Pivotal Decision

A serious game created for the Miller School of Medicine at the University of Miami to train first responders’ ability to prioritize patient treatment in mass casualty incidents, such as tornadoes, earthquakes and terrorism.

University of Miami

Virtual Heroes

Unreal Engine 3

Release Date:
November 2008


Pivotal Decision is a single-player first-person disaster triage game in which the player assumes the role of an Emergency Medical Service provider. Its goal is to improve the first responder's performance in triaging large numbers of casualties at a single site.

Each mission consists of several stages. First, the player is presented with a map of the affected city district in which they must pick and navigate to a proper location for field hospitals. The next stage requires the player to quickly locate, examine and triage the victims of the disaster. Finally, the player is shown an after-action report that provides a summary of the player’s performance and suggested areas of improvement.

During the exercise, players have the opportunity to practice START and JumpSTART triage on a variety of data-driven casualty types and ages. The game is connected to a learning management system (LMS) that tracks detailed player results and allows instructors to analyze performance over time.

As the Technical Director I was primarily responsible for implementing and improving the game’s underlying middleware layers, and for managing my team of programmers to implement all of the game’s features.

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