What was supposed to be an ordinary cruise took a turn for the worse when “Hurricane Elda” unexpectedly made impact with the SS Gregory, wreaking havoc and sending it ashore. Bodies were flung from the ship while injured victims howled and awaited help.

Firefighters rushed to the scene while nursing, medical, public health, social work, dental hygiene, and biomedical informatic students and volunteers arrived to help victims in need of attention.

Fortunately, the casualties and injuries that played out were all part of a scripted scenario, staged at the Houston Fire Department’s Val Jahnke Training Facility, and orchestrated months in advance.

The event, held for the seventh time last Friday, was the brainstorm of Elda Ramirez, PhD, RN, ENP-BC,  the Dorothy T. Nicholson Distinguished Professor at Cizik School of Nursing at UTHealth Houston. She created a unique training event in a strong collaboration with the Houston Fire Department and other schools at the university.

Students from Cizik School of Nursing, McGovern Medical School at UTHealth Houston, UTHealth Houston School of Public Health, and UTHealth Houston School of Biomedical Informatics participated in the mock mass casualty drill. Additionally, students from the dental hygiene program at UTHealth Houston School of Dentistry and Texas Southern University School of Social Work participated for the first time.

Volunteer students played the victims, complete with elaborate stage makeup, known as moulage, coordinated by faculty, and staff from the medical school and nursing school.

After being successfully triaged, survivors were transported to three makeshift hospitals, where students assessed the severity of their injuries and prioritized the number of hospital beds available.

The simulation, which took nearly five months to plan and featured 178 students and 47 faculty, offers UTHealth Houston students the training they need to hone their emergency first responder skills and presents them with a rare opportunity to learn with experienced faculty and staff by their side.

“This is a very special experience for many types of students at UTHealth Houston,” said Ramirez, an emergency trauma nurse practitioner track and project director of the mass casualty incident drill. “The event is 150% based on objectives that are necessary for people to engage in a mass casualty event. Every year we try to get creative with new ideas to see how people respond; getting that adrenaline shot in a simulation and then getting your wits about you and making it work to where it’s as close to muscle memory as possible. The goal is always to take away the most basic structures for when they go out in the real world. What are you going to do when mass casualty events happen? Not if.”

The chaos that ensued from the hurricane was heightened even more when two disgruntled crew members from SS Gregory emerged on the ship with rifles and began shooting at first responders and victims. The sound of gunfire pierced the sky leading to students sheltering in place until the Houston Police Department SWAT team was able to respond, stop the shooters, and secure the situation. Students returned to their emergency response, with several new gunshot wound victims added to the multitude of patients requiring their care.

Additional organizers of the event included Debbie McCrea, EdD, MSN, EMT-P, assistant professor at Cizik School of Nursing, and Kevin Schulz, MD, associate professor of emergency medicine at McGovern Medical School.

Both McCrea and Schulz spoke on the importance of students working together with one common mission and experiencing circumstances they would least expect.

“Every year we do this we learn something new. There’s always a hiccup, but I think in today’s case it went really well,” McCrea said. “It didn’t tire out the students too much. They learned a lot, and I heard from several students today how chaotic it was — and that’s what we were hoping for.”

According to Schulz, the mass casualty event provides students with invaluable first-hand experience.

“Although some have a bit of training coming into this, in a lot of cases today is the first time they’re going to experience something of this magnitude,” Schulz said. “The most important lesson they can come away with is the complexity of the response and understanding of what goes into the professional side of the response, as well as, understanding how important communication and interprofessional collaboration is when you’re dealing with a response like this.”

Second-year dental hygiene student Lauren Frazee said the experience was both educational and overwhelming.

“We didn’t really know what to expect going in. Getting the patients off the dock and to the tarp areas was not only very informational but also a fun experience,” Frazee said. “It was incredibly important to work as a team. Everything came down to communication. I think it was really cool that we were working in teams with students from other schools studying different occupations.” 

Also featured was the UTHealth Houston Mobile Simulation Training Unit, which is an educational outreach vehicle for simulation training. The vehicle offers a realistic simulation environment to train in a high-fidelity, immersive experience to confront life-and-death patient encounters.

The mass casualty incident drill highlights the mission of one of the sponsors, the UTHealth Houston Center for Interprofessional Collaboration (CIPC). The center promotes education, practice, and research within the framework of a health care team. Students from all schools at UTHealth Houston have opportunities to gain knowledge and skills for interprofessional models of care.

“It is essential that students learn how to work together, and as interprofessional team members,” said Tiffany Champagne-Langabeer, PhD, CIPC co-director and associate professor at the School of Biomedical Informatics. “During an emergency, every person is important, valuable, and has a role to play. It is the same in a hospital when caring for patients - we are all valuable and in different ways. We complement each other’s skills and work together. The value of interprofessional collaboration becomes very obvious during an emergency. We want students to learn the importance of working together to create something bigger than themselves.”

President of the American Association of Nurse Practitioners April N. Kapu, DNP, and her team were also in attendance as they celebrated National Nurse Practitioner Week with an address at Cizik School of Nursing and the mass casualty event.

“I couldn’t think of a better way to highlight all the many valuable contributions nurse practitioners bring to care and to patients everywhere on a daily basis, and certainly in these mass casualty situations,” Kapu said. “We’ve really seen over the last three years NPs have stepped up repeatedly throughout the pandemic. They can innovate, lead, and have this blend of nursing and advanced training and education as nurse practitioners.”

Students also donated nonperishable food items as part of the drill, which will be distributed to area food banks.

Kenny Bybee