BAYAMÓN, Puerto Rico – The practice scenario: A car crashed into a tanker carrying liquid chlorine on Highway 167 in Bayamón Friday morning, killing three and injuring dozens of others. The 7 a.m. accident caused a chain reaction on the congested roadway that set the tanker ablaze and released clouds of chlorine gas that quickly covered a 5-square-mile area. At least 50 victims were transported to Hospital Universitario Dr. Ramón Ruiz Arnau for treatment. Hundreds of others were evacuated from nearby homes and businesses.
Some 120 emergency responders and healthcare leaders participated in the four-day training course capped by the mass casualty exercise on Friday. It was offered by the Puerto Rico Emergency Management Agency, the Puerto Rico Department of Health, the University of Puerto Rico, FEMA’s Center for Domestic Preparedness and the U.S. Department of Veterans Affairs.
It is the first time the “Hospital Emergency Response Training for Mass Casualty Incidents” course was conducted outside the center’s campus in Anniston, Ala.
Dr. Hector Colón Cruz, a contract trainer for FEMA who works at the hospital, was instrumental in bringing the mass casualty training exercise to the hospital. He saw how effective the exercises were in Anniston and said he immediately thought of how the medical community in Puerto Rico could benefit.
“What we learn in terms of the decisions made about patient handling (and) proper responses to contamination … is invaluable,” Colón Cruz said.
To mimic the real world feel of the mass casualty simulation, a makeshift emergency treatment zone was set up on the hospital lawn. Caution tape cordoned off lanes to quickly channel arriving victims to decontamination, triage and emergency intake areas inside yellow tents. Inside the hospital was a mock emergency operations center, triage and treatment areas, patient beds, even a studio space for media briefings.
Students demonstrated their skills as healthcare and emergency workers while volunteers and mannequins played the role of victims. They learned to deal with authorities, victims and family members, media and the public while handling the pop-up crises of a hospital whose resources are overwhelmed.
The response: Healthcare workers wriggled into beige Hazmat suits and pulled on white vinyl airtight hoods and respirators. Yellow rubber boots protected their feet. As they hit the ground outside the hospital doors, the panic-stricken cries and screams of the victims competed for their attention. Some lay motionless and unconscious in stretchers on the grass.
Tabitha, 22, of New Jersey, suffered a head injury and burns. Clad in a white T-shirt stained with fake blood, she waited to be treated in the 87-degree sun.
“My mom, where’s my mom… doesn’t someone know where she is? I itch. My eyes are burning. My arms are burning,” Tabitha cried.
José, a security official with a diagnostic center in Arroyo, portrayed a responder treating a young man of about 20, weak with blood loss. “He was dehydrated, fatigued. He had lesions on his arms from the chlorine, coughing horribly, and very upset,” he said. “We stop the bleeding, bandage, and get him to surgery.”
Jose said the exercise caused some anxiety, but that passion for helping others brings him strength. “Because of that, I feel like I have more capacity, more capability to manage whatever is thrown at us.”
Colón Cruz hopes this first exercise will encourage other medical facilities in Puerto Rico to do the same thing. “The more people that train, the better service we can give,” he said.
FEMA Federal Coordinating Officer Mike Byrne, who is in charge of response and recovery operations in Puerto Rico, said there is no substitution for hands-on training for emergency preparation.
“This exercise will remain in the memories of those who participated for years to come,” Byrne said.
For information on Puerto Rico’s recovery from Hurricane María, visit fema.gov/disaster/4339.
Disaster recovery assistance is available without regard to race, color, religion, nationality, sex, age, disability, English proficiency or economic status. If you or someone you know has been discriminated against, call FEMA toll-free at 800-621-FEMA (3362) 711/VRS - Video Relay Service). Multilingual operators are available. (Press 2 for Spanish). TTY call 800-462-7585.
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