In the wake of the September 11, 2001, terrorist attacks and the anthrax scare that followed, public health officials have been working to prepare both emergency personnel and health-care workers to respond quickly and efficiently to a bioterrorism attack.

In an attempt to overcome some of the financial and logistical barriers inherent in large-scale mock-disaster drills for emergency training, UC Davis researchers developed and tested a new Web-based virtual reality environment that allows health-care workers to practice how they would distribute antibiotics in an emergency from the comfort of a desktop computer. The results of the pilot study were published earlier this year in the journal Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science.

"Large-scale mock-disaster events typically cost hundreds of thousands of dollars to run, and are nearly impossible to set up at the busy public landmarks, such as the Golden Gate Bridge, that are thought to be likely targets," said Peter Yellowlees, professor of psychiatry and behavioral sciences at UC Davis School of Medicine and lead author of the study.

"It is also hard to get enough volunteers to mimic a real-world event. But we have shown that you can build a bioterrorism disaster environment on the Web and successfully use it to train people for a fraction of the cost and without the other logistical constraints of staging mock disasters."

Yellowlees specifically designed the UC Davis virtual environment to address a known problem: how first responders would distribute America's stockpile of antibiotics and other medications at sites that will be called on to process hundreds of thousands of people.

Peter YellowleesYellowlees and his team began by attending an emergency clinic distribution exercise at the California Exposition Hall in Sacramento in March 2005.

Yellowlees and his team began by attending an emergency clinic distribution exercise at the California Exposition Hall in Sacramento in March 2005. Sacramento County created a mock strategic national stockpile site. Three hundred of its employees participated in the event, along with 1,000 volunteers from the public. Despite the benefits to those who took part in the exercise, Yellowlees pointed out that the exercise cost around $1 million, included only 10 percent of the county's health-care workers and the 1,000 volunteers were processed in an hour and half. "In real life, there would be hundreds of thousands of people that would be seeking treatment," he said.

Yellowlees and his team used floor plans, numerous photos and professional computer artists to build a mock strategic national stockpile site using the virtual reality program Second Life. (A three-minute video of the site is available on YouTube for public viewing.)

"We measured everything in sight," Yellowlees recalled. He and his team then used the Web-based program and California's planning guide for mass distribution of antibiotics to design workflow patterns. They then held two half-day training sessions, followed by an evaluation by the users.

Thirteen state and county health officials completed a written evaluation of the virtual training immediately following the exercise. The responses showed that all participants found the exercise useful and relevant.

Yellowlees said that he would like to continue to expand the virtual environment, refine the training exercises and continue to evaluate its utility.

"I think this is a very doable project that should move forward," he said. "I hope that more groups will take on this approach."

The value of virtual reality-based training has been proven in recent years. It has been used in everything from training airline pilots and emergency workers to treating phobias and post-traumatic stress disorders. Yellowlees, who previously used virtual reality to simulate auditory and visual hallucinations suffered by patients with schizophrenia, proposed creating and evaluating a pilot bioterrorism-defense virtual training environment to the California Department of Public Health. The department funded the current pilot project using funds from the Centers for Disease Control and Prevention.

Sample of virtual bioterrorism computer simulation training

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