“Prepare for the unexpected” might be the understatement of the year when considering the ups and downs of learning and working through a pandemic. But for Emergency Medicine residents and fellows, it’s also the enduring theme of Disaster Day, one of the most eye-opening educational exercises of this pandemic year—or any year for that matter. Held annually each summer, Disaster Day is a hands-on simulation event integrated into the Department of Emergency Medicine intern orientation training program. It’s held at the Muscatatuck Urban Training Center, located near Seymour, Indiana. The center is used by the Indiana National Guard for domestic preparedness training and by various state and federal agencies for search and rescue training. “The goals of the daylong event are to cover the basics of mass casualty triage,” says Disaster Day coordinator Mark Liao, MD, assistant professor of clinical emergency medicine. “We also introduce topics like chemical contamination, an active shooter scenario or a terror attack on a subway, and go over how each scenario would change the care rendered. “While it’ll be hard for our learners to remember all the details, what they typically walk away with is an understanding that they can count on one another to work together and manage the circumstances of any disaster.”
In this Q&A, Emergency Medicine residents Kayla Nussbaum, MD, MSHCT, George Chen, MD, and Alexandria Weston, MD, share their impressions of Disaster Day 2021, including what surprised them and how they’ll use the learnings as they continue their careers.
What were your thoughts going into Disaster Day and how did the actual experience compare?
Dr. Nussbaum: I had never experienced a Disaster Day sim, so I had no idea what I was getting into. I assumed we would do some sims and have some fun. The experience far exceeded expectations.
Dr. Chen: I felt that Disaster Day was going to be very high stress but a good team bonding experience. I was grateful to learn the basics of triage during the day and get hands-on experience. The environment definitely exceeded my expectations and made the experience realistic.
Dr. Weston: I was very excited for Disaster Day but wasn't sure what to expect. It exceeded my expectations.
What part of the experience was most memorable?
Dr. Nussbaum: For me, it was pulling into the base and seeing the large-scale disaster simulations. The first one I noticed was a flooded street. This was very poignant to me as I am from South Texas, and we frequently experience disastrous flooding during hurricane season. It was a strange but exciting realization to know I would be learning how to respond to similar disasters as a brand new Emergency Medicine physician.
Dr. Chen: The most memorable experience was going into the subway station as the triage team and just not knowing what to expect. (The rave/mosh pit scenario was specifically memorable.)
Dr. Weston: I think the mass triaging was the most memorable experience. It was a great bonding and educational experience to run through the scenarios.
Was there anything that surprised you about the experience?
Dr. Nussbaum: I was surprised by how high quality the simulations were. Each activity was unique, but all of them were very educational, and we had lots of fun. It was a great bonding experience for my intern class as we simulated triaging and treating each other's injuries. We had several different scenarios that required different approaches and skill sets.
Dr. Chen: I was surprised by how much effort and thought has to go into preparing the team to triage, assigning colors, ensuring people go to the right area and getting control of the walking wounded. Also dealing with bystanders or people who are arriving at the scene. It is much more involved than just medical management of patients.
Dr. Weston: I did not realize how difficult it was to respond to a mass event, like a party or a concert, and triage attendees to find who really needs care.
What aspects of your participation in Disaster Day were most rewarding?
Dr. Nussbaum: I think it was learning how to approach a triage system. There were some great discussions regarding the moral injury that can come from such systems. I learned a lot about my role as an Emergency Medicine physician in managing disasters.
Dr. Chen: For me, it was bonding with my fellow interns and getting introduced to how to manage mass casualty events and having the reinforcement that we should always be prepared as EM physicians.
If you had to sum up your experience in “lessons learned,” what would they be?
Dr. Nussbaum: I learned it’s necessary to have an agreed-upon system for triage and stick to it; to communicate clearly with your team; to ensure scene safety before any intervention and to communicate appropriately with the media. I also learned to take care of myself after experiencing a disaster.
Dr. Chen: I’d say it was to have pre-determined roles prior to a mass casualty event; practice scenarios with the establishment of roles and always be on the lookout for secondary devices.
Dr. Weston: I learned the importance of being aware of scene safety and realizing that there is a different triage approach to mass casualty situations.
How do you believe the experience will impact your work in Emergency Medicine going forward?
Dr. Nussbaum: I feel more prepared to triage mass casualty events. It also helped me improve my general triage skills—learning what dispositions can be done quickly is important to daily ED flow. Knowing that a mass casualty event is defined as when disaster demands exceed resources, there are many times a “disaster medicine” approach is necessary, even without bombs or natural disasters.
Dr. Chen: I now realize and better prepare for events that are not what I encounter on a daily basis, but also to always be ready for the rare instances. Hope for the best, prepare for the worst.
Dr. Weston: I think this experience was very valuable. It gives me an appreciation of event medicine, triage, and made me more aware of how we can help as physicians in mass casualty events.
We can't wait for Disaster Day 2022 on July 11th!