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Objectives: To assess the individual and team skills acquired from an interactive training program to prepare emergency personnel to respond to terrorist acts., Methods: We developed a 16-hour, two-day, multimedia- and simulation-enhanced course that places learners in realistic situations using the equipment required to respond to various chemical, biologic, radiologic, and explosive acts of terrorism. Small-group sessions and drills were conducted. Errors in skill performance were corrected immediately, and then skills were repeated to achieve mastery. Participants included emergency medical technicians, paramedics, nurses, and physicians. Team performance was assessed over four successive scenarios using a 100-mm visual analog scale. Individual learner skill acquisition was assessed with precourse and postcourse evaluation of selected skills in a randomized sampling of consenting learners., Results: Nearly all teams achieved mastery of the required skills by the second assessment rotation. Individual learners demonstrated significant gains in the ability to emergently don personal protective equipment and administer a nerve agent antidote kit., Conclusions: An interactive, simulation-enhanced curriculum of terrorism response training for emergency responders can produce significant, quantifiable individual and team skill gain. Future studies should further address performance benchmarks for these newly acquired skills.

Introduction: Responding to acts of terrorism requires the effective use of public-safety and medical-response resources. The knowledge, skills and attitudes necessary to respond to future threats is unfamiliar to most emergency responders., Objectives: The purpose of this report to describe the development, implementation and evaluation of a multidisciplinary, interactive and simulation-enhanced course to prepare responders to acts of terrorism., Methods: We used a 5-step systematic process to develop a blended-learning, simulation-enhanced training program. Learners completed a self-confidence questionnaire and written examination prior to the course and a self-confidence questionnaire, written examination and course evaluation when they finished the course., Results: From July 7, 2003 to March 8, 2005, 497 consenting learners completed the course. After course completion, learners demonstrated significant increases in their knowledge of terrorism response (t = -64.3, df = 496, p < 0.05) and their confidence in responding to terrorist events (t = -45.5, df = 496, p < 0.05). Learner feedback about the course was highly positive., Conclusions: We successfully implemented a two-day course for professionals likely to respond to terrorist acts that included scenario-based performance training and assessment. Course participants increased their knowledge and were more confident in their ability to respond to acts of terrorism after participating in this course.

The possibility that biological weapons, such as smallpox, will be used is no longer unthinkable. Biological agents have been used since antiquity, and the threat that modern weapons will be used has increased since the events of Sept. 11. Despite international efforts to eradicate smallpox, the potential for its use as a weapon of terror is renewed. Prehospital providers should research the possibility of a vaccination program for their respective agencies and decide on its appropriateness under the guidance of the medical director. In addition, EMS personnel must prepare to handle smallpox and other biological terror weapons. Consult your medical director and local Department of Health for guidelines regarding the appropriate response, treatment and transport of patients exposed to smallpox.

Many argue that experience is the best teacher. However, it's often dangerous for the patient and impractical for an EMS system to assess prehospital providers in their actual working environment. Simulated scenario competition fosters clearer thinking and translates into more effective action and enhanced patient outcomes during true emergencies.