Health and Medicine People and Community

Simulation assesses UHealth’s readiness for a complex disaster

In a simulation exercise Sunday morning, a small passenger jet crashed on the University of Miami’s Medical Campus and struck a bus, prompting the collaboration of 17 local, state, and national emergency response agencies to engage in a lifesaving exercise.
Disaster exercise at medical campus
The exercise, codenamed “Operation Fallen Archangel,” tested the readiness of the emergency response capabilities of the University of Miami Health System and a multitude of local, state, and national agencies. Photos: Bob Siegel for the University of Miami

The fuselage of a 20-passenger private jet lay across a major roadway just in front of the Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine campus. 

Next to the plane, a badly crumpled shuttle bus lay on its side. The vehicle, occupied by a group of VIP French dignitaries visiting the medical campus, had been broadsided by the plane that crashed on the roadway. 

With bystanders looking on, fire-rescue personnel used the jaws of life and other tools to extricate victims trapped in the wreckage, carrying the wounded to a triage area in front of Sylvester, where paramedics applied splints and bandages and rendered other medical aid. 

While the carnage in the heart of Miami’s Health District early Sunday morning looked very much like a real-world mass-casualty incident, in reality it was a mock disaster drill orchestrated with all the precision of a Hollywood disaster movie. 

Codenamed “Operation Fallen Archangel,” the exercise tested the readiness of the emergency response capabilities of the University of Miami Health System and a multitude of local, state, and national agencies. 

“It was critically important to make this look as real as possible,” said Vincent J. Torres, emergency management director for the University of Miami Health System and Miller School of Medicine, who was instrumental in planning the exercise. 

The simulation began just after 8:30 Sunday morning. With their sirens blaring and lights flashing, a convoy of emergency vehicles—from fire-rescue engines and hazmat trucks to police cruisers—converged at the intersection of Northwest 12th Avenue and Northwest 14th Street, where, as part of the simulation, the jet’s fuselage and the bus had come to rest after a catastrophic chain of events. 

Struck by a surface-to-air missile fired by a suspected terrorist, the plane fell from the sky and clipped UHealth Tower’s helipad. One of its wings then struck the Metrorail tracks of the elevated commuter train. When the plane crashed on the roadway, it hit and overturned the bus, pinning one of the 20 passengers underneath it. Rescuers used cranes to lift the massive vehicle and employed hydraulic rescue tools to cut through parts of the small plane and bus to free the remaining victims. 

Passenger jet during disaster exercise

“It was a lot at once,” said Miami-Dade Fire Rescue District Chief Ralph Baena. “But through exercises like this, everybody gets a chance to improve on our weaknesses and to fortify our strengths.” 

At the crash site, rescue personnel used stretchers to lift some of the wounded, including live volunteers and mannequins, carrying them to a triage area in front of Sylvester, where paramedics rendered first aid. Ambulances transported other victims to the UHealth Tower emergency department. 

Victims wore moulage and other special effects makeup, which was provided by the Gordon Center for Simulation and Innovation in Medical Education. The center also instructed victims on how to act out injuries such as crying out in pain, and it provided high-fidelity training simulators that bleed and breathe, allowing first responders to test their skills in keeping patients alive. 

The importance of the exercise couldn’t be greater, according to Torres. 

“We are in the direct flight path of Miami International Airport here on the medical campus, so an airline disaster is a known potential hazard because aircraft are landing and taking off right over our heads all day and every day,” Torres said. “We hear it, and we see it only a few hundred of feet above our tallest building on campus.” 

Helicopters also contribute to a considerable amount of air traffic in the area, as both UHealth Tower and Jackson Health System operate helipads that are used by emergency medical services air rescue divisions, Torres noted. 

Sunday’s simulation lasted about four hours from start to finish and included nearly 300 participants, including first responders from 17 different emergency agencies across Miami-Dade County and the nation. The City of Miami Fire-Rescue and Police departments, Miami-Dade County Fire Rescue, and agents from the Federal Bureau of Investigation led and participated in the exercise.  Miami-Dade Transit, ambulance service provider National Health Transport, and other health officials also participated. 

“We all practice for these low-frequency, high stress crises, and it’s not often that you see all these different entities in one situation, so it’s the best environment to expose our capabilities and to know the limitations of each agency,” said Capt. Robert Cardenas of Miami-Dade Fire Rescue. 

Actors portrayed injured victims during the exercise

Beyond the first responders and health care professionals, there were also 67 volunteer victims, who donned cards revealing their injuries. Justin Rodriguez, 21, a student in Miami-Dade College’s EMS program, posed as a victim of the plane crash and received wound makeup to reveal a bloody gash on his arm, although his card explained he died in the crash. Rodriguez arrived at the Medical Campus at 2:45 a.m. Sunday but was still energized by the experience eight hours later. 

“This is great firsthand experience, and it’s what I need to do to see every type of triage,” said Rodriguez, an aspiring paramedic and firefighter. 

Shortly before 11 a.m., police and fire radios echoed a call that the exercise was complete, and Torres led a debriefing for leaders on each “front” of the exercise—including the emergency room at UHealth Tower, the triage area outside Sylvester and part of the center that caught on fire from the plane fuselage, as well as the intersection of the plane crash and bus collision. Evaluators from Ryder Trauma Center, the UHealth system, and the U.S. Army Trauma Training division gave feedback that will be added to a future report that will be shared with everyone involved, Torres said. 

Although the UHealth system runs one large-scale emergency training each year, and several smaller ones throughout the year, this may have been one of the most complex exercises to date. The exercise tested UHealth’s ability to move patients in an emergency and triage overflow of a mass casualty incident. 

“Evacuating a hospital is a rarely done, as it is an extraordinarily complex endeavor,” Torres said. “Such evacuations are usually only conducted following disasters that impact a hospital, such as devastating hurricanes, wildfires, or the failure of a major utility. Adding the complexity of evacuating surgical oncology patients who were mid-surgery and cancer treatment unit chemo infusion patients makes the situation that much more complicated. But if a disaster were to occur, it’s our responsibility at UHealth to do everything we can to ensure patient safety in all situations.” 

“I was very happy with how it went,” Torres said. “We are fortunate to have a lot of strong partnerships and relationships in Miami-Dade County as well as the South Florida region, and with every exercise you’ll find gaps and areas for improvement, but the key is to follow up on it, so that’s what I plan to do.”