By Sarah JacobsSeptember 24, 2018
"What are you doing to me?" the patient moaned, after paramedics failed to insert a breathing tube into his narrowing airway. A bubbly mucous in the man's mouth had to be suctioned before they could try again.
The patient was conscious and alert, but had been exposed to the nerve agent VX, and the team of medical responders scrambled to treat him, inserting IVs and monitoring his vital signs.
That is, until the next medical team came into the room for their round of training on the computerized patient simulator, a mannequin programmed with physical responses to emergency scenarios, including chemical decontamination.
This simulated medical drama unfolded as part of the recent Toxic Chemical Training Course (TCTC), hosted by the U.S. Army Chemical Materials Activity (CMA) and the Program Executive Office, Assembled Chemical Weapons Alternatives (PEO ACWA) at Aberdeen Proving Ground, Maryland, August 27-31. The week-long course trains medical responders who support the communities around the U.S. Army's two remaining chemical weapons stockpile sites, Pueblo Chemical Depot in Colorado and Blue Grass Chemical Activity in Kentucky.
CMA is responsible for the safe storage of stockpiled chemical weapons until they are destroyed, and manages the Chemical Stockpile Emergency Preparedness Program (CSEPP). CSEPP works closely with these stockpile communities, in partnership with the Federal Emergency Management Agency, to enhance emergency plans and provide chemical accident response equipment and warning systems.
The U.S. Army Public Health Center's Surety Medicine Division conducts TCTC every six months, using both classroom instruction and hands-on exercises. Paramedic and Training Specialist Steve Vaira said they've been working with CMA and CSEPP using the mannequins for about 14 years.
"The key to the mannequin training," he said, "is to make sure the medical responders can work together as a team."
One participant is assigned as the team lead, who calls out directions based on the symptoms the mannequin presents. Participants can listen to breath, heart and bowel sounds, take a pulse and insert a breathing tube into the mannequin's airway. Instructional Systems Specialist Tim Merkel customized TCTC mannequins with an application that replicates a seizure.
A monitor displayed vital signs, and responders could choose medications to administer. Merkel monitored their actions from a side room, out of sight, and used a computer to program the mannequin's physical responses to treatment.
"So, if responders do something inappropriate, the operator can make the 'patient' respond appropriately," said Supervisory Nurse Consultant (APHC) Sharon Wilcoxson.
Using a microphone wired to a speaker, Merkel can respond verbally to what the medical team is doing.
"That adds to the realism," Vaira said. "By utilizing the microphone, training participants get more direct feedback, and it becomes a more realistic question-and-answer setting."
In another room of the training facility, participants engaged in a triage exercise with live "victims." Seven people with moulage - realistic mock injuries used for training -- simulated an on-post chemical event.
"Injuries include a motor vehicle accident with a roll-over that has left one patient unconscious," Wilcoxson said. "One patient has exposure to mustard agent, there are thermal burns, emotional trauma, heat illness and a broken leg."
Working in small groups, the nurses, doctors and paramedics had 30 seconds to assess and classify each patient, then met to discuss their actions. Specialized training by Army medical providers covered surety rules and regulations for worker occupational health support and medical response to a chemical accident.
The culmination was a simulated community-wide emergency response to a chemical accident, using a tabletop model of the fictional town of Mayfield. A little larger than a ping-pong table, the model town included farmland, a small business district, cars and trucks, and a water tower emblazoned with the town's name. In one corner, a vehicle carrying chemical drums had overturned, and a liquid substance spilled into the road. Nearby, tiny plastic cows laid in a field, apparently overcome by the toxic plume.
Merkel, a trained firefighter, created the tabletop display to help responders size up a chemical emergency so they can formulate a response plan.
"I was a firefighter starting in 1983, so I understand how they think," Merkel said. "This is something that, as a training exercise goes, just seems to engage them much more effectively than reading a scenario in a book."
Each trainee was assigned a job, with key items to track, a response chain, and resources to assemble.
"In an emergency, it's entirely possible these responders may work with people they've never met before," Merkel said. "The feature of the Incident Command System we use is that it is not keyed to the person doing the job, but to the job the person will be doing."
Because responders don't initially know the full extent of an emergency in a real-life situation, the exercise teaches trainees to collect and assess details and formulate plans, so they are prepared for an actual emergency.
Trainers act as the inevitable distractions encountered during a chaotic event, from inquiries by local officials to a news helicopter hovering overhead, affecting the direction of the toxic plume. Merkel said the incident commander and others managing the event must navigate these distractions to focus on actions to keep the community safe.
Merkel added that the course is designed to help the medical responders in CSEPP communities understand what happens if there is an accident that exposes workers or other people to these chemicals, and how they must respond to it.
"It's part of a public law supporting CSEPP that we help these people be ready, and this is one of the ways we help" accomplish this requirement, he said.
CMA will conduct a CSEPP exercise at Blue Grass Chemical Activity in Kentucky on Sept.19. For more information on CSEPP and CMA, visit https://www.cma.army.mil
(Please note: This article was written by Sarah Jacobs, U.S. Army Chemical Materials Activity Public Affairs Office.)