FORT RILEY, Kan. -- Communication is important when it comes to any emergency situation, but it doesn't always go quite as smoothly as planned.

"There needs to be at least two tiers of communication, and they seem to never work well together, or they never seem to work seamlessly, but that's always the truth in any busy, chaotic situation," said Dr. Grant Forrester, emergency medicine physician at Irwin Army Community Hospital (IACH).

This was the case with the Mass Casualty Exercise held Nov. 23 at Fort Riley.

"No matter how many times we do things in exercises or for real life, communication is always the root of most of our challenges," said Ward Philips, chief of plans and emergency management with the Directorate of Plans, Training, Mobilization and Security. "The challenge with communications is that it's always difficult to take a reporting from an event out on site at an incident, communicate that to one office, then communicate that again over to the installation headquarters and have the clear message get all the way through to those different places."

Improvements have been made and can still be made to the communications system during an incident.

"I always feel like recently, we've made significant improvements, but there's just a lot where we can continue to improve in that area," Philips said.

The incident consisted of an ammunition handling accident at the Ammunition Supply Point (ASP) involving a detail of Soldiers returning and repackaging ammunition that had not been used so it could be returned to the inventory. A defect initiated an explosion that also caused a motor vehicle rollover accident when the occupants panicked.

Key players in the exercise were IACH staff, including the ambulance crew with Emergency Medical Services at IACH; the Fort Riley Fire Department (FRFD); the installation's Consequence Management Team, assembled at division headquarters; the Fort Riley Police Department and the military police. Off-post participants included Life Star and neighboring hospitals, including Geary Community Hospital in Junction City, Kan., and Mercy Regional Health Center, Manhattan, Kan.

"We had the Riley County Emergency Management and the Geary County emergency managers involved in person and over the phone as well as the (Federal Bureau of Investigation) over the phone as we normally would in a scenario of that respect," Philips said.

Because of the type of material involved, the 84th Explosive Ordnance Disposal (EOD), 1st Sustainment Brigade, 1st Infantry Division, also responded to the scene.

Also responding to and assessing the situation was the FRFD with three to four engine companies - eight to 12 personnel - led by Capt. Ryan Trudo, a firefighter with FRFD Station 4.

"My part as a captain would be to run a triage team forward of the operations post," Trudo said. "Basically we begin initial triage of the incident scene where people were effected, ensure our people are safe, begin the triage (and) get people to a collection point. Once they're at a collection point, (we) begin a secondary triage contact with EMS and get the patients extricated to further emergency help, basically outlying hospitals or Irwin Army if necessary."

Trudo also reported back to the command staff notifying them of the situation, potential hazards to fire personnel and resources needed in order to get the injured to further medical attention.

"In a perfect system, initially triage is the most important thing. There's triage at the site of injury itself but really, it's rapid transport to the (emergency room) as quickly as possible," Forrester said.

Forrester said once the injured reach the emergency room, the key aspect is to make sure the less injured are triaged and sent elsewhere in order to not absorb the resources of the ER.

"Ultimately, the role of the ER is to take the critically injured patients or critically ill patients and to stabilize them as much as possible, get them (in) for more advanced care, which in a trauma situation like this is typically to the operating room for the surgeon to address the injuries," he said.

Should IACH become overwhelmed, Geary Community Hospital and Mercy Regional Health Center will assist IACH with the workload, like in the event of IACH having a severely injured patient in need of surgery and the operating room being engaged in activity, limiting the facility to one or two functioning operating rooms.

Instead of having the patient wait for possibly one to two hours, the patient would be transferred to Mercy Regional Health Center, Geary Community Hospital or even a hospital in Topeka, Kan., Forrester said.

During the exercise, a total of 13 patients were treated.

Out of those patients, three were discharged, and two were sent to the IACH operating room. One was medically evacuated to the University of Kansas Medical Center, Kansas City, Kan., and another four were transferred to Mercy Regional Health Center. Two were transferred to Geary Community Hospital. The incident also caused two deaths.

Based out of Topeka, with helicopters in Lawrence and Junction City, Life Star assisted with the medical evacuations (Medevac).

For the exercise, the aircraft landed at IACH for authenticity, but the aircraft is typically located at the Junction City airport, a two-minute flight away, said Adrian Horne, chief pilot with Life Star.

During normal circumstances, the Medevac unit is available 24 hours a day, seven days a week, 365 days a year, with a medic and nurse on every flight.

Horne and Todd Turner, a flight medic with Life Star, said the unit is here to help the community and is a good resource for the hospital, which doesn't have their own medevac unit.

Each year, IACH is required to conduct a mass casualty exercise.

"As we looked at that, we decided we also wanted (to) make the best use of this opportunity, so we also built in (an) emergency management and emergency responder piece with the scenario up at the (Ammunition Supply Point)," Philips said. "We planned out the exercise so we would completely exercise the fire department's incident command structure, as well as integrate our (Explosive Ordnance Disposal) assets on the installation, which is something that hasn't been done in several years."

All persons involved in the exercise said they felt that it went as well, if not better, than expected.

"We were able to do some things working together that hadn't been accomplished in quite some time," Philips said. "We made some steps forward with the EMS integrating with the incident command structure at the incident site."

"We also had EOD very involved in both operations at the ASP and at the hospital, where we had the scenario, called for a munition that was embedded in a casualty," he continued. "So that was something new and different that we were able to do, both for the EOD guys, as well as the hospital staff."

"For us, obviously, with these mass casualty incidents, we don't have this type of scenario every day," Trudo said. "It basically puts all the main players together and gets us on the same page to where we can mitigate the situation, do the most good for the most people. The more that you become familiar with these situations, the easier it is to respond, and the more practice you have, the better you are."

"I think it went well," said Sheree Wilt, assistant head nurse at IACH. "I've been doing this for eight years. I think it was probably one of the better ones that we've had. We still had, obviously, some issues to deal with, but I think overall, it went well."

These exercises also are conducted in order to build personal relationships and comfort levels in working together, said Col. Mike Heimall, commander, IACH. It's about getting to spend time and work with the person you'll be sitting next to, he said.

"We do these things because it's very important that we practice as much as we can for these events, so that if and when they ever happen for real, it's not the first time that we've been faced with some of these scenarios," Philips said.