Background

Blast injuries present unique triage, diagnostic, and management challenges as a consequence of the blast wave from high explosive detonations. Few civilian health care providers in the United States have experience treating patients with injuries from these kinds of blasts. Currently, there exists an urgent and ongoing need to develop, disseminate and exchange information about injuries from terrorism. The Terrorism Injuries: Information, Dissemination and Exchange (TIIDE) Project was established through a cooperative agreement between the Center for Disease and Control Prevention (CDC), Division of Injury Response, National Center for Prevention and Control and seven (7) grantees.

The seven grantees are:

• American College of Emergency Physicians
• American Medical Association
• American Trauma Society
• National Association of EMS Physicians (NAEMSP)
• National Association of EMT’s (NAEMT)
• National Association of State EMS Officials (NASEMSO)
• National Native American EMS Association

The American College of Surgeons – Committee on Trauma (ACS-COT) and the State and Territorial Injury Prevention Directors Association (STIPDA) were added to the TIIDE project in 2005.

Scope of Work

• Conducting a literature review and web-based research to identify existing training courses
• Developing core competencies for traumatic injuries from terrorism training
• Reviewing terrorism training courses currently being presented on a national level for gaps in the training on traumatic injury care
• Developing a matrix of gaps in training on traumatic injuries
• Developing knowledge objectives for each core topic

Representatives from the seven (7) grantee groups as well as the American Academy of Pediatrics (AAP), American College of Surgeons-Committee on Trauma (ATS-COT), American Nurses Association (ANA), Emergency Nurses Association (ENA), Society of Critical Care Medicine (SCCM) and the University of Texas Southwestern Medical Center at Dallas (UTSW) formed a task force to narrow the list of core topics for courses on blast injuries. A peer review work group was established to serve as content experts and review the overall work of the task force.

Authors were selected from content experts in the fields of emergency nursing, emergency medical services and emergency medicine to write about the following topics in the blast curriculum:

System Issues
Scene Safety
Triage
Blast Injuries
Crush Injuries and Compartment Syndrome
Military Experience in Blast Injury Care
Special Considerations
Psychological Issues

Development of a one-hour presentation was completed and pilot tested at three locations. The first test was held in February 2006 during the International Disaster Management Conference, Orlando, Florida. The second test was held in March 2006 during the EMS Today Conference in Baltimore, Maryland. The third test was held in April 2006 at the Mt. Sinai School of Medicine, Emergency Medicine Residency Program in New York City. Approximately 156 individuals attended the three pilot test presentations and represented physicians, nurses and EMS providers.

The one-hour curriculum was designed to be integrated into existing all-hazards disaster courses. The three- hour curriculum was designed as a stand-alone seminar. Both courses are available for download at the American College of Emergency Physicians website, www.acep.org/blastinjury. The title, "Bombings: Injury Patterns and Care" are used for both the one and three-hour courses as well as the interactive CD-ROM/web-based course.

Development of a one-hour self-paced, interactive CD-ROM/Web-based program began in April 2006. The one-hour PowerPoint and curriculum guide was used as the starting point for development.  The course begins with an overview of blast physics, morbidity, and mortality, scene safety, Personal Protective Equipment (PPE), patterns of injury, pathophysiology of blast injury and categories of blast injury. A terrorist bombing at a train station sets the scene and four patients are followed from initial triage to on-scene care through hospital care.

The CD ROM will be distributed free of charge to first responders.  To place an order for a free CD ROM, visit the American College of Emergency Physicians website at www.acep.org/blastinjury. 

The American College of Emergency Physicians website, www.acep.org/blastinjury will also direct first responders to the web-based version.

For more information on "Bombings: Injury Patterns and Care" courses, contact the ACEP EMS and Disaster Preparedness Department at 1-800-798-1822:

Rick Murray, EMT-P, Director, Ext 3260
Deanna Harper, EMT-I, Coordinator, Ext 3313