According to the National Oceanic and Atmospheric Administration (NOAA), in the United States “there were 28 weather and climate disasters in 2023, surpassing the previous record of 22 in 2020.” With the number of disasters increasing in recent years, preparedness is crucial.

Many simulationists may believe that creating a disaster simulation is complicated, expensive, and requires a lot of resources. The opposite is true if you have enough support from your organization and community. The only cost incurred during our disaster management simulation project for nursing students at our institution was the cost of make-up to create realistic wounds.

Finding a gap in student knowledge.

The first thing we did was to perform a needs assessment. We knew that our students were not well prepared in our program for caring for patients during a disaster. In the past, this area of content was never really addressed in our curriculum. As we were working on our curriculum, aligning with the new BSN essentials, we realized there was a gap in emergency preparedness. We started doing research and found evidence to suggest students are not prepared for emergencies and lack the confidence it takes to participate in life-saving measures.

‘Starting small,’ with an earthquake aftermath simulation.

The first semester, we decided to start small and created an earthquake simulation in one of our classrooms. We taught the students how to use the SMART triage tagging system and pre-briefed them on general emergency management information. The SMART triage tagging system is a tagging system used for quickly triaging and prioritizing care of victims during a mass casualty. Here is a brief video (not our own) by an experienced nurse that we show students to introduce them to this system.

As the next step in the simulation, we set up manikins in the room to act as the deceased victims of the earthquake. We had volunteers from lower division nursing courses and instructors portray the wounded victims. Each victim created their own scenario to play during the simulation. We decided to use a fog machine to make the scene more realistic, which in turn unintentionally set off the fire alarm for the entire building. That was not intentional, but did create a realistic, chaotic environment for the students. (Moral of the story: don’t use a fog machine in the building; lesson learned.) Thankfully we were able to rescind the alarm before the fire trucks showed up!

Some initial takeaways.

The simulation went well, but was rather chaotic. We learned from our first simulation and used feedback to improve over the next several semesters. One takeaway was that we really needed a bigger space. It was not ideal to run the simulation in our nursing building, especially while other classes were taking place.

Simulating a shooting aftermath.

The next semester, we moved the simulation from our nursing building to what is known as our convocation center. This is a much larger building that is used for hosting large events such as basketball games and graduation on our campus. This scenario was a little different, as it was the aftermath of a shooting at a basketball game. This time we used volunteers from the local high school health science course to portray victims. The instructor of the health science program at this local high is an alumnus of our nursing program, so we felt that this was a very important community relationship to establish. (Since that time, we have had several students from this high school enter our program.)

In this simulation, we decided to use more defined roles and organized areas for each level of injury, based on the SMART tagging system. Our students were assigned various roles including incident command, responder, triage, and transporter. The health science instructor had her students plan and research their own injuries, vital signs, and moulage. This created a great learning experience for the high school students. EMS volunteers were also present during the simulation with an ambulance.

Adding an interdisciplinary component to the simulation.

Both of these simulations showed us that our students’ knowledge and confidence greatly increased by participation. In our most recent simulation (summer of 2023) we decided to branch out and make this more of an interdisciplinary approach in order to increase teamwork skills. We decided to add a lecture on TeamSTEPPS and focus on building valuable teamwork strategies for the students to use during the simulation.

As previously, we used the EMS volunteers and health science students, but we were also able to partner with our university police department. They had been wanting to do a mock active shooter drill to practice their response time and skills. We stuck with the same active shooter drill scenario, but this time we had a “real” active intruder, played by a member of the police while the other police responded to the scenario. During this scenario, students had to wait until the intruder was detained before responding to the scene.

After these simulations, students reported increased teamwork and confidence on disaster preparedness and management. For more detailed information on using simulations for teaching nursing students disaster management, read “Enhancing Disaster Management Preparedness Through Simulation” in the April issue of AJN.

Hannah Mottel, DNP, RN, CNE, CHSE, is an assistant professor at the University of South Carolina in Aiken.

Kelly Russin, DNP, RN, CHSE, is the director of simulation at the University of South Carolina in Columbia. Their article, tktkt, appears in the tk issue of AJN.

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