Realism, teaching meet in mass casualty drill

When MUSC’s College of Nursing (CON) and Department of Public Safety (DPS) agreed to team up for a mass casualty drill, both saw the exercise as a learning opportunity for officers and students. 

For the DPS, the exercise would be the first time officers worked with students in an active shooter/mass casualty drill. And although nursing students are accustomed to learning in a simulated environment, this drill would take learning to a new level. 

Not only would a class of population health students serve as the victims and potential targets, but they also would become the emergency response team, learning how to assess and triage injured patients. 

“We knew this would be a low-volume, high-stakes experience that we can’t teach in the classroom,” said Dawn Terzulli, DNP, R.N., the college’s simulation director.

 

The full-day exercise featured two scenarios: The active shooter incident in the Charleston Center across from the MUSC Shawn Jenkins Children’s Hospital, followed by the emergency response in the CON building, which was set up with bays, life-saving equipment and a crash cart to simulate an emergency room. 

Terzulli and Bryan Wood, the Emergency Management coordinator for DPS, had two goals for the day. “We wanted to observe how our officers would react to and communicate with the students and also how the students would react,” said Wood. “Our previous drills have always included our officers and employees doing the role-playing.” 

The CON’s goal was to simulate a realistic mass casualty situation in which students would not only learn how to react in an active shooter situation but also practice identifying and assessing patients using SALT, a mass casualty triage algorithm. Developed by the Centers for Disease Control and Prevention (CDC), SALT is an acronym for sorting, assessing, life-saving interventions and treatment/transport. 

The drill got underway around 9 a.m. on June 3 when a “gunman,” portrayed by an MUSC officer, walked into the Charleston Center lobby, threatening a receptionist and telling her she’d “better clear out.”  He fired blanks as he made his way up the stairwell to an upper floor where 40 third-semester students in the accelerated nursing program were portraying clinicians taking care of patients. 

Within seconds, MUSC officers neutralized the assailant, but not before he had fatally shot four individuals, designated by manikins, and wounded others during his rampage through the building. The “uninjured” had barricaded themselves in rooms or escaped down the stairs. 

“It was important for us to see how our officers responded to the students in a full-scale exercise and whether the students adopted a ‘run, hide, fight response,’” Wood said. 

After a one-hour debrief in which Wood and his team discussed active threat prevention and response, the injured began arriving at the CON building. 

But first, their fellow classmates made sure they presented with realistic wounds, known as moulaging or using medical makeup to resemble various injuries. “The students really got creative,” said Brandi Townsend, R.N., the college’s simulation coordinator. “Some of the wounded had intestines spilling out; others had burns and broken bones.” 

 

The other half of the class swung into action, assessing each patient and assigning each one a color-coded designation for the severity of his or her injury. 

“We wanted our students to experience how a mass casualty event would unfold, so the wounded arrived in waves,” Terzulli said. “In our afternoon debrief, we talked through their decision-making process and asked students why they assigned certain tag designations for each patient.”

Terzulli said the drill was a learning opportunity for the students to interact with MUSC public safety experts. “Typically, they’re interacting with health and medical experts, so this scenario added a valuable dimension of interprofessional teamwork.”  

 

Townsend said the students’ reaction to the drill was overwhelmingly positive. “It’s a safe space to learn and to make mistakes. In the past, we’ve used a screen-based computer game to teach disaster response, but this was different. This drill provided a level of realism that wasn’t possible before, particularly when patients started coming through the door.”

Wood said he was pleased with how the day turned out. “The entire exercise was a great opportunity to show our students what to expect in the aftermath of a disaster. ”

Terzulli and Wood have already set a date for their next joint drill. 

“These drills are extremely important,” Wood said. “We have a great working relationship with the College of Nursing, and we’re looking forward to offering more opportunities for nursing students. They are the future health care leaders, and I hope this is something they’ll take with them through their careers.”