The air was humid and thick with smoke in the subway station. Groans from injured passengers seemed to come from everywhere, their twisted bodies splayed across the platform. In one subway car, a young man appeared to have lost an arm. Nearby, another passenger was trapped between the car and the platform. A bomb, very likely the work of terrorists, had just ripped through the largest subway system in the world.
The 10 emergency medical technicians (EMTs) who arrived at the scene had their work cut out for them. They had to count the number of victims and report back to their medical branch director. They had to set up a triage, move patients to a safe area (even if it meant carrying them up eight flights of stairs), and determine if there were any secondary bombs in the area that could explode and cause further injuries.
It was chaos, but the attack wasn’t orchestrated by terrorists – it was an exercise put together by the members of the Fire Department of the City of New York at the department’s Training Academy on Randall’s Island, where more than 2,000 firefighters and EMS personnel are trained each year.
On this September day, the FDNY was giving Hofstra North Shore-LIJ School of Medicine students intense training as first responders to a simulated terrorist attack.
The students’ EMT training is a core element of the first 100 weeks of the medical school’s groundbreaking curriculum and gives the students their first exposure to the clinical practice of medicine. The course uses the standard New York State Department of Health EMT curriculum, as well as more advanced scientific and clinical concepts. The day at Randall’s Island, essentially the culmination of the students’ nine-week EMT training, offered a unique opportunity for them to gain hands-on, realistic experience – right down to encountering fire, smoke and seriously wounded victims.
“By putting the students in these mass casualty incidents, they not only learn emergency response, but more important, they learn how to work as a team while dealing with a situation that is fraught with chaos, urgency and emergency,” said Dr. Lawrence Smith, founding dean of the medical school.
The exercise included a subway catastrophe and a bus bombing. Every student performed as an EMT, as well as playing the role of a victim. Prior to the reenactments, FDNY Deputy Medical Director Dr. Douglas Isaacs gave the students a lesson in the Simple Triage and Rapid Treatment, or START, system – that EMTs use when working a mass casualty incident. They also heard from Captain Anthony Sannella, who explained the “physics of bomb blasts” and from Division Medical Director Dr. Bradley Kaufman, who went over how to classify and prioritize injuries and warned that first responders must remain keenly aware of their surroundings during a mass casualty incident.
“Tunnel vision happens when you arrive at a scene, because you tend to focus in on the victims,” said Dr. Kaufman, “but this can cause you to miss something important, like a secondary device or a suspicious person. So when you arrive, you need to take in the whole scene.”
The students learned how to “package” a victim in a flexible, plastic sled, called a “sked,” and how to use a triage tag system that helps first responders sort and prioritize treatment of patients during a disaster. These tags are not only important for “grading” a victim, but also for keeping track of victims.
Meanwhile, medical students who played victims took their roles seriously as well. They cried out in pain, screamed for help and wandered off – anything to create more chaos and confusion for their colleagues. Jonathan Mallen was assigned to play a 20-year-old man with multiple injuries. In a bit of improvisation, he even faked losing an arm.
“Most of the seriously injured victims were mannequins, so I thought I would make it more interesting,” Mallen said FDNY personnel also demonstrated the rescue of a “space case” (a victim who has fallen between the subway car and the platform), by using a hydraulic lift to push the train away from the platform.
After a short break, the students moved on to the bus bombing exercise – with this warning: be on the lookout for people or objects that may seem out of place. For example: Is someone wearing a heavy jacket in the middle of the summer, or maybe, amid the chaos a backpack or bag placed a little too neatly against a lamppost?
Then it was time for casting. “Who wants to be a female with a broken arm?” “Second degree burns? A gash on the forehead?”
FDNY EMS instructors Rick Marrone and Jason Acevedo were the special effects experts who, using putty and fake blood, created gruesome gashes, wounds and protruding bones. Student Niki Sheth was dusted with black soot to make her appear like a burn victim. Classmate Branson Sparks threw himself into the role of a 60-year-old man with respiratory problems, suffering mental confusion after the blast. Sparks wandered off, again and again, forcing one of the EMTs to run after him.
“In a ‘daily emergency,’ such as a car accident, you have all the resources you need,” Dr. Isaacs said. “But in a mass casualty incident, your victims overwhelm your resources, and an EMT’s goal must be to do the greatest good for the greatest number of victims.”
The Hofstra North Shore-LIJ medical students worked quickly and efficiently, clearing the scene of people who could walk to safety, and then forming a triage for the remaining patients. Victims were whisked between the scene and the safe areas, but no one noticed the dummy dressed in a bulky jacket that was hiding a pipe bomb – the secondary device at the scene that Dr. Kaufman had warned everyone about. Eventually, the students were “tipped off” by one of the victims.
Student Travis Doering, at the debriefing later, said: “Everyone worked well together. But we missed the pipe bomb.”
Classmate Bin Yang described the day at Randall’s Island as an “amazing experience.” “I was quite taken aback by the simulations and by how much thought went into creating the mass casualty incidents,” he said. “It exceeded my expectations.”
Mallen noted how difficult it was to balance the needs of the victims with the need to stay alert to the surroundings and potential threats.
“It’s hard not to have tunnel vision,” Mallen said. “When you arrive at the scene, it’s chaos and you tend to focus on helping people.”
While the students had participated in simulations before, the Randall’s Island exercise was invaluable because of its scale, said Dr. Thomas Kwiatkowski, assistant dean of education/ simulation and the EMS course director. “Randall’s Island was a special event in a very special environment,” he said. “It allowed students to experience a large-scale disaster, a near-realistic environment and an opportunity to practice their EMT skills in the rescue, triage and treatment of patients.”