Training Drill Turns into Real Disaster
Training Drill Turns into Real Disaster
The annual mass casualty incident (MCI) training drill, organized and run by volunteer emergency physicians from Hospital Woeisme, took an unexpected turn this year.
This is my foot*
Held every spring at a lake about an hour outside the city, the goal of the MCI drill is to help emergency medical services (EMS) personnel practice what to do in the event of a large-scale disaster. A fake scenario is staged, such as an explosion or a rockslide, including moulaged actors and props. The EMS crews, comprised of EMTs and paramedics, respond as if the situation were real. The emergency physicians are there to evaluate the responsiveness and effectiveness of the EMS crews, and to give feedback on their performance.
Over 50 medical students volunteered to play the role of the MCI victims this year. The scenario featured a packed tour bus hitting an SUV, with both vehicles ending up in the lake. While the scene was being set up the participating EMTs and paramedics were held at a nearby ranger station, so that they wouldn’t see the scenario ahead of time. They waited for the fake radio call to come in from the scene, which would signal the start of the drill.
The moulaged patients staged themselves around the lakeshore, with various high-fidelity prop limbs scattered throughout the scene for good measure. Each patient had been briefed on their backstory and the alleged injuries they had sustained. To save money on renting props, the tour bus and SUV were said to have “sunk in the lake.”
Just as the last props were placed and the drill about to start, a couple of hikers stumbled across the mass of injured people. On approaching a nearby medical student-turned-patient, who figured the hikers were part of the drill, the patient yelled about the crash, their injuries, the vehicles sunk in the water, with the occasional dramatic, “Oh it hurts! It hurts!” thrown in. The hikers called 911 to report the accident, stammering that they’d come across a lot of injured people.
The 911 call triggered an ambulance, not part the scheduled drill, to arrive on scene. The seasoned medics on the rig, Mr. Lance and Ms. Seki, called in to their base station to report the MCI. Their initial triage report stated that there were nearly 50 injured people, so all available ground and air crews were instructed to convene at the lake. Additional ambulances arrived, followed by law enforcement and firefighters. Each emergency physician thought that someone else had made the fake radio call to start the drill, and assumed that these responders were all drill participants. The EMS crews actually participating in the drill waited patiently at the ranger station up the road.
One of the medics from the ranger station, curious about the late start to the drill, strolled down to the waterfront to see why there was a delay. On spotting the slew of response vehicles he ran back up to the ranger station shouting, “It’s not a drill anymore! It’s a real MCI!” so all the EMTs and medics at the Ranger Station ran to the lake to help, with some now believing they were part of a real MCI, and not a drill.
A medical student gasped as she told an EMS crew, “My asthma… was triggered…on the swim … from the car … to the shore.” The crew exchanged looks as no wheezing could be heard, and the patient’s hair and clothes were completely dry. They took turns listening to her lungs, unable to hear any wheezing or identify any signs of respiratory distress. Sticking to the script, the medical student insisted, “No I swear! I have asthma and I’m wheezing! Like really, really badly!” Not wanting to miss a potential airway disaster, they loaded the patient into an ambulance for transport to the nearest hospital.
Confused EMTs tried to reason with a young medical student who claimed that he was a 62-year-old with chest pain from several broken ribs. The medic confirmed his age multiple times, at which point a nearby emergency physician, there to evaluate the EMS response, interrupted, “He already told you his age several times, you should move onto the assessment.” The medic turned and demanded, “Who are you?” On replying that he was an emergency physician, the medic yelled, “Well then help me or shut up!” Then physician could be seen jotting down several negative comments on his assessment form before walking away to evaluate someone else.
The physician next went to a nearby EMT, who stood perplexed as a young man yelled that he had an injured baby needing help. The patient kept trying to get the medic to examine the child, but the medic hesitated to do the exam, as the baby was clearly a doll. The physician evaluator, frustrated by the delay in care, yelled at the medic, “Will you examine the baby already!?” The physician could be heard muttering, “These EMTs are really struggling compared to last year’s drill…” as he wandered off.
Another patient kept insisting that she couldn’t walk because her foot had been amputated during the crash. The perplexed medics were unable to identify any injury to the patient’s extremity, let alone that it was missing entirely. They repeatedly examined the foot, with its bright pink toenail polish, warm pulses, and brisk capillary refill, unsure whether or not to place a tourniquet, as a tourniquet would certainly be indicated if she had an amputation, but in this case the patient just seemed to have ticklish feet. The EMS crew became convinced that she must have massive head trauma due to the delusion of a missing foot, and loaded her into a nearby ambulance for evaluation of her head.
One of the hikers heard the patient yelling from the ambulance that her foot had been amputated, and spotted a bloodied foot next to a nearby tree stump. In trying to be helpful but being incredibly squeamish, the hiker took a plastic bag from his backpack and scooped up the fake foot without actually looking too closely at the prop. He ran to the medics as they closed the back of the rig, “I found the patient’s foot, it was over there by the tree,” and not wanting to hold it any longer than he had to, shoved the bagged foot into the medic’s arms. Mouths agape, the medics placed the bag into the rig and transported it to the hospital along with the patient without speaking another word.
Another EMT who had volunteered for the MCI drill exclaimed, “This is the most impressive drill I’ve ever seen! They even got helicopters and to come! Wow. I always heard this was the best annual MCI training, and I’m just blown away!” He then walked over to evaluate a physician who got tasered by law enforcement after trying to stop a medic from performing painful maneuvers to wake a patient pretending to be dead. The EMT was heard exclaiming, “Look at these taser barbs! They look so real!”
The fake patients, without evidence of actual injuries, were so convincing that the first responders decided a mass delusion from a drug exposure must have taken place. As the lake is outside a major city, but with no nearby factories or other reasonable explanations of the source, a terrorist attack with a biologic weapon became the best explanation for the situation. EMS responders determined that a neurotoxin must have been released, causing people to have the fixed hallucination that they and their friends had suffered severe physical injuries. At this point, the DEA, the CDC, the FBI, and ABCDEFG were all called in to investigate the attack.
Water rescue boats arrived to dredge the lake for missing patients, the sunken tour bus, and the SUV. Search and Rescue ground crews scoured the area for victims and terrorists that may have wandered off into the nearby forest. Helicopters circled overhead to scan the water for victims, while Highway Patrol shut down all roads in and out of the park. All the patients, medical students and physicians alike, were evacuated from the scene and placed in quarantine for two weeks, despite their repeated protests that they were part of a drill. Experts determined that repeated objections to ongoing medical evaluation were merely a component of the mass delusion. They underwent extensive blood work and testing to determine which neurotoxin had affected them, though the underlying cause continues to elude epidemiologists.
After an extensive and prolonged search, the water rescue teams were unable to locate either the tour bus or the SUV. No terrorist organization ever claimed responsibility for the attack, though the FBI and CIA are still investigating several leads. The patients were eventually released, and all made full recoveries from their non-existent injuries. Since there were no fatalities, all the EMS crews and responding agencies received awards from their respective departments, citing their swift and heroic actions during the MCI.
*Yes, that is really my foot. A mold was made several years ago, and has been used in multiple MCI drills.
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