Photo: P. Bolté (AFRRI)

Ms. Rebecca Rink, above, a contract employee in the AFRRI Military Medical Training and Doctrine Department, awaits attention from emergency response personnel during the mass casualty (MASCAL) emergency drill.

The scene: a picnic for the Uniformed Services University of the Health Sciences (USUHS) employees outside near the USUHS baseball field. Employees are scattered in groups on and around the field enjoying the time away from the office. Their fun is destroyed when a person using a fake identification card gets past base security and drives his car onto the field and into the crowd and detonates a "dirty bomb." Smoke fills the air and chaos ensues. There are 75 "casualties"—10 immediate "deaths," 35 "contaminated and walking wounded," and 30 "worried well."

On Thursday, Oct. 21, 2004, 24 Armed Forces Radiobiology Research Institute (AFRRI) employees participated as "victims," evaluators, experts, journalists, and photographers in a mass casualty (MASCAL) emergency disaster drill performed on the National Naval Medical Center (NNMC) base. Ms. Rebecca Rink, a contract employee in the Military Medical Training and Doctrine Department, was one of the walking wounded. She played, according to the card around her neck, a 30-year-old woman who was standing outside of the baseball field and was hit by fragments and debris from the explosion. Ms. Rink was made up to demonstrate minor abrasions to her skin and injuries to her left eye.

Ms. Rink, in character, was conscious after the blast, but was anxious and upset. She kept repeating "My eye hurts, my eye hurts." It took roughly an hour for emergency response personnel to attend to Ms. Rink and the small group of other walking wounded who were with her.

Once emergency response personnel arrived to assist her, Ms. Rink was ushered with the other walking wounded to the hillside on the side of the road opposite the baseball field. Here she was examined further, and her condition was written on a triage tag and attached to her arm. She was seated on a green tarp—one of four tarps spread out on the hillside—which indicated that she was a noncontaminated, or clean, victim with minor injuries. The other tarps were as follows: yellow indicating a contaminated, but delayed, victim; red, indicating a victim who needs immediate attention; and black, indicating that the victim is deceased.

Photo: P. Bolté (AFRRI)

While emergency response personnel continued to attend to victims, Ms. Rink sat on the green tarp with other victims. She was moved some time later to the yellow tarp after she was found to be contaminated with radiation. This mistake was one of the built-in surprises in the drill to keep emergency response and medical personnel on their toes.

Ms. Rink is examined by a physician and his assistants in the Ambulatory Surgery Center. Medical personnel assess her condition and determine how best to treat her simulated injuries.

Eventually, ambulances arrived to take Ms. Rink and the other victims to the NNMC hospital. Once at the hospital, Ms. Rink was led by medical personnel through a decontamination tent outside the hospital and was decontaminated. She was then taken into the emergency department where she described the extent of her injuries to attending medical personnel. They briefly examined her and took note of her condition. Medical personnel determined that, based on her condition, Ms. Rink needed to go to the Ambulatory Surgery Center (ASC), and an escort arrived to take her there. Once inside the ASC, Ms. Rink was taken into a private room, told to lie down on the table, and examined by a physician and his assistants.

Ms. Rink considered the disaster drill a success overall and thought the emergency personnel and hospital staff learned much from it. She commented, "I was impressed with the preparations the hospital had made for the drill. They were very well prepared for the arrival of myself and the other 'victims.' However, if I were to play a part in the drill again, I would be a more active participant."

In addition to Ms. Rink, AFRRI participants included eight from the Radiation Sciences Department, six from the Safety and Health Department, one from the Scientific Research Department, four from the Administration Support Department, and five from the Military Medical Operations Directorate.

William E. Dickerson, Col., USAF, MC, and John L. Crapo, LCDR, USN, MSC, participated as evaluators and presented lectures in the NNMC Memorial Auditorium. LCDR Crapo discussed the characteristics of radiation and the effects of a nuclear weapon or dirty bomb detonation. Colonel Dickerson covered topics including acute radiation syndrome, internal and external radiation, first-responder actions, and medical center responses. Other lecturers in either Clark Auditorium or Memorial Auditorium covered topics including SARS, avian flu, and the handling of traumatic stress during a crisis.

Colonel Dickerson reported that he was happy with the outcome of the disaster drill and considered it a tremendous success "because it tested the system, identified areas for improvement, and brought all facilities together." He said that as an evaluator and an instructor in the AFRRI Medical Effects of Ionizing Radiation Course, he could observe the practical uses of what he teaches.

He was also impressed with the planning on the part of NNMC, which included a packet for each evaluator, with a checklist of specific objectives to look for. "In these days of terrorist threats, it is important to plan and train before a disaster occurs and for all medical personnel to learn from these exercises," he added. "There is a big difference between knowledge and practice. This was a great opportunity to practice our skills."

NNMC; the Clinical Center at the National Institutes of Health, an agency of the Department of Health and Human Services; and Suburban Hospital, a community-owned hospital serving Montgomery County and the surrounding areas, were the key players in this four-hour drill that also included members of the Red Cross and Montgomery County Emergency Services. The disaster drill came out of a need for the local facilities to improve and coordinate their responses to disasters.

Mass casualty skill stations and informational booths were scattered on the first and second floors of NNMC building 10. Topics included preventive medicine, infectious disease, wound care, chest trauma, burn management, basic life support, and pediatric trauma assessment. Healthcare personnel were on hand to demonstrate such equipment as the SIM MAN, a model that assists medical personnel in learning how to treat patients, and the various types of intravenous equipment used at the hospital. AFRRI participants were as follows.

Military Medical Operations
John Crapo, LCDR, MSC, USN; evaluator, speaker
William Dickerson, Col, USAF, MC; evaluator, speaker, primary AFRRI point of contact
Sarah Kirtland, CDR, MSC, USN; evaluator
Rebecca Rink, victim
Horace Tsu, LtCol, USAF, MC; evaluator
Charles Woodruff, LT, MSC, USN; evaluator

Radiation Sciences Department*
Jason Burmeister, HM1, USN; player (decontamination)
Dina Lyon, SGT, USA; player (decontamination)
Glen Manglapus, CPT, USA; player (decontamination)
Regina Miller, SFC, USA; evaluator
Joniel Ribaya, SFC, USA; evaluator
Diana Tuten, SGT, USA; player (decontamination)
Stephanie Vaughn, MAJ, USA; evaluator and alternate AFRRI point of contact
Christopher Whicker, SSG, USA; evaluator
*All personnel in the Radiation Science Department were also part of AFRRI’s emergency response team.

Safety and Health Department
Kevin Allen, HM3, USN; evaluator
Anamaria Dent, LT, MSC, USN; player (decontamination)
James Ganz, HM1, USN; player (decontamination)
Robert George, evaluator
Daniel Simpson, LCDR, MSC, USN; evaluator
Betty Lou Wampler, evaluator

Scientific Research Department
Antonino Germana, LTjg, MSC, USN; evaluator

Administration Support Department
Patrice Bolté, photographer
David Morse, photographer
Erica Pirrung, reporter