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Over the course of a month, the 100-bed hospital in Anniston, Alabama, might overflow with victims of smallpox, mustard gas, dirty bomb explosions, chemical poisoning, mass shootings or natural disasters—all simulated and dropped into a routine hospital setting. As part of the Center for Domestic Preparedness, the Noble Training Facility (NTF) is the only fully operational hospital in the U.S. dedicated to preparing all disciplines of healthcare for mass casualty events caused by weapons of mass destruction and natural disasters.

Most of the clinicians who participate in mass casualty drills have depth of experience, but have not operated in the midst of a catastrophic disaster. The Noble Training Facility has an emergency room, medical and pediatric ICUs, a pediatric unit, three operating rooms, labor and delivery rooms, a nursery and a collection of patient simulators that includes 12 METImen, five adult HPS and four pediatric HPS simulators.

The scenarios are complex and challenging, intended to impact experienced clinicians on many levels. For example, a hospital might discover a chicken pox outbreak is actually smallpox. Participants may have to lock down or isolate the patients. The simulation team will add more distractions, such as a botulism scare, an abducted baby or drunk patients to break the stress level and simulate a normal day in an emergency room. In a mass casualty situation, people could be pulled from all aspects of the hospital setting. so often, a facility or region will send a team of physicians, nurses, EMTs and medics to run through a scenario together.