title: The use of advanced simulation in the training of anesthesiologists to treat chemical warfare casualties.
abstract: Training anesthesiologists to treat nerve gas intoxication in a mass casualty scenario is a complicated task. The scenario is an unfamiliar medical situation involving the need to decontaminate patients before providing definitive medical treatment, and the need for physical protection to the medical team before decontamination. We describe the development of a simulation-based training program. In one site of a virtual hospital, anesthesiologists were trained in initial airway and breathing resuscitation before decontamination while wearing full protective gear. In another site, they were trained in the treatment of critically-ill patients with combined conventional and chemical injuries or severe intoxication. Intubation simulators of newborn, pediatric, and adult patients, advanced full-scale simulators, and actors simulating patients were used. Initial airway, breathing, and antidotal treatment were performed successfully, with or without full protective gear. The gas mask did not interfere with orotracheal intubation, but limited effective communication within the medical team. Chemical protective gloves were the limiting factor in the performance of medical tasks such as fixing the orotracheal tube. Twenty-two participants (88%) pointed out that the simulated cases represented realistic problems in this scenario, and all 25 participants found the simulated-based training superior to previous traditional training they had in this field. Using advanced simulation, we were able to train anesthesiologists to treat nerve gas intoxication casualties and to learn about the limitations of providing medical care in this setting.
  
  
  CONCLUSIONS
  Advanced medical simulation can be used to train anesthesiologists to treat nonconventional warfare casualties. The limitations of medical performance in full protective gear can be learned from this training.
authors.affiliation: Departments of *Anesthesiology and Intensive Care and †Pediatric Critical Care, and ‡The Israeli Center for Medical Simulation, The Chaim Sheba Medical Center, Tel Hashomer, Israel. Affiliated with the Sackler School of Medicine, Tel Aviv University.
authors.forename: Haim
authors.initials: H
authors.lastname: Berkenstadt
authors.forename: Amitai
authors.initials: A
authors.lastname: Ziv
authors.forename: Daphna
authors.initials: D
authors.lastname: Barsuk
authors.forename: Inbal
authors.initials: I
authors.lastname: Levine
authors.forename: Amir
authors.initials: A
authors.lastname: Cohen
authors.forename: Amir
authors.initials: A
authors.lastname: Vardi
mesh_terms: D000776:Anesthesiology / Q000193:education*; D000931:Antidotes / Q000008:administration & dosage / Q000627:therapeutic use; D002618:Chemical Warfare; D002619:Chemical Warfare Agents / Q000506:poisoning*; D003142:Communication; D004632:Emergency Medical Services; D006801:Humans; D010348:Patient Care Team; D016544:Patient Simulation; D011041:Poisoning / Q000628:therapy; D012140:Respiratory Tract Diseases / Q000139:chemically induced / Q000628:therapy; D011795:Surveys and Questionnaires
chemical_list: D000931:Antidotes; D002619:Chemical Warfare Agents