Each semester, BYU EMTs, nursing students, the Department of Risk Management, and campus police participate in a mass casualty incident drill, or MCI. This drill helps emergency response teams around campus practice valuable skills and teaches nursing students how to operate in emergency situations. This semester, the MCI was a simulated mass shooting that was staged mid-April.
Olivia Marble, the event supervisor for BYU EMS, talked about how decisions are made regarding the type of scenario the MCI is. “We take a look at what could happen on campus,” she explained. “We plan for those worst case scenarios.” In looking at the most likely emergencies on and near BYU campus, Olivia and her team are able to create the most realistic situations possible.
Olivia’s first officer, Calvin Reed, is a first semester nursing student who has been working for BYU EMS for a year and a half. He’s been planning MCIs during that time and explained some of their efforts to make the training realistic. “We had an improvised explosive device on the MCI scene which forced EMTs to move all the tarps into a safe location during the drill,” Calvin said. “We got some comments back saying it wasn’t realistic to have explosives. Then two days later, the Brooklyn shooting happened. On the subway train, there were several unexploded explosive devices.” In real life, incidents of mass casualties are unpredictable; It’s important to Olivia and Calvin to portray that unpredictability in the MCI training.
“The MCI is an interesting bridging point between nursing and EMS,” Calvin further explained. Though important for nursing students’ education, the MCI was initially created for BYU EMTs’ training. Olivia commented, “EMTs learn how to work in more chaotic conditions than usual in the MCI. With emergency medicine, we never know what we’re gonna get. But with mass casualty incidents, it’s taken up to a whole new level.” She continued, “There’s a lot more teamwork and collaboration involved than on a normal call where you’re only working with three or four other EMTs at most. At the MCI, we learned how to work with other agencies. We learned how to work with the nursing program. We were able to see how our EMTs mesh and work with police and with Provo fire.” The other agencies Olivia referred to include Provo’s police and fire departments. Although the decision was last-minute, Provo police were able to participate in the drill and give feedback about the event. “We hope that we’re going to be able to get them involved in future drills,” Olivia said.
Having the Provo police department attend gave the MCI coordinators a new perspective on the drill. “I got some interesting feedback from Provo,” Olivia explained. “I was talking with them at certain points through the drill to see what they would do if they were to run it and saw differences in the command systems.”
Each MCI is run twice. Between simulations, feedback is given to participants so they can implement new techniques the second time. Olivia explained, “What we do for the debrief time is we split into three different groups: we have the patients, the EMTs, and then the nurses. Nursing faculty takes over and facilitates everything on the nursing side of that debrief; they know what nursing students need to get out of it. We have our head duty supervisor for EMS talk to them and gather feedback. And then myself and my officers, we talk to the patients and see how things went from their side, whether they were mis-triaged, mistreated, and any kinds of issues that had come up. Then we take that feedback to all of the responders and try to implement it for the next round.” This semester, there were some issues with triaging–assigning severity of patients’ wounds–which led to inadequate care for many of the “patients.” However, with some instruction, the EMTs were much more successful the second time.
“We train for the worst case scenario every time,” Olivia said. “That way, if that ever happens, we’re more prepared for it.” If a worst case scenario were to happen in Provo, the Provo police wouldn’t go to BYU right away because of its healthy population. “We’re the healthiest population in Provo,” Calvin added, “because we’re all 20 to 30 something-year-old, young, healthy students. BYU EMS and BYU nursing are the frontline for medical care at BYU.”
Nursing students may have reservations about participating in the MCI training if they have decided not to work in emergency medicine, such as a nurse planning to work in the NICU. “You may be in the NICU right now,” Olivia said, “but when the ER is at 200% capacity and they need help, you’ll need to know how to be flexible, and how to adapt in that situation. It’s a lot easier if you’ve done an exercise like this before than if you just get thrown into it.” Calvin also explained that nurses sometimes aren’t aware of what emergency care looks like. “It’s critical for the nurses to see what happens before the hospital setting,” he said, “because I’ve heard complaints of nurses in hospitals about why a patient came in with their bandaging looking awful, like a dog chewed on it. We have 87 patients to deal with. We don’t have the time to make everything look perfect. Before the hospital setting, it’s completely different. Nothing in our field is sterile. In a hospital setting, everything’s sterile, which is wonderful for the patients. For EMTs, we do what we can. We alcohol swab everything we can, we wear gloves to protect ourselves, but really, we’re working with limited resources.” Seeing this side of medical care broadens nurses’ perspectives. Nursing students also get the chance to apply critical thinking. “That’s something we always get feedback on,” Calvin commented. “It really opens students’ eyes to how to think without a procedure manual, or how to make decisions on their own.”
Many nursing students have an idea of a career path before the MCI, but some discover a love for emergency medicine during the drill. “I look at that and think, ‘we just changed somebody’s career path in one training,’” Calvin said. “I think that’s awesome.”
As BYU EMS continues to plan MCIs, they hope it expands. “It’s always about networking,” Calvin stated. “Emergency Management knows people in the National Guard, they know people with medical helicopters, they know people with buses. That’d be amazing to have the National Guard deployed to come train with us. It may happen.” Although the MCI drill is already a fantastic learning experience for our nursing students, it’s great to know that it will continually grow to be more effective and meaningful as semesters continue.
We want to thank all participants, including the nurses, EMTs, actors, and makeup artists for making this educational experience possible.