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Week 5: Simulation Exercise – Immediate Response to Explosion

Week 5: Simulation Exercise – Immediate Response to Explosion

Week 5: Simulation Exercise – Immediate Response to Explosion


Simulation Exercise Scenario:

Immediate Response and the First Two Hours

May 1, 2021, 7:40 AM – Fire and law enforcement units respond to the incident scene. They are careful to approach the incident scene as the incident scene is near the nuclear power plant.

First responders can visually view a mushroom cloud in the area of the incident scene as they make their approach to the incident.

· Upon arrival, the first responding EMS units start to size up the scene from a safe distance. They see many cars on fire on the roadway, there are victims from the explosion on the ground and walking around looking for help.

· Fire and Law Enforcement units realize that the explosion is not at the nuclear power plant but at the law enforcement checkpoint established that morning.

· Fire and EMS are attempting the activation of mutual aid assistance from other departments in the area.

· Fire, EMS, and Law Enforcement reach out to emergency management and the local hospitals as best as possible and inform them that an explosion with a Mass Casualty Incident (MCI) has occurred.

· Minutes later, emergency management and hospital facilities receive information from first responders arriving on the scene recommending emergency management send a shelter-in-place protective action to Bobsville and General County communities. There is a potential that this is some sort of nuclear detonation.  Bobsville Emergency Management puts out an immediate notification instructing citizens to Shelter-in-Place due to an explosion with unknown hazards until further notice.

Bobsville emergency management sends out the following message:

Citizens of Bobsville – there has been a potential nuclear detonation near the nuclear power plant, and Bobsville emergency management is implementing the following protective action:

Shelter-in-Place immediately to minimize time spent near a radioactive source. The less time exposed to the source of radiation, the lower the dose received.

Maximize the distance from a radioactive source. The farther one is from the source of radiation, the lower the dose received.

Shielding yourself from the outside – Shielding means having something that will absorb radiation (such as concrete) between yourself and the source of the radiation. Keep as much protection between oneself and the source as possible.

· Bobsville Emergency Operations Center has been activated and is being staffed by assigned personnel, elected, and appointed leaders.

· The General County Health Department has requested that surveillance systems be initiated both in the county and in Bobsville and at any established evacuation sites.

· EMS and Fire first responders located at the scene are reporting a significant number of injuries as traffic was at a standstill at the Law Enforcement checkpoint in and around SR-323 and I-58.

· EMS and Fire first responders are starting to establish zones around the event. EMS is beginning to provide care to victims that are furthest away from the blast location. EMS providers are reporting various levels of injuries and must decide who and what type of treatment they can provide.

During the first two hours of the event, Bunnyville General Hospital emergency department (ED) begins receiving patients by Personal Operated Vehicle (POV) with a spectrum of injury types and severity, including eye, blast, thermal burns, heat, and fire injuries.  Medical assets are limited and rapidly becoming scarce.

Key staff have not shown up to work at critical infrastructure locations in Bobsville; some reside in General County and have not reported to work.  Staff members want to leave their employment locations, including Bunnyville General Hospital, to find family members in General County or at schools, workplaces, and homes. Most of the population are fearful and anxious.

Community health centers are receiving an increasing number of calls and self-presenting patients that do not want to wait for treatment in what appears to be overcrowding at the Bunnyville hospital emergency department.

Responders report a plume is headed in a southwesterly direction and is starting to enter portions of Bobsville.

Key Issues

· First responders see a mushroom cloud coming from the area of the explosion.

· Upon arrival at the incident scene, first responders see many victims and immediately implement notifications for an MCI.

· Victims are being treated at the incident site.

· A Shelter-In-Place protective action has been issued to the community of Bobsville.

· Hospitals and community health centers in the General County and Bobsville region begin experiencing patient surge within two hours of the event.

· Patients are presenting with a variety of injuries with varying severity from the blast and resulting infrastructure destruction.

· The public, medical staff and patients are fearful, frantic, and anxious.

· A plume is moving towards Bobsville.

Discussion Questions:

Based on the information provided, participate in the discussion concerning the issues raised in Week 5. Identify any additional requirements, critical issues, decisions, or questions you may have at this time.

1. How will public health, EMS and hospital partners ensure the information received will be sufficient to inform decision-makers regarding immediate lifesaving and life-sustaining activities?

2. What system(s) should be utilized by EMS and Fire personnel as they arrive on the scene and start sorting and treating patients?

Examples Below:



I see I few issues with this simulation exercise, from my vantage point that is. With a shelter in place order put out, EMS, first responders and medical staff will not show up to work. They should have made an announcement saying everyone shelter in place besides all EMS, first responders and medical staff please report to designated work areas immediately. EMS and fire personnel need to use START triage (simple triage and rapid treatment) and also do not treat patients in the explosion area because it is unsafe and possibly has radiation, they should be evacuated to a safe area for treatment (EMS Operations, 2023). Also, they should not enter the radiation zone unless properly trained and equipped with the proper protective gear for such an event. Once triaged, send most immediate to the hospital to not overcrowd the hospital with all the accident victims.  All surrounding areas should be notified and asked if they can send their first responders and medical personnel to assist with the affected areas.


EMS Operations,  (2023, July 1). START Triage | MedicTests. Medictests.  https://medictests.com/units/start-triage

Hope you all are having a great week so far, Happy 4th of July tomorrow!

To ensure that public health, EMS, and hospital partners have sufficient information to inform decision-makers regarding immediate lifesaving and life-sustaining activities, several measures can be taken:

1. Effective Communication Channels: Establish clear and efficient communication channels among all involved parties. This can include direct lines of communication between EMS, fire personnel, hospitals, and public health authorities. Utilize technologies like radios, mobile phones, or dedicated emergency communication systems to ensure rapid and reliable information exchange.

2. Incident Command System (ICS): Implement the ICS, a standardized management structure used for emergency response. This system helps coordinate and integrate the efforts of different agencies and organizations involved in the response. It provides a framework for effective communication, resource management, and decision-making.

3. Joint Information System (JIS): Implement a JIS to manage and disseminate information to the public, media, and internal stakeholders. The JIS ensures that consistent, accurate, and timely information is provided, minimizing confusion and speculation. It establishes designated spokespersons and utilizes various communication channels such as press releases, social media, and official websites.

4. Rapid Assessment and Situational Awareness: Deploy trained personnel, such as Public Health Rapid Response Teams, to conduct rapid assessments of the incident scene and affected population. These teams can gather essential data on the number and severity of injuries, potential hazards, and resource needs. Their findings can inform decision-makers about immediate priorities and resource allocations.

5. Real-time Data Collection: Utilize technology solutions, such as mobile data collection tools, to capture real-time information on patient demographics, injuries, treatment provided, and resource utilization. This data can assist in tracking patient flow, identifying trends in injuries, and assessing the capacity and capabilities of healthcare facilities.

Regarding the system(s) to be utilized by EMS and Fire personnel for patient sorting and treatment, the following approaches can be considered:

1. START Triage: Implement the Simple Triage and Rapid Treatment (START) system, a widely used triage methodology for mass casualty incidents. It categorizes patients into four groups based on their severity of injuries: immediate (red), delayed (yellow), minimal (green), and expectant (black). This system allows for a quick initial assessment of patients and helps prioritize treatment based on available resources.

2. Medical Priority Dispatch System (MPDS): Implement a standardized dispatch system that provides pre-arrival instructions and assigns priority levels to incoming emergency calls. This system can help allocate appropriate resources to different incidents based on the severity of the situation, ensuring a more efficient response.

3. Incident Medical Specialist: Deploy trained medical specialists to the incident scene who can provide on-site medical direction and support to EMS and Fire personnel. These specialists can help with patient triage, treatment decisions, and resource allocation, ensuring that the most critical patients receive immediate attention.

4. Triage Tags and Tracking Systems: Use triage tags or electronic tracking systems to identify and track patients throughout their care journey. These systems allow for efficient patient tracking, communication between different treatment areas, and identification of patients who require additional interventions or follow-up care.

It is important to note that these are general suggestions, and the specific response protocols may vary depending on local resources, available technologies, and established emergency response plans. Regular training, drills, and collaboration among stakeholders are vital to ensure an effective and coordinated response in such critical situations.

The most critical blast injuries are typically found in victims who are closer to the explosion, indicating the severity of the incident and the potential for a Mass Casualty Incident (MCI) to occur.

Additionally, the Simple Triage and Rapid Treatment (START) triage system is indeed one of the most widely used systems in emergency situations. START allows responders to quickly assess and prioritize patients based on their injuries and the urgency of care they require. It categorizes patients into four color-coded categories: immediate (red), delayed (yellow), minimal (green), and expectant (black), helping responders allocate resources effectively.

Jump START is a specialized triage system specifically designed for pediatric patients. It considers the unique physiological and anatomical factors of children and follows a similar approach to START, focusing on respiratory, perfusion, and mental status (RPM).

Another notable triage system is SALT (Sort, Assess, Lifesaving Interventions, Treatment/Transport). SALT emphasizes the sorting and prioritization of patients based on their need for immediate lifesaving interventions. It aims to rapidly assess and provide necessary treatment to maximize the number of lives saved.

It is crucial for EMS and fire personnel to receive training in recognized triage systems and regularly practice their implementation. Familiarity with these systems enables responders to efficiently and effectively allocate resources, provide appropriate care, and make informed decisions during mass casualty incidents or disasters.

Additionally, leveraging technology and information systems is vital in emergency situations. Tools such as electronic health records (EHRs), data analytics, and situational awareness tools provide decision-makers with timely and comprehensive information. These systems enable a better understanding of the situation and support informed decision-making.

Overall, a combination of effective triage systems and the utilization of information systems can greatly enhance emergency response efforts and ultimately save lives.


Agency for Healthcare Research and Quality. “Emergency Severity Index (ESI): A Triage Tool for Emergency Department.”  Www.ahrq.gov, 7 Dec. 2020, www.ahrq.gov/patient-safety/settings/emergency-dept/esi.html#:~:text=The%20Emergency%20Severity%20Index%20(ESI.


Center for Disease Control and Prevention .  Explosions and Blast Injuries. 2021.

‌Collecting as much information and data and specimens and testing it would help distinguish the chemicals or whatever airborne specimens that could be floating in the air and if it is mutating to know how to possibly control it or to know how people can protect themselves from exposure. Such as stated above they knew it what chemical and that they needed to be shielded with concrete made walls to keep the particles from getting through. They can also wear protective gear and when in a safe environment that place should have a separate area where the people who come in are washed and disinfected from possible contamination.

The way people are cared for is based on the severity and looking out for such symptoms including eye, blast, thermal burns, heat, and fire injuries and separated into sections to make sure everyone is cared for properly to keep it from getting worse on the individuals who are contaminated. It gets hard to treat people who are being brought in for treatment when there are people who are taking themselves for treatment which overcrowd the hospitals. Which leads people and hospitals to reach out to other nearby and further away hospitals to care for those in need. Seeking out control care is needed and turning away people if their symptoms are not sever enough and giving them home instructions so they can care for themselves. keeping organized and not let the stress and anxiety get to the responders to keep order to assure proper care is still being given to those affected.