I Can Haz Mat?

I took a year off between college and med school, at the urging of my super-supportive parents. So I ended up moving to Boston for a year, and volunteering at Massachusetts General Hospital while I pseudo-supported myself working as a freelance stage electrician.

One of the coolest things that I got to do at Mass General (among a sea of really cool things), was to participate in a Hazmat drill. This drill was to train the physicians, nurses, and ancillary staff on how to handle a mass-casualty situation.

Because I’m a writerly-person, I also was super-excited to participate for research purposes. And I also thought it would be great to write up the experience for my online writers’ group, so they could benefit from the information, too. And now, I can share it with you guys!

The Scenario:

A bomb with components of cyanide is set off in the Park Street T station. (Non-Beantowners: This is a high-traffic transfer point between the Red and Green lines of the Boston subway system.) Due to the highly toxic nature of cyanide, the most critically injured patients pass away before help can get there. The survivors are instructed to get themselves across Boston Common (a park in the middle of the city), and over Beacon Hill to Massachussetts General Hospital. (Walking it usually takes me around 25 mins to a half an hour.)

Preparation:

A couple of days before the drill, we were asked to send an email to the volunteer coordinator, telling them what scrub size we’d need to wear, whether we spoke any languages other than English, what age of victim we wanted to play, and whether we would be willing to act as a critical patient.

The day of the drill, around 70 volunteer victims (VV) showed up, which was awesome. We were told to bring a bathing suit or shorts and a t-shirt to wear under the scrubs we were given; the scrubs would represent our clothes during the drill, and we put strips of red tape on our swimsuits or clothes so the Hazmat team (HT) would know that they represented our skin and shouldn’t ask us to remove those. People who were wearing wedding rings and earrings were instructed to put red tape over their jewelry so they wouldn’t be asked to remove them.

We were then given sheets of paper which described how badly injured we were, our vital signs, the specifics of our injuries, and character scenarios. I had a compound radial fracture and multiple lacerations, and was assigned to show up in a wheelchair as a critical patient. I was to be in a panic because of how bad the wound on my arm looked, and convinced that I was going to die from the blood loss.

Additionally, one of the coordinators approached me and asked me if I would be comfortable playing the part of a Deaf person, since I put on my sheet that I had some experience with American Sign Language. Apparently, the coordinators like to throw stuff at the HT that they aren’t expecting, but that they might run into in a real-life scenario. (I don’t know if they had ever put a signer through the drill, but I was told that the year before they had to figure out what to do with a blind man and his seeing-eye dog. They ended up putting both of them through decontamination. Apparently the dog was really well-behaved during the process.) So I decided that I would play a profoundly Deaf person who used ASL as their primary language and was unable to read lips. And then I was instructed to make as much trouble as I could, within reason and the bounds of the drill.

Oh, did they pick the right person for that! :D <== evilest of evil grins.

Other people were assigned head wounds, various blast-related injuries and burns, and breathing difficulties as a result of cyanide exposure. A bunch of people spoke Spanish, and two women were assigned to a scenario in which the first woman only spoke Mandarin, and the second woman would offer to translate for the HT. A few were assigned to arrive on stretchers and in wheelchairs, but a lot of people had minor injuries and would just walk. Three people were assigned to play a family.

After we got our parts to play, it was back to the conference room for moulage. The makeup jobs were awesome, with fake blood and bandages and torn scrubs with bloody edges. I had my left arm wrapped in bloody gauze (I’m a right-handed signer), and splashes of blood and makeup all over my face and arms to represent various cuts and bruises. I also sported a small head wound (fake blood running down from my hairline) and a nosebleed. It was really a fantastic makeup team, especially for a large volume of volunteers. A girl whose primary injury was supposed to be a head wound looked like she was bleeding out of her ear, under the gauze they had wrapped her in. One woman wore a burn mask. (A lot of people walked by us as we sat in the hallway, staring at the group openmouthed, until we explained that the wounds weren’t real. I think we might have accidentally traumatized some kids, too.)

Being all bloody wasn’t enough, though…in the hallway, we were given palmfuls of goo that would glow under blacklight, and buckets of dirt to smear all over ourselves. By the time we were done and ready to go, we really did look like victims of a subway bombing.

The Drill:

By the time I was done with moulage (they did the non-critical VVs first, since in a real situation they’d probably be the first ones to make it to the hospital), the decon tent was already set up, and the drill was in full swing. I climbed into a wheelchair, inserted myself into the next group of VVs, and waited my turn.

The whole front of the hospital was cordoned off as it would have been in a real situation, with yellow CAUTION tape, crowd-control officers, and police cars. (Since the front of the hospital is also the ambulance bay and the entrance to the Emergency Department, we left room for emergency vehicles to get by.) Another cool feature of the hospital’s area-securing system is a series of hollow plastic barriers. They’re relatively easy to move, but when you fill them with a ton or two of water (which maybe takes two minutes), they turn into a really effective barrier against a possible vehicular assault on the hospital itself.

Additionally, one of the parking garages was ingeniously transformed into an outdoor treatment/overflow center. They drew heavy tarp-curtains over all of the openings, which would allow them to heat up the bottom level of the garage in case of a wintertime large-scale emergency.

The HT personnel all wore white Hazmat suits with clear faceplates, rubber galoshes, black gloves, and air filters/breathing units at the small of their backs. Over the suits, everyone wore color-coded vests with neon yellow strips that told the person’s operational role in big black letters.

The decontamination operation was set up in front of the hospital. As VVs arrived, they were assessed by triage personnel. The triagers had a selection of plastic slap-bracelets in red, yellow, and green. (These represented [green] those who have only minor injuries, and can wait some time to be treated, [yellow] those with injuries that are immediately life-threatening, and [red] those whose injuries are so severe that they are unlikely to be saved by treatment. Group yellow gets first priority.)

After that, the VVs were conducted to the decon tent.

The bright yellow, plastic tent was separated into three corridors which ran the length of the tent. Each of the two outer corridors were separated into three sections. The first section was square and empty, with a little window zippered into the side. Here, VVs were asked to remove all of their clothes, (including shoes, jewelry, etc.), place them in plastic bags, and hand them out through the little zipper window. They then proceeded to the second room, which was separated by zippered flaps (which weren’t zipped up, at least while I was there).

This section was longer than the first, and absolutely FILLED with warm, soapy water. There were spray-nozzles at ankle, knee, waist, shoulder, and head levels, and I assume a bunch on the ceiling as well. These misted a fine but firm spray (like a medium-pressure shower head), which completely drenched the VV. The VV was instructed to scrub off as best he can, running his hands through his hair and under his arms, etc., as he walks through the section. In the third section, also set off by zippered flaps and identical in most ways to the first section, the VV was handed a towel and a hospital gown to cover up with. One of the outer corridors was for men, and the other was for women.

The center section runs the length of the tent and is open at both ends. The middle of this section is taken up by a collapsible-lattice conveyor table covered with rollers. This is where the most critical patients are decontaminated by the suited HT members who stand on each side of the conveyor.

When the VVs finish with the decon tent, they are examined by a guy with a blacklight, who is looking for traces of the glowing goop we had applied earlier. If any is found, the VV is sent around to the front of the tent to repeat the decon process. When they’re contaminant-free, they’re conducted out of the way by hospital transport personnel, who are not suited up.

A couple of the VVs were asked to go through a second time, to simulate more patients.

Using this system, the team was able to decon around 100 VVs, in various states of health, in an hour.

My experience as a Deaf victim:

It seemed rather chaotic when I arrived on the scene, but that could be because I was sitting down and didn’t have my usual view of the world. Presently, a woman in a Hazmat suit came over to me and started talking to me. Remember, I was playing a Deaf character, so I started signing at her, describing the bomb in the station, my injury, and asking if I was going to die from blood loss. Obviously no one really understood. (Interestingly, though, no one ever asked around to see if anyone spoke sign language.) The woman, with the help of the guy pushing my wheelchair (who knew maybe 10-20 signs), determined whether I was having difficulty breathing, whether my arm should be considered a concern, and whether I could walk. I made a show of being in a lot of pain getting out of the wheelchair, but managed to get to my feet.

After a couple of attempts to communicate verbally (some Deaf people can read lips, but I didn’t want to make it easy on them and it’s not like it’s a comfortable form of communication for Deaf people), the woman figured out that I would only respond to gestures. Unfortunately, she didn’t realize that I had to be looking at her in order for her gestures to get through. :D I made sure to be ultra-distracted by the mannequin going through the center aisle of the tent while the woman was trying to get me to take off the “contaminated” scrub suit, and I could definitely see her gesturing out of the corner of my eye. I kept on asking if that “man” was going to be all right, and she would repeatedly tug at the shoulder of my scrub suit.

When I “understood” that I had to strip down, I started demanding an explanation. I explained that my arm hurt like hell, and there was no way I could get my shirt off without hurting it. And when were they going to do something about the blood? I was bleeding to death in front of her, and she wants me to take my shirt off?! The woman was incredibly patient, even though she couldn’t understand what I was saying. I eventually gave her a break, and allowed her to help me remove my scrub shirt. Apologizing profusely, which (of course) got in the way. And I wouldn’t move my “injured” arm. I even remembered to cry out and pull away when she touched it accidentally. And I made sure that I got tangled up in one of the sleeves. (I take my job as a trouble-maker seriously!)

After I had taken off the scrub suit and the little skid-socks I was wearing, she pointed me into the center section of the tent. Again, I gave her all kinds of grief; how could I go in there with my arm all bloody? It was going to hurt like hell! It already hurt like hell! She nodded understanding and made a sympathetic face to me. (It was pretty easy to figure out what I meant; to make the sign for “hurt”, you point your index fingers at each other with a modulating facial expression that tells how strong the pain is, and make the sign near the place where it hurts. Since I was only signing with one hand, it looked like I was pointing over and over to my hurt arm.) She was saying “I know, I know”, whenever I said my arm hurt and was bleeding, but each time insisted that I had to go through the decon section.

I kept this up for a minute or two, then decided to relent. I noticed that while I was turning away, she was gesturing to me again, telling me to scrub under my arms, etc. But my back was turned, and so I decided that the instructions had been lost.

I stepped through the flaps to the middle section (the floor had a little flap of tarp sticking up to act as a trough to keep the water in), and was completely drenched within three seconds. It was like walking into a wall of (thankfully warm) water. The deluge was inescapable; every time I tried to turn my face away from the spray, it was hit by another one. There was nowhere I could turn where I didn’t get a full faceful of medium-pressure water. Thankfully, the soap didn’t sting my eyes at all. It did, however, make it practically impossible to see. So I felt for the wall, and let it guide me to the other end of the tent. My hand occasionally brushed the spray nozzles, which felt like tiny plastic layer-cakes about the circumference of silver dollars.

I stepped out into the third section of the tent, absolutely drenched. Having received no gestural instructions for what to do after I had gone through the center section (even though I actually knew that I was supposed to move on through to the end), I just hung out there, trying to back things up. The victim who came through after me managed to convey to me that I was supposed to be moving on. So I did.

When I emerged, dripping and shivering a little (it was a humid and chilly summer evening, right after a major storm system had gone through), I decided to make some more trouble. I made a big show of looking back through the center section of the tent, fascinated by the decon process that was going on in there. I wanted to see how close of a look I could get without someone noticing me, but one of the suited HT guys to the left of the conveyor waved me away after I had nudged only a foot or two in.

The folks at my end of the decon tent noticed me a minute or two later, and a guy came up to me and started running a handheld blacklight over me. I started signing at him, but he didn’t notice that I wasn’t responding to his instructions; he lifted my chin while he told me to lift my chin, etc. Then a woman came up
to me, examined my arm, and put a piece of gauze over the injury. I guess it was to signify that I had received medical treatment.

Someone helped me into a wheelchair after that, and gave me a towel and a hospital gown, and a green laminated paper that I didn’t remember to read because I was busy making communication problems for people. I started signing up a storm to the guy pushing my wheelchair, demanding to know where we were going, and why. He just smiled at me and shook his head in confusion, every time I tried to say something to him. I eventually gave up, “frustrated”, and rode to the entrance of the hospital. There, a woman wrapped me in a warmed blanket, and told me that I should go through the process again to simulate another patient.

So I did.

This time, the triage guy didn’t figure out that I was Deaf. Whenever he asked me a question, I’d sign at him that I couldn’t hear. His response was to get closer and closer, and he eventually knelt right next to my wheelchair, face to face with me. I could tell that his view of my hands was completely cut off by the chin of his Hazmat suit. I was really confused by that; surely he could see that I was signing!

No matter; I was pegged as a Jane Doe with no story, examined, given a green bracelet again, and sent through the tent again. This time I didn’t make quite as much trouble; I was simulating a completely different person, after all. And the lady on my side had been so patient with me the last time. I was a little concerned since the red tape had come unstuck from my wet clothes, but they substituted the hospital gown for my “clothes” (and they’re not idiots). This time, the woman gave clearer gestural instructions, and made sure I was watching her while she gave them.

After I finished up the process, I went back to the conference room to gather my real clothes and change back into them. And wash off the residual blood. There was going to be a debriefing session a half an hour after the last VV was processed, but there were still people going through when I got done with my part. So I went to hang out with one of the crowd-control cops.

I didn’t need to do any trouble-making at the edge of the scene with the crowd-control cop. The regular denizens of the hospital area were giving him the perfect simulation. He was doing a great job directing people away from the drill, even people who needed to get past to make it to doctor’s appointments, etc. Only ambulances were let through from one direction, and only drill participants from any other. Whenever anyone approached, the CC guy would hold out his arms, palms toward the “intruder”, and motion them back. It was a surprisingly effective gesture; even people who were blustering their way through, indignant at the inconvenience, reacted to it immediately in some way or another. No one got through.

I hung out there until the last patient went through the tent. It was a little difficult to see what was going on from where I was, but I was amused to see that one of my fellow VVs had elected to collapse right after the triage process. A bunch of people in suits knelt around her, and eventually she went through the process like everyone else.

The Wrap-up:

The debriefing was really cool. It was fascinating to learn how much was going on where I couldn’t see, and how many people made this thing possible. In addition to the doctors and nurses on the Hazmat team, there were Buildings and Grounds staff, volunteer firefighters, and any number of other roles that were played away from the site of the decon tent.

Random tidbits:

-It only takes two people to set up the decon tent. Any more than that, said the head of the HT, and people just start getting in each other’s way.

-The stretchers have thin sheets stretched over the vinyl mattresses. This is not just for patient comfort; medical personnel use the sheets to lift patients from one surface to another.

-If the soap/water mixture is too thick with soap, it’ll clog up the spray-nozzles in the tent.

-The Hazmat suits contain radios. If a person engaged in one activity sees something bad happen that’s not a part of his responsibilities, he’s supposed to radio to the others to solve the problem, instead of doing it himself.

-When they went over the decon tent with a UV light, they observed that the first half of the tent was contaminated by the glowy stuff. The second half of the tent was completely clean. So, it’s pretty effective.

-If this were to happen at night, the team can set up floodlights to illuminate the whole process. The decon tent has its own lighting system inside.

-Apparently, a new feature since the last drill: the generators that warm up the water and provide power, etc, were significantly quieter this time. According to many team members, that significantly reduced feelings of uncontrolled chaos.

-There are few things weirder to see than a guy in a Hazmat suit peeling back the headpiece to take a drink of water out of a water bottle, resettling the headpiece, and jumping back into the fray.

-People stop trying to explain stuff to you if you don’t seem to understand them the first time. That lady in the first section of the tent is really the only person who even tried to explain to me what was going on. If I was a real victim, I would probably be scared to death and totally confused by the entire process.

-I might have been shuttled around in the wheelchair so much partially because I couldn’t communicate, and wouldn’t respond to verbal directions.

-Apparently, during the last drill they couldn’t heat the water. AAAAAAAAA!!! I totally lucked out.


Pictures:

http://icanhascheezburger.com/2008/09/21/funny-pictures-cat-warns-about-lolpox/

And, surprisingly, Dr. Grasshopper’s Very Own GrasshopperCam!

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Published in: on August 18, 2010 at 10:20 pm  Comments (4)  
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4 CommentsLeave a comment

  1. Ear Yellow Neons…

    [...] h completely drenched the VV. The VV was instructed to scrub off as best he can, running his hands t [...]…

  2. What a cool experience – and nice to know that the Doc’s and other professionals really know what they are doing…I’m wondering how I could get involved in something like this!

    • Talk to your local hospital’s volunteer department. There are all kinds of cool opportunities to get involved in all kinds of fun projects.

  3. A+ would read again


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