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Mass casualty drill gives Creighton EMS students culminating experience

Creighton EMS education students move a simulated patient during a mass casualty drill on June 3.It’s not real blood. That’s not a real impalement. Those aren’t real screams.

Right?

Friday morning, June 3, Creighton University’s Department of Emergency Medical Services Education conducted its annual mass casualty drill on the grounds of the Bellevue Fire Department’s training facility. Thirty EMS students, along with 30 volunteers simulating victims, and another 20 students from Creighton’s College of Nursing, took part in a mock explosion scenario in a building to assess the skills of the EMS and nursing students as they dealt with fake injuries in a very real way.

“It felt very real,” said Ryan Penn, a senior at Creighton in the EMS program. “They said it took an hour, but it felt like 20 minutes. Things were happening so fast and you could see the stress on everyone’s faces — the EMTs, the victims. It was about as real as you can make something like this. I’m glad we got to go through something like this.”

Anticipating disaster is a tricky business, but it’s what first-responders have spent years training to do.

Creighton’s mass casualty drill is a culminating event for those in the finishing stages of their EMS education and a moment when students realize they’re prepping for just this scenario in real life.

“We tell students it’s a matter of when, not if,” said Mike Miller, Ed.D., assistant professor and director of the Emergency Medical Services Education Program at Creighton. “The potential to respond to a mass casualty incident is part of what an emergency medical responder or a paramedic signs up to do. We’ve had a lot of reminders about that, nationwide, but we don’t really need to look too far from our own backyard. Severe weather, tornados, flooding, explosions, even just a school bus full of 50 or 60 kids that runs off the road — these kinds of things can and do happen.”

Miller cited the recent example of the explosion and fire at M’s Pub in Omaha’s Old Market. While there were few injuries in the incident, the potential for a much larger event was there, he said, and all medical responders have to remind themselves that they could find themselves in the chaos and trauma of such a disaster.

EMS education students work on triaging patients during a mass casualty drill.“It was a good realization of what’s happening in the moment of a disaster,” said Jairo Chávez Jr., a Creighton senior and EMS student who was among the first students on the scene of the simulation. “You have to get yourself calmed down, remember your training. I’ve got seven patients outside I can see, bleeding. I hear more screaming coming from inside the building. You just say to yourself that you know what you’re doing and you do it.”

For good measure, the scenario included injuries and personalities of every stripe.

There was a young boy with gaping wounds to his legs, a woman with a suspected broken leg who called repeatedly for her mother who had been with her just a moment ago, an asthmatic man screamed for his inhaler and rained insults on the scurrying first-responders.

In the midst of it all, a volunteer convincingly played an interloper who told grievously wounded patients he was going to make them all rich if they decided to sue, and lorded it over any student EMT who looked away from one patient, even for a moment, to check on the status of another. It was all part of the bargain.

“It gives students a good realization of the chaos that can ensue in a mass casualty event,” said Eric Ernest, BSEMS’06, MD’10, assistant medical director for the EMS Education Program, who has seen his fair share of drills as a student, a physician and an instructor. “There are people everywhere and it’s a different feeling than dealing with a single patient. There are a lot of moving parts, not all of them good.”

Through it all, a team attitude prevailed.

Simulated victims were triaged, treated and some trundled off in ambulances to the “hospital” on the other side of the training grounds, where Creighton nursing students were there to receive them and begin the next phase of treatment.

The drill became a laboratory for the interprofessional cooperation between the students out in the field and in the hospital.

Creighton nursing students tend to simulated patients as part of a mass casualty drill undertaken jointly with the Department of EMS Education.“We don’t function alone,” said Nancy Shirley, Ph.D., associate professor in community health nursing who had charge of the nursing students as the drill played out. “We need that interprofessional cooperation and this is a very good example of how it works in real life. This gives students an opportunity to really look at what the roles are and what the challenges are.”

Andrew Rappolt, BSEMS’14 and now a student in Creighton’s Accelerated Nursing Program, served as the charge nurse on duty as victims began coming into the simulated emergency room. Having also been on the EMS side of the drill, Rappolt said the appreciation for all the roles in a moment of crisis is a central component of the exercise.

“Time management and communication are two things you never get perfect,” he said. “But you come to the realization that everyone is doing their best and you appreciate the difficult jobs being done on all sides of the event. It’s a place where the Ignatian value of men and women for and with others really takes shape. There’s mutual support for everyone trying to help the people who are hurt.”

In 14 years at Creighton, Miller said he’s heard from EMS graduates who have had the task of responding to a mass casualty incident. He said those reports have all pointed back to this drill as a seminal event in their EMS education.

Creighton EMS students who participated in the June 3 mass casualty drill also had an opportunity to learn about the area's LifeFlight system.“The experience of the drill is vitally important to them,” Miller said. “They’ve found themselves having to triage, to treat, in the aftermath of something and they’ve said they’re taken right back here, to their training. That’s a sign that what we work on here has an impact.”

Even in the face of fake blood and burns and play-acted screams of pain, there is an intensity and a realization that faces all of the students, Chávez said.

“This could happen,” he said. “You could be the first on a scene and realize you do not have nearly enough resources to deal with the situation, but you still have to jump in and do what you have to do. I lost myself in the moments. I was connected to a radio and I don’t think I heard one word out of it, but it was blaring the whole time.”

And that stress of the moment, so palpable to Penn, helped feed his ability, bringing to bear all his training.

“Knowing how to handle yourself and knowing you know how to handle yourself is key,” he said. “You know not everything is going to go perfectly, but you stick to your skills, you take things as they come, and you’re not overwhelmed. You follow through and help patients the way you know how.”

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