U.S. Army Soldiers and civilian staff at Tripler Army Medical Center (TAMC) conducted a mass casualty exercise, July 12, as part of a state-wide coordinated response to a humanitarian and disaster relief (HADR) event during Rim of the Pacific (RIMPAC) exercise.

The full-scale exercise at Tripler provided the hospital an opportunity to test emergency operation plans, ensuring Joint Commission regulatory requirements are met. The Joint Commission is a non-profit which certifies more than 21,000 health care organizations and is the nation's oldest and largest standards-setting and accrediting body in health care.

"Disasters are a vulnerability that all hospitals have to be prepared for, and certainly where we are in Hawaii, we are vulnerable to a lot of natural disasters," said Col. Soo Lee Davis, deputy commander of administration, TAMC. "So we're always in self-assessment mode, it's a continuous state of readiness."

In the scenario, a series of large simulated earthquakes caused significant infrastructural damage across the Hawaiian Islands.

Patient actors with simulated injuries were found at staging areas throughout the islands and transported by medical evacuation (MEDEVAC) to Ford Island. There they were redistributed to nearly every acute care hospital throughout the state. That caused an influx of casualties to TAMC.

Transitioning from routine to disaster mode, the TAMC emergency operations center was activated, and casualty collection points (CCP) and triage areas were established at the hospital's helipad site and emergency department.

"The CCP is set up just as we would in a real-world disaster so the patients could influx here," said Staff Sgt. Knowledge Truth, noncommissioned officer in charge of the TAMC Emergency Department during the mass casualty exercise. "This would stress our capabilities."

During the exercise, Tripler received 98 medical casualties, mostly by helicopter, where they were re-triaged and brought through the emergency department.

"It really did test us because it was chaotic," explained John Orendorff, chief of TAMC Operations. "We were told the roads were impassable and all casualties would arrive by air, but then the engineers 'cleared the road,' and all of the sudden buses arrived with patients."

One key element of the training was to ensure medical casualties were accurately specified and tracked from the point of arrival, through treatment, and discharge.

"Our main goal is to treat as many patients as we can, and in a real-world scenario, we would take in all types of patients, military, and civilian," explained Truth. "We would screen them, and they would be given demographics to differentiate from others. We would have to have those demographics to do lab work, X-Rays, blood transfusions ... and for safety purposes."

Exercises such as a mass casualty are intended to keep staff members at a high-state of readiness by offering a relevant and realistic training opportunity to test the hospital's emergency response system.

"Preparedness, constant training - we are constantly practicing. So no matter what situation we may be faced with, readiness is going to be most paramount and we will be ready to go at all times," stated Staff Sgt. Derrick Peggins, TAMC Emergency Management noncommissioned officer in charge.

This mass casualty drill is part of a larger HADR event designed to facilitate training for expeditionary forces to respond to foreign disasters as a Crisis Response Adaptive Force Package. The scenario included participants from the United Nations, various non-governmental organizations and academia, and aids Hawaii-based Department of Defense medical facilities in their state-wide mass casualty drills and certifications. Bringing these two events together in the umbrella of an HADR event is designed to enhance operability, test communication and exercise crisis response capabilities amongst interagency partners.

Twenty-five nations, 46 ships, five submarines, and about 200 aircraft and 25,000 personnel are participating in RIMPAC from June 27 to Aug. 2 in and around the Hawaiian Islands and Southern California. The world's largest international maritime exercise, RIMPAC provides a unique training opportunity while fostering and sustaining cooperative relationships among participants critical to ensuring the safety of sea lanes and security of the world's oceans. RIMPAC 2018 is the 26th exercise in the series that began in 1971.

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