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Vital Signs

Terrorism response training—available anytime, anywhere

As most people walk or drive through their communities, they see houses, businesses, schools, hospitals. Terrorists see targets. They see patterns and connections, causes and effects. An explosion on a chlorine tanker here sends a toxic cloud downwind there, toward a crowded stadium and an adjacent hospital. The release of a virulent biological weapon here spreads disease there and there and there.

Casualties: Such events would lead to mass casualties, and they would thrust senior health-care providers into roles to which they may not be at all accustomed. Such officials would need to collaborate closely with firstresponders—EMTs, firefighters, and police officers—and with federal agencies using command structures defined by the National Incident Management System. Indeed, public health of- ficials and medical leaders could find themselves assuming primary leadership roles during masscasualty incidents, especially following a biological attack.

That's where Dartmouth's Interactive Media Laboratory (IML) comes in. The IML, part of DMS's Department of Community and Family Medicine, produces interactive educational programs. The group recently won a competitive $3-million grant from the Department of Homeland Security to create the Virtual Medical Incident Management Institute (V-MIMI). How competitive was the grant? "Dartmouth Medical School was one of only 15 grantees selected out of a pool of 267 applications," says Marlene Phillips of Homeland Security's Office of Public Affairs.

V-MIMI, which is still in the early phases of development, will offer health-care leaders "virtual tabletop" simulations and guidance on how to best use resources such as ventilators, hospital beds, and burn and trauma supplies—all with the look and feel of a video game. "The simulations we'll use will look familiar to anyone who's played games like 'SimCity' or 'Civilization,'" says Joshua Nelson, administrative director of the IML.

In addition to teaching health officials how to integrate their operations with formalized command structures, the simulations will require trainees to make critical decisions regarding how best to allocate finite resources when the demand for them outstrips supplies. Then they can watch the consequences of those decisions—good or bad—unfold. "They can see if their decisions overwhelm a particular trauma center, or burn facility, or if they run out of ventilators," says Timothy Elliott, associate media producer for IML. "Obviously, having them be able to learn from their mistakes in a virtual environment is a lot better than having them do it for real."

The grant for V-MIMI is actually the second one awarded to the IML by the Department of Homeland Security. Three years ago, the agency funded the creation of the Virtual Terrorism Response Academy, a training program for first-responders that is expected to be available for distribution early next year.

Interactive: The IML—whose 13-member team includes an art director, medical illustrators, graphic designers, programmers, and editors—takes terrorism-response training very seriously. But, as Nelson points out, "the fact that this program is interactive and fun to use gives it a tremendous advantage over a video or a lecture. It means people will want to use it."

Another important advantage of V-MIMI, which is expected to be ready for distribution through Homeland Security by 2008, is that computerbased interactive programs are a convenient and cost-effective way to disseminate training across the country, from major cities to remote towns. "Every community in the nation has medical personnel who may find themselves in the hot seat," Elliott observes. "And these people are already very busy. With V-MIMI, you get the advantage of training millions of people anytime, anywhere."

Ann Patterson

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