There's just no getting around it.
America post-September 11 is a different country. Doomsday scenarios involving massive numbers of people on American soil once seemed far-fetched at best. Now, many people realize that potential danger could be right around the corner.
To prepare for a full-scale catastrophic event, the University of Maryland Medical Center joined forces with the U.S. Air Force Medical Service and numerous local and statewide agencies to simulate a disaster on Saturday, July 13.
The result was the Free State Response 2002 disaster drill, which took place at the University of Maryland Medical Center and involved about 200 volunteer disaster "victims as well several hundred doctorsnursesand other hospital staff. All were confronted with the following hypothetical situation: terrorists had released a toxic chemical - Phosgene -- at Baltimore Ravens Stadium, which caused an explosion in parking lot just before game.
"In my mind, it isn't a question of 'if' something like this is going to happen, but 'when' it is going to happen," said Thomas Scalea, M.D., Physician-in-Chief at the hospital's Shock Trauma Center. "Doing a disaster exercise of this magnitude is something that we've been wanting to do for some time, but September 11 really galvanized our efforts."
The purpose of the emergency response drill was to find out how well military personnel and medical personnel at the hospital's emergency department and Shock Trauma Center would handle a rapid influx of 200 injured people.
This exercise was one of the nation's first, full-scale disaster drills. One of the reasons it was conducted at the Medical Center is the hospital's extensive experience with critically ill and injured patients. The hospital's Shock Trauma Center, which treats about 7,500 patients a year, is one of the largest trauma centers in the United States. The emergency medicine department sees about 30,000 patients annually.
According to University of Maryland Medical System president and chief executive officer Morton I. Rapoport, M.D., the idea for the disaster drill crystallized during a trip he took to Israel last December with members of the U.S. Air Force and the Joint Commission on Accreditation of Healthcare Organizations. There, they witnessed the Israeli Defense Forces' Home Front Command enact a huge bioterrorism training exercise involving about 1,000 Israeli volunteer "victims".
"Having seen it done in Israel, we knew that it could be done," Rapoport said. "We immediately began talking about the importance of doing this kind of training exercise here so that we could become better prepared to face bio/chemical terrorism."
With the help of the Maryland Emergency Management Agency, the Maryland Army National Guard and the Baltimore Fire and Police Departments, about 145 volunteer "patients" were decontaminated and 43 were admitted to the hospital over the course of the four-hour exercise. Some of the "injured" were sent to the Baltimore Veterans Affairs Medical Center, which is adjacent to the University of Maryland Medical Center. In keeping with the realistic nature of the exercise scenario, there were also six "fatalities".
"What is most important to keep in mind is that today's exercise isn't an evaluation of how well we're doing or of what we know," said Brian Browne, M.D., the Medical Center's Chief of Emergency Medicine. "Today's exercise is a training exercise. There are a lot of people here being trained on a massive scale about what goes into a disaster response."
According to Browne, the focus of Saturday's drill was on what to do with patients once they arrive at the hospital.
"Most disaster exercises end after the emergency services personnel transport the patients to the hospital," Browne said. "Today, we have doctors, nurses, and other hospital staff all being trained in how to sort patients out once they get here. We really need this kind of training. You wouldn't hand a musician some sheet music and say, 'I'll see you at the concert. I hope everything goes well.' No, there is such a thing as rehearsal. This is our rehearsal."
A long, brown table covered with bottles of fake blood, packages of burned, plastic hands and rubber flesh torn apart by "broken" bones greeted volunteers at the Free State Response 2002 disaster drill.
Mary Holmes, a nurse at the Medical Center, sat with a group of "injured" volunteers, while waiting her turn to undergo decontamination and treatment for the bloody gash on her forehead. Upon arriving on the scene at 7 a.m., she was briefed on her role in the drill. She was told that she was a 65 year-old victim by the name of Angela Landsbury, who had been hit with flying shrapnel from the explosion at the Ravens' Stadium.
"I'm 65 and I know how to suture my own wound," she said.
Although her name may not be in lights, Holmes is no novice to this sort of exercise, which elicits a sense of imaginative drama from its participants.
"I used to be in the National Guard," she said. "I've done quite a few of these drills. Of course, nothing this big. I wanted to see what it was like to be on the other side. Today, I'm one of the walking wounded."
After getting made up, the volunteers who didn't mind getting wet were taken to the decontamination area, right outside of the hospital's emergency department. They walked under a huge shower hose perched on top of a fire truck's ladder, and were greeted by Air Force personnel, who were wearing gas masks and gray, plastic decontamination suits.
In the decontamination tent that the Air Force had set up, volunteers were scrubbed down with water before being released to the triage area.
"This is a pretty realistic scenario," said Maryland National Guard Master Sgt. Steve Bloodsworth. "You'd be surprised at how effective massive amounts of water can be. You generally don't want to use anything but water if you don't know what kinds of chemicals you are dealing with. Of course, some chemicals are reactive to water, but even with those chemicals, when you spray a person with massive amounts of water, you can usually get rid of them."
In addition to helping victims with their physical ailments, there were mental health counselors on hand to help victims with psychological problems.
"If this were a real life situation, there would be some people whose injuries may or may not be life-threatening, but who would reach their limit psychologically," said Kandy Aboud, a clinical nurse specialist in psychology at the University of Maryland Medical Center. "Some people will be having a hard time because they have seen a lot of dead bodies, or are fearful because they have been separated from their friends and family. You may even have some people who are actively suicidal, whose attitude is 'I'd rather die than live with this horrible injury or without a loved one.' In the midst of crises, it is also important to take care of your medical personnel, who may not recognize that they are exhausted and emotionally drained and in need of a break."
After most of the patients had been counseled, decontaminated, sorted and admitted to the hospital, the active duty Air Force personnel and the Air National Guard personnel conducted an aeromedical evacuation exercise. They used Maryland Army National Guard ambulances to move some "patients" to Martin State Airport.
It takes an enormous amount of resources and planning to conduct a training exercise as thorough and realistic as the Free State Response 2002. Fortunately, the Medical Center has a strong relationship with the Air Force Medical Service, which was able to provide a great deal of support for the drill.
According to Dennis Schrader, Vice President of Project Planning and Development, all of the entities involved in the emergency exercise began planning it about six months ago.
"We are required by the Joint Commission on Accreditation of Health Care Organizations to do emergency exercises, but we've never done anything that involved this level of intensity and complexity," said Schrader.
Although the effort was the first of its kind, it won't be the last. Schrader said that the Medical Center intends to make the Free State Response disaster exercise an annual event.
"In order to respond well and appropriately in an emergency situation, it takes a lot of cooperation," said Browne. "We are all used to running our own, separate shops, but today, we are learning how to run one shop What this really represents is a merging of the military and the civilian out of necessity. If you wait for federal help in the face of a disaster, you will wait too long. All of the local agencies have to be ready to work together."