Planning for the Elizabeth City, N.C., mass casualty exercise began in December 2023 and included collaboration and coordination between multiple different agencies. Local, county and regional partners included Pasquotank-Camden Emergency Management; Elizabeth City Fire Department; Pasquotank County EMS; Elizabeth City Police Department; Pasquotank County Sheriff’s Office; Central Communications; Sentara Albemarle Medical Center; South Camden Volunteer Fire Department; Currituck County EMS; Gates County EMS; Perquimans County EMS; and Albemarle Transport Company. The exercise simulated a high-impact incident during a large public gathering.

The mass casualty exercise took place on Oct. 19, 2024, after an initial planning meeting and a series of meetings from the planning team. Initial planning helped to establish the exercise’s objectives, define the parameters of the scenario and identify the primary stakeholders. The planning team comprised a variety of representatives from emergency management, fire, EMS, law enforcement, city officials, county officials, communications and the hospital, which helped to guide the planning process using the Federal Emergency Management Agency Exercise and Evaluation Program framework.

“The team held a series of structured meetings, including the initial, midterm and final planning conferences, to coordinate logistics, develop the master scenario events list and confirm each agency’s roles and responsibilities,” Joshua Wyse, Pasquotank-Camden Emergency Management assistant coordinator, explained. “Input was solicited from participating agencies to ensure realism and relevance to local threats and capabilities. The scenario was designed to simulate a high-impact incident during a large public gathering, requiring rapid triage, transport and coordinated response from on-scene personnel through to hospital care.”

The planning team developed evaluation guides, safety plans, protocols for communication and instructions for the exercise’s role players. There were also volunteer actors, local agencies and colleges within the community who played important roles.

“The end result was a dynamic, full-scale exercise that not only tested operational readiness but also strengthened interagency relationships and real-time decision making under pressure,” Wyse commented.

When it came to planning, the team faced three primary challenges. The first was the necessity to close main roads, affecting residents, businesses and parking, for several hours. Emergency management ensured all businesses and residents were notified well in advance, and many even took part in the exercise. The second challenge was that the exercise was held while response and recovery efforts were underway for Hurricane Helene. Many, including Wyse, had been in western North Carolina helping with efforts and returned right before the exercise. The third challenge was volunteers dropping out at the last minute or no show on the day of the exercise. Unfortunately, that meant certain injuries, a mutual aid department response to an incident at the Sentara Albemarle Medical Center and a few other specific items could not be tested as planners had wanted.

Volunteers for the exercise included public safety agencies and community members. Social media was one of the greatest tools for finding the volunteers.

“Well in advance, I put out a call via our social media channels,” Wyse described. “Community members were able to sign up for specific slots as either a role player or patient actor along with time slots depending on specific roles. Several off-duty public safety personnel also signed up to participate. Mid-Atlantic Christian University’s men’s basketball team all played patient actors, and Elizabeth City State University CERT team provided volunteers for moulage.”

Overall, there were over 60 community members, 10 public safety agencies, Sentara Albemarle Medical Center and Towne South Church who participated.

One of the most important parts of the exercise was ensuring all roads were properly blocked off.

“Securing the exercise area was a top priority to ensure both public safety and the integrity of the exercise,” Wyse emphasized. “We coordinated closely with local law enforcement, city officials and public works to temporarily block off streets and establish a secure perimeter around the exercise site. Road closures, detour signage and traffic control points were all strategically implemented to minimize disruption and maintain emergency access routes. All participants were given either lanyards or wristbands so that security personnel knew they were a part of the exercise. I personally walked door to door notifying residents and businesses about the exercise, the road closures and invited them to participate. Road closure signs were placed on all light poles the week prior. Additionally, multiple press releases and social media messages were sent out to include working closely with the downtown business liaison.”

The goal of the exercise was to be as realistic as possible to demonstrate real scenarios and test first responders.

“The exercise scenario simulated a catastrophic vehicle attack during a crowded parade followed by a secondary incident involving structural damage and multiple injuries,” Wyse described. “Responders were tasked with immediate life-saving actions, scene stabilization, triage and treatment, coordinated patient transport and unified command operations. Throughout the event, agencies practiced interoperable communication, resource deployment and decision making under pressure. EMS teams honed their triage skills using realistic patient actors, while law enforcement and fire personnel coordinated scene security, extraction and hazard mitigation. Dispatchers managed simulated 911 call and text volume while hospital staff tested surge protocols and emergency department coordination. The scenario was designed to be as lifelike as possible, allowing each agency to validate plans, train personnel and identify areas for improvement all in a controlled, collaborative environment.”

The exercise’s goal was to train first responders to effectively manage complex incidents with multiple victims while also coordinating with various other agencies. It tested communication, collaboration and the ability to adapt under pressure, while also identifying a few areas for improvement.

“Full-scale exercises like this one allow agencies to test real-time decision making, communication protocols, resource deployment and interoperability in a high-pressure but controlled environment. They also reveal gaps in planning, highlight training needs and build confidence across agencies.”

Full-scale exercises are considered essential to ensure a department’s operational readiness. This mass casualty exercise was deemed a success, testing coordination between agencies from the initial response to final patient transport and strengthening the relationships between agencies.

Wyse said, “It reinforces relationships, identifies issues before a real crisis occurs and keeps response plans current and actionable. Each exercise is a learning opportunity, and the lessons from this one will directly inform how we plan the next — making our community even more prepared for whatever may come.”

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