Military and civilian first-responders must be able to recognize and effectively manage mass disaster
casualties. Clinical management of injuries resulting from nerve agents provides different challenges for first
responders than those of conventional weapons. We evaluated the impact of a mixed-methods training program on
competency acquisition in cholinergic crisis clinical management. Methods: We developed a multimedia and
simulation-based training program based on the more comprehensive USAMRICD courses. The training program
was designed to provide first-responders with the necessary abilities to recognize and manage a mass casualty
cholinergic crisis event. Training included a learner controlled multimedia iPad app and hands-on instruction using
SimMan3Gâ„¢ mannequin simulators. We evaluated the impact of the training through a purposively selected sample
of 204 civilian and military first responders who had not previously completed either of the referenced USAMRICD
courses. We assessed knowledge, performance, affect, and self-efficacy measures pre- and post-training using
previously validated assessment instruments. We calculated results using analysis of variance with repeated
measures, and with statistical significance set at p < .05. Results: Analyses demonstrated a significant improvement
(p = .000) across all domains (knowledge, performance, self-efficacy, and affect). Knowledge scores increased from
60% to 81% correct. Performance scores increased from 16% to 68% correct. Self-efficacy scores increased from
51% to 87% confidence in ability to effectively manage a cholinergic crisis event. Affect scores increased from 75%
to 81% personal comfort during procedures. Conclusions: These findings could aid in the selection of instructional
methodologies available to a broad community of first-responder personnel in military and civilian service.
Although less comprehensive than the USAMRICD courses, training outcomes associated with this easily
distributed instruction set demonstrated its value in increasing the competency of first responders in recognizing and
managing a mass casualty cholinergic event. Retention outcomes are in process.
Training Effects for First-responder Competency in Cholinergic Crisis Management
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