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ENA Mass Casualty Drill

Surprise active shooter simulation gave first-hand experience of disaster nursing

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A surprise mass casualty incident training drill at the Emergency Nursing 2015 conference provided more than 2,500 nurses with real-world spontaneous disaster experience.

The "pop-up drill" occurred in what was scheduled as a general session on disaster preparedness. However, instead of listening to a best practices discussion in a conference room, attendees were immediately immersed into a simulated active shooter scenario with audible gunshots, where volunteers were asked to care for 90 local volunteer actors who displayed life-like wounds and acted out injuries.

Meeting the Training Need
The surprise mass casualty training occurred within a day of a school shooting in Roseburg, Ore., and tragically, just months before the largest mass shooting in U.S. history in Orlando, illustrating the necessity for this kind of disaster preparation.

In planning for the simulation, Emergency Nurses Association (ENA) contracted with Orlando-based First Response Training Group, LLC, the Wounded Warrior Project, emergency nurses, cutting-edge medical supply companies, volunteers, and the local media to execute the drill in the Orange County Convention Center. Boston Marathon bombing first responder and director of clinical operations at Beth Israel Deaconness Medical Center Daniel Nadworny, MSN, RN, provided keynote remarks and moderated the drill, which most attendees viewed on a live video feed. Attendees also learned about critical incident stress management following the drill-an often overlooked concept that aims to help healthcare providers cope with traumatic events.

Developing a Disaster Plan
Nadworny opened what many identified as the highlight of the 2015 conference by explaining the need for having an updated disaster plan on file. The Joint Commission requires hospitals to maintain a hazard vulnerability assessment and he said this needs to be a living document that changes frequently. Even though the assessment isn't always accessible to emergency nurses, he emphasized the importance of a master plan.

EDs also need blueprints for events with a possible patient surge as well as those without, such as a power failure, flood, interruption to information services, or damage to the facility.

Individuals who help during a catastrophe don't always have to be nurses, he noted. When a critical incident strikes, anyone in the department with an interest in disaster preparedness, especially first responders, can take the initiative. What matters more than the drill participants' credentials, he said, is the act of practicing repeatedly.

"Going through these drills builds muscle memory for how things should happen, if there's an actual disaster," remarked Nadworny.

Mistakes should be expected. "If you design a drill and nothing goes wrong, it's not well designed," he articulated.

Focus on Triage
As Nadworny narrated the active shooter drill, he stressed the importance of triaging both patients and resources.

In this scenario, the walking wounded patients were tagged as green and moved out as quickly as possible. The 18 patients tagged as red were the most critically injured and the deceased victims were marked with black tags.

"If you have only one OR available and you use it for the patient with a bleeding controlled extremity injury, what's going to happen when a patient with a chest injury presents and the OR isn't available? Until you know 100% that all your patients are in place, you don't want to assign your resources away," he advised.

Sometime, staffing is a concern and Nadworny recommended putting any available students to work. "Green" Patients can hold the hands of the more critical patients or provide other comfort measures.

SEE ALSO: Earn CE: Rapid Trauma Assessment

Managing Multiple Injuries
For clinicians, developing a standard way of approaching patients saves time and employing it systematically ensures you won't miss any details.

In an active shooter situation, there are always people who present to the ED with concerns that they were in the vicinity, even though they don't have any visible injuries. Assessing eardrums can provide vital clues as to whether a person sustained a blast injury, he instructed.

Chest injuries will account for the majority of the patients after a shooting and providing care becomes much more complicated when you have to account for other co-occurring conditions such as asthma.

The drill was not just a unique learning experience. It earned the Emergency Nurses Association the 2016 American Society of Association Executives Power of a Silver Award for ENA. The Power of a Silver Award is one of the highest honors ASAE bestows upon associations for their efforts to create a competitive workforce and drive innovation.

Kathleen Carlson is president of the Emergency Nurses Association.

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