Disasters with mass casualties can overwhelm local healthcare systems and create challenges for healthcare professionals, including issues surrounding triage, resource allocation, transportation, leadership, and communication.

For students in the healthcare professions, disaster simulations can provide valuable lessons about the interprofessional care involved in mass casualty incidents.

“In most hospital errors, someone recognized that a procedure wasn’t done correctly but was reluctant to speak up, so part of the motivation for simulations is to empower people to speak up,” said Eric Stewart, assistant professor of instruction in the Department of Physical Therapy at the University of Delaware.

“In a real disaster, there’s a handful of people who really know what to do and everyone else needs to follow their directions,” he added. “Communication, organization, and prioritization—those are the important pieces we want our students to take into practice.”

To prepare future healthcare providers for these types of incidents, UD held a disaster drill on Nov. 27, 2017. The scenario, a truck crashing into pedestrians on campus, was kept secret until shortly before the event so the students would be forced to think and act with little time to prepare.

Brian Winkler, a second-year physical therapy student assigned to the red triage mat—for patients in critical condition—said the experience was a great professional development opportunity.

“Usually in our training, we get a lot of single-patient experiences, so it was really interesting to take that and apply it to multiple patients,” he said. “There were lots of challenges, but it’s good to look back on them and figure out how to make improvements.”

Setting up the scenario

UD’s disaster simulation has been an annual School of Nursing event for the past several years, with previous scenarios including a train accident, a building collapse, and a bioterrorism attack.

However, the 2017 incident was the first collaborative event, with second-year physical therapy students working alongside future nurses. First-year physical therapy students played the role of victims along with sophomore nursing students and participants from UD’s Healthcare Theatre Program, while second-year PT students and upper-class nursing students served in a variety of provider roles, ranging from supply coordinator and transport to triage and incident command.

In all, the drill featured 117 healthcare providers and more than 150 casualties.

“Our students will have to work in partnership after they graduate, so it’s important that they learn that way,” said Bethany Hall-Long, professor of nursing. “Interprofessional communication is critical to determining who on the scene has what skills and to identifying the best treatment for the patient.”

Improvisation and creativity were the orders of the day at the drill, with a walk-in clinic, an intensive care unit, an emergency room, a medical-surgical unit, and an overflow tent set up in various rooms and areas around McDowell Hall. Makeup and other theatrical props defined injuries, and rolling chairs served as makeshift stretchers.

Lessons learned

Laura Schmitt, assistant professor of instruction and a member of the Physical Therapy Department’s Clinical Education Team, noted that students were struggling with allocating resources and shifting gears after a job was done.

“They need to learn that after the torch is passed, they have to look for a new role even if it’s just reassuring patients. It’s important for them to work as a team even when they’re out of their comfort zone,” she said.

Heiddy Digregorio, simulation resource center manager for the School of Nursing, pointed out that while simulations can teach important lessons about leadership, supply allocation, and treatment of victims, there’s another important aspect of the value of disaster drills.

“With patients, the ‘squeaky wheels’ get the attention while critically injured patients are oftentimes left alone,” she said. “Through debriefing, our students learn that there are other aspects to this mass casualty event that they have to address.”

First-year physical therapy student Amy Bednarek was assigned the role of a 38-year-old female suffering from severe back pain but exhibiting normal vitals.

“It was a good experience to be a patient first so that it has me primed for the emergency response course [taken between the first and second years],” she said. “Hopefully with this experience and the course, if I ever have to be involved in a disaster, I’ll be ready.”

Some lessons, however, are a little tougher.

In a debriefing with physical therapy students after the simulation was over, Stewart asked, “Is it appropriate to leave a patient who’s going to die?”

“You have to think about how best to use your resources in a mass casualty incident like this,” he said.

In the end, all of the faculty said that the first UD interprofessional disaster drill was a success.

“Overall, the students did well for this early exposure to interdisciplinary interactions and mass casualties,” Schmitt said.