The UNC Trauma program hosted eight emergency medical technician (EMT) teams at its 5th annual Paramedic Skills Competition on Tuesday, May 2, at the UNC Hospitals Hillsborough Campus.

Two men hang a banner. One of them has a heart attack and falls off his ladder, knocking his co-worker off of the other ladder. Someone driving by sees the two men lying on the ground and calls 911. First to arrive on the scene are the EMTs who must quickly assess the situation and stabilize the patients.

But on this windy day in Hillsborough, the patients are medical simulation manikins, and the EMTs are working to win points rather than save lives. It’s all part of the 5^thannual Paramedic Skills competition, hosted by the UNC Trauma program.

“In some ways it’s an educational event,” said Al Bonifacio, RN, UNC Trauma Program manager, “but to bring these teams in to one place so they can get to know one another, celebrate their craft and for us to thank them for the work they do is something special. It’s something that we are very proud of.”

Each team consisted of three EMTs and was given the same medical scenario – the two men on falling from their ladders.  Teams had a limited time to respond and were awarded points based on assessment techniques and treatment standards outlined by the NC Office of Emergency Medical Services.

The competition was judged by Daryhl L Johnson II MD, MPH, FACS, Trauma Medical Director, and assistant professor of surgery in the division of acute care surgery at the UNC School of Medicine, and Jefferson G. Williams, MD, MPH, deputy medical director of the Wake County department of emergency medical services and adjunct clinical assistant professor in the UNC School of Medicine’s department of emergency medicine.

A high school EMT class from Harnett County Central High School was also in attendance to observe the event.

Winners of the event were:

• First Place: Harnett County EMS
• Second place: Guilford County EMS
• Third place: Hoke County EMS

The other teams that participated were:

• Alamance EMS
• Cabarrus EMS
• Cape Fear Valley LifeLINK
• UNC REX Critical Care Transport
• Orange County EMS (winners of last year’s competition)

The competition was a kickoff event for the 28^th annual May Day Trauma Conference, an event presented by the UNC Trauma Program that provides a forum for nationally recognized experts in trauma care. The conference is designed to meet the educational needs of trauma care professionals from across the state.

In August, UNC Hospitals held a mass casualty exercise to evaluate the organization’s preparedness for the unthinkable – an active shooter event on the premises.

Saturday, Aug. 6, 2016, was a typical weekend morning at UNC Hospitals – calm, with nothing out of the ordinary happening on the premises – until a man barged into the North Carolina Children’s Hospital lobby, yelling, “My friend’s in the car – he’s been shot!”

As Guest Services, UNC Hospitals Police and the Code Medic Team sprang into action, the hospital’s first-ever, fully functional, simulated active shooter drill began.

Two UNC Hospitals Police Officers quickly and cautiously rushed to the scene to find an actor with simulated gunshot wounds to the chest seated in the vehicle parked outside. Once the scene was secure, the Code Medic Team rapidly assessed and transported the pale, unconscious and bloody victim to the emergency department.

“The first part of the scenario grew out of a real-life event here at the hospital,” said Dalton Sawyer, director of Emergency Preparedness at UNC Hospitals and one of the leaders of the UNC Mass Casualty Group, which led the drill. “But we didn’t think this scenario alone would test our response systems as much as necessary, so we added additional events to the drill.”

Nine minutes later, police radios crackled, “Gunshots near the Emergency Services loading dock!”

There, another actor armed with a mock AR-15 assault rifle “shot” several victims. Again, UNC Hospitals Police responded, but this time with red pistols drawn. Turning the corner, they saw and neutralized the threat and began the difficult work of treating the screaming, bloody victims lying on the floor.

Close to Home

On June 13, 2016, after the Pulse Nightclub tragedy, Orlando Regional Medical Center faced incredible challenges, treating more than 40 trauma patients and locking down the hospital to visitors except for the victims’ families. The hospital received praise for its actions, and one physician described the experience as “the worst and best day of my career.”

Last month, at Parrish Medical Center, in Titusville, Florida, a gunman with a troubled past killed two people in the hospital. During the last several years, doctors have been shot at major hospitals in Boston and Baltimore.

“These are the kinds of incidents we, as trauma physicians, think about day and night,” said UNC trauma surgeon and Trauma Medical Director Daryhl Johnson, MD, MPH, who served as one of the executive directors of the UNC Mass Casualty Group. “We feel we’ve been fortunate here at UNC, but in our current society, we worry that it’s not a question of if something will happen that tests our response capabilities, but when.”

Incidents that test hospitals’ emergency response capabilities hit close to home for Johnson and many members of the UNC medical community, including Christian Lawson, RN, Director of Emergency Services at UNC Hospitals. But since Lawson arrived at UNC Hospitals in 2015, he has been encouraged by the ongoing emergency response preparation, education, and training at the hospital.

“We’ve been preparing for these kinds of events for a while,” said Lawson, who worked at University of Tennessee Medical Center (UTMC) prior to moving to Chapel Hill. “This year, before the Orlando and Titusville incidents occurred, we had been planning this mass casualty exercise at UNC Hospitals, which included an active shooter, and we knew that the exercise would go a long way toward testing and improving our ongoing preparedness.”

The Aftermath: Learning Lessons

Three days after the drill, on the afternoon of Tuesday, Aug. 9, the UNC Mass Casualty Group gathered in the Emergency Services conference room at UNC Hospitals for a debriefing session on the event.

The group, comprising physicians and nurses from the Emergency Department, UNC Hospitals Police, and the UNC Trauma Program, among other hospital and unit representatives, reviewed what went well during the simulation and discussed areas where improvements must be made.

Johnson referred to the session as an effective opportunity to “Monday Morning Quarterback” the simulation.

“This gave us the chance to find the holes and deficiencies in our responses and systems that perhaps people hadn’t considered,” said Johnson. “How did the operating rooms respond? Were they staffed sufficiently? Did police take proper action after removing the threat?”

As they watched a video of the exercise, Al Bonifacio, UNC Trauma Program Manager, described the feeling he had while watching the first-person footage of UNC Hospitals police, with mock pistols drawn, clearing space among actors with simulated gunshot wounds who were screaming for help.

“It was eerie,” said Bonifacio. “As exercise staff, we were monitoring for safety, evaluating the participants’ actions, and timing how long it took victims to get to the Emergency Department, yet we were thoroughly immersed in the experience. Even though we knew and rehearsed what would happen time and again, it felt all too real – but it needed to be to be effective.”

Lawson echoed Bonifacio’s response, recalling a moment during the exercise in which he turned to Sawyer and shared how real the scenario felt as it was being executed.

“That was a common reaction from everyone involved,” Lawson said. “There was a visceral reaction to the event from all responders, and we, as leaders, felt that. Active shooter incidents occur way too frequently in this country. We wanted to run an exercise that mirrored what’s been happening around us and use it as an opportunity to improve our response protocols and policies and enhance our systems. We owe it to our staff, patients, and the larger community to be prepared.”

In addition to improving protocols and response agility, Lawson wants all employees to know that UNC will continue to invest the time, resources and leadership to ensure that the hospital is a safe place for employees, patients and their families.

“Part of communicating that is becoming better prepared, and part of being prepared is developing our culture of running mass casualty exercises,” he continued. “We’re going to do them frequently to make sure that everyone has what they need, that action plans can be created based on what we learn from these events, and that polices and processes will change.”

Lawson has led similar disaster drills at hospitals around the country. UTMC drilled for these scenarios regularly, and because of the large number of trauma cases seen annually in the Emergency Department in Knoxville, operating rooms and the entire healthcare team were very agile. But, he said, although UTMC and other institutions may more routinely drill, the recently performed UNC drill may have been the best he’s been a part of – and he credited Sawyer, UNC Hospitals Police and members of the Tar Heel Trauma Team for putting it together.

“The team set it up, got buy in from all the key stakeholders, and executed it nicely,” he explained. “It makes me confident in our abilities to do more of these in ways that add value to the organization. It makes me confident that we can be as prepared as needed for an influx of patients coming to the Emergency Department and to our operating rooms and into the hospital.”

Sawyer said that the exercise, which included participation from nearly 50 staffers from across the hospital and from other regional agencies, helped improve emergency preparedness at UNC Hospitals.

“Though preparedness will always be ongoing and much work has yet to be done,” he said, “we feel we are better prepared to deal with these unthinkable events because of the hard work of everyone who participated in the exercise.”

In all, nearly 50 staffers from across the hospital and region helped to conduct the exercise. Here is a list of those who participated:

External Agencies

• Orange County EMS
• New Hanover Trauma Services
• Emergency Nurses Association’s Heart of Carolina Chapter
• UNC Public Safety and Risk Management

UNC Medical Center Participants

• UNC Hospitals Police
• Department of Surgery
• Department of Emergency Medicine (including Scribes and EMS Fellows
• Emergency Services (including Tar Heel Trauma, the Emergency Department and Carolina Air Care)
• Hillsborough Hospital Emergency Department
• House Supervisors
• Peri-operative Services
• Respiratory Therapy
• Nursing Practice and Professional Development
• Operational Efficiency
• and many others

Please note that UNC Hospitals Police will offer Active Shooter Response Training classes at the Hedrick Building (Aug. 31, 10 a.m. and 1 p.m.; Oct. 18, 8 a.m.) and the Hillsborough Campus (Oct. 11, 8:30 a.m.). Log in to LMS to sign up for the courses. Click here for more information.