Building a Curriculum

Once ACEP determined that adequate bomb injury management training material didn’t exist, it set out to develop a curriculum with emergency medicine experts, including its partner organizations in the Terrorism Injuries Information, Dissemination and Exchange project (TIIDE). The resulting curriculum, “Bombings: Injury Patterns and Care,” includes 1-hour and 3-hour didactic courses, as well as interactive training. ACEP also developed a wall poster of key points and a pocket reference guide.

“This is an open-source course for any emergency care provider—not just emergency physicians,” said Dr. Hunt. “It’s designed for trauma surgeons, EMTs, nurses, and anyone else who treats blast injury patients.”

“You don’t have to be a blast injury expert to teach this course,” said ACEP’s Mr. Murray, who is helping to disseminate the training. “Some background on the topic is necessary, but it’s designed so that any skilled instructor can present it using the provided, detailed notes and slides.”

The course, available for download on the CDC’s Web site, provides an overview of the types and severity of blast injuries and addresses other topics such as blast physics and how individual organ systems are affected by blast injuries. It also covers an area of blast injury response that’s often overlooked: the system challenges that accompany such injuries.

“The system is not just a hospital or an emergency department,” said Dr. Kapil. “There are so many system components, including prehospital care and transport, emergency department care, surgical care, anesthesia, critical care, rehabilitation after the event, communication issues, and issues related to transfers and resource sharing between facilities—all of which may have an impact on patient survival.”

Dr. Kapil cited several examples: “Patients may suffer blast-associated tympanic membrane injury; this may result in significant difficulty in communicating with a large number of victims from a blast event.” Emergency providers might also be faced with many casualties from a bombing who arrive quickly at the closest hospital by various means of transport.

In addition, a trauma center may be overwhelmed with a large volume of patients with relatively minor injuries, or patients with life-threatening injuries may present to hospitals not prepared to handle major trauma. “This is why it’s so important that the course address both the clinical care and the system challenges that are part of incidents like these,” Dr. Kapil explained.

Training Goes International

Dr. Kapil and Dr. Hunt have presented the training to an estimated 1,000 emergency physicians, nurses, and EMS personnel on at least six occasions in various areas of India, including Mumbai, New Delhi, and Ahmedabad. The training is catching on in the United States as well—even firefighters, police departments, and bomb squads have requested the training information, and a podcast held in November has already been downloaded more than 1,600 times.