The lack of emergency preparedness training (EPT) for patient care providers—including clinicians, hospital workers, mental health providers, public safety and law enforcement officials, community volunteers, EMS, HAZMAT and fire personnel—poses significant risks to both patients and patient care providers. During the 1995 Tokyo sarin gas attacks, for example, up to 80% of patients bypassed first responders and reported directly to hospitals where hospital staff suffered secondary exposure to sarin due to inadequate personal protective equipment (PPE) and training.1 Furthermore, during Hurricane Katrina, the lack of EPT was cited as a significant factor contributing to adverse patient outcomes.2–7 Providing comprehensive EPT for medical trainees—including medical, nursing students and other health care trainees—is important to the future success of emergency preparedness operations in the US.8–15 Just weeks prior to the 9/11 terrorist attacks, an American College of Emergency Physicians (ACEP) task force published recommendations for medical students to develop skill-based EPT competencies for nuclear, biological, and chemical incidents.16 Immediately after 9/11, a report by the Association of American Medical Colleges (AAMC)—and later by the Institute of Medicine (IOM)—encouraged early introduction of bioterrorism topics in medical schools.17–18 Unfortunately, US medical schools have been slow to develop stand-alone EPT curricula.17, 19 Few medical schools have defined and implemented EPT core competencies for health professionals19–20 and newly developed EPT programs have largely focused on practicing clinicians and not trainees.21–24 Disasters are rare, complex events involving many patients and environmental factors that are difficult to reproduce inside a classroom. Recent reviews suggest that health care worker EPT programs lack clarity, objectivity, competency-driven goals, scientific rigor, prospective validation, and consistency across medical specialties.25–28 In a prior study, we revealed how medical students can value and rapidly learn some core EPT elements via a novel addition to a medical school’s curriculum.19, 29 Students who completed our 3-hour ‘Disaster 101’ curriculum vastly increased their overall knowledge and comfort level with EPT skills. A significant limitation of our study was the relatively simplistic measurement of EPT performance. In one scenario, students were required to rapidly triage 100 life-sized inflatable mannequins tagged with physical parameters indicating respiratory, circulatory, and mental status. It was suggested from the curriculum review that the validity and reliability of the EPT performance measurement would be better suited in a controlled environment, such as the university human patient simulation laboratory, in which a combination of live actors and human simulated patients could reproduce the ‘chaos’ associated with a clinical disaster. It was further suggested that high fidelity patient simulators could help us evaluate the impact of our EPT on patient outcomes, for example, whether trainees could appropriately triage and intervene medically to save a life. Here we described the development of a human simulation-based EPT curriculum for patient care providers that recreates a chaotic clinical disaster through a combination of up to 15 live actors and 6 high-fidelity human simulators. Specifically, we detail the Center for Health Professional Training and Emergency Response’s (CHPTER’s) one-day clinical EPT course—provided first to medical students, then to a group of experience disaster medical providers—including its organization, core competency and content development, medical student self evaluation and course assessment. To our knowledge, this is the first published description of a curriculum method that combines high-fidelity, multi-actor scenarios to measure the life-saving performance of patient care providers during a moderately-sized clinical disaster (> 10 patients at once). Curriculum Development—Organization In 2009, CHPTER was formed as South Carolina’s first collaborative EPT center for health professionals (www.musc.edu/chpter). A community-wide advisory committee of emergency preparedness stakeholders—including regional hospitals, NGO’s, public health officials, EMS and law enforcement agencies—met to establish goals for CHPTER to enhance regional health security. CHPTER’s established a mission to enhance regional health security and surge capability by giving patient care providers hands-on lessons that will protect and save patient lives during a disaster. A curriculum task force of the CHPTER Advisory Committee consisting of health professional and emergency preparedness experts met and decided: 1) the EPT course should be no greater than 1 day to ensure increased attendance from busy trainees and other patient care providers, 2) the curriculum should be directed toward the general medical trainee, defined broadly as any patient care provider during a disaster, so it could develop into an interdisciplinary experience 3) the curriculum should be interactive and case-based so trainees could recognize the relevance of disaster medicine knowledge and clinical skills to their work place; 4) human simulation and multi-patient encounters should be used to create realistic clinical disasters; and 5) research metrics should be developed to measure trainee skill acquisition and performance to save lives during a disaster. The task force hypothesized that the newly proposed EPT course would improve patient care provider knowledge, skills, and comfort level necessary to save lives during a disaster. The task force evaluated existing competency objectives and domains from a course given to 4th year university medical students in 2008 and 2009.19, 29 Additional competency and evaluative frameworks considered included those from the Veteran’s Health Administration (VHA), the American Medical Association’s Center for Public Health Preparedness and Disaster Response, the Agency for Health Care Research and Quality (AHRQ), Columbia University and others.30–35