South Florida has been hit by a massive hurricane, sending people into a makeshift emergency shelter where nurses are working on the front lines to help evacuees with a range of needs. As the storm rages outside, it’s organized chaos in the shelter. Nurses try to maintain calm as they assist an elderly shelter resident who lost his cane, track down an irate woman’s meds and isolate a group of evacuees who have contracted an intestinal illness, among other issues.
Meanwhile, the nearby emergency room is at capacity after the storm caused destruction that wiped out half the beds—but that hasn’t stopped hurricane victims from pouring in. A woman goes into labor as nurses attend to a patient who fell off her roof. A father is agitated and flailing because his son is missing, but he has a bloody gash on his head that needs care.
At least this time, it’s just a simulation.
Less than two months before the official start of the Atlantic hurricane season, 118 undergraduate nursing students from the School of Nursing and Health Studies, as well as faculty, staff, grad students, and community volunteers, role-played the reaction to a hurricane hitting South Florida. The scenario—held in the Simulation Hospital’s auditorium and Medical-Surgical Unit —was made up. But it was meant to demonstrate a very real threat and test how nurses would react.
“What we put in these scenarios isn’t far-fetched. This is real life, and this is going to happen,” says Susana Barroso-Fernandez, assistant professor of clinical and director of Simulation Hospital Special Projects, who organized the simulation. “It’s very close to the real world.”
Disaster response is usually associated with police officers, firefighters, and emergency medical technicians, who show up to the scene of storms, terrorist attacks, shootings, epidemics or accidents. But nurses play a key role, too. For over a decade, the World Health Organization and the American Association of Colleges of Nursing have been pushing for disaster nursing training to be incorporated into nursing education. As more large-scale manmade and natural disasters unfold across the globe, the demand for nurses as first responders will only grow.
With expertise in simulation-based education and cutting-edge facilities, the University of Miami School of Nursing and Health Studies is giving undergraduates powerful experiences to take on the controlled chaos of full-scale disaster response.
“As nurses we need to be prepared because it will affect all of us in some way, shape or form,” says Barroso-Fernandez. “For me it’s important because it’s not a matter of if—it’s a matter of when.”
Students are introduced to disaster response as part of their Public Health Nursing course, taken senior year. They also complete five hours of Federal Emergency Management Agency (FEMA) trainings at the beginning of the semester. The online training counts as part of the requirement to join the Medical Reserve Corps (MRC), which activates volunteers during disasters across the country.
Later in the semester, students are introduced to the concept of disaster nursing in lecture, where they learn everything from how disasters impact health to specific triage methodology and the different stages of disaster response.
Simulation gives them a chance to experience it up close. Whether a simulated pandemic, hurricane, or act of terrorism, students put theory into practice as they maintain order, conduct triage among evacuees and patients, and make split-second leadership decisions.
“I don’t think students get how overwhelming it can be without actually experiencing it and having a bunch of individuals screaming at you, injured in pain and moaning,” says Yui Matsuda, assistant professor at SONHS who helped facilitate April’s mass casualty incident for her public health nursing students. “This opportunity gives them the chance to see what it’s like.”
The first disaster simulation at SONHS took place in fall 2014 during the Ebola outbreak and was directed by then-lecturer Summer DeBastiani, PhD ’18, who went on to earn a PhD at SONHS after working as a health scientist in the Office of Public Health Preparedness and Response at the Centers for Disease Control and Prevention.
“My concern when returning to nursing education was that we were not training our nurses in a similar manner as other disaster responders,” says DeBastiani, now an assistant professor of nursing at University of North Carolina Wilmington. “I worked to develop novel disaster simulations that were a hybrid of classical simulation training and disaster exercising.”
Simulations have since been held each semester. Master’s students are also invited to oversee undergrads and lend a hand.
The Spring semester hurricane simulation was designed to have two separate portions: community and hospital. Before each, Barroso-Fernandez assigned students a role—as nurse or patient; patients received a list of signs and symptoms to act out.
First, the community portion, the makeshift emergency shelter, served to show students how to function outside of the acute care setting. Nurses were tasked, principally, with responding to the varying needs of evacuees brought on by the chaos and uncertainty of a disaster. They handed out intake forms and documented vital information. When situations escalated, they sought to maintain order.
Given that South Florida is ground zero for hurricanes, and neighbors a number of Caribbean nations also facing significant storm risk, it wasn’t far off. In fact, SONHS lecturer Régine Placide Reaves, who teaches public health nursing with Matsuda and assisted with the simulation drill, says her first exposure to disaster response as a nurse was a hurricane. While working as a pediatric case manager for Children’s Medical Services, she was part of the team that stayed at the shelter when Wilma hit in 2005.
“Being new to this type of nursing, it can be very overwhelming,” she says. “It’s a really good benefit to be able to go through it ahead of time in this way, just knowing how to keep everyone calm and being attentive and helpful to anyone that comes in.”
Next, the hospital portion of the simulation tested nurses’ response to acute needs. To make it as realistic as possible, SONHS staff outfitted injured and ill students with wound care dressing, as well as fake blood and bruising.
As soon as the simulation began, patients entered the ER in a steady stream, which didn’t let up for the duration of the hour-long portion of the exercise. Many patients were in crisis, and nurses struggled to find space and beds for the sick and wounded.
The disaster drill was meant to simulate a “surge” situation, where health care professionals must treat a flood of patients needing medical attention, triage, treatment, and even surgery.
“What do you do when you have an influx of patients?” Barroso-Fernandez says. “How do you deal with the chaos and unknown of what it would be like?”
A handful of students were also assigned to the Medical-Surgical Unit’s full-scale incident command center to simulate coordinated management of the emergency. Using walkie-talkies, they monitored the situation and mobilized and coordinated personnel, equipment, and supplies to provide care.
During the simulation, FNP student Rachael M. Socarras, an ER nurse at Jackson Memorial Hospital, oversaw eight undergraduate students in the command center. Socarras is an MRC member who has received training to respond to hazmat disasters, terrorist bombings, Ebola, and more. She says the incident command center simulation is an innovative opportunity for students to be exposed to leadership and decision-making responsibilities under tough circumstances, such as when systems go down.
It also enables them to consider becoming trained in FEMA’s Incident Command System, a standardized approach to the command, control, and coordination of emergency response across organizations.
“I was so excited to see that the University is taking steps to prepare our undergraduate nursing students in being first responders,” Socarras says. “As an undergraduate nursing student, I was never exposed to these types of simulations, but UM’s students are being provided with a unique experience that is further preparing them for the workforce they will be entering as new nurses.”
After the simulation, participants gathered in the auditorium to debrief and share lessons learned.
Barroso-Fernandez, Matsuda, and Placide Reaves say students often describe the exercise as eye opening, and many feel inspired to volunteer in the community in case of a disaster. Perhaps most transformative for their students, they add, is the opportunity to see a situation from a victim’s perspective.
“Just for a little bit you put yourself in another’s shoes and see how it would feel—to suddenly lose everything or not be able to find a loved one, or be elderly and not able to find your cane, or be taken out of nursing home,” Barroso-Fernandez says. “It gives them an opportunity to see things from a different perspective and build empathy and kindness and compassion. And that’s really the art of nursing.”
