title: Using innovative simulation modalities for civilian-based, chemical, biological, radiological, nuclear, and explosive training in the acute management of terrorist victims: A pilot study.
abstract: OBJECTIVE
  Chemical, biological, radiological, nuclear, and explosive (CBRNE) incidents are low frequency, high impact events that require specialized training outside of usual clinical practice. Educational modalities must recreate these clinical scenarios in order to provide realistic first responder/receiver training.
  
  
  METHODS
  High fidelity, mannequin-based (HFMB) simulation and video clinical vignettes were used to create a simulation-based CBRNE course directed at the recognition, triage, and resuscitation of contaminated victims. The course participants, who consisted of first responders and receivers, were evaluated using a 43-question pre- and post-test that employed 12 video clinical vignettes as scenarios for the test questions. The results of the pre-test were analyzed according to the various medical training backgrounds of the participants to identify differences in baseline performance. A Scheffe post-hoc test and an ANOVA were used to determine differences between the medical training backgrounds of the participants. For those participants who completed both the pre-course and post-course test, the results were compared using a paired Student's t-test.
  
  
  RESULTS
  A total of 54 first responders/receivers including physicians, nurses, and paramedics completed the course. Pre-course and post-course test results are listed by learner category. For all participants who took the pre-course test (n = 67), the mean value of the test scores was 53.5 +/- 12.7%. For all participants who took the post-course test (n = 54), the mean value of the test scores was 78.3 +/-10.9%. The change in score for those who took both the pre- and post-test (n = 54) achieved statistical significance at all levels of learner.
  
  
  CONCLUSIONS
  The results suggest that video clinical vignettes and HFMB simulation are effective methods of CBRNE training and evaluation. Future studies should be conducted to determine the educational and cost-effectiveness of the use of these modalities.
authors.affiliation: Department of Emergency Medicine, Johns Hopkins University, Baltimore, Maryland, USA. italo_subbarao@yahoo.com
authors.forename: Italo
authors.initials: I
authors.lastname: Subbarao
authors.forename: William F
authors.initials: WF
authors.lastname: Bond
authors.forename: Christopher
authors.initials: C
authors.lastname: Johnson
authors.forename: Edbert B
authors.initials: EB
authors.lastname: Hsu
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Wasser
mesh_terms: D023482:Bioterrorism; D051337:Chemical Terrorism; D004059:Diffusion of Innovation; D004189:Disaster Planning; D004521:Educational Measurement; D004632:Emergency Medical Services / Q000458:organization & administration*; D005107:Explosions; D006801:Humans; D009689:Nuclear Warfare; D010865:Pilot Projects; D011361:Professional Competence / Q000592:standards; D013663:Teaching / Q000379:methods*; D014481:United States