Scenes from a fake emergency

School of Nursing students learn by doing in a disaster simulation, complete with blood, chaos, and interfering bystanders.

Cathy Shufro teaches writing at Yale.

To our readers:
We had planned to publish this feature article a year ago. But then came the pandemic, and we felt that a time of sudden anxiety and changes wasn’t the right time for blood and wounds—even imitation blood and wounds. Now that the COVID vaccine is being administered to more people more quickly, we’re finally publishing this article about how nurses learn their discipline.

And while we’re on the subject: we are dedicating this article to every nurse who has cared for a COVID patient. Thank you for the care you’ve given to people in need.—The Editors

Forty-eight hours ago, School of Nursing lecturer Shannon Pranger was in this building on Yale’s West Campus, laying out tubes of fake blood, wigs, and make-up to transform a dozen volunteers into victims. They would look injured—or in one case, dead—in the simulated disaster shown here: a coffee-shop ceiling that collapsed on customers. Their rescuers would be students at the School of Nursing.

One victim would stand out, Pranger had said: a man with a metal pole embedded in his thigh. An impalement will remain stable if no one tampers with it. She hoped the students would stabilize and evacuate the worse-off victims before the man with the pole. “He has a big, exciting wound,” said Pranger. “But is he a priority? He’s a distraction.”

A sucking chest wound is another matter, she’d said, holding up a hand-sized patch of artificial skin, painted with fake blood to indicate a punctured lung. A volunteer wearing ghostly pale foundation would tape the wound on her ribcage and wear a tag around her neck reading “cap refill > 2 , R 0.” That would inform the students that her circulation, or capillary refill, was so impaired by her injury that she is close to death. Her R, or respiration, would be zero—but, confusingly, she would gasp for breath occasionally. Would the students recognize that immediate treatment could save her life? In a classroom, they surely would. But in a scene of chaos? “There will be blood everywhere,” Pranger said, cheerily.

The focus of the exercise will be good communication, she added. The students, who have all finished the first year in their three-year master’s program, must work in teams to figure out how to swiftly and safely move injured customers out of the ruined café and into the hands of emergency medical services (EMS).

Pranger, who left Yale for Sacred Heart University last summer, has helped oversee disaster simulations before, and she had a prediction: afterwards, at least one nursing student would say, “This is the first time I realized I can’t save everyone.” The student would probably be crying.

The comment period has expired.