Prehospital and Disaster Medicine http://pdm.medicine.wisc.edu Vol. 25, No. 5 ORIGINAL RESEARCH Abstract Introduction: Training emergency personnel on the clinical management of a mass-casualty incident (MCI) with prior chemical, biological, radioactive, nuclear, or explosives (CBRNE)-exposed patients is a component of hospital preparedness procedures. Objective: The objective of this research was to determine whether a Virtual Emergency Department (VED), designed after the Stanford University Medical Center’s Emergency Department (ED) and populated with 10 virtu- al patient victims who suffered from a dirty bomb blast (radiological) and 10 who suffered from exposure to a nerve toxin (chemical), is an effective clini- cal environment for training ED physicians and nurses for such MCIs. Methods: Ten physicians with an average of four years of post-training expe- rience, and 12 nurses with an average of 9.5 years of post-graduate experience at Stanford University Medical Center and San Mateo County Medical Center participated in this IRB-approved study. All individuals were provid- ed electronic information about the clinical features of patients exposed to a nerve toxin or radioactive blast before the study date and an orientation to the “game” interface, including an opportunity to practice using it immediately prior to the study. An exit questionnaire was conducted using a Likert Scale test instrument. Results: Among these 22 trainees, two-thirds of whom had prior Code Triage (multiple casualty incident) training, and one-half had prior CBRNE train- ing, about two-thirds felt immersed in the virtual world much or all of the time. Prior to the training, only four trainees (18%) were confident about managing CBRNE MCIs. After the training, 19 (86%) felt either “confident” or “very confident”, with 13 (59%) attributing this change to practicing in the virtual ED. Twenty-one (95%) of the trainees reported that the scenarios were useful for improving healthcare team skills training, the primary objective for creating them. Eighteen trainees (82%) believed that the cases also were instructive in learning about clinical skills management of such incidents. Conclusions: These data suggest that training healthcare teams in online, vir- tual environments with dynamic virtual patients is an effective method of train- ing for management of MCIs, particularly for uncommonly occurring incidents. Heinrichs WL, Youngblood P, Harter P, Kusumoto L, Dev P: Training healthcare personnel for mass-casualty incidents in a Virtual Emergency Department: VED II Prehosp Disaster Med 2010;25(5):424–432. 1. SUMMIT, Stanford University Medical Center, Stanford, California USA 2. Innovation in Learning, Inc., Los Altos, California USA 3. Professor (Emeritus) and Past Chair, Department of Obstetrics and Gynecology, Stanford University Medical Center, Stanford, California USA 4. Department of Surgery, Division of Emergency Medicine, Stanford University Medical Center, Stanford, California USA 5. Forterra Systems, Inc., San Mateo, California USA Correspondence: Wm. LeRoy Heinrichs, MD, PhD 8 Campbell Lane Menlo Park, California 94025 USA E-mail: wlh@stanford.edu This study was conducted with a Small Business Innovation Research contract W81XWH-05-C- 0040. Keywords: chemical, biological, radioactive, nuclear, and explosive; mass-casualty incidents; Incident Command; training; simulation; Serious Virtual World; Virtual Emergency Department Abbreviations: CBRNE = chemical, biological, radiological, nuclear, or explosive ED = emergency department MCI = mass-casualty incident OLIVE = online, interactive, virtual environment SUMMIT = Stanford University Medical Media and Information Technologies SVW = Serious Virtual World VED = Virtual Emergency Department Received: 02 November 2009 Accepted: 27 January 2010 Web publication: 20 September 2010 Training Healthcare Personnel for Mass- Casualty Incidents in a Virtual Emergency Department: VED II Wm. LeRoy Heinrichs, MD, PhD; 1,2,3 Patricia Youngblood, PhD; 1 Phillip Harter, MD; 4 Laura Kusumoto, MA; 5 Parvati Dev, PhD 2 Introduction Preparation for mass-casualty incidents (MCIs) remains a priority of the medical community in the post-9/11 era. Staged disaster drills (Incident Commands) have been the primary method for practicing skills necessary to manage large numbers of sick and/or injured patients. These drills are expen- sive to provide/conduct and require abundant resources, including volunteers to play patients, moulage artists, and participation of many healthcare and safety personnel, taking instructors and trainees away from their normal duties for extended periods of time. 1,2 Tabletop drills are another method of