Abstract:

This paper presents a discussion on a mass casualty incident (MCI) training event for public schools in Jackson County in Northeast Alabama. This one-day event is being used as a model MCI training for other schools in the region. The organizers of the event were the University of Alabama in Huntsville (UAH) College of Nursing (CoN) and the UAH Systems Management and Production (SMAP) Center.

The objectives of the MCI training were:
1) to Identify challenges and gaps in each school’s current preparedness and safety plans;
2) to increase familiarity of available resources in the county;
3) to increase knowledge for triage and safety training;
4) practice drill with stakeholders and event leaders to review current process;
5) to update each school’s emergency plans. Planning began with meetings with stakeholders two months prior to the scheduled event.

A great deal of time and resources were put into planning this large MCI event, including:
1) planning and developing the active shooter scenario,
2) moulage training,
3) training the standardized patient (SP) as the active shooter,
4) recruiting speakers and participants, and
5) preparing the emergency class room kits.

The training event consisted of the following elements:
1) Preparation of the site and participants the morning of the event,
2) prebriefing,
3) school shooter simulation,
4) debriefing,
5) individual school preparedness and safety plan review and update,
6) ALICE active shooter program training,
7) introduction to triage and small group practice,
8) STOP THE BLEED training,
9) small group demo and practice with stop the bleed emergency kits,
10) individual school kit location plan and distribution, and
11) groups report out.

The SMAP center developed the emergency kits and first aid classroom kits for each school. SMAP also developed the gelatin wounds and tattoo wounds used in the simulations. One of the spinoffs of the MCI training has been the establishment of the Model Exchange & Development of Nursing & Engineering Technology (MEDNET). MEDNET links K-12 schools, technical schools and medical facilities in the region to the resources available from the CoN and SMAP. As an example, stereolithography (STL) files of the 3D printed healthcare models, along with the specifications to fabricate the models, are available on the MEDNET website.

In summary the following conclusions are made:
1) repeating the mass causalities incident (MCI) training helps school principals/administrators remember and update their preparedness and safety plans;
2) a combination of lecture and hands-on simulation is an effective method of MCI training;
3) moulage with simulated wounds and blood brought realism to the school shooting simulation;
4) having subject matter experts as presenters, such as law enforcement officials, provide for quality training and add credibility to the training;
5) using already developed MCI training materials, not only reduces time to deliver training, but also reduces costs; and
6) MEDNET provides a valuable resource for follow-up and additional resources to schools such as 3D printed models and MCI training materials.

Included in this paper is a description of the training event, the school shooter simulation, the ALICE active shooter program, the STOP THE BLEED program, the use of gelatin and tattoo printed wounds in the simulations, MEDNET and conclusions.

Keywords:

Mass casualty incident training, school shooter simulation, Alice, stop the bleed, gelatin and tattoo wounds.