“Prepare for the unexpected” might be the understatement of the year when considering the ups and downs of learning and working through a pandemic. For emergency medicine residents and fellows, it’s also the enduring theme of disaster day, one of the most eye-opening educational exercises of the year—or any year for that matter. Held annually each summer, disaster day is a hands-on simulation event integrated into the Department of Emergency Medicine's intern and fellow orientation training programs. It’s held at the Muscatatuck Urban Training Center, located near Seymour, Indiana. The center is used by the Indiana National Guard for domestic preparedness training and by various state and federal agencies for search and rescue training. “The goals of the daylong event are to cover the basics of mass casualty triage,” says disaster day coordinator Mark Liao, MD, assistant professor of clinical emergency medicine. “We introduce topics like chemical contamination, an active shooter scenario or a terror attack on a subway and go over how each scenario would change the care rendered. “While it’ll be hard for our learners to remember all the details, what they typically walk away with is an understanding that they can count on one another to work together and manage the circumstances of any disaster.”
To better understand the
impact disaster day has on our learners, we interviewed three of our EM
interns. Below you will find their responses to our inquiry.
What were your thoughts going into disaster day and how did the actual experience compare?
Dr. Colton Junod: I really had no idea what to expect! IUEM has great simulation and EMS division faculty, so I knew the experience would be interesting and engaging.
Dr. Zachary Birner: I didn’t really have a great idea of what to expect going in. I figured there would be some simulation, but I didn’t realize the scope. The actual experience was a fun break from more lecture based side of orientation, but also surprisingly somber at times when we realized that a lot of these scenarios were based on real life events.
Dr. Shannon Faehling: Going into disaster day, I wasn’t sure what to expect. I was blown away with how many different realistic scenarios could be simulated in one setting.
What part of the experience was most memorable?
Dr. Colton Junod: The most memorable part for me, was how my brain was thinking in those moments. We had a scenario where there were a large number of causalities and we had to go through and attempt to triage them as quickly as possible. It was a good exercise for me, personally, because I have never been put in that situation before.
Dr. Zachary Birner: The most memorable part of the experience for me, were the scenarios in the subway- Particularly the phone ringing scenario and realizing it was simulating family members trying to call their loved ones.
Dr. Shannon Faehling: For me, the most memorable part of disaster day was the sole survivor scenario. This exercise was a testament to finding the mental strength to move forward when it seemed that all hope was lost. This is true for both the remaining victims as well as the rescuers.
Was there anything that surprised you about the experience?
Dr. Colton Junod: Learning about what resources our community has in place to prepare for these disasters.
Dr. Zachary Birner: I think what surprised me most about these disaster scenarios, were the parts that seemed to be most challenging. While I thought the medicine would be the most challenging portion, it was ignoring all the distractions to care for those who need it most and communicating with the team while the distractions were occurring.
Dr. Shannon Faehling: I was surprised by the entire facility and the attention to detail in making the scenarios as realistic as possible. At the same time, it was still a safe learning environment without being triggering or traumatizing.
What aspects of your participation in disaster day were most rewarding?
Dr. Colton Junod: The most rewarding aspect was confirming the deep appreciation I have for first responders. It is not usually physicians out there at these scenes, so I have a ton of gratitude for the people that prepare and think about these situations daily.
Dr. Zachary Birner: I thought one of the most rewarding portions was hearing from individuals who had worked in or closely with real disaster situations. It added a sense of tangibility to the scenarios since these are situations that most us will hopefully never actually have to be a part of.
Dr. Shannon Faehling: One of the most rewarding aspects of disaster day was practicing disaster triaging. Throughout our educational careers, we are taught triaging in a classroom setting. However, prior to disaster day, I never got the experience of actually practicing it. In a classroom setting, scenarios can feel distant and unrealistic, but being in the field and getting hands-on experience helped grow my confidence and my emergency medicine knowledge base.
If you had to sum up your experience in “lessons learned,” what would they be?
Dr. Colton Junod: “Failing to prepare is preparing to fail” was the mantra I kept thinking about during and after this training. Being prepared to deal with disasters, such as the ones simulated during disaster day, will be an integral part of some of our jobs after residency.
Dr. Zachary Birner: The importance of a command structure where people know their roles to minimize conflicting plans and orders. The importance of minimizing distractions since it’s already a difficult enough situation without them. I also think debriefing after stressful situations is important.
Dr. Shannon Faehling: Don’t be afraid to jump in and try to make a difference, provided that you aren’t putting yourself or others in danger. Also, know that you may not be the best suited for a particular role in a disaster, in which case it’s important to have open communication with your team.
How do you believe the experience will impact your work in Emergency Medicine going forward?
Dr. Colton Junod: I think our faculty really stressed how important it is that we know what resources we have in the community- if one of these disasters were to happen. I’ll for sure think about these scenarios and help my future community prepare in case something like this were to happen.
Dr. Zachary Birner: I think the lessons on optimal communication and minimizing distractions apply, on a smaller scale, to the stressful environments that we will all experience in the ED. I have interest in doing global health work and I think the lessons of triaging the limited resources available will carry over.
Dr. Shannon Faehling: Disaster day helped me to further develop critical situational awareness while outside of the clinical setting. I believe this, along with trying to anticipate future obstacles to patient care, will positively impact my work while in the emergency department.
We are incredibly fortunate to have such strong and dedicated educators who plan and execute such an incredible training experience for our learners!