There is no such thing as a “typical” CERT class – but some classes are more atypical than others. The usual CERT program encompasses a wide range of demographics. It can include a variety of ages from 18 to 70-plus, an assortment of occupations from students to housewives to clergy and top level managers, and a wide range of physical abilities and disabilities. There are many individual reasons for wanting to learn about CERT, but everyone shares a common trait – they are voluntarily giving their free time to learn how to take care of themselves and other community members in the event an emergency overwhelms the first responders.
Teaching CERT to a group of Denver School of Nursing (DSN) students breaks new ground, however. DSN is an acclaimed private school of nursing advertising small class sizes and one-on-one teaching. In late 2011 the administration decided to add a mandatory disaster drill program to the leadership training curriculum and asked O.M.E.G.A. to teach CERT classes for the school’s students. The first class was held in early spring and a second one was offered in late spring. Class participants would be sixth semester students nearing the end of their nursing education and needed the CERT course credit to graduate. This presented a challenge to the CERT teaching staff – how should the students be held accountable for their program performance? How should the instructors teach a classroom of students who don’t necessarily want to be there? In a “standard” CERT environment, the participants voluntarily attend class and generally have high individual expectations for learning, and give their best effort in the classroom and practical exercise. With the DSN program, sitting through class and showing up at the exercise would earn the needed credits. Could the standard program successfully fit their needs?
Class room experience:
Early Spring Session:
The early spring program was an abbreviated course taught on two consecutive Saturdays in February, with the practical exercise taking place on Sunday, February 19. Student behavior during class room presentations confirmed fears of the teaching staff – minimal interest at best, and complete disinterest at worse. Observing the class from the back of the room found that many students surfed the web, completed homework for other subjects, texted on cell phones, or just slept. It appeared that the students wanted to be anywhere but in classroom! The lone exception was the unit on triage.
The CERT program contains two units on disaster medical and the typical instructor would think that nursing students should know as much as, or more than, the CERT curriculum. However, this class of students indicated a strong interest in field triage, as opposed to clinical or hospital triage. When told that emergency triage should take no more than two minutes, and could be done in as little as thirty seconds, they acted surprised. They realized that functioning in a disaster emergency without the benefit of a majority of supplies and equipment found in a hospital environment was completely outside their regular studies. Upon completion of class time, the students were anxious to begin the practical exercise.
Late Spring Session:
The late spring program was taught over a period of eight weeks with the practical exercise taking place on May 19. Although mandatory class attendance was again declared by DSN administration, a scheduling conflict with other required courses resulted in many of the students missing one or more units. Only six of the thirty-one students enrolled for the course attended every class. And, as previously mentioned, the spotty attendance was compounded by the lack of student accountability for learning the course material.
The lack of attendance created a dilemma for the program instructors as they attempted to comply with program regulations. The Department of Homeland Security, administrators of the national CERT program acting through the Citizens Corps, requires participants to have twenty-four hours of classroom instruction and a practical exercise. In addition, every slide of each PowerPoint presentation, one for each unit, must be viewed by all participants. These rules ensure that course material has been taught per program guidelines, limiting liability to instructors. To verify that participants read the course material, it was decided to review and test all participants who missed any class time. Ultimately, test scores confirmed the students understood the material well enough to pass with excellent scores. Once again, they looked forward to the practical exercise.
Early Spring Class-2012:
The O.M.E.G.A. training staff was skeptical of student’s performance for the upcoming practical as they generally appeared disinterested in the classroom. To the contrary, however, the practical went very well – almost too well!
Exact numbers of role players and CERT student-responders are not available, but there appeared to be at least a 2-to-1 ratio of role players to responders. For lack of a better venue, the DSN building was chosen for the exercise site. The exercise planners noted that the building has an unusual floor plan, utilizing an isolated mezzanine layout and incorporating a mock-up of a hospital ward, and believed that the responders would struggle with the search-and-rescue aspects of the exercise. However, the student-responders pulled a surprise on the own.
Although they appeared to be lackadaisical in their approach to classroom learning, they had met the night before the exercise to develop a general plan for who would assume duties of division chiefs. Creation of their Incident Command structure was aided by a student volunteering to be the Incident Commander. The remainder of the command staff was in place and ready to proceed. A critical factor working in student-responders favor was an intimate knowledge of the building, including the building’s unique floor plan and the location of unusual nooks and crannies. Rather than struggling with the building search, they excelled at finding the quickest routes and knew where to look for hidden victims. The superior performance of the search and rescue portion was balanced by near chaos in the medical area as the number of victims quickly overwhelmed the medical staff. Overall, their performance matched that of most graduating CERT classes – rough around the edges but basically well done.
With the student-responders knowledge of the building, and their planning the night before, the practical finished in less than two hours. Although the usual difficulties associated with practical exercises were encountered – not separating Incident Command from Operations and Medical, lack of properly identifying search areas and results, lack of communication and documentation in all areas – they located and extricated all victims. Due to the rapid conclusion of the first drill, the instructors decided to run another simulation but with a twist to challenge the student-responders. For the second drill, the two stairways onto the mezzanine were blocked off and screaming victims placed in full view. The blocked stairways were the only means of access to the mezzanine forcing the responders to devise alternative plans. Coming off a successful first drill and believing they could handle any situation, the student-responders were motivated to help the victims but were prevented by the blocked stairways. Within a fairly short time, however, they arrived at an “outside-the-box” solution using a construction ladder located at the back of the building and fabricating an escape route for the victims. Once again, all the victims were rescued.
Late Spring Class-2012:
Based on experience with the practical for the early spring program, the O.M.E.G.A. staff knew a change was needed for the late spring practical. Ideally, relocating the drill to another site would remove the student’s advantage of familiarity with the building. However, numerous attempts to find an off-site location for the drill were unsuccessful. The DSN location would have to be used again, but fictional hazards would be placed throughout the building to counteract the student’s knowledge of the floor plan. The hazards included flooded areas, small and large fires, live electrical wires, downed electrical wires that were not arcing, a bad smell to simulate gas leaks, and a leaking propane tank. In addition, the mezzanine stairways were partially blocked, the main stairways connecting all floors were also partially blocked to prevent unimpeded passage from basement to rooftop, and all electricity was ruled out of service. The result was a much more difficult structure in which to search!
Although fewer role players were used for this drill, a nearly 2-to-1 ratio of role player to responder was maintained. Total participant numbers for this drill were:
Role players – 56
CERT Responders – 31
OMEGA Staff – 6
Support Staff – 1
DSN Staff – 3
Total – 97
The large number of participants gave a realistic feel to the drill. Several role players were positioned in isolated areas, while others roamed the building looking for companions. In addition, a handful of media reporters were simulated by role players and were instructed to pester the student-responders at every opportunity. In addition, this drill utilized stuffed animals to simulate household pets. Three stuffed dogs and two stuffed cats were placed throughout the exercise site and were tagged with various scenarios for student-responders to consider.
Once the exercise began, it was apparent that this group of students did not communicate with each other as well as those in the early spring exercise. This group was not nearly as organized and did not work together as well. The Incident Commander was selected by O.M.E.G.A. staff and performed a credible job, although she had difficulty communicating with others and didn’t exhibit superior leadership skills.
Search of the building was noticeably more difficult in this drill. The student-responders struggled at first with victim rescue due to blocked stairwells and strategically placed hazards. Eventually, however, they came together and performed well. In one case, a victim staged behind hazard boundaries was rescued by voice triage. By working together, a group of student-responders convinced her to crawl to a location where straps from a backpack could be used to pull the victim to safety – an excellent example of team work and thinking outside-the-box.
In appraising both practical exercises, the DSN students’ performance generally mirrored those of standard CERT classes. Most fundamentals learned in the classroom are ignored when the pace of the exercise increases, but are usually recalled as the drill progresses. As with most practical exercises, communication between responders was spotty, but improved over time. Some aspects of CERT training, such as marking doorways to indicate search results, are seldom utilized and may require increased training to imprint. Although the DSN students are training professionally in a field of medicine, they were unprepared for the rudimentary level of medicine in a disaster drill. The CERT course demonstrates that disasters and emergencies can occur anytime and anyplace, outside the reach of modern medicine, and responders must be self-reliant to be most effective.
Training staff techniques require modification for future DSN programs or for any program where attendance is mandatory. Classroom planning should include greater engagement of the participants in either discussion groups or small group exercises. In addition, satisfactorily passing the program test should also be required.