A disgruntled patient and his supporters launched an attack against Madigan Healthcare System Dec. 6 in a mock scenario, setting off a homemade bomb near the emergency department before multiple shooters terrorized the command area and the hospital tower.

Although the situation was made up by exercise planners, Madigan's provost marshal office and emergency department reacted with full force, taking care of patients covered with moulage, clearing rooms and apprehending the shooters.

The shock of the attack was essential to creating a more realistic exercise.

"You never know what the bad guy is going to do, what the enemy is going to do in real life, so I think it's really good that we surprised them like that," said Staff Sgt. Jacob Getchell, a Soldier with the 1st Battalion, 38th Infantry Regiment, 4th Brigade, 2nd Infantry Division, who acted as a shooter.

With this exercise, Madigan practiced how it would react to a multipronged terrorist threat- Madigan providers and staff had to initially respond to the mass casualties caused by the explosion and then quickly change mindsets to respond to several active shooters.

"(The attack was) created to develop a conflict between the two scenarios," said Joseph Weston, Madigan's emergency management planner. "The reason the training was so in-depth was because the rest of our response capability depends so critically on getting it right from the beginning."

Exercise evaluators looked at how the staff reported the incidents and how the areas locked down; at the staff's ability to communicate; at the ability of the emergency department to reestablish medical operations at another location; and at the incident command response, among other areas.

"For active shooters, our primary goal was the provost marshal office ... respond appropriately, neutralize the threat, and then do the appropriate clearing to make sure the environment is safe," Weston said.

Although the exercise focused on Madigan's responses, the Joint Base Lewis-McChord fire department, military police and explosive ordinance disposal units participated as well as other garrison units. Madigan staff also reached out to the Tacoma Police Department to help evaluate the effectiveness of their active shooter response team, and to Pierce County Emergency Management to look at their communications process.

"As much as possible, we try to interact with our civilian partners in order to build stronger emergency management relationships," said Weston. "During disaster response one of our greatest assets is having strong working relationships with our counterparts in the communities where our Families reside, and the time to forge those relationships is not when the disaster strikes."

Jorge Marciano, a communications system technician with Pierce County, paid close attention during the exercise to how Madigan staff would react after the simulated loss of their communication center.

"In the absence of a communication center, I'm looking to see if they fall back on the basics," said Marciano, who said that could be communication tactics from radios to cell phones to runners.

The lessons learned from this exercise could translate to big impacts on Madigan's emergency preparedness.

"Preliminarily, just as with most exercises, we have identified some areas for improvement in communications and some of our activation processes," said Weston.

While departments will get feedback, this exercise won't be graded; instead, it focused on training.

"It's a training environment, an opportunity to look at our plan," said Weston. "We're validating the plan ... what worked well, and what do we need to change."

While Madigan focused on how to respond to an attack on the hospital, Weston encourages everyone to practice good antiterrorism habits at work or at home.

"Antiterrorism preparedness should be important to all of us because the best response to a terrorist event is prevention.

Vigilance and paying attention to our surroundings for things that are ‘out of place' increases our likelihood of recognizing terrorist activities before they act," he said.

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