The sun was just setting beyond the swinging double doors of South Nassau Communities Hospital’s Emergency Department when a voice crackled over the radio: A mass shooting had been reported at a Long Beach movie theater, and the hospital was being activated for Code Triage Level Two — a designation reserved for nearby mass-casualty incidences. The emergency room staff braced itself.
Elsewhere, there was a train derailment in West Islip, a bus explosion in Mineola and a ferry crash near Port Jefferson. It appeared that the Island was under siege. But that was the point, because amid the nurses and doctors rushing through the hallways were volunteers with signs that read, “This is a drill.” And all the wounds they were about to see were fake, as were the names of the wounded.
“We need to test and stress the system to find where the weak spots are,” Dr. Joshua Kugler, the Emergency Department chairman, said of the exercise, which was happening concurrently at hospitals Island-wide.
Minutes after the activation code went out, a pickup truck rushed up to the entrance, its driver beeping the horn. “We need stretchers and wheelchairs,” a nurse shouted, and within seconds at least half a dozen were rushed down the hallway and out the doors.
Outside, a group of nurses hoisted a middle-aged woman — who doctors said appeared to have suffered a gunshot wound to the foot — out of the truck and onto a stretcher. She was playing a young boy, and cried out for his (her) grandfather. The injury was non-life threatening, so the nurses moved her inside, her shrieks growing distant until her voice could be heard shouting meekly, “Where are you taking me!?”
For the personnel on call, Kugler said, the drill was a lesson in the split-second, life-or-death decisions they must make when dealing with many injured patients. “If someone doesn’t have an airway, they may leave them to die,” Kugler said. “Because there are 15 other pa-tients you can save right now.”
Soon a minibus arrived and with it, more patients, many with gunshot wounds to the legs, chest, abdomen and for one 21-year-old “man,” the head.
Inside, the scene was chaotic as trauma staff members quickly assessed their patients’ injuries. “Where’s the blood?” one nurse shouted as her patient bled from a neck wound. “We need two units here!”
When another staff member announced that they were running low, Trauma Coordinator Margaret Puya advised that they call the blood bank for an additional supply. More injured arrived, and Puya phoned the hospital command center, “I need more nurses,” she said. “They just keep coming.”
Puya explained that SNCH holds a similar exercise annually. Last year was an Ebola outbreak, but this year, she said, “We wanted to do a really big drill.”
“We need another two units!” the nurse yelled as the bleeding continued.
“All right, we can’t assess down here,” critical care surgeon Dr. Paul Grewal told her. “Prep the OR for a neck exploration.”
Grewal stood among the staff, barking commands and asking for updates on each patient. He noticed one surgeon and a patient chatting briefly. “Why is she not intubated?” he grilled the surgeon, referring to the process of inserting a tube down a patient’s throat to clear the airway.
“I already did!” the surgeon shot back.
“Then why is she talking?” Grewal said, and the two shared a smile.
But the spell was broken only for a moment. “We’re going to lose a patient if we don’t get them to the OR,” Grewal shouted, resuming the scenario.
Nearby, the hospital’s communication staff was standing, typing on their phones and responding to a report that reporters had arrived at the hospital. The drill attempted to simulate all aspects of such an event, down to contending with the press and distraught family members. “There’s a lot of moving pieces in an incident like this,” explained Joe Calderone, South Nassau’s senior vice president of communications. For his team, the drill involved quickly fielding phone calls, texts and emails.
As the exercise wound down, more and more patients were moved to the operating room. Those who had “died” wandered the hallways.
The 21-year-old man shot in the head, played by recently retired nurse Christine Parks, could be seen leaving the Emergency Department. Parks confirmed that she hadn’t made it. Doctors declared the man she had played, “Tony Garcia,” dead shortly after arrival.