How can medical personnel recognize the signs and symptoms associated with chemical, biological, and radiological (CBR) agents? How can they conduct triage among potentially contaminated mass casualties? What is the proper use of personal protective equipment?
Is there a real threat? Secretary of Defense William S. Cohen thinks so. Here is what he said in the 26 July 1999 Washington Post: "In recent months, the eyes of the world have rightly focused on the threat to American interest and values in the Balkans. At the same time, we cannot afford a national case of farsightedness that precludes us from focusing on threats closer to home, such as the potential danger of a chemical or biological attack on U.S. soil."
Such weapons are attractive to various groups because they cost less than conventional weapons of mass destruction. In addition, delivery to specified targets is easier—an aerosol containing a biological agent sprayed from a helicopter could create untold destruction before anyone might discover the source.
Under contract to the Naval School of Health Sciences, analysis conducted by C2 Multimedia, Inc., has revealed the need for interactive courseware to train U.S. Navy and Marine Corps medical personnel to respond effectively to CBR warfare incidents, as well as a need for training in field assessment and treatment of chemical, biological, and radiological casualties.
As a result, the School's Audiovisual Interactive Medical Multimedia Department (AIMM) developed and videotaped a program on location at the National Naval Medical Center, Bethesda, Maryland, to be used in interactive courseware to train medical personnel on the procedures for differentiating among chemical, biological, and radiological casualties. This interactive program covers differential assessment of patients exhibiting a variety of similar symptoms, with one of three possible etiologies: chemical, biological, or radiological. One scenario deals with exposure to anthrax, a biological agent. Private Peters, coughing uncontrollably, is brought into a field hospital by his buddy, where a corpsman discovers a red scab on this Marine's arm. A second scenario involves Corporal Povitch, also in a field hospital, describing his symptoms to a corpsman: he has been vomiting, has a headache, and has experienced blurred vision when attempting to zero out a dosimeter.
While examining Private Peters, the corpsman learns that he was exposed to artillery fire that spread anthrax when shells exploded nearby. Corporal Povitch was building a sandbag wall in an encampment formerly inhabited by the enemy. The encampment had been contaminated by radiation before the enemy abandoned it. In both cases, the corpsmen go through six assessments to determine causation: systemic, epidemiological, neurological, pulmonary, cutaneous, and circulatory.
"The interactive program builds in potential distracters to encourage corpsmen to discriminate when making assessments," said Judith Goldman, AIMM department head. The patients present a variety of similar symptoms, e.g., tissue disruption, burns, neurological effects, cyanosis, etc., with one of the possible etiologies being chemical, biological, or radiological. The objective is to train a student to be able to assess quickly and accurately the etiology of these symptoms and to foster a healthy suspicion that innocuous symptoms, which appear to be similar to "the flu," could be much more deadly.
The final project will create two deliverable versions: a CDROM version digitized in MPEG1 video and a DVD-ROM version supported by MPEG-2 compression projected for the future.
The department's next interactive project, Management of Biological Casualties, will examine field assessment and initial treatment of patients who have been exposed to biological agents and exhibited symptoms. This program will address biological hazards such as anthrax, botulism toxin, plague, staphylococcal enterotoxin B (SEB), ricin, tularemia, and Venezuelan Equine Encephalitis. The project also will include individual biological protection techniques—such as the use of field expedient decontaminants, self-decontamination and self-protection—and identify training needs related to mass-casualty incidents brought on by terrorism.
Ms. Klein is a project officer for multimedia programs in the Naval School of Medical Sciences’ AIMM Department.