Zaffer Qasim, MD, FRCEM, EDIC, and Dale Butler, MD, were flown by Black Hawk UH-60 military helicopter to site of simulated mass casualty event.
Imagine what would happen if a hypersonic missile struck Lincoln Financial Field, resulting in mass casualties and presumed chemical, biological, radiological, or nuclear exposure. Rescue efforts would require extrication of victims from collapsed structures; large-scale decontamination of survivors; and coordination between city, state, and federal responders.
In July, this catastrophic event was simulated as part of a well-coordinated, citywide training exercise organized by the United States Army National Guard Task Force 46, a specialized unit of the U.S. Department of Homeland Security. Penn Presbyterian Medical Center (PPMC) was one of five Philadelphia hospitals invited to take part in the unit’s Dense Urban Terrain (DUT) exercises to prepare for “America’s Worst Day.”
Emergency Department staff participated alongside hundreds of members of the U.S. Army, National Guard, Coast Guard, and Federal Emergency Management Agency (FEMA), as well as from the City of Philadelphia Fire and Police departments, and the Office of Emergency Management.
PPMC’s Zaffer Qasim, MD, FRCEM, EDIC, assistant professor of Emergency Medicine and Critical Care, described the two drills in which PPMC staff took part. “We practiced receiving casualties that were decontaminated in another part of the city, and then brought to the hospital, where we performed a secondary decontamination and took over care,” he said. The casualties in the hospital drills were mannequins with their injuries and vitals noted on a tag.
Qasim explained that the drill also enabled the military to test its ability to drive their larger vehicles in Philadelphia streets, and for military, city, and hospital teams to practice communicating across organizations in an emergency situation.
Black Hawk UH-60 military helicopter on PPMC helipad.
The second drill involved the military landing a helicopter at a local hospital. PPMC is the only hospital in the area with a helipad capable of handling the weight of a Black Hawk UH-60. Team members not only tested the landing and “direct to the operating room” procedures, but practiced “advancing medical care” in the field – in this case, deploying a surgeon and emergency physician from the hospital to the location of other casualties in the city. Qasim flew in the Black Hawk along with trauma surgeon Dale Butler, MD, MBA, FACS, who recently completed a Trauma Surgery & Surgical Critical Care fellowship at PPMC and previously served as a surgeon in the U.S. Navy.
ED nurse Carrie Day, RN, is part of PPMC’s multidisciplinary Hospital Emergency Response Team (HERT) that prepares and assists the hospital in receiving patients who are injured during mass casualty events. She said, “The drill provided a very realistic simulation of what conditions would be like when receiving multiple injured patients in a short amount of time. It allowed us to practice the skills needed to care for patients during a disaster and protect the hospital and our co-workers from possible contamination from a chemical, biological, or radiological event.”
C. Crawford Mechem, MD, FACEP, FAEMS, medical director of Emergency Medical Services at Penn Medicine, has also served as the EMS Medical Director for the Philadelphia Fire Department (PFD) for nearly 25 years. He explained the value of these exercises in training first responders: “For the PFD, benefits included the building of partnerships that will endure long past the drill, that may be valuable in future, real-world incidents,” he said.
Mechem pointed out the challenges faced by participants, including severe (hypothetical) damage to roads and other infrastructure, and bringing together medical and non-medical emergency responders and agencies with different training, skill sets, equipment, terminology, communications equipment, and organizational structures.
Trauma program manager Kristen Chreiman, MSN, RN, TCRN, who helped coordinate PPMC’s participation, said the lessons learned during the exercises will last well beyond the three days in which they took place. While her department looks at their policies on a regular basis, the simulation helped to highlight opportunities for refreshing them, as was the case with “direct to OR” procedures. “We … saw we were missing some pieces, like registration – making sure the patient had an arm band before moving along. We were able to mitigate that ahead of time and now I will rewrite that policy to match the scenario we played out, which worked so well,” she said.
Chreiman added, “We at Penn Trauma are so grateful to the military and pre-hospital emergency personnel who facilitated this type of ‘play’ so that we can streamline hospital processes and ensure the best possible outcomes for injured patients.”