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 Chris Kelly/MEDILL


First responders meet Second Life: Public health enters the virtual world

by Liz Hoffman and Chris Kelly
Feb 04, 2009

It’s an urban nightmare scenario: A plane has released anthrax over Chicago. Millions are exposed and you have 48 hours to give people antibiotics.

You are a medical screener at one of the city’s emergency vaccination centers, and thousands of people – impatient, scared, sick – are lined up in front of you.

Check the correct box on the forms. Make sure you have enough bottled water. And don’t spend too long on any one patient – remember, every minute counts.

Ready? Go.

Welcome to the virtual world created by experts at the University of Illinois at Chicago School of Public Health. In it, public health workers can test their skills in scenarios ranging from a bioterrorism attack to a smallpox outbreak to a Katrina-type natural disaster.

It’s not rocket science, but it is one facet of technology that is slowly bringing public health into the Web era. Its creators say it promises a seismic shift in the way officials prepare for emergencies.

“Public health has been a little bit behind the curve up until now,” said Kevin Harvey, assistant director of development at the Center for the Advancement of Distance Education, which developed and maintains much of the technology at its West Side campus. “We saw a need for public health to come up to speed with technology.”

For decades, health departments such as Chicago’s have relied on what is called “just-in-time training” – massive real-life drills that are activated, as the name implies, just before an emergency.

But these drills are expensive and their training value is limited, especially since 2004, when stricter federal guidelines required faster response times. For municipal health departments, that means more workers and more training, said Suzet McKinney, acting deputy commissioner for the city’s Office of Public Health Preparedness.

For example, to meet the federally mandated 48-hour medication window for an anthrax attack, Chicago would need about 20,000 employees – nearly impossible to practice in a live drill.

“We needed to come up with another way,” McKinney said. “That’s where having the virtual technology comes in.”

The city approached the university in 2004 with the idea of tapping into the virtual world. Similar technology had been used for years by the military, hospitals and even drivers’ education classes, but had yet to be applied to public health.

The result was a computer game, completed in 2006, to train the city’s health workers. It is called the POD Game, which stands for “points of dispensing.”

To begin, players are dropped into one of Chicago’s 55 PODs – churches, community centers and high-school gyms that turn into makeshift triage and vaccination centers during an emergency.

Players must quickly assess the medical needs of “patients” and send them to the proper station or dispense medicine if needed. They must also pass pop quizzes on anthrax symptoms and emergency protocol.
And the clock is always ticking; they can spend no more than 30 or 40 seconds on a patient.

The goal of the game is to maximize “flow” – people per hour – which is the most important number in a dispensing scenario. “Flow is what it’s all about,” Harvey said. “Putting pills in people.”

Center director Colleen Monahan and Harvey and the 25 other employees at the center have also tapped into Second Life, an online virtual community launched in 2003. Users can sign up and create an avatar – a computerized alter ego – to explore 3-D virtual worlds, called “islands,” that are created by users themselves.

The center has built several of its own islands to practice more than a dozen different scenarios. Among them: Avatars can practice setting up a dispensing station in the gym at Lane Tech High School in Chicago or evacuating patients from UIC’s medical center, as both locations are replicated perfectly to scale.

“This is not your basic face-to-face lecture style training,” McKinney said. “This is something that captures the imagination and keeps learners engaged.”

Harvey and Monahan have taken their technology statewide through a contract with the Illinois Department of Public Health and will conduct seven training sessions this year in cities statewide.

They have also worked with county and state health departments in California, Georgia, Indiana and Ohio, and with the Indian Health Services, a federal agency.

Harvey said the response from officials has been overwhelmingly positive, though public health’s older, less tech-savvy generation has been slower to jump on board.

“Some people ask, ‘Why do I have to do this? Paper and pencil worked just fine,’” Harvey said. “My answer is, ‘So did flint and stone … This is better.’”