Emergency Drill prepares Medical Residents for potential Mass Casualty Event

A nightmare scenario was simulated earlier this month to prepare Texas Tech University Health Sciences Center El Paso residents and students to be at their best when circumstances are at their worst.

The emergency drill conducted on May 13th, was the first on campus since October when El Paso’s COVID-19 cases began to rise.

“It felt real to me, and I was nervous. I wasn’t sure what to expect, and I didn’t know how I’d react in real-time versus how I needed to, but I think I did pretty well,” said Pamela Garcia, a fourth-semester Hunt School of Nursing student who worked triage during the drill. “It didn’t feel like it was two hours; it felt like 30 minutes. It was a rush of adrenaline the whole time.”

The drill simulated the types of injuries first responders would see during a mass casualty incident. The fictional scenario centered on an improvised explosive device going off at a nearby high school. As the drill progressed, residents and students discovered radioactive material was involved in the explosion.

All events of the scenario, except the actions of the learners, were predetermined by TTUHSC El Paso’s Training and Educational Center for Healthcare Simulation (TECHS), the Department of Emergency Medicine faculty, and the Department of Radiology faculty

“Many of the mass casualty drills we’ve run in the past have had some type of toxicology component in them,” said Scott Crawford, M.D., FACEP, CHSOS, director of simulation at TECHS. “This particular drill has an emphasis on radiation, because unfortunately in today’s world, these are the type of events that could generate mass casualties if not treated and cared for in a short amount of time.”

Residents from the emergency medicine and radiology departments were joined by nursing students, medical students attending emergency medicine rotations and students from a local EMS course.

They were at TTUHSC El Paso for a seminar when the University Medical Center emergency alert system sent a notification at about 7:20 a.m., similar to how it would in a real emergency. As the teaching and partner hospital for TTUHSC El Paso, UMC is where Foster School of Medicine and Hunt School of Nursing students complete a majority of their rotations.

None of the participants had advance notice of the two-hour drill, but still followed standard triage protocols using the START (Simple Triage and Rapid Transport) triage system, which uses colored tags to determine how severe the injury is and where the patient must go for treatment.

Patients were tagged in the triage area outside the Hunt School of Nursing, where a decontaminant shower was also set up.

“One of the main things we looked at was how they prioritized care requirements for the patients based on different injuries,” Dr. Crawford said. “The other thing we evaluated was the art and importance of rapid communication of critical findings, such as any injuries that could be fatal. They have to be able to transition patients between care areas without losing track of their critical findings. As an instructor and observer, I was looking for the learners’ ability to stay on track with protocol-type evaluation techniques.”

All 33 patients were actors when they presented; however, if the person treating them determined their injuries and symptoms were severe, they were switched with a medical manikin to allow for more invasive treatment. Each patient had a set of fictional case files that included their medical history, lab results and images, including X-rays, to allow learners to triage and provide accurate care.

“In the beginning, it was a little chaotic trying to figure who was doing what, what everyone’s role was, where to be and how to help,” said Robert Orynich, a second-year emergency medicine resident at TTUHSC El Paso. “It was a phenomenal experience. I loved seeing the cross-profession collaboration here between EMTs, nurses and residents. To see everyone come in and handle a large amount of patients at once was amazing. I think we did a great job, and it was a vital learning opportunity. Once we’re in residency, we never know what kind of catastrophe can happen, and it’s up to us to step up to the plate. Days like this help prepare for that.”

The drill was executed with help from the Southwest Center for Pediatric Environmental Health, the West Texas Regional Poison Center, University Medical Center of El Paso and instructors from TTUHSC El Paso and the EMS course. Each instructor supervised and evaluated participants.

A local news crew was also involved in the drill, asking participants for information on the fictional event.

“One of the things about these drills is there are always unforeseeable events and, as usual, we had unpredictable occurrences today, but ultimately it was all handled very well,” said Radosveta Wells, M.D., associate professor and Emergency Medicine Residency Program director.

“These drills are essential in preparing our residents for real-life disasters, which was evident during the unfortunate events of Aug. 3, 2019. On that day, our residents performed superbly, and afterward, they shared with us that they felt prepared because of the disaster drills we put them through. They knew what they had to do in a critical situation.”

After the drill was completed, participants were gathered for a debriefing session with their instructors. The debriefing session was different from a traditional lecture, it was led by the participants and required them to reflect on the care provided and identify how to improve.

“We’re not just teaching and lecturing – we’re reviewing and understanding why the care was performed in a certain way,” Dr. Crawford said. “The debriefing session is led by the learners, and they provide us with insight on what they did in the situation and why they did it. This is done so we can better understand those performances.”

The disaster drill was originally scheduled for October 2020, but due to the increasing number of COVID-19 cases in El Paso County, TTUHSC El Paso postponed the event.

While distancing protocols were relaxed, since more than 80% of participants confirmed they had been vaccinated, face masks and other forms of personal protective equipment were still required.

“During the training exercises, we allow learners to briefly reduce the 6-foot distance requirement while performing specific patient care activities in the simulation,” Dr. Crawford said. “We don’t want to train bad habits just because we’re trying to keep our distance. If we knew there was enough risk for that to be a concern, we wouldn’t have them in person at all.”

TECHS is a laboratory space on the TTUHSC El Paso campus that allows students to practice diagnosis and treatment of patients using high-tech manikins, virtual reality simulators, role-playing “standardized patients,” and other methods and equipment designed to simulate real-world medical scenarios.

Students from the Foster School of Medicine and Hunt School of Nursing, as well as TTUHSC El Paso residents, train at TECHS in order to be better prepared for real-life patients.

The center oversees large-scale emergency drills on the TTUHSC El Paso campus.

Previous mass casualty drills helped TTUHSC El Paso alumni and student to be better prepared to care for the victims of the Aug. 3 shooting at an El Paso Walmart. That incident left 23 dead and 23 more injured, with many taken to UMC, where residents practice and where many medical and nursing students were completing their rotations.

Gallery photos courtesy TTUHSC El Paso