In an effort to stay poised and ready to confront potential threats, the staff at the Keller Army Community Hospital exercised a mass casualty/decontamination scenario testing their emergency operation plan to receive casualties on July 22 at the U.S. Military Academy.
“It was a long process. First, we made revisions to the emergency operations plan because the last one was in 2018. Then, in 2020, we had COVID-19 and that messed everything up — this is an annual event, but everything got put on hold,” Sgt. 1st Class Scott Cash, the operations chief, said. “We basically had to start from scratch, revamp the emergency operations plan, set up the training for all the stations and then do concurrent training.”
Cadets and staff members constructed four triage tents during the Mascal/Decon exercise. The tents were distinguished by the colors green, yellow, red and black, which corresponded with the injury. For example, the yellow tent represents delayed patients with critical injuries but are likely to survive. Red represents immediate patients with severe injuries who need primary care. Green represents patients with minimal injuries and black represents patients who have succumbed to their injuries.
Subsequently, evaluators watched as KACH exercised its Mascal/Decon scenario testing its emergency operations plan and initial setup to receive simulated casualties. Twenty-five civilians volunteered and were a part of the exercise. They all had varying degrees of hypothetical injuries that medical practitioners assessed during the detail.
The process began with figuring out if the patients had chemical or non-chemical injuries. Then, anyone with chemical injuries went through the colored decontamination tents. The patients were kept apart, otherwise, patients would start to cross-contaminate each other.
With that, great detail went into managing a patient with chemical injuries compared to a patient that wasn’t exposed, Col. Amy Jackson, the KACH Commander, said. Medical practitioners routed the patients through the decontamination tents. They assessed the patient from top to bottom to adequately notate their medical conditions.
Afterward, they assigned the patient a number and then that triage practitioner, whether it was a doctor, physician or nurse practitioner would say where the patient needed to go. Then the litter bearers conducted the fast pace movement transferring the patients into the hospital.
“This exercise allowed us to practice aspects of our job that we don’t do every day,” Dr. Jeffery Lawson, an emergency room physician working in the immediate area of KACH, said. “We have nurses coming in from other sections of the hospital, and they’re reorienting themselves to things they have done in the past but not until recently.”
Lawson added that the nurses trained on various tasks, including setting an intravenous pump to give medicines or fluids. The exercise also allowed Lawson to dust off the cobwebs as well.
“Normally, I’m a flight surgeon in this hospital, and I haven’t been working in the emergency room recently, but I’m trained to operate in it,” Lawson said. “It’s refreshing and constructive having to go back in my mind to the basics and intermediate levels of the primary and secondary survey of a trauma patient and reminding myself how to do it and then getting the team and making sure we’re all on the same sheet of music. It’s great practice for things we don’t do every day.”
The notional exercise focused on an active shooter that led to casualties and a suspicious liquid that posed a chemical threat to the community. The staff at KACH needed to go through decontamination and the hazardous material process to divide the patients into their perspective tents outside of KACH before entering the hospital, Bob Brown, the Emergency Operations manager, added.
During the exercise, a scribe at the Public Affairs Office at KACH wrote a chronological record of everything that transpired so that, later, staff members at KACH can analyze and study the information when they conducted their briefings. The record goes up to the garrison region and soon be disseminated to various garrisons throughout the nation, Sgt. 1st Class Scott Cash, the operations chief, said.
“So, we want to know, minute by minute, everything that’s happened. For example, we have 20 minutes for Decon to set up their stations,” Cash said. “If we find out, based on this timeline in the record, that it took 25 minutes, we then know that Decon needs a bit more training in terms of setting up their equipment. Basically, with this timeline, we get an overview of everything that’s happened and where we need to adjust fire to make things more efficient in the future.”
This event was Cash’s first time conducting an exercise on this scale as the chief of Operations. This exercise offered him the experience he needed to work in a Mascal situation. He added this experience would help him in next year’s Mascal exercise and, as a result, he will have a better, more focused perspective on coordinating the training.
Furthermore, Cash feels, based on what he observed, his subordinates learned the importance of teamwork and developed a shared understanding of the overall concept of the Mascal.
“Basically, in a real-world scenario, this would be an all-hands-on-deck situation,” Cash said. “We want everyone on the team to know what everyone’s job is and how they can help. Also, everyone must understand what the processes and procedures are during a Mascal or active shooter situation or any other incident that affects KACH as a whole.”
To execute the operation effectively, staff members reviewed all of their policies and then started conducting two-hour training sessions every Thursday for the last four months.
“Within that time period, we have been shutting down our operations as much as possible to focus on the training,” Jackson said. “First and foremost, we wanted to validate our process and validate a shared understanding across the organization so that we all know our roles and responsibilities and get a more refined grasp on how to respond to an emergency management situation.”
Jackson added the Emergency Operations Center is another critical aspect of the exercise. It is, essentially, the hub of all the activity taking place during this scenario. The EOC manages everything that takes place as there is a dire need for quality communication equipment and effective two-way radio etiquette so that information seamlessly flows as staff tends to their patients.
“This is West Point’s Emergency Operations Center and if we have an incident on the installation, I need to coordinate efforts to the best of my ability. This is what the EOC is for,” Brown said. “With an active shooter present, an incident command post under FEMA (Federal Emergency Management Agency) is established. So, our role in the EOC is to support the incident commander, so if he needs more ambulances, a front loader truck, or any piece of equipment, we will tend to their logistical needs (among other things).”
Brown added the incident command post runs the incident and then reaches back to the EOC as its support element. In addition, representatives from the Logistics Readiness Center, Directorate of Public Works, KACH, the G-3 (project management) and the U.S. Corps of Cadets are connected to the EOC to coordinate the effort effectively across the post.
The EOC helped organize this collaborative effort to develop, enact or coordinate a plan to get a hold of the resources necessary to support that effort.
“The end state that I’m looking for in this exercise is that my people are confident and competent in their perspective roles, and if something happens on this installation, we are there to support and take care of our patients in the best way we possibly can.” Jackson said. “Another thing is, routinely, we see well-patients. We don’t have a lot of trauma come through this hospital. We’re not a trauma hospital. So, that’s why when the need arises and a trauma patient comes through these doors, we have the muscle memory to execute our mission and facilitate the needs of the patient.”
Jackson added she was thrilled to see everyone working as a team to accomplish the mission adequately and believes this exercise will make the staff at KACH more resilient and prepared to deal with potentially severe threat levels.
“I understand that no person, system or process is perfect, but consistently establishing that muscle memory will get us close to it,” Jackson said. “Remember, it’s about building confidence through training and paying close attention to the smallest of details. There is a wide range of things you must do in the medical field. My hope is that we recognize the things we need to work on, but also recognize the strengths we’ve developed along the process and the milestones we’ve achieved as a team.”