title: Just-in-time learning is effective in helping first responders manage weapons of mass destruction events.
abstract: BACKGROUND
  Chemical, biologic, radiologic, nuclear, and explosive (CBRNE) incidents require specialized training. The low frequency of these events leads to significant skill decay among first responders. To address skill decay and lack of experience with these high-impact events, educational modules were developed for mobile devices to provide just-in-time training to first responders en route to a CBRNE event. This study assessed the efficacy and usability of the mobile training.
  
  
  METHODS
  Ninety first responders were randomized to a control or an intervention group. All participants completed a pretest to measure knowledge of CBRNE topics. The intervention group then viewed personal protective equipment and weapons of mass destruction field management videos as an overview. Both groups were briefed on a disaster scenario (chemical nerve agent, radiologic, or explosives) requiring them to triage, assess, and manage a patient. Intervention group participants watched a mobile training video corresponding to the scenario. The control group did not receive prescenario video training. Observers rated participant performance in each scenario. After completing the scenarios, all participants answered a cognitive posttest. Those in the intervention group also answered a questionnaire on their impressions of the training.
  
  
  RESULTS
  The intervention group outperformed the control group in the explosives and chemical nerve agent scenarios; the differences were statistically significant (explosives, mean of 26.32 for intervention and 22.85 for control, p < 0.01; nerve agent, mean of 23.14 for intervention and 16.61 for control, p < 0.01). There was no statistically significant difference between the groups in the radiologic scenario (mean, 12.7 for intervention and 11.8 for control; p = 0.51). The change in pretest to posttest cognitive scores was significantly higher in the intervention group than in the control group (t = 3.28, p < 0.05).
  
  
  CONCLUSIONS
  Mobile just-in-time training improved first-responder knowledge of CBRNE events and is an effective tool in helping first responders manage simulated explosive and chemical agent scenarios.
  
  
  METHODS
  Therapeutic/care management study, level II.
authors.affiliation: From the Gordon Center for Research in Medical Education (I.M., A.A.B., R.D.R., H.F.R., S.B.I.), and William Lehman Injury Research Center (K.F.W., S.H. C.I.S.), Department of Surgery, University of Miami Miller School of Medicine (W.A.B.), Miami, Florida.
authors.forename: Ivette
authors.initials: I
authors.lastname: Motola
authors.forename: William A
authors.initials: WA
authors.lastname: Burns
authors.forename: Angel A
authors.initials: AA
authors.lastname: Brotons
authors.forename: Kelly F
authors.initials: KF
authors.lastname: Withum
authors.forename: Richard D
authors.initials: RD
authors.lastname: Rodriguez
authors.forename: Salma
authors.initials: S
authors.lastname: Hernandez
authors.forename: Hector F
authors.initials: HF
authors.lastname: Rivera
authors.forename: Saul Barry
authors.initials: SB
authors.lastname: Issenberg
authors.forename: Carl I
authors.initials: CI
authors.lastname: Schulman
mesh_terms: D000328:Adult; D004189:Disaster Planning; D004632:Emergency Medical Services / Q000458:organization & administration*; D004635:Emergency Medicine / Q000193:education*; D060731:Emergency Responders / Q000193:education*; D005260:Female; D006801:Humans; D008297:Male; D011361:Professional Competence; D011795:Surveys and Questionnaires; D014741:Video Recording; D054044:Weapons of Mass Destruction