title: A multidisciplinary approach to teach responses to weapons of mass destruction and terrorism using combined simulation modalities.
abstract: OBJECTIVE
  To reinforce concepts presented in the lectures; understand the complexity and speed of casualty and information generation during a Weapons of Mass Destruction and Terrorism (WMD/T) event; experience the novelty of combined weapons' effects; recognize the time course of the various chemical, biological, and radiation agents; and make challenging decisions with incomplete and conflicting information.
  
  
  METHODS
  Two environments simulated simultaneously: one a major trauma center emergency room (ER) with two patient simulators and several human actors; the other an Emergency Operations Command Center (EOC).
  
  
  BACKGROUND
  Students for this course included: clinicians, scientists, military and intelligence officers, lawyers, administrators, and logistic personnel whose jobs involve planning and executing emergency response plans to WMD/T. SIMULATION SCRIPT: A WMD/T attack in Washington, D.C., has occurred. Clinical students performed in their real life roles in the simulated ER, while nonclinical students did the same in the simulated EOC. Six ER casualties with combined WMD/T injuries were presented and treated over 40 minutes. In the EOC, each person was given his or her role title with identification tag. The EOC scenario took cues from the action in the ER via two television (TV) news feeds and telephone calls from other Emergency Operations Assets. PERFORMANCE EXPECTATIONS: Students were expected to actively engage in their roles. Student performances were self-evaluated during the debriefing. DEBRIEFING: The two groups were reunited and debriefed utilizing disaster crisis resource management tools. ASSESSMENT OF EFFECTIVENESS: Students answered an 18-point questionnaire to help evaluate the usefulness and acceptance of multimodality patient simulation.
  
  
  CONCLUSIONS
  Large-scale multimodality patient simulation can be used to train both clinicians and nonclinicians for future events of WMD/T. Students accepted the simulation experience and thought that scenario was appropriately realistic, complex, and overwhelming. Difficulties include the extensive man-hours involved in designing and presenting the live simulations. EOC-only sessions could be staged with only a few video cassette recorders, TVs, telephones, and callers.
authors.affiliation: Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA. rkyle@usuhs.mil
authors.forename: Richard R
authors.initials: RR
authors.lastname: Kyle
authors.forename: Darin K
authors.initials: DK
authors.lastname: Via
authors.forename: R Joel
authors.initials: RJ
authors.lastname: Lowy
authors.forename: James M
authors.initials: JM
authors.lastname: Madsen
authors.forename: Aileen M
authors.initials: AM
authors.lastname: Marty
authors.forename: Paul D
authors.initials: PD
authors.lastname: Mongan
mesh_terms: D004190:Disasters; D004219:District of Columbia; D004504:Education, Medical, Undergraduate; D004631:Emergency Medical Service Communication Systems; D004636:Emergency Service, Hospital; D006801:Humans; D016544:Patient Simulation; D023481:Terrorism; D014193:Trauma Centers