NATIONAL NAVAL MEDICAL CENTER—Smoke fills the hallways as emergency responders move quickly to rescue the bloody victims who lay lifelessly on the floor in a damaged building. While the scenario is treated with the seriousness of a real event, it is a simulated mass casualty drill held by the Bethesda Hospitals’ Emergency Preparedness Partnership.

For the last five years, the entities in the partnership—NNMC, Suburban Hospital/Johns Hopkins Medicine, and the National Institutes of Health—have joined together for an annual drill on the grounds of NNMC to test their ability to respond to a major disaster. The partnership began in 2004, and links military, federal, and private mass casualty medical response efforts within the National Capital Area.

These annual emergency drills are important to ensure that the region is maximally prepared to handle an event that would produce mass casualties, according to Chris Gillette, NNMC’s command emergency manager. “We continue to work with our agencies and identify what areas we can improve upon. The overall goal is that we want to provide an immediate and sustained response when the next catastrophe strikes.”

The drill held last month culminated a week of disaster exercises that were held in conjunction with the Joint Forces Headquarter’s annual National Capital Region Capital Shield Exercise 2010. This event involves a variety of agencies around the capital area testing their efforts to respond to a disaster.

Drilling A Response

This year the partnership’s drill involved a simulated scenario in which a number of terrorist strikes occurred in the national capital region, with one attack resulting in the interior of an NNMC building collapsing. Shortly following that attack, an explosion occurs at a nearby Metro station.

The drill tested the abilities of the responders to rescue victims trapped in the NNMC building and the use of some new technologies to help the hospitals deal with the mass casualties. In order to make the disaster scene as authentic as possible, volunteers wearing moulage makeup simulated real injuries and lay trapped in the damaged building. Responders navigated smoke and the challenges of rescuing the victims from a damaged building.

Gillette said that the exercise was important practice because if a hospital structure were to be attacked, responders would be evacuating patients who may be attached to ventilators and other equipment. “How are we going to handle getting patients from second and third floor structures down to the ground level, and what mechanisms are in place for that?” he said.

Personnel participating in the exercise included those from the facilities in the partnership, Walter Reed Army Medical Center, Montgomery County hospitals, and Montgomery County Fire and Rescue Service. The scenarios chosen for these annual drills aim to test a wide variety of personnel who would be involved in responding in a real attack. “Anytime you bring together over 20 different agencies, the many different firefighter personnel, and all of our hospital personnel to exercise and train together, it will always be a success, because it will identify not only the areas we did very well in, but also where we can improve upon. That is really the ultimate goal,” he said.

After the emergency preparedness event, the participants will conduct a formal debriefing to identify the lessons learned through the event. The issues pinpointed that need more work will be incorporated into next year’s drill.

Patient Care in a Mass Casualty Event

The partnership has worked to expand its emergency response capabilities by spearheading 11 disaster information management research projects led by the National Library of Medicine. One of the projects that this year’s drill tested was the use of a digital pen that allows medical personnel to capture live triage data for patients as they come for care.

Gillette said that the partnership had sought a way to improve information data capture during a mass casualty event. Instead of filling out a chart with a regular pen and form when a patient arrives, information filled out on a form with the digital pen can automatically be uploaded to a computer without having to type the information into a computer. If the patient needs to be moved to another facility, the data could then be readily accessible on a computer. “That would really aid responders as they are beginning to document information that it is automatically uploaded into a computer system and can be shared across facilities.”

The drill participants also tested a web-based lost person finder system that can help families locate missing family members during a disaster event. One of the challenges in mass casualty disaster situations is reuniting family members who have been affected by the disaster. “We knew based on Katrina there is a need for improving how families and patients are reunited,” said Gillette.

The family reunification system allows for photos of the casualties to be uploaded to a computer and then automatically shared with partnering hospital facilities. Users will be able to search the lost person finder database to find a missing person. “As we were taking the photos here, we could instantaneously send those photos and demographic information to Suburban Hospital and also to the NIH Clinical Center,” he said.

NNMC also has a new hospital command center that was used during the drill. The center is the first of five that Navy medicine is establishing across the country. The center will eventually be a 24/7 operations center for both emergency and nonemergency command and control. During a mass casualty event, senior staff can go there and start incident planning measures to ensure that hospital operations continue and that the needs of the casualties are being met.

The new center has classified secure telephones, videoconferencing room, Internet and more space, among other capabilities. One of the advantages of the center is that personnel can now put needed maps on a video system for everyone to view, rather than having staff gather around a paper map on a table. Prior to standing up the facility, it took the hospital an hour to stand up its emergency operations center.

The drill was also an opportunity to showcase the partnership’s rapid response shelter, which is a 25-bed, multi-purpose facility that can be deployed to rapidly augment surge capacity in a mass casualty event. With the assistance of six to ten personnel, the facility can be fully deployed within five hours and medical personnel can receive casualties. “In the event of a prolonged crisis, a series of these units could be set up and serve casualties,” Gillette explained.

The rapid response shelter is the “first of its kind,” according to Gillette, who said it is similar to a Navy Fleet Hospital or the Air Force Expeditionary Medical Support. If HIN1 turns into “a crisis mode,” the deployable facility could be used as a complete isolation area where HIN1 patients would be cared for noted Gillette.

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