Playing games

Playing games

Before any cruise liner sets sail from port with a new compliment of passengers it is the duty of the ship’s company to perform a passenger evacuation drill.  Just like airline personnel pointing out the nearest exits and showing you how to buckle up your seatbelt, the crew teach you how to put on your life jacket and where to muster in the event of an emergency.  This system is far from perfect, as  can be seen in the recent tragedy onboard the Costa Concordia, but the drills are not just for the passengers.

In an emergency every member of the ship’s crew has a role to play, whether that is keeping passengers calm, lowering the life rafts, manning the fire hoses or running the medical centre.  Each and every week different scenarios are played out aboard the various ships of the fleet looking for systems errors, flaws that may turn out to be fatal in the event of a real disaster.  Tank entry drills are performed to ensure engineering crew know how to use breathing apparatus and harnesses – the medical team on standby in case an unfortunate crewman gets overcome by toxic fumes.  Fire fighting drills are performed below decks in the engine rooms, as well as above decks in empty cabins, with artificial smoke providing much-needed realism. And ‘man overboard’ drills are performed to make sure the crew can deploy the fast response boat in a timely manner.

When it comes to drills, ships are inspected by their flag state as well as the local maritime authorities such as the US Coast Guard, and UK Port Authority, to make sure they meet stringent safety standards.  These inspections are often much more challenging than the ones we would put ourselves through.  In the first I had to relocate the medical centre to a secondary location with five casualties and the elevators out of action.  I ran up (and down) 87 flights of stairs that day, with patients and equipment.  After that we had a serious rethink as to where the secondary medical centre should be located and what should be kept there.

We also took place in table-top exercises with fleet operations in the US testing their response to onboard disasters – fires, terrorism and running aground.   We took place in war-games speeding through the Gulf of Aden, ever vigilant for the threat of pirates.  And we took place in high stakes games of hide-an-seek where fake bombs were planted around the ship and we had to find them (top tip – no mobile phones or radios) before time ran out and they sent a plume of smoke in the air.

In the fifteen (plus) years I have been a doctor I have taken part in exactly two mass casualty drills.  One, in the UK was an exercise in logistics and handing out tabards and action cards.  The other, in Australia, was a well run Emergo Train exercise, that felt like a pen-and-paper role-playing game at first until life was breathed into it.  Many of us hope that someone else will tell us what we need to do.  In my last post it took five minutes to pull the bomb threat checklist off the hospital intranet. This is not about the medicine or how to triage or sort and sieve  How many of us know our role in the event of overwhelming casualties?  How many of us know what we are supposed to do if we have to evacuate ICU with our ventilated patients?  How many of us know what to do if a bomb threat is phoned through?

Perhaps it’s time we played a few more games?

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