Originally published August 28, 2015
By Laura L. Acosta
UTEP News Service
Nursing students at The University of Texas at El Paso got a dose of reality in emergency preparedness during a full-scale active shooter exercise at UTEP on Aug. 12.
Although the purpose of the drill was to test the University’s safety protocols, the training exercise provided an opportunity for 22 undergraduate and nurse practitioner students from the UTEP School of Nursing to prepare for an active shooter situation in a simulated hospital setting.
Nursing students jumped into action as 10 actors playing the role of victims were transported by Fire Medical Services (FMS) personnel to the Center for Simulation in the Health Sciences and Nursing Building.
As EMS rushed in a victim with a gunshot wound to the head, nursing student Amber Ellis quickly evaluated the patient’s condition to determine the type of care and the appropriate level of care.
After checking for a pulse, Ellis’ professor Melissa Wholeben, Ph.D., asked her, “OK, what are you going to do?”
Ellis, the designated triage nurse, immediately directed the other nurses to start CPR. Her classmate Courtney Valenzuela jumped on the stretcher and began chest compressions as fellow nursing students Jason Ortegon and Vincent Alexander wheeled the gurney into one of the simulation center’s hospital rooms.
“When they got into the room, they called it within a couple of minutes,” said Wholeben, UTEP clinical assistant professor, referring to the patient’s death. “But it was a huge learning experience because it was one of those grey areas. In an emergency, you can’t utilize resources for people who will probably not make it because there are so many other victims that will need those resources. It’s very difficult for providers to halt life saving measures during a disaster scenario.”
Preparing for Emergencies
The active shooter exercise was conducted in the area surrounding the UTEP Library, across the street from the Health Sciences and Nursing Building.
The disaster drill in the Center for Simulation was similar to the School of Nursing’s Simulated Hospital Day, which was created in 2010 to allow future nurses to practice their skills on students posing as patients in a safe learning environment.
Several UTEP departments and city and county agencies, including the Far West Texas and Southern New Mexico Regional Advisory Council on Trauma and Emergency Healthcare, or Border RAC, participated in the active shooter exercise.
Border RAC developed 10 victim scenarios with injuries including gunshot wounds, spinal injuries and burns and breathing problems caused by tear gas. To simulate the injuries, Border RAC also applied moulage, or mock wounds, to the victim’s head and limbs.
Even though Andrea Rodriguez previously worked as a registered nurse at University Medical Center, a level one trauma hospital in El Paso, she had never participated in a disaster drill or been part of a real mass casualty situation.
“I realized to experience something like that would be very overwhelming for everyone – fire department, paramedics, the hospital setting, all the nurses involved, the doctors,” said Rodriguez, one of eight students in UTEP’s Acute Care/Adult Gerontology Nurse Practitioner (AGACNP) program who participated in the exercise. “But we’re used to the high-stress level. Everyone has their role to do.”
Incoming patients were separated into different categories depending on the severity of their wounds using a four-color system. Red tags were assigned to critical patients who required immediate treatment. Yellow tags were given to seriously injured patients who received treatment after critical patients. Green tags were reserved for ambulatory patients with relatively minor injuries. Black tags were used for the deceased and victims who were beyond help.
“One of the first steps of disaster training is being prepared,” Wholeben said. “This drill was an opportunity to teach our students how to be prepared for a (disaster) situation if it occurs in the real world.”
The exercise also allowed 16 students in their final semester of the undergraduate nursing program to practice their assessment, documentation, prioritization and communication skills one last time before graduating from the UTEP School of Nursing on Aug. 19.
“We want our students to have the best possible learning experiences that they can have,” said Pearl Pope, clinical nursing instructor in the Center for Simulation. “That’s what drives us. We’re very innovative, very creative, very willing to try something new. It’s all about how can we make this better for our students.”
To add to the reality of what nurses face in a real hospital, nursing students also cared for five patients who walked into the emergency room before and during the mass casualty situation. Patients had a variety of symptoms ranging from cough and colds to chest pain.
“One of the things students have to look at is just because there is a disaster does not mean that people do not still seek emergency care for other reasons,” Wholeben explained.
Learning Together
Undergraduate students were paired with nurse practitioner students, who are professional nurses, to help guide them through the chaos.
Nurses from Del Sol Medical Center’s emergency department, intensive care unit, cardiovascular intensive care unit, and training and development departments were also available to advise the students.
Ellis, who completed her clinical rotation in the emergency department at Del Sol, performed rapid triage assessments of each patient to determine if there were any life threatening injuries.
She was assisted by Nicole Smith, a nurse practitioner student who had previously participated in disaster drills when she was a registered nurse at a hospital in Oklahoma.
“Triage is a really quick assessment of breathing, airway, (neurological) status,” said Smith, who along with her classmates graduated from the nurse practitioner program Aug. 14. “You do that quickly and then you move them into one of the rooms. (Ellis) did most of the work. I think she did really well.”
Once patients were moved from triage into the simulation lab, undergraduate students continued their assessments, checking for broken bones and heart and lung sounds. After students documented their assessments, nurse practitioner students gave them orders, which they prioritized, such as lab work, CT scans or pain medications.
Nurse practitioner students then determined the disposition of the patients, whether to transfer them to another unit or discharge them home. If patients were transferred to another unit, undergraduate students gave a report of the patient’s health status to the nurse who would be taking over the patient’s care.
“(Nurse practitioner students) got to experience their role as an advanced practice nursing leader and do some real-time teaching with the undergrads just as they will do in the real world,” said Kathleen M. Cox, DNP, director of the AGACNP program. “They also got to function as the provider for care of the trauma victims in a disaster scenario, which will better help them prepare for any such incident in the community or workplace in the future.”