‘Skyfall’ exercise aimed to push systems to limits

Everything was realistic about the disaster drill, including the “injuries” suffered by victims.

Everything was realistic about the disaster drill, including the “injuries” suffered by victims.

Forty-six agencies from in and around the Colorado Springs area took part in the community-wide “Skyfall’’ exercise May 9, which simulated a plane crash with mass casualties.

The exercise, which began at the Colorado Springs Airport, tested emergency procedures for city responders, including the Colorado Springs police and fire departments, as well as the Memorial and Penrose-St. Francis health systems.  

The Colorado Springs Office of Emergency Management was responsible for planning and implementing the exercise and, according to Erin Duran, emergency management coordinator, the mock disaster provided an opportunity for all agencies involved in testing communications and readiness in case of a real mass-casualty incident.

“All the city departments and responding agencies were able to train their initial response capabilities, triage and treatment as well as the transporting of patients,” she said. “It helped bring us all together and practice our inter-operational abilities.”

Duran said the airport conducts hands-on emergency exercises every three years, but this is the largest inter-agency exercise she has seen in the city.

Memorial Hospital Central alone received 56 simulated patients, as well as five simulated pediatric trauma patients who were assessed and treated by Children’s Hospital Colorado at Memorial Hospital.

Useful outcomes

According to Dr. Andrew Berson, director of trauma and acute care surgery at Memorial Central, the lessons learned during such exercises directly result in improvements in the quality of day-to-day care.

“The whole process is aimed at making sure our plans actually work and finding areas that are vulnerable and improving those areas,” Berson said. “It pays dividends on a lot of levels. It assures us that our processes work. It pays off in our [daily] operations.”

More than 300 Memorial employees participated in the exercise and, according to Berson, the goal was to stress the health system’s capabilities.

“From a facilities standpoint, we look at our ability to ramp up from normal daily activity to surge capacity and see if, operationally, we can absorb multiple patients unexpectedly,” he said. “We can integrate those skills into everyday operations.

“We analyze each step, from the notification of [a crisis] to staff to receiving patients to integrating and working to get patients assessed in an efficient fashion. If we can do all this under these circumstances, then everyday illnesses and injuries can be taken care of more easily.”

Berson added that every level of operations benefited from the exercise.

“It hones our cohesiveness as a team,” he said. “From the physicians to the lab and blood bank, to things as simple as the operations of the janitorial staff to make sure we get rooms cleaned and that we have enough supplies and gurneys.”

Penrose’s involvement

According to Chris Valentine, director of marketing and communications with Penrose-St. Francis Health Services, “Communication remains an issue. Obtaining accurate and timely updates from field units was still a challenge but is getting better with every exercise.”

Both Penrose-St. Francis campuses initiated their “external disaster” plans, according to Valentine, opening the incident command centers at each hospital as staff began preparations for the surge of patients. As the drill progressed, the actual mock patient count from a simulated plane crash for Penrose-St. Francis came to eight patients at St. Francis Medical Center and 33 at Penrose Hospital.

Valentine also stated that the exercise provided a “good experience for our staff in assessing a large volume of ‘patients’ with a variety of injuries and ensuring they receive the best quality care.  It was an incredible opportunity for our staff to practice interagency response with community agencies we don’t work with very often, such as the military.”

Some patients were transported to Evans Army Hospital at Fort Carson via Army Blackhawk helicopters, and Peterson Air Force Base provided medical personnel for the drill.

This exercise, according to Berson, differed from others he has participated in because patients were processed through departments as they would be in the event of a true disaster, rather than checking in at the emergency room only to be released.

“We treated this drill like a real mass casualty incident and put our staff to the test,” said Colette Martin, chief operating officer at Memorial. “We transported patients to the appropriate care units within the hospital with medical staff responding. By participating in events like this, Memorial equips itself to be the most prepared trauma center in the region as it pursues a Level I trauma center designation.’’

According to Berson, his team utilized best practices learned prior to the exercise from a range of resources, both external and internal.

Berson said members of his trauma team have served militarily in combat zones overseas and have first-hand experience with mass trauma situations.

In addition, he said he studied major Level I centers, including University Medical Center in Tucson, Ariz., and Jackson Memorial Hospital in Miami.

“The trauma director in Miami looked at Israeli mass casualty drills, spent time [in Israel] and brought back lessons learned,” Berson said. “From that experience, he revamped how Jackson Memorial runs its trauma department.”

Berson and his team also examined the handling of the Gabby Giffords mass shooting in 2011 and he says that Arizona’s University Medical Center now conducts similar exercises every six months.

“We, like them, adopted a mindset that we train like we fight,” Berson said.

An Army Blackhawk helicopter comes in for a landing at Memorial Hospital Central during the Skyfall exercise.

An Army Blackhawk helicopter comes in for a landing at Memorial Hospital Central during the Skyfall exercise.

Transition helps

It’s been two years since governance of the city-owned Memorial Health System switched to University of Colorado Health, and Berson said new ownership helped make the exercise as successful as it was.

“University of Colorado Health Memorial has done a great job integrating with physicians in the community,” he said. “We received help not just from doctors who have their checks signed by University of Colorado Health. Overall, the effort that was made to reach out to [the local health care] community seemed to result in more robust support for the exercise.

“With University of Colorado Health’s commitment to make Memorial a Level I trauma center, we participated to a higher degree than we were required to. The administration from the top down has supported this and provided us with the needed resources.”

Duran said the Colorado Springs Office of Emergency Management, like the individual entities involved, is conducting an assessment of the exercise and will have a comprehensive evaluation completed in the next few weeks.

“Overall, the exercise was successful,” Duran said, adding there will be another inter-agency exercise in three years. “The agencies are talking about outdoing this one. It could be even bigger next time.”