Screams for help broke the stillness of the courtyard of The Denton A. Cooley, MD and Ralph C. Cooley, DDS University Life Center.

During a simulation designed to train students how to work together, a “shooter” left nearly 30 people injured or dead. Students from The University of Texas Health Science Center at Houston (UTHealth) were tasked with assessing the severity of the patient’s injuries using limited medical supplies to stabilize them in the field before transitioning them to an ambulance.

Some of the “injured” wailed for help, while others quietly groaned that they were in pain, their breathing labored and uneven.

The scene was part of The Center for Interprofessional Collaboration's annual Mass Casualty Incident Simulation. In all, 529 students from McGovern Medical School at UTHealth, Cizik School of Nursing at UTHealth, UTHealth School of Public Health, and UTHealth School of Dentistry participated in the exercise, which was broken into two parts.

Rotating in groups of 20, the students addressed a mass casualty event in the courtyard, then went into a hospital simulation where the patients from the shooting were brought into an already busy emergency room.

There, actors came into the emergency room, and students assessed the severity of their injuries and prioritized the limited number of hospital beds available. The injured sometimes cried for missing family members instead of answering medical questions, like what kind of medications the patient was taking.

Organizers said the scenarios are intended to foster collaboration among students learning different medical disciplines.

“The goal is for students to triage the patients based on acuity, treat them to the best of their ability with limited resources, and decide who needs to be transported to the hospital and in what order,” said Kevin Schulz, MD, clinical assistant professor of emergency medicine and program director for the EMS fellowship at McGovern Medical School. “The focus is less on the medicine and more on the interprofessional collaboration. We are using the medicine as a compelling scenario so that the students are engaged, but the point is how they work together.”

Third-year medical students Angela Sheng and Katherine Yu said they learned about themselves during the exercise.  

“As a medical student, you often feel like you don’t know much, but I was surprised to know I did know what to do,” Sheng said. “We haven’t been in the hospital yet, working with patients. We have the theoretical knowledge, but not the hands-on experience.”

The pair said it was also good to learn from their peers.

“It was nice having it interdisciplinary,” Yu said. “There were different skills that we brought based on the level of our training. Some people were stronger in certain areas, but you could lean on other people’s experience. I didn’t know how to talk with people, if the patient was anxious or stressed. Others knew what words to say, and I felt like I could learn from them.”

Jennifer Swails, MD, assistant professor in the Department of Internal Medicine at McGovern Medical School, said the scenarios were designed by an interprofessional team of faculty using grant funds from the University of Texas System. The exercises are now fully integrated into the curriculum. Swails is also the co-director of the Center for Interprofessional Collaboration.

Many universities hold mass shooter-type exercises, but since UTHealth has a unique student population, it takes a more personal approach to use the event as a training tool. Faculty facilitators watch each small group of students go through the exercises and give them a debriefing after, citing what was done well, and ways to improve responses.

There are also emotional complications written into the scenarios. For example, in the emergency room scenario, students address how to tell the family of a stabilized patient that their loved one needs to be moved to make room, and they had to break the news that a loved one died to an already distraught patient.

“I hope that most students will never be involved in a mass casualty event, but if they are, we need to make sure they are prepared,” Swails said. “As health care providers, they should have the training to be able to help quickly. It could be a mass shooting, a fire, or a flood. They need to understand how to take care of patients compassionately despite limited resources, and how to communicate with colleagues when tension levels are high.”

Swails thanked the large team of faculty and staff for their time, involvement, and dedication to making the scenarios feel real.

“The students seem to enjoy it,” she said. “They enjoy spending time together, and it increases their confidence. As they see these horrible events in the news, it’s important they know their role and how they can support their community in the event of a disaster.”