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CORONAVIRUS (COVID-19) RESOURCE CENTER Read More

Mass Casualty Exercise

State: FL Type: Promising Practice Year: 2019

  • Brief description of LHD- location, demographics of population served in your community.                                  Our Health Department is located in Milton, Florida (Santa Rosa County) a predominantly rural county with an estimated population of 174,272, a median age of 39.5 and a poverty rate of 12.3%.  The population of Santa Rosa County is approximately 83.1% White, 5.62% Black and 5.11% Hispanic. An estimated 5.83% of the population primarily speak a language other than English.
  • Describe public health issue.                                                                                                                                    In 2017, the Federal Bureau of Investigation (FBI) reported the most active shooter incidents, and the highest number of people killed in active shooter incidents, since 2000. Florida had more than five incidents in 2017, making Florida, California and Texas the states with the most incidents in 2017 (Active Shooter Incidents in the United States in 2016 and 2017, FBI, April 2018).
  • Goals and objectives of the proposed practice.                                                                                            Exercise Design Objectives

    Exercise design objectives focus on improving understanding of a response concept, identifying opportunities or problems, and achieving a change in attitude. This exercise will focus on the following design objectives selected by the Exercise Planning Team:


  1. Demonstrate the proper technique for conducting a primary assessment on a mass casualty patient.
  2. Demonstrate techniques to establish a level of responsiveness from a patient.
  3. Demonstrate the ability to recognize life threatening bleeding.
  4. Demonstrate the proper technique for stopping life threatening bleeding using a tourniquet.
  5. Demonstrate the ability to apply a pressure dressing to stop bleeding.
  6. Demonstrate the ability to open a patient's airway.
  7. Demonstrate the ability to check for breathing.
  8. Demonstrate the ability to apply an occlusive dressing for a chest wound.
  9. Demonstrate the ability to conduct a secondary head-to-toe assessment on a patient.
  10. Demonstrate an ability to recognize and treat a patient showing signs of shock.
  11. Demonstrate the ability to prioritize patients with immediate life threats.
  12. Demonstrate the ability to sort patients by the categories of: immediate, delayed, walking wounded, and deceased.
  • How was the practice implemented/activities.                                                                                                       This practice was implemented and executed using a Mass Casualty Exercise for LHD staff (medical and non-medical) and MRC Volunteers conducted on November 9th, 2018.
  • Results/Outcomes (list process milestones and intended/actual outcomes and impacts.                                     The Mass Casualty Exercise is intended to educate LHD staff and MRC Volunteers to perform mass casualty first aid in the event of a mass casualty event in order to assist in saving lives while waiting for medical first responders to arrive.
  • Were all of the objectives met?                                                                                                                               All the objectives were met, albeit with some challenges.  With continued practice and training, it is the goal to have LHD staff and MRC Volunteers  improve their first aid skills, ideally to the point of becoming second nature.
  • Were all of the objectives met?                                                                                                                               All the objectives were met, albeit with some challenges.  With continued practice and training, it is the goal to have LHD staff and MRC Volunteers  improve their first aid skills, ideally to the point of becoming second nature. 
  • What specific factors led to the success of this practice?                                                                                         A mass casualty training course was conducted with DOH-Staff and MRC Volunteers, two (2) months prior to the Mass Casualty Exercise event this was reinforced with intermittent several email blasts over the following two months containing key points of the training for reinforcement purposes prior to the Mass Casualty Exercise event.  Additionally, we had superior instructors whose combined expertise had extensive EMT, Search and Rescue, Armed Forces Medic & Corpsman experience for both the Mass Casualty training and the actual Mass Casualty exercise, along with valuable input from the local Santa Rosa County Emergency Management personnel, and LifeGuard Ambulance Emergency Medical Services (EMS) personnel during the exercise.
  • Public Health impact of practice.                                                                                                                              In a possible future mass casualty event, the Mass Casualty Exercise and subsequent training is intended to educate LHD staff and MRC Volunteers to perform mass casualty first aid in the event of a mass casualty event in a public setting (not just at the LHD) in order to assist in saving lives while waiting for medically trained first responders to arrive.
  • Website for your program, or LHD.  http://santarosa.floridahealth.gov/



The current estimated population of Santa Rosa County in the State of Florida is 174,272. (US Census July 1, 2017).

There are numerous large and small businesses, consisting of retail, commercial, industrial, and government operations (according to 2016 US Census figures, there are 2,622 total employer establishments, and 11,745 total non-employer establishments) including 76 churches and 39 public schools.  Every one of these places have the potential to become a target of an active shooter/assailant incident.  There are also many large outdoor and indoor events, such as concerts, festivals, parades, and many other types of public gatherings.

To the best of our knowledge, our LHD is one of the first health departments in the State of Florida to engage and focus solely on mass casualty training and subsequent mass casualty exercise for our LHD staff and MRC Volunteers.

In the future, we plan to incorporate mass casualty training and exercises into our active shooter/assailant exercises.

The LHD in collaboration with Santa Rosa County Emergency Management, Santa Rosa County School District, and a local training coordinator developed the Mass Casualty Training and Mass Casualty Training Exercise, with input and evaluation from LifeGuard Ambulance Emergency Management Services (EMS) for Santa Rosa County, and Santa Rosa County School District. We also had participation in the exercise from the LHDs in neighboring Okaloosa and Escambia Counties.

The exercise follows the standards as prescribed by Homeland Security Exercise & Evaluation Program (HSEEP).  

Planning for the mass casualty training and exercise began in July 2018 with a mass casualty training session for LHD staff and MRC Volunteers on September 7, which was followed up the Mass Casualty Exercise on November 9th to practice what was learned in the training class.

The LHD Exercise Planning Team constructed design objectives that focus on improving and understanding the skills and components that can be used in a mass casualty event/incident by non-medical personnel to assist in saving lives, before skilled medical responders arrive at the scene.

Exercise Design Objectives

  1. Demonstrate the proper technique for conducting a primary assessment on a mass casualty patient.
  2. Demonstrate techniques to establish a level of responsiveness from a patient.
  3. Demonstrate the ability to recognize life threatening bleeding.
  4. Demonstrate the proper technique for stopping life threatening bleeding using a tourniquet.
  5. Demonstrate the ability to apply a pressure dressing to stop bleeding.
  6. Demonstrate the ability to open a patient's airway.
  7. Demonstrate the ability to check for breathing.
  8. Demonstrate the ability to apply an occlusive dressing for a chest wound.
  9. Demonstrate the ability to conduct a secondary head-to-toe assessment on a patient.
  10. Demonstrate an ability to recognize and treat a patient showing signs of shock.
  11. Demonstrate the ability to prioritize patients with immediate life threats.
  12. Demonstrate the ability to sort patients by the categories of: immediate, delayed, walking wounded, and deceased.

These are the objectives that are tested in the Mass Casualty exercise. For the most part, all of these objectives are met, albeit with challenges.  After the exercise, every participant is asked to complete a hotwash/evaluation document which asks for three things that went well during the exercise and three things that needed improvement during the exercise.  Additionally, an after action hotwash session was conducted with the exercise participants.  The results of that session along with the results from the hotwash/evaluation documents are integrated into the After Action Report Improvement Plan (AAR/IP) as prescribed by HSEEP.  Items needing improvement are assigned to the appropriate accountable person(s) and are addressed for mitigation/remediation in the next planning session for the next Mass Casualty Exercise.  Several things that were mentioned in this exercise were increasing training and review opportunities which will be offered in the coming year to LHD staff and MRC Volunteers, leading to increased confidence in implementing the first aid techniques in subsequent exercises and real-live events.

As described in detail in the previous module, sustainability is achieved through the aggressive and consistent use of our action reports and improvement plans as prescribed by HSEEP.  We find this to be a valuable tool for the continual improvement and sustainability of this exercise.  Active shooter/assailant and other mass casualty incidents will always be a public health concern and as a LHD it is our commitment, duty, and priority to proactively and continualy educate our LHD staff and MRC Volunteers and hopefully mitigate the effects of these events/incidents through the continued use of this annual exercise and trainings.

All of the stakeholders (as identified in the previous modules) are always eager to be actively engaged and participate in one way or another in this annual viable LHD event/exercise.

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