1. Dorman, Todd MD, Reviewer

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BIOTERRORISM SIMULATOR Anesoft Corporation 18606 NW Cervinia Court Issaquah, Washington 98027 Telephone: 877-287-0188 E-mail: Web: Price: $89 (single), $449 (network), $1399 (departmental license)


Since September 11, 2001 it is obvious to every clinician that not only has the world changed but that most clinicians are ill prepared to triage, diagnose, and treat the conditions related to biological and chemical terrorism. Few medical, nursing, or ancillary health schools provide sufficient education in biological and chemical agents and only recently have training programs and continuing medical education courses begun to include pertinent information. Anesoft Corporation, through the release of Bioterrorism Simulator, attempts to fill that void.


Like many first edition software programs, this one has its strengths and weaknesses. Fortunately, the majority of the weaknesses are technical and the strengths are clearly the program's biological and chemical agent content. The company states that the simulator "provides the opportunity for you to improve your management of biological and chemical agent exposure through computer simulation." Indeed the content regarding the agents, their diagnosis and treatment, and involvement of public health officials is extremely well executed. The case-based presentations are well constructed and have been demonstrated previously to be a better manner of education than classic didactic lectures. The novice will find this content quite useful and instructive while the expert will enjoy the review. It is unfortunate that the content regarding the management of the unstable or critically ill patient-related issues is much less robust. For instance, it is possible for one to complete an exercise successfully and never really do anything about an elderly patient's hypoxemia or tachycardia. This occurs because the program defines success by correct diagnosis and management of the agent, not the patient. In addition, the program's content would be improved if the authors included many more unknowns and a section for the random presentation of cases. Consequently, the authors fall slightly short of their stated objective.


The true weakness of this software, however, is its technical aspects. It is not designed in an extremely user-friendly or intuitively obvious manner. I have used other Anesoft programs and despite this familiarity with their basic approach to the user interface I still had some difficulty in finding all needed activities, the most important of which is the debriefing section. This should be prominently positioned and when one has completed all necessary clinical activities for a case one should be automatically taken to this review/summary section.


In addition, there are some technical glitches that are quite distracting. These include errors in some laboratory numbers, chest radiographs that do not show endotracheal tubes after one has intubated the patient, picture repetition between cases, and, after some interventions, the clinical exam remains identical to the presenting exam and does not transition to an exam showing the effects of one's interventions. If users can keep these limitations in mind, they will find the content robust enough that once they finish the program they will be able to readily recognize the improvement in their knowledge of the diagnosis and treatment of these agents.


System Requirements: CD-ROM drive; approximately 10 MB of free hard drive space; no specific requirements for MB RAM; no specific processor requirements; can be run on a black and white monitor but should be run on a color monitor to see rashes, etc; Windows 95, 98, 2000, NT, or XP; any Windows system using JAVA and JAVAScript enabled browser; Internet Explorer 4.01 or higher; Netscape 4.x or higher; pointing device required (ie, mouse or similar device); not available for Mac OS.