practice their triage skills in a role-playing game.

The entire system is situated within a learning management system that includes didactic content, such as Flash animations and audio narratives that medical workers review before entering the simulation environment.

The program includes 30 examples of casualties that trainees can encounter, with a total of nine in any one scene. "The bulk of the cases are trauma victims, but we are adding in medical cases," said Furberg, who is a practicing paramedic. "Realistically people are going to be injured by more than kinetic forces. Someone will be so freaked out, they have a heart attack. Or a diabetic person will forget to eat. These have to be triaged as appropriately as everyone else in the mix of injuries."

The triage simulator has been used at pre-deployment training of Army medical staff on their way to Iraq. RTI also developed a program to train civilian Iraqi primary care physicians to use the Simple Triage and Rapid Treatment method.

Furberg's efforts to localize the content of that simulation led him to a startling realization. "I was looking to make it appropriate for local learners and asked a few contacts in Baghdad to send a picture of a triage tag doctors use in Iraq that I could insert in the simulation," he recalled.

When he got no response within a week, he contacted them again. His Green Zone contacts said they had asked several Iraqis and no one knew what Furberg meant by color-coded triage tags. "They said in Baghdad they don't do triage. They just load all the wounded into a van and sort them out at the hospital," he said. "Apparently for these emergency physicians, this simulation was the first time they were getting any formal triage training."

The triage simulator also was tested at the Duke University School of Medicine in 2006. In a program designed to prepare medical students for disaster management, some students were trained using verbal presentations while others used virtual reality-based training. Furberg said that when asked to perform triage, the trainees who used the simulator performed as well, or better than, the group trained traditionally.

Furberg is convinced that virtual reality simulation is a valid educational method for triage training, and that it should be carried over to widespread civilian use.

"It is a high-yield way of upgrading skills with minimal investment upfront," he said, adding that triage in an emergency situation challenges the standards of normative care. It asks emergency physicians and other care providers to make decisions they don't normally need to make.

Also, he argued that these are perishable cognitive skills. To apply them effectively, you have to use them. "If there is one skill that could maximize or improve the outcome in a mass casualty incident, it's triage," he added. "It drives the remainder of the response."


Running Simulations for EOCs

While some simulations are designed to help first responders practice, others use modeling to train people in emergency operation centers (EOCs). The Emergency Management Training, Analysis and Simulation Center (EMTASC) in Suffolk, Va., works to create realistic simulations to help train managers to communicate in an emergency.

"You've got a guy driving in to the EOC who hasn't sat in that chair in more than six months," explained Randy Sickmier, EMTASC's exercise plans manager. "During the day, he's the public works officer for Staunton, Va., and all of a sudden he's in charge of some aspect of this emergency response. It's not something he does every day. This is where the simulation can be valuable."

With grant funding from Virginia, the nonprofit EMTASC was formed in 2005 as a partnership between Old Dominion University and 17 companies involved in modeling and simulation efforts. For agencies that want to

David Raths  |  contributing writer