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Planning for Disaster

Penn’s Nursing in the Community course prepares learners to handle large-scale medical emergencies through simulation.

Even though I know my little brother is going to die, when I’m told the nurses can’t hear his breath sounds anymore, my throat closes in panic, and hot tears collect on my face. I scream for my mother as I watch them tie a “deceased” triage tag on his leg. 

These thoughts might comprise an actor’s inner monologue during a simulated disaster here at Penn Nursing. Each semester, NURS-380, Nursing in the Community, culminates in a staged catastrophe. This fake scenario trains students in using scene safety assessment, delegation, and self-awareness to ensure patient protection during an emergency. A full-blown theatrical production, complete with actors, costumes, makeup, lighting, and even smoke machines, the entire Helene Fuld Pavilion collaborates to create a true-to-life mass casualty event.  

About a week before the event, the simulation operations team of the Pavilion begins physical preparations, dressing manikins in burned and tattered clothing, collecting debris to be strewn about the center, counting makeup inventory, and stocking up on fake blood. 

And then it’s showtime. The morning of the disaster, volunteer actors begin filing through the doors of Claire Fagin Hall as early as 6 a.m. Disaster participants munch on bagels and sip coffee as makeup artists fill wounds on their heads, knees, and arms with dark, oozing blood. Manikins are switched on and critical vitals programmed. After comparing notes with their costars for the day, actors take their places. Lights go out, smoke billows throughout the simulation center, and students are rushed into rooms to triage victims. 

After the drama subsides, students debrief on multiple levels. These discussions augment a prebrief they received of the scenario, including steps to take if they find the material triggering. Each scene debrief includes approximately twelve students and is facilitated by a simulation instructor trained in managing difficult conversations. Participants provide plus/delta feedback, addressing acute emotional reactions and reflecting on team performance.

These discussions move from small-scene reflection to a large debriefing session that includes all eight scenes of the disaster. Students are encouraged to identify themes for the following objectives: identification of a team leader, communication skills, triaging and prioritization, assessment, resource allocation, and ability to deliver bad news to individuals and families in a manner that is informative and emotionally therapeutic.

Danielle Mouradjian, a simulation instructor in various undergraduate clinical courses at Penn Nursing, has participated in many disasters throughout her career at the school. Having taken on multiple acting roles, she would recommend the experience to everyone. “I learn something new each time I participate in the simulation. Identifying team leaders and recognizing roles in emergencies provide nursing students valuable tools that they will need throughout their nursing careers.” 

In unprecedented times of uncertain global health and stability, it is more important than ever to train the next generation of healthcare professionals in disaster management. Here at the Helene Fuld Pavilion, we take pride in confronting our students with true-to-life challenges in a controlled environment. Our future safety is secured in today’s simulation. 

If you would like to participate in our upcoming fall disaster simulation, email Annie Hoyt-Brennan, Director of the Helene Fuld Pavilion, at