Every year we participate in the community-wide exercise drills. We plan in advance who will work real-world patient care and who will be in charge for the exercise. I typically take on a supervisory role for the drill, helping with unusual requests and communicating with incident command. I also stay at the 30,000-foot level to look for safety issues. We want staff to gain experience in the charge nurse role, decontamination lead and moving patients through the system. The leadership team attends the debriefing, and I obtain information from the staff for the after-action report. The goal is to improve each time. 

Because we are a Level One Trauma Center, mass casualty incidents (MCI) are very real in our department. Frequently we receive alert messages regarding multiple-vehicle car crashes or industrial accidents. These test us even more than the annual drill. When we get multiple trauma patients at once or we receive mass casualty alerts, we start planning immediately. Generally, we anticipate receiving about half the number of patients that the alert predicts. We first focus on moving admitted patients upstairs and discharging patients who are ready to go home. This event, however, was definitely different.