As the Scout motto goes: Be Prepared.
And when you work in a hospital, be very prepared. Failing to prepare is preparing to fail, and institutions like Vanderbilt University Medical Center continually assess what their emergency response might look like in the event of a catastrophe.
On April 30, the VUMC Department of Emergency Operations conducted a large-scale mass casualty event simulation at the emergency department (ED) of Monroe Carell Jr. Children’s Hospital at Vanderbilt. It was the first of its kind held inside the walls of a VUMC hospital since 2010.
I was there as a reporter for the VUMC News and Communications Office and was credentialed as a “chaperone,” complete with an official green vest for the occasion. I tagged along with facilitators, observers, evaluators and — most important of all — Volunteer Injured Persons, or VIPs, who played the roles of the juvenile patients in the simulation.
The premise of the drill was simple: A tornado had struck a school in a nearby part of the state, and the pediatric ED had to respond as dozens of “patients” flooded the emergency room for triage to assess their injuries and treatment.
Preparing for preparation
“This exercise was an actual physical test to see how we facilitate a very high influx of patients moving throughout the hospital and how we triage and move our hospital resources to effectively care for many patients at once,” said Tucker Anderson, MD, assistant professor of Clinical Pediatrics in the Division of Pediatric Emergency Medicine.
“We wanted to see our failure points. When you test something, you want to see how good it is, but this was also an opportunity to improve.”
When he came to VUMC in 2020, Anderson set a goal to give the institution a true picture of the pediatric ED’s disaster response readiness. Now, as he prepares to step into the role of Emergency Operations co-medical director in July, Anderson sees this opportunity to assess resource utilization and response as more important than ever.
On the day of the drill, some VUMC staff learned about it gradually as VIPs were sent one or two at a time to the ED with a chaperone and a simulation facilitator.
Clinicians in other areas of the hospital, though, found themselves suddenly in the midst of the simulation. They knew a drill was coming but were in the dark about exactly when and under what circumstances it would happen.
An alert went out shortly before 9 a.m. to inform employees at Monroe Carell that the simulation had begun. It explained the situation: A tornado had hit a nearby school, and the ED was expecting injured patients.
Junior thespians on gurneys
A couple dozen children had been recruited to serve as the simulation’s patients, and they had VIP tags visible on their yellow vests. These kids, most of them the children of hospital staff, were given instructions by their green-vested chaperones and red-vested facilitators about how to behave based on the backstory of the injured character they were asked to play.
The made-up injuries were wide-ranging, from a 6-inch laceration on the hip to a chest fracture from a falling wall. With each injury came a story. For instance, a high school-age student might play the role of an 8-year-old who was pinned under a piece of furniture and suffered a dislocated shoulder.
“Sometimes they just volunteer and go with the flow, but sometimes they really act,” one participant said as we watched a VIP feign having breathing problems as he went through patient registration.
While some children, particularly the younger ones, didn’t go full Broadway mode in their roles as dramatis personae, plenty of VIPs played their characters quite convincingly.
“Sometimes they just volunteer and go with the flow, but sometimes they really act,” one participant said as we watched a VIP feign having breathing problems as he went through patient registration.
During the simulation, clinicians and registration teams processed patient after patient, asking basic triage questions to determine where each VIP needed to go next for further evaluation. Some VIPs were in and out in a matter of minutes — at which point they returned to the staging area for another go-round in a different role — while others with more serious injuries were upgraded to a more acute level of response.
A family of volunteers
At one point, as I stood in the ambulance bay, I saw a woman and her son enter, and I heard, “Look, there’s Dad!”
I had come across an entire family of volunteers.
Matt Schmidt, PharmD, BCPPS, is a clinical pharmacist specialist in pediatric emergency medicine, and his children, Abigail and Owen, had volunteered to be VIPs for the simulation while his wife, Erin, served as a chaperone.
Abigal and Owen both wound up in the ambulance bay during one of their trips through the simulation. As Abigail boarded a gurney to be assessed, I heard Owen say, “Why does she get to do all the fun stuff?”
Owen, as it turned out, had been given the role of a child with a simple broken arm. Nothing too devastating. Watching his sister get rolled away on a gurney had Owen wishing he could experience such an elevated level of service while sporting a more interesting injury.
I tagged along with Owen and Erin to a separate patient room where the nature of his minor fracture meant he was discharged quickly. When we returned to the staging area for Owen’s next assignment, he was given a more complex role to play.
“Now my head itches!” Owen said as a towel was wrapped around his noggin, complete with red tape to symbolize blood.
Owen switched off to a different chaperone, and I headed back down to the ED with them as facilitator Amber Greeno, MSN, APRN, explained to Owen that he’d been struck in the head by a tree branch and was to play the plum role of a child who was either disoriented or unresponsive.
This was way better than a broken arm. Owen was wheeled into a large patient room where a doctor called for a neurosurgeon, ordered the patient to be intubated and explained that as a result of an intercranial bleed the head trauma might lead to brain damage or even death.
It was a sobering reminder of why we do simulations like this. Working out the kinks in triage and decision-making goes a long way to ensure the process is refined when a medical team is faced with a real patient with a significant injury.
Yahtzee, lunch and a reminder: “This could happen any day”
Through it all, Owen remained a stellar actor as the doctors and nurses ran their simulated tests and decided to move him on to the operating room. In lieu of an actual OR, Owen was treated to a game of Yahtzee in a conference room while the simulation progressed. He’d just racked up his first full house when we were informed that the simulation was complete.
Everything wound down as simulation leaders thanked the participants for their time and effort, and they were invited for lunch downstairs.
“What I told my kids is that this is an opportunity for us to practice, and if something were to happen to a bunch of kids, we’d want to be able to take care of them well.”
All were in good spirits, assuredly in part due to the feast awaiting them, but also because many parents, including Anderson, took care to explain the value of the simulation to their kids. The importance of missing school to help the greater good at Dad’s hospital was not lost on the young volunteers.
“What I told my kids is that this is an opportunity for us to practice, and if something were to happen to a bunch of kids, we’d want to be able to take care of them well,” Anderson said. “We might ask you to say some things or pretend like you’re injured, but there won’t be anything bad or dangerous that happens to you.”
And while the juvenile participants got an explanation of what to expect leading up to the simulation, clinical staff wasn’t as lucky — but for good reason.
“We tried to keep our clinicians mostly in the dark leading up to the simulation,” Anderson explained. “We didn’t want them to be set up to fail, but we wanted them to be unaware of what to expect because something like this could happen any day.”
