In early 2006, a dozen staff members from the California Department of Health Services received extensive training on how to administer antibiotics from the Strategic National Stockpile in the event of an anthrax attack.

Unlike previous exercises the state had run, however, this simulation didn't involve recruiting mock patients or setting up a staging area. The setting - and patients - were all virtual. Researchers from the University of California-Davis Health System re-created a 3-D model of the California Exposition and State Fair in Second Life, an Internet-based world in which people are represented by virtual body doubles called avatars.

"The aim of the exercise was to see if the state could constantly train people in setting up emergency clinics," explained principal investigator Dr. Peter Yellowlees, a professor of psychiatry at UC-Davis, whose research interests include the use of virtual reality for health education on the Internet. "One big advantage is that they could do this training 24/7 from wherever they are, and you don't have to recruit patient volunteers."

Yellowlees isn't alone in seeing the potential of using virtual reality simulation to train first responders, medical personnel and emergency management officials. Across the country, researchers are exploring how simulations can augment training efforts. Much of the impetus is coming from the growing use of simulation in medical training. Most medical schools are incorporating simulation in their curricula and measuring its  effectiveness.

Another driving force is the U.S. Department of Defense, which for years has been funding research about computer simulation for war fighting and medical purposes. Research to support military operations done by organizations such as the Telemedicine and Advanced Technology Research Center is being customized for homeland security exercises.

Robert Furberg, a research analyst for the Center for Simulator Technology at research institute RTI International in Research Triangle Park, N.C., noted that virtual reality simulations are appealing for emergency response training.

"A full-scale exercise takes a lot of advanced preparation and requires daylong drills - it is expensive and time-consuming," he said. "With simulation, we can run through a mass casualty event and change the parameters. Each case is a little different, and it is available 24/7."


Virtual Patients

With an $80,000 grant from the California Department of Health Services, Yellowlees and his staff sought to determine if they could make the training in Second Life realistic and worthwhile for emergency medical personnel.

Two years ago, they went to a real-life simulation held at the Sacramento Exposition Center, with 250 state employees and 1,000 members of the public volunteering as trial patients. Yellowlees and his crew taped the exercise as patients were registered, signed consent forms, were examined and given simulated antibiotics.

They then worked to re-create the environment in Second Life. Virtual patients flowed through the clinic, while staff members role played. The program can be adjusted to simulate different numbers of patients. For instance, it could be ramped up from 100 to 150 patients per hour. Yellowlees said his team also built quiz tools to assess how well people have grasped what they've learned.

He said he believes the project was a success because they made the virtual environment look reasonably like the real thing. Also, feedback from state employees indicated the program worked quite well. Nevertheless, California has yet to expand its use. "That was 18 months ago and they haven't taken us up on it yet," he added. "They are trying to see how it fits into their long-term goals."


Virtual Reality Triage

With funding from the Telemedicine and Advanced Technology Research Center, RTI has been working for several years on a simulation platform for primary care doctors, nurses and paramedics. A virtual reality simulation that runs on a basic laptop computer allows medical workers to study and

David Raths  |  contributing writer