency professionals reported higher anxiety levels during the simulation than professionals working in non-emergency settings, although absolute anxiety levels remained low overall. Exploratory cluster analysis suggested heterogeneous emotional and organizational response profiles, particularly among less experienced and non-clinical staff. These findings support the development of role-specific disaster training and simulation designs that reinforce perceived safety.