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Art of the drill: From mass casualty incident to chemical spills

 A recent webinar conducted by Dr. Steve Goldman, Ed.D. of MIT reviewed an array of tactics that a hospital needs in order to conduct realistic and successful drills, everything from mass casualty incidents (MCI) to chemical spills.  These drills are not required annually, and help save lives while making our job easier. Resources for active drills draw more on key personnel than finding funding. When preparing a drill for your hospital, Goldman suggests keeping a few things in mind.  First and foremost, determine the purpose of the drill. Why are you doing this and whom are you benefiting? Next, whom are you getting support from? You’ll need support from including but not limited to, management, the hospital and department you’re working with, external support from volunteers, fire and EMS, and the proper tangible resources.  Along with those aspects, you will most certainly need a positive outlook, strong leadership, flexibility, teamwork, and management skills.

8 Steps for successful active drills

During our webinar, Dr. Goldman reviewed his best practices for a successful drill, breaking it down into 8 steps.  Dr. Goldman includes updates that meet the new CMS Emergency Preparedness Guidelines.

Emergency plan or emergency organization

Assuming you have an emergency plan, there should also be an emergency response organization that will staff your drill. This plan should also outline the actions, policies, procedures, contacts, equipment, facilities, etc. that you will be testing.


The next thing you need to look at is the scope of the drill. This will define the basics of your drill.  It will include:

  • Who is participating
  • Who is not participating
  • What facilities/equipment can be used
  • What facilities/equipment cannot be used
  • How far events will be played out


Upon establishing the objective from your emergency plan, you then need to figure out how to “satisfy” that objective, and determine any limitations that you have to meet the objective. Examples of these limitations can be “any interface with non-drill participants must be prefaced with ‘This is a Drill’ or equivalent”, or “in-field responders will wear ‘Drill’ vests”.

Scenario development team

It’s not expected that you know everything about developing the mass casualty incident scenario. That’s why internal and external support are there to help! For internal support, you can reach out to Human Resources, medical and nursing staff, Risk Management, or security.  For external support, you can reach out to the fire department, health department, or police department.


Now it’s time to put together the timeline for the scenario. NOTE how important it is that all documents associated with the drill are marked “For Training Use Only!”.  If you do not, somebody may think the drill is real, and that is the last thing that you want to happen.  There are many different possible scenario events.  There are the “typical” events, such as natural disasters, human-caused emergencies, technological disasters, or public health emergencies.  You could also use “hospital-specific” events, such as an incident in a laboratory, or a specific room such as the ER or OR. Next thing you want to do is develop your timeline.  You should first have a preliminary timeline, with a column for approximate times, a column for key events, and a column for the expected action/comments.  Next, you should make a semi-final timeline, with the approximate times established, along with what is going to happen at those times and any additional comments to add.

Exercise participants

The participants are crucial for a successful drill. There are the responders, controllers, and evaluators.  The responders should be assigned staff, because they are the people you want to test, so use primary along with alternates staff from your Emergency Plan if possible.  The controllers ensure that the drill proceeds as planned.  They can inject pre-scripted messages, and very importantly they record the actions, successes, problems, and areas of improvement.  Evaluators are those who independently observe the exercise.  They report compliance with the plan, and any positives or negatives of the response.  In many cases, the evaluator role is combined with the controller role.  It is important to inform all observers and non-observers that what is happening is only a drill. It is one thing to run a drill, but it is another thing to make it realistic.  In order to do so, you can use doctored photos or maps of the “damage”, color the water/sand in the area to simulate spills, or tape off any flooded areas.  Use your imagination, but always make sure to inform people it is just a drill.

Conduct the mass casualty incident exercise

Finally, it is time to conduct the exercise. Pre-exercise briefings should include the controllers, evaluators, and responders. Also, ensure that everything is set up correctly, and all props are in place.  Now it’s time to start the mass casualty incident exercise, ensuring that it is controlled and once concluded, you conduct the critique.


The critique is an essential part of the drill. It should be done right after the drill, or no more than one day after, and if possible, in the same spot where the drill occurred.  Everyone in this situation is equal.  Whether one is the CEO or secretary, doctor or nurse, everyone’s input and comments are equal. All in all, developing successful drills, such as a mass casualty incident, requires a lot of hard, but also satisfying, work.  The desire to really test your program correctly, and knowing why you are doing it, are integral aspects of an effective drill. Watch the full replay of our webinar now and learn more details from Dr. Goldman.

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