Multiple gunshots. A classroom in chaos. Victims are screaming and crying for help. Some are wounded. Some are dying. Others lie in shock behind overturned desks.
Sirens are sounding in the distance and police are arriving . The shooter has left the scene, or has he? Before they can begin to assess and treat the victims, first medical responders must help answer that question.
This scenario could be another Sandy Hook Elementary mass shooting or Boston Marathon bombing , but it isn’t. It’s a simulation drill, planned by Georgia State University’s Byrdine F. Lewis School of Nursing and Health Professions.
The March event was the idea of Kenya Kirkendoll, a clinical instructor who teaches community health at Georgia State.
“It was my goal that my senior nursing students would have an opportunity to participate in a hands-on emergency response activity. The department and school agreed, so then all we had to do was make it happen,” said Kirkendoll, MSN, MPH, RN. “It proved to be more complicated than we thought, but so worth it.”
Faculty members Teresa Bates, RN, BSN, and Regina Spratling, Ph.D., RN, CPNP, brought additional expertise to the planning committee. Bates suggested adding a simulated emergency room to the simulation so students could practice treating mass casualty victims.
Keith Sumas , director of emergency management at Georgia State, brought the campus police presence, located the staging areas and made sure the university community was informed about the drill.
As the idea grew, Kirkendoll enlisted the assistance of Jim Zerylnick, manager of operations and training for Emory University’s Office of Critical Event Preparedness and Response. Founded after Hurricane Katrina, CEPAR plans and coordinates Emory’s response to catastrophic events and also trains other community organizations and agencies.
Leah Hoffacker, health care community preparedness training and exercise specialist with the Georgia Department of Public Health, brought years of expertise in running mock scenarios and disaster training to the table. Finally, the Epsilon Alpha chapter of Sigma Tau International Honor Society of Nursing sponsored and helped fund the exercise.
“Jim Zerylnick gave the students a fundamentals in mass casualty training course before the simulation and then led three runs of the event, so that all 120 students could play roles as either victims, site responders or ER staff,” Kirkendoll said.
The students also took an online course in incident command systems from the Federal Emergency Management Agency.
Keeping it real
Hoffacker, an experienced stage manager, enlisted the help of four professional actors and some makeup artists to create lifelike wounds.
“Kenya made up a list of victims and their injuries, and what symptoms they would have. We coached them on how to assume their roles, even how to hyperventilate in a safe way,” Hoffacker said. “Having some professional actors on the scene keeps it real and safe. We don’t want people getting too dramatic and pushing responders too far. The professionals are aware of what’s right and what’s wrong and can oversee the others.”
The responders were charged with identifying an incident commander, a triage supervisor and two other leaders, Kirkendoll said. “We put a plastic gun in the pocket of one victim and the last group found it and held the man for the police.”
In the mock ER, a nursing school alumna played the role of resident and helped guide the decision making.
“The whole thing felt like a real emergency and turned out better than I thought. It gave the students a lot of opportunities to think on their feet,” Kirkendoll said.
The responders assessed and tagged patients for medical treatment according to the severity of their conditions: green for minor injuries; yellow meant delayed treatment was acceptable; red for immediate care; and black for dead.
ER staff used the tags and their own assessments to decide who was treated first. They also dealt with the emotional aftermath of patients who died on the way to the ER, a wounded baby and mother, and family members looking for their loved ones.
Zerylnick and Hoffacker led the debriefing sessions afterward to discuss what students did well and what they could do differently next time.
“We saw some hands shaking and some heart rates go up but, overall, they performed well. It was a successful event,” Zerylnick said.
“We can’t say enough about the usefulness of this kind of hands-on training, especially in light of recent bombings and shootings,” Hoffacker said. “Our country has been training people since 9/11 and our agencies have learned how to structure an incident command system and work together. A lot fewer lives were lost in Boston as a result.”
Kirkendoll said the simulation made students more aware of the need to be prepared for disasters.
“Some students said that they would seek out other classes because they wanted to learn more,” she said. “We believe it will make for a better-prepared work force.”
The nursing department plans to repeat the exercise this fall, and will include students from other health science departments.
“Training nurses early, as part of their education, will make disaster preparedness just something else they can do,” Hoffacker said.
“In light of the recent explosion of the plant in Texas, it’s very important that all health care workers have disaster-response training, and hands-on is a great way to learn,” Zerylnick said. “Kudos go to Georgia State’s nursing program for giving this level of training to its students. It’s rare and absolutely progressive.”