Disaster Simulation Prepares Yale Nursing Students for Chaos

During the mass-casualty simulation, a runaway golf cart careened into a gas grill at a community cookout, prompting an explosion.
September 30, 2022

The Yale School of Nursing (YSN) Simulation Team spends every semester tailoring “sim” exercises to specific clinical and academic needs. The annual mass-casualty disaster simulation for Graduate Entry Prespecialty in Nursing (GEPN) students serves as a cumulative assessment of everything they have learned during their first year.

Simulation Lecturer in Nursing Linda Ghampson, MSN, RN, CHSE, stressed the importance of empowering every student to feel confident in a disaster scenario, even when they may have no expectation of encountering a similar situation during their post-graduate careers.

“GEPN is a generalist year, and we introduce students to every aspect of what they’ll encounter in nursing,” Ghampson said. “Disaster simulations are very fluid, and our goal is to give students the tools to navigate a situation like this. In our debriefings after each group is finished, we’re talking through the thought process behind the decisions they made of who to save and who could not be saved.”

Simulation Lab Technician Gustavo Carrillo said GEPNs don’t know what to expect because the scenario changes every year, but they might know that previous classes encountered a building collapse and a tornado-ravaged supermarket. The 2022 scenario took place at a crowded community tag sale and cookout. A golf cart careened out of control, driving through a propane gas grill and causing an explosion, injuring nearly two dozen bystanders.

YSN partnered with Yale University Police, Yale New Haven Hospital EMS, and Nelson Ambulance to make the simulation as realistic as possible. The hybrid model utilized staff volunteers role playing specific characteristics and manikins with various capabilities. 

“When the students hear the sirens and see the motorcycle officers and the ambulance, it adds to the realism,” said Carrillo, who provides on-site tech and filming expertise. “If we ran a smaller sim without all these elements, it’s harder to imagine the full scenario. This is intense!”

Students are divided into teams for assessment and staging, and victims are color coded from green (okay), to yellow (monitor closely), and red (critical). Deceased victims receive black tags.

Nurse Midwifery and Women’s Health Nurse Practitioner (NP) student Taylor Evans ’24 MSN served on the staging team, assigned to watch survivors with green tags, assessing vital signs and noncritical wounds, and trying to reassure and comfort panicked people.

“The nature of the sim is that you don’t really get a chance to think about all that while it’s happening,” Evans said. “I think what I struggled with most was thinking that I should be doing more. I watched several of my colleagues pick up some victims and carry them to waiting emergency services or apply tourniquets to bleeding wounds. Meanwhile, I was just trying to keep my group calm. However, it occurred to me that I was doing exactly enough at that moment, because by keeping my group calm and with me, I was preventing them from wandering back into the scene and possibly getting even more injured or causing even more confusion in an already chaotic scene.”

Pediatric NP Primary Care nursing student Wing Hung Yuen ’24 MSN is a licensed EMT who has previous large-scale simulation experience and especially appreciated debriefing with Yale Police Officers and local emergency services after the exercise. 

“These scenarios are great for everyone, especially for those who have never experienced one of these scenarios before, it’s a lot to take in and react to,” Yuen said. “You can’t teach these in a classroom and learning in the field is the best way to learn. I am pretty sure a lot of my friends will remember this sim and all the adrenaline they felt when it started and all the way through.”

Staff Volunteers

The annual exercise also presents a great opportunity for YSN staff to engage with students and faculty in a unique way.

“I learned a lot just from sitting and watching the students team up to figure out who had each role in the disaster areas,” said Maggie Kelly, Senior Administrative Assistant for the Clinical Support Unit. “My favorite part was talking about everything after with the students and watching them explain why they did each thing and how it felt so real to them. I would definitely do it next year!”

Julia Pafford, Program Coordinator for Development and Alumni Affairs, also appreciated the chance to observe up close. “It was wonderful to see our students in action. I was impressed by how they were able to project calm, be present, and listen to patients with compassion in the middle of a chaotic situation.”

Experienced volunteer Catie Wagner, Senior Administrative Assistant in the Business Office, played the role of an older adult who didn’t have serious injuries but had some scrapes and was disoriented. 

“My favorite part of volunteering for the disaster sim is being able to work so closely with the sim team, other co-workers, and students,” Wagner said. “This was my fourth year volunteering, and I will continue to help out as long as the sim teams wants me to.”

Watch the Sim

Please note: video of the mass-casualty disaster simulation shows an academic assessment in which all participants exhibit cosmetically applied injuries. The volunteers are acting out their roles as victims, and while no one was harmed during the exercise, the images may be disturbing to some viewers. Video content contains fake blood, simulated burn injuries, and special effects makeup to resemble wounds from flying debris.

Visit the YSN YouTube Channel for an in-depth look at the 2022 mass-casualty disaster simulation.