HONOLULU -- On April 24, 2013, an Army vehicle carrying two Soldiers, an embedded French journalist and a detainee was involved in a single-vehicle accident during a humanitarian mission. The injuries, ranging from minor to critical, required immediate action. The patients needed to be triaged and treated for medical evaluation. Although this exercise is familiar territory to medical personnel at Tripler, this mass casualty scenario was presented to Hawaii public high school students during the 2013 Career Pathway Performance-Based Assessments on April 24th and 25th at the Sheraton Waikiki Hotel.

The scenario was a comprehensive assessment of the academic knowledge the students received throughout high school. The students, involved with Career and Technical Education (CTE) from Hawaii's Health Services academy, had to write a research paper on the evolution of emergency medical services, perform a variety of clinical skills, and present a slide presentation with oral arguments to justify their clinical approach. Over 50 high school students in the Health Services academy from all over the Hawaii islands participated in the assessment, with hopes of receiving a "proficient" rating on their transcripts, if successful.

The mass casualty scenario culminated from a partnership between Tripler Army Medical Center, United States Army Recruiting, and the Hawaii State Department of Education. Led by Maj. Stephanie Rigby-Tomasko and Master Sgt. Ronald Henley, from Tripler's Department of Health Education and Training, the seven-person team (Sgt. 1st Class Zella Gilkey, Sgt. 1st Class Jeffrey Iliff, Sgt. 1st Class Jonathan Lucas, Staff Sgt. Andre Williams, and Sgt. Brandon Cummings) defined the rubrics for the scenario and formulated the clinical skills assessment for the students. Henley reasoned that the assessment should mirror EMT-Basic National Registry standards, yet also be presented at a level appropriate for high school students to understand. For the clinical skills portion of the assessment, his team provided six training mannequins, three CPR mannequins, and standard medical equipment to simulate the casualties in the scenario.

"When we originally discussed the mass casualty scenario with the Hawaii Department of Education, they were excited about the military's impact on medicine throughout history," said Henley. "When the administration went back to the teachers to discuss the Army's involvement with the scenario, there were a lot of reservations because of the presumptions of war. Ultimately, the administrators stood by the military scenario because it presented unique medical and ethical challenges that are not as prevalent in the civilian world."

At 0830 on the 24th of April, Henley, NCOIC of DoHET presented the military mass casualty scenario to the students. The students, as well as the teachers that accompanied them, were immediately overwhelmed.

"Their collective jaws just dropped to the floor because they had never been required to do anything like this before," said Illif. "After talking with the teachers, the most the students had done was taken blood pressure readings at community health drives and learning about the human body in medical textbooks."

The students, in two-person teams, were required to identify and treat anaphylactic shock, head injuries, fractures and lacerations, as well as perform CPR. Although many of the students never received hands-on instruction on how to treat these injuries in their respective classrooms, they were given four hours to research and learn how to provide treatment and gain an understanding on medical ethics. Although the Tripler personnel were available to the students to answer questions about medical supplies and clarify the scenario, they were not allowed to provide any clues on which injuries were present and how to treat them.

During the clinical skills portion of the exercise, the teams were escorted to the outside of a room, and told to fill up an aid bag with medical supplies in lieu of what was waiting for them behind the door. Referring to the Boston Marathon bombing that occurred one week prior, Stephen Goering, Education Services Specialist with the United States Army Honolulu Recruiting Company, reminded the students that a mass casualty event could occur at anytime. He told the students, "If you look at the videos of the Boston Marathon bombings, you had some people running towards the direction of the explosions and providing treatment without even thinking about their own personal safety," Goering instructed the students to, "Just go for it, because although the patients may die if you make a mistake, they will certainly die if you do nothing."
Once the students filled their aid bags and signaled that they were ready, the door opened, the scenario began, and they had 30 minutes to treat three injured victims. At the end of the day, many of the students rose to the occasion and had done enough to satisfy the Tripler DOHET team.

MSG Henley is proud of what his team accomplished over the two day assessment. Through Tripler's commitment to community service, they were able to promote the quality of Army medicine, while also ensuring that education standards in Hawaii's public high school classrooms are being met. After the assessment, MSG Henley received numerous letters from students, which he proudly displays on his office wall, stating that the scenario impacted their decision to work in the medical field after high school.

One student wrote, "As a future medical professional, you along with the rest of the Army personnel taught me so much throughout the assessment…I was able to see first-hand the different types of medical equipment I would use in the future, and learned how to use them. Through the scenario, I learned how to use a splint and saw an epi-pen for the first time. I've gained a broader perspective of the medical field from physically using the different medical supplies and techniques on the mannequins rather than just reading about them in my textbooks."

Tripler's involvement also changed perceptions about the military among Hawaii's Department of Education. Immediately after the Performance Based Assessment, many teachers, who initially had reservations about a military mass casualty scenario, have asked for Tripler personnel to come into their classrooms next year to train their students on basic first aid techniques. One of the teachers, whose team took first place, is trying to organize a field trip to Tripler for all of her Health Services academy students and asked for a recruiter to come into her classroom for an overview of all of the Army medical jobs available.