Emergency room staff dressed in hazmat suits waited for dozens of volunteers role-playing as victims of a mass casualty to approach the ambulance bay at Providence St. Patrick Hospital on Saturday.
The event, called Operation Presidio Guardian, was a drill to test the readiness of the Hospital Emergency Response Team in the case of a mass exposure to hazardous materials that would require staff to decontaminate large numbers of patients.
In the event of an exposure, the HERT team would act as the primary defense and preliminary medical care provider for patients. The drill served as an opportunity for the team to get a step ahead of a disaster and practice how to decontaminate patients before treating them.
The drill featured a full-scale setup with everything that would be needed to treat victims exposed to lye. Lye, or sodium hydroxide, is a chemical used to make soap and household cleaners. But when it’s exposed to living tissue like skin and eyes, it can cause chemical burns, scarring, blindness and other injuries.
There were about 50 people who volunteered as victims. Each was given a card with the name, age and injuries of the victim they would be playing. When the drill began, they approached an entry point adjacent to the ER marked by neon cones and caution tape.
Hospital staff in yellow hazmat suits listened to their pleas for help and assessed each person’s condition. The idea of the drill was not only to walk staff through the procedures but also to handle patients in distress.
“Please help me,” said Amelia Zepnick, a volunteer. “Why won’t you help me? I’m burning. She said we’re going to die!” Zepnick was one of several MSU nursing students attending the Missoula branch of the university who volunteered. She said one of her teachers mentioned the drill, which counts toward clinical hours nursing students are required to complete.
The response team stayed calm as it sorted victims into groups based on the urgency of their needs. Each patient received a tag with a color. Green was assigned for minor injuries like scratches. Yellow was assigned for more substantial but non-life-threatening injuries such as a broken leg. Red prioritized patients were those who could be saved if they underwent immediate surgery. Black meant that a patient’s condition was too severe to be treated.
“There are patients that are going to die,” said Shawn Paul, the public information officer for St. Patrick Hospital. “It’s really hard for the person to say “Red, go,” and “Sorry, black, go over there.”
After patients were tagged, they removed their clothes and placed them in bags that were placed in a biohazard bin. For the purposes of the drill, they delayered to black t-shirts that said: “I’m naked.”
Staff then ushered victims through a series of shower chambers in a tent, where they were washed with soap and water in one chamber and rinsed in another. Volunteers shivered as they waited for emergency staff to wrap them in blankets.
“They could have done this in August,” said Tom Thompson, one of the volunteers. “It was so much warmer then.”
Thompson said he participated because he likes to be involved in the community. Hospital staff lifted him from a wheelchair onto a long table where team members washed him with a sponge. The table was a central part of the setup for people who may have difficulty walking through the showers.
Once rinsed, the staff does a final test to make sure patients have been decontaminated before they’re taken to a waiting room and directed to a different area of the hospital to be treated. Patients in the most critical condition stay in the intensive care unit or go into surgery.
“I think it’s great that they’re doing this here and being more prepared for things like this that could happen in the future,” said Beverlee Shivers, a volunteer and MSU nursing student.
Although the drill focused on a lye hazard, the same procedure would be used for a lot of other chemicals.
”We have a highway that comes through town, we have a railroad that comes through town,” Paul said. “All those different industries that are shipping hazardous materials through our community every day. We need to really be prepared for all of those hazardous materials out there, from industry to transportation.”
The drill also served as an opportunity for staff to record how long it took them to decontaminate and treat patients. Paul said the team noticed some areas it can improve on, such as finding a better way to contain hazardous water between people showering and staying conscious of how many patients they can handle at once.
“Every time we drill, we try to figure out what our lessons learned are and we take those back to continuously improve,” Paul said. “(Our) number one goal is to protect the footprint of the hospital. As the only trauma level II hospital in this region, we have to stay open.”