I went to an MSF mass casualty simulation and this is what happened

12 April 2017

Smoke, blood and chaos: mass casualty simulations are used to train MSF field staff with the skills they’ll need in real emergencies. Here Andy blogs about joining the team for the day…
 
Never in my working life did I think I’d be asked to get slathered in fake blood, have my shirt ripped open, and run around screaming for the nearest doctor; but then again, I work for Médecins Sans Frontières/Doctor Without Borders (MSF).
 
I recently took part in one of MSF’s mass casualty simulations, held at the Espace Bruno Corbé (EBC), our organisation’s training and innovation centre in Brussels.
 
Being there was like being on the set of a war movie, complete with smoke machines, sirens, and a cast of (fake) blood-stained ‘patients’ sprawled out across the training field.
 

At EBC

At EBC. Photo: Andrew Headspeath.

 
The purpose of all this is to give  MSF field staff a taste of what’s to come – that is, to prepare them professionally and personally to deal with real-life medical emergencies.
 
For office staff such as myself, it serves to paint a picture of how MSF responds to those in need, giving us a more concrete sense of what our more adventurous colleagues get up to while we’re clicking away behind screens and getting excited about M&S meal deals. 
 
*Disclaimer: I promise no bloggers were harmed in the making of this post.
 

Welcome to the EBC

 
Picture a large industrial plot of land, barren apart from an impressive MSF compound: complete with Ebola tents, water pumps, a radio control room and land cruisers.
 
This is the EBC:  a little slice of life in the field, conveniently brought to life in Belgium.
 

An MSF land cruiser at EBC

An MSF land cruiser at EBC. Photo: Andrew Headspeath.

 
Upon arrival, we are given a tour of the compound, led by Martin – a logistician who’s been with MSF for decades. His long flowing hair was L’Oreal magnificent, and you could tell this man has used his handyman talents to build hospitals that have saved a few babies.
 
All MSF structures at the EBC are constructed by our staff onsite: from a massive hospital tent to a fully functioning water system supplying the entire compound. This served as a reminder of MSF’s independence and agility – our staff are able to bring their skills as engineers, carpenters and builders to magic up hospitals, complete with electricity, clean water and waste disposal systems using limited resources.
 

An MSF storage unit (formerly a shipping container)

An MSF storage unit (formerly a shipping container). Photo: Andrew Headspeath.

 
We arrive at Martin’s workshop, where he shows us a table.
 
“This is where I train logisticians to prepare all sorts of things we need in the field,” he says.
 

Martin showing us his workshop

Martin showing us his workshop. Photo: Andrew Headspeath.

 
He reaches under the table to unfasten something. To our surprise, the table is on wheels. He grins as he rocks it back and forth.
 
“It also doubles up as a hospital bed,” he says. “We can make pretty much anything we need.”
 
Soon the tour ends and we are told to go get our make-up done in the ebola tent. 
 

Make-up

 
To look the part of casualties, those of us volunteering that day were given a ‘makeover’.
 
To achieve these looks, professional make-up artists are hired and armed with a set of paints, fake blood and gruesome prosthetics.
 

Make-up artist at work

Make-up artist at work. Photo: Andrew Headspeath.

 
Each of us is given a lanyard with a laminated sheet, complete with a diagram and description of our injuries. They range from minor to severe; one colleague is told to go around demanding medical attention for a broken fingernail, while another has a prosthetic pole sticking out of his chest.
 
My lanyard states I’m one of the less severe cases: I’ve been concussed and sustained a broken wrist, with some visible cuts to my face and chest. The make-up artist dabs on a mixture of blacks and blues onto my wrist, then slathers on the fake blood (which was giving me serious Halloween flashbacks). To my chagrin, my shirt needs to be ripped open, and I cry a little on the inside as she goes to town with her scissors.
 

 
My colleague is told she is a ‘black’ case, meaning she’s ‘dead’ on the scene. She gets fitted with a very 80’s inspired wig, and a huge chunk of brain spilling out of the side of her head. (I’m told this wig is a new feature, as they used to stick fake brain onto people’s heads, which was near impossible to wash out).
 

My colleague and her new look

My colleague and her new look. Photo: Andrew Headspeath.

 
All made-up and ready to go, we congregate outside, at the scene of the emergency.
 

Pep talk

 
Roughly 30 volunteer patients are at the scene, an eclectic gathering of characters that form parts of this mass casualty simulation. Today the scenario is an explosion.
 
There are the wounded (who make up the majority); friends and loved ones of casualties (I had a ‘girlfriend’ who spent the entire simulation trying to barge into the medical tent to reach me); a pregnant woman; a group of drunk soldiers told to cause disruption; a news crew filming the incident; and a member of another aid organisation offering their help.
 
Each of these roles has their own needs and creates unique problems for the MSF field staff to handle. How to organise this chaos, and ultimately ensure that the wounded are taken to the right places, is the test they face.
 
Before we begin, a man in an MSF vest calls for our attention. Like a film director, he carries a megaphone and directs everyone to their starting positions.
 

Everyone gets ready to begin

Everyone gets ready to begin. Photo: Andrew Headspeath.

 
He tells us to ham it up. We’re there to emulate a real-life scenario, and the staff in training should be given the chance to deal with the stresses and challenges faced in the aftermath of such a tragedy.
 
Given license to go all out, the siren blares, green smoke fills the area, and the MSF doctors and nurses walk out in single file towards us.
 
The drama is about to begin.  
 

Mass Casualty Simulation

 
On cue, everyone is on form, playing their part with surprising energy and intensity.
 
One woman stumbles around, grabbing MSF staff by their sleeves and exclaiming she needs an operation. My ‘pregnant’ colleague screams at the top of her lungs, emanating an agony that makes me wince. One man lies on the ground, cradling his leg that is ‘bleeding’ profusely.
 
The staff immediately hone in on the most serious cases. They run to a man with a pipe sticking out of his abdomen, rushing him to the emergency tent round the corner.
 
My colleague with the brains lies ‘dead’ on the ground. Later she explains that when she opened her eyes for just a few seconds, a supervisor promptly reminded her that she was dead and to keep them closed.
 
I stumbled around, clutching at my wrist, giving my best ‘concussed performance’. I’ll admit I was trying to keep a straight face doing this while my colleague ran around making loud vomiting sounds.
 
Eventually I came across a doctor preoccupied with a clipboard.
 

MSF staff in action during the mass casualty simulation

MSF staff in action during the mass casualty simulation. Photo: Andrew Headspeath.

 
“I don’t know what’s happening,” I say, imagining this is what concussed people would say (I’m no method actor, so be kind). “What’s happening, what’s happening, my wrist hurts.”
 
She looks up, and speaks with concern and clarity.
 
“Everything will be okay,” she says. She picks up my lanyard, scanning the details of my diagnosis. “How do you feel?”
 
“I feel dizzy,” I reply. “My wrist hurts and I don’t know what’s happening.”
 
Amidst the shouting, sirens and commotion she places her hand on my shoulder, offering a moment of comfort in the confusion.
 
“See that tent over there?” she says, pointing to the triage area. “I need you to go inside there. Someone will help you, can you do that for me?”
 
And so I stumble my way inside the tent, narrowly bumping into people as this cast of volunteers and MSF staff engage in a tumultuous dance for control.
 

Triage

 
Suddenly, the noise outside is muffled by the tarpaulin walls of the triage tent.
 
‘Patients’ lie on the ground on plastic mats, while others sit on chairs lined along the back wall. A woman next to me holds a cloth to her bleeding head, muttering to herself “I need an operation,” over and over. Her commitment to realism is contrasted by a group of guys on the ground writhing, wailing and giggling like a bunch of schoolboys (it’s pretty funny).
 
Soon, a group of MSF staff enter the tent to assess who is in most urgent need of medical attention.
 
I watch as a good half-dozen of them lift a man on the ground onto a stretcher. This much manpower surprises me, and I grimace a little, half-expecting them to drop their ‘patient’. However, they successfully load him on, and with regimented choreography they lift him up, each of the handles gripped securely as he floats towards the medical tent.
 

 

All of a sudden, one of the drunken soldiers barges in. He makes a beeline straight for the staff with the stretcher, swaggering and swigging a bottle of beer while yelling profanities in French.
 
Like a pack of nightclub bouncers, MSF staff descend upon him, secure and move him outside as he swings his arms about – and then everyone breaks out in laughter and applause!
 

 

The staff are working together as a unit, switched onto the MSF protocol they have been trained to follow. Amidst all our fake tragedy and tomfoolery their sheer professionalism shines through, approaching us with the serious intent needed for a real field emergency.
 
Towards the end of the scenario, a doctor comes up to me and reaches for my lanyard. He tilts his head, looks me up and down and smiles.
 
“You’re in the right place,” he says. “Hold tight.”
 
The sirens blare. The MSF staff’s shoulders drop in relief. The mass casualty simulation is over.
 

Debrief

 
We stand over a plastic bucket of water, washing off the fake blood and dust.
 
Around us, the MSF staff are speaking with their supervisors, going over what went well and what they could have improved.
 
It was a privilege to be part of the simulation and meet such professional and compassionate people. Gaining an insight into MSF’s work in the field made me proud to be part of this organisation, full of individuals who wear their hearts on their sleeves.
 

The MSF flag

The MSF flag. Photo: Hannah Whitcombe

 
While it may have been a fun day out for me and my colleagues, this simulation holds dark truths – every injury, every situation is a reflection of what can happen in a real emergency, devastating tragedies which destroy communities and tear families apart.
 
What our staff do is nothing short of inspiring; and as part of the communications team, I’m proud to tell their stories.
 
 
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