Utilizing Information Technology to Prepare the Nation’s Responders to Chemical, Biological, Radiological, and Nuclear Events

Recent events have demonstrated that the US must be prepared to respond to a wide range of threats – including attacks utilizing chemical, biological, radiological, or nuclear (CBRN) weapons. While the US goal is to prevent such attacks through diplomacy, deterrence, intelligence efforts, and other means, preparing military and civilian medical and emergency personnel to respond effectively to incidents involving these weapons is an essential part of a balanced response to these new threats. Unfortunately, many of our emergency and medical personnel do not have the training that would allow them to respond to a CBRN attack in a way that would limit casualties.

Providing this training presents a number of challenges, including:

1. A large number of people must be trained;
2. Complex new material must be mastered;
3. New information is being generated constantly; and
4. Few, if any, of the people will have had any direct personal experience with injuries or illnesses caused by these new kinds of weapons.

This article briefly outlines a national approach for using advanced information technology to address these challenges.

Large numbers of people must be trained and their skills updated continuously. We must also be able to provide rapid training updates to large numbers of people in the event of an actual emergency. The number of individuals needing some level of CBRN response training in the US is staggering. Individuals that can be characterized as emergency response personnel include more than 1 million firefighters in the US including approximately 750,000 volunteers, more than 800,000 full-time employees in local police departments and sheriffs’ offices, more than 150,000 nationally registered emergency medical technicians (EMTs), and approximately 60,000 army medics. Medical personnel include the roughly 700,000 physicians and 2.7 million nurses in the US. Each of these groups will need varying levels of training and expertise in different aspects of responding to CBRN events.

The threat of CBRN weapons is current, so a national program should provide training material that can be delivered to large numbers of providers in the next year (therefore material must be compatible with hardware already in place). A first step should be to identify and convert the best existing traditional training material into readily available online resources, but this iniative should be framed in the context of a plan that will take advantage of simulation-based training and other innovations as they become available. A successful program will necessitate bringing together groups with different areas of expertise to perform the following require activities:

• Content and curriculum development
• Training material certification
• Robust delivery network development and maintenance
• Advanced training technology research and development.

Content and Curriculum

It is essential that the emergency and medical responder communities identify appropriate curriculum and identify where current training material is incomplete. These groups should also develop the pedagogy for using current and future instructional tools. Another requirement will be to propose and help develop multi-dimensional measures of competence (such as: written tests, performance in a simulation, and performance in live exercises) that focus on the assessment of cognitive and psychomotor skills for the target audience.

Certification

Course materials, course curricula, and assessment tools must be peer-reviewed and certified to ensure their appropriateness and technical accuracy. Fortunately there are existing bodies for certifying training material for the target audiences such as the National Registry for EMTs. These groups are accustomed to certifying more traditional training material, such as textbooks and training manuals, but have the expertise to evaluate online training material and advance training tools such as virtual reality simulators.

Robust Delivery Network

A robust, scaleable, and secure communication network is needed to store and deliver the varied training material required for the different target audiences. The network must be compatible with any new emergency service communication systems and serves health care and emergency responder facilities with a wide range of infrastructure (extending from 56K dialup to broadband). The network must provide a technical infrastructure for peer-review/certification, bug reporting and response process, and a means for protecting intellectual property rights.

Advanced Training Technology

The pressing need for improved CBRN response training dictates utilizing existing technology to deliver online text (low bandwidth), images (medium bandwidth), and video (broadband) with perhaps the ability for email-based Q&A with experts. However advances in communication technology, if coupled with increased national support for learning technology research and development, could permit:

• Collaborative, discovery-based learning
• Intelligent tutoring/user modeling assistance to instructors
• Simulation-based instruction (such as immersive training environments, digital human)
• Linking of learners nationwide to teachers, counselors, and subject matter experts.

Such advances would greatly improve the readiness of the nation’s medical and emergency response personnel.

The Way Forward

Resources are likely to be available to improve training for responders to CDNR events. The President’s Fiscal Year 2003 budget asked for more than $6.8 billion to improve the nation’s security against bioterrorism attacks alone (including $665 million to the Federal Emergency Management Agency to train state and local first responders). However, without a national plan, much of this money and other resources could be divided into many disjointed efforts without solving the actual problem. An interagency steering group is needed to avoid redundancy and leverage the strengths of the various federal agencies. The steering group would:

• Define the overall mission and requirements
• Review existing materials and ongoing programs
• Assign roles and responsibilities to agencies
• Provide for coordinated issuance and review of requests for proposals
• Develop and enforce interoperability, quality control, and other standards
• Provide regular reporting to Congress and the public.

The Department of Defense (DoD) has a comparative advantage in leading such an interagency group. The DoD has experience building and maintaining secure communications networks. The DoD also has expertise in developing and utilizing online and simulation-based training tools. Additionally, the military has its own network of medics, doctors, nurses, police, and firefighters who need to be trained to respond to CBRN attacks (an army study conducted in 2000 showed that only 16% of 347 medics examined passed a cognitive test on how to treat nuclear, biological, and chemical casualties1 ). These responders would provide a test audience for training material as it is developed.

Notes:

1. Chemical and Biological Defense: DoD Needs to Clarify Expectations for Medical Readiness, General Accounting Office (GAO-02-38, October 2001)